Staying fresh in December

It's that time of year when the heavy comfort food is getting old, the number of layers one needs to wear to stay warm indoors sizeably increases one's bulk, and the necessity of end-of-year productivity limits physical activity. In addition, I'm on a running hiatus right now not due to weather but due to exacerbation of an old injury -- I don't want talk about it.

So how to eat in a way that helps you to feel fresh, despite the chronic dry skin and static? I think citrus helps, but I'm not yet ready to bid goodbye to apple season. So I tried this quite simple salad, which is not exactly seasonal but is also not too appallingly unseasonal either (no miserable unripe tomatoes!).

Fresh winter salad:

• butter lettuce, arugula, or both
• radishes, quartered
• toasted walnuts*
• goat cheese (optional, I skipped it)
• juice of half a lemon
• olive oil

Toss all together and dress with lemon and olive oil. Serve with a hard boiled egg, cheese on toast, a yogurt, etc. for a more substantial meal.

*I've been craving walnuts since their health benefits were all over the yuppie and medical news last week.

Sources of iron

Med school often feels like that book or movie I read or watched when I was a kid, where whatever the characters read about in a book came true for them in real life (was it "Jumangi"?). To illustrate, I got a headache the day we studied headaches and reflux the day we studied reflux.

Since taking hematology in September, I've been convinced that I have iron-deficiency anemia. I sleep all the time, I hardly any meat, I eat a lot of fiber and drink a lot of tea (both inhibit iron absorption). Three months later, we're studying GI and I find myself reviewing mechanisms of iron absorption. I was reminded that we absorb heme iron (Fe2+) much better than nonheme iron (Fe3+), and that what matters is not just that we each iron-rich foods, but that we eat foods containing the right form of iron.

Well, I looked up heme and nonheme iron here, and it turns out that I eat virtually no heme-iron-rich foods regularly (they are all meats). However, I do eat a lot of nonheme iron, such as oatmeal, lentils, raisins, and kale.

Tonight's dinner is super easy, will last you the week, is a perfect antidote to the snow, and is centered around nonheme iron. Some iron is better than none!

Lentil soup (consider this a 'kitchen sink' recipe: these ingredients are just suggestions)

• 1 large onion
• 4 cloves garlic
• 1" piece of fresh ginger
• olive oil, chili flakes, cumin, salt, pepper
• 2 tablespoons white vinegar or lemon juice
• lentils (I used about 2.5 cups, but didn't measure)
• 1/2 can chopped tomatoes or 1 chopped fresh tomato
• 1/2 sweet potato, cut into large chunks (or 2 carrots)
• 2 celery stalks, cut into 1/2" pieces
• 1 bunch of kale, parboiled and chopped
• chicken stock

Chop the onion and garlic into large pieces and the ginger into small pieces. In a large pot, saute onion, garlic, ginger, chili flakes, and cumin in a few tablespoons of olive oil. (In retrospect I think caramelizing the onion first would add a lot of flavor, so do that if you wish.) Add in lentils, celery, and sweet potato and continue to stir at high heat, then add several cups of water and chicken broth to cover. Simmer at high heat, adding water as needed, until lentils are soft to your liking. Add in the tomatoes, kale, and vinegar/lemon along the way and season as needed. Garnish with cilantro and feta cheese, if you like.

My friends can cook!

Friday afternoon I saw my third hospital in-patient: this woman was sicker than the previous two. Fifty-seven going on 75, she had profound edema and venous stasis as a result of congestive heart failure and acute kidney failure; the suspected underlying cause is amyloidosis (abnormal protein formation and deposition in tissues), possible of multiple myeloma form. I have already been introduced to amyloidosis and multiple myeloma this year, but of course I remembered nothing about them until I looked it up Friday night. And I found, contrary to what I might have expected, that spending time reading up on these diseases online--dwelling on this woman's condition in a scientific sense--made me care more about her in a human sense. This caring happened subconsciously, until I landed upon the prognosis and sat back, surprised and sad.

In happier news, last night we had a Thanksgiving potluck at our place. In case you thought med students couldn't cook, here's a list of our spread (all homemade):

Dinner items:

• poutine with mushroom gravy
• stuffed mushrooms
• potato latkes and apple sauce
• sweet potato fries
• spicy stuffed sweet potatoes
• purple mashed potatoes
• some cranberry-whipped cream-gelatin floating concoction
• veggie loaf "brisket" with veggies
• roast broccoli
• roast green beans with crispy onions and almonds
• sausage, bean, kale, and sweet potato soup
• salad with walnuts and cranberries
• dinner rolls
• naan

Dessert items:

• pumpkin and apple pies
• apple crisp (two versions)
• rhubarb crisp
• baklava

Med school reading list

In better news, I've lately been talking to lots of people about lots of great books to read related to medicine and health care. (Mostly, people suggesting books to me.) I've started to compile a list:

• David Ansell, County: Life, Death, and Politics at Chicago's Public Hospital
• Rita Charon
• Jerome Groopman, How Doctors Think
• Tracy Kidder, Mountains Beyond Mountains
• Perri Klass
• Bernard Lown, The Lost Art of Healing
• Danielle Ofri
• Oliver Sacks, The Man Who Mistook His Wife for a Hat
• Samuel Shem, House of God and Mount Misery
• Rebecca Skloot, The Immortal Life of Henrietta Lacks
• Abraham Verghese, Cutting for Stone

What are your favorite books about medicine and health care? Please comment below!

Riled up

Lecture today by a doctor who quit family practice to become an integrative medicine consultant, working independently with patients to help them develop holistic approaches to illness. For example, treating a patient with irritable bowel syndrome not only with meds but also with nutrition and counseling. She emphasized the importance of taking a good history and developing rapport with the patient.

I mean, duh. We're totally on her side. (We are. We're only second years. We've been hearing about this from every clinical skills professor.) This physician was the first to admit that she left family practice because she was sick of seeing a new patient every 10-15 minutes and prefers taking up to three hours with each patient. So why, instead of putting a hand on our shoulders and looking forward to our careers with us, helping us to problem solve around the constraints of time and money that will be placed upon us, did she get preachy with us, implying that we'll want to treat diseases not people?

The real question is, "How do good people become bad doctors?" I see the problem in a healthcare system that reimburses physicians for prescribing rather than counseling, where income depends on volume rather than quality.

