Dramatic irony, part 1

This afternoon, I spent an hour interviewing a 70-year-old retired lawyer who had been brought to the hospital for "confusion" and "unpleasant vivid daydreams." When I first met him, he said to me, "Well, it's been a fascinating trip so far. I didn't know that all this stuff is going on, that delusions like this can happen to people." He then elegantly launched into a nonsensical explanation of recent events, from being lost in the snow in Vermont with only strange innkeepers in sight, to being kidnapped and brought to Japan, where he was given hospital socks. As I struggled to keep him on track and progress with the interview, I felt frustrated with his verboseness. Listening closely, trying to make sense of his eloquent speech, I realized that his words added up to nothing more than nightmarish delusions. He, too, has been struggling to make sense of these experiences: "I've been trying to analyze why these things are happening to me... I feel better since they've mapped out a game plan, [which is] to bombard people with reality." Later, he failed a simple neurocognitive assessment. A picture emerged of an intelligent, educated man using those reserves to compensate and mask a significant decline.

As the interview seemed to be going on forever, we paused for a neurology resident to do her exam. I watched as numerous Parkinsonian features were revealed: bradykinetic hand movements, perseveration, increased muscle tone, shuffling gait. After, I stepped out of the room to ask the resident her thoughts. "We're thinking Lewy body dementia," she said, a diagnosis that goes along with Parkinsonism. I felt excited at discovering something new, the chance to diagnose, glad to have stumbled upon a neuro exam for a disease I hadn't seen before. A hypothesis shared only between the resident and me, not yet voiced to the patient himself.

I stepped back into the room to finish my interview. Towards the very end, I asked the patient to describe his mood at present. "One hundred percent better!" he said, and smiled. "I actually think I have a chance now of being able to do things again, of going back to how I was. I was really worried about Alzheimer's, but the CT and MRI came back totally benign!" I choked up. Minutes later, I stood up, thanked him, shook his hand, and left the room.

Albany update

Just marched down Central Avenue in Albany with a mixed race crowd chanting for a more just and peaceful policing system. We started in Arbor Hill, the broke and black part of Albany where so many of our patients live. For a start, I felt safe in a neighborhood where I have been told never to feel safe. (That's been an effort of a local family doctor here, to get people out in the neighborhood and feeling safe.) People came out of their apartments to cheer, men joined in as we passed, cars stopped and honked in support. Just as I feel empowered by my white coat to join in where I might have been shy in the past, the rally seemed to empower this neighborhood; or perhaps the neighborhood, empowered, created the rally. I passed one patient's street and then another. I was so moved by the crowd chanting, marching with both hands raised, that for several blocks I was silent. But I am not a tourist: my grandmother drove black families to the polls to vote for JFK in 1960. As medical students, we work with people and care for patients whose communities face injustices and challenges that many of us don't face personally. I want to be able to look my patients in the eye and let them know that I know and I care about what's going on outside of the hospital. To demonstrate that people in a position of authority want change too. Last winter I attended my first rally ever, marching down Michigan Avenue in Chicago with Students for a National Health Plan, feeling awkward and ambivalent. Yet trying something once makes it so much easier to try it again, sets off a chain reaction.

My patient woke up

For the past three weeks, I have been following an elderly male patient. First in the ICU, where he was delirious, in and out of consciousness and often nonresponsive. I spoke to his daughter, who told me that before his 75-day-and-counting hospitalization, he had been an independent man who used to come to her house daily to walk and watch TV with her dog. She was concerned that with so many transfers between and within the hospital, his providers had lost sight of his baseline, and only knew him as the extremely ill, nonverbal, mildly disheveled patient before them. In fact he suffered quite a loss of independence and dignity.

Today I met him on the floor (out of the ICU, in a regular surgery ward), and I introduced myself. I often feel the need to be careful when revealing to a new patient just how much I know about them from reading the chart and speaking to others; I don't want to appear to be a stalker. In this case, the patient was lonely, and soon the encounter became intimate. He asked which daughter I'd talked to. We talked briefly about how long he'd been in the hospital. Without prompting, he burst out, "I feel depressed" and "I'm scared," a phrase he kept repeating. When asked why, if perhaps he is afraid that he won't get well, he said, "I don't know." I was scared knowing he was scared.

"Rule out suicidal ideation by knife emoji"

On crisis call the other night at the local psychiatric hospital, we were asked to evaluate a girl brought in by the police, with her mother's urging. She had run away and was rumored to have threatened suicide. Apparently, she got in a fight with her mother over an alleged Facebook post in which she posted a "knife emoji" and said she was going to hurt herself. She denies having ever posted it and her mother never actually saw the post. We did not think she was suicidal, so I can joke about it. Kids these days.

