stealing joy

Wow, it's been a while since I've posted anything here. The longest yet. I've been thinking a lot about writing lately - writing or reading poetry and short stories, writing as a means of understanding medicine and human interactions. I want to delve into the newly-discovered world of narrative medicine. I should have some time to do so in the coming months, so we will see how far that goes.

In the meantime summer ended. The farmer's market made it's transition from strawberries and asparagus, to every green thing imaginable and berries, to squash and apples, and now it's gone. A chilly August was followed by a warm September and October (relatively speaking), but November  was ushered in with a freeze and I harvested all our potted herbs. The rosebush remains, two buds debating whether or not to bloom. My cooking followed the market trend. Transitioning from salads and things like these noodles to roasted squash, bean stews and all kinds of things with miso. The leaves turned and have almost all fallen, sweaters have migrated to the front of the closet, and I've initiated a daily ten minutes of sitting beside my SAD lamp. Autumn is verging on winter and I am determined to enjoy it by relishing in coziness as much as possible. I'm talking double socks, fun hats and scarves, casseroles and cookies, bubble baths, steam room at the gym, hot tea, poems like "November Night" by Adelaide Crapsey:

Listen. . 
With faint dry sound,
Like steps of passing ghosts,
The leaves, frost-crisp'd, break from the trees
And fall.

We already had our first snowfall, just a few days ago, it collected and stayed on the ground the whole next day, despite the brightly shining sun, deceptively not warming things up.

Actually, the first snowfall I saw was in October, but most people were asleep and it barely touched the ground before melting. I saw this beautiful snow - barely a fall at all, really a light drifting down, like a feather or crepe paper confetti - because I was up in the middle of the night on the labor and delivery floor of a community hospital, helping/learning how to deliver babies. Delivering a baby is one of the most magical experience I've ever had, and I struggle to describe it adequately. One doctor said it was like "stealing joy". There is something accurate about this, as it indicates that the doctor is still somewhat removed from this new family being formed. An integral part of the experience but ready to transform into bystander as soon as the whole visceral process is over. If you think of joy as something that is not diminished by being shared, but rather increases, then it sounds even more fitting.

But it's more than just the joy of new life (what a presumptive thing to say, just). It's the entirety of this most ancient ritual, born of complete necessity, drenched in blood and vernix (lit. 'fragrant resin'). The hours of the mother contracting, dilating, effacing, breathing. Teaching your gloved fingers to feel blindly for cervix and station, like digging through a bag  of cotton balls trying to find the one that is slightly softer. The absolute miracle of a newborn maneuvering through the cardinal movements of birth, filling his water-clogged lungs with air, remodeling his entire vascular system. A fish becoming a bird. When things go perfectly smoothly, it's seems the baby would have slithered out whether your hands were there guiding him or not (which does occasionally happen even in a hospital!).

That night, minutes after the baby was born, the nurse looked out the window and remarked, we had a little snow angel on our hands. I've delivered four babies so far. And yes, I am most definitely keeping count.

veggie nachos

I took 4 weeks off from clinical rotations last month to study for Step 2 of the medical licensing exam. You might remember me talking about Step 1 last summer, which was much more traumatic. Step 1 seemed like a huge hurdle to overcome on this path to becoming a doctor. By the time Step 2 rolled around, I realized the whole track is filled with hurdles. To keep that metaphor going, it really does remind me of when I did the hurdles on my high school track team. The first hurdle was terrifying, coming out of the blocks and the brief seconds leading up to the first leap. But once I made that first one, I found this rhythm - step, step, hurdle, step, step, hurdle - and the hurdles became less of an obstacle and more just a part of the way I ran. In some ways, medical education is like that. I know that I will continue to face small daily challenges, occasional monumental ones, and everything in between, which allows a sort of rhythm and acceptance.

During that month of studying, alone, day after day, alone, I wrote this on the edge of a to-do list:

I can already feel
how when it's all over
I'll look back
and say,
"It wasn't so bad, really."

In hindsight that sounds like a reassuring realization, but at the time it wasn't. At the time it seemed devastating. Because it meant that I would be brushing off one of those challenges as if I had accomplished nothing, telling my friends "you'll be fine, it's not so bad", and leaving them to feel alone when the the hurdle looked a little bit too high off there in the distance. We do this to ourselves over and over, and it's one of the unexpected ways that medical school has struck me as an emotional challenge.

The more I think of this though, the more I think it's actually a sign of something really good. When we stand at the finish line and look back at the hurdles we crossed, they don't look nearly as threatening because we know we just made it over all of them. And it's natural to say that it was worth it all - the fear, the planning, the training, the sacrifices - because we are doing exactly what we were meant to be doing, what we signed up for, what we are called to. So now when I look back at my weeks of studying, I see that those days took on a beautiful cycle. Each morning I woke up, made a smoothie, studied, went to a yoga class, made a tomato sandwich or salad for lunch, studied, practiced mindfulness meditation, studied, made mushrooms and greens for dinner, studied, read something non-medical, went to sleep. There was very little variance to that schedule and that type of life works really nicely for me. I haven't made it to a yoga class since, and my mindfulness practice has nearly disappeared.

But I am not here to complain. I am here to remind myself that that was good, but impractical for today. I am here to say that I will find a way to keep some of those things in my life no matter what else is going on.