It turns out that this physician exclusively sees patients who pay out of pocket. For those of us who don't plan on that career path, what can we do?

Come for the policy, stay for the food

Over the past year, I've had a great experience getting involved with Students for a National Health Program, a national and on-campus advocacy group. The organization's long-term goal is to reform health care financing in favor of a single, public insurance offering for all Americans (the "single payer" movement). Its short-term goal is to increase grassroots support among physicians and health professional students (see www.pnhp.org).

One thing I've learned in this experience is that a tight social bond around an issue can provide much of the ongoing impetus to keep pushing the work forward. As a group, we keep each other on task; more than that, I actually look forward to our meetings. Without this group of friends I would lose the reassurance that I have peers who are interested in the same broader questions as I am. As one friend said tonight, “I don’t want to be forcing single payer down people’s throats, I want to be having intellectual discussions with my classmates.”

Comparing this project to so many other ideas that I've had, started to work on, and then deprioritized, it's not the passion that I lacked, it was the social support.

Tonight we had a big potluck dinner and discussion. The food was great, the conversation even better -- I even had one of those "out of med school moments."

Potato latkes: You can use any online simple recipe, with a couple of simple tips. After grating the potato and onion together, fold them into a large kitchen cloth and wring out as much water as possible. Then toss with other ingredients (you can use flour instead of matzoh meal). Fry at high heat and don't be afraid of oil!

Apple sauce: Wash and core apples. In a large pot with a lid, add the apples, about half a cup of water, and cinnamon to taste (or one cinnamon stick if you have them). Leaving the lid on, cook over medium-low heat for about half an hour, until the apples are completely soft and falling off the skins. Stir occasionally and add more water as needed to prevent apples from sticking. At the end, use an immersion or regular blender to puree the skins. 

Cold-weather vegetarian

To continue the theme of beautiful vegetables, last week I bought some baby eggplants and large cherry tomatoes, which have been almost too beautiful too cook. Before putting them under the knife, I took some still life shots.

Like brussels sprouts, roasted tomatoes and eggplant can be made to feel hearty, satisfying that wintry desire for heavy food, without the meat. I roasted these veggies with garlic: the fragrance filled my apartment, and a taste on the spoon revealed tangy, naturally sweet-and-sour tomatoes that melted and coated the eggplant.

Roasted tomatoes and eggplant:

• several baby or japanese eggplants, sliced in half; or one large eggplant sliced about 1-cm thick
• cherry or regular tomatoes, sliced in half
• several garlic cloves, skins on
• olive oil
• salt and pepper
• couscous or pasta
• feta or goat cheese and/or fresh herbs as garnish

Preheat the oven to 325 or 350 degrees. In a large baking dish, toss the eggplant, tomatoes, and garlic with the olive oil, salt, and pepper. Roast 30-45 minutes, tossing occasionally and checking frequently to make sure the tomatoes don't burn. You may want to turn down the heat if you find the tomatoes are cooking faster than the eggplant. 

Serve on top of couscous or tossed with pasta. You may want to add crumbled feta or goat cheese and fresh herbs such as mint, cilantro, or basil for additional flavor.

Vegetables begging to be cooked

How to get yourself to eat vegetables as it gets colder, when all you want are heavy starches and broths?

Why not start with vegetables that are so beautiful they're just begging to be brought home?

Here in upstate New York we are blessed with beautiful farmer's markets; the Troy farmer's market even goes indoors in the winter so as to be open year-round! Last weekend I found brussels sprouts on the stalk, green tinged with purple. In the same family are white or purple cauliflower, kale, and then there are squash of many shapes and colors.

Easy stir-fried brussels sprouts with mushrooms:

• handful of brussels sprouts, sliced in half lengthwise
• handful of mushrooms, thinly sliced
• 2 cloves of garlic, thinly slices
• 1 tablespoon olive oil

Heat olive oil in a frying pan at high heat, then add garlic and cook for a moment until fragrant, then add brussels sprouts and mushrooms, stirring the whole time. Throw in a quarter-cup of water. Cook until the water has evaporated and sprouts are just soft enough to eat but not mushy. Season with salt and pepper.

Privilege

I've probably said this before, but it's amazing what people will tell us just because we're going to be doctors. The trust that complete strangers put in us makes me want to do good.

Today at lunch a guest speaker shared her experience as a survivor of a gang rape that occurred ten years ago to the date, on campus during her freshman year of college. She was emotional in front of us, but even without her emotion her words were enough to make us emotional. She told us that because we were future health professionals and could handle "the gory details," she would tell us the parts of the story that she leaves out for college audiences.

People like her, and we are privileged to hear from them all the time (substance abusers in recovery on Monday, stage IV cancer patient last month), subject themselves to telling their story again, publicly, because they believe in us. They believe that by sharing, they will make us better physicians and better able to help others like them.

The next step? As a physician told us yesterday, "You're only allowed to ask the patient a question if you're going to do something with the answer." It's not knowing for knowing's sake, but knowing in order to provide better care.

Doctoring is harder than I thought

Last night I saw a few patients at Dr. Bob's student-run free care clinic that takes place Wednesday nights. Every time I get a little bit better at one thing, it just gets harder: for instance, I've figured out how to fill a syringe and deliver an injection at the proper 90-degree angle, but then I realize that I've done none of the hard work to coo at and calm down the screaming toddler receiving the shot. Or, I've learned to read a blood test and identify iron-deficiency anemia, and I even flexed my "depression screening-stress counseling" skills for the first time, but then I realize that I did nothing to determine the underlying cause of the patient's anemia or counsel her as to prevention. In a chart it notes that a teenage girl had a negative pregnancy test a few weeks back: do I assume the provider at the time counseled her as to birth control and safe sex, do I take that on myself, or do I schedule a follow-up for more counseling?

Thus my feelings at the end of a clinic night are ambiguous or mixed: pride is followed by awareness of gaps and subsequent disappointment in myself. Do I end the night feeling optimistic or downtrodden? This is where I'm grateful to the residents and attendings, who witness the night and are our immediate role models. Their support and encouragement comes when it's most needed: it's okay, they say, and I should feel good about it.

