Archive | August, 2011

heart sounds

31 Aug

Julia and I were trying to decode Harvey’s heart sounds over VC:

Me: I can hear the tones, or I can hear the rhythms–not both at the same time.

Julia: Aren’t you supposed to be a musician?

Touché, Julia.

I once had a descant in a choral arrangement that had a wickedly weird entrance.  I was almost always a half a beat early.  Finally my mentor said (in front of the 90-person choir): “Anna, just conduct the beats at your side.  You’re in the back row, no one’s looking at you.”

So now, in the still of the deserted carrels of Van Pelt, I’m conducting the closures of the atrioventricular and semilunar valves (the “lub” and “dub” of “lub-dub” respectively), while trying to wrap my mind around the accompanying murmurs and gallop rhythms.

Next time, we should remember to not listen at 1.8x, giving Harvey false tachycardia (a resting heart rate over 100 beats/minute).  That might help us too.


controversial safety

28 Aug

It’s an issue I’ve been grappling with this summer, mainly with regards to my commute.

There are two good public transportation options to school.  One is safe, but less convenient.  One is more convenient, arguably less safe…as in, I’ve been told it’s fine during the day, sketchy at night.  How does one measure safety?  Is public hearsay a good indicator?  How reliant can I be on my immediate reactions and instincts?

As I made the trek home on Friday evening, easily an hour before dark, I was stalled at 69th Street Terminal, where I regularly make my transfer from subway to light rail.  I sat on the stopped train for about 45 minutes as they fixed whatever trouble occurred elsewhere down the line.  I watched the woman a few rows ahead of me rock back and forth, gently at first then more intensely, in the only double seat that was occupied by only one person.  At one point she whispered something to the empty seat next to her, then began to weep.

A scene like this one isn’t uncommon on this train.  Still, I thought to myself, Okay, I think might have had enough.

I’m not sure how I feel about having this reaction.  Yesterday, I listened to the podcast “How Schizophrenia Works” on Stuff You Should Know, a very pleasant review of a splice from Brain and Behavior.  A couple things struck me: 1) The recovery rate for schizophrenia in developing nations is higher by a full third than it is in industrialized nations.  Some hypotheses exist for why: a) lack (of lesser degree) of social stigma; b) more rural environment providing consistent employment that is typically more “schizophrenic-friendly” and noncompetitive.  2) Our fear of schizophrenics in this country is oftentimes unjustified.  If they were not violent people prior to exhibition of schizophrenic symptoms, they are unlikely to be violent schizophrenics.  Furthermore, most acts of violence, if they occur, are toward themselves and, as a distant second, toward their family.  In conclusion, the schizophrenics I run into day to day are little threat to me.

It also got me thinking of maintaining safety in general as a woman, which is a conversation I’ve had with a number of loved ones recently, each moving it in a distinct direction.  I’m particularly struck by the statistic (of course, I don’t remember the exact numbers) that states that a woman is much more likely to be the recipient of violence from someone she already knows.  Therefore, how protective of myself do I really need to be on this potentially “less safe” commute home?  I’ve been curious to know how much this caution is unnecessary, possibly even detrimental (to a small extent) to my sense of gender equality.

phlebotomist needs crash course of icm or dr-pt relationship

25 Aug

It’s a little ironic.  Today was our first small group session in Introduction to Clinical Medicine.  We met with a few standardized patients and practiced taking patient histories of present illness.  We experimented with ways of making sure we hit on all the major, preliminary bullet points while creating a pleasant flow in the interview and demonstrating respect and empathy.  As a novice, it’s not always intuitive.  For me, it’s hard to always listen well while going through a check-list in my head.  I’ll practice.  I’ll get better.

Immediately following, I went to get some bloodwork performed.  Not unusual.  I get stuck a fair bit, and I’m actually a little proud of being good with needles, a talent that’s come with practice 🙂  So, no biggie: I heard my name; I sat in the chair with the funny armrests; I watched as one my usual phlebotomists (who still looks at me like it’s our first time meeting) wrapped a tourniquet around my right arm.  Then I made my first mistake: I asked her whether I needed to change my insurance information at their lab or whether just being in the Penn system would suffice.  Exactly what information she provided was unclear to me; she definitely did not answer my question, but at least she repeated herself multiple times while interrupting me as I tried to clarify.

