My friends can cook!

Friday afternoon I saw my third hospital in-patient: this woman was sicker than the previous two. Fifty-seven going on 75, she had profound edema and venous stasis as a result of congestive heart failure and acute kidney failure; the suspected underlying cause is amyloidosis (abnormal protein formation and deposition in tissues), possible of multiple myeloma form. I have already been introduced to amyloidosis and multiple myeloma this year, but of course I remembered nothing about them until I looked it up Friday night. And I found, contrary to what I might have expected, that spending time reading up on these diseases online--dwelling on this woman's condition in a scientific sense--made me care more about her in a human sense. This caring happened subconsciously, until I landed upon the prognosis and sat back, surprised and sad.

In happier news, last night we had a Thanksgiving potluck at our place. In case you thought med students couldn't cook, here's a list of our spread (all homemade):

Dinner items:

• poutine with mushroom gravy
• stuffed mushrooms
• potato latkes and apple sauce
• sweet potato fries
• spicy stuffed sweet potatoes
• purple mashed potatoes
• some cranberry-whipped cream-gelatin floating concoction
• veggie loaf "brisket" with veggies
• roast broccoli
• roast green beans with crispy onions and almonds
• sausage, bean, kale, and sweet potato soup
• salad with walnuts and cranberries
• dinner rolls
• naan

Dessert items:

• pumpkin and apple pies
• apple crisp (two versions)
• rhubarb crisp
• baklava

Med school reading list

In better news, I've lately been talking to lots of people about lots of great books to read related to medicine and health care. (Mostly, people suggesting books to me.) I've started to compile a list:

• David Ansell, County: Life, Death, and Politics at Chicago's Public Hospital
• Rita Charon
• Jerome Groopman, How Doctors Think
• Tracy Kidder, Mountains Beyond Mountains
• Perri Klass
• Bernard Lown, The Lost Art of Healing
• Danielle Ofri
• Oliver Sacks, The Man Who Mistook His Wife for a Hat
• Samuel Shem, House of God and Mount Misery
• Rebecca Skloot, The Immortal Life of Henrietta Lacks
• Abraham Verghese, Cutting for Stone

What are your favorite books about medicine and health care? Please comment below!

Riled up

Lecture today by a doctor who quit family practice to become an integrative medicine consultant, working independently with patients to help them develop holistic approaches to illness. For example, treating a patient with irritable bowel syndrome not only with meds but also with nutrition and counseling. She emphasized the importance of taking a good history and developing rapport with the patient.

I mean, duh. We're totally on her side. (We are. We're only second years. We've been hearing about this from every clinical skills professor.) This physician was the first to admit that she left family practice because she was sick of seeing a new patient every 10-15 minutes and prefers taking up to three hours with each patient. So why, instead of putting a hand on our shoulders and looking forward to our careers with us, helping us to problem solve around the constraints of time and money that will be placed upon us, did she get preachy with us, implying that we'll want to treat diseases not people?

The real question is, "How do good people become bad doctors?" I see the problem in a healthcare system that reimburses physicians for prescribing rather than counseling, where income depends on volume rather than quality.

It turns out that this physician exclusively sees patients who pay out of pocket. For those of us who don't plan on that career path, what can we do?

Come for the policy, stay for the food

Over the past year, I've had a great experience getting involved with Students for a National Health Program, a national and on-campus advocacy group. The organization's long-term goal is to reform health care financing in favor of a single, public insurance offering for all Americans (the "single payer" movement). Its short-term goal is to increase grassroots support among physicians and health professional students (see www.pnhp.org).

One thing I've learned in this experience is that a tight social bond around an issue can provide much of the ongoing impetus to keep pushing the work forward. As a group, we keep each other on task; more than that, I actually look forward to our meetings. Without this group of friends I would lose the reassurance that I have peers who are interested in the same broader questions as I am. As one friend said tonight, “I don’t want to be forcing single payer down people’s throats, I want to be having intellectual discussions with my classmates.”

Comparing this project to so many other ideas that I've had, started to work on, and then deprioritized, it's not the passion that I lacked, it was the social support.

Tonight we had a big potluck dinner and discussion. The food was great, the conversation even better -- I even had one of those "out of med school moments."

Potato latkes: You can use any online simple recipe, with a couple of simple tips. After grating the potato and onion together, fold them into a large kitchen cloth and wring out as much water as possible. Then toss with other ingredients (you can use flour instead of matzoh meal). Fry at high heat and don't be afraid of oil!

Apple sauce: Wash and core apples. In a large pot with a lid, add the apples, about half a cup of water, and cinnamon to taste (or one cinnamon stick if you have them). Leaving the lid on, cook over medium-low heat for about half an hour, until the apples are completely soft and falling off the skins. Stir occasionally and add more water as needed to prevent apples from sticking. At the end, use an immersion or regular blender to puree the skins. 