The one thing that is easiest for me to keep around, and to keep myself connected to a sense of wellness is food. Going to the farmers' market, keeping a fridge full of produce, and eating fresh wholesome meals at least twice a day are things that I have managed to maintain. One of my favorite meals this summer is vegetarian nachos. They are quick and easy, there is no need to follow a recipe once you get the idea, and it's an easy way to use up whatever happens to be on hand. The combination I had yesterday was particularly stellar, so I decided it was time to share it with you. And I'd love to hear, what is the thing that keeps you connected to yourself when life starts to get in the way?

Vegetarian Nachos for 2:
Blue corn tortilla chips
4 oz. ground seitan (My favorite is Upton's chorizo)
1/4 cup red onion, diced
1 handful chopped kale
1/2 a zucchini, sliced into thin half-moons
1 avocado, peeled & sliced
1/4 cup crumbled feta
Tomatillo salsa, to taste (I used this one)

Heat a bit of oil in a small pain over low heat and add the seitan, stir occasionally, cook until warm.

Meanwhile, spread some chips out onto a plate. Layer on the already chopped veggies, the seitan, the avocado, and the feta. Finally top with salsa to taste.

Enjoy with a Corona and lime on the patio and savor the remaining days of this fleeting summer.

thought for food. part 2

Clearly, many people are struggling to navigate the world of healthy eating trends, trying to figure out how to feed their bodies and souls, confused by all the options. Here is my favorite thing I've read about it: "the terrible tragedy of the healthy eater" - it's hilarious! And talk of the microbiome is going mainstream, thanks to the New York Times and Michael Pollan. But eating well is about more than just what we eat, it's also about how we eat, so that's what I want to talk about in part 2.

Fortunately, this is much more straight forward, and it basically boils down to taking the time to appreciate your food. Ideally, we would do this through every step of the process - from purchasing whole ingredients or actually growing them, to preparing a meal from scratch, to eating it mindfully. Usually when I hear people talk about these ideas, it conjures up this image of some do-it-all woman making her own homemade sunscreen, with a chicken coop in her backyard, friend of all the farmers at the weekend morning market, cooking 3 meals a day for her family and baking her own bread each weekend. She probably has an awesome blog with 100s of followers, too. It's beautiful, terribly impractical, and probably nonexistent.

Fortunately, you don't have to treck out to a farm or become a gardener or a gourmet chef. Food appreciation can fit into your everyday life. Even simple weekday meals  can be eaten mindfully. When we know a bit about where our food comes from or have taken the time to pick out the nicest bunch of radishes at the supermarket, it's easier to relish it a bit more. When we take the time to cut and wash those radishes, we begin to think about how nice it will be to eat them. When we eat more slowly, without music or television as a distraction, we enjoy it more and we eat less.

To me, sharing food and recipes is a big part of this as well. I think the most wonderful thing about this bubble of food blogs is that it encourages just that. Similar to church women's leagues creating cookbooks, I often feel like I have a community of like-minded people writing about their love for food. It's a community that has introduced me to all kinds of new ingredients, like spelt flour, chia seeds, and ramps. I also think cooking for others is a very powerful thing. It fulfills a desire to nurture and to give in the most fundamental way. It also exposes people to things they might not try otherwise, like quinoa (really, some people don't know about quinoa yet!) or simply a vegetarian meal. In fact, it's one of my favorite things to do, and I wish I did it far more often.

I recently read a summary of the characteristics of a group of Greeks who tend to live much longer than most people. A few of the "10 ways to live to be 100" are: take naps, stop worrying about being late, grow a garden and eat from it, 'get it on', walk daily, be part of a spiritual community, and surround yourself with people who do the same. Even if you won't live to be 100, don't those sound like ways to have a happier life in general? Taking the time to enjoy your food is the same. It's good for you, and you will enjoy it. Win-win.

Of course, this is all easier said than done. But it's definitely worth striving for.

thought for food. part 1

I've been mulling over the idea of writing a more substantial post about my thoughts on food for a while now. Finally the combination reading tweets from the Nutrition and Health Conference at the University of Arizona College of Medicine, hearing about Michael Pollan's latest book, and a few integrative medicine conferences I've been involved in recently has pushed me to do it. My plan is to break this into two posts: one about what we should eat, and a second about how we should eat.

There's almost no need to even say that we are constantly bombarded with different theories regarding what we should eat. The diet industry has been around for decades, and now the internet gives us access to a near-infinite number of theories about which foods will increase our risk for heart disease, which to avoid to 'lose belly fat', and which to eat if we want to stay young. I think there's actually a lot more to this than people trying to make money. The rates of obesity, diabetes, and cardiovascular disease (CVD) have grown to atrocious levels, affecting people of all ages and socioeconomic statuses. There's a lot at stake here, and I’d like to think we all know that on some level. The problem is that we want a quick fix - turmeric and garlic to fight cancer, veganism to lower cholesterol, raw milk to erase allergies. Even those who are willing to make some sacrifices want a clear-cut answer to health. Ian often asks me which nut is healthiest, or if I could make him some sort of smoothie with all of the healthiest ingredients possible. It doesn't quite work that way, though. Pollan does an excellent job of explaining the downfalls to this route of "nutritionism" in his book An Eater's Manifesto. When we reduce food to it's parts, or try to reduce our needs to a formula, something goes missing. That being said, I completely understand and share in this desire. Navigating the world of food health blogs can be as confusing as the supermarket.

