Chocolate espresso dacqoise (gluten free), and science of egg whites!

Valentine's Day Menu

Lots of things are happening. My rank list is in. Tyler and I are going to Peru this week with a tenuous plan at best. Formation came out and I loved it. Hillary Clinton is running for president and is BOSS. Oh yeah, and I finished my last clinical rotation in medical school. It's weird -- it's almost like yesterday when I stepped on the wards for the first time, with a clean white coat (it's an odd shade of yellow-brown-white now), a stethoscope around my neck (which has since been replaced after losing it), and a pocket full of snacks and books (still there). I started on the Heart Failure service on my medicine clerkship with my "cohort" for the clerkship being Dave Cholok, Jason Kung, and Kira Masco, people I had never really talked to much or thought about much before the start of third year. My first presentation was...not good...and I spent at least 45 minutes preparing it. And now my next patient presentation will probably be as an intern, hopefully a little better than it was two years ago.

We'll see.

Look at all those layers!

Anyways, I made a dacqoise for valentines dinner! It's a french dessert made with almond and hazelnut meringue that seems super complicated to make, but it's really not. I made it, I know the pitfalls, now I can share them with you! And realistically...my future self. Anyways. It's simple. It's meringue, buttercream, and ganache. It just takes a full day mostly because you have to rest it and allow it to soften. Then at the end of the day, or the next day, you have a delicious, delicious cake. Arguably the best cake I've ever had.

Some science: Beating eggs

What is Cream of Tartar? 
It's an acid. It is the salt of tartaric acid. There are a few definitions for an acid two of which are that acids can be a proton donor, or an electron acceptor -- but this is a little too detailed to matter right now. What you need to know is that tartaric acid has a bunch of protons in it (or that it can accept a lot of electrons).

What happens when you beat eggs? 
You agitate it with a whisk enough that you (A) incorporate air bubbles that have water on their surface and (B) denature the proteins, meaning you make then go from gooped up blobs to unraveled. The proteins, since they are made up of a bunch of different atoms, start attaching to each other. Particularly, the sulfur ions that help stabilize the structure of the proteins start attaching to each other. These bonds surround some of the air bubbles, and "squeeze" the water off the surface of the air bubbles. This is why when you whisk egg whites sometimes you get that pool of water at the bottom if you let them sit for a minute.

What's the point of adding Cream of Tartar to egg white when you beat them? 

They "stabilize" the proteins. What that means is that the acid (protons) in the Tartaric acid bind to the sulfur ions and prevent them from bonding too tightly and keep them in an "open" loose formation. They keeps the water in the meringue for the most part and keeps your egg whites from deflating.

What does this mean?

This means that you can add any acid and achieve similar results! Lemon juice, etc. The upside to the tartaric acid is that (A) you don't add liquid volume and (B) you don't impart (much) flavor other than the tang of the acid if you add too much...which I've done before.

So wait...it doesn't increase the volume of the egg white?

Nope, beating it just does that, cream of tartar just stabilizes the proteins by donating a protein (or accepting electrons!). Another thing you can do to make your egg white beating go faster is not add sugar at the beginning.  This is because sugar attracts water (hygroscopic) and the crystals can get in the way of the egg proteins unravelling and finding each other. So if you add the sugar part way through, it can help keep the water in, and won't slow down your egg white beating.

Whew, now that we're done with the science...on to the delicious!

Chocolate-espresso dacquoise
Modified from Treats-SF

My advice when starting this --

• read the directions for each component first and get your mise en place (ingredients ready to go). 
• Actually put everything in the fridge for the resting times. 
• Really make sure your meringue has a smooth top when you put it in the oven, it really makes life so much easier when you are putting the whole thing together later. For reals. FOR REALS. 
• All components can be made ahead of time up to two days. Even the whole cake can be made a whole day ahead of time. 

Meringue

• 4 egg whites (save the yellows, you need them for the buttercream) 
• 3/4 cup almond meal
• 1/2 cup hazelnuts, toasted
• 3/4 cup plain white sugar
• 1/4 tsp cream of tartar
• 1 tablespoon cornstarch
• 1/8 tsp salt 

Preheat oven to 250F 

Line a baking sheet with wax paper. Measure out a rectangle of 10x13inches and draw it in with a pencil. Then place the pencil side down on the baking sheet. This is important because it'll let you make a perfect rectangle, which will help with the dacquoise. You can get your parchment paper to stick by spraying the bottom of your baking sheet and then putting the parchment paper down.  

In a food processor, pulse 1/2 the sugar, all the hazelnuts, almond meal, cornstarch, and salt together into a fine texture. In the bowl of stand mixer, put the eggwhites and cream of tartar in the bowl, put it on low-medium and with whisk attachment, and whisk until foamy. Then turn up the speed to medium-high and slowly add the other half of the sugar. Keep beating until stiff peaks form. It took me 4-5 minutes. Then fold in the almond meal-hazelnut mixture in two batches. 

Spread it evenly on the parchment paper and make sure the top is as level as you can get it. Trust me, I didn't, and this step is important. 