You know what does get easier each time? Chicken soup. That universally makes me feel good. This time I tried an ultra-simple recipe: 1 whole chicken, 2 celery sticks, halved; 2 carrot sticks, halved; half an onion, 1 turnip, chopped; salt and pepper. Boil all together for 90 minutes, then serve with chopped celery, carrot, and onion, cooked in the soup for about half an hour, and rice, cooked separately.

Marks of the trade

In any sub-culture or field, there are codes that people use to identify with each other. As a second-year med students (the sophomores of med school), I feel on the cusp of cool -- we're beginning to learn clinical stuff (as opposed to those poor first-years mired in basic science), we think we've figured out med school, and yet we're still stuck in the library instead of on the floors, in the academic rather than clinical years of med school.

So to make myself feel cooler--and for efficiency as the workload has increased--and because they actual make sense to me now, I've started to pick up medical abbreviations:

The causes of aseptic meningitis? HSV-2, HIV, VZV, LCM, EBV, and CMV, among others (and yes, I know what those stand for)

The write-up of a disease? Well, you have to know the Sx, Si, Dx, and Tx

Just wait: soon my handwriting will be abysmal.

Getting mad about healthcare disparities

At our school, there's a well-known CBS news clip about Dr. Bob Paeglow, who serves the Arbor Hill community in the broke part of Albany, in which the TV anchors conclude by calling Dr. Bob "a saint." Well I don't think we should call someone a saint for seeing poor patients; I think we should be outraged that not everybody is doing it.

This morning we had an introduction to rehab medicine, an important and underutilized field of medicine helping some of the most disadvantaged and underserved patients out there, the impaired and disabled. The lecture was great and highlighted physical limitations that health care providers often overlook. If anticipated, these limitations can be addressed and mitigated, sparing a patient with a disease from experiencing impairment or disability. The problem is that many of these interventions require drastic changes to the patient's environment (house renovations, special vans, etc.), which cost money and are often not covered by insurance. Such changes have been known to bankrupt even the insured.

In contrast, at lunch I attended a guest lecture by an alumnus whose practice is situated in a homeless shelter in San Antonio, Texas. Ninety percent of her patients are uninsured (and Texas has rejected a Medicaid expansion) -- as a result, she described with pride learning to manage chronically ill patients on the bare minimum.

Why do we spend so much time learning about ideal healthcare when most people--and yes, I need some stats here--don't have access to the ideal?

Courtesy Physicians for a National Health Plan, www.pnhp.org

Possibilities

This morning I volunteered at a flu clinic targeting Albany's refugee community, families from Bhutan and Nepal, Thailand, Iraq, and Africa, among others. The clinic came about a joint effort between Koinonia Primary Care, Albany's Refugee Health Round Table, and SUNY's School of Public Health. Koinonia is a family medicine clinic and federally qualified community health center serving the Arbor Hill community; most of their patients are African American and religious Christians, although they are open to all and serve some refugees as well. For this event, there was a specific drive to reach a different community, including Muslim families.

Accordingly, the student groups who volunteered for the flu clinic came from three campus clubs: Care from the Start, where students see patients at Koinonia; IMANA, which runs clinics at a mosque; and AMCRI, which works with the refugee families directly. We learned to fill syringes with vaccine and give shots, while downstairs, interpreters welcomed families and explained paperwork. Dr. Bob of Koinonia supervised but once we got running, we ran entirely independently, even training the next group on our own.

So what if we had a student-run clinic every Saturday, built out of the three clubs whose efforts currently run in parallel? Imagine the possibilities...

Then I came home to a quick lunch of cold sesame noodles, all components made ahead of time and just in need of assembly. A lunch produced through cultural exchange:

I am reblogging* this recipe from here, which was adapted from Fuchsia Dunlop's cookbook Land of Plenty, which translates Chinese recipes for American home cooks. Think of it as a recipe that has traveled a long way to your computer screen.

(*I used the condiments that I happened to have at home, and thinly sliced cucumbers instead of the other veggies.)

Problems as patients

A question I am frequently asked by my younger brother is, "So when did you become such a nerd?" My latest answer to this question would be, "When I started using Harrison's Principles of Internal Medicine."

Our deans have told us to start thinking of classroom medicine in terms of patient presentation, and vice-versa, using patients we meet as opportunities to study diseases in greater and more memorable depth. While I didn't take their advice at the time, it must have sunk in. Second year is about disease, which presents in people -- it is relevant to turn not just to First Aid for the boards but to Harrison's tome of the natural history of disease. After meeting a real patient with gallstone pancreatitis this week, I looked up "gallstones" and "pancreatitis" to understand what causes them, how they are related, what symptoms they cause, and how they can be treated.

This morning we were shown a cartoon of an imaging study showing where Alzheimer plaques cause damage in a brain (in red):

The amazing thing is that you can connect those locations to the normal function of those parts of the brain (e.g. hippocampus and memory, parietal cortex and visual-spatial processing) and then relate them to symptoms in Alzheimer patients.

Anyway, it's starting to click, and that's cool. So, what's for dinner?

Tomato sauce in less time than it takes to boil water

Are you the kind of person who, like me, dances around the pasta pot waiting for water the boil, munching on uncooked noodles?

Sometimes I pretend that I am going to memorize flashcards during this waiting period, but instead I end up tiptoeing over to the pot every few minutes "just to check on it."

Well tonight I learned that by being extra lazy, it is possible to make a delicious fresh tomato sauce during this awkward gap between stove-lighting and pasta-box-emptying.

Whole cherry tomato sauce (two servings):

• 1/2 pint cherry tomatoes, washed
• teaspoon-ish butter
• teaspoon-ish olive oil
• 2-3 cloves garlic
• dash white wine
• few sprigs parsley
• chili flakes, black pepper, salt
• parmesan
• 1/2 pound pasta

Judges, start your timers! (Turn on your pot of pasta water.)

Heat the butter and olive oil on high heat. Peel and mince the garlic and add to the pan, cooking for a minute. Dump in your cherry tomatoes. Dash your white wine over the top. Push everything around with a wooden spoon. Stab the cherry tomatoes with a fork, then smash them with your wooden spoon. Add water as needed. Cook until sauce thickens, without burning in the pan. Mince the parsley, toss in along with seasonings, and turn off the heat.

Is your water boiling yet? (Why yes, it just started to boil!)

