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

Has anything changed?

Back at school, I am amazed at how much everything appears to be the same: social cliques, study habits, daily routine. How did we pick up so smoothly exactly where we left off? We strain to ask each other about summer experiences, but quickly the conversation veers towards apartment redecorating, upcoming dinners out, and lecture content. And yet I get the sense that many people feel changed by their summers, and are keeping that feeling within.

Without much fanfare, they have launched us into second year. Oddly, because there was much more fanfare at the start of first year (the white coat ceremony), this year feels like a significant departure from the past. A series of lectures on the "principles of drug therapy" represents the study of medicine opposed to human biology.

Here's a recipe with a little tweak on the norm, a variation in honor of summer (and my CSA share). My dad, being a food purist in favor of traditional recipes, commented, "What, do you want to eat like you live on a commune?" Despite his objections, the summer squash in this recipe adds a sweetness to the sauce and lightens the dish overall, a nice summer adjustment.

Summer pasta with squash and tomatoes (feeds two):

• 2 cups large macaroni or shells
• 1 medium-sized summer squash or zucchini
• handful of cherry tomatoes
• 1/2 red onion
• 2 cloves garlic
• handful of parsley
• parmesan
• 1/2 tablespoon each butter and olive oil
• salt & pepper

Get water boiling for the pasta.

Melt butter and olive oil together in a saucepan. Finely chop the onion and garlic (both peeled), and add to the hot oil. Cook for a minute until fragrant. Chop the squash into 1" cubes (notice a pattern here?) and slice the tomatoes in half. Add the squash and cook for a few minutes until slightly soft, then add the tomatoes. Cook for just a minute and turn off the heat.

Cook the pasta in salted water. Before the pasta is fully cooked, drain most of the water and add the pasta to the saucepan with the sauce. Cook at high heat, stirring constantly, adding pasta water as needed. Stir in chopped parsley and grated parmesan. Serve hot!

+ =

Summer vegetable soup

Back in Albany!

Exciting news: while I was away, I signed up for a CSA (community-supported agriculture) share from the local Patroon Land Farm. This means a fresh load of vegetables each week: beautiful kale, fennel, corn, lettuce, lots and lots of squash and zucchini, etc. For only $100, I will have fresh, local vegetables through October. I like CSA's because they take the decision about which vegetables I need to buy (which, as you might imagine, occupies a lot of brain power) out of my hands. Instead, I am presented with the challenge of how to use different (and abundant) vegetables.

This recipe comes from my friend Sasha's grandmother, the source of many delicious vegetable dishes.

Summer vegetable soup (two small servings):

• 1 large zucchini or squash or several heads of broccoli (really any vegetable you like)
• 4 cloves of fresh garlic
• 1 small onion (I used three large scallions from my farm share instead)
• 1-2 tablespoons olive oil (or butter)
• 1-2 tablespoons sour cream or Greek yogurt
• (chicken stock optional)
• salt & pepper

Chop the garlic and onion into small pieces. Heat the olive oil and add the garlic and onions, cooking for a minute, until fragrant. Meanwhile, chop the zucchini into 1" pieces (skin on), then add to the hot pan. Saute over high heat, adding a 1/4-cupful of water (or chicken stock) as needed, until the zucchini is soft, much softer than usual for eating. You should be able to crush a piece using just the back of a spoon. Season with salt and pepper.

Turn off the heat and allow the zucchini to cool. Using a food processor or immersion blender, puree the zucchini entirely, then add sour cream or yogurt to taste. Enjoy warm or cold.

Everything has grown much greener since I left

Picnic food

"Home alone" for a few days without the 'rents, I naturally raided the fridge. In this case, for an airplane picnic for an overnight flight. The outcome: a beautiful picnic that will look almost as good on a plastic tray as it would on a blanket spread over grass.

German potato salad (no mayonnaise!):

• fingerling potatoes
• grainy mustard
• 1 lemon (or any type of vinegar)
• olive oil
• chopped parsley or other herb
• ground black pepper

Steam the potatoes (washed but not peeled) over boiling water or in the microwave until a fork pierces them easily but they are not mushy. Cool and then slice into quarters.

Mix together mustard, lemon juice, olive oil, chopped parsley, and black pepper -- adding ingredients to taste. Toss with the potatoes and serve warm or cold.

The other components of my picnic: chopped watermelon, a peach, cold noodles with sesame oil and soy sauce, and homemade trail mix (one dried nectarine chopped into pieces, dark chocolate chunks, toasted almonds). I definitely went overboard but I've got almost two days of traveling ahead.