Here is the huge divide in the foodie movement as I see it. [Sorry, I'm going to over-generalize a bit.] On one extreme we have Vegans. The Ornish Spectrum diet is a prime example of this school of thought. It keeps fat down to 10% of your total caloric intake and eliminates animal products (with a few exceptions). Instead, there's an emphasis on vegetables, whole grains, and legumes. In concert with exercise and stress reduction techniques, Dr. Ornish's research indicates that this program may actually reverse CVD. Closely related are Dr. Weil's Anti-Inflammatory Diet and the often touted, though less defined, Mediterranean diet.

On the other hand is the Traditional Foods revival, which is where I’d place the popular Paleo Diet. Here, the emphasis is on grass-fed meats, whole fat (often raw) dairy, sprouted grains or no grains at all, and fermented foods like sauerkraut and kombucha. It seems like gluten-free diets can overlap with either of these branches, whereas the Gut and Psychology Syndrome (GAPS) diet seems to fit better with the latter. To be fair, I don't know nearly as much about this line of thought. But there is research out there indicating that full fat dairy may also help to reduce CVD. The Weston A. Price Foundation is a big name in researching and promoting this type of diet, and they have some really interesting studies to show for it.

But how can this be? Two diets that seem so different at first glance: one focuses on eliminating animal products, the other focuses on eating more, but better, animal products. Let's start by looking at what they have in common. The most obvious thing is the elimination of junk. Nobody is talking about dunking Oreos in their raw or soy milk. Prepared and processed foods account for a lot of the bad stuff in our diets: preservatives, coloring, extra salt, extra sugar, and refined grains. It's amazing how much of this we eat without realizing it - even plain old butter often contains "natural flavor." (Shouldn't it just taste like butter all by itself?) Aside from getting rid of all the non-food in our food, eliminating processed items also cuts down on the simple carbohydrates in our diet. This is a really big first step to eating better. Carbs (bread, pasta, potatoes, crackers) are essentially converted to pure sugar in our diet, so in some ways you can lump them right in there with soda, cake, and ice cream. Without fiber and protein to balance them out, they send our blood sugar level through the roof, forcing our body to secrete loads of insulin and stress hormones to combat all that sugar, and setting us up for developing diabetes. It also augments the immune response, causing some normal protective processes to progress to the point of unnecessary inflammation. Most people have heard of some of inflammation's deleterious health affects by now, like arthritis, irritable bowel disease, and various autoimmune disorders, but it's also being linked to a lot more. In fact, inflammation seems to be turning up as a key player in major chronic illnesses like stroke, heart disease, and even depression. A lot of this research is still in the works, and I don't know of any good studies linking diet with inflammatory markers and a particular chronic disease, but I won't be surprised if we discover that inflammation plays a much larger role than we now know. It's exciting to think about, in a nerdish kind of way.

The second big thing these two ways of approaching food have in common is a lot of fruits and vegetables. I’m still shocked every time a patient tells me he doesn’t like vegetables. There are so many of them! and so many ways to prepare them! How can you possible not like any of them? Hopefully, if you’re reading this, you already know that fruits and vegetables are delicious packages of vitamins and phytonutrients. If you’re not convinced about any one particular produce item, just look it up on this site. They also have lots of fiber, and veggies are low in calories, so there’s no need to limit your intake like you do with other food groups. If you’re not convinced that you should be eating at least 5 servings of fruits & veggies daily, e-mail me and we’ll have a chat.

Finally, what I’m really excited to talk about, is why I think the Vegans and the Traditional Foods folks might both be correct, why both might offer really good advice on what we should eat. Perhaps the link is how we digest and process foods, and it’s all largely dependent on our normal gut flora. There’s been a lot of talk about the importance of probiotics for a variety of reasons, and this is where the fermented foods come into the spotlight in the Traditional Foods diets, so it’s something I’ve thought about casually for a while. I’ve also been fascinated by what I’ve learned about our normal intestinal flora (the bacteria that always live in our gut). But when I read the article by Tang et al. in the New England Journal of Medicine about intestinal microbial metabolism and cardiovascular risk, a few light bulbs lit up. There are two parts of the study, and I’m going to go ahead and explain it in a bit more detail than some might care to read. You see, this is the kind of research that fields like nutrition and integrative medicine need, because it’s so important to say that these lifestyle recommendations are evidence based. The “n” or number of participants is small, but I think the design is fantastic. So, here we go:

For the first part of the study, 40 healthy adults were given a dietary phosphatidylcholine challenge, i.e. they ate two hard-boiled eggs. Phosphatidylcholine is found in egg yolk, and it’s a major constituent of all our cell membranes. The closely-related choline is found in meat. Bacteria that live in our intestines metabolize phosphatidylcholine to trimethylamine-N-oxide (TMAO). After eating these eggs, researchers measured the amount of TMAO in the subjects’ urine and blood. Then, six of the subjects were given a one-week course of antibiotics (500mg each ciprofloxacin & metronidazole), to wipe out the intestinal bacteria. (This is the same process by which taking antibiotics can give you diarrhea.) They repeated the phosphatidylcholine challenge after finishing the antibiotics, and then a third time one month later after the intestinal flora had presumably restored itself. They found that the course of antibiotics significantly lowered, indeed, nearly erased, the amount of TMAO measured. After one month, these levels came back up. This study demonstrates that our intestinal flora is responsible for producing TMAO.

