It’s That Time of Year Again….

and once again, I am a bit late in submitting my entry to the Bulwar-Lytton Writing Contest. But since the deadline appears to be a floating one, I have nonetheless sent in this tasty little nugget for consideration as the worst opening sentence to a badly written novel –

The last person to see Eveline Massuer alive was her gynecologist, who, coincidentally was also the first person to see her alive, since he also happened to have been her mother’s obstetrician.

I think I may  stand a chance at winning with this one…

Blog Rally in Support of Roxana Saberi

I’ll admit, I’m not a ribbon sort of person. But this is one ribbon I feel compelled to display in support of journalist Roxana Saberi, who has been imprisoned in Teheran and convicted of espionage in a kangaroo court there. Both Hillary Clinton and President Barack Obama have demanded her release.

Seven other journalists and two cyber-dissidents are also being held in Iran.
I encourage my fellow bloggers to join the rally and display this ribbon on your blogs in support of Saberi and her fellow prisoners, and in gratitude for the freedom of speech we enjoy in this and other countries with a free press.

Thanks to Anesthesiaoboist and Paul Levy for getting this blog rally going.

Happy Birthday Shakespeare!

I think the Bard would have loved this rendering of Abbott and Costello’s classic bit as performed by Jay Lebowitz and David Foubert of the Shakespeare Theater of New Jersey.  (Thanks, Sofia!)

Just in case you’ve never seen the original, here it is. 

“Be not afraid of greatness: some are born great, some achieve greatness and some have greatness thrust upon them.”

Spring Break in Washington, DC

Washington, DC has never looked more beautiful, and I never felt so proud to be an American as I did when spending time in this wonderfully cosmopolitan, cultural and international city. It’s a great place to take your kids, especially in their teens when they have a grasp of history and politics and can appreciate all there is to learn here.

Where we stayed

We stayed at the Melrose Hotel in Foggy Bottom, just two blocks from the Metro, a short walk from Georgetown and right on the Circulator and MetroBus routes. The Melrose is a not very large, older but nicely renovated hotel that is well-run by a small, attentive and friendly staff who became familiar faces to us during our 3 night stay. Most importantly for me, it was reasonably priced ($140 a night on Hotwire.com, with wireless an additional $10 and valet parking $35 a day), and had room windows that open (I hate being trapped in a room with no fresh air). The nearby Aroma Cafe, a small coffee shop with excellent croissants, sandwiches and coffee, was our daily breakfast stop.

What we did

  • The International Spy Museum– Loved it! Great for teens and adults alike. You need at least 3 hours to do it justice, and don’t get so waylaid by the early exhibits that you miss the cold-war stories at the end. The Spy Experience, a timed pre-ticketed small group adventure, was really fun, though not essential to enjoying this marvelous museum.

 

We also saw the controversial Obama “Hope” collage – the original has beautiful graphic detail that the mass-produced poster does not capture.

The museum’s central enclosed atrium reminds me of the one at the the Chicago Museum of Art, and is a wonderful spot for an afternoon tea or coffee break. Located right across the street from the Spy Museum, so you could combine the two museums with lunch at one of several local restaurants, the Spy Cafe or in nearby Chinatown.

  • The White House – If you want to see the White House from the inside, you need to book a tour months in advance through your Senator or Representative. Since I am not a good advance planner, we had to be content with paying our respects from outside the fence. I was amazed at how close we were able to approach, even putting our cameras through the rails to get a close shot. I’m guessing the Obamas were out for the day…

  • The Holocaust Museum – The dreary, cold and rainy day seemed an appropriate backdrop. My mother-in-law was with us, and her stories of relatives who were lost and friends who had survived the Holocaust made the experience even more real for us. The kids did not want to leave without seeing and listening to everything, so we actually spent the entire day here, with lunch in the cafe. This was my second visit, but I still learned so much about this important and terrible time in the world’s history.
  • The Renwick Gallery – The Renwick is located just across the street from the White House, making for a nice combo visit. We went specifically to see the fabulous exhibit on the arts and crafts of the Greene brothers, but I was taken in even more by the Indian Gallery, a collection of 19th century paintings by artist George Caitlin.

  • The Kreeger Museum – This former home of David and Carmen Kreeger was designed by architect Philip Johnson to house the Kreeger’s expansive art collection and provide a venue for the musical concerts the couple often hosted. The art collection is fabulous and varied, including Impressionists, Picassos and other modern paintings and sculptures, and a small African art room.