Cold-weather vegetarian

To continue the theme of beautiful vegetables, last week I bought some baby eggplants and large cherry tomatoes, which have been almost too beautiful too cook. Before putting them under the knife, I took some still life shots.

Like brussels sprouts, roasted tomatoes and eggplant can be made to feel hearty, satisfying that wintry desire for heavy food, without the meat. I roasted these veggies with garlic: the fragrance filled my apartment, and a taste on the spoon revealed tangy, naturally sweet-and-sour tomatoes that melted and coated the eggplant.

Roasted tomatoes and eggplant:

• several baby or japanese eggplants, sliced in half; or one large eggplant sliced about 1-cm thick
• cherry or regular tomatoes, sliced in half
• several garlic cloves, skins on
• olive oil
• salt and pepper
• couscous or pasta
• feta or goat cheese and/or fresh herbs as garnish

Preheat the oven to 325 or 350 degrees. In a large baking dish, toss the eggplant, tomatoes, and garlic with the olive oil, salt, and pepper. Roast 30-45 minutes, tossing occasionally and checking frequently to make sure the tomatoes don't burn. You may want to turn down the heat if you find the tomatoes are cooking faster than the eggplant. 

Serve on top of couscous or tossed with pasta. You may want to add crumbled feta or goat cheese and fresh herbs such as mint, cilantro, or basil for additional flavor.

Vegetables begging to be cooked

How to get yourself to eat vegetables as it gets colder, when all you want are heavy starches and broths?

Why not start with vegetables that are so beautiful they're just begging to be brought home?

Here in upstate New York we are blessed with beautiful farmer's markets; the Troy farmer's market even goes indoors in the winter so as to be open year-round! Last weekend I found brussels sprouts on the stalk, green tinged with purple. In the same family are white or purple cauliflower, kale, and then there are squash of many shapes and colors.

Easy stir-fried brussels sprouts with mushrooms:

• handful of brussels sprouts, sliced in half lengthwise
• handful of mushrooms, thinly sliced
• 2 cloves of garlic, thinly slices
• 1 tablespoon olive oil

Heat olive oil in a frying pan at high heat, then add garlic and cook for a moment until fragrant, then add brussels sprouts and mushrooms, stirring the whole time. Throw in a quarter-cup of water. Cook until the water has evaporated and sprouts are just soft enough to eat but not mushy. Season with salt and pepper.

Privilege

I've probably said this before, but it's amazing what people will tell us just because we're going to be doctors. The trust that complete strangers put in us makes me want to do good.

Today at lunch a guest speaker shared her experience as a survivor of a gang rape that occurred ten years ago to the date, on campus during her freshman year of college. She was emotional in front of us, but even without her emotion her words were enough to make us emotional. She told us that because we were future health professionals and could handle "the gory details," she would tell us the parts of the story that she leaves out for college audiences.

People like her, and we are privileged to hear from them all the time (substance abusers in recovery on Monday, stage IV cancer patient last month), subject themselves to telling their story again, publicly, because they believe in us. They believe that by sharing, they will make us better physicians and better able to help others like them.

The next step? As a physician told us yesterday, "You're only allowed to ask the patient a question if you're going to do something with the answer." It's not knowing for knowing's sake, but knowing in order to provide better care.

Doctoring is harder than I thought

Last night I saw a few patients at Dr. Bob's student-run free care clinic that takes place Wednesday nights. Every time I get a little bit better at one thing, it just gets harder: for instance, I've figured out how to fill a syringe and deliver an injection at the proper 90-degree angle, but then I realize that I've done none of the hard work to coo at and calm down the screaming toddler receiving the shot. Or, I've learned to read a blood test and identify iron-deficiency anemia, and I even flexed my "depression screening-stress counseling" skills for the first time, but then I realize that I did nothing to determine the underlying cause of the patient's anemia or counsel her as to prevention. In a chart it notes that a teenage girl had a negative pregnancy test a few weeks back: do I assume the provider at the time counseled her as to birth control and safe sex, do I take that on myself, or do I schedule a follow-up for more counseling?

Thus my feelings at the end of a clinic night are ambiguous or mixed: pride is followed by awareness of gaps and subsequent disappointment in myself. Do I end the night feeling optimistic or downtrodden? This is where I'm grateful to the residents and attendings, who witness the night and are our immediate role models. Their support and encouragement comes when it's most needed: it's okay, they say, and I should feel good about it.

You know what does get easier each time? Chicken soup. That universally makes me feel good. This time I tried an ultra-simple recipe: 1 whole chicken, 2 celery sticks, halved; 2 carrot sticks, halved; half an onion, 1 turnip, chopped; salt and pepper. Boil all together for 90 minutes, then serve with chopped celery, carrot, and onion, cooked in the soup for about half an hour, and rice, cooked separately.