California for a second

I'm in California, for a second. For a hot second. Not husband, no dogs, no stocked kitchen (though I seemed to have stocked my the fridge where I'm staying pretty well), no bed that I'm used to with blue walls to wake up to. But a purpose -- see new things, eat new things, work in new places, learn new things. It will be interesting. I'm in California, for a second.

I've learned a few things

1. Never say never -- I discovered the wonders of a selfie stick that my husband decided to give me as a gag gift. That's right. I'm a convert. This realization has shaken me to my core -- who am I? What do I stand for now? Selfie sticks apparently.

My very first self-stick picture. It happened. I'm a selfie sticker.

2. Just because jay walking is totally normal and even expected in one part of the country, does not mean this holds true in another part of the country. People will stare at you, honk at you even.

The view from a mountain.

3. Similarly weather is not uniform. Before I left AZ, I thought all summers were dry and overbearingly hot. In MA, summers were overbearingly hot and muggy. The same was true of TX. In NorCal apparently summer takes place in what I mistakenly thought of as "fall." Getting off a plane in a pea coat, scarf, and two layers of shirts -- which was weather appropriate on the East Coast -- caused a bit of a...sweat issue on the West Coast.

That's the sun. That's the beach. That's the ocean.

4. Running can be fun. Running along the ocean is funner.

A pause in my morning run.

5. There is no inherent rudeness to Boston people / East Coast people in general. Brusqueness in action does not equate rudeness. There are rude people everywhere -- take a rude person from Manhattan and stick them in sunny CA, they'll probably be rude here. On a more positive note, there are kind and happy and helpful people everywhere. Thank you two ladies who helped me figure out the bus system. You were nice, and it made my day easier.

A beach! A puppy! 

6. Pumpkin cognac cheesecake may sound weird, but you should always get it. Because the weirder something sounds, the better it (usually) tastes. I was not wrong on this front. It is currently in my belly and I. regret. nothing.

Pumpkin cognac cheesecake. Go here. Get it. 

That's all for now. More updates forthcoming as I explore my world.

A cake! With a face! Vampire cake!

More cake! 

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.

Camping and Camping Food

One of my goals for this summer is accomplished -- camping! We went to Otter River State Forest near Sterling, MA on a Friday. It was definitely the most "organized" camp site I've been on, with a lot of spots, pretty close together...so if you're looking to "rough it" this is definitely not the spot to go. But they allow pets, the sites and reasonably sized (fit a four person tent, a car, a fire pit, and a picnic table), and there's swimming...though we didn't partake in that particular joy because it was a bit too crowded for my taste. I'd definitely recommend it for a weekend getaway for someone who is interested in camping/getting away but doesn't want to go somewhere too remote.  

Our tent

Circle of trees

That view

Either way, it was pretty fun. Friday we got there and made an awesome dinner with our camp stove of cilantro tofu with cheese and Arriabata sauce from TJs. We took our big dog with us and made our lives much easier by investing in a spiral pet stake, which we put in the ground first thing, hooked Rain up to it, and let her have "free" run of the site. Next day we got up early, made coffee with our aeropress, packed up our stuff, and hiked up Mt. Wachusetts. All in all a medium hike, definitely possible for beginning hikers.

of puppies and more puppies

I recently invested in hiking shoes, and they made a world of a difference in my hiking. My feet hurt less at the end of the day, my ankles didn't roll as much and as such hurt much less, and I was way more stable walking which is super important. Anyways, it was beautiful up at the top, and my favorite aspect was the windmill "farm." They have two windmills near the top of the mountain, and you can get pretty close to them. The quiet coupled with just the sound of the windmill is pretty awesome.

windmills!

Then the piece de resistance, pizza. We made campfire pizza. Easy, peasy, lemon squeezy. Trader Joes pre-made pizza dough, arriabata sauce, some peppers, some pickles (we had leftover pickles so I thought, why not?!) and some cheese. Man alive was that pizza good. 

For the pizza dough, we floured it, and then cut it into four parts, so that our pizzas would be small and thin, and we rolled them out as thin as we could.

