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.

One year blog birthday!

Since its inception, this blog has received over 7,700 hits (thanks mom and dad!); been picked up as a regular column for in-Training, a peer-reviewed medical student journal (thanks Ajay and Aleena!); and gained acceptance to an AMSA Medical Humanities conference. It has also introduced me to peers passionate about food and others who work in nutrition. Over a year when I've spent many hours alone studying material that departed from my previous schooling, this blog has connected me to others and to my past self, who was interested in writing, public health, and cooking. Thanks to all my readers!

I've also had friends tell me that they "don't cook" or that they try to cook but that the results don't taste good. A friend started a mock "medschoolfailblog" in which he would send me photos of dinner disasters. My two cents is that learning to cook is a matter of practice and becoming familiar in the kitchen. I grew up sitting on the countertop or helping to chop vegetables while my dad cooked; this gave me and my brother an incredible level of comfort in the kitchen. On the other hand, my first cooking experiments in high school were failures: inedible Italian egg drop soup (canned broth does not equal chicken soup), tomato sauce that would not taste as good as my dad's (I learned to give in and use butter). Over several years of practice and simplification (fewer ingredients, fewer random spices), my cooking has gotten better. There's still the occasional bitter or bland or painfully weird tasting dish: I recently got overambitious with a cold rainbow carrot-cumin-quinoa-chickpea salad that I refused to accept as inedible and which I attempted to save by pureeing into a sweet tasting hummus before tossing it into the trash.

So tonight's post has no recipe but I encourage you to cook something, and if it tastes good, to let me know!

Carefully documented, beautiful looking, 

totally inedible rainbow carrot-cumin-quinoa-chickpea salad

Envy-of-the-co-op salad

There are musicians who can play any song by ear. I don't have an ear for music, but I do have a palate for spices and an average ability to read ingredient lists. I also don't really like to pay for prepared food unless it's really good, but occasionally I treat myself and I try to use these opportunities as inspiration for new recipes. A few weeks ago I tried a great tofu-and-quinoa salad (sans spinach) from Albany's Honest Weight Food Co-op; that salad provided the inspiration for tomorrow's lunch (and tonight's late night snack).

Spinach, quinoa, and tofu salad:

• ~1/3 block firm tofu
• 1/2 cup uncooked quinoa, prepared in a rice cooker
• raw spinach
• 1 carrot
• scallions (few)
• cilantro (handful)
• suggested seasoning for tofu, to taste, using just a drop or a pinch each: canola oil, sesame oil, soy sauce or black vinegar, five spice powder, spoonful of sesame paste or peanut butter (alternate tofu seasoning with fresh spices suggested here)
• dressing: dash of sesame oil and soy sauce

You can either press and marinate the tofu as I do here or, more simply, cube the tofu and toss it in your sauces and spices directly in a pan before baking at 400 degrees. Bake about 10-15 minutes, or longer for crispier cubes. Meanwhile, wash and chop your spinach, peel and grate the carrot, and chop the scallions and cilantro. Once the tofu is done to your liking, toss all ingredients together and dress sparingly with sesame oil and soy sauce, being wary of overdressing the salad. Makes two "side" salads or one large salad.

Biochemistry of stress eating: Part I

I have always thought of stress eating as a pyschological phenomenon: snacking as avoidance, food as comfort. This may be true, but it doesn't fully explain how truly hungry I felt just after the renal exam last week, even after the need to procrastinate through eating had gone away.

According to a 2007 review article in Nutrition entitled "Relationship between stress, eating behavior, and obesity," I am not alone:

The effect of a major stressful event (school examination) on food consumption was investigated in 225 male and female high school students. Total energy intake was significantly greater on the examination day when compared with the stress free day (2225 versus 2074 kcal).

In a large cross-sectional study with 12,110 individuals, greater perceived stress was associated with a higher-fat diet. Individuals in situations of greater perceived workload and perceived stress reported increases in total energy and fat intake compare with periods of low workload and low perceived stress.

But why? Is stress eating purely psychological, or can we find a biochemical explanation?

One of our renal workshop cases got me thinking: cortisol, a stress hormone, causes transient insulin resistance. For instance, diabetic patients on insulin need to increase their dose under periods of stress (illness, surgery, psychosocial) to avoid hyperglycemia. Could the stress of exam anxiety be enough to affect glucose metabolism through cortisol release? Would that impact appetite? What other effects could cortisol have on appetite?

Cortisol mobilizes energy stores -- glucose from the liver, protein and fat breakdown. Perhaps we eat to increase or replace these nutrients. So does cortisol affect appetite directly? Unfortunately, I haven't been able to find conclusive data, either online or in old lectures. According to a 2014 study accepted for publication in Psychiatry and Clinical Neurosciences ("Plasma levels of leptin in reproductive women with mild depressive and anxious states"), stress in humans has been associated with decreased, increased, and normal levels of leptin -- a hormone that inhibits appetite.

How does this...

Source: 2007 Nutrition review

Lead to this?

Part II -- Nutritionists in my audience, how can we improve satiety under stressful situations? Foods to eat or avoid? Please write in and let me know!