The second part of the study enrolled 4007 adults who were undergoing elective cardiac catheterization without evidence of ongoing heart attack, and measured the TMAO level in their blood. These subjects were followed for three years, to see who had adverse cardiovascular events. Those who did were more likely to have many of the expected risk factors, as well as a higher baseline TMAO level. Even after adjustment for traditional risk factors, a higher TMAO baseline level was still a significant predictor of major adverse cardiovascular events.  Further, it proved to predict risk on a graded scale, rather just a simple high or low cut-off, even for subjects in the lowest quartile of other risk factors.

To summarize without so much jargon, though this may also make it sound more definitive than most scientists like:

·       Phosphatidylcholine is a substance found in eggs. Choline, found in meat, is very similar.

·       It’s not all bad; our body needs it to some degree.

·       Some of the bacteria in our gut convert it to TMAO.

·       It doesn’t get converted to TMAO without those bacteria.

·       More TMAO = higher risk of heart attack or stroke.

Therefore, one would think that more meat and eggs also equals higher risk of heart attack and stroke. The authors give a really nice conclusion in their discussion of what this might mean for dietary recommendations.

“Our data suggest that excessive consumption of dietary phosphatidylcholine and choline should be avoided; a vegetarian or high-fiber diet can reduce total choline intake. It should also be noted that choline is a semiessential nutrient and should not be completely eliminated from the diet, since this can result in a deficiency state. However, standard dietary recommendations, if adopted, will limit the intake of phosphatidylcholine- and choline rich foods, since these foods are also typically high in fat and cholesterol content. An alternative potential therapeutic intervention is targeting the composition of the microbiota or biochemical pathways, with either a functional food such as a probiotic or a pharmacologic intervention.”

The speculation that I would like to make, and this is of course reaching quite a bit, is that the “functional food” component of the Traditional Foods movement – raw milk & yogurt, fermenting – does in fact change the microbiota or biochemical pathways. It would be fascinating to do a similar study as the first part of this article – phosphatidylcholine challenge with 3 arms: a control, a group treated with antibiotics, and a group eating a reasonable amount of these foods on a daily basis for some period of time.

But we’re not there yet, so where does that leave us? I think Aristotle got it right millennia ago with the Golden Mean. Life is about flux and trying to find balance, and this applies to diet too. There are a few things about which we can walk away from all of this with certainty, though. The first is that we should keep prepared, processed foods to a minimum. Anything that comes in a box or a bag with a long list of ingredients, especially if you don’t know what some of those ingredients are, should not make up a large percentage of your diet. The same thing goes for inflammation-provoking carbohydrates and added sugars. The second thing is that we should eat more fruits and vegetables. Everyday. Period. The beauty of this is that once you start eating this way, your body won’t ever want you to go back.

chia seeds

You probably aren't going to be very interested in a recipe without a photo, right? I usually want a photograph before I consider a recipe. It's just so much easier; a quick glimpse and I know if I'll be interested, before I take the time to read the list of ingredients and imagine how they will taste once melded together in my mouth. And eating ought to be a visual experience as well as oral and olfactory. The more senses you use, the more you can enjoy. Unfortunately, I have reached the limit of my free blogger photo space.

I didn't know a limit existed, but it does, and it has me questioning what this is all about. Really though, that questioning is nothing new. I go through phases that range from feeling like I'll keep blogging indefinitely and have this fantastic archive and many followers, to satisfaction that I just enjoy writing it for it's own sake, to the whole thing being utterly pointless...like writing into some void. I recently read a comment elsewhere which read: "when my blog grows up I want it to be like _________." Certainly, many people feel this way. Because there are a lot of beautiful blogs out there (I have a theory about blogs and Victorian letter-writing; perhaps I'll share it another day), and we can be inspired by them, or transported, or educated. And there are a lot of women out there with great recipes, beautiful homes, flourishing prose, and lovely photographs. Do I really have something to add to the near-infinity of what is already on the internet?... I'll think of giving it up, but then another idea will come to mind that I'd like to share, and I find myself writing again. Which is all quite fine. At the very least, I know of a couple friends who read it. And my dad, and maybe even one of his friends (hi Mr. McFarland!).

Anyway, I plan to keep it up for now - even without photographs - because I want to tell you about chia seeds. Chia seeds are about the size of a strawberry seed, get stuck in your teeth just the same, and are packed full of fiber and omega-3 fatty acids. In 1 ounce, they have 11 grams of fiber (reference: recommended daily amount for women is 25g, for men it's 38g), and almost 5 grams of omega-3 fatty acids (that's 8x more than salmon). They also have calcium, antioxidants, and a bit of protein. They have very little flavor, so you can do all sorts of things with them. Throw them in a smoothie, sprinkle them on top of yogurt or a casserole. I bet you could go so far as to sneak them into an omelet and nobody would notice. Apparently you can even use them as a pectin substitute to make jam, and, like ground flaxseeds, you can use them as a substitute binding ingredient in baking. This is because they absorb water and become like a gel. Aside from easing digestion, soaking them in water (1:6 seed:water ratio) is also a great way to soften them up and prevent them from sticking in your teeth, which can be rather annoying. My big chia seed kick has been based on this soaking method. I keep a mason jar in the fridge, and in the morning I stir a spoonful into my oatmeal or yogurt. Here's a recipe for my current favorite breakfast:

Yogurt with Chia Seeds Recipe:
1 bowlful of Greek yogurt - whatever you consider an appropriate serving size. My favorite is Fage 2% fat.
1 spoonful of chia seed gel
1 spoonful of jelly or honey

optional: 1 spoonful of peanut butter. I don't care for this, but Ian loves it!
other extras: nuts, granola, fresh fruit, dried fruit, etc.

