anna in med school

Kind of loving this article maybe more than I should.  Whenever we had lectures on nutrition and health management in med school, it was always a little mirky because, in the past, the medical profession has been pretty poor at pinpointing exactly what foods help you maintain/improve health (yeah, turns out that mimicking the healthy Asian population by eating low-fat, high-carb isn’t the best diet).

And of course, there are so many measurements beyond pounds, waistlines, and cholesterol–it’s tough to get a good assessment of health.  John and I are currently on week three of the Paleo Challenge at our crossfit box (made considerably more easy by the fact that I can indulge with brownies and nutella).  I like the lifestyle, but the one thing I can’t get behind is the encouragement that we get pre- and post-challenge blood work, which includes such measurements as c-reactive protein, a non-specific measure of inflammation.  Any change made by the challenge seems arbitrary, but what do I know, right?

This short piece succinctly summarizes with a pop culture twist a lot of what I’ve learned.  My favorite debunked myth is rightfully number 1; makes me feel better about consuming 3-4 eggs daily and feeding my daughter an over-easy (which she promptly destroys/devours) every morning:

kathleen and isaac’s chickens’ eggs

1. Eggs Are Bad For Your Health

Eggs are so incredibly nutritious that they’re often called “nature’s multivitamin.”

The nutrients in them are enough to turn a single cell into an entire baby chicken.

However, eggs have been demonized in the past because they contain a large amount of cholesterol, which was believed to increase the risk of heart disease.

But the truth is that despite being high in cholesterol, eggs don’t really raise the bad cholesterol in the blood. In fact, eggs primarily raise the “good” cholesterol (1, 2, 3, 4).

Despite all the warnings about eggs in the past few decades, studies show that they are NOT associated with heart disease (5, 6, 7).

If anything, eggs are pretty much a perfect food for humans. They’re loaded with protein, healthy fats, vitamins, minerals and unique antioxidants that protect the eyes (8, 9).

They are also an excellent source of Choline, a nutrient that is very important for the health of the brain and about 90% of people aren’t getting enough of (10, 11).

Despite being a “high fat” food, eating eggs for breakfast is proven to cause significant weight loss compared to a breakfast of bagels (12, 13).

Bottom Line: Eggs are among the most nutritious foods on the planet and do not raise your risk of heart disease. Eggs for breakfast can help you lose weight.

In our psych rotation, we have the option of getting out of a weekend call by engaging in a quick book club.  We read a book chosen by the clerkship director, then get together with a handful of psych interns to discuss it over pizza.  I don’t know the details, but the book club was started shortly after an intern at Penn committed suicide for unknown reasons.  This collective reading and discussion serves many purposes: it sheds light on mental illness, something that we as a society are painfully poor at acknowledging; it gives that illness a face, not so unlike you or me, or those we hold dear; it allows us to appreciate what we learn on the wards in a different forum, thereby deepening our understanding; it recognizes those, like the young intern, who perhaps wasn’t fortunate enough to find comfort and aid, to receive treatment, and calls for us to do better, to not let other colleagues slip through the cracks.

My cohort read Brain on Fire: My Month of Madness by Susannah Cahalan.  Cahalan was in her mid-twenties, an up-and-coming reporter for the New York Post when she developed hallucinations, seizures, behavioral changes, and delusions before entering a catatonic state.  She had been seen by a number of physicians in a variety of specialties, spent weeks in different inpatient units, and when she woke up, strapped to a bed, her head covered in electrodes, she had little memory of any of it.  Through the use of hospital records, a journal kept by her father, and other first-hand accounts, Cahalan pieced together her story.

My colleagues were most disparaging about the last third of so of the book, which Cahalan devotes to describing her recovery.  Many of her critics hold the same complaint: the puzzle had been solved, and she had been “cured”; she spent too many pages going on about her painful and frustrating recovery.  I admit, it wasn’t as gripping, but in many respects I think it was the most important part for me, as a med student, to read.  We’re all health twenty- or thirty-somethings.  Very few of us have had to endure a long recovery, let alone one that involves your mind.  The exciting part of patient care is the diagnosis and finding a treatment that works, not managing side effects and trudging through the long road that we can’t expedite.  It’s important for me to be reminded that the patient’s journey is many times just starting when she’s discharged from the hospital.  And Susannah was one of the lucky ones.  Many don’t fully recover from this kind of brain insult, and some die, even after treatment.

By no means one of her most traumatic moment, but a time that sticks out in my head during her recovery is when she attended a wedding, several months out.  It was to be her big comeback.  She, Susannah, had returned to being the person she once was.  She and her boyfriend would be that cool hipster couple with whom others want to talk.  Sure, she was bloated and swollen from the steroids, her speech and movements weren’t fully back, or even fluid.  But she bought a great new, pink I believe, dress, and got a new haircut.  Only months later, looking at video and photographs, did she realize that she actually looked like a deranged robot, with her mechanical, broken movements on the dance floor.