    The Kreeger Museum is located just outside of Georgetown on Foxhall Road, and is easily reached by car or cab.Docent led tours are by appointment only, but this was easily obtained by email two days prior to our visit. The personal stories of the Kreegers and their many friends in the arts were as interesting as the paintings. We packed a picnic lunch, which we were allowed to eat on the grounds of the museum just before our tour. I would love to return to this museum some evening for one of the chamber music concerts held there.
  • The Library of Congress – This was an unplanned visit, and one of the highlights of our trip. One of the most beautiful buildings I’ve ever seen, recently restored and worth a special trip. The Docent tour was informative, and allowed us access to the gallery above the great reading room, which you may remember seeing in National Treasure 2. If, unlike us, you plan ahead, you can combine a visit to the Library with a visit to Congress – but best to book in at least 6 weeks in advance though your senator or representative.

 

  • Georgetown – Great food and shopping for teens and adults alike. Take the 30 series buses or the circulator, or walk as we did, from Foggy Bottom.

 

What we did not do
  • Bike tour of the monuments – This was top of my wish list, but bad weather precluded it. Next time…
  • Flight of the Conchords Concert at DAR Hall – Sold out (damn!), and I just could not bring myself to pay over $100 to the resellers for what was originally a $35 ticket.

Where We Ate

  • Ethiopian at Meskerem in Adams Morgan was disappointing. Not so the company – friend and blogger Linda drove in from Fredricksburg, and seeing our daughters reconnect their friendship was a highlight of our trip. Thanks, Linda and Paige, for schlepping in – it was great to see you both !
  • Clyde’s in Georgetown. My best meal, to my surprise, since I tend not to favor American traditional joints for anything other than a burger. Softshells had just come into season, and were served very lightly breaded and perfectly cooked on a large crisp potato pancake with a zucchini and carrot salad atop. (I’m still thinking about that softshell 5 days later…) The fireplace on a damp rainy night gets extra points.
Did you know?

More Americans visit Disneyworld each year than Washington DC. I encourage you to reverse that statistic and visit this wonderful city. I certainly plan to head back again soon. There’s so much we did not do.

________________________________________

Great site for finding hotels near the Metro

Well, There Went My Chance…

Susan Boyle has taken what is probably the world’s only slot in the big time for an overweight middle-aged newbie singer. Good thing I kept the day job….

The Daily Record has unearthed that recording up there of Susan singing “Cry Me a River” for a charity CD in 1999. She’s no one-hit wonder.

Ending Genital Mutilation, Village by Village

Ten villages in Western Niger have decided to end female circumcision and genital mutilation in response to a campaign by Unicef and other NGO’s. SInce 1998, the rate of female circumcision has dropped by 50% in Niger, and was outlawed in 2003. Still, villages in the western part of the country have been resistant to change until now. Education villagers about the health risks of female circumcision has proven to be a persuasive and effective approach.

Female circumcision leads to obstructed labor and birth trauma due to scarring of the genitals. I learned early in my career that if I was delivering a women who had had a previous clitorectomy, I needed to cut a good episiotomy, even if she had had prior children, because the scarred upper portion of her genital tract would massively tear at delivery.

The most tragic consequence of female genital mutilation is the formation of fistulas – holes between the bladder or rectum and the vagina that cause a woman to constantly leak urine or feces. It is estimate that over 200,000 women in Niger suffer from fistulas, which causes them to be ostracized by their villages and abandoned by their husbands. The risk for fistula is compounded among young women who are married and give birth in their teens – in Niger, half of all girls are married by age 15. Unicef is working to persuade the Niger government to raise the marriage age to 18. In the meantime, educating fathers about the health risks of early childbearing for their daughters has prevented early marriage in some families.

This sort of approach, which respects the dignity of villagers and uses education rather than punitive methods, appears to be effective in moving groups away from tribal customs that negatively impact the lives of women. Kudos to Unicef and other NGO’s involved in the campaign to end female genital mutilation.

The Shiksa Does Passover, Part 2 – Almond Cake

Almond Cake for Passover

In Part 1 of this series, I made a really good brisket that was not my mother-in-law’s recipe. This year, I decided to tackle dessert.

As anyone who has tried to make an unleavened dessert for Passover dinner knows, the words “baking” and “Seder” should probably not be used together in the same sentence, let alone a blog post. But dessert must be had at a Seder, and so an entire tradition of baked goods made without flour or leavening has evolved – cakes made with ground nuts, dense chocolate tortes and macaroons are traditional. (My mother-in-law Irene makes a fabulous strawberry shortcake every year using a light sponge cake made with ground nuts.)

