OB Cookie

Perky Poached Salmon with Pink Pisco Sour Sauce

noreply@blogger.com (Elizabeth) — Sun, 29 Jan 2012 22:13:00 +0000

Somehow the other night I inadvertently made an all pink dinner. Sometimes the only things you have in your fridge are salmon, beets and Meyer lemons. Forget lettuce or carrots. But after last weeks’ all brown dinner, which is a frequent specialty, fluorescent pink looks great on the plate. This would be a great meal for Valentine’s day.

I loosely based this meal on Peruvian cuisine. I went to Peru in 2005, alone. I'm not sure how well advised it is to travel solo in South America as a 21 year old girl, but I’m still alive. I spent the afternoons wandering around Cusco conversing with a textile shop owner, and wandered around Machu Picchu with a wicked cold, warding off death as I admired the beautiful stone structures.

My pisco sour sauce derives from the tangy sweetness of a pisco sour cocktail, reduced with red onion and a splash of salt, for a southern hemispheric take on sweet and sour sauce. Between Peru and Chile, pisco, a distilled grape liquor, abounds. Family gatherings and fancier restaurants offered a pisco sour, a cocktail frapped with egg white, sugar, lemon juice and pisco. After living in Chile for a year, I tried pisco mixed with just about everything, a piscola or pisco and coke was my favorite.

I poached the salmon in olive oil, resulting in a delicious, delicate fish. It is a treat because it requires about a cup of oil per fish fillet. The oil cooks the fish at a low temperature allowing the fish to retain every drop of moisture without overcooking it. I accompanied the fish with beets and quinoa which absorbs aberrant olive oil and sauce.

Pisco sour sauce

1/2 small red onion thinly sliced

1 tbsp butter

Juice and zest of 2 Meyer lemons

1/4 cup sugar

1/4 cup pisco

Tsp salt

Olive oil poached salmon

1 cup oil per fillet of salmon

Wild salmon fillets

For the sauce. In a small saucepan over medium heat, melt the butter and sweat the onions, about 5 minutes. Add lemon juice and zest, sugar, pisco and salt and reduce until thick, about 20-30 minutes. The texture should be similar to syrup.

For the salmon. Over low heat in saucepot large enough to fit the fish, add the oil and heat until warm to touch. You do not want to boil the oil or overheat it, just simply warm it. Add the salmon. Allow to cook 15-25 minutes until the surface of the entire fish appears white. Remove the salmon and the excess oil.

Stout Braised Short Ribs with Horseradish Gravy

noreply@blogger.com (Elizabeth) — Tue, 24 Jan 2012 23:40:00 +0000

I would love to take a bath in beer right about now. My back is sore from hunching over the desk from too much studying. (We just had our CREOG exam, the national OBGYN in-service test). Instead though, I put juicy shortribs on the bone in a languid stovetop bath of beer, maple syrup and balsamic. They emerged tender and relaxed, I wish my muscles felt the same.

The last few months have had their ups and downs. I finally have a moment to rest in the past couple of days. With the best intention of sitting down and writing, I wake up on the couch three hours later, the sun set, grocery store unvisited, and the husband hungry.

Work has been just a touch less demanding this year, so I’ve filled my time with other activities including creative writing classes, a Christmas cookie baking marathon and studying. This makes me just as tired as before, but maybe a little more emotionally whole.

This recipe is very easy, but it does take a few hours. It is a great dish for a Saturday night at home and goes great with a nice cabernet, or obviously with beer. I served it with boiled kale, which is better than it sounds, and polenta. The shortribs I bought with the bone on, which makes a much more succulent gravy.

3 lbs ribs, bone on

1/4 cup olive oil

2 cloves garlic

1 large shallot or medium sized onion

2 carrots, cut in discs

One parsnip, cut in discs

1 whole sprig rosemary

1 bottle stout

1/4 cup maple syrup

2 tbsp balsamic

2 tbsp apple cider

Salt and pepper

1 1/2 cups water

For the gravy

4 cups strained braising liquid

1 tbsp flour

2 tbsp freshly grated horseradish

Salt

1 tbsp cream

Over high heat in a large dutch oven, being careful not to splatter and burn your arm as I might have done, brown the ribs on all sides. Remove the meat and reducing the heat to medium high add the chopped garlic, shallot, parsnip and carrot until shallot is transluscent. Place the ribs on top of the vegetables. Add the beer, vinegar, water, rosemary, salt and pepper, making sure the meat is almost covered (you can add more water if necessary). Reduce the heat to low and let cook until the meat is fork tender (about 3-4 hours). Remove the ribs and allow to rest.

Strain 4 cups of braising liquid into a small saucepan over medium heat and add fresh horseradish. Whisk in flour and salt. Allow to thicken and whisk in cream. Enjoy.

Turkey Meatloaf with Tomatoes, Arugula and Goat Cheese

noreply@blogger.com (Elizabeth) — Wed, 28 Sep 2011 22:18:00 +0000

Can you tell I have goat cheese in the fridge? A healthy yummy meatloaf. Easy to make and easy to eat.

1 tbsp olive oil

1 medium shallot chopped

1 clove garlic chopped

1 handful parsley chopped

2 cups arugula

2 roma tomatoes cubed

1 tsp salt

1.25 lb ground turkey

1 egg

1/2 cup milk

1 slice white bread

1/2 tsp salt

1 tsp dijon mustard

1/2 tsp honey

4 oz goat cheese

In a saute pan over medium high heat, heat olive oil. Cook shallots and garlic until fragrant and soft about 3 minutes. Add parsley and tomatoes, cook until tomatoes begin to wilt, about 3 minutes. Add arugula and salt and wilt arugula. Set aside and allow to cool.

Preheat oven to 375. Soak bread with milk. In a medium bowl add turkey, egg, soaked bread, salt, honey and mustard. Combine with hands until bread is evenly distributed. Add vegetable mixture and mix throughout. Gently crumble in cheese and combine.

Put mixutre in loaf pan and cover with foil. Bake for about 30 minutes. Remove foil and allow meatloaf to brown, about another 20 minutes. Allow to rest for about 30 minutes before eating.

Refreshed-- Tart and snappy apple, fennel and fig salad

noreply@blogger.com (Elizabeth) — Thu, 15 Sep 2011 02:25:00 +0000

Life is worth celebrating!

Feeling happy and refreshed. Even though I’m still working a lot I feel comfortable in my job and I’m loving what I’m doing. Second year has been fantastic so far; I’m not so nervous about every decision I make or what everybody thinks of me. I’m not falling asleep with the pager under my pillow praying it doesn’t beep.

This year I’m focusing on two goals--improving my surgical skills and more importantly appropriately counseling patients. As much as I wanted to give patients the right information I think I failed many times last year due to time constraints, fatigue, frustration and lack of knowledge. I’m trying to take the time to step back and truly make sure patients understand what is happening to them and why, and it’s a really good feeling.

I’m also trying to bring a bit of balance back into my life. It’s easy to forget what being a human is like. The other night I made this easy and fresh salad using fresh fall flavors which is very tart and sweet--but not too sweet. The salad was very easy to make with a mandoline for thin slices. A very sharp knife would work just as well. I brought fresh figs as something new to try and was very happily surprised and how great they taste raw tossed in some lemon juice and olive oil.

Tart and snappy apple, fennel and fig salad

2 gala or other tart apples cored, unpeeled

1 fennel bulb

4-5 fresh figs

1-2 lemons (depending how tart you like your salads)

½ cup toasted and salted pepitas

crumbled goat cheese

¼ cup olive oil

½ tbsp salt

With a mandoline or sharp knife, slice apples and bulb of fennel into paper thin slices. In a medium bowl combine apple and fennel with lemon, salt and olive oil. Toss to combine. Place on platter, leaving remaining juices in bowl. Slice figs into thin slices and toss in remaining dressing. Place figs on top of apple and fennel combination. Sprinkle pepitas and goat cheese on top. Enjoy!

Panna cotta, cherry and champagne parfait (aka creamy, boozy, fruity Jello)

noreply@blogger.com (Elizabeth) — Tue, 19 Jul 2011 21:32:00 +0000

layers of cream, fresh pureed cherries and champagne adorn this simple, beautiful parfait

Can I tell you a secret? I love Jello. Slurping fluorescent red goop between my teeth is pure pleasure. I eat less Jello now than I did in college, but my obsession was so great that my friends bought me a whole Jello cookbook after graduation. This is just one of the hidden junk foods that I love. I am a total food snob with a private occasional hankering for all things processed, salty and neon colored-- I could never turn down a bright orange cheese puff.