My heart, I think, skipped a beat when I watched this video.  (Seriously, watch it–your day will be brighter.)  And of course I could not be more proud to get to learn at the same institution as these physician-scientists.  It really is a magical place…

I am not a scientist.  If anything, science is probably my weakest subject, something I’ve really struggled with while being in med school.  My hat is off to my fellow colleagues who possess not only the type of raw talent needed to be leaders in modern medical science (to think, infecting healthy cells with the HIV virus to kill cancer!), but also the passion.  It’s not a glamorous life but, every now and then, you get to do something like this.

Oh, our sweet one-year-old!  A year and six days!  

We spent her birthday relatively simply.  I’d read somewhere on a blog about the tradition to have one friend over when you turn one, two friends at two, and so-on.  I like that idea; keeps things grounded (because even 12 kids at 12 doesn’t sound too extravagant).  So we suckered our friends Sam, Jill, and little Charlotte over for dinner–we may have even forgotten to mention that it was a birthday, whoops!

I couldn’t help but wrap as many things as I could: new clothes from her grandparents and great-grandparents; a toolbox (a purple and green one!) from her Popop; little Hedwig from Kathleen; a funky singing flashlight-y thing from Doria; a magic wand from Stephanie.  She made out like a bandit!  And she, not surprisingly, took much delight in destroying the wrapping paper.

I have been a little nostalgic recently, thinking about my own mother and how special birthdays were to her.  She used to make the best chocolate cupcakes with white icing that she let us bring to school.  I wish I knew the recipe.  But I do have her old recipe box (one of those old wooden ones that was probably in every kitchen in the 1950s, stuffed to the brim with different cards labeled “from Marcine’s kitchen,” for example).  There are six different recipes for chocolate cake/cupcakes.  I took my chances and tried one that had a few of my mother’s scrawls on it.  Of course, since I can’t eat gluten, I couldn’t even tell you if I got it right.  Instead of bothering with the homemade icing, I just went ahead with funfetti (what could be better really? my mother probably rolled over in her grave!).  Ultimately, I think the birthday girl approved:

Now she’s back to contemplating the great questions of life: Phillips or flat?

Our last installment in the Italy series.  Tivoli, home of two world heritage sites, was a perfect last stop en route to the airport from Assisi.

Villa d’Este was once a Benedictine convent, converted to a pleasure palace in 1550 by Cardinal Ippolito d’Este.  There are frescos and water-spouting gargoyles.  And there must be at least a thousand fountains, including a 130m-long path of the Hundred Fountains, all powered by gravity alone.  One fountain, designed by Gian Lorenzo Bernini, uses its water pressure to play an organ!

I know the pictures do not convey the sentiment, but our sweet daughter adores water.  She is fascinated by the sound and loves the feel on her skin and her ability to splash!  It was all we could do to keep her on dry land.  (Incidentally, on our recent trip to the Chesapeake Bay, John took Ari out on the kayak, but had to turn back early because she kept trying to crawl out into the water!)

We almost bypassed Villa Adriana, Emperor Hadrian’s summer residence in the early second century.  On the five-km drive from Villa d’Este to Villa Adriana, our tuckered out girl fell asleep and we considered cutting our losses.  We felt a little guilty, but she certainly rose to the occasion–it was almost like she knew it would be our last adventure in Italy, for the time being.

And nothing gets a smile on her face more than being on daddy’s shoulders…near water!

Unlike Villa d’Este, Villa Adriana was more like a town.  Many of the structures have been designed as reproductions of buildings in Athens and Alexandria.  We were in awe by how well preserved the buildings were (I can only wonder what they would have been like in their heyday) and how much access we had to them.  We could reach out and touch the stone and marble; imagine doing that in the states!

Thank you all for your thoughtful comments and private notes on our less than ideal flight over to Italy.  The flight back went much better.  Of course it helped that it was during the daytime so, although it made for a really long day, most people were not sleeping for much of the flight.  And someone with the airline pulled some strings and got us a bassinet for Ari.  As a result, she slept a full hour and 15 minutes, not terribly long over the course of a nine-hour flight plus getting to the airport ridiculously early (in order to try to obtain said bassinet), security, and taxiing on the runway, but it improved her overall demeanor considerably.  Instead of berating me for being the rudest woman ever, several passengers and crew commented on what a sweet daughter we have.  It was still hard keeping her happy and occupied, with lots of bouncing and paper-ripping and brownie nibbling (as John put it, it was like doing burpees for eight hours), and she melted down in the very last few minutes, but it didn’t leave me desperate to never take her on an airplane again.  In the comment section, we discussed this awesome idea.  All suggestions are welcome and encouraged–please share your wisdom!  Ari’s been on 10 flights, and I am still very, very much a novice!