Next comes the mildly humiliating part.  I’ve been told I’m a hard stick.  My veins, apparently, like to “jump”–as in, the phlebotomist or other care provider will see a nice, juicy vein right below my skin, and think he’s got it made, but then my vein dodges away after the needle pierces my skin, at which point he either attempts another stick or goes digging.  The former is preferred by me.  The latter was attempted by said phlebotomist today.  It was not pretty, and I think this was the first time I actually let a f—! escape from under my breath.  For most caregivers, this would be cue to apologize or demonstrate some empathy, even for a wimp like me.  Her reaction: “Looks like someone’s not good with needles!”

Are you kidding me?

A few more somewhat demeaning interactions later, and I was walking out of the lab livid.  Then I thought: Wait a sec.  She should know better.  I deserve better, and she should want to know how to do better.  So, in a moment of complete stupidity, I walked back into the lab and approached her.  I composed myself, looked into her eyes, referenced our long-standing, normally good relationship.  Then I expressed that I didn’t feel like today went so well, and I enumerated my reasons, using tons of “I” statements (ex. “I felt embarrassed when you commented that I wasn’t good with needles”).  She interrupted me and told me that she was sorry I was upset (which is not a real apology), then proceded to tell me techniques about how to become more comfortable with needles (seriously?).

I’ve decided that she either doesn’t care or she’s an idiot.  Too harsh?  I mean, I know I’m a biased opinion here but, in this case, I do not think this is a problem of anna’s oversensitive nature.

I ran into one of my doctor’s while leaving.  I hadn’t seen her in person in six months, but she called me by name, asked how I was doing, and said that she would call me ASAP with the results of my bloodwork.  She’s a brilliant physician (one of our lecturers at Penn) and she’s socially competent.  Today’s experience reaffirmed that it’s totally possible to be both or neither.

day two

23 Aug

Okay, looks like I’m in this thing for real now.  Today was a beautiful autumn-ish late summer day, the kind that makes you feel like you really should be back in school.

I commuted to the voice of Ira Glass, which definitely helped set the tone of day.  If anyone has good podcast suggestions, I’m all ears (get it?  oh dear :/).  Then three hours of not-so-painful lecture followed by my favorite anatomy session of Mod 2 yet.  May I say, it’s pretty swell when you stand over different cadavers and hearts listening to residents prattle off clinical correlates, and the terms you’re hearing actually sound familiar!  Lunch was spent at the MD/MBE info session (I was supposed to give the student prospective as someone already in the program), and I got my first solid look at a number of members of the current MS1s, already two and a half weeks in and still willing to pounce on any free lunch offered.

Finally, we had our introduction lecture to clinical medicine on adult history and physical examination, in preparation for the start of our clerkships in January:

“Patients usually judge medical quality based on the quality of the relationship not the technical skill.” (Annals of Internal Medicine. 2006; 144: 665-672)

a.k.a. It pays to be nice (quite literally).

Less than four more months!

class of ’62

22 Aug

Not gonna lie, it was pretty difficult to come back to school today after what became an incredibly rich summer vacation.  Sometime this week I’ll finally post some pictures of my recent adventures in LA, Laguna Beach, Yosemite, Palo Alto, Alameda, and San Francisco.  For now, I need to start reviewing the anatomy of the heart like whoa.

Today, my biggest success was getting from my new home to my new lecture room, “the Class of ’62 lecture hall,” without getting lost.  (According to our darling GI course director from the Spring, I half-fulfilled one of the three objectives for a happy life right there.)  As my feet met the Penn grounds this morning, the voice in my head repeated, just don’t walk into Reunion Hall, just don’t walk into Reunion by mistake.  As though it’s not already embarrassing enough to walk into class 30 minutes late on the first day, imagine the horror of walking into the MS1s’ genetics lecture?  llllllllllllllllllllllll…

I wish I had taken more pictures from my last summer hurrah this weekend, but thanks so much to Erica, Dan, Ted, Matt, Claire, Stephie, Kristen, Lisa, Javier, Santiago, Ariel, Evan, and John for making it so delicious!  It was the perfect kind of weekend, days spent getting to know new little corners of NYC and showing off some of my favorite nooks and crannies  of Philly, nights spent enjoying feasts with fabulous company.