Call this dish what you want, panna cotta with champagne gelee, but let’s not hide the truth. Think of it as a fancy creamy, cherry flavored Jello shot. The recipe is very light and refreshing in this horrible heat.

The parfait is very easy to make, it just takes some time because each layer must set before the next can be concocted. The first layer, panna cotta, which I had never made before, tastes almost like ice cream without an ice cream maker and couldn’t be simpler to whip up. Fresh bing cherries are not as fluorescent as red food coloring, but they are certainly more delicious. Champagne makes a great gelatin dessert; make sure to add a pinch of sugar to help bubbles form as the parfait sets for the final layer.

Panna cotta, cherry and champagne parfait (inspired the French Laundry cookbook)

9 inch loaf pan

pitted bing cherries to top

Panna cotta

1 packet gelatin

½ cup milk

1 cup heavy cream

3 tbsp sugar

1 tsp vanilla extract

Cherry layer

1 lb bing cherries, stemmed and pitted

2 ½ tbsp sugar

1 ½ packets gelatin

¼ cup champagne

juice of one lemon

Champagne layer

2 cups champagne, divided

3 tbsp sugar

1 ½ packets gelatin

To make the panna cotta, sprinkle gelatin over milk and let sit 5 minutes. In a saucepan over medium high heat, bring cream and sugar barely to a boil. Remove from heat, add gelatin and vanilla extract and whisk until all ingredients are combined. Add mixture to loaf pan and allow to cool and set, at least one hour.

Cherry layer. While panna cotta is setting, in medium bowl break up cherries with hands. Add champagne, lemon juice and sugar and allow cherries to release juices for at least half an hour. Add cherries and juices to blender and blend until smooth, about 3 minutes. Strain mixture. Sprinkle gelatin over ¼ cup water and allow to sit for five minutes. Bring cherry puree to a slight boil, remove from heat and add gelatin. Pour mixture over already set panna cotta and allow to cool and set, at least one hour.

Champagne layer. Over ½ cup champagne, sprinkle gelatin. Bring 1 ¼ cup champagne to a boil with 2 tbsp sugar to cook off alcohol. Remove from heat. Add gelatin and whisk until combined. Add final ¼ cup champagne and 1 tbsp sugar (this will make it bubble). Quickly add to loaf pan and allow to set, preferably overnight.

When ready to serve, loosen parfait from the sides of the pan with a sharp knife run along the edges. Run the bottom of the pan under warm water for one minute and carefully invert onto platter. Slice and enjoy with fresh cherries.

Corn, carbon and hair

noreply@blogger.com (Elizabeth) — Wed, 13 Jul 2011 20:27:00 +0000

Sweet, creamy elote dip made from fresh summer corn

A friend of mine asked me to write a dip recipe for the 4th of July. Oops. Well, it’s still July isn’t it? I based this recipe on one of my favorite foods that I’ve been introduced to since moving to Texas. Termed “elotes”, which simply means corn in Mexican Spanish, these delectable treats are served in Dallas at roadside stands and adjacent to taco joints. In a Styrofoam cup, corn kernels are layered with butter, sour cream, cheese, hot sauce and lemon pepper. Certainly not a diet food, but my husband and I fell immediately in love with this local fare and even asked our caterer to make a fancy version for our wedding which was a huge hit.

This dip uses some sour cream and mayo but the creaminess is amped up by the corn itself, half of which is pulsed through a food processor to make almost a corn pudding-like consistency. The dip is topped with a thin layer of cotija cheese, a salty dry cheese, not unlike a high quality Kraft parmesan. The whole thing is baked for a nice gooey texture and served with corn chips.

I was asking my friend Heather if she thought this was too much corn for an appetizer. She made an interesting point about a documentary she saw, King Corn, in which scientists used radioactive isotopes to trace about 50% of the carbon that we consume as Americans to corn. As carbon, hydrogen and oxygen are the basis for carbohydrates, fats as well as amino acids and thus energy, it is quite remarkable how corn dependent our food chain is.

The scientific methods used to trace the foundations of humans’ diet are fascinating and use human hair as the tissue of study. Hair leaves an excellent footprint of what we eat—it is metabolically inactive, is derived from what we consume and immediately reflects changes in diet. This excellent article in the UVA magazine biographies one of the major scientists, Stephen Macko who helped advance research in using hair to trace the origins of diets, even using mummy hair to deduce food consumption among ice men and paleo humans. He also helped the filmmakers of King Corn use their hair to measure the amount of corn in their diet.

Using various concentrations of variations of carbon, nitrogen and sulphur, known as isotopes, scientists can deduce the biologic origins of humans’ diets. Corn is rich in the 13C isotope, thus allowing scientists to trace corn as it escalates in the food chain. Scientists also use 15 nitrogen isotopes, which increase in an animal that eats a plant, then in a human who eats that animal, to track the amount of meat somebody is consuming in their diet.

In the US, most livestock is corn-fed, thus meat is a large contributor to the corn carbon isotopes. In fact, it has been demonstrated that when somebody moves from the UK to the US, their carbon isotopes from corn increase by approximately 3%. A 2008 study from the University of Hawaii traced the carbon isotopes of various fast foods, and after a survey of various restaurants throughout the US, only about 5% of the chicken and beef were not solely corn fed; also many of the fries contained large amount of corn isotopes.

The politics behind corn growth, production, alteration and consumption is a heavy debate--one that represents many levels of lobbying, industry and culture. It cannot be denied that corn is pervasive and permanent in our daily lives. Surely though, it is not corn in its unaltered form, such as this delicious elote dip, that calls for concern. What is alarming however, are the ways that corn is manipulated and passed through the food chain and can produce potentially damaging effects on health, the economy and the ecosystem.

Elote Dip

4 ears corn, grilled, roasted or steamed, or 2 cups frozen corn defrosted

¼ cup mayo

¼ cup sour cream

¼ tsp cayenne

juice of ½ lemon

¾ cup grated cotija cheese (or if you cannot find this anywhere, grated parmesan)

1 tsp black pepper

2 tbsp Mexican hot sauce, such as Bufalo (or substitute for 1 tbsp Louisiana hot sauce)

Preheat oven to 400. Cut corn off cob. In blender or food processor place half kernels, mayo, sour cream, cayenne, lemon juice, pepper, hot sauce, pepper and ½ cup cotija cheese. Blend until smooth. In heatproof dish, combine blended mixture with the other half of whole corn kernels. Top with leftover cheese. Bake for 20-25 minutes or until brown and bubbly. Serve with tortilla chips.

Macko, SA. Engel, MH, et al. Documenting the diet in ancient human populations through stable isotope analysis of hair. Philosophical transactions PHILOSOPHICAL TRANSACTIONS- ROYAL SOCIETY OF LONDON SERIES B BIOLOGICAL SCIENCES. 1999, VOL 354; ISSUE 1379, pages 65-76

McCullagh, J et al. Carbon isotope analysis of bulk keratin and single amino acids from British and North American hair. Rapid Commun. Mass Spectrom. Volume 19, Issue 22, pages 3227–3231, 30 November 2005.

Jahren, A, Kraft R. Carbon and nitrogen stable isotopes in fast food: Signatures of corn and confinement. PNAS November 18, 2008 vol. 105 no. 46 17855-1786

Petzke, KJ et al. Carbon and nitrogen stable isotopic composition of hair protein and amino acids can be used as biomarkers for animal derived dietary protein intake. J Nutr. 2005 Jun;135(6):1515-20.

Grilled chicken and eggplant salad with arugula pesto

noreply@blogger.com (Elizabeth) — Mon, 11 Jul 2011 14:29:00 +0000

I’m feeling lucky and relaxed, back from another wonderful vacation with my husband spent in the car driving around the Midwest. Also, even bigger cause to celebrate, I’m a second year resident! Intern year is over and I feel so proud and accomplished of all that I learned and did in one year (tons of deliveries, dozens of C-sections, gynecologic surgeries, hundreds of emergency and clinic patients.) More than anything, I’m freaking relieved by the promotion. The second year schedule is a bit more forgiving and well balanced and there is a scant amount of clout that comes with the job.