  

Feel free to study flashcards as you wait for the pasta to cook...

Cash money

Last week at the doctor I was given a choice between two meds and without even thinking about it, the first question out of my mouth was, "is there a difference in cost?" Immediately I thought I should have asked her, instead, which she would recommend and why. Although I am 26, this is the first time I'm paying for my own health insurance and the first time that I'm acutely aware of being a poor student. Perhaps I'm being overly cheap, but I now consider whether a doctor's visit will be billed as an annual physical (free) or not ($20 co-pay) and make decisions accordingly.

When was the first time you became aware of the cost of healthcare? When did it first begin to influence your decisions?

Friday night in med school

Study hall

Vegan interlude

Walking down the hospital halls after neuro, every twitch, twist of the neck, or odd posture appears a nail to my hammer. Neuro lectures are captivating but depressing, largely because right now we can treat only the symptoms but not the underlying cause of several diseases. However, everything we can treat is breathtaking, and soon we will have cures for more diseases! (Hopefully.)

In the land of food, it seems that fall in upstate New York is an excuse for spice-themed binge eating: s'mores to "reward" hiking, cider doughnuts to "reward" apple picking, apple and pumpkin desserts, etc. In between all this sugary indulgence, it's nice to have a few items that are hearty and comforting but healthy! Last weekend I made a kitchen-sink vegetable soup; this week I went the raw route.

"Massaged" kale salad (I don't believe in pampering vegetables, but the brief effort here pays off. Recipe took all of two minutes!)

• 1/2 bunch dino kale, stems removed, sliced crosswise into ribbons, and washed
• 1/2 or 1 avocado, cubed
• handful of cherry tomatoes, washed and sliced in half
• small handful of almonds, toasted and chopped
• balsamic vinegar
• olive oil
• pinch of salt (apparently this helps to soften the kale)

In a large bowl, dress the kale with oil, vinegar, and salt. Wash your hands and then massage the kale, grabbing handfuls at a time and rubbing them together between your fingers or palms. (Surprisingly therapeutic!) After a minute or two, the kale will be noticeably softer. Toss in your other ingredients! The buttery, nutty avocado makes this quite comforting despite the lack of cheese or bread.

Two neuro patients

Today we had two guest patients, one each for lectures on Parkinson disease and cerebellar ataxia, a disease of severely uncoordinated movement. Both patients had been first diagnosed in his/her early forties and had to adjust from a normal adult life to one of increasing disability. The second patient, a man with cerebellar ataxia, continues to golf several times a week even though he walks with a cane and suffers from slurred speech. He told us that he heard that Michael J. Fox still golfs, "and he's worse than me!" I was struck by the importance of role models.

Both patients were cheerful and good-humored, but what I really admired about them was their willingness to make themselves vulnerable for the purpose of teaching. Our lecturer, a neurologist, began by conducting a neuro exam on his patient with Parkinson's in front of the class: she did very well. He then used a small handheld machine to turn off her deep brain stimulator (magic!) and repeated the exam a few minutes later: this time, the patient was shaky and uncoordinated, clearly uncomfortable and dangerously unstable on her feet. Finally, the doctor turned the deep brain stimulator back on and the patient returned to what appeared to be a very normal, non-Parkinsonian state.

The immediate effect of the deep brain stimulation was awing; more than that, my visceral fear that the machine would not turn back on, leaving our guest in her more severe form of disability, gave me a glimpse of how anxious a patient must feel when a drug starts to wear off or stop working. How precarious to be dependent on modern medicine: a semblance of health can so quickly fade away.

Unexpected bit of light

I just went to see the doctor (nurse practitioner, actually) and she made me feel so much better just by talking to me and coming up with a plan. It's good to be reminded that at the end of all of this health providers can make people feel better! I do forget!

Getting into jazz as my uncle is falling out of it

I have always liked jazz: it reminds me of Saturday mornings and the Disney movie "101 Dalmatians." Certain songs by Miles Davis and John Coltrane take me straight back to my parents' kitchen, where those musicians have been on rotation for the past 20 years. But recently, as I have been studying more and have introduced music into my study routine, listening to music for many more hours a day than ever before, I have branched out, delving further into jazz... Nothing particularly creative, mostly artists I have heard at home, Christian McBride and Wynton Marsalis, Charles Mingus and Thelonius Monk.

Browsing my online music library reminds me of the cats my cousin grew up with, Mingus and Mojo, who were cared for so lovingly by his dad. My uncle was once a jazz musician and music teacher who loved to talk about jazz, although these were conversations I would eavesdrop in on rather than join. I could never keep up and never had much of an interest.

It's a bit sad and strange, then, that I should just now be getting into jazz as my uncle is losing his memory and his ability to talk about music in the way he once did. I have never met anyone more passionate about the subject.

Food as comfort, jazz as comfort...

Transformations II

The other night a friend from home asked me what we're studying these days. "Blood disorders--like bleeding and clotting--and leukemia and lymphoma," I replied. "Blood clots--ew!" was his response.

His reaction reminded me that not too long ago I couldn't have a conversation about a blood clot without feeling sick and faint. And yet without realizing it I've completely changed. We've zoomed in on clots, so that I now think about how you build a clot and how you take one down, almost as if it's construction work. What are the heritable or acquired diseases or drug interactions that impact clotting and bleeding? There's so much more than "clot--gross!" Thank goodness.

For many years I thought eggplant was gross. I didn't like the flavor, texture, or anything about it. Now I love how it's soft and meaty--a great vegetarian substitute!

Barley salad with fall vegetables:

• 1/2-3/4 cup barley, cooked in a rice cooker with 2:1 water:barley
• 6 chard or kale leaves, steamed and chopped
• 1/2 or 1 slice small eggplant, sliced 1-cm thick and roasted in the oven (I used leftovers from this sandwich that I did end up having time to make)
• few cherry tomatoes, sliced small
• feta cheese to taste
• olive oil to taste, about 1 teaspoon

Cook ingredients separately and toss together with olive oil. Enjoy warm or cold!

 

Neither of you scare me now!

Fried green tomatoes

Even I sometimes run out of time to cook. But this doesn't mean that I'm not still thinking about food, that the green tomatoes my friend and editor gave me aren't calling out to me from the fridge. I had some great plans for these beautiful tomatoes before it struck me just how little I knew about chemotherapy for leukemia and lymphoma.

