Avoiding diabetes for boards

Everyone has their own plan to survive boards. My friend Lauren seems to be the queen of this: she has pre-made healthy homemade meals (vegetable soups, butternut squash mac-and-cheese) in single servings in the freezer, a fashion theme for each day ("On Fridays we wear PINK!") to keep it interesting, and even a customized daily yoga plan from her yoga teacher. All tricks, of course, to get herself to study every day for five weeks. My role model.

My plan for boards is to not get diabetes. I love to snack, especially while studying, and I recently realized that the bowls of free bite-size candy around school could become a problem given the long days sitting in front of a computer. I also realized that I prefer savory snacks to sweet, but that sweet is what's usually easy and available.

So, for week one, I premade a couple of these kale salads from Smitten Kitchen, which are really good (or I wouldn't repost them). I substituted tomato for dried cranberries, skipped the cheese, and used olive oil and balsamic instead of making a salad dressing, but the real "secret ingredients" that make this salad are the lemon zest (not sour or bitter like lemon juice, but complements the kale) and chopped scallion (pretty subtle). Crunchy, refreshing, and yet hearty with the almonds and quinoa!

I also made these whole wheat English muffins from the NY Times Recipes for Health: not particularly healthy, as they had about half a stick of butter for six (large) muffins, but incredibly delicious. Easy to make, I would make them again in a heartbeat (next weekend?).

Finally, tonight I'm planning on filling veggie tacos with this savory/salty/crunchy-looking avocado-cabbage slaw.

Ever feel like you can't muster the energy to be creative? Board studying is leaving little room in my brain for anything else, including even the most minimal decisions... And this is when it's good to have some trusted recipes to turn to. (Or it would be grilled cheese every night...)

Making note

The last day of second year classes feels terribly anticlimactic. We ended with a drawn-out, ill-timed, non-controversial "bioethics" discussion of home birth vs. hospital birth; an afternoon class, everyone was eager to leave, and we left without so much as an acknowledgement of what we have accomplished by getting to this point or round of applause. The end of first year was much more appropriately acknowledged.

On Thursday we have our last school exam, and then we move on to six weeks of independent studying for the USMLE Step 1 exam, which we both have to pass and excel on to increase the amount of choice we will have in choosing a residency. This week I have been fluctuating between an absolute inability to study (how meaningless school feels with boards looming, ironically) and moments of excitement over how interesting I find obstetrics (the non-surgical parts). We all seem caught between slamming on the breaks and pressing down the gas pedal.

While the year is unfinished--because of boards--if we don't stop to appreciate what we've accomplished, how will we have the confidence and the focus to continue?

Just reflecting, because no one else has.

The overly prescribed life

As a runner, I track my exercise. I love my Google calendar, and I mark blocks of time spent in class, at the library, studying lectures at home, etc. Sometimes I note what I'm eating to make sure I'm getting enough protein and not too much sugar. As a second year, I have to make a carefully thought-out, oft-discussed, and re-edited study schedule to make sure that the six open weeks I have to study for the USMLE Step 1 exam are not squandered.

And I'm one of the more "chill" med students.

But something has got to give. Unable to stand it any longer, I've let up a bit on the running schedule. My friends have too. And when it comes to cooking -- a dash of this, a dash of that, this temperature sounds about right, let's just watch it until it seems done -- flexibility serves me well most of the time. After all, it's not surgery.

So recently I made my first brisket, which was perfect because it is nearly impossible to go wrong with beef. It's so high in fat that it melts and tastes good all on its own. After a quick chat about it with my dad, I vaguely followed Joan Nathan's brisket, although made it even simpler.

Brisket:

• beef roast or brisket cut (could likely make another meat the same way)
• half head of garlic
• 1 onion
• 1 carrot
• 1 celery stalk
• 1 mini can of tomato paste
• 1/4 bottle red wine
• canola oil

On the stove, heat a little bit of canola oil in a large, oven-proof roasting pan. Lay the beef down in the oil and allow it cook at medium-high heat for a few minutes. Once it smells fragrant (like a hamburger), turn it over and brown the other side. Browning the meat first seals in the juices.

As you're cooking the beef on the stove top, peel the garlic, slice the onion, and chop the carrot and celery. Once the second side has browned, smear the beef with tomato paste, sprinkle all the vegetables over the top, and pour a couple of cups of wine and water over the whole thing. Season with salt and pepper and place in the oven at 300 degrees.

Allow to roast, checking periodically, for 2-3 hours. Make sure there is always 1-2" of liquid around the meat. Use a cup measure or ladle to spoon some of the juices back on top of the meat. Turn off the heat and leave in the oven for another 1-2 hours (I went to class).

Refrigerate overnight so that you can skim off (and discard) the top layer of fat in the morning. Too much liquid fat in the gravy detracts from the taste. Slice the beef against the grain (you skeletal muscle experts know what I'm talking about) while it's still cold. Lay out again in the pot, cover with gravy, and reheat at 250 degrees for about an hour. Adjust salt and pepper.