Even though I had an awesome year, it is great to know that it will be somebody else running around labor and delivery trying to get it all done--although I think I’m hard wired to sprint when I hear “doctor for decelerations/delivery/exam” on the overhead speaker. As second year, we learn how to be consultants to midwives and are in charge of the women’s ER. Plus, there will be lots of scalpel time as we are primary surgeon to all C-sections at night. It is amazing how much I’ve seen after just one year, and I’m excited to keep learning and gaining more responsibility as I work my way up.

Perhaps now with a new year and a new job, July is a much better month than January to make New Year’s resolutions. While in January I was merely trying to survive; to get out of bed, go to work and do the best job I could, I’m blessed to have a bit of time this month to make some real changes in my habits. I’m feeling bloated after eating a hot fudge sundae every day of my vacation. This is worsened by the fact that even though I joined the gym almost a year ago, I haven’t been at all since February. (My husband is surely chuckling)

Thankfully, summer is a great time to eat a lighter diet. I found beautiful small eggplants at the grocery store and they grilled up just great. We have a gas grill as part of our apartment, and I know, I know it’s not charcoal but I’m getting the hang of the grill and hopefully someday can promote myself to hot coals. Even though pesto isn’t necessarily diet food, it at least is a step in the right direction. I love making pesto with arugula as it has a wonderful peppery bite and is cheaper than basil. This “salad” can be served hot or cold and would be great over bread, mixed in with lettuce or pasta or can be eaten alone.

Grilled chicken and eggplant salad with arugula pesto

Arugula pesto

Handful loose basil

1 cup arugula

Salt and pepper to taste

Clove garlic

¼ cup grated parmesan

¼ cup walnuts

1 tbsp high quality balsamic vinegar

¼ cup extra virgin olive oil

1 lb eggplant

1 lb roma tomatoes, seeded and divided in eight pieces

½ red onion thinly diced

1 lb boneless skinless chicken breasts

Olive oil and salt for seasoning

To make the pesto, place basil, arugula, garlic, cheese, walnuts, salt and pepper into food processor. Run until all components are well combined. Scrape down sides and pulse in balsamic vinegar. With machine running, slowly add oil until all ingredients well combined. Set aside

Preheat grill to medium high heat. If using small eggplants such as thai or Indian as I did, cut in half and salt and brush with olive oil. If using a large eggplant, cut into 4-5 horizontal slices and salt and brush with oil each side. With the chicken, salt and oil each breast. Grill eggplant for about 6-7 minutes on each side until juices run from the eggplant and they are soft to touch. Grill chicken for about 7 minutes on each side until juices run clear and the chicken has an internal temperature of about 150F.

Dice eggplant into about 1 inch cubes, doing the same for the chicken. In a large bowl, add eggplant, chicken, tomato and onion. Add pesto by the tablespoon until each piece of salad well coated. You will have leftover pesto which can be put aside for a separate use.

Pork and Peaches—Pork Chops with Perky Peach Salsa

noreply@blogger.com (Elizabeth) — Tue, 14 Jun 2011 00:26:00 +0000

The best thing ever happened a couple of months ago. The USDA lowered the cooking temperature of pork. Now pork can sit at a pink tinged 145 degrees instead of a crusty, chewy, floss-inviting 160. The evolution of this change is directly related to laws passed in food safety.

Even though there is much disturbing news these days about food production including E. coli infested sprouts in Germany, overcrowded, overmedicated, overfed cows and chickens, and genetically modified plants and animals, it’s amazing how far we’ve come in many ways regarding food safety. The main concern about undercooking pork used to be trichinellosis, a disease provoked by tissue dwelling roundworms that caused fevers, muscle aches and a whole bunch of nasty. The trichinella rate has declined exponentially since the 1940s. In a survey by the CDC between 1997-2001, there were only 72 cases reported to the CDC, including 29 cases from bear meat and one from cougar meat (only 12 cases from commercial pork). 1

The rapid decline in trichinella is directly related to government policy. Disgustingly, pigs were previously fed garbage contaminated with raw animal waste. Only until garbage laws were passed in the 1950s did this rate begin to decrease. Other policies enacted by the USDA have also reduced the rate of trichinella.

Even though trichinella is killed by cooking at 140 degrees, there was concern by the USDA that due to uneven cooking, trichinella would survive. This concern has now decreased and pork can be safely cooked to 145, also killing other potential microbes looming on the surface.

Now that I’m officially allowed to undercook my pork, I like it a whole lot better. There’s nothing like a quickly brined pork chop nicely grilled with a tangy fruity sauce on top. This peach salsa is bright and only slightly sweet, complimented by mint, cilantro and jalapeno. I know it’s a lot of fruit recipes lately, but I can’t help myself. It’s summer!

Peachy Pork

4 center loin boneless pork chops

for the brine 4 cups water, 3 tbsp kosher salt, 1 tbsp brown sugar

For the peach salsa

5 ripe peaches

handful mint leaves--chiffonade

handful cilantro—chiffonade

1 large shallot finely diced

1 tsp salt

1 jalapeno finely diced

juice of 1 lime

Place chops in brine and let soak two hours in fridge. Remove from brine and blot with paper towels to dry. To cook, grill (outside or on grill pan) on each side about 7-8 minutes until golden on the outside and 145 degrees on inside. Combine all ingredients for peach salsa. Serve with cold salsa.

Trichinellosis Surveillance --- United States, 1997—2001. MMWR July 25 2003. 52 (SS06); 1-8. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5206a1.htm

Hawaiian Style Pina Colada Creme Brulee

noreply@blogger.com (Elizabeth) — Thu, 09 Jun 2011 00:59:00 +0000

Ahh. Wondrous vacation.

sunset at our Hawaiian paradise

Makes a girl go from looking like this

Self portrait after a horrible night shift

to this.

It’s hard to come back from a romantic belated honeymoon with time in the sun, a cool Hawaiian breeze, tropical fruit, and lots of pleasure reading to 100-degree heat and C-sections.

*********************************************************************************

I love scientific research that is so obvious. For example, a 2009 meta-analysis in the Journal of Occupational Health states that vacation has a positive effect on health. People have actually spent money researching the fact that sitting on a sailboat drinking lemonade is more healthy than working a 12 hour shift overnight without sitting or eating taking care of 15 patients. Yeah, I know.

Sadly, the same study suggests that coming back to work erodes away all positive effects of vacation between two and four weeks. However, I have to disagree. Having gone a six-month stretch between vacations this year with only one weekend off between, I think a vacation got me through about three months of that. Then it was pure pain.

With this recipe, we can all go on a tropical vacation together. I love pina coladas with their 1200 calories of rummy goodness. I begged my husband to buy me ONE at the pool bar because it was 12 bucks. (It wasn’t even that good.) Now home, attempting to maintain my island spirit, I decided to make my own version of a pina colada in the form of a creamy crème brulee. This recipe has all the tropical hints of a pineapple and coconut without being overly sweet or cloying--just the elegance of fresh fruit and a tiny splash of rum wrapped in a ceramic package of a delicious custard and a crispy sugar shell.

Pina colada crème brulee

2 cups coconut milk

1 cup heavy cream

1 tbsp rum

2 tsp vanilla

5 large egg yolks, 2 large eggs

¼ cup brown sugar

Thin pineapple slices

granulated sugar to top

blowtorch! Or oven broiler

6 6 oz ramekins

Pre-heat oven to 350. In heavy bottomed saucepan over medium heat, whisk together coconut milk, cream, rum, vanilla and brown sugar. Heat, stirring constantly until almost simmering. In separate bowl, whisk eggs together. Temper eggs by slowly adding 1/3 of the warm cream mixture to the egg mixture and then add the tempered eggs back into the saucepan with the rest of the cream mixture. Continue to heat over medium heat, stirring continuously until mixture begins to slightly thicken, about 2 minutes. Do not allow to curdle. Strain custard with a fine mesh strainer. Divide mixture between ramekins. Place ramekins in large roasting pan. Place pan with ramekins in preheated oven and fill pan with boiling water ¾ of the way up the ramekins to make a water bath. Bake for 15 minutes and as custards begin to set, carefully place pineapple slices on top. Bake for another 15 minutes until the custards are set. Remove from heat, allow to cool and refrigerate overnight.

The next day, add 1-2 tsp granulated sugar to the top of each ramekin. With a blowtorch or carefully with the broiler, caramelize the sugar until it is golden brown.