Here is what I would be cooking if I were cooking.

Fried green tomatoes:

• green tomatoes
• 1 egg
• flour
• breadcrumbs
• canola or olive oil
• salt and/or parmesan

Arrange three shallow bowls or plates side by side: flour, then egg, then breadcrumbs. Slice large tomatoes into 1-cm slices or cherry tomatoes in half. Dip in flour, then a beaten egg, then breadcrumbs. Heat a generous layer of canola or olive oil in a large frying pan; when hot, lay the tomatoes out side by side in the oil. Fry at high heat until crisp on one side, then flip over (using two forks) and fry the other side. Cool on a paper bag or paper towels. Sprinkle with salt or parmesan cheese and serve right away. I'm salivating just thinking about it.

Roasted eggplant sandwiches:

• 1 small eggplant
• 1 tomato
• feta cheese
• bread or pita
• olive oil, salt, pepper

Slice the eggplant and tomato 1-cm thick. Place the eggplant slices side-by-side on a baking sheet and brush with olive oil, salt, and pepper. Bake at 400 degrees for 5-15 minutes, until soft or crispy (as you like it) but not burned. More oil = crispier eggplant. Toast your slices of bread and create a stack of eggplant-feta-tomato slices. Drizzle with olive oil if you're feeling really luxurious. Ah, the combination of textures and sweet-and-sour flavors, mm!

I did toss these into a quick stir-fry -- and yum!

Tricks for when you run out of time to cook: keep frozen soups, chili, ravioli, even prepped veggies in the freezer. Try stir-fries. Stock your fridge with snackable fruits and veggies and proteins such as yogurt and cottage cheese. Hunker down. But you know all this!

Fall is the best!

Today is one of those stunning fall days, with a clear blue sky, chill in the air, and trees ranging from green to yellow to red. After a gorgeous bike ride through a nearby neighborhood, my housemate and I stopped at a happening farmer's market that reminded us of former days in Brooklyn and Seattle. We indulged this feeling with freshly fried hot, greasy, soft cider doughnuts (perhaps the best I've ever had, not hard and cakey at all), tiny end-of-season strawberries, and a start-of-season potato pancake with applesauce. Top notch.

All this to forget the squirrel seen investigating the mouse traps in our kitchen at 9 am today.

I've been trying to buy even fewer processed foods, and learn to make what I can quickly at home. I figure it's far cheaper and often better this way. Thus the homemade bread, and today I decided to finally try granola. As I made this today, I realized that it's perfect for someone like me who loves to bake, but holds back in favor of more practical cooking. The process of measuring and stirring is about the same.

Homemade granola

• 1.5 cups oats
• 1/4-1/2 cup chopped nuts
• 1/4-1/2 cup seeds (flax, sesame, pumpkin, etc.)
• 2 tablespoons honey, maple syrup, brown sugar, etc. (this makes for a fairly-unsweet granola)
• 2 tablespoons canola oil, melted butter, coconut butter, etc.
• 1 teaspoon vanilla
• 1 teaspoon cinnamon or other spice
• 1/2 teaspoon salt
• 1/4-1/2 cup raisins or chopped dried fruit

Mix everything except fruit together in a large bowl, first dry then wet ingredients. Spread thin on a baking sheet and bake at 300 degrees until golden, stirring about every 10 minutes, about half an hour. Granola will harden as it cools. Mix in dried fruit at the end.

Scattered thoughts

I had lunch with a friend today, who has moved on to her intern year, and we talked about the sense of disorientation we sometimes have that we're actually doing this. Studying to be (or practicing as) doctors, that is. For her, it's the power to order tests and make diagnoses and prescribe, and the thrill of having her own patients. I sometimes wake up and wonder what I'm doing here, how I ended up in my small green bedroom in Albany, New York, going to med school. My friend said that for the first few months, she would forget that her patients were not standardized patients (paid actors pretending to be patients as part of medical school training); I had a similar thought with a stage IV cancer patient who came to speak to our class earlier this week. On the one hand, kudos to our standardized patients for being so believable; on the other hand, why is it that we're forgetting that real people come to us with problems? Their lives revolve around them, and we are there to help -- their lives do not revolve around us.

I suspect it's because we're so busy all the time, with hardly a moment to stop and think. We lose track of where we are and what we're doing and why. Real patients pull us out of ourselves too quickly for us to adjust; it is hard to give another person your full attention when you are stressed.

The solution, for her, was to come back from two weeks of vacation to emails from her real patients awaiting their doctor's response. Real patients, real problems without pause.

Meanwhile, baking bread. Is it real or an olfactory hallucination?

Blog-worthy fall salad

My farm share arrived today, and rather than let the veggies rot at the bottom of my fridge, I decided to chop and wash them all now. Not a bad antidote to learning about leukemia and lymphoma all day: it's all very interesting, until you fall asleep wondering what it would be like to receive such a diagnosis.

Fall harvest salad:

• 2-3 small beets, washed and sliced thin (see use for beet greens below)
• 1 small sweet potato, washed and sliced thin
• thyme, rosemary, or other herb
• handful of toasted almonds or walnuts
• salad greens (farm share gave me frisee and lettuce)
• olive oil, salt, pepper, balsamic vinegar
• garlic or shallot optional

Toss the beets and sweet potato with olive oil, thyme, salt, and pepper in a roasting pan, then roast at 400 degrees until soft with crisped edges (move them around a few times to prevent burning).

Meanwhile, wash greens (three times, if yours have as much dirt as mine!) and toast nuts. Making a salad dressing of olive oil, balsamic, plus garlic or shallot is optional.

Serve everything warm over the greens. Add goat cheese or lentils or chicken breast or sausage, etc. for protein! I will be having a white bean soup with beet greens (from above) on the side.

Familiar flavors

Since my grandmother died this summer, my dad has continued undeterred to imitate her voice. It's freaky to hear that strong Brooklyn accent now that she's gone.

I can't imitate voices, but I do have a knack for imitating flavors, whether or not I set out with the intention. It's comforting to work your way through a recipe (off-book or on-book) and end up with a flavor that is almost shockingly familiar.

