April 2005 Archives

Well, apart from my recent hair adventures, life back in the states has pretty much returned to normal. I'm hoping that my itching, scabby, chemically burned scalp will soon return to normal too. I am back on autopsy service, which has been a nice quiet re-introduction to the world of american pathology. We have only had one case in the past two weeks, which has allowed me to focus on the autopsy presentation that I gave this morning. There is a weekly autopsy conference where the interesting cases are shared with a group of devoted pathology fans, and this week it was my turn to entertain everybody for an hour.

Preparing one of these things is kind of a lot of work, as you have to go through the patient's chart (which sometimes can be six inches thick), dig up their old slides, dig up obscure papers, make a powerpoint, take pictures of the organs, take pictures of the microscopic slides, incorporate those pictures into the powerpoint, and generally just figure out what you want to say. And putting a microscopic slide up on the big screen and then describing it accurately, articulately, and in front of a room full of professional pathologists is kind of a daunting task. That's when you pull out the big fancy words.

Note the marked hypercellularity of the alveolar septae, with increased thickness due to proliferation of primitive mesenchymal cells. Also note the type 2 pneumocyte hyperplasia and the presence of macrophages in the intra-alveolar space. Sounds pretty fancy, eh?

Fortunately there were no radiologists in the house, because I found myself attempting to interpret chest x-rays by saying things like "this looks pretty bad" and "there are these patchy infiltrate... thingies... everywhere." Good one. Thingies? Did that actually come out of my mouth at an academic conference? Yes. It did.

But all in all it went pretty well. I was presenting a case of this very rare and almost universally fatal interstitial lung disease that has only been described in 21 people worldwide. I might try to write up a case report for publication, in an attempt to fill that strikingly blank void in my future CV titled PUBLICATIONS. There is this little known desperation among medical students to get their name attached to a published paper. It looks really good if you have something, and in competitive residencies (like dermatology, for example) it is a necessity. They won't even consider your application unless you have been published. Some people go out of their way to do really complicated and time-consuming research to get there names listed first in a paper as the principal investigator. Some people, like me, make absolutely no effort and just kind of hope something falls in their lap. Maybe something just did.

Oh crap! Brain cutting starts in 5 minutes!

I am embarking on a very scientific experiment to test the well-known hypothesis that blonds have more fun. I bleached my hair! And cut it. Well, I had those things done to me this morning. And man. Two hours of burning scalp is not usually the way I want to start my day, but I think it was worth it. It feels really weird though. I catch glimpses of myself in windows and mirrors and it startles me every time - there is now this blinding whiteness where my head used to be. It will take some getting used to, that's for sure. And it will be interesting to see what the pathologists on the hill think about it.

I also think I look very much like a butch lesbian robo-gangster from the future. But in a good way.

Everybody's favorite emergency physician turned Oregon governor recently published an article about how effed up it is that Congress recently passed a $92 BILLION CUT in Medicaid funding while at the same time clamboring for federal intervention in the Terry Schiavo case. The U.S. medical system is completely broken and its priorities are unimaginably stupid, not to mention costly and dangerous.

I know everyone loves Google image search, but I have finally put up my own actual Spain photos! To check them out, click this picture on the right, the picture in the sidebar, or go to my flickr page.

This one is from Calle San Nicolas in Pamplona, the street in the old town that has all the tapas bars. A lot of my experiences in Spain were anchored around this street.

In the lively, picturesque coastal city of San Sebastian, there is an antique carousel on the boardwalk by the beach.

This is SPAIN. Packed, well-lit, with legs of ham hung above the bar. This bar was supposedly a frequent haunt of Hemmingway, and was definitely a frequent haunt of Jessica and Fiona.

Navarra is one of the most beautiful places I have ever been. One day Jessica and my dad and i drove to the top of this mountain to see this old 12th century church. This was the view.

We went to the Feria de Abril in Sevilla, where impromptu flamenco dancing broke out everywhere, and people partied til dawn in their festive caseta tents. It was one of the most amazing things I have ever experienced.

The Alcázar in Sevilla is filled with amazing, intricate tile-work.

Bodega Santa Cruz. They had the most amazing tuna salad. And really good Vermout.

Today in the pathology residents room, talk turned from the usual discussion of cute pets and rare tumors to something that has apparently been making headlines in the marathon world: hyponatremia. Hyponatremia, or too little ("hypo") sodium (Na) in the blood ("emia"), is a condition that results when the concentration of plasma sodium decreases, leading to all sorts of problems. On of the possible causes of this decrease in concentration is by dilution - if you drink a lot of water, and you don't pee it out, all of the ions in your blood (read "electrolytes") will be diluted. And because sodium plays such an integral role in most physiologic functions, for example nerve transmission and cardiac rhythm, and because sodium concentrations are closely regulated to control the fluid content of every single cell in the body, becoming hyponatremic can have really disastrous consequences.