De Bloom J, Kompier M, et al. Do we recover from vacation? Meta-analysis of vacation effects on health and well-being. J Occup Health. 2009;51(1):13-25. Epub 2008 Dec 19.

Almond Ricotta Cake with Grilled Peaches

noreply@blogger.com (Elizabeth) — Mon, 23 May 2011 23:01:00 +0000

Nothing is more lovely than the first signs of summer. For us in Texas, that started in March, but the true signs of summer, like fresh local tiny peaches at the Whole Foods are sure signals that barbeque season is here to stay. This is the perfect dessert to finish off a grilled meal with friends, which is just how I enjoyed this cake. Nothing is more wonderful than an evening outside with chickens pecking in the background eating home-grown greens, pasta made with fresh chicken eggs and pesto with basil from the garden.

The cake is moist and light, fluffy and golden. It has a nice bite to it from the almonds. I prefer the taste and look of whole almonds compared to blanched--a little bit of brown almond peel enhances the color and texture of the cake.

Peaches on the grill are incredibly wonderful. My friends thought the idea was somewhat strange but when the peaches gave off their fruity aroma, they were instantly sold. You have to try this cake!

1 stick unsalted butter

1 cup whole milk ricotta

1 ¾ cup sugar divided

1 tsp vanilla extract

¼ tsp almond extract

6 eggs separated

1 cup raw whole almonds

2 ¼ cup all purpose flour

2 tsp baking powder

½ tsp salt

¼ cup milk

5 peaches

Fresh vanilla ice cream or whipped cream

Preheat oven to 350.

In a food processor, pulse almonds until they are finely ground but before they become pasty. Pulse flour, salt and baking powder until well combined.

With electric mixer on high, whip egg whites. Slowly add ½ cup sugar while mixer is on. Whip until soft peaks. Set aside in medium bowl.

With electric mixer, beat butter, ricotta and 1 ¼ cup sugar until fluffy, about 2 minutes. Add vanilla, almond extract and egg yolks, mix to combine. Slowly beat in flour/almond mixture and then add milk until well combined. Fold in 1/3 egg white mixture with a rubber spatula, and then fold in the rest of the whites.

Grease 11x7 baking pan and add batter. Bake approximately 40 minutes or until top is golden brown and knife comes out clean when cake is poked. Allow to cool.

Split peaches in half. Grill until golden brown and fragrant.

Advice to New Interns

noreply@blogger.com (Elizabeth) — Wed, 11 May 2011 18:24:00 +0000

As intern year is winding down and all of the giddy 4th year medical students are shelling out 200 dollars to rent that silly robe thingy for one day of pomp and circumstance, all of us interns are impatiently waiting for the fresh meat to arrive. Having just experienced every single emotion under the psychological rainbow this year, I am going to give a few pointers (or not really pointers but just some anecdotal evidence that it’s ok to feel the way you’re feeling). I am stupid enough to admit to all of the silly things that I did. This is not to prove that I’m an idiot, but to allay the fears of anybody who finds themselves in my shoes starting July 1.

1) You might have been a good medical student but you now know essentially nothing. You also have much more power and ability to screw things up than you ever had. This, however, is ok because you are being very closely watched by every single nurse, medical assistant, older resident, attending, even the lady who empties the trash, and you will not really do anything so stupid that you could actually hurt somebody (hopefully). You will do really dumb things though, for example, a wet prep is called a WET prep for a reason…you need to put a few drops of water on it. Somebody, not to name names, did a DRY prep. The whole point of residency is to do dumb things. The dumber the thing you did, the more likely, if you’re smart, is to not repeat the dumb thing.

2) Accept the fact that you will dumb things and you might hear about it. It might be a change from being a protected doe-eyed medical student to be paged by an older resident or attending to ask you to explain why you did such a thing. DON’T ARGUE. Just say, I’m sorry, cry in the corner for ONE SECOND and get over it. The whole point of residency is to do dumb things. You are not a bad person or incompetent because you made a mistake.

3) Having a pager sucks. The only profession ever that still uses an outdated contraption invented in the 1970s for drug dealers, residents and all doctors for the rest of eternity are given pagers which need to be worn and answered at all times. This cannot be turned off and have the potential to bring bad news at any time. However, I must add that having a pager is also something that becomes normal very quickly and grows more annoying than scary as time goes on. You might start to feel naked without the two pounds of buzzing plastic with two lines missing from the screen.

4) It’s ok to be absolutely terrified. I was so nervous when I did my first speculum exam as a resident that it took me five minutes to realize that the speculum was actually broken and that I wasn’t just a complete idiot that didn’t know how to use it. Being nervous reminds us that we are taking care of people who are sick and we shouldn’t be nonchalant about it. When I did my first delivery, I think I almost vomited. Being scared is totally normal.

5) As a continuation of point 4, there is a fine line between being terrified because it’s new and being terrified because something bad is happening and you are in over your head. If you are completely over your head, ask for help. Seriously, even if it might seem dumb to somebody older than you. Because, back to point 1, you are stupid and everybody knows that. Don’t pretend to be smart because that is dumb.

6) Things that seem scary will become second nature. The most awesome thing about being an intern is that while I almost vomited during my first delivery, I now am comfortable in the delivery room and can handle many different situations. Lots of bleeding, ok! Bad laceration, ok! (to a point, then same thing, ask for help). I’ve done enough deliveries now that I have fun with them. You will develop your own style and you will learn. Everybody does it. Something that helped me get through all the nerves is reminding myself that almost everybody that graduates from medical school survives residency and graduates to be a competent physician. So, if they can do it, why can’t I?! You can do it too.

7) It’s ok to complain. Residency is full of sacrifice. You will miss holidays with families, weddings, birthdays, weekends off, dates with boyfriends. You will be grumpy. You will be exhausted. My advice though is to complain to your co-workers. Complaining at home and to your family doesn’t really work as well because they are also suffering your hours and your holiday-missing and they really don’t understand how much your job sucks. I have completely failed to follow this advice. Fortunately I have an understanding family and a wonderful, exceptionally tolerant husband. (And on a completely personal tangent, avoid getting married as an intern. The wedding was great but planning ruined my life.)

8) Step back and realize how totally amazing your job is. You get to help people at their most vulnerable moments. I get to use needles and knives, scissors and suture as everyday tools. I bring life into the world. Wade through all of the crap, the hurt feelings, and just appreciate how great it is to be a physician. Even though the field of medicine is changing probably to the disadvantage of all of us, there is a reason people are willing to sacrifice so much to do what we do. Medicine is rewarding, stimulating, complex and most of all, really fun. Residency is a great community and an awesome bonding experience. Enjoy it.

9) Most importantly, work hard, keep your head down, take care of your patients and take responsibility for your actions. This is by far what will get you through and all that people really expect of you. Just keep going and you'll be fine!

Mini Coffee Cheesecakes

noreply@blogger.com (Elizabeth) — Sun, 08 May 2011 14:54:00 +0000

I made these cheesecakes as a gift for my sister to keep her awake during her law school finals. The crust is an adaptation from Doris Greenspan’s awesome book Baking that my amazing friend Julia gave us as an unsolicited wedding present. With the aid of a food processor, it whizzes together in no time and is flaky and delicious.

After all of the lemons and limes from the wedding, I was trying to find ways to use them and I decided to make a key lime pie/cheesecake hybrid using cream cheese and condensed milk. What resulted was a very creamy cake, which baked evenly and didn’t crack--a cheesecake miracle. I tried the concept again with coffee and with great result. This is pretty much no fail cheesecake so for those of you that are scared, go ahead and try it.

This recipe makes about 36 mini cheesecakes or enough to make bars in a large baking pan (I only made 24 and had a ton of leftovers). Make sure to use non-stick cupcake pans with lots of Pam, a little faith, and a sharp knife to extract them.

Mini Coffee Cheesecakes with Chocolate Crust

For the crust (adapted from Doris Greenspan’s Desserts)

3 cups flour

1 cup powdered sugar

½ tsp salt

2/3 cup cocoa powder

2 sticks plus 2 tablespoons very cold butter

3 egg yolks

For the filling

2 8-oz packages cream cheese

2 14 oz cans condensed milk

1 cup freshly brewed coffee—cooled to room temp

1 tsp vanilla

6 eggs plus one yolk

Chocolate covered espresso beans to top

Per Doris Greenspan’s instructions:

Put the flour, sugar, cocoa and salt in a food processor and pulse a couple of times to combine. Scatter the pieces of butter over the dry ingredients and pulse until the butter is coarsely cut in. Stir the yolks and add a little at a time (you probably will only need 2 yolks and a bit from the 3^rd so don’t add it all too quickly). When the egg is in, process in long pulses until there are clumps and curds. Press the dough into very well greased muffin tins and freeze the crust for 30 minutes.

