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!

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

Cold-weather vegetarian

To continue the theme of beautiful vegetables, last week I bought some baby eggplants and large cherry tomatoes, which have been almost too beautiful too cook. Before putting them under the knife, I took some still life shots.

Like brussels sprouts, roasted tomatoes and eggplant can be made to feel hearty, satisfying that wintry desire for heavy food, without the meat. I roasted these veggies with garlic: the fragrance filled my apartment, and a taste on the spoon revealed tangy, naturally sweet-and-sour tomatoes that melted and coated the eggplant.

Roasted tomatoes and eggplant:

• several baby or japanese eggplants, sliced in half; or one large eggplant sliced about 1-cm thick
• cherry or regular tomatoes, sliced in half
• several garlic cloves, skins on
• olive oil
• salt and pepper
• couscous or pasta
• feta or goat cheese and/or fresh herbs as garnish

Preheat the oven to 325 or 350 degrees. In a large baking dish, toss the eggplant, tomatoes, and garlic with the olive oil, salt, and pepper. Roast 30-45 minutes, tossing occasionally and checking frequently to make sure the tomatoes don't burn. You may want to turn down the heat if you find the tomatoes are cooking faster than the eggplant. 

Serve on top of couscous or tossed with pasta. You may want to add crumbled feta or goat cheese and fresh herbs such as mint, cilantro, or basil for additional flavor.

Tomato sauce in less time than it takes to boil water

Are you the kind of person who, like me, dances around the pasta pot waiting for water the boil, munching on uncooked noodles?

Sometimes I pretend that I am going to memorize flashcards during this waiting period, but instead I end up tiptoeing over to the pot every few minutes "just to check on it."

Well tonight I learned that by being extra lazy, it is possible to make a delicious fresh tomato sauce during this awkward gap between stove-lighting and pasta-box-emptying.

Whole cherry tomato sauce (two servings):

• 1/2 pint cherry tomatoes, washed
• teaspoon-ish butter
• teaspoon-ish olive oil
• 2-3 cloves garlic
• dash white wine
• few sprigs parsley
• chili flakes, black pepper, salt
• parmesan
• 1/2 pound pasta

Judges, start your timers! (Turn on your pot of pasta water.)

Heat the butter and olive oil on high heat. Peel and mince the garlic and add to the pan, cooking for a minute. Dump in your cherry tomatoes. Dash your white wine over the top. Push everything around with a wooden spoon. Stab the cherry tomatoes with a fork, then smash them with your wooden spoon. Add water as needed. Cook until sauce thickens, without burning in the pan. Mince the parsley, toss in along with seasonings, and turn off the heat.

Is your water boiling yet? (Why yes, it just started to boil!)

  

Feel free to study flashcards as you wait for the pasta to cook...

Vegan interlude

Walking down the hospital halls after neuro, every twitch, twist of the neck, or odd posture appears a nail to my hammer. Neuro lectures are captivating but depressing, largely because right now we can treat only the symptoms but not the underlying cause of several diseases. However, everything we can treat is breathtaking, and soon we will have cures for more diseases! (Hopefully.)

In the land of food, it seems that fall in upstate New York is an excuse for spice-themed binge eating: s'mores to "reward" hiking, cider doughnuts to "reward" apple picking, apple and pumpkin desserts, etc. In between all this sugary indulgence, it's nice to have a few items that are hearty and comforting but healthy! Last weekend I made a kitchen-sink vegetable soup; this week I went the raw route.

"Massaged" kale salad (I don't believe in pampering vegetables, but the brief effort here pays off. Recipe took all of two minutes!)

• 1/2 bunch dino kale, stems removed, sliced crosswise into ribbons, and washed
• 1/2 or 1 avocado, cubed
• handful of cherry tomatoes, washed and sliced in half
• small handful of almonds, toasted and chopped
• balsamic vinegar
• olive oil
• pinch of salt (apparently this helps to soften the kale)

In a large bowl, dress the kale with oil, vinegar, and salt. Wash your hands and then massage the kale, grabbing handfuls at a time and rubbing them together between your fingers or palms. (Surprisingly therapeutic!) After a minute or two, the kale will be noticeably softer. Toss in your other ingredients! The buttery, nutty avocado makes this quite comforting despite the lack of cheese or bread.