The really tragic underlying story is that her mother has been trying to get her outpatient counseling services for a year, that counseling services were ordered by in-school supports, and that it never happened. In between the girl has been kicked out of school; it took a day waiting in crisis for an evaluation to finally connect her to badly needed services. Imagine the difference for a family of means trying to connect their kid to services. It was telling to me that the mother said proudly of her son, "He's doing well. He's 17 and never been arrested."

For fun, let's compare local 2013 high school graduation rates:

Among the top performers were suburban districts such as Niskayuna, with a 96 percent graduation rate in four years and 2 percent dropout rate; Voorheesville showed a 94 percent graduation rate and a 3 percent dropout rate. 

Less-impressive results were found in cities with higher concentrations of students living in poverty, including ethnic minority youngsters. In the Albany school district, the graduation rate was almost 54 percent, with a 21 percent dropout rate. Schenectady had a 65 percent graduation rate and a 20 percent dropout rate. 

(Times Union, http://www.timesunion.com/local/article/Graduation-rates-up-5574062.php)

Where do I even begin?

How do you pull a blog back from the brink? Let's start by explaining how I got here.

In addition to having a precious few free hours a day as a third year, working with real patients every day is an intensely personal experience. There is so much to process; over the past few months I've found it easier to do that with just the people to whom I am closest. Then there's the fear that I won't convey as well in writing interactions that have meant so much to me on the interviewing or observing end. Finally, how do you end a glimpse into someone's decision-making with a trivial recipe for kale salad?

Over the past few months, I've learned to feel ownership over my patients, to follow them daily in the hospital and try and make myself useful to them regardless of whether a note needs to be written or not. It's the luxury of being a med student that we have time to do this. And in practicing this, I've begun to feel for this handful of patients, worry about them on the days when I'm not there, become very upset when I hear about a miscommunication. Medicine takes you into the most intimate moments in strangers' lives, from a family meeting in which an elderly couple turned down palliative surgery in favor of home-hospice, to planning next steps after a miscarriage, to intrusively asking a patient whether he wants to die.

Last week I met a man who was a survivor of the earlier AIDS epidemic, diagnosed with HIV in the mid-80s and told at 22 that he would have five years to live. He buried all of his friends from that era, grew close to his family, and only a few years ago stopped taking all medication because he had grown tired of it. I felt so strongly for him, felt so privileged to be in the room interviewing him. Over the past few months I've been reading a nonfiction book, My Own Country, by Dr. Abraham Verghese, about the AIDS epidemic in rural Tennessee as experienced by an Indian-trained, African-born infectious disease doctor. I can only see that book as increasing my interest in this patient.

As I've written enough, I think I will link to this recipe from the New York Times, which looks delicious and inspired my lunch for tomorrow: Apples from Thanksgiving Start to Finish. My adaptation was a quick chopped dinosaur kale, sliced apple, Cabot farmhouse cheddar cheese, toasted walnuts, and a mustard/balsamic/olive oil/black pepper dressing.

On pulmonary outpatient clinic, part 2

Last night marked the last TGIF yoga class from the teacher who has been there since well before I started med school. It was a momentous occasion: I've attended this class every single Friday night that I've been in Albany over the past two years. Friends have changed, apartment has changed, schedule has changed, I've changed, and this yoga class has been there the whole time. It reminded me of when I finally moved away from Boston, I realized that the most consistent companions I'd had over the six years post-high school (besides my family) were not my friends or my co-workers but the kids I babysat for every week. These are background patterns I take for granted.

It was an unexpectedly sad and amazing week on pulmonary outpatient clinic. For the first time in my career as a med student, I was fascinated and impressed by the rare cases as opposed to the mundane: nocardia pneumonia with a healing abscess, acquired pulmonary alveolar proteinosis, two patients both alive and well five years after diagnoses of lung cancer with brain metastases. In the past I've felt that the rare cases, while "cool," don't reflect what we really need to learn to manage most patients, nor do they encourage empathy for the suffering person. I'll take this as one more instance in which I'm becoming culturally more similar to the rest of my profession.

Friday ended with a pair of sisters--fairly young, fit and healthy-looking women in their early sixties (one thing I've learned this week is that my "healthy-looking" sensor can be way off)--sitting before me in the exam room. One of them was just diagnosed with lung cancer in May and had the entire right lower lobe of her lung removed in June. She was now suffering from bloody pleural effusions and her sister was there with her to learn how to drain the fluid at home. What a mental shift that must have been for both of them: one previously healthy to sick and missing a huge piece of lung; the other now taking on a caretaking role. Both seemed to be taking it in stride: cheerful, matter-of-fact, not grossed-out, hopeful yet concerned about prognosis. I was so impressed.

So this week was tinged with endings, both of the new-beginnings kind and of the beginning-of-the-end kind. Let's be thankful for the former.