This recipe is modified from one I found in Jewish Cooking by Marlena Spieler. The recipes in this marvelous book hail from both Sephardic and Eastern European Jewish traditions, and the pictures are gorgeous. The original recipe, Pesach Almond Cakes, has a bit more intense almond flavor than the one I’ve posted and calls for the creation of a thin icing made with confectioner’s sugar and brandy that is poured over the almost cooked cake, which is then returned to the oven while the icing crisps.

My first attempt at the original recipe was a fallen yet delicious failure that my friends Larry and Sally graciously served at their Seder with a large spoon. (I guess La Crueset lasagna pans are not meant for baking cakes…)

On my second attempt for Mr TBTAM’s family Seder, I used the right pan but the cake still fell a tad, so I just soaked the cake with some brandy and sprinkled the final product with confectioner’s sugar. It was delicious!

If you try the original recipe and it works perfectly, do let me know how you did it so I can figure out what I did wrong (probably too many years of Catholic schooling…) I’m thinking it may have been because I used the American measurements rather than the original metric ones, so I am posting only the metric units for you.

A few pieces of advice: (1) Don’t open the oven door to peek. (2) It may take longer than the stated time depending on your oven. Be sure the middle is set before you take the pan out to sprinkle the brandy on top. (3) Make sure the cake is really, really cooled before cutting it. (4) Finally, it will be difficult to get out the squares out of the pan unless you have a small cookie spatula, which I did not have, but Irene did.

Of course, the fact that this recipe needs so much advice only speaks to the difficulty of making unleavened baked goods. Then again, getting the Israelites out of Egypt was no small task…

Almond Cake for Passover
  • 350 grams cups ground almonds
  • 50 grams matzo meal
  • ¼ tsp salt
  • 30 ml vegetable oil (I used canola oil)
  • 250 grams sugar
  • 300 grams brown sugar
  • 3 eggs, separated
  • 1 tsp almond extract
  • 1 tsp vanilla extract
  • 150 ml orange juice
  • 75 ml brandy for the batter
  • 50-75 ml brandy for soaking the cake
  • Confectioner’s sugar

Preheat the oven to 350 degrees Fahrenheit. Lightly grease a 12×15 inch rectangular cake pan.

Whisk the ground almonds, matzo meal and salt together in a large size bowl.

Lightly whisk the oil, egg yolks, sugars, vanilla, almond extract and 75 ml brandy in another bowl.

Beat the egg whites in a small deep bowl till stiff.

Stir the oil-egg yolk-sugar mixture into the almond mixture. Fold 1/3 of the egg whites into the batter, then fold in the rest. Pour the mixture into the prepared cake pan and bake for 30 mins till nicely set and lightly browned. (Mine took longer than 30 mins.)

Remove the cake from the oven and soak it with the rest of the brandy (A little spray bottle would work well, or you could just sprinkle or brush it – I still haven’t figured out the best way to do this). Pop it back into the oven for another 10 minutes, then remove it to a rack to cool.

Cool the cake in the pan. When completely cool, sprinkle with confectioner’s sugar. To serve, cut into squares in the pan, and use a tiny cookie spatula to remove the pieces carefully.

This is a cookie spatula

So is this

How to Talk to Your Kids About Sex

It’s about taking advantage of those teachable moments that provide an opportunity for you to discuss sex with your child in a way that helps you find out what’s on their minds and also impart the values that can protect them from the consequences of beginning sexual activity too soon.

That fabulous video up there is from Planned Parenthood of NYC, and is filled with great tips, including a technique called the Four Steps that you can use when your kids ask the tough questions –

The Four Steps Technique

1. Normalize and Validate – “That’s an interesting question.”, and “What makes you ask me this today?” – this gives you context as to why the issue is on their mind.
2. Ask what they think the answer is – that let’s you know how much they know (or don’t know) on the topic at hand.
3. Give and honest answer in sync with your values. And finally,
4. Check for understanding.

I’ll never forget how I first learned about sex.

I was in 4th or 5th grade and I had a friend whose mom was single. This puzzled me, since every parent I knew was married (those were the days, huh?), so I asked my Mom how this could be so. My big brother, who happened to be standing there, whispered “That’s a sin!” Mom hushed him up, then brought me right upstairs to her bedroom, where she pulled out “The book” from her bureau drawer. (I don’t remember the name of it, but it was biologically correct.)

Right then and there, using the book as her guide, Mom gave me the 411 on the birds and the bees. Then she gave me the book to read. And although Mom surely imparted her values to me in that conversation, she was very careful not to judge my friend’s mom. I remember leaving the conversation mostly feeling sorry for her that she had to raise a child on her own, while we had this great family and a Dad who piled us into the station wagon and took us to the Drive-In movies.

