Welcome to the Holicraze!

Cross-posted on Dose of Reality

Friday evening marked the start of my winter vacation, but it was by no means the start of my preparations for the holidays and other festive winter activities. Since starting my psychiatry rotation, with it’s generous schedule and emotionally intense patient interactions, I’ve been doing lots of things to celebrate 1) being 2/3 done with M3 year, and 2) the coming solstice and all the holidays nearby. There’s been so much going on that it will take a few separate posts (some of which will be cross-posted on Dose of Reality).

First was the tour of the Parade Company workshop and warehouse. The Parade Company puts on the Detroit Thanksgiving Day Parade each year, and also supplies floats, balloons, and expertise to parades across the country and the world. Their facility is in an old car factory, which was apparently on the cutting edge of industrial design because there was so much natural light coming in through the overhead windows. (All of the photos should enlarge if you click them... If you're a Detroiter, see how many floats and big heads you can identify in the pictures!)

 
You could still see the old train tracks where they came into the factory.

It is impressive to see all of the floats and balloons together, and I was particularly taken with the storage of the big heads in a gallery on the wall.

The big heads are a Detroit tradition, after some artists in Venice taught the Detroiters how to make them out of papier mache. Some of them are as light as 5 lbs, while others way much, much more.

 

Overall the tour was pretty incredible, and I have to thank Gary, my dad’s neighbor, for discovering the tours and inviting me along!

More holidaze posts to come…

One of the best $15 I've ever spent

More delicious things to do with greens and squash

As we near the real winter, I know I’m not the only one constantly looking for more things to do with greens and squash. My CSA ended a while ago, and I still have some squashes to eat. Luckily the squash keeps for a while, so I focused on the greens to keep them from wilting into little bags of brown goo in the fridge! Here are some of my more recent endeavors:

 

Ravioli on a bed of wilted greens 

 

Fried egg sandwiches

 

Scrambled eggs with greens and potatoes 

Baked tofu sandwich 

I’ll leave you with the directions for crafting that last sandwich, which I would consider an excellent achievement for the following reasons: (1) it is delicious, (2) it would be vegan if you used vegan mayonnaise instead of the addictive substance filled with egg yolk that I love, (3) in uses greens, and (4) it also features chili garlic chutney, which used a bunch of the hot peppers I also had accumulating in my fridge from the CSA. A win all around!

Chili Garlic Chutney
Adapted from 1,000 Indian Recipes by Neelam Batra
1 tablespoon black peppercorns, ground
3-4 large cloves garlic, peeled
3-4 quarter-size slices of peeled fresh ginger
8-10 fresh hot chile peppers, in any combination of red and green, serrano, jalapeño, whatever, coarsely chopped
1-2 red or green bell peppers, chopped
1/8 cup of lime juice
1/2 tablespoon paprika
1/2 tablespoon ground ajwain seeds (available at some Indian groceries, or use dried thyme)
1/2 teaspoon cayenne pepper
1 teaspoon salt
Put the garlic, ginger, hot peppers, bell peppers, and lime juice in a food processor and process until they form a paste. Add the paprika, ajwain/thyme, pepper, and salt and process until smooth. Transfer to a serving bowl, or to a container for freezing or storing in the refrigerator. Per Ms. Batra this will keep in the fridge for about a month or in the freezer for 6 months.

Baked Tofu
1 package extra firm tofu
1/3 cup tamarind date sauce (available at Indian markets, or substitute barbeque sauce or something else a little sweet)
1 tablespoon chili garlic chutney
Preheat the oven to 350F. Mix the tamarind date sauce and the chutney in a large bowl or pie pan. Press the tofu between two paper towels to remove some of the excess water, and cut into 1/2” slices. Place the tofu slices in the sauce mixture and let them sit while you prepare the pan to bake them. Film a baking sheet or roasting pan with a small amount of oil, and lay the tofu slices in the pan. It doesn’t matter if they have had a ton of time to marinate, because they will pick up more flavor as they bake.
Once you’ve spread the slices in the pan, spread some of the extra sauce on each on in a thin layer. Bake until they are slightly chewy, usually when a fork will no longer easily poke through, flipping approximately every 5-10 minutes and applying additional sauce with each flip. Remove from the oven and let cool.