On pulmonary outpatient clinic, part 1

I've heard that respiratory failure is one of the more painful ways to die. In renal failure, once you're off dialysis, toxins build up in your blood and you slip into a coma, going gently into that good night. In respiratory failure, you are hungry for air: it's a set of diseases that causes anxiety.

Similarly, then, patients living with lung disease live actively with their disease. They sense it, feel it, accommodate it, fear it around the clock or spontaneously here and there. Cystic fibrosis, asthma, emphysema are debilitating conditions around which patients may define themselves. This morning I met a very healthy appearing young woman, dressed nicely for her office internship, ready to start her college semester next week. On exam she seemed totally fine: no cyanosis, no clubbing, perhaps some very brief end-inspiratory wheezes but no extraordinary breath sounds. You would not pick her out walking down the street. Yet she has cystic fibrosis, a very treatable form, and when I told her I'd once met an older lady with CF during a lecture, she said, "An older woman? That's good to hear!" Raised with CF, treated with a drug only made available in 2012, she lives with a sense of her own mortality. She is comfortable enough with her mortality to allude to it in a comment to me, while I look at her and see a healthy person, and deny to myself the possibility of serious illness.

All of this to speculate as to why I've found the physician-patient relationships over the past week (shadowing in pulmonary) so profound, even as compared to a previous weeks in cardiology and endocrinology. It could just be the particular physician, but it could also be that hypertension and even type 2 diabetes are relatively silent diseases (for diabetes that's a questionable statement that certainly depends on the patient and how much insulin affects their daily living, but those in denial are able to live in denial, it seems). Over the past few days we've had patients cry in the office; express joy and gratitude over improved asthma; dismay over worsening, untreatable emphysema. My attending lingers with his patients, dreamily reminiscing about his intern days, thoroughly explaining the mechanisms underlying symptoms or treatments. I think it keeps them coming back, improves their disease self-maintenance. How privileged to be a fly on the wall for conversations that have been years in the making.

First farm share

Farm shares and zucchini go together like summer and apple pie. I decided to revisit this recipe for cold zucchini soup. This time, I started by sauteing half a head of garlic and an onion in two tablespoons of butter, added one roughly chopped huge zucchini, and finished by boiling in a cup of miso broth. Then I pureed the whole thing and added a few spoonfuls of Greek yogurt. And that's it.

(Over the last year I started using miso broth instead of chicken broth. Usually I'd start with olive oil and finish with sour cream, but being out of sour cream I decided to switch my fats and started with butter, ending with nonfat Greek yogurt. No extra shopping trip needed.)

See? Not all cooking has to be ambitious.

Thai noodle stir fry with chicken and vegetables

Remove box of leftovers from fridge. Microwave on high for 1-2 minutes, until hot to the touch, stirring if needed to heat evenly. Serve in leftover container or on a plate.

Welcome to third year.

(Photo credit Serious Eats, http://www.seriouseats.com/recipes/2011/12/pad-see-ew-thai-recipe.html)

Zucchini ribbons with garlic

These can be whipped (or ripped) up in less than five minutes.

• 2-4 cloves garlic
• olive oil
• 1 small-medium zucchini

Wash your zucchini. Use a vegetable peeler lengthwise to create thin ribbons. Once you've reached the center of the zucchini from one side, flip over and peel lengthwise from another side. Discard the 2-3 pieces that are primarily peel. Once the remaining zucchini is too thin for the peeler, use a knife to slice into just a few more pseudo-ribbons.

Use a garlic press to get your garlic into really tiny pieces. In a large frying pan, heat the olive oil and fry the garlic until fragrant and golden, toss in the zucchini ribbons, and fry, stirring frequently, for 2 minutes only.

Serve hot and just barely cooked.

Penne pasta with asparagus, lemon, and tomatoes

Bunches of asparagus look irresistibly fresh and appealing in May and June, and lend themselves to grilling, broiling, or pasta primavera. This dish resembles a warm pasta salad, equally vegetables and pasta. I chose penne because it's roughly the same size and diameter as thin asparagus spears, and I cut the asparagus into penne-length pieces to emphasize the effect. Lemon brightens the whole thing up for early summer.

You will want (makes leftovers or can be easily halved):

• 1 bunch asparagus
• 1 pound pasta
• 1 tomato
• 1 lemon
• 4 cloves garlic
• olive oil
• parmesan

Begin boiling salted water for your penne. Once boiled, add the pasta and cook until al dente, then drain and set aside.

Wash your asparagus, trim the bottom 1" from the stems, toss in olive oil, and either grill or spread out on a baking sheet to broil 5-15 minutes. I've burned dishes numerous times while broiling, so check on these every five minutes to avoid burning!

Meanwhile, finely chop four cloves of garlic and sauté in olive oil in a large frying pan. Add one chopped fresh tomato and cook until slightly soft, then turn off the heat.