A teachable moment, indeed. Thanks, Mom!
____________________________________________

You can also view the video in Spanish

Family Planning in an Economic Crisis

Cristina Page explains why vasectomy rates are up, and writes one of the best editorials in support of family planning that I’ve ever read.

Family planning is nothing less than a foundation on which many Americans build sturdy, responsible lives. Regardless of political affiliation, that’s exactly what many are struggling to do right now. Those who have lost their jobs and health insurance are in great need of family planning. They’re also, alarmingly, the ones with the least access to it. Meanwhile Republicans openly mock attempts to include family planning as a part of the economic recovery, actively work to defund Planned Parenthood, promote policies that encourage health care workers to deny patients access to contraception, and defend programs that withhold basic information about contraception to sexually active teens. (Then they’re baffled to find the number of teen parents spiked during the Bush years.)

Read it, then send it to everyone you know.

Grand Rounds – When Things Go Awry

Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, and author of the excellent blog Running a Hospital, is hosting grand rounds this week. A champion of transparency in healthcare who walks the walk and talks the talk at his own insitution, Levy asked medical bloggers and patients to post about their experiences on both sides of the exam table when things go wrong in healthcare.

Head on over for a gread read.

The V-Word

The Onion has a hilarious article this week that epitomizes our relationship to the word Vagina. (Hat tip to Rachel).
Renowned Hoo-Ha Doctor Wins Nobel Prize For Medical Advancements Down There.

STOCKHOLM—In recognition of her groundbreaking work treating life- threatening diseases of the privates, renowned hoo-ha specialist Dr. Victoria Lazoff was awarded the Nobel Prize in Lady Medicine this week.

The world’s foremost authority on ailments down south, Lazoff led a team of cutting-edge hoo-ha doctors to develop new strategies for detecting abnormal growth in…you know, that area.

What makes this article so funny is that it’s so true. We’ll do anything to avoid saying the word vagina, won’t we?

Of course, my sisters and I don’t call it Hoo-Hah. That’s too silly. We call it Virginia. (As in Yes Virginia, there is a Santa Claus… Oh, never mind….)

Seriously, though, why do we hate to say the word “Vagina”?

I think I have it figured out. Vagina is just not an easy word to say. Try it – Vagina.

Your mouth has to open for the “Va”, then go to the pucker of the soft G and then to the vertical open of the long I then back open for the “na” at the end. It’s a work out.

Now try saying it over and over again out loud – vagina, vagina, vagina, vagina…. It’s exhausting, right?

But guess what? It’s easier if you say it softly. Go ahead, try it – Vagina, vagina, vagina, vagina…

See? It wants you to say it softly. (Vagina)

Which has got me thinking that maybe the word vagina is just not meant to be spoken outside of an intimate conversation.

So when we hear it in a crowd, or spoken too loudly, or in mixed company, we get uncomfortable.

But What About the Vagina Monologues?

Hasn’t that play removed the taboo on the word Vagina by now? Brought it out of the closet and into the vernacular?

I’m not so sure. (And here’s where the Feminists kick me out of the club…)

My five sisters and I went to see the Vagina Monologues a few years back. We even had front row seats. No one was more suprised than me to find that despite the fact that I talk about this stuff all day with my patients, and say the word vagina at least 20 times an hour, I was very uncomfortable sitting in that audience. More so even than my sisters. It all seemed so – personal.

Save it for your shrink! I wanted to yell out. I don’t want to know this about you. Really. This is Broadway, after all, and I paid a lot of money for this ticket. Couldn’t you just sing “I Enjoy Being a Girl“, or something?

Of course, if one of these women were to tell me that stuff in my office, I’d jump right into the discussion. It seems right in a doctor’s office. And I think I could read it in a book or memoir. After all, a book is really a conversation between two people – the writer and the reader. (Just like me and you….)

But listening to vagina talk, right there on a stage, before hundreds of strangers (including a few men), it seemed – well, wrong.

Which is not to say that women should not learn about their vaginas, and feel comfortable with their vaginas and love their vaginas and all that. Because they should. And they should feel comfortable saying the word vagina.

But maybe the whole world doesn’t need to hear it.

Vagina.

So go ahead, say it.

But say it softly. And keep it private.

The Painting that Inspired Another Masterpiece

Mortin Lauridsen, the composer of the unspeakably beautiful choral work O Magnum Mysterium, writes in the WSJ of how the structure of his work was inspired by Francisco de Zurbarán’s “Still Life With Lemons, Oranges and a Rose“.