Pop it in the oven for an hour and a half. Then turn the oven off without opening it (you don't want the heat to escape) and keep it in the oven for another hour to hour and a half to harden. Then pull it out and let it cool. 

German Buttercream 

• 4 egg yolks
• 2 tbsp sugar
• 3/4 cup whole milk
• 1.5 tsp corn starch 
• 1/4 tsp salt
• 2 sticks butter (16 tbsp) 
• 2 tbsp amaretto mixed with 1.5 tbsp instant espresso or coffee

Basically a german buttercream is a pastry cream mixed with butter. It gives it a creamier texture. So you make the pastry cream first. Mix the egg yolks, sugar, and cornstarch in a medium heat proof bowl. In the small saucepan, heat up the milk until it's simmering, turn off. Then, while constantly whisking slowly mix half the milk into the egg yolk mixture. This tempers the egg yolks and prevents them from scrambling which is what would happen if you added them in right away. Then pour the whole shebang back into the saucepan and turn it back on, whisking constantly until it's thick like pudding.

Put it in the fridge for 30 minutes to an hour to cool down. 

After 30 min, in a stand mixer with a paddle attachment beat the room temperature butter. In three separate batches add in the pastry cream, scraping down the sides to make sure everything is well incorporated. Then add in the amaretto-coffee mixture. Turn it up to high and beat the crap out of that butter until it increases in volume and starts to look like a butter cream. 

You can store that covered in the fridge.

Ganache 

• 6 oz bittersweet or dark chocolate
• 3/4 cup heavy whipping cream 
• 2 tsp corn syrup

Put the chocolate in a heat proof bowl. Heat up the heavy whipping cream and the corn syrup in a small saucepan until simmering. Pour over chocolate, and whisk it to incorporate. Donnnne. That step is easy. Oh yeah, and let it chill in the fridge for about 10-15 minutes until it's still liquid, but not hot. 

Okay, so with the meringue, cut it down with a serrated knife so it's 10 x 12 inches. You want to do this slowly, so you're using the weight of the knife to cut it. Then, make a mark/nick in the meringue to divide it into four equal parts. These will be your layers. Cut them length-wise gently. If it breaks...oh yeah, you can glue that back together with the butter cream/ganache, but try to keep them in one piece. 

Then lay them out on a baking sheet. Put 1/4 cup chocolate ganache on three out of four layers. spread it, save the remaining chocolate. Put it in the fridge for 20 minutes. Then pull it out, and but 1/2 cup of the buttercream on the layer that does not have chocolate. Then place the buttercream side down on top of a chocolate layer, so the buttercream and the chocolate are touching, and you're making a meringue-chocolate-buttercream-meringue sandwich. Then put more buttercream on the top of the sandwich (another 1/2 cup) and put a chocolate piece on top of that, adding to the sandwich. 

By the end of it, you should have a clean (no chocolate,no ganache) top, and a four layer sandwich going on. Then you want to coat the outside in whatever buttercream you have left. The most important part is the top, the sides can be coated kind of mehhh...but the top should be smooth and flat. 

Then refrigerate it for half an hour to an hour. I skipped this step, and boy did I pay for it. My stuff still turned out tasting amazing, but I mean, it was defffinitely not as pretty as it could have been. When you're about to pull out the dacquoise, pop the remaining chocolate in the microwave for 10 seconds to melt it so it's pourable but not hot. 

Pull out the dacquoise. Pour the chocolate on top, and quickly spread it over the top into a smooth layer. Then spread the chocolate that dripped on the sides. 

Almost done...

Topping

• Hazelnuts
• Toasted slivered almonds

Then you want to coat the side of the dacquoise in almond. You can do it with it sitting on a tray, or you can lift it up if you're so bold (I did, it's no big). Just press the almonds into the side. 

Then use the hazelnuts on top. You can line them up in a row to "mark" the pieces so it is easier to eyeball pieces when you cut. I put the slivered almond on the entire dacquoise because I wanted to...but you don't have to. 

Then refrigerate for hour or two before slicing. Or you can let it sit over night. Stays good for 2-4 days covered in the fridge. 

Best. cake. ever.

Why don't patients remember your name?

It's simple: you don't look at them

A patient comes in, and you vaguely introduce yourself while sitting down to your computer (not looking at them), ask them what brings them (not looking at them), ask about their medications (not looking at them), ask about their pain (not looking at them). You turn around and look at them for the exam, but are you? You are looking at the aspect that you are inspecting / auscultating / palpating / precussing. You are not looking at them.

This is not a piece arguing against the use of computers during patient visits, it's a commentary about how the culture of medicine, particularly specialized medicine, is changing such that it is okay to not afford someone the basic respect of seeing them.

Why does this happen?

Part of the problem is that we function in a broken healthcare framework: a system that incentivizes piling up patients, double and triple booking them, to maximize profits because clinic visits don't pay as well as procedures. So providers can frequently be booked to see more than 30 patients in a day. For only 30 patients, in a normal eight hour day that's 16 minutes per patient encounter -- that's working straight, without a lunch break, time to write notes, or run to the restroom. This invariably leads to provider frustration, fatigue, and just "wanting to get the job done."It is an impossible system that needs to be fixed.