travelling without

15 Aug

We found out recently that John cannot request vacation time during the two weeks I have off at the end of second year.  As I come off an 11-day vacation sans husband (ready as all get out to see the main squeeze waiting for me at the arrivals gate and shamelessly seize the Love Actually moment), I’m a bit blue about this news.  Not to say that we haven’t had some wonderful trips together in the last year—our much delayed honeymoon; our Thanksgiving excursion to Tuscany; our week at the beach with some of the best people on Earth; little getaways hither and tither—but it feels like so many of our memorable adventures have been experienced separately.  They’re always choices, of course, and I don’t think either of us regrets our decisions toward brief separations in favor of, say…a summer of medical service in Guatemala…a clerkship in Ghana…a backpacking trip through Europe, Northern Africa, and the Middle East…a quick couple weeks in post-earthquake Port-au-Prince.

A colleague of mine once commented that he appreciated how John and I have maintained our independent pursuits and personalities within our marriage and that we support each other’s separate, distinct passions.  Especially considering there is so much overlap in our professional and personal interests, this is one of my absolute favorite compliments.  While I certainly feel changed by my marriage (and I think I have, to some extent, had an effect on John as well), it’s important that I keep a sense of self outside of it as well, which runs far deeper than our series of solo journeys.

A family friend once jokingly teased John that he was surprised that he let me go off to medical school a couple hundred miles away.  John didn’t miss a beat: “I don’t let her do anything.”  True, but he could have made the whole experience a hell of a lot worse.

I really love this bit about us.  And yet, though I’ll do my damnedest to not pout quite so much when John leaves me for his next “man week” (hopefully not on our anniversary this time around), I hope this is the last year in which we’ll have to do the bulk of our adventuring separately.  Just hoping…now if some of the higher powers at Penn and Christiana could throw us a frickin’ bone, that’d be swell.

Glacier Point. Alon (adventure buddy/photographer): "Smooches for John!"

P.S. Will I totally gross you out if I share some entirely too cutesy traditions of mine?  1) I love postcards.  The pictures are way better than anything I can capture, and the postage is less than that of a letter.  I try to send John a postcard from every place I travel, even if we’re there together…so it’s kind of like I’m receiving the card as well…what started as something somewhat romantic has become mostly self-serving.  Aren’t I the loving wife?  2) So…I just noticed this about myself on this last trip.  Turns out, when I travel without John, I almost always choose a song that I, for that trip only, associate with him.  I’ll listen to it once or twice (or more) a day and give myself permission to think about and miss him.  God, I’m like a small child needing a lullaby to coax myself to sleep, but it actually helps.  When I studied abroad in college, I used “In My Place” by Coldplay.  When I moved to Philly, it was Nickel Creek’s “When You Come Back Down.”  This time it was “Airplanes” by the Local Natives.  Kind of weird that I took part in this ritual for so long without realizing…not weird at all that I use music as a coping mechanism.


8 Aug

Hello from beautiful Los Angeles, where there’s never a cloud in the sky, the temperature never drops below 61 or rises above 82, and humidity and allergies are foreign concepts.  Oh, and some of my closest friends also call this place home, so it’s been a pretty fantastic vacation so far.

The only hiccup in travel so far–knock on wood–was on day one, when I was taking the train to the Philadelphia airport from University City.  As the ticket-hole-puncher-guy (what is his title?  I was about to call him the “ticket master”) walked by to tell me to move my suitcase, he looked at me inquisitively, “So, where are you going, anyway?”  When I told him that I was going to the airport, he responded, “Well then, you have other problems.”  The train was definitely going to Wilmington, and I would have to take a train back into the city and wait for the next train to the airport.

So, it’s me, right?  Tears, of course, started welling up in my eyes as I ran through all the worse case scenarios (which, let’s be honest, are inconvenient at worst but not that bad).  This woman, Lorraine, three rows ahead turned around, “Why don’t you get off with me at my stop, and I’ll drive you to the airport?  I live like 10 minutes away, and I just need to pick up my three-year-old on the way.  Really, it’s no trouble.”

As we walked to her car she reassured me, “Don’t worry at all about all this, it happens all the time.  They really need to mark those damn trains better.”  Sure enough, when her daughter, Brianna, hopped into the car, she looked at me in the front seat, then turned to Lorraine, “Mom, are we going to the airport again?”  Adorable.

Reason #487 why Philadelphia really is the city of Brotherly/Sisterly love.