Just mix it all together and enjoy!




p.s.: if I did have a photograph, I would want it to look something like this one

looking at art

A few weeks ago I went to the Chicago Art Institute. I always feel rejuvenated after visiting an art museum. It pulls me out of my head and distracts me from all the mundane things I worry about unnecessarily on a daily basis. This trip seemed long over-do, and somehow reflecting on it now makes me realize how much this past month was recovering from the prior five.

I began by studying some photographs, comparing the differences between printing and developing methods, reading the name of each artist, title, and materials. Then I set out through the contemporary building and decided that I was not going to read anything. Instead I would just focus on the painting itself – I could only take in so many words and changing my focus constantly was becoming somewhat dizzying. Often though, I couldn’t help myself and I needed the curator’s enlightening descriptions. I made my way through a few connected rooms and, quite pleased with what I had seen, stepped back into the hallway. Suddenly overwhelmed by how much was housed in a single wing of this building, I considered calling it a day - until I thought of all the beautiful paintings that would be in the next room over, so many artists I love. I decided that I had to walk through a few more rooms, just to be in the presence of such beauty and wonder. I stood to look at a painting, but rather than study it I let the whole room flood over me, with such richness that it far surpassed any one masterpiece.

Somehow my few hours immersed in artwork mirrored my recent experiences as a third year medical student, at least in sentiment. I have many stories to tell, each of them great on their own, but all together they make up something greater. Something I don’t yet have the words for and maybe never will. But it is wonderful, this mixture of excitement and anxiety, sadness and relief, complete engagement and detachment. And there has been an overarching sense of being overwhelmed. Not in the way I felt overwhelmed by the massive amount I had to learn in anatomy, not a sense of something being unconquerable or time being too short, but such a flood of experience that I will need some time to pull myself up out of the water before I can reflect on it all.

In contrast to all that, my few days of Christmas vacation have been so beautifully simple. I’m back in Texas, and I think that adds to the feeling, both for its reminder of my youth as well as the basic kindness of strangers that goes hand in hand with southern hospitality. I’ve been relishing in walks through the neighborhood, blue skies, green leaves still hanging to trees, and lazy mornings with my family. I think it’s the perfect transition into the new semester, with a new confidence that I know what I want to do with my future, and a renewed connection with the idea of becoming not just a doctor but a healer.

I saw some art again today. This time it was the Menil Collection, a much more manageable, focused collection of art. I walked through the naturally lit rooms, surrounded by beauty, and felt like I was able to take it all in and process it to some degree. My last stop was the Rothko Chapel, and left with a profound feeling of peace.

I hope you have all had a wonderful Christmas and are filled with love and joy as we begin to look towards the new year.

thanksgiving

Thanksgiving is such a wonderful holiday. It's so much simpler than Christmas. Sure, there's a big dinner to prepare, but I think sharing good food with friends and family is one of the nicest things you can do. Now that we live in Chicago, we have spent Thanksgiving with some more distant relatives for the past 3 years. It's comforting to be with family, and to know that they are nearby should we ever need them, even if we are separated by a few branches on the family tree. I always bring a different side dish, and this year I was proudly named the vegetable queen. Fresh green beans the first year that definitely outshined your standard mushy casserole, kale salad last year that gave some people their first taste of that amazing vegetable, and Brussels sprouts this year.

It's good to have a simple holiday, allowing plenty of time to just sit and relax with family, and to reflect on all that we have to be grateful for. It feels a bit cliché to write about this, but we really don't take enough time for this in our normal hectic lives. I'm sure we would all be much happier and healthier if we did so. Just having 4 days away from the hospital is a major blessing! Already I've listened to good music with friends, gone to a yoga class, taken a few walks, cleaned the apartment, lounged around after the big meal, watched the Charlie Brown Thanksgiving, slept for 11 hours last night (!), and it's only Friday.

While I was preparing the Brussels sprouts and Ian was washing dishes, we listened to the radio a bit and were intrigued by a question the reporter posed (rhetorically?) to the audience: What books are you thankful for? As we thought about it we realized that this is very different than asking what your favorite books are. Right now, I'm thankful for the Brothers Karamazov because I'm really enjoying it right now. Interestingly, one of the first books I thought of is called Anticancer, which talks about how diet, exercise, and stress affect our health in a very significant way. I think reading this book played a big role in sparking my interest in integrative & preventative medicine, which has influenced my life in a major way. I'm not sure what else, but I really like this question and plan to think on it a bit more.