But part of it is a culture problem. Somewhere along the way, in large part because of the system we work in, we forget that most of us went into medicine for the love of the science and the people.

Looking at someone provides them agency and respect, and allows you to indicate that you are listening, allows you to convey empathy, concern, and interest in what they are saying. It is why we teach children to look someone in the eye when they speak. It is treating someone as an equal, another human being, and that in and of itself is healing. It is a subtle but real treatment we as providers can give every patient -- the opportunity to be seen, to be looked at, to have their words respected, and to perhaps leave with some relief that they were heard.

Maybe this is because I am coming off of my geriatrics rotation, but now when I see older patients coming into clinic I wonder if this is their only outing for the day. I wonder if they had a challenging time getting here with a walker, a cane, with diminished vision, and slower response times. I wonder how it must feel to have someone who is less than half your age speaking faster than you can hear, not looking at your when you speak, and pecking away at their computer for most of the 15 minute visit. I wonder at what point in my training will I stop wondering about that and just want to power through patient after patient?

I'm not suggesting anything radical. I'm simply saying that when you come into a room, look at the patient when you introduce yourself. Look at them when you ask a question, look at them when they give the answer. Type away in between, maybe explain that you're going to use the computer. These are simple things you can do in the 15 minute window you do have. Just, remember that looking at someone is part and parcel to making them feel better. Maybe then patients will remember our names.

And May The Odds Be Ever In Your Favor...

And they're in! Applications that is. Actually, they went in two days ago (9/15/15). Yep, I typed that whole date out. It's a date I'm going to remember. Four years. Remember this post when I started medical school? I do.

The details are fuzzy, I honestly don't remember the white coat ceremony well other than we had to wait in line and it was hot. But I remember getting my picture taken for my ID. I was so nervous--not because of having my picture taken, but that it was getting a medical school ID. After the worrying, and the applications, and the what not, I'd get a tangible piece of something saying I was a medical student.

Then I remember taking pictures in front of the school with my mom and Tyler and my dad in my white coat. I remember wondering what kind of doctor I'd be.

So now to wait for interviews, then eventually rank lists, then match day. This is the song that I keep playing in my head. Catchy.

NSVD: normal spontaneous vaginal delivery: that time when I almost passed out.

Yesterday was my post-call day. What that means is that I was "on call" or in-hospital for 24 hours prior, and I got to go home after watching 4 babies delivered in a foggy haze with judgment similar to after having 2-3 drinks, and pass on out.

I'm currently on my OB/GYN rotation with 24 hour calls. I grumbled about this initially, but the underlying reason makes sense: it's easy to think "YAY BABIES! WOMEN'S HEALTH! SURGERY! MEDICINE! ALL IN ONE PACKAGE!" but not think about what life could be like if you're up for 24+ hours straight, looking down the barrel of a vagina at some unholy hour with a mom that's been in labor for a ridiculous amount of time, who is now too tired to push.

That's why OB/GYNs are awesome. Really, who else can get a living parasite (beautiful, wonderful gift of a parasite) out of your body in <1 minute. OB/GYNs, that's who.

I've been through half of this rotation so far, and have done my GYN portion. I saw some serious surgeries: myomectomies with 5L of blood loss, periurethral abscess drainage with a 200 mL fountain of frank pus, D and C, ruptured ectopic pregnancy, etc. I have counselled women about birth control methods (IUDs galore!), talked about menses, done pap smears, and asked some seriously personal questions. It has been awesome. But nothing has been as nuts as seeing a person pop out of another person. 

I landed on labor and deliver at noon, after going through post-partum rounds in the morning with an great nurse midwife who, after asking if I had been on L&D before (labor and deliver...I hadn't) told me "things move fast...maybe you should eat something before you go to the floor." Me being, well...me said no, I'll just go the floor -- after all, I've been on surgery, that's tough and I still got to eat.

One key point I missed there, surgeries, though not always, are frequently scheduled. Babies are not. I introduced myself to the team, and put my things away, and sat down to nutritious and delicious lunch of tofurkey and cheese when the intern pops his head into the break room and says, "three babies, NOW" and leaves the room. I freeze, tofurkey goodness having just touched my tongue, and staring at the spot where he just stood then at the nurse eating her salad sitting across from me until 10 seconds later she says, "Well...GO!"

I got my butt into gear, pushing my lunch back into it's bag, shoving a handful of chocolate almonds in my mouth, biting my tongue in the process, and dashing out of the room into the patient room.

Oh my. She was giving birth. Now, mind you, I have never felt like I was going to pass out during any of the other rotations I've been on. Guy throwing up straight up blood? I'm cool. Connecting the rectum back up to the sigmoid colon by shoving a big metal rod up the anus? No sweat. Cut open an aorta, get sprayed with bright red blood, stick a vacuum suction in it to stop it? My jam. Seeing a woman, legs spread as wide as can be, no epidural, supported by partner and mom, bearing down, sweating, and actively pooping, with clear amniotic fluid coming from her vagina...I think I'm going to pass out.

