Week off

Just to torture those of you still in school...

Since coming home it's been BLT's for breakfast, chicken club sandwiches for lunch, iced coffee throughout the day, homemade cheeseburgers for dinner, onion rings, and then this over-the-top picnic along the river:

None of this is my fault: I have not been cooking, but I have been wined and dined by the generous people around me. The chicken club was already made and waiting for me when I returned home from a run: what was I to do?

In summary: everything in moderation. Eat modestly and largely vegetarian at home, and enjoy the treats when the occasion is right.

I wonder how those bugs are doing.

Who owns organics?

If my thoughts seem a bit scattered lately, it's because learning microbiology requires a rarely-before-seen-in-me level of focus. Imagine trying to memorize all the details on this chart (which, by the way, you should check out in a more legible size here):

Source: The Cornucopia Institute

Buttermilk shakes!

Clearing out your cupboard does wonders for experimentation. I had half a pint of buttermilk to defrost, and in reading the nutrition label I discovered that one cup has 100 calories and eight grams of protein -- which puts it on par with yogurt. Being out of eggs, buttermilk pancakes were not an option. And buttermilk biscuits seemed much too unhealthy for this time of year.

So, in light of it being a hot, humid day, having just gotten back from a run, and preempting my eve-of-the-exam trip for ice cream, I decided on a milkshake. The tang of the buttermilk made for a much more complex chocolaty flavor than a regular milkshake, and allows you to control the level of sweetness. The flavor was richer than plain milk, and lighter than ice cream. I would definitely buy buttermilk just to make this again!

Chocolate buttermilk shake:

• 1 cup half-frozen buttermilk
• 1 tsp vanilla extract
• 1.5 tsp cocoa powder
• 1.5 tsp brown sugar (or maple syrup or honey or white sugar)
• chia or other seeds for fun (totally optional)
• (I'm sure this would be delicious with a banana or frozen berries -- I happened to be out)

Blend the buttermilk until it's creamy. Blend in the other ingredients. Enjoy! Now get back to work!

Unique moment in time

In the med school right now, our paths have temporarily diverged: the fourth-years are graduating, and their families are here and everybody is celebrating; the second-years are deep in the middle of national board exam studying; the third-years are continuing rounds into the summer, going about business-as-usual; and the first-years are studying for our last final, ready for two months of summer vacation -- in a pattern reminiscent of college. Everyone is very busy. But because we are all in close quarters, we are reminded of what others are doing and of the excitement, anticipation, or dread felt by those around us.

Picked up!

Last week my blog was picked up as a weekly column with the online magazine in-Training! The journal is for med students, by med students, with content from students "around the globe." How cool is that?

Check out my column and get the pulse on med school from other student writers here!

And welcome, new readers!

Deep thoughts on little critters

Once again, it was on day four or five of mapping out microorganisms onto a giant flowchart that I was struck by an idea that zoomed me out to the entire course of human history. An idea mentioned in passing on day two of lectures.

On our bodies live bacteria and viruses that we refer to as "normal flora" and with whom we happily coexist. When humans interact with a new organism for the first time, either our immune systems kill it, or it kills us. Neither of these situations benefits an organism, because by killing its host it's lost its place to live. Over time, microorganisms have evolved alongside humans so that they can reproduce in and spread human-to-human, and so that they can live in their hosts for a long time. Thus, our normal flora are creatures that don't harm us.

Except: some pathogens are normal flora organisms that have escaped from where they are supposed to live on our bodies (the surface of our skin, the inside of our gut, etc.) and found residence in tissues where they do harm us. Human influenzae type B (HiB), a bacterium for which we have a vaccine, is an example of this.

So it occurred to me that these normal flora with pathogenic capacity are probably at an evolutionary disadvantage to their normal flora compatriots without pathogenic capacity. They are slowly killing off their hosts faster and thus wiping themselves out relative to other bacteria and viruses. That means that we are studying a set of pathogenic normal flora that exist at a unique moment in history: there may have been others before that wiped themselves out; this set we have now would eventually wipe itself out if left to its own devices.

But then, we vaccinate against some of these pathogenic normal flora: this doesn't mean that we don't have HiB on our bodies anymore, only that we have it still and that it can't make us sick. So, in a way, aren't we ensuring its longevity in the population with our vaccine? (Note: not all vaccines are against normal flora. Other vaccines can essentially wipe out an organism by making sure that its only host, humans, can always kill it. Smallpox was eradicated through vaccination.)