Transformations II

The other night a friend from home asked me what we're studying these days. "Blood disorders--like bleeding and clotting--and leukemia and lymphoma," I replied. "Blood clots--ew!" was his response.

His reaction reminded me that not too long ago I couldn't have a conversation about a blood clot without feeling sick and faint. And yet without realizing it I've completely changed. We've zoomed in on clots, so that I now think about how you build a clot and how you take one down, almost as if it's construction work. What are the heritable or acquired diseases or drug interactions that impact clotting and bleeding? There's so much more than "clot--gross!" Thank goodness.

For many years I thought eggplant was gross. I didn't like the flavor, texture, or anything about it. Now I love how it's soft and meaty--a great vegetarian substitute!

Barley salad with fall vegetables:

• 1/2-3/4 cup barley, cooked in a rice cooker with 2:1 water:barley
• 6 chard or kale leaves, steamed and chopped
• 1/2 or 1 slice small eggplant, sliced 1-cm thick and roasted in the oven (I used leftovers from this sandwich that I did end up having time to make)
• few cherry tomatoes, sliced small
• feta cheese to taste
• olive oil to taste, about 1 teaspoon

Cook ingredients separately and toss together with olive oil. Enjoy warm or cold!

 

Neither of you scare me now!

Fried green tomatoes

Even I sometimes run out of time to cook. But this doesn't mean that I'm not still thinking about food, that the green tomatoes my friend and editor gave me aren't calling out to me from the fridge. I had some great plans for these beautiful tomatoes before it struck me just how little I knew about chemotherapy for leukemia and lymphoma.

Here is what I would be cooking if I were cooking.

Fried green tomatoes:

• green tomatoes
• 1 egg
• flour
• breadcrumbs
• canola or olive oil
• salt and/or parmesan

Arrange three shallow bowls or plates side by side: flour, then egg, then breadcrumbs. Slice large tomatoes into 1-cm slices or cherry tomatoes in half. Dip in flour, then a beaten egg, then breadcrumbs. Heat a generous layer of canola or olive oil in a large frying pan; when hot, lay the tomatoes out side by side in the oil. Fry at high heat until crisp on one side, then flip over (using two forks) and fry the other side. Cool on a paper bag or paper towels. Sprinkle with salt or parmesan cheese and serve right away. I'm salivating just thinking about it.

Roasted eggplant sandwiches:

• 1 small eggplant
• 1 tomato
• feta cheese
• bread or pita
• olive oil, salt, pepper

Slice the eggplant and tomato 1-cm thick. Place the eggplant slices side-by-side on a baking sheet and brush with olive oil, salt, and pepper. Bake at 400 degrees for 5-15 minutes, until soft or crispy (as you like it) but not burned. More oil = crispier eggplant. Toast your slices of bread and create a stack of eggplant-feta-tomato slices. Drizzle with olive oil if you're feeling really luxurious. Ah, the combination of textures and sweet-and-sour flavors, mm!

I did toss these into a quick stir-fry -- and yum!

Tricks for when you run out of time to cook: keep frozen soups, chili, ravioli, even prepped veggies in the freezer. Try stir-fries. Stock your fridge with snackable fruits and veggies and proteins such as yogurt and cottage cheese. Hunker down. But you know all this!

Don't stress eat!

Last night I had one of those horrible nights where bacteria- and virus-laden nonsense raced through my head as I lay in bed, in powerful mockery of my lame attempts at meditation and mind-clearing. Once an hour this was punctuated by becoming fully awake, getting up, and then laying down once again to the same as soon as my head hit the pillow.

I've been trying to do everything right, too: yoga, running, studying, dinner out, tea with a friend, reading David Sedaris stories before bed. Despite all this, the stress of having an exam every two weeks is overpowering.

So today I am allowing myself to bake a pie, make a fresh salad for lunch, and then resume studying. I will beat these pathogens!

Simple Greek salad: one chopped tomato, crumbled feta, some chickpeas, toasted almonds, romaine lettuce, oil and vinegar dressing. Each bite gives a satisfying crunch!