The midwife is there. The resident is there. They're supporting her, encouraging her, helping her with different positions, applying pressure to her perineum so it doesn't rip (yes, RIP) when a pot roast tries to come out a hole the size of your nostril. That's hyperbole, but you get the point. Meanwhile, I'm standing back, gloves on, prepared to be the most helpful med student I can be and watch, occasionally translating things to Spanish. It's amazing in how times of fear/adrenaline/whatever you want to call it, things you didn't think you'd remember from high school come back to you. Mind you, it was still quite poor given the context that I took spanish for 7 years.

Anyways, I'm standing back, staring at her vagina/poop/fluid amalgam, and I start to see spots and I think oh no, not here. NOT HERE. Baby >>>>> you passing out. So I squeeze my calf muscles, tighten my abs, squat ever so slightly, and valsalva (push down like you're going to poop) and try everything I can to increase blood return back to my heart and up to my freaking brain which is still seeing spots with my vision starting to narrow in on the sides so ALL I CAN SEE IS THE VAGINA/POOP MIX. Excellent job brain, wise decision.

Luckily, it works. Either that or it was the midwife saying, "grab some sterile gloves, you're delivering the placenta." Probably that -- I work well when given direction. Brain clears up, I grab some gloves, and watch for another 30 minutes while this amazing, incredible woman pushes and pushes and contracts and contracts her baby's precious little head out. And yep, it ripped when her baby's head popped out, and I cringed but she didn't care at all. Or maybe she did, but was too excited and overwhelmed by her new baby girl that she didn't care. I don't know, I haven't done it yet.

The rest is the resident walking me through delivering the placenta...the cord gets longer, there's a gush of blood, and out comes something that looks very much like it's a prop from Alien vs. Predator. Then there's stitching up her vagina and cleaning up the hot mess of blood/poop/fluid down there so we can lay her down properly. But she doesn't care. Why should she? She did it, she's got her mom and partner next to her, and she's getting ready to go to sleep (pass out?) with this new baby girl she brought into this world resting on her chest. 

Burnt Orange Rose Cocktails

Germany, 2013. On our way to Berlin

It's been a while. It's not that I haven't been inspired by food, it's that I haven't been inspired to write about food. But now...I am. In less than 6 months I'll be "on the wards." What that means is that instead of lecture, study, exam, repeat, I'll be see how what I learned translates into actual patient cases...and then lecture, study, exam, repeat. It's amazing the things I've managed to shove, and I mean shove, into my brain over the past 1.5 years. I remember sitting on the floor nearly in tears over my Netter anatomy book because I was so overwhelmed by all the muscles in the body, 2nd year seemed like a million years away, and the Board exam were the farthest thing on my mind. Now, I've passed Anatomy, over half way done with second year, and I'll be taking the Step 1 Board exam in May...so  I'm definitely thinking about that. 

Gluehwein at a Christmas Market in Berlin 

Famous Hamburg Gardens

It's amazing how life can just happen sometimes. I was talking to my friend Lauri yesterday after our latest exam--we were sitting in a coffee shop tying up the last few strings from our latest module before celebrating another exam being done--and I said my biggest worry was that I would lose myself in work. I love learning about medicine, but I definitely scared that I won't DO the things outside of school that make me happy. I'm scared that I'll get so myopic in my view that all I'll be able to see is the next step, and everything else will get only marginal amounts of my focus. 

Burnt Orage Rose Cocktail

But I think that the fear is good. I think having that fear will motivate me to do things...like go to Germany over winter break when I'm living on loans and when it would be easier to give into inertia and study over break. It'll motivate me to keep doing things I love: walking my dog along the river so that I can see the world outside, finding creativity in food, etc. It'll motivate me to remember that life is happening. 

So on that note, I made this interesting drink last night with oranges, limes, and rose water. Caramelizing the oranges brings out a very interesting flavor that is highlighted by the rose water. Try it, it'll be amazing. 

Burnt Oranges

Mason Jar Shaker

Rose Water

Salt rimmed and beautiful

Dinner and Drinks

Burnt Orange Rose Cocktails
Makes one drink

2 oz. tequila
1.3 oz. Triple Sec or Grand Mariner
0.33 fresh lime juice
2 Oranges, sliced in half
0.67 oz rose water 
Crushed Ice

Salt for the glass rim

Take the orange halves and put them in the broiler for about 7 minutes or until the tops are brown-black, but not burnt. Pull them out of the oven to cool. Mix the tequila, triple sec, rose water, and lime juice in a container. Shake them up well to mix. When the oranges have cooled, juice them into the container, and shake it up again. Pour them over ice in salt-rimmed glasses and enjoy. 

Dill Butter and Salad Dressing

It's been a while blog, it's been a while. Apparently medical school is just as time-consuming as everybody made it out to be--shocker! Well, I was a little. I was surprised by how quickly the day goes by, how I will how generally choose studying over everything else, and how quickly time moves.