Awesome sandwich
1 square pita
Mayo to taste
Chili garlic chutney to taste
4-5 small spinach leaves, washed
2-3 slices baked tofu
Combine and enjoy!

Reflections on the seasons as an M3

From Dose of Reality:

In talking to a friend about the weather last week, I realized how much of the seasons I’ve missed this year. While I’ve been so consumed with learning about medicine this year, the world around me has often been observed only through a layer of glass…

During the summer I was immersed in the long hours and overnights of inpatient rotations, and I often arrived at the hospital before the sun came up, and headed home as it was setting. I managed to miss the hottest days of summer this way, seeing the sweltering heat radiating up from the roads and sidewalks from the privileged position of the windows outside the operating rooms. I caught the tail-end of summer on my family medicine rotation, watching the sunshine stream in through my car window as I drove out to my assigned clinic location. I did take advantage of some free weekend time to enjoy the warmth and light, but it was already September and I was looking forward to fall. As the leaves changed and temperatures cooled a bit, I again found myself appreciating the vista from the OR windows during my week on neurosurgery, wondering if it would be inappropriate to bring my camera back (I decided it was) to capture the fall color as I was seeing it for the first time from inside the hospital. The last six weeks of the OB-GYN rotation have been some of my favorite weeks of medical school, and yet I couldn’t help but notice how drawn I was to the post-partum rooms on the 7th floor of Mott, with the long hallway of windows between the elevator and the patient rooms. When we followed our team for a quick tour of the labor and delivery floor of the new Mott, we all stood and marveled at the beautiful views from the patient rooms, watching the river meander through the falling leaves from the windows on the 9th floor.

And now somehow it’s really winter. Dividing up the year into 4-8 week blocks makes it really fly by, and I’m not sure how it’s the beginning of December already. We’ve gotten the first good snow of the season, and I’m looking forward to avoiding being out in it too much, as I’m starting my community psychiatry rotation on Monday. I’ll be enjoying the next 6 weeks of winter weather from the car.

Greens and Squash

Ooops... I wrote this a while ago and forgot to hit post!

In the interest of bringing some of the color back into the word clouds from my blog, I thought I’d share another recipe. I’m onto the “extended” version of my CSA (an extra three or four weeks at the end of the season), and in a few weeks the frozen CSA will begin, and I’m still pretty overwhelmed with the volume of greens and squash I have at my house. It’s also been getting cooler here, which for me means that it is getting toward one of my favorite times of year: soup season! Soup (and stew, and chili…) season is convenient as well, because nothing freezes and thaws quite like a delicious soup, and nothing is forgiving like a stew recipe in terms of absorbing greens and other miscellaneous vegetables. I enjoy these dishes on their own, or over grains. Most recently I’ve cooked up some barley and farrow, and they are really delicious in or under hearty soups/stews! I tried a new one last night, and was thrilled with how it came out. The recipe didn’t call for greens, but that has never stopped me before. I think the chard was a delicious addition… Enjoy!

 
Peanut Squash Stew
Adapted from Real Simple
1 cup grain of your choice (farrow and brown rice are excellent options)
2 tablespoons peanut oil
1 large onion, yellow or white, finely chopped
2 tablespoons grated fresh ginger
1 small green chili, serrano or jalapeno, or whatever you have, chopped
3 cloves of garlic, finely chopped
2 teaspoons kosher salt
1.5 teaspoons ground cumin
4 cups vegetable broth or water
2 1/2 cups tomato puree or canned diced tomatoes (roughly one 28 oz can)
1/2 cup peanut butter
1 medium squash (acorn or other firm squash is best, I used what I think is a buttercup squash), cut into 1”-thick slices
2 tablespoons brown sugar
2 16-oz cans black-eyed peas, or 3-4 cups cooked beans
2-3 cups baby chard (I think that’s what I had, I think most kinds of greens would be delicious), sliced into thin strips

