Mind. Blown.

Over the past 24 hours, I was following this recipe, adapted from Sullivan Street Bakery in NYC, which I know makes fantastic breads. Blindly following along (nearly exactly, except that I used two smaller pots instead of one large pot at the end), I had no idea that I would wind up with perfect baguette. The crust, chew, and flavor of this loaf are on par with the best baguette I've ever had. If not for the shape and the fact that it needs an ounce more salt, it would be indistinguishable from the best. I can't recommend the recipe highly enough!

And it takes next to no time, other than the time needed to wait for the bread to rise (18 hours), then rise again (two hours), then bake (30-60 minutes). No kneading. Perfect for a busy med student!

Not to be gross, but after seeing yeast infections all week, it's nice to know that something good can from from yeast as well.

The top crust

The bottom crust

First slices (now gone)

Another perfect day

Another three-hour hike to San Marcos on the ridge along the lake, this time with two pleasant women from the Iguana, the hostel down the road. They responded to my "personal" looking for fellow hikers and we became temporary friends for a few hours. Excellent company.

Then of course my day was made in San Marcos because I went grocery shopping! For my last week: an eggplant, a chayote, a cucumber, three small white onions, five plum tomatoes, three avocados, a pineapple, a small papaya, two eggs, two mini corn tortillas fresh off the grill and eaten hot, and a bag of strawberries. All for under $10. My lucky day! The egg shells were hard when I cracked them, with dirt on the outside and orange yolks inside. Fresh!

Before lunch I went for a swim in the lake and then sunbathed and read on the dock. Then lunch, turning over of the Sullivan-Street-recipe bread I've had rising since last night, and now an iced coffee and back to reading on the balcony! I will report back on how the bread turns out. High hopes.

I object to calling it paradise due to the poverty and poor sanitation and lack of education and jobs and diseases the locals are facing: but as a visitor it's pretty nice.

Oh, you wanted to hear about something medical?

Occasionally, I enjoy beginners luck, and I am fooled into thinking that I can go from not having a skill at all to having that skill right away. Instead, I am reminded that most things take practice, and that improvement is incremental (usually with a few steps back). 

This has been my experience with learning the pelvic exam, which I have been practicing under supervision on patients over the past three weeks. I dread and look forward to giving them, because I know that I am causing the patient more discomfort than she would experience at the hands of my attending, but I am also eager to learn this skill that I will eventually need to have. I feel a great deal of empathy for the patient when it comes to the physical exam.

The stakes are a bit higher than with home cooking, no?

Vegetarian two-pot supper

Sometimes you want to eat locally, but you don't really want to eat locally -- know what I mean? I don't really like rice and beans and tortillas unless they're well seasoned or served with a lot of cheese. But I want to be in touch with my surroundings and the people around me. Besides which, I'm limited by what's available in the grocery stores.

Tonight I decided to make rice and beans (both of which I happen to like in general) part of the meal, rather than the center of the meal. I cooked up two vegetables, separately: first chayote with red onion, garlic, and ginger; then large green beans with garlic, ginger, and red pepper flakes. Next I reheated my black beans, unseasoned, allowing them to soak up the flavors in the pan. In a separate pot I steamed some rice. I served it all in a bowl with cilantro, mimicking an "Asian rice bowl." Variety of flavors and textures, and pretty healthy!

Vegetarian feast

In the summer, vegetables are plentiful, but I find that it's not always obvious how to get the most out of them. Two summers ago, when I had a CSA share and more vegetables than I knew what to do with, I found myself making some pretty inedible vegetable soups and longing for more substance. In previous years, I've been enamored with the same corn, tomatoes, and salad every night. Here in my small town in Guatemala, vegetables are fresh and abundant, meat is scarce, and staples such as rice, beans, and flour are cheap and easily available.

I think I've figured out what to do to: buy whatever looks good; cook most vegetables separately with onion or garlic plus one other spice; supplement with a simple starch or protein. Cooking separately keeps flavors fresher and makes for a more varied and interesting meal.

On Saturday night, I shared a vegetarian feast with some friends. Many people to chop and to share in the variety of dishes, all freshly made from scratch with a bit of local flavor:

• smoky eggplant dip
• guacamole (recipe below)
• sweet potato chips (recipe below)
• white bread
• cheese and butter for my German friends
• salad consisting of chopped tomatoes, carrots, and zucchini (the latter sauteed first with onion in a bit of butter and oil before tossing with the other raw veggies)

A feast!

Sweet potato chips and eggplant dip 

Freshly baked bread

Simple guacamole:

Mash together avocados, lime juice, one clove or less of chopped garlic, salt & pepper. Fewer ingredients brings out the flavor of the each.

