Winter salad to beat those mid-February blues

I can't even talk about renal. Renal is very difficult to understand because all of the processes happening within the kidney, within the nephron, are interrelated, and so content overlaps and is not presented clearly because it cannot be presented all at once. I'll get there. On the other hand, every morning we go through cases that demonstrate how a hospitalized patient can rapidly deteriorate from a relatively healthy state if someone orders the wrong hydration or diuretic treatment. Never before have I felt the extreme importance of a subject as someone who, in two and a half years, will be writing orders for hospitalized patients. That daunting impending responsibility!

My preferred coping mechanism is avoidance -- I can get so much done! Mostly I have spent time in the woods moving quickly so not as to die of hypothermia and breathing so heavily that renal is the last thing on my mind (aka blowing off CO2 to prevent acidemia). 

Monday I went grocery shopping with a friend, who told me that she planned to make roasted tofu over spinach for dinner. I was intrigued; a quick glance at the recipe she sent me yielded this inspiration. I don't usually make new things, but making something new that tastes great is always a fun surprise. 

I wasn't sure how to dress this salad: I didn't want to mess with the strong flavors of the tofu marinade. I almost didn't dress it at all, but I ended up going with a simple sesame paste and lemon that I liked very much.

Roasted sweet potato and tofu over spinach:

• 2 small sweet potatoes (or carrots), cubed
• ~1/2 block firm tofu, cubed
• 6 garlic cloves, peeled

Marinade:

• fresh ginger, about 1 tablespoon, grated
• soy sauce
• canola, sesame, and/or olive oil
• white vinegar
• sugar or honey
• cayenne powder and/or chili flakes
• garlic powder optional
• black pepper

Salad:

• cilantro and/or scallion
• fresh spinach
• 1/2 lemon
• 1 tablespoon tahini

This can be a one-pot dish. In a large square baking dish, toss together your cubed sweet potato, tofu, and peeled whole garlic cloves. Grate ginger over the top, then add your marinade over the top: about one tablespoon each of soy sauce, oil and white vinegar, then a sprinkling of sugar and spices. Marinate in the fridge for a few hours or bake at 400 for about 20-30 minutes, tossing every 5-10 minutes to prevent burning.

Serve over chopped spinach with a cilantro or scallion garnish, and a simple dressing of lemon juice and tahini. Toss to coat. Could also serve over quinoa or brown rice for a heartier dish, but I found this plenty hearty as it was.

Valentine's Day and friends and advocacy

There's a scene in "Clueless" where Cher, coming out of a dark place, decides that she needs a complete makeover of her soul. "What makes somebody a better person?" she wonders.

And then I realized all my friends were really good in different ways. Like Christian, he always wants things to be beautiful and interesting. Or Dionne and Murphy, when they think no one is watching, are so considerate of each other. Poor Ms. Geist, always trying to get us involved, no matter how much we resist.*

I quote Cher to explain why Albany Med's inaugural Med Student Advocacy Day meant so much to me. It is wonderful to feel led by friends to try something new, to develop skills of which I am perfectly capable but which I would not have thought to explore on my own.

Six months ago, three of my good friends on campus decided to organize a day when med students from Albany Med and across the state could speak with legislators about issues relevant to our patients and our careers. For me, the first step was becoming comfortable allowing others to take the lead, deciding to join as a participant rather than an organizer. Over the next few months, as they developed the process and scheduled our meetings, I worked with other participants to research and develop our arguments. We practiced a few times in teams, adjusting our talking points to become more clear individually and cohesive as a whole.

On Advocacy Day, I attended three meetings with legislative staff. In these meetings, I was able to take on an identity and a persona that took me out of my pajama-wearing, sleep-deprived, textbook-hovering norm. I tried to step outside of myself and speak as a future physician on behalf of patients, as an influencer of New York state health care policy. As someone informed, empathic, a good listener. (Really my voice was shaking and my arguments halting.) Equally importantly, I saw my friends in the same light. Well dressed, excellent postures, speaking eloquently and passionately about the people they've met and the experiences they've had. Peers I can admire and learn from.

Advocating on behalf of patients was a dream that I once had while shadowing a doctor during my premed days. It was something I had forgotten about. And then it was finally something that I was able to do because my friends made it possible.

Happy Valentine's Day!


*I did not have this scene memorized but I was able to go exactly to the spot in the movie where it takes place.