While brisket is pretty expensive, small portions served with sides comfortably satisfies a large number of people.

 Before

After: nothing a good scrubbing couldn't fix

Grandmother's banana bread

Recognizing that it is Passover and that my grandmother would have cleaned her house of bread by now (a ritual I used to do with her), I wanted to post this recipe for my grandmother's banana bread because I made it last week and it made me think of her. Cooking is a powerful thing: it takes us back to the past not only through taste but through doing the exact same ritual, following the same steps as someone in the past.

I've been wanting to post for a while something brief about the deaths of my four grandparents, two of whom died this past year and the other two almost-a-decade and over-a-decade ago. What better time to post than 10 minutes into a placental pathology lecture?

With each of my grandparents's deaths, I felt a drastically different emotion. With my mother's mother (whose banana bread recipe this is), I became anxious, and remember clinging to my mother over the months that we visited New Jersey as my grandmother was dying. It was my first taste of dying and the parallels between my mother's mother and my mother were obvious to me. When my first grandfather died, I felt pure grief, which was a relief in a way because sadness has been sanctified as a normal emotion around death. My second grandmother's death made me sad in a quiet sort of way, as I felt that it was "her time," relatively speaking; I've written about her here and here. When my last grandparent died, I felt relief because he had been a difficult man whose relationships with others were equally difficult--and later I felt guilt at that relief. I haven't written about him at all.

All of this to reflect that some emotions around death are expected, others a surprise; some endorsed, others shameful. Our patients' family members may not feel as we expect them to feel--and certainly not all feel the same way--and it is up to us to observe, listen, and modify the comfort we offer. Perhaps that makes empathy more interesting?

Banana bread:

• 1 1/4 cups white sugar
• 1 stick butter
• 2 eggs
• 1 teaspoon vanilla
• 1 teaspoon baking soda 
• 1/4 cup sour cream or plain yogurt
• 1 1/2 cups flour (white or whole wheat)
• 1/4 teaspoon salt
• 1 cup mushy/smashed/rotten bananas (about 3-4 bananas)

Preheat oven to 350 degrees and grease a loaf pan. Cream butter, sugar, eggs, and vanilla. Separately, lightly beat the baking soda into the sour cream until dissolved; add to the mix and beat well. Stir in bananas, flour, and salt and mix well. Bake for 45-60 minutes until a knife inserted into the middle comes out clean; better undercooked than overcooked.

The original recipe is written out in my grandmother's handwriting on a water-stained index card in a tin at home. Smitten Kitchen has an interesting and amusing post about how many of our "grandmother's recipes" originated in the 50s; no promises that this banana bread goes back to the Old Country.

Living with uncertainty

I recently met a patient whose credit card wouldn't go through as she was checking out. The problem was with the machine, not her card, but she was instantly on high alert for credit card fraud. "You have to understand," she said, "as a paralegal, I see identity fraud every day, and I'm paranoid that it will happen to me." We (the other students at the clinic and I) got it: we study diseases every day, with signs and symptoms that often appear relatively benign and familiar (fatigue, enlarged lymph nodes, etc.). Thus, med student syndrome. Yes, the possibility exists that one has lymphoma or lupus--but probably, hopefully, not.

Similarly, failing an exam--and with that, losing your summer or having to repeat the year--is always within the realm of possibility. Before med school, "failing" for many of us meant a bad grade; now, passing is a one-shot deal, determined by one exam at the end of the course. There are relatively few questions on that exam, and it's up to your best guess as to what material will be covered. This makes med school is a relatively unique and stressful experience.

So what do we do? One thing we can to is to accept the possibility and let go. Find activities that are pleasurable, soothing, distracting--like cooking! And if you choose to cook, don't worry so much about getting it exactly right: even if it's not perfect, it will likely taste just fine. G = MD.

Refreshing "mud season" salad (before spring veggies have quite hit their stride):

• fresh spinach
• handful of cilantro
• 1/2 apple
• 1/4 lemon
• olive oil or balsamic vinegar optional

Chop the spinach and cilantro. Cut the apple into 1-cm cubes. Pack up with the lemon wedge. Before eating, squeeze the lemon over the leaves and toss together. For added substance, serve with: cheddar or goat cheese, toasted walnuts, pumpkin seeds, lentils, quinoa, or yogurt on the side.

Adds a little bit of sunshine to your day!

Weekend off

A whole weekend away from First Aid and an intensive conference experience and an interesting transformation happens. You let loose, and you try new things! I find that conferences are very intense. I wrote my first poem in years and years -- crazy!

Bedsides, which is a "riff"* on Garden Variety, a poem by Colette Giles Tennant

All of my friends
in this garden of second chances
dance like spiders between the ceiling and a hardbound book.

On the ward,
safely tucked in between ER and home,
whatever brought them in momentarily at bay.

They lie on their backs
blue gowns mirroring blue scrubs,
and stare at that spot
between ceiling and wall--
space, TV, world beyond--
anywhere they would rather be--
waiting.


*first stanza lifted from her poem. Think of cooking something new as riffing on another's recipe.