Prepare your grain according to the directions. Heat the oil in a skillet over medium heat. Add the onions and cook until tender. Add the ginger, chili, garlic, salt, and cumin, and cook for another few minutes. Add the tomato puree, peanut butter, broth, and sugar, and stir until blended. Add the squash slices and cook over medium heat until the squash is tender, 20-30 minutes depending on the size of the squash. Add the black-eyed peas and greens and heat through. Spoon over the farrow or rice and enjoy. You can also sprinkle peanuts on top as a garnish…

The best weeks of med school

From Dose of Reality:

I have to apologize for the long gap since I last posted here. It seems like the days are passing without my really noticing, so I’ll give a brief recap of the past few weeks…

I am loving my OB/GYN rotation! I had been hedging over the past 6 months since I hadn’t gotten to try it yet, acknowledging that I’d really enjoyed being in the OR during my surgery rotation, and that I liked the continuity on my family medicine rotation. I felt like I really couldn’t just say that I wanted to do OB/GYN when I hadn’t really gotten a chance to do it. Now that I’m here, however, it’s clear that the things I liked most about other rotations were the things that make up the core of this rotation. I think that most students have an ah-ha moment when they realize that they are rotating through their future specialty. I know that some have many such moments throughout the year and a few reach the end without one, but usually some elective time solidifies things and these moments present themselves, if later than your average medical students’ anxiety level would prefer. Here are a few examples highlighting how I know that I’ve found my place, in no particular order:

• Delivering babies is pretty cool. I think most vaginal births are pretty awesome, and as much as I wouldn’t wish a C-section on anyway, they are pretty magical in their own way. One minute, you’re in the OR cutting through skin, fascia, and smooth muscle, and the next minute there is a baby coming out of the incision!
• The surgeries on this rotation are some of the coolest I’ve seen. Fixing (or at least improving) incontinence surgically makes a huge difference for patients, and the anatomy is fascinating. I love that we still don’t totally understand how it all works!
• There is a strong research ethic, and the research program includes many of the social and economic determinants that I have come to know and love. I think I’d be well-supported! As much as I love “blazing trails” and “defining my own path,” I worry that in some fields those might be synonymous with “being completely alone and isolated” and “not getting any respect or funding.”
• The people I’m working with are engaging and entertaining. I have had really good experiences all year with both residents and faculty, so this doesn’t seem like an entirely fair thing to say; most rotations have featured an entertaining cast of characters, and this one is no exception. I like strong personalities, and they are present in abundance!

Suffice it to say I’m really enjoying these weeks, and am wishing I could stay longer…

Words!

In June one of the blogs I enjoy posted a Wordle image based on her blog. I thought it was a really beautiful example of art meets technology, and decided to do one myself. In June, here’s the word cloud my blog generated:

I repeated this experiment a few weeks ago, and in addition to intuiting that the color has gone from my life, Wordle seemed to pick up on my shift toward the clinical:

Thoughts?

Gratuitous Walter Photos

 Snuggled on the couch

Walter helps with the laundry

Cider Mill!

A few weeks ago, my friend and med school colleague Mike suggested that we check out one of the local cider mills. I was really excited, and wanted to suggest the best possible cider mill experience, something that would be quintessentially autumnal. I perused online, and must confess that looking back, I feel a bit misled. Although I had heard great things about Jenny’s Farm Market and the Dexter Cider Mill, I opted for Wiard’s Orchard. Their website highlighted the fact that in addition to their cider mill, they had apple orchards, and a pumpkin patch, and even something they called their own “country fair.” When we got there, however, there was a parking lot the size of a football field, there was a high (it seems unseemly to print it here) entrance fee for the country fair, and the cider press proved to be a relatively small piece of machinery that you could watch behind a window at certain times of the afternoon. I feel obligated to note that the country fair also included karaoke, which is ridiculous. In spite of this, I think Mike and I managed to have a good time, but I’m optimistic that we can check out a real cider mill sometime yet this fall…

Mike and I enjoying the beautiful day...

  The best Wiard's had to offer...

Detroit Beerfest!