Preheat the oven to 375. Cover the muffin trays and prebake the crusts for 10 minutes. Turn the oven down to 350.

With a mixer, whip the cream cheese until fluffy, slowly adding the condensed milk until well combined. Add the coffee, vanilla and eggs until well combined. Fill the crusts, cover and bake for 15 minutes or until the filling is set. Remove and while still warm add an espresso bean to each one. Chill. Once cakes are cooled, carefully remove each with a sharp knife.

Is Marriage Good For You?

noreply@blogger.com (Elizabeth) — Fri, 06 May 2011 20:56:00 +0000

I am loud, disorganized and live by hyperbole. My husband is quiet, focused and logical. We’re an unlikely match. But I can only say that my life has changed for the better since we’ve met. I feel incredibly blessed.

The New York Times' Pauline Chen had an interesting perspective on the issue of marriage and lifelong health. Overall, married people have better lifelong health than those who are single, however those that have turmoil in their marriage or ultimately divorce may have more health difficulties overall. Good communication within a relationship can even promote wound healing.1

Nobody in this society is stranger to marriage strain and divorce; I am definitely not alien to marital demise. There is never certainty that everything will be ok. So I’m just going to take this whole marriage thing one day at a time and count my blessings. I’m going to try and play my part to be a good wife and a supportive partner. For me, there’s no better way to express my love for my husband than through a pot and pan.

This recipe is the dish that I make that my husband loves most. Which is funny because of all the things I make, it’s just stir-fried chicken and cabbage. The delicious factor is the home-ground five spice powder which gives a unique taste and aroma. You can always buy pre-packaged spice for a shortcut, but it’s never quite as good as what you can whack up in a coffee grinder or a mortar and pestle.

I actually got the idea for this recipe on an airplane of all places. I know, I know, an airplane?! But I was flying to Asia, and the five spice was just so yummy. Even though five spice is commonly used in Chinese food, it’s not really something that is served most commonly in restaurants. It’s almost like a punchy version of mulling spices which gives a warming taste to the food. You gotta try it.

Five Spice Chicken and Cabbage Stir Fry

For the five spice

1 cinnamon stick

5 star anise

15 cloves

1 tsp Szechuan peppercorn

1 tsp fennel seed

Toast the spices on high heat until fragrant in a dry skillet. Pulse in spice grinder until it’s a fine powder.

For the stir fry

1.5-2lbs boneless skinless chicken thighs

½ large onion diced

½ head of Chinese or regular cabbage cut into matchsticks

1 inch ginger finely chopped

1/3 cup soy sauce

3 tbsp vinegar (rice wine or white)

1 tbsp sugar

¼ cup Chinese cooking wine or dry Sherry

2 tsp corn starch

In a measuring cup, mix soy sauce, vinegar, sugar, wine and cornstarch. Set aside. In wok or large sauté pan, place 2 tbsp vegetable or peanut oil over high heat. When oil is smoking, add onion, chicken and five spice. Cook until chicken is almost cooked through. Add ginger and cabbage and cook for another 2-3 minutes. Add sauce mixture and allow to bring to a boil. Serve over brown rice.

1: Gouin JP, Carter CS, Pournajafi-Nazarloo H, Glaser R, Malarkey WB, Loving TJ, Stowell J, Kiecolt-Glaser JK. Marital behavior, oxytocin, vasopressin, and wound healing. Psychoneuroendocrinology. 2010 Aug;35(7):1082-90

The Agony and the Ecstasy...of chilies

noreply@blogger.com (Elizabeth) — Tue, 26 Apr 2011 19:32:00 +0000

“Recent findings suggest that pain and pleasure share common neurochemical circuits, and studies in animals and humans show that opioid-mediated descending pathways can inhibit or facilitate pain”1

While this quote from the abstract of a Journal of Neuroscience article is meant to pertain to specific medication that is an agonist/antagonist to opioid receptors, naloxone, the general concept can be applied to many facets of life including residency which is pain and pleasure embodied. This statement also can easily be made about spicy food.

My husband and I burn for spicy food. When we had been dating for about a year, we ventured to Thailand for a week. Seeing as were not about to pay 25 bucks a person for a fancy breakfast at our hotel, we ventured to the local street vendors for a plate of deliciously mouth numbing curry and jasmine rice.

Well, we didn’t think this through quite enough because as we went to buy something to drink, our mouths ablaze, the lovely vendor offered us a bucket of tap water and a ladle. Considering that my stomach is fairly sensitive and I didn’t even survive a night at the Texas state fair without my gastric contents painting the lining of the toilet bowl, I wasn’t about to imbibe a gallon of e. coli laden tap water certain to make my linings explode. Surely, one can imagine a bunch of sun burnt idiots running around the alleys of Bangkok with their tongues hanging out of their mouths.

Even though the experience was painful, it was by far a happy moment in my life. This is because chilies are one of those foods that cause as much pleasure as they do pain. Paul Rozin, psychology expert suggests that spicy food are a “constrained risk” in that the act is a generally harmless however the body responds in with a warning system that is physically painful. Basically, people love spicy food because it feels dangerous but it isn’t. 2

I actually made these tamales for a recipe contest on Food52, a weekly competition for a community-compiled cookbook. One of my recipes, this soup, actually was picked to be published in the cookbook. Anyway, one of the problems with being a resident and an idiot is that I misunderstood when the entry time was over. I spent all day making these tamales and I didn’t even submit them.

The contest theme was coffee, so I braised short ribs in coffee and spices and then made a blistering red sauce to coat the meat to fill the tamales. The caffeine and chile is a great combination for your gastritis…I recommend taking a prilosec first. I think that if you just made the meat and the sauce and skipped all of the corn husk, tamale steaming assembly disaster and used the meat as a taco filling or serve it with rice and beans it would be a delicious meal. Our tongues were burning with deliciousness.

Makes about 12 tamales, takes about forever

For meat

1.5 lb shortribs with bones

2 tsp sesame seeds

1 bay leaf

1 cinnamon stick

2 tsp cumin

2 cloves

1 tsp black peppercorns

¼ cup pumpkin seeds

2 cloves garlic

2 tsp Mexican oregano

2 sprig thyme

4 cups strong, freshly brewed coffee

1 tbsp brown sugar

½ onion diced

1 tsp salt

For chile sauce

5 large dried guajillo peppers

5 dried chile de arbol

1 tbsp cider vinegar

1 cup beef broth from above

water as needed

1 tsp honey

For tamale dough

12 corn husks

2 cups maseca

1 cup braising liquid

1 cup warm water

1 tsp baking powder

1 tsp salt

½ cup Crisco

The meat can be braised in either the oven in a dutch oven or in a slow cooker. If using the oven method, preheat the oven to 300. In a large clean skillet over high heat, toast the sesame seeds, coriander, bay leaf, cinnamon stick, cumin, cloves, peppercorns and pumpkin seeds until brown and fragrant. Add all ingredients to pot and braise for about 6 hours until meat is very tender. Remove bones, bay leaf, cinnamon stick and cloves. Remove meat and place in bowl and shred with fork. Strain braising liquid and divide liquid (there should be about 2 cups). Keep solids that you have strained.

To make chile sauce, in large hot dry skillet toast chiles until smoking. Submerge chiles in boiling water and weigh down with bowl, let sit 20 minutes or until soft. In blender, add solids from the braise, 1 cup braising liquid, salt to taste, vinegar, honey and chiles. Add water as needed and blend until very smooth, about 5 minutes. Add about a cup of the sauce to the shredded meat, set aside the other to top the tamales

If you are smart, stop here and eat the meat and sauce with beans and be done with it. If you are crazy like me, get your tamale pot ready. Mix dry ingredients in bowl, slowly add braising liquid and water and then whisk in Crisco until fluffy. Soak corn husks in warm water. Place about 3 tbsp masa in each corn husk and place filling in middle. Fold bottom of husk up and then wrap up husks and tie with extra husk. For better instructions watch this video. If you are a dork like me, then you obviously have a tamale steamer which is a just a large pot with a layer of metal with holes to steam them. You can use a bamboo steamer or improvise in another way. Steam for about 75 minutes or until tamale dough is set.