This week it was turkey chili, cooked from habit, without a single thought or creative decision, that tastes exactly like dinner at home. What a way to hit the first of fall and mitigate the stress of lymph-heme. A couple of weeks ago, it was a Jewish apple cake from Smitten Kitchen. If Deb's mom didn't read the same recipe as my grandmother, then I don't know what. Could the same mutation have arisen independently twice?

Can we apply this to our patients? Is there anything we can do to offer a degree of familiarity and comfort in an otherwise foreign and scary situation? A story, a familiar word of advice, something cultural we share?

Embryological development of an apple cake

So as not to feel alone

My favorite med school activities are potluck dinners and running with friends. Most of the time, I don't actively study with other people -- passively alongside, at best. Recently there has been a lot of reading, a lot of studying alone, a lot of yoga, a lot of cooking and eating alone -- time in my own head.

The appeal of stupid websites such as What Should We Call Med School and Facebook and The Onion, all of which I frequent more -- or only, really -- as a test approaches, is that they remind me that there are other people who are going through what I'm going through.

Anyway, I found this clip of Louis C.K. charming.

Schadenfreude

After 10-hour library days and piles of new material, we don't want to hear about people having fun. We want to hear about people suffering. Last Saturday night, my housemates and I were regaled with stories of third years' surgery rotations: five a.m. call, days spent dodging residents and falling asleep standing up, watching surgeries well past lunch, jumping at pimp questions, hiding in the library. Tales of suffering and hijinks, with a subtext of, "aren't we hardcore?"

Other things that make us feel better are listening to first years struggle through the monotony of molecular and cellular biology (wouldn't you rather be studying patient care than tyrosine kinases?) and imagining those first years who complained, "I studied too much -- the test was easy" in our sorry shoes next year. We'll see how they're talking then.

Fortunately, we have a couple of clinical years after boards to bring us back to the proper levels of empathy that everyone wants in their physician. To reintroduce us to society, if you will.

Colors

I'll confess that I had a Luna bar and Goldfish for dinner Tuesday night, and some homemade hummus with sliced tomato and pita bread for dinner tonight. But besides Tuesday's fiasco (test week) and tonight's very lazy post-run pre-studying summer supper, I ate very well this week thanks to my friends. I have been cultivating them (the friends) with food for a year...

On Tuesday it was a kitchen-sink stir fry with lots of flavor: fresh basil, garlic, ginger, onion, and hot chili peppers. With some maple syrup in the sauce it tasted extremely Thai and unbelievably delicious.

Wednesday lunch was a Chinese-influenced kale-white bean-sausage soup, made with carrots, celery, and cellophane noodles. For dinner we had Indian eggplant curry with fresh peppers and tomatoes from a friend's garden. Hot, spicy, fresh -- so good!

And today I walked down the hall from the library to the hospital cafeteria to pick up my farm share! Let's see where it takes us...

Thanks, friends!

Don't stress eat!

Last night I had one of those horrible nights where bacteria- and virus-laden nonsense raced through my head as I lay in bed, in powerful mockery of my lame attempts at meditation and mind-clearing. Once an hour this was punctuated by becoming fully awake, getting up, and then laying down once again to the same as soon as my head hit the pillow.

I've been trying to do everything right, too: yoga, running, studying, dinner out, tea with a friend, reading David Sedaris stories before bed. Despite all this, the stress of having an exam every two weeks is overpowering.

So today I am allowing myself to bake a pie, make a fresh salad for lunch, and then resume studying. I will beat these pathogens!

Simple Greek salad: one chopped tomato, crumbled feta, some chickpeas, toasted almonds, romaine lettuce, oil and vinegar dressing. Each bite gives a satisfying crunch!

White girl makes fried rice

There are certain foods that I know how to make quite well, because I have made them a hundred times (tomato sauce) or because I grew up around them (turkey meatballs). Then there are foods that I see the people around me making, and it's fun to try them too (noodle soup).

My housemate makes a healthy version of fried rice for breakfast/lunch all the time. On Monday, another friend, Xin, brought a delicious homemade pork-and-veggie fried rice over for dinner. I like watching people cook dishes that are familiar to them because you can observe their comfort with the ingredients and process.

If you make it right, it seems healthy enough, so I figured I'd try my hand at it.

Zucchini fried rice (for one):

• (1/2 cup dry) cooked brown rice
• 1/2 cup zucchini, in 1-cm pieces
• 1/4 cup hard tofu, in 1-cm pieces
• 2 medium garlic cloves, chopped
• 1 tablespoon fresh ginger, chopped
• 4 scallions, white and light green parts, chopped
• 1 egg
• 1 teaspoon each canola oil and soy sauce

Heat canola oil in a frying pan on high heat. Add ginger and garlic and cook for a minute. Add rice, stirring, then white parts of scallion. After a minute, add the zucchini, tofu, and green parts of scallion. Clear a portion of your frying pan (or use a separate pan) and scramble the egg directly into the pan; once cooked, stir it into the rest of your rice.* Add soy sauce to taste, stir, then cook for a minute longer until crispy to your liking.

Did I get it right? It certainly tastes pretty good.

*Thanks to Xin for this correction to my procedure! She pointed out that the egg should be scrambled separately and then added, not mixed in wet with the rice.

Juggling

For 24 years I lived in Cambridge, Mass. with or near my parents. I was in high school when my maternal grandfather died, and I remember when my mom and brother met me at a dress rehearsal one evening to share the bad news. I was a few blocks away, living at Harvard summer school, when my dad was briefly hospitalized with an ulcer. I lived just one zip code over when my brother was hit by a motorbike and came home early from studying abroad; I was able to greet him with a basket of handpicked goodies from Shaw’s when he finally arrived.

To avoid sounding too morbid, I was often home for happy events too: every family birthday, crew meets, dinners, dirty laundry and snowstorms.

So of course it feels weird to be away, ensconced in medical school, when things have been happening at home. First one grandparent was dying; as soon as that ended, the other one seems to have started dying with hardly a break between. I would like to be there for my dad in a more substantive way than a phone call every few days.

Juggling independence with a connection to home is a regular part of growing up, hardly unique to med school. But for us who are to be managing the illnesses and deaths of other people’s loved ones, it seems invaluable to participate in the illnesses and deaths of our own loved ones. We are missing out not only on important family time, but experiences that would make us better physicians.