 Every year I plan to attend the Michigan Summer Beer Festival in Ypsi, and every year I miss it for one reason or another. I think I’ve either missed buying a ticket before it sold out, been out of town, had a local engagement I couldn’t miss, or had to work in the hospital for at least the last 5 years. Enter the Detroit Fall Beer Festival.  After missing this year’s summer beer festival as well, I was thrilled to learn of another opportunity! The Michigan Brewer’s Guild invites breweries from across the state to serve the best they have to offer alongside some delicious local eateries and amongst a wildly entertaining crowd. The only disappointment was that I didn’t know that I should have made a pretzel necklace to wear/eat during the festival – next year!

 Here are Alicia, Heather, Matt, and Patrick enjoying the festival...

 

It was a beautiful day, and as a special bonus, there was an exhibition of giant apple sculptures (?) at Eastern Market...

More about the middle (Or, everything tastes better with mayonnaise)

I’ve continued to love my CSA vegetables all summer, even though I’ve fallen off the wagon with regard to posting about them here. One challenge that continues to present itself, however, is kale. I like kale, and I probably like it more than your average person. I’ve used it in saag paneer, fresh salad, soup, and muffins, among other things. That said, there is only so much kale one person can eat. In spite of the fact that everyone I know (and even a few people I don’t) has suggested I try kale chips, I’m fairly certain that I made them a few years ago and they were gross. As I’ve continued on my quest for delicious uses for kale, I was inspired by this post from Crazy Aunt Purl about the deliciousness of raw kale salad. It made me think about using kale instead of lettuce in other applications, and reminded me that I hadn’t made any crazy sandwiches in a little while. My most notable and original creations have involved peanut butter (side note: green bean and peanut butter sandwiches are amazing), but I tend to be willing to combine any number of odd condiments and vegetables on a sandwich. In particular I love mayonnaise combined with spices or other spicy condiments. Now, I think to think I’m pretty creative between those slices of bread, but it really hadn’t occurred to me to include kale. Now it has… The kale is nice and crisp, and lasts longer in the fridge than most other sandwich greens. This is also a great use when the share only includes a few small leaves of kale.

Earlier in the summer the sandwiches included tomatoes, which were also in my CSA. My most recent sandwich creation required the roasting of eggplant, which I would highly recommend.

Pesto Sandwich Spread

1 tablespoon basil pesto

1 tablespoon mayonnaise

Mix and spread onto a sandwich. Enjoy, and try not to eat it out of the bowl.

Roasted Eggplant Slices
Adapted from Smitten Kitchen

As much eggplant as you can eat before it molds, cut into 3/4” slices

Salt and pepper to taste (or other spices if you’d prefer)

Olive oil for drizzling

Preheat the oven to 425 degrees. Coat a cookie sheet generously with olive oil. Arrange eggplant slices on the cookie sheet so that they don’t overlap. Sprinkle with salt and pepper. Roast, without disturbing, for 10 to 15 minutes. Let them cook until they can easily be separated from the pan – the edges and the bottom should be brown and even blistering. Carefully flip each piece and sprinkle them with additional salt and pepper and roast for another 10 minutes, until the undersides match the tops.

Let cool, and add to just about anything…

Square One

Some of you will read this post and recognize it as the larger metaphor it could be, and some of you will just enjoy a post about knitting. I can’t decide which camp I fall into at this point, but here it is.

I got some really beautiful yarn for Christmas this year, and I knew as soon as I saw it that I wanted to make a sweater for myself. I have made myself several vests, and made sweaters for other people, but have never made a real sweater with sleeves for myself. I spent hours on the interwebs trolling for patterns, and finally found one that I liked. (For those of you who are interested, it’s here on Ravelry, and here on Knitty…) I wanted to change the edging, substituting some nice ribbing for the scallops and the seed stitch, but that’s a modification I knew how to make. I printed out the pattern, and finally cast on in April of this year, shortly after finishing my dissertation defense. In a moment of what in retrospect seems like either psychic vision or self-fulfilling prophesy, I named it the “Someday Sweater.”