Trader Joes Pizza Dough

1/4 of the dough rolled out thin

We used our cast-iron skillet, coated in some oil, heated it over the campfire, and when it was hot, we put the pizza dough on it to cook and removed the cast iron from the heat (the residual heat will cook the pizza)

cast iron skillet heating on the fire

It's cooking

Flip it a few times

After the dough was mostly cooked, we topped it with pizza sauce, cheese, and toppings (light on the sauce so you don't get a super soggy pizza), and finished it on the stove top. You can definitely finish it on the fire if you want, you'll just have to watch it carefully to make sure it doesn't burn. 

Toppings!

Add caption

Finishing it on the fire

Puppy wanting food!

Finished product!

Bottom of the pizza!

Full and happy bellies!

Super fun, I'd definitely recommend it for your next trip, and if you don't have a cast iron pan, I'd recommend investing in one -- it's one of my few kitchen must-haves because it's so versatile! 

Summer Goal 2015: Camping at least once, ACCOMPLISHED!

This. Almond. Tart.

I just finished eating a slice. It is so good. Simple, not too sweet, not overwhelming. Just the cookie-like crust, the slight tang of the jam and the wonderful flavor of the almonds. My words of advice: if you don't have almond meal, you can make it easily by pulsing whole almonds in a food processor. Pulse them because you want almond meal, not almond butter. Please don't skip out on the layer of jam on the crust, it add to the flavor. Pick a jam that isn't too sweet and has a little tang...it'll go a long way. I'd go with apricot, or sour cherry. Enough with the words, on to the recipe.

Almond Tart 
Slightly mdified from Cooking with Manuela

Tart Crust

2 egg yellows (save the whites for the filling)
0.33 cups sugar
1 tsp vanilla
2 tbsp milk / heavy cream (I used heavy cream)
1.5 sticks butter, cubed
2 cups all purpose flour
pinch of salt

Preheat oven to 375F.

In a food processor or with a hand mixer or even in a stand mixer, beat the egg yellows and sugar together until well combined. Then add the vanilla, heavy cream/milk, salt, and mix. Then beat in the butter until it's mixed thoroughly with the liquid (it doesn't have to be smooth, just mixed). Then, mix the flour in a 1/2 cup until it comes together. Since this is a tart dough, it'll be wetter than usual crust, and that's okay. Transfer the dough into a pre-buttered and floured tart part, sprinkle a little flour on top of the dough, and press it out thinly into the pan. You want the tart crust to be thinly spread because it will rise, so you can peel off any excess. Poke holes in the base with fork tines so that no bubbles form during the baking process and put it in a 375F oven for 20 minutes.

While it's baking you can make the filling:

Filling
0.25 cup jam (tart and sweet, but not too sweet -- apricot, blackberry, cherry. I used a jam from my friend Laurie over at Laurie's Little Kitchen)
5 egg whites
0.33 cups sugar
2 cups almond meal
Slivered almonds for topping

You can either buy the almond meal or make it yourself (see above text prior to recipe). Beat the egg whites to stiff peaks. Add in regular white granulated sugar, and fold it in by hand. Then add in the almond meal, and fold in well. You'll see the egg whites deflate a little, but that's okay, just make sure you're folding, rather than stirring the stuff in.

Now...to assemble the tart! After the shell comes out of the oven, turn your oven down to 350F. Pour the jam filling into the tart and spread it out, creating a thin layer. Then pour the filling into the tart and spread it out with a spatula/spoon. Top with silvered almonds. Bake for 20-25 minutes, until the top is slightly brown.

Jam!

Pre-baking

Pull out, let cool, and serve with powdered sugar dusted on top, or by itself.

So good

Immediately post-baking

Cauliflower Bowl

I want to do things this summer/fall. I'll make a list. That way I'll get like 80% of them done.

1. Kayak on the charles
2. Get through Native Son, Notes on a Native Son, Queen of Shadows, and Lolita. A mix of books.
3. Join a book club.
4. Go camping x 2...hopefully in New Hampshire. Or the Berkshires!
5. Paint something
6. Finish applications...that way I know I do AT LEAST one thing
7. Train my dog to do 1 new tricks.
8. Run 2 miles at < 10 minute pace for each.
9. Finish Insanity
10. Find and purchase my "fall tea" collection.
11. Perfect my banana bread recipe.
12.  White Mountain Hike.
13. Start posting weekly menus


Thirteen things. I'll come back and mark them off as I go along. Hopefully. But this way I've articulated it, it's on paper....or e-paper in this case, and when I'm thinking...what should I do? I do this stuff. Instead of watching Fraiser. Too much Fraiser.