It's amazing...I've been in medical school for nearly 2 months and now (as of 10 minutes ago) taken an exam in every core subject that I have. It's a bit crazy to think about. I think I've been pretty good at maintaining my stress level, but this weekend threw me for a loop. It was weird, I lashed out at people I love more than I normally would, which made me feel terrible, which made me not happy, which made me study more furiously, which made me not want to study period.

It's a vicious cycle I tell you, vicious. But a learning experience nonetheless. It was important for me to once again realize that medical school was not life, it's just medical school. Yes, it's stressful, yeah, it's a lot of things to learn, but it's not the number one most important thing in the world.

However, my mental health, which largely depends on the happiness of those I love and my own sanity, is the most important thing in the world.

It's only going to get harder from this, so learning to stay calm, not lash out at those closest to me, and realizing again that hey, other people have stuff happening in their lives too. Whether it's objectively as hard as what I am doing doesn't matter, it's stuff, and it's important, because it's their stuff. So this is my note to myself to get over myself, and keep that calm that I've spent years, years, building. After all, it's just school.

Now...a recipe! So I've recently become a little enamored with dill. I use it in salad dressing, mix it into butter (courtesy of some great dill butter sandwiches from Sonali), mix it with olive oil, lemon, salt, and pepper to make a pasta sauce...basically in anything.

But I don't have a ton of time to cook unfortunately, so my new obsession is the EarthBound Herb Puree. Sounds odd, but it's amazing, and it lasts a LONG time. Try it, and you'll love it--it'll jazz up any regular old salad dressing, oh hey, like the one below.

Dill Dressing

0.25 cup olive oil
2 tbsp. lemon juice
1 tsp. minced garlic
A squeeze of the dill puree (about 1 tbsp)
Salt and pepper to taste

**Optional: a splash of heavy cream or a small spoonful of sour cream or non-flavored yogurt to make it creamy**

Which all these things together and in a small bowl, and drizzle on top of salad, pasta, bread, or just use it to marinade veggies! 

Medical School Starts With White

So it's been a while. Mostly because in the past few weeks after getting back from Paris, we've been running around like chickens with our heads just barely still attached.

We ran to IKEA, bought all of our furniture, built all of said furniture, dealt with an IKEA delivery mishap (they forgot to deliver one piece of furniture), unpacked all of our stuff, went on a trip to Hawaii (awesome!), came back, painted the apartment, cooked food for a month to feed us, went to Acadia (awesome!), came back, finished unpacking, and oh yeah...started medical school.

Ziplining in Kauai

A morning swim. Tyler and Adele. 

Our jam-packed apartment! 

My dad and I picked blueberries in Maine!

Hiking in Acadia

Surreal

Typical

More Hiking!

Love and a red hat :-)

My lovely sister in law and her frog

After a life time of dreams, moments of wavering fears, and still completely unsure of what's to come, I am now a medical student. Not a pre-med. Not a doctor. A medical student. A physician-in-training, as one of our professors put it.

One of the major events that most medical students in the US all experience is the "White Coat Ceremony." At the beginning of your medical school career (or in some cases, later) you are given a white coat by your school, signifying that you are now on the path to becoming a physician. Our coats are shorter than the actual doctor's coats, with a plastic name tag that we pin to our pockets, but they were significant none the less.

Cotton, slightly larger than expected, and white, they represented the culmination of the work we had all done to get to this place. The studying, the activism, the caring, the growth and maturation as individuals. But more importantly, the coat was humbling.

It's amazing that a piece of clothing humble you, but I should have known putting on a white coat would. I realized, or rather re-realized, that in a few short years, after my brain has been jammed packed with more information that I thought possible, people will be opening up their world to me. The life, the secrets, the illness, the pain, the happiness--all of it wrapped up into one person for me to care for. I became suddenly and uncomfortably aware of my ignorance. There is much to learn in the next four years, both in terms of the science and the humanity of medicine, before I really can touch my first patient. It is scary. But I am thankful for that time to learn, thankful for the support and guidance, and thankful I have seen my family go before me and do it well. I am not afraid.

So the white coat ceremony is done, my white coat is neatly put away, waiting to be taken out for my Introduction to Clinical Medicine class where I take my first steps talking to patients. Classes have started, and my time is spent primarily on concepts of Biochemistry and, soon, Anatomy. But every once in a while, when I open my closet and see my coat, and I get that tingly feeling of excitement for the day it becomes just a bit longer. 

Udon Chard Wraps

We leave San Antonio in 40 days. We drive to Boston in 40 days. We leave Texas in 40 days. We start searching for an apartment in 44 days. We go to Paris in 50 days. We go to Hawaii in 76 days. We go to Arcadia in 92 days. And I become a medical student in 96 days. 


Woah, that's a lot of countdowns. I've been trying to ignore them recently though...just having fun with what I can do now, read books, teach children, read the newspaper...sleep late. All things I hope I can still retain to some extent in medical school.


That's one of my bigger fears, that it will be a "step back" in some way. That I have just gained my adult life, and it will be yanked away from me by school. Don't get me wrong, I am ridiculously excited for medical school, and going back to studying, but I am worried that I will gain a myopic perspective about studying, and I don't want that. I want to continue to be well-rounded, read books, cook, make random political commentary, etc. I understand that I can't do it to the extent that I am now, and I don't really want that, but I am going to work damn hard to keep it. Luckily, I also think Tyler will help me out in remembering that hey, I can and should take breaks! Anyways, on to the recipe! 