Like, all your brain cells swell up and you go into a coma. Or die.

And apparently, marathon runners have been dying of this. Because your body drastically decreases its urine output during extended exercise (because most of your blood is re-routed from the kidneys to the working muscles) runners are trapped in this dangerous cycle of sweating off sodium and then diluting the blood with water, without peeing off the excess. Interestingly, its the inexperienced, slow runners who are dying, because they are running for longer and they drink a lot more water. We are all taught that the worse thing that can happen to you while you are exerting yourself is dehydration. So everyone drinks a lot of water to stay hydrated. Oops! Turns out that's way worse for you. No one has ever died from dehydration after the Boston marathon. But a couple people a year die from hyponatremia.

Crazy, huh? Read about it here, or read the original study here.

Oh, and I know what you're thinking: Shouldn't you just drink gatorade or a similar sports drink to replenish your electrolytes? Nice thought, hot shot, but gatorade, though it does have some sodium, only has about one fifth the concentration in blood. So you're still putting way more water in than sodium. Nice try, though.

I am in Portland. I am relishing the portland-ness of it all - the gray skies, the light drizzle, the coffee shops, the art warehouse I am sitting in, the blog-fest I am about to attend. I just ordered coffee in the U.S. for the first time, in the requisite giant to-go cup. Mike is proud of me, but its so different than just sliding up to the neighborhood spanish bar and getting a cafe con leche. Anyway, its nice to be home.

Getting home, however, was a bit more of an adventure that I would have liked.

So Jessica and I stayed up all night on friday. We went to a couple bars, had a couple drinks, and then made our way to the crowds of people lining up on the street to get into the dance clubs to catch the 3:45 am night bus (bus de buho, or "owl bus") towards the airport. And yes, at a quarter to 4 in the morning, the bus was packed. Like, people were standing. We were smart. We figured out that instead of paying for a cab ride all the way from madrid, we could take this bus almost all of the way and then get a cab. And even though the bus dropped us off in a deserted plaza, a taxi almost immediately pulled up and we were on our way to the airport, where all of our luggage was in storage.

And as we were walking to get our bags, on time and stress-free, Jessica looked at me and said, "We MADE it." We both smiled and sighed, pleased at the pleasant event-free end to a very nice trip.

Little did we know, we had just affixed upon ourselves the biggest jinx the universe has ever known. At that very moment, a tiny wrinkle opened up in the fabric of the space-time continuum and those words escaped to the universe of Famous Last Words, where they were unanymously voted to be the Famousest of all Last Words and a huge curse was sent back, hurdling through all of history to land squarely upon our innocent little shoulders.

What could go wrong, we naively thought, now that we have safely arrived at the airport? Oh, poor sweet ignorant children. How little did you know. What is the worst thing that can possibly happen to a person in another country who is awaiting their flight home? How about losing their passport?

Check. I lost my passport. I was leisurely repacking my stuff when i picked up the little travel bag that had successfully housed my important documents for the past month. It felt different somehow, thinner. I had that instant, horrible, sinking revelation. My passport is gone. My passport is gone. What do i do. Oh my god. I think my actual words were, "Oh shit."

I knew where it was. In the back of my tired mind, I had a vague memory, more of a passing sensory image, of my passport slipping out of its spot as i fished around in my wallet to pay the cab driver. Its something that barely registered at the time, something i attribute to being very groggy from staying up all night after several nights of not enough sleep, but something that I could suddenly see so clearly. My passport was either in the cab, or it had fallen on the ground as I got out.

My flight was leaving in an hour and a half. Trying not to panic, but not really having another viable option at that point in time, I ran through the desserted Madrid airport, retracing my steps. Nothing. Not outside. Not on the ground. I stopped a taxi and asked if there was anyway to radio back to the headquarters to find the driver of my cab. He just kind of looked at me. This taxi doesn't have a radio, he said. And there are seven different taxi companies in Madrid, only some of which use radios. I found one with a radio and he looked at me as if i was insane, that finding a single cab driver in the 3.3 million pop. city was a laughable impossibility. That was infact the word he used. Impossible,

The police were of no help, other than to express to me how screwed I was. Thanks, officer. What do you do without a passport? You have to go the consulate or something, and then wait for like 2 weeks until someone decides you can get another one. That is not what i wanted to do. I wanted to go home. But still, not letting my screwed-ness settle in, I was about to go over to the Lufthansa info counter to ask what the chances were that i could fly to the US with only a drivers liscense and an old photocopy of my passport. I was trying really hard not to cry, and not doing a very good job of it.