In composing music to these inspirational words about Christ’s birth and the veneration of the Virgin Mary, I sought to impart, as Zurbarán did before me, a transforming spiritual experience within what I call “a quiet song of profound inner joy.” I wanted this piece to resonate immediately and deeply into the core of the listener, to illumine through sound.

I had the privilege to sing Lauridsen’s O Magnum Mysterium last year with my Chorus. It is not an easy piece to sing – the soprano part spans the range, and requires the breath control to hold a note at low volume without a lot of vibrato. I’d sing it again tomorrow if given the opportunity.

de Zurbaran’s painting is on view at the Frick until May 10 as part of the Masterpieces in European Painting from the Norton Simon Museum Exhibit.

If you’ve never been to the Frick, it is one of New York’s gems – an intimate, stately and beautiful museum that reminds me of a miniature version of the Tate in London in the days before it changed to compete with the Tate Modern. (If that makes any sense…) They don’t allow kids under 10 into the Frick, but the guard let me daughter sneak in a few years back becuase she had a sketch book and we were going there to draw. I still remember that day as one of our best together.
__________________________________________________
You can listen to Lauridsen’s choral work by clicking on the links embedded above.
Thanks to fellow soprano Kathleen for the tip…

It’s a Good Time to Buy a New Car

Big Bro’s Car

My big brother – the penny pinching ex-airline pilot Uber-Saver and investor, who never bought a newspaper because he could read the used ones left on the airline seats by the passengers, who drove an old used car without a radio for years and lived almost as long with an empty dining room because he was too cheap to buy a table and chairs, and who moved his entire IRA to cash a little over a year ago – just bought a new car.

He paid $7,990.

That’s right – a brand new car for just under $8K.

Here’s the breakdown –

He bought a Chevy Cobalt LS/XFE with air conditioning, OnStar, 80 days of XM radio, 3 yr bumper-to-bumper/5 yr 100,000 mile warranty and 5 yr roadside assistance. But no power windows. (He is my brother, after all…)

MSRP $15,650, Invoice 14,995
Dealer rebates brought the price down to $9,995
Minus $3,000 in points on his GM credit Card
End Price $6,995
Add in tax and Transfer – Final Price $7990

Oh yeah, there’s one more thing – he’s getting 36 MPG.
______________________________
Photo from Myride.com

Estrogens Found in Bottled Water

Mineral water has been found to be contaminated with estrogens.

In a report published in Environmental Science and Pollution Research, German scientists Martin Wagner and Jörg Oehlmann measured the estrogen activity in 20 different brands of commercially available mineral water – some bottled in glass, and others bottled in in PET or Tetra Pak plastic. (They did not give out the brand names, sorry.)

The researchers were surprised to find significant estrogenic activity in 12 of the brands, with activity the equivalent of as much as 7.5 ng/L of 17 beta-estradiol, the naturally occurring sex hormone. Estrogen activity was lower when some of these same brands of water were bottled in glass, or in plastic bottles that were deemed returnable and reusable. The researchers proposed that the estrogen activity is from xeno-estrogens leaking from the plastic bottles, or in the case of glass bottles, from plastic used in the bottling process.

To prove it, they bred snails in both the plastic and glass bottles – snails bred on plastic had higher reproductive output, a lab measure of estrogenic activity of the plastic.

Our results demonstrate a widespread contamination of mineral water with xenoestrogens that partly originates from compounds leaching from the plastic packaging material….Overall, the results indicate that a broader range of foodstuff may be contaminated with endocrine disruptors when packed in plastics.

The amount of estrogenic activity in some mineral waters is around the same amount that has been found in milk, another modern food product known to be contaminated with hormones. So if you’re only drinking hormone-free organic milk, you may want to rethink your water source as well. If you drink mineral water, glass-bottled brands may be a better bet.

I for one, will use this as just one more reason to stick to my favorite source of H20 – NYC water, straight from the tap.

APA Ends Pharma-Sponsored CME

The American Psychiatric Association has called an end to Pharma-sponsored CME and meals at their meetings. (via NY Times) Pharma-sponsored fellowships, ads in the group’s journal and exhibits at meetings will continue, however.

In the past year, two prominent academic psychiatrists have been investigated for failing to disclose drug-industry income, and the APA itself has been faced scrutiny by Congress for the close financial ties of its leadership to the pharmaceutical industry. 

The APA joins the Oregon State Association of Family Physicians, Memorial Sloan Kettering Cancer Center, and the Massachusetts Psychiatry Society in banning pharma-sponsored CME.

C’mon NAMS and ACOG – you can do it, too.