Some of my earliest memories are sitting on the counter top next to my dad while he cooked. Now when I’m home, we cook side by side. Last weekend I went home and fried up these zucchini flowers for the whole family.

Fried zucchini flowers:

• fresh zucchini or squash blossoms (best and easiest to find if picked directly from the garden)
• breadcrumbs
• one egg, beaten
• canola or olive oil
• salt

Trim the flowers: snap off their stems and any small green spikes near the base. In a large bowl, toss the flowers in the beaten egg. Cover a plate in breadcrumbs and coat each flower in breadcrumbs. Heat about half a centimeter of oil in a frying pan; test the heat by dropping in a breadcrumb—it should sizzle immediately. Lay the flowers one by one into the frying pan; when golden brown on the bottom, turn each flower over using tongs or two forks. Cook until the other side is golden brown. Take out of the frying pan and cool on paper towels or a paper bag. Sprinkle salt over the flowers and eat immediately.

Fresh from the garden.


Hot and ready to eat!

Thanks to my friend Anna for her gorgeous garden bounty!

Transformations

Sometimes I hear a joke that's just too good, that makes me want to run and repeat it to the people I love. But then I can't because I realize that it doesn't make any sense out of the context in which I heard it.

I heard a joke this week, from a classmate: non-steroidal anti-inflammatory drugs (Advil, aspirin) work to prevent inflammation by inhibiting enzymes called COX1 and COX2, which produce molecules that cause fever, swelling, and pain. So instead of calling this class of drugs NSAIDS, why aren't they called COX blockers?

Anyway.

This is just one tiny way in which med school transforms us from the people we were into the people we are going to be. I would expect the same from any good job or school or intense experience.

"But I can't swim!"

Last night my housemate dreamed that she missed the pathology exam; she was told that she had to take the make-up exam under water. "But I can't swim!" she realized. Our kindly pulmonologist-dean swam down and offered her oxygen, then rescued her and told her she could take the exam in his office.

We are drowning.

I woke up to pouring rain, which was lovely and much-needed and caused me to sleep through my alarm. Followed by a drenched walk to school to record this morning's lecture. Of AV (those students among us who record lectures so the rest can watch from home), I thought:

"Neither snow nor rain nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds."

Love the rain! Here's to more studying.

Peptic ulcer, obviously

Whereas this is obviously a shocked small bowel, duh

The Hebrew school paradigm

I was always a good student in elementary school, going so far as to do extra chores around the classroom in fourth grade to rack up "good checks" with my teacher. But in Hebrew school, I was something different. I would sit in the back row and skip the homework, struggling to answer questions about Hebrew vocab when called on. I wasn't proud of this behavior, but it could be fun.

This experience helps me to understand our collective approach to our evidence-based medicine and health-care-in-society classes. As a professor recently told us, we are all gunners, that's why we're in medical school. So it's a bit of a relief when the entire class bands together to do the best we can to give the least effort possible during a few of our required non-science classes. The computer screens below me display Facebook, League of Legends, golf videos, newspaper articles, and the occasional academic slide. Certainly nothing to brag about, but also a sign of collective de-stressing.

Thank goodness my former self can't see me now.

"Med student syndrome"

Speaking of model patients, sometimes I feel like a walking textbook. Amidst lectures about acute and chronic inflammation and healing, I have a banged up ankle, two banged up toes, and a cankle due to an hypersensitive reaction to a bee sting. With class and homework as reminders, the temptation to obsess over every bump and bruise is irresistible!

White coat ceremony 2.0

A friend and I both noticed that since the first years arrived, the second years have been much nicer to each other. In their hesitant and formal speech, clean-cut appearance, and in the packs they move in so as not to get lost, we see how far we have come. It sounds corny, but a hike with friends on Saturday marked the one-year anniversary of the hike we did together before starting orientation. As a result, there are more high fives, more big hellos, more hallway chats. It's what I imagine moving to the midwest would be like.

This afternoon, we "coated" the first years. Here's what I wrote about the ceremony last year:

The white coat ceremony was lovely: second years each gave us our coats and helped to put them on, then sat next to us for the rest of the hour. It was sweet, caring (I felt cared for, at least): the introduction of a mentor, someone who wants me to succeed. And also for a moment I had a flash of myself doing this next year for someone else: proof that I can succeed Year One. In my pocket were three chocolates placed there by my peer.

After each first year received their white coat from a second year, both classes stood and recited the Hippocratic Oath. It seemed appropriate to have this reminder 1) at a time when it's not such a blur and 2) when we're feeling confident and no longer on our toes.

On their best behavior!

(Photo courtesy of Phyllis Ying)

Summer non-cooking

In the summer, even I don't feel like cooking. I'd rather be outside. I'd rather eat raw, fresh food. My appetite is diminished. Etc.

However, too much of this attitude and I wind up eating yogurt, berries, granola bars, and grilled cheese for meal after meal. Enough is enough!

Fortunately, summer dishes can be mostly raw and therefore take less time to cook. Simply toss a few things together, or pour one thing over another thing.

For instance:

• 10-minute pickles that will last a week (I halved the recipe for 1 large cucumber and 1 small head of celery from this week's farm share)
• cold soba noodles and stir-fried Chinese greens with garlic
• tossed summer grain-and-corn salad

Cold soba noodles: boil the noodles as directed, then drain and immediately run under cold water until cool. Toss with a little bit of soy sauce, ponzu, and scallions. Enjoy with tofu or greens or as is.

Stir-fried Chinese greens with garlic: wash and chop greens into large pieces. Peel a few garlic cloves and leave whole. In a large frying pan or wok, heat about a tablespoon of canola oil until very hot (test with a drop of water or a piece of garlic), then add garlic. Cook for a minute, then turn off the heat and add the greens (if you don't turn off the heat, sometimes the whole thing will catch fire). Turn the heat back on and cook for a minute on high. Season with salt if you're feeling indulgent (or just went running!).

Summer salad: toss together the following ingredients.

• any grain, cooked al dente (I used some cool-looking black forbidden rice)
• 1 ear of corn, steamed and de-kerneled
• handful of chopped cilantro and scallion
• half an avocado, cut into small pieces
• handful of cherry tomatoes, sliced in half
• lemon juice
• red pepper flakes

Happy Swiss Independence Day!