And now for something entirely different, a cauliflower bowl! I've been skeptical about cauliflower "rice" for quite some time. I've seen it all over other blogs, on pintrest, and some of my friends have gone on about how much they love it. But meh.

Then I saw this great cauliflower rice bowl from ohmyveggies.com and figured...why not? I have the time, I didn't yet have my articulated list of pre-prescribed activities. Plus, I think I can do it under 30 minutes. Hey, if I can make it in <30 minutes on a weekday, I'll give it a shot.

And this worked. The "rice" has no real flavor...so it's takes up the taste of whatever you season it with, in my case a little garlic, salt, pepper, and lime juice. It acts as a medium over which you can layer other flavors, beans, guacamole, salsa, corn, cilantro, red pepper, etc. and is healthier than rice.

 

Finished product!

Surprisingly easy to make if you have a food processor, without...it'd be harder. I used the grater attachment on mine to get the cauliflower small. I just cut it into raw relatively large chunks, put it in the food processor, and it's done. You can also use a box grater...or just cut it up into small pieces.

Then just sautee it up with some olive oil or butter until it reaches the "softness" you desire. Try it out.

Cauliflower Rice Bowl (Mexican flavor inspired) 

1 head raw cauliflower
Butter/olive oil

Optional toppings:
Beans
Salsa
Guacamole
Red Pepper
Corn
Cilantro
Tempeh
Lettuce
Hot Sauce
Red Onion

Cut the head of cauliflower into pieces that either fit into your food processor/food processor shoot, or to use on a box grater, or cut into small (super small) pieces.

When it's grated, heat up a pan with 2 tablespoons olive oil or butter, add garlic or whatever other aromatics you want at this point, then toss in the cauliflower when warm. Sautee the "rice," turning it moderately frequently until it reaches the crunchiness or softness you desire.

Then top it with your toppings! I did a Mexican-inspired one (see optional toppings above). You can do middle eastern inspired with some yogurt, roasted eggplant, yams, and spices. Or try Greek inspired with cucumber, tomato, red onion, yogurt, etc. Or Asian inspired and top with a stirfry.

The "rice" keeps in the fridge for ~2-3  days, so you can reuse it :-)

Chocolate Chili Peanut Butter Popsicles

During my fourth year, I've been more able to give things outside of medical school more focus than I could during my third year. It's still pretty novel for me, but I'm trying to enjoy it. Going on run and experiencing summer: the smells, the colors, the inevitable allergic rhinitis. Dog walking and the inevitable apologizing for Krinkle barking a dog 10x his size. Trying new recipes and the inevitable mishaps (never put turnip and beet in coconut curry) and the undeniable successes.

These popsicles fall into the latter category. I forgot I had these popsicle mold I bought last summer with dreams of all different kinds of frozen treats. In reality, I made 2-3 types of popsicles and packed the molds away. But I've been craving them recently, because let's face it...there's nothing like coming back from a run in the middle of summer like a popsicle.

Telling Tyler "pull out the popsicles, I want to take a picture" and hearing "...whoops"

Especially these ones: chocolate + chili + peanut butter + honey + milk/yogurt + salt + popsicle mold + freezer = Honey sweetened chocolate chili peanut butter popsicles. Clearly when it comes to dessert names, size matters.

Evidence of their deliciousness

I made this in the morning in under 10 minutes on a whim. Try them out. If you're hoping to make it vegan, use full fat coconut milk. If you want to make them a bit healthier / don't love super sweet things, cut down on the honey by half.


Chocolate Chili Peanut Butter Popsicle

0.25 cup honey
1 cup milk / yogurt / half and half
0.75 - 1 cup peanut butter
0.33 cup unsweetened cocoa powder
1 tsp red chili powder / cayenne (or less if you want it less spicy)
1 tsp salt
Dash of cinnamon

Whisk together honey, milk, and peanut butter until there are no clumps. Then add in the cocoa powder, chili powder, salt, and cinnamon and mix until clumpless. Pour into popsicle molds and freeze for 3-4 hours. Pop them out on a warm summer day and enjoy!