These udon chard wraps are really freaking good! Albeit kind of messy to eat...


They are already vegan, but they are easily made gluten free if you substitute the udon noodles for rice noodles, or for quinoa. Try them, seriously. They might sound weird, but don't run away...I swear! They're great! Also, they're pretty easy to make...it took me just under 30 minutes.


Udon Chard Wrap 


There are 3 parts to this recipe: sauce, chard leaves, and noodles. 


Sauce
3 tbsp. peanut butter 
1 tbsp. toasted sesame seed oil 
2 tbsp. soy sauce
squirt of your favorite hot sauce (mine is sriracha) 
handful of chopped chives 
slightly less than 1/4 cup water


Stir these items all together, and you have yourself one tasty sauce! Add some salt if needed. 

Noodles
Some tofu, cubed
udon noodles


Cut up the tofu into cubes, and saute them in some olive oil until they are lightly brown on either side. 


While this is happening, boil some udon noodles until they are the softness you like. Strain the noodles, and then mix the sauce into the noodles and let it cool.


Chard Leaves


Bunch of rainbow chard leaves, that are relatively in tact still


Cut off the stems of the chard leaves, until it's just the leaves. On the bottom of the leaf, there will still be a thick stem left...cut it out careful. 
--------

When everything is done, lay out a chard leave, fill the middle with a bit of the noodles, put a few slices of avocado, or some walnuts or pumpkin seeds in the middle, a splash of hot sauce, and roll it up like a burrito. Enjoy! 

Why I Bake

So a few people have asked me why I bake. It's simple--baking is something I can DO. It's input to output ratio is generally equal, and you get a tangible result within a few hours usually. 


That's not true for most things in life. 


Teach for America? As a high school teacher, I take the wins I can get. Student X showed up to class on time? WIN. Student Z turned in his homework? WIN. Student D brought in a pencil and didn't pull out their cell phone? WIN. Heck, Student A stayed awake during class? WIN. 




Medical School Application? As an applicant, I take what I can get, and refresh my inbox like a rabid chipmunk hoping desperately for an interview, or some smidgen of hope that I'm not totally lost in the pile applicants the admissions committee must read. Hours of heart, sweat, and ME that goes into the essays, the personal statements, the descriptions, everything. 


Baking? Mix together flour, sugar, and butter? Shortbread cookies to feed 30! Mix together apples, oats, brown sugar, flour, and butter? Crisp for plenty! Mix together hazelnuts, chocolate, flour, sugar, and vanilla? The most tasty "nutella" cookies you'll find. 


You see the difference? 


I was wait-listed today at a school I interviewed at in September. It's odd. I was rejected from Stanford, Vanderbuilt, and Davis, without any real emotional fall out--was I sad? Sure. But was I hurt? Was I mad? No. I thought--huh, this is what rejection feels like? Not so bad. WRONG. I just didn't see myself there. 


I was mad when I got the e-mail today. I was hurt when I got the e-mail today. I was frustrated when I got the e-mail today. I'm not cocky enough to say that I thought I would get in right away, I just didn't think of how it would suck to not know. Just something I didn't think of. 


So I baked. Because it works. I think about just the baking, I don't focus on how frustrated I am, I just think--how lovely these cookies will be when I take them out of the oven! And it makes me happy.


So there, when you're frustrated, when you're irritated, when you're blergle, or whatever--bake, and bake these cookies, because they're tasty. 

TMDSAS, AMCAS, and Lemon Bars!

So medical school applications opened this past week for Texas and AMCAS. I'm busy pecking away at the key board trying to find the right words (but under 5000 characters) as to why I want to be a doctor. I definitely thought 5000 characters (with spaces) was more than what it is...so now I'm anxiously trying to cut down on the essay to make sure I'm not leaving out any important parts. 


But I figure I'll be writing A LOT of essays anyways, so whatever I don't say in this one will get covered in another one. 


I'm surprisingly excited about this whole process, the medical school application. The scary process is actually...soothing in a way. After a year of teaching, which is most certainly no walk in the park, it is nice to have something...concrete. Something I know I can do, something I want to do, something I want so bad. So -- in a sick, masochistic kind of way, I'm looking forward to it. 


So! To celebrate the process, and to get T- off my back about making these again, I decided to make lemon bars! 


I used a recipe from the great Ina Garten...but I just modified a tad bit. 


Try them -- they're so good. If you've never had them before, let me try to describe them...


they're like lemons, but sweeter, with biscuits on the bottom, but flakier, with eggs, but it's not at all eggy. It's wonderful.


My first try with the recipe today, was terrible. I forgot to turn the oven down when I was cooking the lemon custard stuff on top, and it turned into lemon scrambled eggs. BLERGH. epic fail. 

At least he thought they were tasty

So I let the dog eat some, after I threw a mini-fit about ruining them. 

woof

Try 2 = perfection. I turned the temperature down, checked them like an insane person every 10 minutes. Beautifulness. 