How about you, what books are you thankful for?

being present while cycling

 
One of the beautiful things about riding a bicycle is that you can't multitask. When I'm in the car, I feel the need to be talking on the phone or looking at something at every stop light. That's not really an option on a bicycle. So instead, I notice things like how the pink morning sky is so bright that for about 47 seconds everything glows neon, and the interesting combination of autumn's mums with the few choice rose bushes that have chosen to continue blooming, and a woman sitting on a balcony, playing with her granddaughter. People say hello when they pass by on foot or bicycle. And when I get to wherever I'm going, I feel like I'm ready to be there because I was really present throughout the journey.

creativity

I suppose I've always liked to think of myself as a creative person. One of my favorite things to do as a child was arts & crafts. My mother kept a room of the house well-stocked with things to keep me and my sister occupied during the many summer months that were filled with the plea, "let's make something!" Unfortunately, that room is still quite full of half-completed friendship bracelets, scraps of material and tear-off instruction sheets from fabric stores.

Now-a-days cooking is my main consistent creative outlet, along with a bit of writing and the occasional re-arrangement of something in the apartment. It's really not much and I have found that when I go a few weeks without much time in the kitchen I begin to crave creativity. A few weeks ago I found myself in this situation. I wasn't sure what it was at first but little by little I began to concretize it and pin it down: I wanted to burst out in a rainbow of colors - I questioned the point of this blog - I wanted to publish a poem - I wanted a channel for expressing creativity - not just expressing but also disseminating it. It was a strange feeling and I was glad when it subsided. I was surprised by what did it, too.

It was a conference on clinical hypnosis. First of all, I think it's really unfortunate that the word hypnosis stuck, which immediately conjures up images of yo-yos, swirling cartoon eyes and clucking like a chicken. The history goes back at least as far as Franz Mesmer, from whom we get the term mesmerize, so I guess there was a lot to work with/against. I would rather call it something like enhanced-relaxation-through-guided-imagery, but even that is somewhat limiting. If you've ever done yoga, it feels a lot like the final relaxation, Shavasana.

I went to this conference because clinical hypnosis is a fantastic tool for doctors. It can be used to help people with bladder control, chronic pain, addictive behaviors, and anxiety. It has many more uses also, especially in clinical psychology. I was encouraged to go as a student because of the way it would change the way I speak to patients even now. I definitely learned a lot but, to stay on topic here, I was also pleasantly surprised to find that it quenched my thirst for creativity.

The one thing you should know is that all hypnosis is self-hypnosis. Nobody can make you feel anything or control your mind. That being said, a big part of the basic level workshop was practicing self-hypnosis on oneself. I found this to be nothing more than tapping into my own imagination and letting my mind rest there for some time. This allows for all kinds of creativity and self-expression. Most importantly, it allowed me to enjoy and appreciate my own imagination in a way that I can tap into it on a regular basis without feeling like I needed to do something outrageous, like become a painter or a poet alongside medical school. (That would be a stretch of the imagination.) Once again, I was presented with exactly what I needed. It may not have been a great need, but what grace!

Do you ever feel the need for a creative outlet? Have you found it in an unexpected place?

the way things go

It was a perfectly cool and sunny day and I was riding the train into the city, on my way to an art museum. I had been planning this day for some time. I would go downtown and walk through the crowds, observing, feeling both like I was part of the crowd and yet completely separate from everybody else. At the museum I would spend as much time as I wanted, alone, in front of each piece. Relishing the fact that I would take the whole day for myself, without obligations to anybody else or to anything else. Pausing to write or think, or stop thinking. In fact I was thinking entirely too much - about school, my family, what I wanted to do with my life, everything. Shortly before I got to my train station, where Ian and I would part ways, I told him that I couldn't decide if I wanted to sit and think about everything or not at all. His response? Either one would all be all right as long as I didn't think about thinking because, according to Aristotle, that's what God does. Well, then.

I got off at the wrong station, so that answered that question. It was a good answer. After walking and studying my map for some time (I'm somewhat slightly anti-GPS) I arrived at the museum and the first work that caught my eye was a film titled, "The Way Things Go". How fitting. I reflected on how I have felt so much gratitude recently for the way things go and the way that life sometimes seems to hand me exactly what I need, often without even knowing I needed it. Maybe I just take it and spin it this way in my head, but I feel no less gracious for it. Do you know what I mean? Things like seeing hundreds of faces that snapped me out of feeling sorry for myself, or a conversation with a friend about faith and hope that made me realize how special our friendship was, or something I read that encouraged me to write a little bit more often, just for myself.

How often do I miss the opportunity to see things in this light? But when I do realize what a blessing this world is, it is such a joy. Suddenly I am surrounded by a magical world with trains rushing by and people leaving work and children on their way home from school. In cars, on bicycles, walking, listening to headphones, carrying shopping bags. I see each of them as amazing individuals. I feel so blessed to witness these people in their daily routines, to glimpse their worlds as an outsider. It's incredibly beautiful.

What fills you with gratitude? Is there some little thing that reminds you that the world is full of beautiful things?

la paz

I am leaving La Paz for want of peace.

As I approach Isla del Sol,

he throws at me coins of light

 and I know that I am searching for something else.

Or rather that something is searching for me -

Something that will mellow my inquietude

And fill me with a glowing red love.

Something that will allow me to live from the heart

And heal wounds and souls.

The sun god cried when the pumas ate the people

but he knew that injustice had always existed.

A happy child without a future is still a happy child.