By contrast, on my first day in LA, we accidentally happened upon a manhunt on Mulholland Drive and a man vigorously masturbating on Spring Street.  But the weather and the company are the best!

tastes like december

2 Aug

I started the search for the perfect molasses cookies my senior year in high school, when I took Ms. Stegall’s writing sem.  Every now and then, she would bring in these cookies–I can remember the fragrance of mingled clove and cinnamon spilling out into the hallway, the texture of the sugar granules surrounding the buttery molasses goodness.  I don’t know why I never thought to ask for the recipe.

Anyway, this recipe is the best I’ve found.  It’s from the Cook’s Illustrated The New Best Recipe (by the way, if you own just one cookbook, this should be your book).  I’ve had a few requests for the recipe in the last year (I might bring them to small group from time to time), so without further delay…

Molasses Spice Cookies

courtesy e.r.


2 1/4 cups all-purpose flour
2 teaspoons of baking soda
1/2 teaspoon of salt
1 teaspoon ground ginger
1 1/2 teaspoons ground cinnamon
1/4 teaspoon ground allspice
3/4 teaspoon ground cloves
3/4 cup (1 1/2 sticks) unsalted butter, softened
1/2 cup dark brown sugar, packed
1/2 cup granulated sugar, plus 1/3 cup for rolling cookies
1 large egg
1 teaspoon vanilla extract
1/3 cup unsulphered molasses


1 Preheat oven to 375°F.  Mix together flour, baking soda, salt, cinnamon, ginger, cloves, allspice together in a bowl and set aside.

2 Use an electric mixer and beat the butter for 2 minutes.  Add the brown sugar, and 1/2 cup granulated sugar and beat until light and fluffy, about 3 minutes with mixer set at medium speed.  Add egg, vanilla extract, and molasses. Beat until combined, about 30 seconds.  Scrape down sides of bowl with a rubber spatula.

3 Add dry ingredients and beat at low speed until just combined, about 30 seconds.

4 Place remaining 1/3 cup of granulated sugar in a shallow bowl.  Working with 2 Tbsp of dough each time, roll dough into 1 3/4 inch balls.  Roll balls in sugar and place on ungreased cookie sheets, spacing them 1 1/2 to 2 inches apart.

5 Bake until the outer edges of the cookies begin to set and centers are soft and puffy, about 11-12 minutes, do NOT overcook.***  Cool cookies on sheets for 2 to 3 minutes before transferring them to cooling racks .

*** The centers of the cookies should be somewhat soft and spongy (they look under-cooked) when you take them out of the oven, otherwise they will end up hard and dry.

There’s an optional glaze, but I’ve never tried it…I really think these cookies are the cat’s pajamas without the added hoopla (though Eric and I once made them with homemade cream cheese frosting, but that was pretty much just an excuse to eat frosting with a spoon).  Now I just need to try a gluten-free alternative…rice flower?  Otherwise I’ll be forced to stick with frosting and fro-yo, I suppose.  And chocolate.


1 Aug

John and I stayed at “our” place in the city last night (a.k.a. our friend’s studio that he is generously letting us enjoy while he’s away).  I don’t think we even realized how wonderfully like a vacation it could be.

John just got his schedule and realized that he had two days off in a row.  When in residency, this was almost unheard of, so I think we’re still in the take-advantage-and-go-do-something-while-you-have-the-chance mode…not a bad place to be.  We ran down our list of options: camping; B&B; trip to Fallingwater; another treehouse overnight; a quick excursion to NYC or D.C.  Then we though, f— it.  We totally love road-tripping together and all, but sometimes the last thing you want to do is really go somewhere.

This Center City studio gave us the luxury of having a night on the town (without having to worry about staying sober enough to get home) and the novelty of staying somewhere other than at our actual home (pretending for a night to be a fancy-smancy two-home type of couple…yyyeeaaaah, with hundreds of thousands of dollars of student loans, like that will be happening ever).  After dinner and fro-yo, we finally made it out to this old speakeasy I’d been hoping to try.  I had the Continental Divide, followed by the Dead Turk., and I was completely sloshed.  Hep A has really done a number on my tolerance.

We slept in, then had brunch at Ants Pants, which is kind of an institution around here.  I’d never been because the line is always around the block on the weekends, but at 11am on a Monday, it was pretty sleepy.  Deliciously so, in every respect.

It was one delightfully sticky summer retreat in the city, a very much appreciated getaway!