Sweet potato chips:

Peel sweet (or regular) potatoes and slice 1/2 cm thin. Toss in olive oil, salt & pepper, and an herb (such as rosemary or thyme) then spread out on a baking dish so that pieces are not overlapping. Bake at high heat until pieces are crispy, turning each piece over to cook on both sides. Recipe courtesy of Nick Haas.

Healthy tacos

Today we worked a long day, for here anyway -- we didn't get home until 6pm. Seeing patients nonstop for the first time in our careers is a novel and tiring experience. My housemates were on the verge of going out to dinner when we decided on an impromptu taco party. In this case, many hands make light work, and being limited to what we had in the house made for healthier and more delicious tacos than the norm, I think.

Our tacos were meatless, and I did not miss the meat one bit (more room for other stuff)! Here are some suggestions for getting more punch out of less salt and fat:

• sauté black or pink beans with garlic, half a chopped onion, cumin, paprika, and a dash of white vinegar
• pan roast corn by sautéing in a frying pan until browned, with or without chopped onion
• pan roast a mix of chopped vegetables, such as garlic, onion, zucchini, and green beans, until slightly caramelized but still crunchy (I did not add any water to the pan this time, and cooked for just a few minutes)
• serve with lime slices, cilantro, scallion, and hot sauce

I find that the spices, acid, and roasted flavors add so much more than beef, refried beans, and salt ever do. We also had avocados and a small amount of shredded cheese on hand, for that fat and salt!

Tacos are great for group dining because they have many components to cook, are fun to assemble, and timing doesn't matter (it doesn't matter if the food is served lukewarm). I cooked each component in the same frying pan, one after the next, making for fewer dishes.

So much time

A little lesson in community health: the patients here mostly come in complaining of GI distress, rashes, genital discomfort, or colds. Apparently, the main causes of GI distress are ascaris (worms), giardia, or (rarely) amoeba (I don't actually know that that means). The rashes are either fungal, scabies, or reactions to sun or use of laundry detergent as hand soap. The genital issues are fungal infections or STDs. And my "attending" claims that the colds are bacterial in nature.

The main social issues underpinning these complaints, as they have been explained to me so far, are 1) public sanitation related to food and water, and handwashing, 2) personal sanitation as the weather is damp and clothes are washed and changed infrequently, and 3) sexual behaviors aka men cheating on their wives.

Well, those are my oversimplified observations at the end of week one. Yesterday, I got home at 1pm, and having already exercised, and not feeling like reading, I decided upon a cooking project.

Butternut squash ravioli:

This recipe is really from the anti-med school cookbook, because it is relatively time-consuming and benefits from a pasta machine, which is a bit obscure as a household item. However, the ingredient list is short, simple, and cheap, and overall the process took no longer than 45 minutes. If you've ever attended a Chinese dumpling party, why not try an "Italian dumpling party"?

Filling

• 1/2 butternut squash (should make 1 cup mashed)
• 1 clove garlic, chopped
• 1 tbsp butter
• handful of fresh or dried thyme, sage, or rosemary, stems removed and chopped
• salt and pepper
• ~1/2 cup grated parmesan, or to taste

Dough

• 3 cups flour
• 4 eggs
• 2 tbsp olive oil
• dash of water as needed

Slice the butternut squash in half horizontally, and then again in half lengthwise. Scoop out the seeds and place face up in a large baking dish. Pour in 1/2 cup of water to surround the squash. Bake at ~400 degrees, adding more water as it evaporates, until a knife or fork slices in easily. Cool in the fridge.

Combine all the ingredients for the dough, kneading until the consistency is solid and stretchy. Roll into a ball and cover in plastic wrap, in the fridge for half an hour.

Using a sharp knife, peel the squash and cut it into 1" cubes. Melt butter in a large saucepan and add the garlic. After a minute, add the squash. Saute until completely soft, adding water as needed to keep from burning. You should be able to mash the squash easily using just the back of a fork. In a large bowl, mash the squash, herbs, salt and pepper, and parmesan. Return to the fridge.

Roll the dough out on a floured surface, using one fist-sized ball of dough at a time while leaving the rest in the fridge. If you have a pasta machine, follow those directions. Otherwise, roll the dough as thin as you can get it with just a rolling pin. Using a glass or round cookie cutter, cut out rounds. Place 1 tsp of squash filling into a round of dough, place another round on top, and knead the edges together to seal. You may need to wet your fingertips with water to get the edges of dough to seal. Store on a floured surface under a lid to keep ravioli from drying out.

Cooking time will depend on how thin your dough is. My ravioli were as thick as periogies and took at least 20 minutes to cook through, although the recipe suggested 12-15 minutes. I served mine with a simple tomato sauce and some freshly grated queso duro.

Overall a success, and now I can say that I've made ravioli from scratch!

Recipe simplified from: here for the filling and here for the dough.