A hungry child is not just a hungry child.

Balance these two things.

You cannot.

So I drift on towards the island,

The sun god warming my core and burning my face.

Maybe that something will find me.

But I suspect the answer to all life's great questions is love.

The rest is just extrapolation and uncertainty.

the anatomy lesson

This is Rembrandt's Anatomy Lesson of Dr. Tulp:

It pictures many of the things we expect to see in such a painting: men with beards, exquisitely dressed, huddling around a dead body in a dark room, intently listening to Dr. Tulp. The instructor is demonstrating how when he pulls on the flexor digitorum muscles it will cause the fingers to curl, and he is mimicking this action with his own hand at the same time. This is something I found myself doing repeatedly as a student of anatomy. Moving my own body that is, in order to picture how the inanimate muscles would function. Sometimes I even tried to imagine staring down at myself lying on that table,  in order to keep right and left in their appropriate places. So, are we using ourselves to understand that body and science, or are we using science to understand ourselves?

It is interesting to note that the men are not looking at the cadaver, but just beyond his feet, perhaps at an anatomical atlas. Rembrandt alone is focused on the body of the dead man and the shadow of death cast over his eyes. A little bit of research will reveal that the cadaver is a criminal that has been recently executed for multiple charges of theft. This may explain why it is his hand that has been dissected first. In those days the guts were usually removed first to get the gross part over with before it really started to decay. Today we start with the back, where amateur medical students are less likely to slice through arteries, nerves, and tendons that must be preserved and studied.

The dissected hand also appears to be quite out of proportion, larger than the right hand. And there is an anatomical mistake - the muscles in the painting originate on the lateral epicondyle, but they should originate on the medial (the side of the elbow nearest the torso). We certainly don't want to assume that this was actually a mistake. Rembrandt was a meticulous artist and he was likely in that room himself.  In his lecture "Observing Reason: Critique of Scientific Stance", J.M. Bernstein of the New School for Social Research suggests that Rembrandt purposely drew the faulty anatomical details based on the illustration of the opposite hand in the atlas these other men are looking at. He further proposes that this illustrates how science attempts to understand our world and, therefore, ourselves. I must admit that at some point I find it difficult to follow what Bernstein is saying because I am not familiar with Hegel's Phenomenology of Spirit. Nonetheless, he raises a point that we can all think about. Perhaps the fact that we get caught up in this anatomical error further emphasizes what Rembrandt wanted to show us. The men in the painting see the atlas, the instructor sees the mechanics behind the movement, we see the dissected right arm, but nobody sees a man who has just died.

thought feeling itself

The English Surgeon is a documentary about a neurosurgeon from England and his attempts to help a neurosurgeon in Kyiv, Ukraine. The Ukrainian is running a private practice and he's doing it in a way that the government does not like very much - performing risky operations, recycling equipment from England. The film depicts a faulty medical system that is controlled by a government bent on saving money. It's focus on a few individual patients and the general conditions of this clinic paints these two neurosurgeons as heroes. I would definitely recommend watching this film, but here is an interesting article if you are uncertain about committing the necessary two hours.

I'd like to share a few lines that really caught my attention.

• The film begins with the English surgeon saying this: "It is difficult to know when one is being reckless and when one is being wise, when one is being brave and one is being a coward." He said this in the context of the risks a surgeon chooses to take as well as the risks they were taking by battling the Ukrainian system, but it certainly applies to many areas of life.

• Here is another thought-provoker: "Everyone is equal. Everyone will get a consultation. The crowd should decide who gets to go first." This is what the surgeon said to quiet the mob of people waiting for a second opinion after being told their tumors were inoperable. But here, in the land of the equality and freedom, I have never seen such a system in place. It seems that we do not have enough confidence in our fellows, nor in ourselves, to handle such situations in a calm and polite manner.

• Recently I've been trying to pay more attention to subtle techniques used in film, journalism, and literature. I hope to offer you more examples in the future. These two neurosurgeons are not ones that people are inclined to criticize and the film does, appropriately I believe, show them in a very positive yet human light. But if you watch this film, look for what I am about to describe while they are in the marketplace. The two surgeons have gone to buy common drill bits, which they will be sterilizing and using to drill through a man's skull. It is crowded as many people shuffle from one booth to the next, carrying their goods and bartering. The camera pans through the crowd and stops on a ragged-looking woman picking through a few coins in the palm of her hand. A minute later, as the doctors purchase the drill bits, the camera zooms in on the Ukrainian physician's well-endowed wallet. I am slightly puzzled by this because in every other sense he is shown as a modest, self-sacrificing man. Perhaps the director's aim was to show that this man is still comparable to the doctors of Europe and America in some ways, or maybe he wanted to ensure the viewer that this is not a saint, just another man with personal interests as well as good intentions and good acts.

             How do you interpret it?

• One last, marvelous, captivating line. The two surgeons perform brain surgery on a young man, removing a large tumor from a completely exposed brain while the man is awake. As we see the brain pulsating, slimy, like a living organism in and of itself, the English surgeon says, "That is thought feeling itself." And that, my friends, is one of the great puzzles of life!

hands

I have decided that the hands are the most intimate part of the body. I am getting to know an old man's hands very well. He is (or, was) eighty-three years old and his hands are large, the hands of a man who has used them for many years. I am getting to know these hands so very well, beneath the skin, discovering what makes them tremble or sends blood through the arteries or causes the hairs of the dorsum to stand on end. But that is all I will learn about these hands. They are the hands of my cadaver, so I can only wonder about the rest. I find myself occasionally holding his hand to reposition his arm, as if it were that of a living person, and I wonder who the last person was to hold it before me.