1. The Journal of Neuroscience, 16 March 2011, 31(11): 4148-4153; doi: 10.1523/ JNEUROSCI.3736-10.2011

2. Rozin, P, et al. The Nature and Acquisition of a Preference for Chili pepper by Humans. Motivation and Emotion, Vol. 4, No.1, 1980.

Migas

noreply@blogger.com (Elizabeth) — Mon, 18 Apr 2011 20:02:00 +0000

Literally, crumbs or scraps, migas are the genius breakfast of some Mexican brainiacs disguising chips and salsa into a delicious breakfast. Migas are a great use of the bottom of the tortilla chip bag or some stale crumbs that you found in the back of your cupboard hidden behind the seven pound bag of chocolate chips.

Migas are a Texas staple and one of the amazing foods that have become necessities since I became a resident of this great state almost a year ago. Yep, it’s been a great year in Texas. The weather, the food, the people—it’s all awesome. So, here I share some of my joy with you.

Gooey cheese, tortilla chips and eggs. Breakfast of champions.

Migas

Serves two hungry people

2 tbsp veggie oil

1 small onion diced

1 clove garlic

½ cup green salsa or small can green chiles

½ cup tortilla chips broken into small pieces

4 eggs

½ cup shredded cheese (cheddar, jack, whatever you got)

salsa, sour cream, cilantro to top

In a large skillet over medium-high heat, heat oil until ripples. Add onion and garlic with pinch of salt and stir carefully until translucent. Add green salsa and chips, stir until chips are slightly soggy. Add eggs and stir until cook, add cheese until melted. Serve with toppings and enjoy.

Meatballs

noreply@blogger.com (Elizabeth) — Mon, 11 Apr 2011 22:50:00 +0000

Just feeling like sharing a recipe--I think I'm going to try and do this more often. This is a middle eastern twist on meatballs. Easy and delicious. The trick is finding bulgar wheat as a binder which adds whole grain and a nice nutty crunch. I love lamb and I used ground lamb in this instead of beef or pork. I served them with baba ganoush and sauteed veggies. They would also taste great in pitas or in pasta.

Lamb Meatballs

1lb ground lamb

1 cup cooked bulgar wheat*

2 tbsp chopped parsley

1 tbsp chopped dill

1 tsp ground cinnamon

1 tsp ground cumin

1 tsp ground coriander

2 tbsp pine nuts chopped

salt to taste

Preheat oven to 400. Mix all ingredients together with hands until combined. Take about 1-2 tablespoons filling, roll into balls and place on foiled baking sheets. Bake until golden brown and cooked all the way through, about 15 minutes.

*To cook bulgar wheat bring 1/2 cup wheat and 1 cup salted water to boil, reduce to low and cook for approximately 20 minutes

What to do when life gives you a case of lemons? Get Married!

noreply@blogger.com (Elizabeth) — Thu, 24 Mar 2011 01:48:00 +0000

The funniest part about writing this post is that I was that without even thinking I felt my fingers grace the “R” key for “R1 Gynecology (or L&D or OB Clinic) Progress Note". Sadly, the reflex for writing anything down at this point is for patient documentation.

Not that this is a bad thing. I like my job and I’m settled into the fact that this “being a resident” is also my primary role as a human. Match day is over, which means that there will be 20 new suckers coming our way to relieve us from being the most clueless members of the OB/GYN department, and oh, by the way, I got married in the hubbub of intern year. Plenty to celebrate.

Spring is here and life is new. The holidays were hard and the only research I did for the blog was a paper written about intern burnout and mental illness. It’s amazing how much a week of vacation, seeing family and going out of town for a weekend can renew the soul.

The wedding was a beautiful and intimate affair. It’s such an incredible blessing to have people that you love surrounding you and as much as I moaned and groaned about the party planning and its complete consumption of any semblance of a life, it was nothing short of perfect. The food which we hand-picked was awesome thanks to Beyond the Box Catering and Chef Doug Brown. They made the exact Tex-Mex inspired gourmet that we wanted and there was surplus and beyond. (PS, I was the naysayer that told everybody that unlike other brides I would pig out at my wedding but with the nerves and the dress constricting all digestion, even I struggled to swallow every bite.)

I purchased a case (200) lemons and a case (245) limes for decorations/floral for the nuptials. Well, needless to say, they were not all consumed at the wedding and I came home with approximately 70 pounds of fruit. No scurvy in this house! Our collagen synthesis is up to speed and we are in a race against the fungus among us to not mold our zingy fruit. Linus Pauling would be proud. (PS, did you know that he as the Nobel Prize winner for much vitamin C research consumed 10g of vitamin C a day?)

I can tell you now that there are many great things you can do with so much citrus, also with all new knives, pots, pans and everything glorious. I made a beautiful chicken dish with a whole chicken cut up into pieces, half a red onion finely diced, four cloves of garlic finely chopped, sesame seeds, fresh cilantro, about a cup of soy sauce, half a cup of brown sugar, the juice of twelve limes and a dash of sesame oil cooked in the oven until golden brown. The citrus is surprisingly subtle.

Also, I made this lovely pine nut lemon saboyan tart which is much more beautiful and better elucidated by the lovely Carol Blymire of a retired blog “French Laundry at Home”. This recipe comes from the French Laundry Cookbook; the book is written by the inspiring Thomas Keller based on his four star Napa French restaurant. Everything looks so delicious yet within an experienced home chef’s reach. You should ask for it as a gift too.

Stained Glass Cookies

noreply@blogger.com (Elizabeth) — Wed, 26 Jan 2011 20:08:00 +0000

Now marks the one year birthday of OB Cookie. It's been a crazy year. Last year I was sitting on my couch, freezing my butt off, thinking of things to keep me busy during dead time as a fourth year. Now, thankfully, it's not so cold. I'm definitely not sitting on the couch nearly as much, although I do fall asleep on it frequently.

I'm calling these cookies stained glass cookies. They are loaded with little pieces of sour candies and they turned out really pretty. They are tart with great textural contrast as well. So happy birthday blog! I've had a bunch of fun writing here, and even if posts are more sparse than before, I'm not giving up quite yet.

Stained Glass Cookies

2 sticks unsalted butter at room temp
3/4 cup granulated sugar
1 egg
1 tsp vanilla
zest and juice of one lime and one tangerine
2 1/2 cups all purpose flour
1/2 tsp salt
8 oz sour candies cut in small pieces and tossed in 1 tbsp flour to prevent sticking

Beat butter and sugar until light and fluffy. Add vanilla, citrus, egg. Beat until well combined. Add flour and salt. Mix until well combined. Add candies. Divide dough into 2 pieces. Roll each piece into a 2 inch thick log and shape into a square (or a roll). Put into freezer to form dough for about 1/2 hour. Leave other half in freezer (depending on how many you want). Pre-heat oven to 350. Carefully slice cookies with a serrated knife into 1/4 inch thick slices as candy pieces can be fragile and place on baking sheet. Bake cookies for 15 minutes or until golden brown.

Happy New Year

noreply@blogger.com (Elizabeth) — Tue, 04 Jan 2011 00:18:00 +0000

I’ve started to write a million blog posts but I haven’t quite been able to finish. As much as I wanted to celebrate the holidays with y’all, I just couldn’t. I feel in desperate need for free time lately. The good thing--intern year is officially half over. It’s pretty incredible to think about how much I’ve learned in the past six months and how much I’ve seen. I have delivered over 50 babies and done 30 C-sections, and that’s just in the 3 months that I was on obstetrics.

The past couple months I’ve been off service on internal medicine. I had to take my white coat out of the bag to start the rotation. I’m learning a lot and the people are very nice, but I’m just homesick in a lot of ways. I haven’t had enough time to see my family in quite some time, and I really miss OB. I was just starting to feel happy and comfortable as an intern in obstetrics as I switched to something completely new and different; it felt like starting all over again.

I love being a doctor, but it’s really hard. It’s not the hours or the daily grind of the work per se, it’s just that being a doctor is now synonymous with being me. Work isn’t just work when it involves life and death. It isn’t just your job when you catch an exhausted mother’s beautiful newborn in your hands. It isn’t just a vocation when you declare a 32 year old dead from a horrible cancer on New Year’s Eve and tell his family that he isn’t there anymore as they look at you with their hopes shattered.