Today I studied pharmacology (think Geneva-based pharmaceutical industry), ran some hills with the housemate, and finished the day off with a homemade potato-and-green-onion soup (using CSA ingredients! the most flavorful potatoes of recent memory) topped off with Gruyere cheese and black pepper, followed by cherries for dessert.

Potato leek soup (vaguely following what I remember from a Julia Child recipe):

• 5 small potatoes
• 1 leek or 2 green onions
• water or chicken stock
• sour cream, regular cream, whole milk, or Greek yogurt
• salt and pepper

Peel the potatoes; chop both leeks and potatoes into large pieces. Boil in just enough water or stock to cover the vegetables until potatoes are soft enough to mash with a fork. Puree using an immersion blender or food processor. Add cream, salt, and pepper to taste. Not exactly a summer dish, but do I have any say over when my CSA delivers me potatoes? At least it has been threatening rain all day.

Model patients

Last year, my grandmother, who was 83 and dying of everything, was my model patient for each theme. In the order of molecular biology, musculoskeletal, nervous system, cardiovascular, respiratory and renal, endocrine systems, and microbiology, she had or had had a melanoma, osteoporosis; hypertension, atrial fibrillation and blood clots; emphysema, renal failure requiring dialysis, hypothyroidism, and C dif. The hypothyroidism she actually did not acquire until the month we began the theme. It was not, as one might expect, that she made me feel sad about each disease as we learned about it; rather, I had to check my enthusiasm when finding connections between her experience and my daily lectures. She was kind enough to humor my enthusiasm without taking offense. She was also one of the few people who cared about me enough to listen to me ramble about med school on my cell phone while walking home from class.

She died over the summer; I was away, it was time, we were prepared. For those reasons and others I felt sad but not distraught.

Today, as I began to study a heap of pharmacology flashcards, drugs for COPD came up time and again, and each time I thought of my grandmother, and whether she had ever taken them, and what side effects she had (and what drug interactions!).

My grandmother's favorite peanut butter cookies:

• 1 cup natural peanut butter
• 1 cup sugar
• 1 tsp baking soda
• 1 egg

Preheat oven to 350 degrees. Beat together peanut butter and sugar, then egg, then baking soda. Roll into 1" balls and place 1" apart on a baking sheet. Flatten each with a fork in a cross-hatch pattern. Bake for about 10 minutes, until crispy.

She liked these so much that she was the only person I've known to look disappointed when I arrived once with a batch of homemade chocolate chip cookies.

Pharmacology

Is it possible that our efforts could be better spent elsewhere than in memorizing every drug known to man? Is this really the highest-priority endeavor?

Eventually all of us will be specialists (I'm including primary care specialties here), where we will need to know well the subset of drugs relevant to our field... Is it nonetheless important to grasp at this broad overview now? I hope it is.

Simple veggie frittata

The first week of second year flew by, leaving me one week behind despite my good-faith efforts to keep up. No, I don't remember anything about the autonomic nervous system, but thanks for picking up where we left off last January. Last night, I showed up to a potluck empty-handed (save for a six-pack), unable to scrounge together even something simple. How embarrassing!

In an effort to stay sane, a few friends and I had an impromptu dinner a couple of nights ago. Once again spoils from the CSA ensured that we were well fed. Plus, I've now used up my zucchini for the week, which feels like an accomplishment! Onto more challenging items, like adrenergic antagonists.

Zucchini frittata with pesto (looks moderately fancy, tastes delicious, feeds many):

• 1 medium or large zucchini (or any vegetable you like)
• 1/2 red onion
• 2-3 tablespoons pesto, to taste, or a handful of chopped herbs
• 6-10 eggs (~2 eggs per person)
• 1-2 tablespoons butter and/or olive oil
• grated parmesan or other cheese, optional
• salt & pepper

Preheat the oven to 400 degrees. In a cast-iron or other oven-proof skillet on high heat, melt the butter into the olive oil. Slice or chop the onion and add to hot oil, stirring now and then. Cook until the onions are soft and translucent. Slice the zucchini into very thin rounds. Add the zucchini to the pan and saute until soft (again, softer than if you were eating the zucchini plain). Add the pesto, salt, and pepper to taste.

Beat the eggs together in a bowl. Pour over the zucchini, still on the stove at high heat. Cook without stirring for 3-5 minutes. Grate parmesan over the top and place the entire skillet in the oven. Bake for 10-15 minutes, until the eggs are set throughout the pan (slice a knife in to check that the eggs are not liquid).

Serve with a salad and/or fresh bread.

Bringing home summer

Returning to Albany was a bit of a shock. While I can't take the mountains back with me, I can perhaps recreate some edible memories. Switzerland's summer fruits are apricots, cherries, and berries. I have a particular attachment to apricots because I once worked on an apricot farm for a summer. For several weeks I picked fruit, stirred hot pots of jam, dewormed apricots for schnapps, and cut down nettles surrounding the trees with a scythe.

Apricots are abundant this time of year. These tangy fruit make for delicious sweet-and-sour desserts and jams. The fun of this tart is that it can be modified post-baking to each person's preferences for sweetness and richness. The basic tart is baked without sugar or cream, although both may be served at the end.

I've had versions with an egg custard and versions without; my Swiss friend Fiona's is without. Double the recipe for a large crowd.

Swiss apricot tart:

• 1 package puff pastry (or homemade crust)
• 1 lb apricots
• ~1 cup crushed hazelnuts, almonds, or walnuts
• sugar and unsweetened whipped cream for serving

Assemble as if you are making a pizza: on a cookie tray with short edges, spread out the puff pastry. On top, sprinkle a thin layer of crushed hazelnuts: these add some flavor and soak up the fruit juice, keeping the crust from getting soggy. Slice apricots in half, remove the pit, and arrange insides-facing-up in overlapping rows (pack in the fruit, as it shrinks while cooking). Bake at 400 degrees for 10-20 minutes until fruit is soft and crust has browned. Serve in slices like a square pizza, with sugar and whipped cream at the table. (Homemade whipped cream: simply whisk cold heavy cream in a pre-chilled bowl until stiff.)

Arranging the apricots into rows on top of crushed hazelnuts

Chef Fiona removing the finished tart from the oven

Enjoying the tart with sugar, cream, and tea. It's vacation!

The setting didn't hurt - dinner over Lake Brienz