Then suddenly, i saw an angel. Shrowded in light, emmitting stunning rays of hope and goodness, my savior arrived. Actually, my savior looked more like a balding, droopy-eyed middle aged spaniard in rumpled drab clothing, holding something in his hand and looking around confusedly. It was taxi driver. Returned to return my passport. He had my passport!! He happened to find it, and happened to go to the right terminal, and happened to be next to the line I was standing in, and i happened to see him, and we happened to be standing next to a cash machine so that I could conveniently take out the 50 euros ($65) that he happened to charge me for the service of returning my freedom. I cried and hugged him. And then gave him money. And then wished I was religious so i could thank someone other than the cab driver for the fact that I was not going to be stranded in Spain.

I left my passport in a taxi and it came back to me within an hour. Can you believe that??? I have never known such incredible relief, nor have I been happier to see someone in my entire life (sorry mike. you are a close second). So go on the plane, sleep all the way to Frankfurt. Still amazed by my unbelievably bad luck followed by ubelievably good luck.

After that, what else could possibly go wrong? How bout, the airline could lose all your luggage?

Check. They lost all my luggage. All of the bags Jessica and i checked are currently floating around in some mysterious airline purgatory. They are out there in the international ether. My theory is that they are at this moment circling around on a rusty conveyor belt in some rundown airport in rural India. It can be partially explained by the fact that Jessica and i volunteered to give up our seats in exchange for 1200 euros in travel vouchers or 600 euros ($800) in on-the-spot cash. $800 IN CASH!!! Yes please. Unfortunately, not only did they not give us $800, they made us wait for a very long time for the priveldge of losing our seats and getting re-boarded at the last minute. The also did not give us $800 in exchange for pulling our luggage off the plane that they then put us back on.

But I can tell you, there is literally nothing more exciting than getting off a 10 hour flight and then standing in baggage claim for 45 minutes as every piece of luggage comes out except yours, and then waiting in line for another hour to file a lost luggage claim. But then you get to get a private bus ride to the main terminal, where your nice boyfriend is waiting for you to kiss you and hug you and carry your bag and take you out to sushi.

And then you are back in portland, where things are pleasant and rainy, where your boyfriend and your nice big cat and your friends live, and where your apartment is, and where you eat trader joes cheese puffs and watch old scrubs episodes online and go to bed at 11 and sleep in your very own bed. And it is nice. And everything will be ok.

NOTE: As I was writing this, the airline called to tell me that they have our luggage and that they will be delivering it tonight! Cool. Now, considering that I did not die in a car accident on the way home from the airport, and assuming that I don't come down with a rare lethal spanish virus, I can conclude that the jinx is spent and the curse has been lifted and I am home for real.

Back in Madrid. The never-ending party that has been this Spain trip is about to end. I get on a plane at 6:30 tomorrow morning to head back to my much less of a party (but very pleasat)life back in portland, OR. But not to go out without style, Jessica and I have decided to opt out of a hotel for the night in favor of staying up all night and taking a cab to the airport at around 4:30 in the morning. And on a friday night in Madrid, that should be EASY.

And to continue witht the incredible, lavish stylishness of our last day, we treated ourselves to a little shopping spree in the discount fashion halls of this great city. Why doesn't portland have an H&M?? I got some kickin clothes for not very much money at all, and though my karma points may have dropped a notch or too (for supporting oppressive indonesian sweatshops and all) my fashion points are soaring. Well, for me that's not saying much, but i do like what i got. NOw the only trick will be fitting it in my luggage.

We spent last night in the white-washed Jewish quarter of Cordoba, a city that was once the capital of the western muslim world. They have this incredible builing, La Mezquita, which the muslims built on a church that they destroyed, after which the christians took over and turned it into a cathedral of sorts. So you have this incredibly strange, intense juxtaposition of ornate islmaic architechture and plaster work with gothic christian imagry. Only in spain.

Ok, on to the never-ending party that's about to end.

A tart carbonated lemon beverage that is not too sweet. Perfect for mixing with beer or red wine. Seriously. Very tasty. I swear.

Last night, after feasting on tapas and Spanish vermuth, jessica and i arrived at the fairgrounds and watched, along side hundreds of thousands of Sevillanos (and one or two tourists) the Alumbrao. The lighting of the huge gates that marks the initiation of the Feria de Abril, the biggest festival in spain.

It was amazing. I am too distracted to write about it right now, so get the details on Jessica´s blog.