Summer greens

Is there anything worse than attending a lecture about lifestyle balance, the need for sleep and relaxation, four days before an exam? If only I were so good at managing my need for sleep as I am anticipating my need to eat well. Priorities...

To balance out the macaroni and cheese and meatballs, I also made a large pot of collard greens to ensure some vegetable intake throughout the week. Think of these as another iron-rich, fiber-rich, cholesterol-clearing alternative to kale, which you may be getting sick of by now. I'm no expert at cooking collard greens, but these came out quite delicious.

Collard greens:

• 1 bunch collard greens, washed and sliced into ribbons horizontally (against the direction of the stem)
• 1 onion, cut into quarters and sliced lengthwise
• 4 garlic cloves, whole
• olive oil
• salt, pepper, red pepper flakes
• vinegar
• cooking wine (optional)

In a large pot, heat a few tablespoons of oil. Add the onion, garlic, and red pepper flakes, and stir until the onion is translucent. Add the collard greens (may need to add in batches until they have cooked down to make room), 1-2 cups of water, and generous splashes of vinegar and cooking wine (this was serendipitous in my case -- I added wine by mistake but it came out well). Simmer at low-medium heat for about an hour until greens are soft. Season generously with salt and pepper.

Test week, stress week

In contrast to the idealistic chatter of last weekend, my mind lately has been in a bacteria-laden fog that perks up only in reference to pathogens or vectors. These days it's fungi and caffeine that make me happiest.

There has been a lot of caffeine, and around the house, each of us has just made our favorite lazy, unhealthy comfort food: hamburger helper, ramen, and Annie's mac and cheese. We could not have planned it better had we tried.

The coolest thing I've learned lately is that we are all covered in bacteria and viruses: treat a bacterial infection with antibiotics and you risk killing off some of your "normal flora" -- which means less competition for the invasive bacteria you're trying to fight! This one is reason why hospitalized patients get bacterial infections after antibiotic treatment -- opportunists rush in to fill a vacuum, so to speak. (Word of the day: iatrogenic, illness caused by medical examination or treatment.)

However, very little of this has changed the way I eat or cook.

It's time to put a stop to this store-bought comfort food with some homemade comfort food extraordinaire, my all-time favorite home dinner: spaghetti and meatballs.

• ~1 lb ground turkey or chicken
• 1 chopped onion
• 1 egg
• 2 slices bread, soaked in milk and then crumbled into small pieces
• 1/4-1/2 cup grated parmesan or other cheese
• salt & pepper
• handful of chopped parsley, optional
• breadcrumbs for rolling
• canola oil

Wash your hands with soap and water and scrub down all cooking surfaces. Remove ingredients from the refrigerator. In a large, clean bowl, mix together the turkey, onion, egg, bread, cheese, parsley, and salt & pepper. Wearing latex gloves, roll mix into balls about 1-1.5" in diameter. Spread out breadcrumbs onto a separate plate: roll each meatball in breadcrumbs and place onto a clean plate. Wash your hands with soap and water.

Heat about 1/4" of oil in a frying pan, then fry the meatballs over medium heat about 10 minutes until cooked through and autoclaved. Use two forks or a pair of tongs to turn the meatballs every few minutes, cooking on all sides. Keep warm in the oven at 200 degrees. Serve over spaghetti with a simple tomato sauce.

 

Order in a world full of chaos.

Maybe it's the work, maybe it's the weather, but I've been cooking less

The year is wrapping up and we are emptying out our cupboards. A friend fed me tomato sauce made with dried porcini mushrooms that lasted me two nights. In my house, a mouse has been helping us with this process. The overall result is that I have been cooking less, cramming more.

As we're transitioning into second year, I wonder if my empathy is at an all-time low. After studying normal human biology for a year, pathologies suddenly seem "cool" and "exciting." It's like they're the badasses who have figured out how to break all the rules. I've spent this year learning the rules, and now I'm about to spend a year learning about how they're taken down. In contrast, I haven't yet met any patients to put a human face on pathology and bring back some of that empathy.

Well, not quite... Yesterday I met my first hospitalized patient. I was freaked out by the gowns and the degree of serious illness, overstimulated by the sounds around us, and conflicted between my desire to interview this man as I would any random person (being highly curious myself) and the need to interview him as I would a patient (as I've been trained to do in the Clinical Competency Center). The key takeaway: more practice is needed!