Neither of us is Ari’s favorite this week.  I had to hold her down for her one-year blood draw to test for lead poisoning and iron deficiency.  Poor thing had to just sit there as they drained two vials from her little arm, the whole time looking at me with fat tears rolling down her red cheeks.  All seemed to be forgotten after a few nibbles of homemade neiman marcus cookies.

But then a few days later she fell from standing on John’s watch.  It was slightly, slightly more dramatic than her normal fall that she makes 10+ times daily (the perils of learning to walk!), and she was easily consoled.  But then John brought her down the stairs in the middle of her going-to-bed routine: “Anna, we have a problem.”

He set her down on all fours in the middle of living room; she tried to crawl, and her right wrist crumpled underneath her weight.  After a few attempts, she looked up, grimaced, and made a pathetic little whimper.  John: “I think she has a buckle fracture.”

Okay, here’s where we demonstrate, yet again, that the doctor-med student combo does not make the most compliant patient/parents of patient…

In med school, John got hit by a car while biking to his ED sub-internship, an important month in school.  He broke his hand and seriously banged up his leg.  He arrived to his shift in the back of an ambulance, but he refused pain management so that he could finish up his shift.  Badass?  Absolutely.  Slightly idiotic?  Without question.  Have I ever mentioned that this kid also went out drinking then tried to go for a run while suffering from a collapsed lung?

Then there’s me.  Less badass, more just lazy.  I fell (well, more like skidded/slid) down the stairs at 38 weeks pregnant.  It was 10pm on the Sunday before my last week of clinical rotations prior to maternity leave.  I was tired and heavy, and I sobbed at John, “I don’t want to be on toco for four hours!!”  (Cardiotocography: recording of the fetal heartbeat and uterine contractions; after minor trauma, it is standard practice to sit in the ED, hooked up to the monitor for four hours to make sure everyone is doing well.)  John monitored me with a simple stethoscope every 20 minutes, even heard a good fetal heart rate acceleration, and we called it a night.

So for our daughter we weighed the pros and cons: take her to the emergency room where we’ll wait for several hours, resulting in an incredibly cranky, overly tired little girl, and where they would at most, take x-rays and splint her (otherwise inexpensive procedures that will end up costing something exorbitant in the ED); or wait until the morning and take her to her primary care, and risk coming off overly cavalier, under-concerned parents.  We opted for the latter.

The x-rays confirmed John’s diagnosis: a buckle fracture of the right distal radius (a really small, hardly visible on x-ray break of the bone that extends from one side of elbow to the thumb, on the end of the bone closest to the hand).  A nurse from our pediatrician’s office called me with the plan: we were to take Ari in to see a pediatric orthopedist and, in the mean time, we were to take her to the local emergency room to get the wrist splinted.

Already fearing that they must be suspecting child abuse, I was ready to take Ari in the ED and throw away the rest of the day.  John refused to let me consider it, stating that “it was the worst waste of resources!”  Instead he scrounged around for supplies himself and fashioned her his own brace.

She was pretty perplexed, then peeved by the restraint in motion.  But then she learned how to glide!  She places her right hand down on the hardwood floor, and simply propels herself around with her left arm–it’s really more efficient than her standard crawling ever was, although she looks like an awkward turtle.

The funny thing is that I’ve tried hard not to be the ridiculously overprotective first-time parent.  Just hours before the event, we were at brunch with Ellen at Silk City (with it’s bright lights, funky sculptures, outdoor seating, and casual atmosphere, it’s a sort of heaven for older infants and toddlers), and Ari was banging around the metal legs of the table.  I was all like, “It’s cool!  She has to learn somehow.  She’s not going to break anything.”  Famous last words, right?

l’boo & l’bo (both gross and adorable).  The impetus for this trip.

Assisi is the town where Lorenzo’s family is from.  On Friday afternoon, the day before the wedding, Lorenzo was generous to give everyone who wanted to join a walking tour of Assisi up to La Rocca.  After our 2.5-hour lunch at the Trattoria Pallotta (a feat it was indeed to keep Ari occupied and reasonably content that long), Aurelia decided to cleanse her prosciutto-laden palette with grass at the top of La Rocca.  As we neared the end of our wipe supply getting the dirt out of her mouth, we decided to plop her down on an old wine cask to keep her out of trouble.

Each guest was given a goodie bag complete with a bottle of local olive oil and these:

Of course, John being John, he wanted to check off AS MANY BOXES AS POSSIBLE.  We tried, we did what we could, we loved every minute.