The Best Soup

I read an interesting article this weekend entitled, "Why Nutrition Is So Confusing" that described what all med students know: nutrition data is largely inconclusive, often contradictory, and falls short of strong claims that would make for truly useful recommendations. Trials are often done for a few years and then extrapolate to decades or, conversely, populations are followed for decades and then analysts try to pull out a few recommendations. Although many of us philosophically favor diet and exercise modifications over medications, medications are not only often easier for patients, but also easier to understand as med students. We memorize pharm for the boards; we don't memorize the benefits of garlic. That doesn't mean that we should give up, just that it's a complex problem.

Intrigued by this op-ed, I decided to test just how confusing nutrition is. I looked up "garlic" in the Natural Medicines Comprehensive Database, and didn't find it confusing at all. The database ranks claims in terms of varying levels of safety and effectiveness, and concludes that garlic is "Possibly Effective" (this is a good thing) at slowing atherosclerosis and lowering blood pressure. Is it the chemicals within garlic that lower blood pressure, or is it the deeply relaxing experience of eating something comforting and delicious after a long day?

Lately I've taken up snowshoeing, which lends itself to comfort food. This soup has everything that you’d want in say, a French onion soup—umami, salt, a rib-sticking effect—and yet it’s a trick: it’s so deeply flavorful that you achieve the same satisfaction without cheese or beef stock. I didn’t set out to make a healthier version than Smitten Kitchen’s original, but being limited by what I had on hand, I’m glad that I did! I don’t think this soup needs a drop more than what I put in it.

Makes two very small bowls of soup:

• 2 small garlic heads
• 1 white onion
• 1 teaspoon dried or fresh thyme
• 1 teaspoon miso paste
• 1 tablespoon butter
• 1 tablespoon olive oil
• drop of cream optional
• salt and pepper

Preheat the oven to 350 degrees. Separate the garlic heads into cloves. Peel one-third of the cloves and set aside. Place the remaining two-thirds of the garlic cloves, unpeeled, into an ovenproof dish and toss with olive oil, salt, and pepper. Cover tightly with tin foil and roast 30-40 minutes until golden brown (but not burned!). Remove from the oven, cool, and peel the cloves.

In a small pot, melt the butter over medium heat. Add the onion and thyme and cook about six minutes until translucent, stirring occasionally. Add a drop of water if needed to prevent the onion from browning. Once the onions are clear, add the raw and roasted peeled garlic cloves. Cook another three minutes, stirring occasionally.

In a mug, pour one cup of boiling water over miso paste and stir to dissolve. This is my dad’s trick substitute for chicken broth; feel free to use chicken broth instead if you like. Pour the miso broth and another half cup of water over the garlic and onions. Cover the pot, turn the heat to low, and simmer for 20 minutes until the raw garlic cloves are soft.

Puree the soup. Stir in a drop of cream if you like, although not needed. Serve with freshly baked dark bread.

Recipe adapted from Smitten Kitchen.

Garlic soup waiting at home.

Two heads of garlic, one cup of soup.

Super Bowl Sunday salad!

I went to a couple of talks this week that emphasized the importance of protein. While osteoporosis is a well-known public health problem, sarcopenia, or the loss of muscle mass, is less well-understood by both doctors and the general public. Prevention of sarcopenia is perhaps one reason why people who stand or move around at work may be healthier as they age than people who sit all day (like med students). In terms of the obesity epidemic, concentrated protein (as in meat) is lower calorie and more filling than protein stretched across legumes and whole grains (which I generally prefer). Keeping it simple, most adults should aim to eat 1 gram of protein per day for every kilogram (or 2.2 pounds) of body weight.

In January, I made that resolution to eat more protein, and yet I still find myself gravitating towards vegetarian dishes and grains. To compromise, I decided to substitute quinoa for brown rice in a flavorful beans-and-rice salad. Mexican flavors of vinegar, cumin, and cilantro add spice to these dreary, late winter days, and are perfect for Super Bowl Sunday.

Quinoa "rice and beans":

• 1/2 cup dried black beans, reconstituted (or about 1 can of black beans, rinsed)
• 1/2 cup quinoa, cooked with 1 cup water in a rice cooker
• chopped tomatoes to taste (I used half a can instead of fresh tomatoes)
• 1/4 red onion, minced
• handful of cilantro, finely chopped
• 1 garlic clove, finely chopped 
• 1 teaspoon chili flakes (or 1 freshly chopped chili)
• 1-2 teaspoons ground cumin
• 1-3 teaspoons white vinegar
• salt to taste

In a large bowl, toss together your black beans and quinoa, then add tomatoes, onion, and spices to taste. Enjoy as-is, or with salad greens, eggs, or grated cheese (I added some cheese to mine and honestly I'm not sure that it adds much. But up to you.) I doubled the recipe and will have more than enough salad for lunches this week.

Before tossing

After tossing