Once the asparagus is no longer stringy, remove from the oven, cool, and cut spears into penne-length pieces. Toss the penne and asparagus into your garlic-tomato sauce, add the juice of one lemon, grated parmesan, and black pepper. Enjoy!

Summer hiatus and return

Coming off of six weeks of board studying, I returned to Albany in June for two weeks of orientation to third year and an apartment move. How rare to be in Albany without a dizzying number of facts to study, and yet everything that had piled up over the past few months, along with packing, provided plenty of activity. Long summer days, relatively relaxed, an entirely free three-day weekend... somehow it called neither to cooking nor to pulling out my laptop to blog. Only now, on a hiking vacation with my parents a small modern wooden cabin, tucked in for a second consecutive day of rain and waiting for a cloud to lift, do I have time to catch up!

Whether because you are working absurdly late and long (keep up the good work, interns and third years!) or hiking and swimming until sunset, summer dinners call for vegetables and minimal time in the kitchen. Here are a number of quick fresh vegetable dishes for the cook who hardly feels like cooking:

• Penne pasta with asparagus, lemon, and tomatoes
• Grilled vegetables (and fruit!)
• Zucchini ribbons with garlic

Sometimes, there are better things to do than cook…

Fresh pea soup

It's summer! What happened to May? I can't remember... something about a big exam...

It was raining and cold all last week in Albany, however: fresh pea soup seemed like the perfect compromise between summer expectations and a more chilling reality. This soup can be whipped up in about 15 minutes.

Fresh pea soup:

• 1-2 cups fresh or frozen sweet peas
• 1 small onion
• 1 tablespoon butter (this recipe calls for no cream, so use the butter)
• dash of olive oil
• chicken or miso broth (1 tablespoon miso paste dissolved in 1 cup boiling water)
• salt and pepper to taste

Chop the onion, melt the butter and olive oil in a small saucepan, and saute the onion on low heat for for several minutes until translucent, stirring occasionally. Add the peas (frozen right out of the bag is fine), stir, and saute for a few more minutes. Add about a cup of broth (just enough to cover the peas and onions), cover the pot with a lid, and leave it alone for a 5 minutes (I took a shower during this time). Cook just long enough for the peas to soften a bit so that the skins will puree more smoothly, but not so long that the peas turn that sickly yellow-green color. Turn off the heat and remove the lid to cool, then puree with an immersion blender and adjust seasonings. Serve hot or cold!

The soup will be this color! 

(Flowers at the summit of Sleeping Beauty mountain by Lake George, NY.)

Food blogger raids the fridge

Even a food blogger gets tired of cooking sometimes.

At 26, I figure that "board studying" will be my last legitimate opportunity to move home and have my parents take care of me, so here I am. My dad has been doing all the cooking, while my skills have been relegated to dessert. And what better time to apply my creativity to leftovers?

The routine is I come down, raid the fridge, then retreat to my room with the spoils. On Friday night my dad made buttermilk fried chicken from scratch; underneath the batter, the leftover chicken is juicy and briny. Leftover chicken is perfect for Asian-style salads: served cold with sesame noodles or over spinach with a simple dressing.

Leftover chicken salad:

• piece of cold chicken, skin and bones removed, cut into bite-size pieces
• chopped fresh spinach
• chopped radishes
• toasted sesame seeds
• dash or few drops each of rice wine vinegar, sesame oil, and soy sauce

Toss and enjoy!

Study set-up

Protein for boards

Ever notice how food blogs (see links to the right, along with the NY Times Recipes for Health column) feature vegetarian dishes heavy on grains and legumes, while restaurant cookbooks (like Mario Batali's, which I have in my kitchen) have you do as little as possible to more expensive ingredients: cheese, roasted fish, meat, etc.? (The more you can spend on ingredients, the less you need to do to them.) Some of this is motivated by health, no doubt, but I also suspect that it's financial. Bloggers have themselves and their audience in mind: poor, busy young adults like myself. Grains and legumes are way cheaper than meat and cheese.

As someone who has bought into the mostly vegetarian, high fiber, lowish salt and lowish fat way of cooking, I occasionally wonder if it always makes sense. I've been running longer distances again lately and came home the other night craving some solid protein. I switched over to turkey burgers for the week: nothing fancy, no seasoning, not blog-worthy, but satisfying and delicious (with some cheese, freshly ground black pepper, and spinach). No doubt some Americans eat too much protein, but trying to get your day's protein entirely from sources less dense in protein per calorie can be a challenge.

Mix it up.

Microwaveable turkey burger kit (school lunch):

Pre-cooked turkey burger, cheddar cheese, black pepper, 

homemade whole-wheat English muffin/bun, tomato slices, bed of spinach.

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!