The wedding service was held at Lorenzo’s mother’s favorite church Santo Stefano, a simple and exquisite 12th century church built in the Romanesque style, with gothic arches and a wooden ceiling.  One of my favorite parts of wedding event was right before the ceremony.  Everyone, including Lorenzo, waited outside the church on the cobblestone streets for Lauren to arrive.  There was an audible inhalation when Lauren turned the corner and emerged at the top of the stairs approaching the church.  She and Lorenzo met and entered the church together.

The wedding was a full mass, in Italian.  I sheepishly snuck in the back for easy escape access, and I was relieved to see a cluster of small children and their parents also huddled toward the rear.  Next to the church was a small courtyard complete with olive trees and grape vines.  Someone involved was brilliant and had set out a table with a pitcher of water and glasses, and at one point or another, it seemed like every child under eight made an appearance to release some energy.  Personally, it was nice to talk with some other parents, and of course always fun watching Ari interact with other children.

After the ceremony, Lorenzo and Lauren rode to the reception in style.  The rest of us walked the short distance–we felt like we were part of a parade through Umbria!

The celebration that awaited us at the Giotto Hotel was spectacular.  Prosecco was flowing when we walked onto the terrace, and every turn revealed another table generously decked with mouth-watering Italian cuisine: cured meats; seafood; cheeses; fantastical salads; freshly baked focaccia; roasted vegetables; figs, melons, and other fruit; and more appetizers than I could possibly try.  Perhaps the most awesome was the giant wheel of Parmigiano Reggiano–I kid you not, it was at least four feet wide–sliced in half and then partially carved such that it looked like an enormous orchid blooming.  And our sweet daughter, already getting sleepy but beside herself surrounded by her most favorite foods, rallied with the best of them.

My only regret of the evening was that I didn’t completely overstuff myself on the gran buffet di aperitivi e antipasti, for I unfortunately had to depart prior to the secondi piatti (I’m still unreasonably disappointed that John didn’t sneak out the beef fillet in a pistachio crust, as classy as that would have been, for me to consume late that night).  We sat down to the “first course” a little after 9pm.  We were honored to get to share a table with the bride and groom, with Ari happily enjoying pasta and risotto until close to 10pm, when she finally made it known that she could not make it a moment more.  But the hour we spent getting to see up-close how happy our friends were/are, watching them relax as they started to enjoy breaking bread with loved ones–we’ll never forget it.  

John walked us back to our room a few blocks up the hill, and then returned to enjoy the rest of the celebration.  Ari quickly passed out and, though I was sorry to miss the rest of the evening’s festivities, I sank into the mattress with my kindle (finally reading Tina Fey’s Bossy Pants–wahoo-wah!  Uni-V-Virginia!).

The next morning we all walked to the cemetery where Lorenzo’s mother is buried.  Together, Lauren and Lorenzo left Lauren’s bouquet at her grave.  It was intimate, and a beautiful and thoughtful way to include her and conclude the weekend.

A brief detour from our Italy posts (still need to post Assisi and Tivoli!).  Last weekend was the kind where I hardly picked up my phone–to text, check email, take pictures.  It was the kind of weekend we really needed.

Glen and Lauren are two of our closest friends.  For our wedding, they gave us maybe the best gift ever: a weekend away with the two of them.  Our lives are varied and full, and scheduling is always complicated.  But four years and two little ones later, we were able to make it happen—uh, really all credit goes to Glen and Lauren.  They set aside the weekend, found this place, and packed up a toddler and a sweet geriatric doggie.  All we had to do was show up, and somehow we scored massive points for thinking to bring olive oil.

I’m not sure who originally suggested that we meet in a town equidistant from our two cities, about 2.5-3 hours from each, but he/she is brilliant.  Set along the waterfront of the Chesapeake Bay, Deale felt like a true vacation from our Philly suburb, but it wasn’t a distance overwhelming to travel with an infant and toddler who are both rather travel weary.  There were no expectations for the weekend, and I took advantage by being profoundly lazy.  John and I might have also taken naps while Ari did–glorious!

One of my favorite parts of the weekend was marveling at the new words that came sputtering out of Graham’s mouth every day.  He’s such a different boy than he was back in May:

We had been in Charlottesville for a wedding.  Lauren was so kind to us, and she had agreed to babysit Ari while John and I went to our friends’ wedding reception.  Ari was barely sitting unassisted at the time, and Graham was already walking.  As I got ready to make my exit, Graham kept getting up to bring Ari toy after toy.  The sweetest, right?  Still makes my heart swell!

And now this kid is speaking in, occasional, four-word sentences, and asserting ‘Pace! (space) when Ari would get too close (sometimes that meant the same room), and running, and hopping!  It’s thrilling to watch, but at the same time I think, “Too fast, too fast!”