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!

Staying fresh in December

It's that time of year when the heavy comfort food is getting old, the number of layers one needs to wear to stay warm indoors sizeably increases one's bulk, and the necessity of end-of-year productivity limits physical activity. In addition, I'm on a running hiatus right now not due to weather but due to exacerbation of an old injury -- I don't want talk about it.

So how to eat in a way that helps you to feel fresh, despite the chronic dry skin and static? I think citrus helps, but I'm not yet ready to bid goodbye to apple season. So I tried this quite simple salad, which is not exactly seasonal but is also not too appallingly unseasonal either (no miserable unripe tomatoes!).

Fresh winter salad:

• butter lettuce, arugula, or both
• radishes, quartered
• toasted walnuts*
• goat cheese (optional, I skipped it)
• juice of half a lemon
• olive oil

Toss all together and dress with lemon and olive oil. Serve with a hard boiled egg, cheese on toast, a yogurt, etc. for a more substantial meal.

*I've been craving walnuts since their health benefits were all over the yuppie and medical news last week.

Having escaped maternal rejection

It was a wake-up call to recently find myself scribbling "what happens to sperm not ejaculated? do they die?" without a concern in the world other than whether sperm left in the epididymis are phagocytosed after a few weeks and by what. Makes you want to take a hard look in the mirror at what you've become.

Yesterday we learned that maternal white blood cells can recognize fetal blood cells as "foreign" (if they happen to come in contact) and may then develop antibodies against them. The mother "mounts an immune response" against the developing fetus in her uterus -- leading to problems down the road. "The ultimate maternal rejection," as my professor put it.

But my mother loves me, so why not post a simple recipe that she taught me?

Haroset (technically a dish for Passover, but such a good snack...)

• 2 large green apples
• 1/4-1/2 cup walnuts
• ~1 tbsp cinnamon
• ~1/4 red wine (or grape juice; a smaller amount of balsamic vinegar would probably work too)

Chop the apples into 1-cm or less chunks. Roughly chop the walnuts (untoasted). Toss all together. Makes a great snack! I confess that I brought some to school for lunch, wine and all.

Walnut and zucchini pasta

There's nothing like studying the biochemistry of omega-3's to whet your appetite for some walnuts and flax seeds. Combine that with a few nutrition lectures on PUFA's and MUFA's (poly- and mono-unsaturated fats) and you've got yourself a meal.

As it turns out, cells build fatty acids as long saturated molecules like this:

Then process them by de-saturating some of the bonds (adding a double bond) to make a variety of different molecules used in the body:

But cells can't just add a double bond anywhere they'd like: in particular, they can't add double bonds 3 or 6 carbons down from the far end. Thus, we can't make omega-3's or omega-6's ourselves, but we still need them, so we have to acquire them through the foods we eat!

Salivating, I know. But don't get me started on saliva, I've just finished studying that too...

The following recipe is not particularly original (see Mario Batali's ambitious Pansotti -- ravioli -- with Walnut Sauce and Smitten Kitchen's zucchini strand spaghetti) but it's so easy and delicious that every busy cook should be making it.

For one large serving:

• 1/8-1/4 cup walnuts, toasted (good source of omega 3's)
• 2 cloves garlic, minced
• 1/2 zucchini or 4 baby zukes, sliced into rounds
• 1/4 box of pasta
• olive oil (good source of monounsaturated fat, which lowers LDL cholesterol)
• parmesan
• red pepper flakes
• salt & pepper

Prep the vegetables as you boil the pasta water. Heat the olive oil in a frying pan and add the pepper flakes and garlic for about a minute, then zucchini rounds. Cook for just a few minutes, until the garlic is toasted and the zucchini is slightly soft but still has some crunch. Cook the pasta until just before it's ready (still fairly al dente), then drain. Add the pasta and walnuts to the frying pan and toss everything for 1-2 minutes until the pasta is to your liking. Serve with salt, pepper, and Parmesan.

 

A pre-spring salad

This winter I have tried to learn the physiology of the nephron as well as how to cook root vegetables, which are cheaper and less egregiously out-of-season than tomatoes. The nephron is a series of parallel tubes in the kidney that filter electrolytes and manage the pH and osmolality of the blood. Root vegetables are starches that grow in the ground. Guess which endeavor met with more success.

Today's lunch:

• 1/2 beet, peeled, steamed, and sliced thin (prepped this over the weekend to have on hand)
• 1 carrot, raw, peeled and sliced thin
• Handful of quinoa (leftover from a Seder last night -- but easy to cook just as you would rice -- my roommate has a small rice cooker that she allows me to commandeer)
• Toasted walnuts, about 1/4 cup or less (a treat! -- also Seder leftovers)
• Arugula
• 1/2 lemon

I pack the quinoa, beet, carrots, and lemon in the bottom of a tupperware with the arugula on top, keeping the walnuts in a separate container to keep them crisp. At lunch I'll squeeze the lemon over everything and toss it all together. The lemon cuts the bitterness of the arugula perfectly.

Today I'll be eating it during an advocacy and service learning meeting on how to do a community needs assessment. What are the needs in my community? What is my community?