When is your next weekend "off"? What will you do?

Taking the long view

I'm at this fantastic AMSA Medical Humanities conference with a hodgepodge of workshops on integrating the humanities into medicine, with demonstrable benefits to patients and providers. For instance: Nancy Morgan at Georgetown's Lombardi Cancer Center leads journaling sessions with patients and families in the waiting room. Results of her study--showing improved self-reported quality of life for patients--were published in Oncology. (See a brief BBC synopsis of her work here.) Yesterday, Dr. Adriane Fugh-Berman, also at Georgetown, led us through a lively presentation on medicines derived from herbs, explaining her rationale for integrating natural products into patient care (which I've never understood before): the herbs she uses have fewer adverse effects and are cheaper than traditional pharm. Almost as importantly, she was funny and engaging as a teacher -- something we could all use more of!

The problem is that I get totally jazzed at conferences like this, but then I return to normal life and feel completely overwhelmed by new ideas and projects I've committed to. I wrote before how it helps to work on projects with a community of peers. This time, rather than holding myself to too much, I'm going to try not to over-commit, and remind myself that as long as I write down my ideas, I can always return to them during fourth year, residency, or as an attending. These are ideas that will be relevant for a life time.

Allston Court, where we lived until I was seven

Nancy Morgan led through the following activity (which also worked with a group of caregivers in Japan): quietly draw your childhood neighborhood. Then, share one story from this neighborhood with the person sitting next to you. Observe as you begin to laugh and lighten up! It works! "In order to know who you are and where you're going, it helps to know where you're from."

Chicken and kale stir-fry

I'm at the Albany airport en route to the AMSA (American Medical Students Association) Medical Humanities Institute for the weekend -- with this blog as the writing project submission that earned me acceptance! Just took an exam, looking forward to a long weekend off from schoolwork, enjoying a glass of wine and some chocolate, and yet already regretting my decision not to bring my best friend and constant companion First Aid. Ah, the life of a second year med student with the major "step one" board exam coming up in June... I'm embracing it.

With this conference coming up, though, it's time to catch up on some writing.

I've always been hesitant to post a stir-fry recipe, because it's not a dish that's been passed down to me through family or for which I have any particular expertise. This particular version, though, is simple and reproducible and consistently tasty; a decent go-to for something healthy and quick if your Chinese mother or grandmother happens to be busy. Sometimes after a long day I'll come home and cook next night's library dinner before going to bed. Again: step one. One of the keys to eating decently during exam week is to be prepared.

Chicken and kale stir-fry:

• 3 cloves garlic
• 1"-square fresh ginger, peeled
• 1 chicken breast
• 1/2 bunch kale
• any other vegetables you so desire
• canola oil, soy sauce, black vinegar, white pepper, chili flakes

Chop the kale into ribbons, removing thick parts of the stalk and chopping separately. Slice the chicken into small thin pieces. 

Heat the canola oil in a frying pan. Finely chop or grate the garlic and ginger. Add to the hot oil along with chili flakes and stir. Once fragrant, add the chicken and stir. When the outside of the chicken is white, add the chopped kale stalk (as these take longer to cook than the leaves). Once the chicken seems to be cooked through (no longer pink in the middle), add the kale leaves. Add a 1/4-cup of water as needed to keep from burning. When the kale leaves are soft to your liking, season sparingly with soy sauce, vinegar, and white pepper. You can always add more soy sauce, but you can't take it away!

Soooo simple, right?

Prepping for a long week

There are exam weeks, as I approach the end of second year, where I just don't want to spend time cooking. I stay at the library for long hours, and if I can make it through dinner I feel that much more productive. I try to anticipate these weeks by freezing meal-sized leftovers of soups or chili, but that's not always possible. And I refuse to eat in the hospital cafeteria because each meal there--while pretty decent--is more expensive, less flavorful, higher in salt, and includes fewer vegetables than what I would cook at home. Not to sound like a total snob.

On Sunday afternoon while home doing laundry and studying, I opted to roast a fennel and onion: flavorful, versatile, good to have on hand for the week, made my house smell good. Monday night before bed I popped half a cup of white beans into my pressure cooker, and for last night's library dinner I ended up with a tossed stew of white beans, fennel, and onion. It was homey, comforting, and healthy towards the end of a long day. For tonight I'll stir the rest of the fennel and onion into tomato sauce and serve it over penne. Pretty nice for such quick meals. Of course, the atmosphere contributes a lot.

Minimalist fennel, onion, and white beans:

• 1 fennel bulb
• 1 onion
• 1 cup white beans
• olive oil, salt and pepper

Wash the fennel bulb and slice it crosswise (on the horizontal if you have it standing up) into rings, removing the thick core at the base and discarding the celery-like stalks at the top. Peel and slice the onion. Toss together in a roasting pan with olive oil, salt, and pepper and roast at 400 degrees for about 20 minutes, until caramelized. Toss every 10 minutes, checking to keep from burning.

Toss with white beans and adjust seasonings. Or: enjoy as a base for chicken or fish, toss into tomato sauce, etc.