People that aren’t in residency have said “you knew what you were getting into when you signed up for this.” But how could I, or anybody in residency truly anticipate what would this would be like? It’s an incredibly surreal experience. The highs are unbelievably amazing and the lows are ship sinking. Sure I knew I would work a lot, watch people die, and be far away from home. The fact of the matter is that the amount of emotional, physical and intellectual energy expended as an intern cannot be quantified or described.

This post wasn’t meant to depress people or to have somebody send out a suicide watch. I’ll be fine--in fact I’ll be great. For my New Year’s resolution, I don’t want to change anything. I can’t spend my whole life feeling bad about all the stuff I didn’t do. I just want to keep the resolve to be myself even with constricted time and limited sleep--happy, loud and proud. I dare you all to do the same.

Haikus to Internal Medicine

noreply@blogger.com (Elizabeth) — Wed, 01 Dec 2010 16:02:00 +0000

Oops, I kind of disappeared. No worries, I'm around, just got busy. Doing internal medicine right now. While I might have liked it in medical school, no more. I miss the operating room.

Haikus to Internal Medicine

Pager, I hate you

You beep constantly at home

You are here to stay

Thirty hour call

You suck. I am so sleepy

Who invented this?

Potassium, you

Are always low, I am sick

Of repleting you

EKG, no clue

How to interpret you but

I pretend to know

Volume overload

Bores me, they should sell lasix

Over the counter

Sticking needles in

Fluid collections is fun

Cytology pending

Black and White Cloud Pudding

noreply@blogger.com (Elizabeth) — Fri, 22 Oct 2010 19:12:00 +0000

It's been an interesting month. I wrote about my experiences as a "black cloud" and what that means as a resident here on Kevin MD. In honor of my first post to KevinMD, an awesome medical blog with significant collaboration from health professionals all over the country, and my new black cloud status, I made a dark chocolate and whipped cream pudding parfait.

The dense, rich chocolate pudding is layered with a fluffy white cloud of homemade whipped cream. Are you a black or a white cloud?

Dark Chocolate Pudding and Whipped Cream Parfait
(pudding recipe adopted from Bon Appetit)

For the pudding:
1/2 cup sugar
1/3 cup unsweetened cocoa powder
2 tbsp cornstarch
1/4 tsp salt
1 3/4 cups milk divided
1/4 cup heavy whipping cream
3 oz very dark chocolate (such as 88% cocoa) finely chopped
1 tsp vanilla extract

For the whipped cream:
1 cup chilled heavy whipping cream
1 tsp vanilla
3 tablespoons powdered sugar

Whisk sugar, cocoa, cornstarch and sal tot a blend in a heavy medium saucepan. Gradually add 1/3 cup milk, whisking until smooth paste. Whisk in remaining milk and cream. Using wooden spoon or heatproof spatula, stir mixture constantly over medium heat, scraping bottom and sides of pain until pudding thickens and begins to bubble at edges, about 5 minutes. Add chocolate; stir until mixture is smooth. Remove from heat and stir in vanilla. Allow to cool to room temperature and then refrigerate.

For whipped cream, in chilled bowl, whip ingredients until stiff peaks form.

From The Board to Bored—a month of sleep

noreply@blogger.com (Elizabeth) — Wed, 06 Oct 2010 17:29:00 +0000

This month has definitely been a change of pace. From running around non-stop, I’ve switched from the crazy county to the cushy private hospital. From not eating to over-eating, watching movies and napping, the mania has definitely ended.

I’m really tired. That’s that. I was feeling really good, but I’m positive that even with a week vacation thrown in there, there is no way I’ve caught up on sleep constantly flipping from days to nights and working my tail off. I’ve had a little mini-vacation at home and I’ve found myself surprisingly waking up at 11 or noon everyday. I have only slept until noon once in my life before.

Is the concept of sleep debt real? Scientists argue that, in fact, yes, sleep debt is a true concept. In one recent study, scientists chronically sleep deprived a study arm of subjects, similar to resident hours. They found that even if those subjects slept 10 hours one weekend, they were only wakeful for a few hours before performance again began to decline [1]. An editorial article in Scientific American suggests that it is possible to regain sleep debt, however it must be done hour per hour of sleep lost [2].

HA! Even after 3 ½ months of residency, I’m positive that the amount of sleep I need will never be reconciled. However, my body is telling me to relax, so I oblige. Another perk of a couple of extra hours of free time is time in the kitchen. I made lovely little ravioli “pillows” the other night. This recipe takes a bit more work, but the simple, rich fall flavors are certainly worth it. You don’t need a pasta maker, in fact I found having a pasta maker to be equal work to simply giving it a go with the rolling pin.

Butternut squash ravioli pillows

Pasta

1 cup semolina flour

¾ cup all purpose flour

1 egg and 2 egg yolks

1 tsp salt

Glug olive oil

Water as needed

Filling

1lb ricotta

¾ lb butternut squash cut in half

12 sage leaves

¼ tsp nutmeg

¼ cup grated parmesan

Pinch red pepper flakes

1 tsp salt

1 egg

To top

1tbsp butter

1tbsp olive oil

~6 sage leafs

2 tbsp pine nuts

salt, pepper and parmesan cheese to taste

To make pasta: In bowl add flour and salt and combine. Make well and add oil, eggs and yolks. With fork, start to combine. Bring together with hands. Add water as needed to bring the dough together so it is slightly moist but not tacky. Knead with hands a couple of times and then either keep kneading with hands or transfer to Kitchen Aid with kneading attachment. You can add water or flour depending on whether is dry or wet. Knead for about 10 minutes or until dough is smooth and very stretchy. Break dough into about 4 pieces and either roll with pasta maker or the OLD FASHIONED way, with a rolling pin until dough is thin enough to be slightly transparent.

To make filling: Preheat oven to 400. Place sliced squash on baking sheet. Bake until very tender, about 1 hr. In cast iron pan or other heavy bottom pan, coat with vegetable and olive oil and heat until oil is rippling and smoking. Add sage leaves and fry until starting to brown and crispy. Drain on paper towel. In bowl place ricotta, egg, sage, nutmeg, parmesan, salt and pepper flakes and mix. Once squash is cooked, remove from oven and mash with fork. Add to filling.

Put about a tablespoon of filling on the dough and fold in half crimping down with water to seal the edges. Cut the raviolis with either a cutter, a crimping roller, a pizza cutter or simply scissors. Add to a pot of boiling, salted water and cook until water reboils about 2-3 minutes.

In pan, heat up oil and butter, add pine nuts and sage. Add raviolis and toss.

1. Cohen, DA, et al. Uncovering residual effects of chronic sleep loss on human performance. Sci Transl Med. 2010 Jan 13;2(14):14ra3.

2. http://www.scientificamerican.com/article.cfm?id=fact-or-fiction-can-you-catch-up-on-sleep

Full Moon Pies

noreply@blogger.com (Elizabeth) — Thu, 23 Sep 2010 02:40:00 +0000

AAOOOOOOOOOOOOOOO! The 23rd is a full moon. Time to get your werewolf self ready for the big howl. Besides bringing out beasts and goblins, full moons are thought in the obstetrical world to bring out babies. As an already overworked and overwrought poor little intern running around labor and delivery, this can’t be a good thing.

But are full moons actually related to the onset of labor? Most studies suggest that, in fact, they are not. A 1979 study of 11,681 live births at UCLA hospital showed that there was no correlation of lunar cycle to births. These results were reproduced in a smaller study of 3706 births in the 1990s in New York City. However, some studies suggest otherwise. One small Italian study suggests that there might be a small effect on multiparous patients (those that have had more than one baby) with the lunar cycle.

Not only is tonight/tomorrow (the calendar says tomorrow but it looks full tonight) a full moon, but it is also a harvest moon. Besides being a great Neil Young album, a harvest moon is when there is a full moon at the autumnal equinox. Supposedly the harvest moon appears bigger and brighter than a normal full moon. Time to get out the scythe and start farming.

To celebrate the full moon, I made a traditional southern classic, the moon pie. A moon pie is 2 graham cracker cookies filled with marshmallow and topped with chocolate. To celebrate my day off, I made my own graham crackers and my own marshmallow. Although it seems difficult, it isn't too tough. Just takes a candy thermometer. Graham crackers require graham flour, which I know some people have had trouble finding. I like Bob's Red Mill which is in the health food section with the other whole grains.