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!

+ =

Pepian

So, what did we cook?

The request (again, this dinner party was not my idea), was for pepian, the traditional Guatemalan stew made with chicken and vegetables. I think of it as the Guatemalan equivalent of mole: a thick sauce with many ingredients -- sometimes with chocolate. We served this with salad (including avocado), a basil salad dressing, seasoned rice (with diced onions, carrots, tomatoes, and cilantro), and tortillas. The plating was beautiful, per Paulina's experience at the luxury hotel.

Pepian (or, Guatemalan chicken soup):

Amounts not exact

For the soup:

• 1 chicken
• several potatoes
• several carrots
• 1 chayote or small squash

For the sauce:

• 1/4 head of garlic
• 1 dried ancho chili
• 1 dried red chili
• 1 cinnamon stick
• 1/2 cup sesame seeds
• 1 cup pepitas (shelled squash seeds)
• 1 tomatillo
• 5 plum tomatoes

In a large pot, get a chicken soup going: cover the chicken with water, add salt, and boil. Peel and chop the potatoes, carrots, and chayote into large pieces.

In a pan that you don't mind burning (like a cast iron), begin browning the tomatoes on all sides. Blacken the skin -- you will discard it later -- and cook the tomatoes through. In another frying pan, begin browning the seeds. Slice each chili pepper lengthwise to flatten -- discard the seeds if you don't want a spicy sauce; keep them if you do. When the seeds are toasted, replace them with the garlic, then the chili peppers, then the tomatillo, as you have space. You will toast all of the sauce ingredients separately before blending them together. When they are cooked through and cool, slip the skins off the tomatoes. In a food processor with some water, blend the sauce ingredients together.

When the chicken is cooked and the soup has flavor (see tips for basic chicken soup here), remove the chicken to prepare for serving (take the meat off the bones and shred it with your fingers). Add the veggies and your pureed sauce to the stock and boil until the veggies are cooked through. Add the chicken back in to serve. Season to taste.

Serve with cilantro, lime, and avocado, if you like. This dish can be made veg by adding the sauce to a vegetable broth.

Paulina toasting sesame seeds and tomatoes

Plated dinners for 20

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.

Learn something new every day

I think diabetes is fascinating! Yesterday's post just skims the surface. As I learned today, chronic hyperglycemia causes all sorts of damage over time, yes. But in the short-term, hyperglycemia is barely felt -- it's the ketoacidosis that brings people into the ER. Basically, since glucose stays in the blood instead of getting into cells, cells rely on alternate forms of energy. A byproduct of these "alternative energy sources" are molecules (ketone bodies) that make your blood more acidic. Patients come in breathing rapidly to clear the acid by getting rid of carbon dioxide. Only then do they notice that they're dehydrated (dangerously so) due to the hyperglycemia.

For tonight's dinner, I give thanks to my pancreas. After many years of trying, I finally made tomato sauce that tastes just like my dad's. It's sweet without adding sugar or wine and so simple that all you taste are tomatoes and spaghetti. There's nothing daunting about it, only you can't skip on the butter.

Simple tomato sauce (makes ~2-3 servings):

• 3 cloves garlic, peeled but whole
• 1/2 onion, left whole (you can peel the outer layer or not, up to you)
• 1/2 box or 1 small can of peeled tomatoes (whole or crushed or pureed -- my favorite brand is Pomi, which comes in a small box instead of a can)
• 1 tsp butter
• 1-2 tbsp olive oil

Melt butter and olive oil in a pan over medium heat, then add the garlic and onion and leave it alone for few minutes. The garlic and onion should begin to soften and smell fragrant. Before they brown, add the tomatoes and simmer all together. If necessary, add some water to the pan to keep the sauce from drying out or burning. Simmer under a lid on to cook the onion through. My dad usually discards the onion, but I like to salvage it and eat it sliced with my pasta. Keeps the vampires away.

I may have mentioned this before, but I've learned to undercook the pasta and finish cooking it in the sauce with about 1/4 cup of the pasta water added back in -- this way the pasta absorbs the sauce as it finishes.