Crunch time

Exam week (or pre-exam week) means snack week. I take one look at a 50-slide lecture on immunoglobulins and decide I can't make it through without the proper hydration and nutritional support (malnutrition makes you more susceptible to infections, does it not?).

I've tried to get healthier with my snacking: quickly sauteed broccoli with soy sauce for salt and crunch, raw veggies or air-popped popcorn for crunch and volume, granola bars or yogurt for wholesome and filling, etc. Here is a recipe for those of you craving cheese and crackers. It requires burning a vegetable, something most of you should be able to do.

Smoky eggplant dip (recipe courtesy of my friend's 86-year old grandmother):

• 1 medium-sized eggplant, whole
• 1/2 red onion
• 1-2 tbsp olive oil
• salt & pepper
• crackers or toast for serving

In a cast iron frying pan at medium-high heat (no oil), burn the whole eggplant on all sides until the skin is blackened and pulls away from the flesh, which should be soft. (This will likely turn your pan black, so use a cast iron or some pan that you don't mind burning. Turn the eggplant every few minutes to get all sides.) Cool the eggplant, peel and discard the skin, and puree in a blender or food processor along with the olive oil, salt & pepper. Add onion to taste, still in the food processor (too much onion is easily overpowering). Enjoy on crackers.

Better keep studying: Med School Dropouts for a National Health Plan doesn't quite carry the same punch, does it?

(My brain on immunology)

Single payer for breakfast

This weekend I attended a fantastic conference by Students for a National Health Program in Chicago. Held in the Physicians for a National Health Plan (PNHP) headquarters, the conference was entirely by students, for students. I was treated to a series of lectures and workshops providing compelling evidence that a single payer system (akin to Medicare for all) would bring us closer to a more equitable, less costly system.

It makes sense that universal health insurance would provide equity by eliminating insurance as a barrier to health care. But I did not understand until this weekend how a single payer system would help stem our ballooning health care costs and fuel economic growth.

I learned that the majority of rising costs are due to administrative costs (billing, private insurance companies) rather than direct medical costs or physicians. Simplifying our payment system and reducing administrative costs to Medicare levels would provide huge savings. On the other hand, a national health plan would take the burden off of employers to provide health insurance, which has been a barrier to growth and an incentive to take business oversees (not to mention how it makes employees dependent on their employers for insurance).

At one of our advocacy trainings, it was suggested that we become relentlessly obsessed. "What did you do this weekend?" "I attended a conference on single payer." "That's very nice, but what did you eat while you were in Chicago?" "I ate single payer. Everybody in, nobody out."

For more information: http://www.pnhp.org/

A crowd pleaser

When I go for a run I feel like I travel worlds away in a time warp that seem to have lasted hours more than the run itself (a bit like Jodie Foster in Contact). I imagine that's what meditation must feel like. It's especially true in Albany these days, when the people I see while running are tending their gardens or walking their dogs or admiring the flowers in the park with their families. I think it's because as med students we get completely self-centered -- nearly 100% focused on bacteria and viruses at the moment -- and we forget that we live in a community of people doing other things.

Today on my run I saw overwhelmingly gorgeous tulips in the park -- so beautiful and so abundant that I didn't know what to do with them. I think the only thing to do in that situation is to lean in really close with a camera and take hundreds of photos that you will never print out. Makes a really nice Facebook cover photo or something.

Anyway, the tulip festival reminded me that Sunday is Mother's Day, and on Mother's Day people get together for brunch, so while I do not endorse the health benefits of this quiche, I will say that it's extremely delicious, high in protein rather than sugar, and good for sharing with a crowd (small portions!).

Homemade quiche (largely inspired by Mark Bittman's How to Cook Everything):

Crust:

• 1 stick unsalted butter, cold
• 1 cup flour
• pinch of salt
• ice water, about 1/4-1/2 cup

Cut butter into pea-sized cubes. In a large bowl, use your finger tips to combine the butter, flour, and salt into crumbs: texture should not be uniform, because it is the melting chunks of butter that will give you a flaky crust. Do not knead the dough but combine with your hands just enough so that it stays together. Add the ice water a few tablespoons at a time: just enough so that you can roll the crust up into a loose ball. Cover in plastic wrap and refrigerate 30 minutes. Meanwhile...

Filling:

• 6 eggs
• 2 cups whole milk
• pinch grated nutmeg or cayenne
• black pepper (skip the salt if you plan on using cheese or bacon)
• filling suggestions: grated cheese, chopped bacon, mushrooms, spinach, caramelized onions, tomatoes

Beat together the eggs, beat in the milk, add the seasonings. Saute any veggies on the stove (together or separately) so that they lose their water.