I will add one thing though. We went to the public caseta, because, despite my efforts, we have not succeeded in getting an invitation to any of the private casetas. We ordered what we thought to be large 20oz plastic cup of cerveza con limon (beer with lemon fanta), which has come to be a favorite drink of mine here in spain. However, turns out that what we each actually ended up with was a gigantic cup full of sherry mixed with lemon fanta. Apparently, the big drink here is sherry with sprite (lemon fanta is a major no no), and one large cup is divided among a group of people in many smaller cups. This we did not know. So we each ended up with a gigantic portion of sickly sweet alcohol, which we delicately dispensed into our own tiny plastic cups and sipped slowly until about 3 in the morning.

Today, Jessica and I have spent a beautiful day wandering slowly through beautiful gardens and drinking coffee in beautiful gardens and eating lunch in terraces next to beautiful gardens and getting yeld at by old men for sitting on the grass in beautiful gardens. And then having the police yell at us and kick us off the grass.

This was actually a kind of stressful, unsettling experience because this old man was yelling things like 'how could you be so disrespecful as to sit there?' and seemed genuinely upset that we were being so offensive. But there were no signs, and kids climbing everywhere, and people lying out on the grass in other parts of this park... there are some rules of conduct here that i have not yet come to understand.

Last night we stayed out til 3:30 in the morning, and when we came home the streets were packed. Packed. The nightlife in Madrid is startling. The schedule of meeting for dinner at 9:30, eating until 12, and then bar hopping literally all night long is something that takes a little getting used to. But it is FUN. The energy in a huge cosmoplitan city like madrid (pop 3.3 million) compared to Pamplona (pop. 200,000) is so different.

Tomorrow we take the train to Sevilla.

Tonight we will attempt to find vegetarian food, after which we will watch the movie Hitch, starring Will Smith, dubbed in Spanish.

Ya me voy. I can't believe an entire month has passed. I have been here for four weeks! It really seems quite impossible. On the one hand, I am really sorry to leave Pamplona. I really like this city and I am just starting to feel comfortable and at ease. Plus I keep discovering new things - just yesterday I went to a park that i hadn't been to before and found myself in a beautiful european-style garden with wide avenidas and sculptured fountains and expansive beds of fragrant spring flowers in bloom. I bought myself a half-dozen churros (fried dough covered in sugar - my favorite thing in the world) and wandered around the park to the sound of an accordian.

And as I was wandering I discovered that the other side of the park contained ruins of the walls of the old medieval fortress that used to make up Pamplona. And within these walls was a little zoo. Well, not exactly a zoo. More like tons of birds mingling freely with a herd of scruffy looking europen deer (ciervos). Peacocks, swans, ducks, roosters, a half a million pigeons, a couple of mountain goats, and an entire herd of deer. Very weird.

They tell me that there used to be a monkey that lived there too. El mono Charley. But apparently the put him to sleep because all he did was steal people's possessions and masturbate in front of groups of small children. Pobrecito.

Anyway, so there are very interesting things in this city that i am just getting to know. And now I'm going. However, I am looking forward to the next leg of my journey, which will involve me taking a bus to madrid early tomorrow morning and then traveling to Sevilla to take in one of the biggest celebrations in all of spain - La Feria de Abril (april fair). This i will be doing with jessica, who is currently in madrid. I am excited to have her back!

Today was the funeral of the pope. They hooked up a big screen here in the path lab with a live broadcast of the whole affair. We watched it while intermittantly looking at slides. It was such a funny juxtaposition - to look up from the microspopic slide of a nasal brushing to see one of the most significant world events of recent history. I was glad to be able to see it. Very intense. Now I have to dedicate the next few hours to the mundane, but very important activities related to leaving a place you have lived. Phone calls, bus tickets, packing, cleaning, one last glass of Navarran wine. Well... maybe more than one.

The pope's death has been a huge deal here in spain, for obvious reasons. The entire country is catholic, for one thing, but not just in that culturally catholic way. They are CATHOLIC. People go to mass here. People pray. The church is a part of their daily lives. I have never seen so many actual priests in my life. And so the pope dying has affected almost everyone that I am in contact with.

One of the pathologists was going to try to go to rome for the funeral, but decided against it because the italians basically pleaded that no more people come to rome because the city is on the point of collapse, with hundreds of thousands, if not millions of people arriving daily to pay their respects and pray for the upcoming conclave.

Today they held a kind of event in the medical school in memory of the pope. They showed a video of his trip to spain a couple years ago, in which millions of people showed up to catch a glimpse of their spiritual leader. And then there was a discussion of some of his lasting legacies.