Babies & eggs

One of the things that I love about science is that you can be immersed in biochemistry and anatomy when suddenly you stumble into something very moving, and you realize that you are at the crux of life and death. Take this preface to a lecture on growth hormone, delivered by a very old man with a thick Czech accent:

When you get to the delivery room you will understand what a miracle it is that from a fertilized egg such a cute human being is born, and you will be touched by the expression in the eyes in the mother when she sees the baby for the first time.

This week a quiet wave of concern spread among some of the female med students as we were subjected to several lectures about how fertility diminishes with age -- beginning in the late 30s and completed by the early 40s -- with few words of comfort or encouragement about our own futures, given the years of training we have ahead. We had to remind ourselves and each other that many of our mothers had us at those ages; but it would have been nice to hear such reminders from some of the women doctors at school. Instead, one professor (a PhD) told us that her friend in med school had been told "better freeze your eggs now!" -- the underlying assumption being that this was a somewhat offensive warning, but it wasn't really contradicted in the retelling. I guess we should worry less about ourselves and more about our patients: don't take this stuff so personally, that is.

I was just sent a book in the mail about med school and motherhood called This Won't Hurt a Bit (And Other White Lies): My Education in Medicine & Motherhood. The author, Dr. Michelle Au, had a baby during residency. She too kept a blog in med school; she is now an anesthesiologist in Atlanta. Inspiration to us all.

Scrambled eggs (get it?) with scallions and tomatoes:

• 2 eggs, beaten
• 1/2 chopped tomato
• 1-2 scallions, chopped
• 1 clove of garlic, chopped
• dash canola oil
• dash soy sauce

Heat the oil, add the garlic and tomatoes, and cook until soft. Add the eggs, scallions, and soy sauce. One of my favorite meals from the summer I spent in China:

"I cannot responsibly answer this question"

My parents, who are both clinicians, of different sorts, frequently debate how much knowledge one should have before suggesting an answer to a question. There are certain questions (such as, "Daddy, why are there tides?") which they historically refused to answer, and others on which they are happy to speculate ("why haven't we passed gun control yet?").

I have one professor, in his late 70s or early 80s, who seems to revel in the phrase "I cannot responsibly answer this question." Some of my classmates seem frustrated with this answer, perhaps supposing that the professor would be able to answer the question responsibly if he kept up with the latest research. I think, however, that he's trying to be a role model for us, to discourage us from BS'ing when we don't know an answer -- the consequences in medicine, after all, are significant. Yet the key difference is that this elderly gentleman has the confidence and authority to profess ignorance -- whereas we, still unproven and largely incompetent, are going to be spending the foreseeable future getting asked "pimp questions" (pop quizzes) to which we will have to come up with reasonable answers on the spot. You can see how bullshitting seems tempting.

What do I know a little bit about? Cooking. Running at a nice easy pace. Tidying up the apartment. Etc. It's nice to have a few arenas where I feel some confidence, to which I can retreat for a few hours when the facts being thrown at me seem overwhelming.

Here's a nice Sunday evening supper.

Roasted eggplant parm (also simplified from Mario Batali):

• 1 eggplant, sliced into strips or rounds about 1/4-inch thick
• 1 ball of fresh mozzarella, also sliced thin
• tomato sauce, or:
• 1 can tomatoes
• 1 clove garlic, chopped
• few tbsp olive oil
• olive oil
• salt & pepper
• basil optional

Preheat oven to 400 degrees. Arrange eggplant slices side by side (not overlapping) on a baking sheet, then brush each one with olive oil and sprinkle with salt and pepper. Flip slices over and repeat on the other side. Roast in the oven for 10-20 minutes, until eggplant is soft (some pieces may be crispy) but not burned.

If you are making your own tomato sauce, heat the olive oil in a pan, add the garlic, cook for a minute or two, then add the tomatoes and simmer for a few minutes until the eggplant is ready.

Layer eggplant: eggplant-sauce-cheese (and throw basil in there if you like) in a smaller pan and bake at 300 degrees until mixture is bubbly. Serve with bread or pasta to mop up the sauce.