As I migrate through the lab, studying the bodies my classmates have been assigned to, I am not impressed by the faces nor the genitals of the cadavers. The hands carry more meaning to me. One woman has fake nails, painted barbie-doll-pink.

I picture the hands of people who have been important in my life - 

my mother's precise hands that bring instant comfort with their touch;

my father's wide knuckles, that I inherited, and that can tickle so well;

my husband's careful hands with long nails for strumming nylon strings;

his grandmother's hands that were crippled from arthritis but perfect for stroking a cat's head;

my friend's talking hands that are excited about life and spread their wanderlust.

I also remember the hand of a man in the ER that had gotten caught in a corn mill. As he revealed it to the doctor, holding it with his opposite hand, lest the finger completely fall away without the supporting bandage, the man stared at it in awe, wondering if this destroyed appendage was really his own.

I remember the hand of a woman who came to the ER that, despite the IV in the same arm pumping in man's greatest attempt at a miracle, despite the hands of a nurse crushing her sternum, forcing the blood to circulate through her body, fell limp. Even when we all admitted she was dead, I was oddly captivated by her slender, beautiful hand. I wanted to hold it, but did not.

I can understand why people believe their fortune can be seen in their palms. Those dermatoglyphs are indeed unique, formed in the womb, a product of epigenetics.

I look at my own hands and I see an old scar from playing hide-and-seek, another that will soon fade because it's young, because I'm always running into things, nails that are smooth but will never hold nail polish for more than an hour without chipping. A new freckle. A broken pinky, recalcified. These hands take a scalpel and peel back the skin of another's, with the hope that one day soon these hands will heal.

expectations and eggplant

I'm afraid I could not come up with any way to link these two things, other than the fact that they both start with E and I want to talk about both.

First, the expectations. When I was young enough that only my mother could understand my high-pitched voice I used to get very upset when something did not go the way I expected it to go. My mother cleverly told me stories about what it was like to go to a new store or to a stranger's house during the car ride there. This gave me a better idea of what to expect and softened the blow of a new situation. Today, when I enter a new situation I don't have a caring, protecting figure who can tell me exactly what will happen and what I will feel. Rather, I have hundreds of people telling me what to expect, and none of them quite get it right.

We seem to have such a desire to control the world around us and create rules so that we know exactly what to expect. This is, in effect, absurd. When learning a new language, one quickly learns (and becomes annoyed by the fact) that every rule has exceptions. In everything I am learning about cell biology and genetics, I am discovering more and more instances that do not feet into neat categories. Just ask any histologist. If these grand systems of linguistics and biology do not allow for our expectations to consistently be met, how can we expect our everyday life to do so?

I am beginning to see that if I let go of my expectations I will be much more satisfied with the outcome. What exactly does that mean? It means not assuming that tomorrow I will be able to study for 10 hours, or that I will soon become best friends with somebody I met, or that a rainy day will lead to melancholy. Balancing this with organization will be difficult but I think that when I try, each day will be filled with a bit more wonder.

And now for the eggplant. This is the second time I've made this dish recently and I cannot get enough of it. I'm tempted to call it an eggplant caponata, but there are probably some traditional guidelines to what gets to be called a caponata and, well, I don't want to give you any false expectations.

Eggplant Recipe:

Roasting an eggplant is my favorite first step in any eggplant dish. You don't have to go to the trouble of salting and pressing, nor do you have to use a ton of oil for it to take on a rich, creamy texture. I don't even bother with removing the skin - it's a tricky step, and I want to keep all those antioxidants in my meal.


1 good-sized eggplant
1-2 Tbs olive oil
1/2 red onion, chopped
4 cloves garlic, minced
Pinch of salt
1 Tbs tomato paste
Fresh basil, chopped or cut into ribbons

Preheat oven to 350˚F
Cut the eggplant in half, length-wise, and spray or rub the inside with olive oil. Place it on a baking sheet and roast for about 40 minutes, until it is good and mushy
Meanwhile, heat 1 Tbs of olive oil in a large skillet. Add the onion, garlic, and salt, and cook over low heat until the onion is soft and translucent.
When the eggplant is done roasting, allow it to cool for a few minutes and cut it into 1-inch cubes. Add these to the onions along with the tomato paste.
Let this cook for a couple minutes longer, making sure the eggplant is heated through and everything is nicely mixed. I like to mash the eggplant a bit with the back of the spoon.
Remove from heat and top with fresh basil.

Serve with good crusty bread or wasa crackers and kalamata olives.
Serves 2 on its own.

bebelplatz

This plaque is laid in the ground at  Bebelplatz in Berlin, the historic site of the Nazi book burning. Nearby is a small glass-covered chamber that descends into the ground, like an up-right coffin. All that is inside are empty bookshelves.

On the plaque is a quote from 1820 by the German Jewish poet, Heinrich Heine. It reads, "That was only a preview, where man burns books, in the end he also burns men." (my translation)

Something to keep in mind, in these days filled with anger.