Enjoy!


Lemon Bars
Recipe modified from Ina Garten


Shortbread Crust
0.5 lb butter, room temperature
0.5 cups sugar 
2 cups flour
1 tsp salt

Preheat oven to 350F

Cream together the butter and sugar in a mixer with the paddle blade. Add in the flour slowly (I did about a 1/2 a cup at a time), and add in the salt. 

Yep, I ate some.

You can change the amount of salt for how salty you like things to be...I like more salt to contrast the sweet, but it's really up to you. 

Spread it in a 9x13in evenly, and toss it in the oven for 15 min. When it's done, pull it out. 

It was good.

Ready for the oven!

Lemon Topping
6 large eggs
2.5 cups sugar 
1 cup flour
1 zest of lemon
1 cup lemon juice

Lower the temperature of the oven after the shortbread crust comes out to around 250F.

Whisk all these items together. I suggest the wet ingredients first, then the flour slowly to prevent any clumping. If you don't have zest of lemon, seriously, don't worry about it. I did it the first time without, it's not a big deal. 

Pour this on top of the shortbread crust after its cooled for a bit. 

hello, beautiful.

Put it in the oven for 30 min at 250F, but check it every 15 min. You don't want the eggs to scramble, that's why you lower the temperature. You want it to set like a custard (kind of like lemon curd, but thicker). 

Yum yum yum

Tasty :-)

After that, pull it out, let it set and cool, and sift some powdered sugar over it! 

Tasty goodness :-)  

Dead Miss X

OH! So I forgot to address the dead woman.

When I first got to the hospital, I was put into a semi-private room, which was like okay, whatever, I heard people come and go. One woman had an abscess on her foot and her husband? boyfriend? girlfriend? lover? was very VERY worried about it and didn't seem to understand the what the phrase, "I don't know any more about it!" meant.

But there was one woman, mid-forties, large, light brown hair, white, whose name I don't recall. When she came in, I was on one of my four-hour advil-induced highs, wherein I had no fever and overall felt relatively okay, so I was able to gather information (when you're in a hospital, you get bored easily, so pretending you're a spy listening in on conversations that nurses are having with other patients becomes inordinately interesting). She came in because her oncologist had said she was dehydrated, which for a patient with stage 3 colon cancer undergoing chemotherapy can be a big deal. She came in during the late-evening, probably around 7, and I never talked to her one-on-one, just saw her on one of my many trips to the bathroom to pee out the saline that was coursing through me (which, by the way, is so weird! I barely drank any water all day, but I had to pee like a incontinent racehorse). 

Anyways, from the moment she came into the room, she was wheezing heavily. She had some serious trouble moving air, which I assumed was from her enormous size, since she fared better sitting up. But, throughout the course of the night her wheezing just got worse, and even I thought that someone needed to help her, to put an oxygen mask on her or something, because she was clearly having difficulty. But med-techs came and left the room, just asking if she was in pain, but not really paying any heed to her wheezing. At about 7AM the day after she came in, a tech was in the room with a nurse because they were having trouble taking her vitals when I heard the following:

"Miss X's eyes rolled back into her head"
"What?"
"Her eyes! They rolled back into her head"
"Miss X! Miss X! Are you with us?? Oh god she's not moving air...get me the suction and oxygen...oh god she's coding! Pull the code line! Pull the code line!"
"The what? Where?? Where is it?"
"The blue line!! Pull it now! Get me oxygen"

*Tech pulls the line, about 50 seconds after asked to...has trouble finding it, mean while Tyler and I are still in the room, I am attached to a IV, which is attached to the wall**

**Three more nurses run in, with a doctor asking to be briefed, chest compressions start, frantic movement around the room, another doctor comes in asking to be briefed**

**Another nurse pops over, notices me sitting there in horror, listening to this woman die, unsure of what to do and how to exit the room. She asks Tyler to leave, which he was already getting ready to do, and says they'll send a wheel chair for me**

**Some time passes and they continue to work on Miss X. Another doctor comes in, the room seems to be frantic and in chaos, people not really sure what to do during a code. I am still in the room**

**Miss X's body suddenly starts to fart a lot, and there are weird noises**

**Finally a nurse seems me trying to unplug my own IV because Miss X's bodily death-functions are starting to really frighten me...so she helps me up and out, muttering about how people should have gotten me out right away**


So I end up outside, sitting in the nurses station, with one shoe on, in a patient gown, slightly frightened at the incompetency I heard/saw in the room. Questions swirled: Why hadn't they taken me out right away? Why didn't they know where the code line was? Why did it seem like mass chaos instead of an organized well-oiled machine? Wasn't that what was needed to save a life, not the bumbling that occurred in there? Why hadn't the woman been helped with her breathing earlier?

All of these questions continue to bother me. Particularly, I am frightened by the complete shock I heard at this woman coding. I feel that hospitals need to run like practiced machines: while it may not be common for people to code in that hospital, the staff should be prepared through practice runs to handle it when it does happen. Precious seconds are important at that time.