Full Moon Pies

For the cookies (adapted from Martha Stewart's baking)

1 1/2 cups all purpose flour

1 1/2 cups graham flour

1tsp baking soda

2 tbs cocoa powder

1/2 tsp salt

1 1/2 sticks unsalted butter at room temp

3/4 cup packed light brown sugar

2 tbsp honey

Preheat oven to 350. Combine flour, baking soda, cocoa powder and salt and set aside. In mixer, beat sugar, honey and butter until fluffy. Slowly mix in flour, stir to combine. On floured surface roll out cookies thin about 1/8 inch and cut with 1.5 inch round cookie cutter (or glass or jar which is what I used). Place on baking sheet and bake about 7 minutes until brown and crisp.

For the Marshmallow (from Food Network)

1/4 cup water

1/4 cup light corn syrup

3/4 cup sugar

2 egg whites

1 packet plain gelatin

2 tbsp cold water

1/4 tsp vanilla

Combine the 1/4 cup water, the corn syrup, and the sugar in a saucepan fitted with a candy thermometer. Bring to a boil and cook to "soft-ball" stage, or about 235 degrees F.

Meanwhile, in a standing mixer fitted with a whisk, whip the egg whites until soft peaks form. Sprinkle the gelatin over the 2 tablespoons water and let dissolve. When the syrup reaches 235 degrees F, remove it from the heat, add the gelatin, and mix. Pour the syrup into the whipped egg whites. Add the vanilla and continue whipping until stiff.

Transfer the mixture to a pastry bag fitted with a round tip. Pipe a "kiss" of marshmallow onto half of the cookies, and top with the rest to make sandwiches. Let set at room temperature for 2 hours.

For the Ganache

8 oz chocolate chips

1 cup heavy cream

Over double boiler on medium heat, melt chocolate and cream, stir together. Dip cookies in ganache. Also can make white chocolate for an extra drizzle

Abell, GO.; Greenspan, B. “Human births and the phase of the moon.” New England journal of medicine, v. 300 issue 2, 1979, p. 96.

Joshi, R.; Bharadwaj, A.; Gallousis, S.; Matthews, R. “Labor ward workload waxes and wanes with the lunar cycle, myth or reality?.” Primary Care Update for OB/GYNS, v. 5 issue 4, 1998, p. 184.

Gabriele Ghiandoni, Roberto Secli, Marco B. L. Rocchi, Gilberto Ugolini, Does lunar position influence the time of delivery? Eur J Obstet Gynecol Reprod Biol. 1998 Mar;77(1):47-50.

Tik Tok Board Doc

noreply@blogger.com (Elizabeth) — Tue, 21 Sep 2010 03:24:00 +0000

This month has been awesome. I'm what is called board doc which means I run the labor and delivery board making sure everybody has been examined, monitors are placed and all of them are delivered. It's been a blast but it's probably the most crazy experience of my entire life. There is no time for sitting, or eating, or thinking. In honor of board doc, I have re-written the words to a favorite pop song, Tik Tok by Kesha. In medical school we used to have a show Doc Opera with a very similar feel to it, and I used to direct the band. Since there's no Doc Opera in residency, I've spent my few minutes of free time re-crafting the song. So here ya go!

Wake up in the morning feeling oh so S%ty
I got my glasses, I’m out the door, I’m lookin oh so gritty
Before I leave, brush my teeth and I pull my hair back
Cause when I leave for the night, I ain’t coming back

I’m talking danskos on our toes toes
Scrubs instead of clothes, clothes
Blood all over ourselves, selves
Pulling out all the babies
Sewing up all the ladies
Trying to get a little bit messy

Don’t stop, make her pop
Nurse will you run my pit up high
Tonight, push it right
Till that baby sees the light
Tick tock on the clock
But the babies don’t stop, no-oh-oh no-oh-oh-oh

Don’t stop, make her pop
Turn the epidural up to high
Tonight, imma write
Notes til I see the sunlight
Tick tock on the clock
But the pager don’t stop, no-oh oh oh

Ain’t got no sense in the world but got plenty of fear
Ain’t got no food in my belly but nobody cares
Now the tasks are lining up, can I work any faster?
There are 8 million things I’m not sure I can master

I’m talking about everyone running around round
Feet never leave the ground ground
Gonna pit her if she’s moving too slow
Decels so she can’t no second miso-so
Can’t wait until she crowns crowns
Wait until she crowns crowns
Wait until she—

Don’t stop, make her pop
Nurse will you run my pit up high
Tonight, push it right
Till that baby sees the light
Tick tock on the clock
But the babies don’t stop, no-oh-oh no-oh-oh-oh

Don’t stop, make her pop
Turn the epidural up to high
Tonight, imma write
Notes til I see the sunlight
Tick tock on the clock
But the pager don’t stop, no-oh oh oh

I’m cramping up
I might break down
The heart, it pounds
FSE
With my hands in
I got it through
I think we’ll know
IUPC
Let’s build it up
Head come on down
We’re hoping for
Adequacy
With my hand in
With my hand in
Get your hand in

No the party don’t stop when I walk in

Get On Your Feet

noreply@blogger.com (Elizabeth) — Thu, 09 Sep 2010 19:13:00 +0000

HOLY HOLY! Sorry for that more than brief absence. I am glad I bought comfortable shoes because they are the only thing keeping me standing--along with fear, adrenaline, motivation and a healthy reliance on Diet Dr. Pepper (love this Texan Dr. Pepper phenomenon). The theme of my residency seems to be MOVE! GO! GO! GO! Faster, faster, faster. Don’t breathe, don’t stop, don’t sit down. As one of my senior residents told me, “Don’t tell me you’re going to do it, just do it!”

It’s been incredible. I feel exhausted, but satisfied at the end of the day. I’m learning how to give appropriate, effective care, and the whole environment of frenetic energy is encouraging the more manic side of my personality to emerge. I really hated sitting around in medical school waiting for things to happen, and I’m happy to be working at work. Besides, doing C-sections and deliveries couldn’t be more fun.

Didn’t you know standing at work is good for you? Sure if I keep this up I’ll probably have varicose veins by the age of 30. Even so, I feel energized. A couple of months ago, the New York Times profiled a certain type of desk that is adjustable for people to work standing up. One recent study from Canada showed that in a cohort of 17,013 people, those that spent almost none of their time sitting had a significantly reduced mortality rate compared with those that sat more, even when sedentary subjects participated in vigorous exercise (1).

So, what to eat to keep you on your feet? Well, I don’t get to eat much during the day, but I made some food that is great for any meal of the day be it breakfast, lunch, dinner or a midnight snack. There is nothing quite as delicious as some high fiber, well seasoned black beans and brown rice to give energy and not drag you down.

I know, if I were on Top Chef and I served canned beans I’d probably get sent home, but let’s be honest, I’m not the queen of dried beans and they take forever. This recipe uses black beans and cooks them with veggies and spices, topped off with a little vinegar, fresh cilantro and queso fresco for a vibrant, warm and delicious meal.

Black Beans and Rice

1 medium onion finely chopped

1 carrot finely diced

1 jalepeno finely chopped

2 cloves garlic finely chopped

2 tbsp veggie oil

salt to taste

½ tsp dried marjoram

½ tsp Mexican oregano

2 tsp ground cumin

2 tomatoes diced

2 cans 15 oz black beans drained and rinsed

¼ cup – ½ cup water (depending on how soupy you like your beans)

1 tsp apple cider vinegar

1 tsp (or more for spice) hot sauce

fresh cilantro and queso fresco for garnish

Over medium high heat, preheat the oil in a saucepan. Add the vegetables, salt generously and cook until carrots are soft. Add the spices and cook until aromatic about 30 seconds. Add the tomatoes and cook until begin to release juices. Add beans and water, salt to taste. Turn heat down to medium-low and simmer beans for about 15 minutes until canned taste has disappeared and flavors are melded. Add vinegar and hot sauce. Serve with brown rice and garnished.

Or, just do what I do and shove a string cheese in your mouth when nobody is looking.

1.Katzmarzyk, PT.; Church, TS.; Craig, CL.; Bouchard, C. “Sitting time and mortality from all causes, cardiovascular disease, and cancer.” Medicine & Science in Sports & Exercise, v. 41 issue 5, 2009, p. 998-1005.