Using a rolling pin (or wine bottle covered in plastic wrap), roll out the dough on a floured surface and place into a pie dish. Sprinkle with veggies, then bacon, then cheese. Pour egg-milk mixture over everything.

Bake on a baking sheet (this will help cook the bottom crust) at 350 degrees for about 1 hour, until the middle no longer "jiggles" when you shake the pan. Allow time to cool: this will help solidify the filling. Serve warm (can always reheat at 200 degrees as needed).

(last spring but same idea)

So this is med school

All year I have been able to get by without flashcards, without mnemonics (I think they're silly), with a more holistic, logical approach towards learning as well as lifestyle -- plenty of time to run, eat well, and socialize. Most of the time, anyway. But this week we are getting slammed with microbiology, and it's moving rapidly -- we're already onto immunology! Just two weeks to cover hundreds of species and an entirely new vocabulary. So, I wonder, is this what second year is going to be like? All signs suggest yes.

This new level of intensity means I have to be more focused, which, paradoxically, lends itself to more distinct study breaks, as opposed to a slow, dawdling style of studying. Dinner with friends is a way to retain some humanity in these daunting times. (Am I being overly dramatic? I'm just sensing a shift in the workload and trying to make sense of it.)

Spring risotto. Good food (and ramps) bring people together.

Servings for one person:

• 4 ramps or 1 small onion, chopped
• 1/4-1/2 cup peas or other spring vegetable (such as mushrooms or spinach)
• 1/4 lb Arborio or Japanese rice
• 1/2-1 tbsp butter
• ~1 tbsp olive oil
• dash of wine (optional)
• unsalted chicken broth (optional)
• 1/4 cup parmesan
• salt and pepper

On medium heat, melt butter and olive oil in a frying pan, then add the lower half of the ramps (the white and pink parts; or all of the onion). When translucent, add the rice and stir to coat. Add water or stock 1/4 cup at a time, as needed to keep the rice from sticking to the pan, stirring constantly. At some point, add a dash or two of wine. Cook until rice is fully cooked and creamy but still chewy. Just before finishing, stir in the green ramp leaves, the peas, and parmesan, and season with salt and pepper. Drizzle each serving with olive oil and a sprinkle of cheese before serving.

A green and fibrous feast

Theme of the day: antibiotic resistance. Do not over-prescribe antibiotics! But, wow, the main culprit is not physicians but farming practices. Pump cattle full of antibiotics and it will run off into the environment. Yet another reason to avoid beef.

Instead: finally got my hands on ramps! Perks to being out in the boonies. Found a large pile of them at the Troy farmers market for $3 a bunch (that's half a bunch pictured below), still available even as the market was closing up for the day. Added a couple to a quiche yesterday and thought they made a huge difference.

To take a page out of my dad's cookbook, tonight's dinner were those eagerly-anticipated ramps, combined with English peas and spaghetti, alongside artichokes. The star of the dinner ended up being those artichokes, cooked up by my friend Travis according to his mother's recipe. (At one point we were each on the phone with our parents, asking for cooking tips.) We ate them slowly, leaf by leaf, after the pasta as a sort of drawn-out summer dessert.

Artichokes steamed with garlic:

• 1 artichoke per person (available nearly year-round at Trader Joe's)
• 1 clove of garlic per artichoke
• olive oil, salt, and pepper

Slice the stems and tops off of the artichokes so that they resemble flowers. Slice up each clove of garlic and stuff slices in between the artichoke leaves. Place the artichokes upright in a large pot (with a lid) and fill the pot with 1-2" of water. Drizzle the artichokes with olive oil and sprinkle with salt and pepper. Place the lid on the pot, bring to a boil, then lower the heat and steam for 30-45 minutes until tender.

Pasta with ramps and peas (quantities for one person):

• 1/4 box of pasta
• 1/4-1/2 cup of peas or other spring vegetable
• 4 ramps
• ~1 tsp olive oil
• parmesan and black pepper

Slice the ramps, from roots to leaves. Heat olive oil in a frying pan, then add the ramps and peas. Cook for just one minute and turn off the heat. Toss with the almost-cooked pasta and serve with parmesan and black pepper.

Take that, gut flora!

New theme, knocked off balance

The first day of microbiology feels like trying to learn a language by memorizing random words when you don't yet know the alphabet, the grammar, or the vocab. A little like Hebrew school.