Honestly, she probably would have died sooner than later with a cancer that bad (from what I gathered from the not-so-subtle nurses), but she didn't have to die like that. She was in distress for a while, and people wasted the time they should have been using to save her, bumbling about trying to find an oxygen machine.

Therefore, I have a couple of resolutions:

--When I am a doctor, I will work at a teaching hospital, one where you are constantly kept on your toes by residents and interns who have just learned the material, and nurses who constantly have to be on their toes to correct the mistakes made by those residents and interns, and too cocky attendings.

--I will not be satisfied with mediocrity in my career. Being satisfied with mediocrity leads to general absentmindedness. When you are a healthcare professional at any level, RN, tech, LPN, doctor, you cannot afford that, peoples lives are in your hands. That sounds so ridiculous, but it's true, and I felt that no one questioned this woman's seriously distressed breathing, and that is settling, and thinking someone else would deal with it.

Maybe she would have died anyways, I don't know, but what I saw at the hospital, her death, and so many other problems, very much bothered me, and made me even more sure that when I am a doctor, I will not let myself become complacent. I will be constantly meticulous and work in an area where I am forced to stay so.

Okay, now I'm off to play video games.

M

Sick and stuff

So it's been over a month since I've posted and here are some things that have happened:

1. It became November
2. The new Harry Potter came out
3. I almost visited my friend, Sam. Almost.
4. I missed a week of school.
5. Oh yeah, I got Pneumonia
6. I heard a woman die.

So last week, on Friday, T-'s dad came and I felt like crap. My head was hurting, as were my eyes, I was exhausted, my body ached, and I was nauseous. However I assumed I had a day or two virus/illness. Saturday it got worse, but I went out, stubborn as I am. I went to the farmer's market, whole foods, and HEB with T- and his dad, and got home with a fever of 102.5 and vigorous chills. My mom suggested I go to the hospital, she was very worried I had a bacterial pneumonia, but again I argued: No mom, I have a short-term flu, I'll be fine.

T-'s dad left on Sunday, and I felt worse and began throwing up. My fever went up, it was not 103.4. So we went to urgent care since I didn't want to wait for hours in the emergency room at the hospital. They gave me an IV, advil, and a butt-shot of Rosefin (an antibiotic). They also took a chest x-ray, and confirmed the first of many things my mom was right about: I had a lower right lobe Pneumonia, small but present.

When my mom heard this she said she WAS coming down to SA because she knew I was seriously, seriously ill (something I thought was over zealous and over-reacting, however I would soon find I needed to thank my lucky stars my mom came down).

See, the amazing thing about my mom -- she's a genius. I'm not lying, my mom has her faults, as we all do, and we are both stubborn women which can cause head-butting some times, but I cannot deny that my mom is a brilliant doctor and an awesome mom. When she got there, she took my temperature: 103.7. She stomped her foot and said "M-, you're very very sick, you need to go to the hospital" so she took me to the ER. She thought I was very sick, I thought she was over-reacting.

Long story short -- she was right, right about everything. Over the next 4 nights, I was kept in the hospital. For the first three days, they gave me antibiotic after antibiotic, changed my IV three times, gave me IV morphine, innumerable doses of advil and tylenol, and watched my vitals -- trying to see if my fever would go down, and nothing happened. The antibiotics didn't seem to be having an effect, advil worked for four hours, breaking my fever, but it came back like clockwork, higher and worse than ever usually: 104. I had chills, meaning I was septic (meaning I had bacteria in my blood).

Worst of all, my body was not producing its own antibodies. I had a massive illness and my white count was normal. NORMAL.  And my protein levels were those of a "malnourished HIV patient" to quote my brother. Apparently, I got so caught up in TFA and teaching, that I forgot to eat, for several weeks. I had noticed my weight drop dramatically, but I didn't really pay attention to it. I was too lazy to make food for myself, so I just ate random stuff around the house, not taking in enough protein. So they pumped all this medicine into me, because I couldn't make my own antibodies...but it didn't seem to be working.

Eventually on the fourth day, it seemed to take affect, my fever only went up to 100.2, and then the next day, I didn't have a fever at all.

So far it's been a little less than a week that I haven't had a fever, and I'm loving it. I'm still coughing a lot, I get tired very easily, I need to drink tons of water, and oh yeah, I'm still on tons of antibiotics, but no fever so far.

I'm disappointed in myself. When I got out of the hospital, everyone told me that I was life-threateningly ill, primarily because my body was too weak to fight off illness. I didn't take care of myself, so I had to have other people come and take care of me. I'm not trying to sound melodramatic, but it's disappointing.

My mom is old, she's not well, and I should be taking care of her. Instead she's down here taking care of me. So a new rule: my job with TFA takes a back seat to my health. I love my students, I love that I'm helping some of them, I love that I heard that some of them were worried about where I was, but I need to look after number 1, and that's me.

If I can't take care of myself, I can't help other people. Because of my foolishness and bad luck, I will have to miss a good deal of school because I will be too weak to really go and give it my all with my students, and really -- with my kids I need to be giving it my all. So now, I take care of myself.

Going to go play video games --

M