For me, even though I am no where near even being religious, and have very little idea of what it actually means to be catholic, this whole experience has really impacted me. Es impactante. To see the effect that this one man, this ancient, crippled man, has had on so many people, to see the love that so many have for him, to see so many millions of people across the world united in celebration and mourning... well, me afecta. Me impacta. I even cried during this video where they showed this little boy, crippled for life with some sort of cerebral paralysis, who when asked what he was going to ask the pope for, said that nothing, that he was there to pray for the pope, to pray that he may keep being pope for a long time. Tears! Because this little boy loved the pope so much.

Today at lunch all we (and by that i mean 'they') talked about was the pope, and stories about him, and the funeral, and whether or not they were going to embalm him, etc etc.

El Papa.

And being here has let me learn so much about his life. Maybe you all are learning these things too, but i find it really fascinating. Like, did you know that everyone in his family had died by the time he was 20? That he was once an actor and a writer? That he singlehandedly kept catholocism alive in Poland during a very anti-religious communist dictatorship? That his most famous phrase, the one that he said in his first speech as pope, and in almost every speaking engagement since is 'No tengais miedo'? Don't be scared.

Man. El Papa.

(photos courtesy of Google image search)

Jessica and I have gone out a couple of times, Spanish style. And though we never much expanded on our stealthy list of questions, we managed to meet a couple people who made our evenings a little more entertaining. And yes, these people were male spanish bartenders. Jessica happens to be a very good conversationalist, and I am, well, tall, so perhaps we together stand out as ladies that a male spanish bartender might want to talk to.

But the thing that I have noticed, the thing that I have noticed all my life, is that there has been a slight difference between the guys who want to talk to my friends and the guys who want to talk to me.

I will elaborate. We went out last friday night to this bar in the heart of the old town (and by old i mean like 1600s) called Sarria, which was supposedly a favorite hangout of Hemmingway. Its muy spanish atmosphere was made complete by the wood-panneled walls covered by black and white photos of people getting bored by bulls, and by the hundreds of large legs of jamon hanging from the ceiling over the bar. Ham and bulls and death and wine and smoke and tons of people = spain. Anyway, a nice conversation with one of the very nice bartenders got us an invitation to a tour of the city on sunday morning, which we accepted. This guy, Iñaki (basque name), walked us around the old town with the requisite stops every half hour or so for beer and wine. Very cool, knowledgable, decidedly un-sleezy guy, who shared with us a lot of very progressive ideas about cities and marriages and politics. And he happened to show more of an interest in sharing these ideas with jessica. But that's ok. That's ok.

So back to friday night, after leaving Iñaki's bar, we went to another of our common evening destinations, a more modern bar called Otano. This place literally turns into a tapas bar to a night club in a matter of seconds - suddenly we looked up and all the food was gone and the lights were out and the music was turned way up. Instant scene. And then we met one of the bartenders there. A nice but extremely weird little guy with a lazy eye who appeared to greatly enjoy flexing his muscles and doing little dances and buying us shots of some pineapple-flavored alcohol. And that's who ends up talking to me, and makes a big effort to meet my dad when he comes by the bar to pick us up, refering to him as his new father in law.

So who does jessica get? The cool, thoughtful, slightly nerdy guy with an interest in history, politics, and alternative forms of transportation. Who do I get? The short, weird, cross-eyed aerobics instructor with an interest in flexing his pecs. WHY, GOD, WHY?? Are you punishing me? Why does it always have to be the short cross-eyed one? WHY??

(note: neither jessica and I are actively looking to 'get' anyone, any any connection made was purely in the interest of talking to someone other than ourselves)

Jessica and I went out on wednesday night, which we quickly learned was not really a popular night for going out here in Pamplona, Spain. But it did afford us the unique opportunity to sit at the bar and talk to the friendly bartenders (one of which was a cute indy guy with cute little indy glasses). And Jessica and I came up with the idea that we should make a list of questions that we, as curious travellers, can ask a bartender in order to engage them in coverstaion. Because, really. Its much more fun if someone is talking to you. And the easiest way to get them to do so is to ask them things.

So I asked the cute indy glasses guy what was differnce between regular wine, and wine labled 'Crianza' (which I already knew to be older wine that was stored longer in the barrel and then in the bottle, than your average young wine).

So I'm trying to think of other good quesions. The obvious one is 'What is that?' in reference to a mysterious plate of food, which invariable ends up being some unappetizing combination of anchovies and octopus tentacles (only slight exaggeration). But they get that question all the time, especially from tourists, so we need better ones.

Like 'What is the best kind of ham' You know, speaking their language.

Or 'In Pamplona, where is a good place to go out dancing?'
Or 'How could you possibly eat octupus tentacles?'

See? I need help. These questions are awful.