Besides that, learning about bugs is cool. I feel a juvenile excitement looking at colonies of bacteria infecting their human hosts.

One can only hope that things will start to make sense soon.

Weekend hiatus

The results of the healthy food contest are in, and I won Best Meal! A strong endorsement of my chicken and chickpea curry. I insist that my dish was also the healthiest, but as it did not taste particularly healthy, that went to ants-on-a-log instead (you see what I was up against. The ants-on-a-log were delicious though. Classics are classics for a reason).

Friday afternoon I was exhausted (post-exam) and hungry, so I made a vegetarian stew that I will claim is the healthiest, easiest, and cheapest delicious stew out there, though not particularly refined. Once you have a well-stocked cupboard, it doesn't even require a trip to the grocery store.

Vegetarian stew from the cupboard (inspired by this Persian stew from Serious Eats):

• 6 kale leaves, washed and chopped (or other vegetable, such as tomatoes or peppers)
• 1 tbsp ground cumin (or other spice, such as curry or chili powder)
• 1 tbsp chopped garlic
• 1 tbsp chopped fresh ginger
• 1 small onion, chopped
• 1 cup lentils, cooked
• 1 cup chickpeas, cooked
• 1 cup brown rice, cooked
• juice of 1 lemon
• handful of chopped parsley (or cilantro or scallions, etc.)
• hot sauce and/or sour cream for seasoning -- this stew is an extremely flexible base and could be seasoned with a variety of things
• 1 tbsp canola or olive oil
• salt & pepper

I cooked the rice, lentils, and chickpeas the night before.

On medium-high heat, heat canola oil in a large soup pot, then add garlic, ginger, and onion. Saute until translucent, then add cumin and stir a few minutes until fragrant (you may need to add some water to keep everything from burning). Add the kale; once it has cooked down a bit, add the rice and beans. Cover with water and simmer on low-medium heat for 15-30 minutes. Add lemon juice and chopped parsley. Season with salt and pepper. Serve with hot sauce and/or sour cream.

                                                   Before:                                   After:

My excuse for not blogging this weekend:

Matzoh Brei this morning

Jewish breakfast of champions! May those who have gone before guide me through this exam.

Another exam week

Do we eat poorly because we're stressed out, or are we stressed out because we're eating poorly? I think both. Today, I treated myself to a decent lunch to trick myself into feeling relaxed for the upcoming test. It actually took only a few minutes, and was made entirely from ingredients I had lying around.

I stopped buying cheese for a long time because it's not very good for you and it's too expensive for my budget, but I recently bought a couple of "sampler" pieces from the co-op for $2-3 each. They're actually much better suited for one person. The following recipes are heavy on veggies, light on cheese.

Mushroom toasts (my dad makes these all the time):

• 5-6 small mushrooms, sliced or finely chopped
• 1 clove garlic, minced
• 1/4 onion, finely chopped
• ~1 tsp olive oil
• 2 slices toast
• few slices hard cheese
• black pepper

Saute garlic and onion in the oil until translucent, then add the mushrooms and saute until they've shed their water. Spoon onto lightly toasted slices of bread, add cheese, and broil in toaster or oven until the cheese melts and bubbles. Add black pepper to the top.

Meanwhile...

Salad with goat cheese and radishes. Simply toss together:

• chopped romaine, arugula, salad mix, etc.
• small handful of almonds or other nuts, toasted and chopped up
• 2 radishes, sliced thin
• small piece of goat cheese, crumbled
• balsamic & olive oil

I'm feeling better already.

We are photosynthetic!

With the sun coming out and calcium regulation on Friday's exam, now seems as good a time as any to write about vitamin D. Vitamin D aids in calcium absorption in the gut -- so that when you're eating calcium-rich foods (and secreting parathyroid hormone properly), you actually get the calcium into your system.

Many people know that going out into the sun will increase your vitamin D levels. But why? Does vitamin D come down from the sun? No, silly history major.

We have the precursor molecule (a cholesterol) for vitamin D present in our skin all the time... all we need are a little UV rays and a little heat to convert that molecule to the vitamin D we need.

So how long can we goof off in the sun before it becomes blatant procrastination? The amount of time in the sun varies from person to person, because the lighter the skin, the quicker the UV absorption. According to an NIH fact sheet: "approximately 5–30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen" is sufficient. Not nearly enough for my taste.

On the other hand, I drink vitamin D-fortified milk -- but if vitamin D is fat-soluble, how is it dissolved in my skim milk? Anyone?