I knit a swatch, measured, ripped back, knit, measured, ripped back, knit, measured, and finally thought I had something that would work. I also measured several sweaters I already own that fit me well, and compared their measurements with the pattern schematic. I proceeded to knit through most of my trip to Colombia, and on through my M3 orientation. At the end of that long week of lectures, I had what was starting to look like a lovely sweater. Unfortunately, it was also starting to look like a big sweater, not in the absolute sense of the word, but compared to the desired measurements. I set it aside for a week, and then finally tried it on and confirmed that it was too large. I ripped back several inches, added a few decrease rows, and kept knitting. I made a brief pause to whip out a baby sweater, and to start some socks that currently seem never-ending, but mostly I knit on the sweater. It has been hibernating for a while in my bag because I was a little afraid that the modifications I made weren’t enough. The thought that the shoulders are actually too broad and the neckline too deep has been haunting me, and today, as I realized how lovely and cool it is getting and how nice it would be to have a sweater, I pulled it out of the bag. I carefully threaded a strand of cotton yarn through the live stitches and tried it on. It’s too big. My plan for tonight: rip it out and carefully rewind the yarn in preparation for casting it on anew.

Someday I’ll have a nice sweater to wear…

Welcome to the middle…

From Dose of Reality:

As we near the end of the current four week rotation period, I’m realizing that we are nearing the end of the fifth month of M3 year. We are no longer early M3s, no longer the fresh-faced members of our inpatient teams, and no longer blissfully unaware of how far behind we set our preceptors in outpatient clinics. We’ve learned that being “on service” means working on a medical team in an inpatient setting, that getting someone “teed-up” means ordering all the necessary labs and imaging for the next step in treatment, and that asking whether there is “anything else that needs to be done” means that you’re ready to go home. I’ve also learned, and I can only speak for myself here, although based on lots of different conversations, I think it’s safe to say that I’m not alone, that I still don’t have any real sense of how I’m doing or what’s coming next. Over the course of a single day I can count both instances where I felt competent, well-prepared, and like I’d learned a lot on my previous rotations and those where I felt like I might as well have been some random person off the street for all I was demonstrating any medical knowledge in my presentations. As we start to get back feedback and grades (I say start because we’ve only really completed two whole rotations so far, and it takes 5-6 weeks to get grades) I’m also realizing that I’m probably somewhere in the middle of my class, and that by definition all but two of us are in the middle somewhere. There are things I’ve done well on, things I wish I done better on, and things I hardly remember doing (note that most things that occurred before about 5am fall into this category). I’m finding relative grading (that is, grades that compare you to classmates) a disconcerting change from PhD-land where everyone can be a superstar. I’m trying to move forward though, learning as much as I can along the way, and not letting the little hiccups get me down.

In which both my camera and my oven make a long-awaited appearance

It’s been a long time since I posted something unrelated to school in this space, and even longer since I posted a real photo (not taken with my phone). We can either just pretend that I successfully took photos to document the summer I spent in the hospital or pretend that I didn’t miss a season at all, since summer is by far my least favorite. I think that sounds good: 2011, the year of only three seasons.

To kick off fall, which comes right after spring, I think these muffins are quite fitting. I slightly modified this recipe, in that I used kale rather than spinach. You could smell the kale slightly after they were cooked, but couldn’t taste it at all. I plan to continue this variation on a theme, as I still have a lot of kale from the CSA and I am tired of eating it other ways.

Time to reflect

From Dose of Reality:

Last week as an informal addition to my surgery curriculum I decided to participate in the 2011 Fast-a-thon. In case you didn’t catch the short piece about it on NPR, the UMMS Fast-a-thon is a chance for non-Muslim medical students, staff, and faculty to fast for one day during Ramadan with the Muslim Medical Students Association. They organize a beautiful fast-breaking dinner at 8:30pm (this year – I think it’s much earlier when the 9th lunar month falls in the winter!) along with a program of speakers. I was not sure how fasting would work with my surgery schedule. I ended up being in clinic that day, which was probably for the best, and I discovered that I spent most of the morning thinking about the fact that I wasn’t eating. I didn’t feel very meditative, and I certainly felt awful for all of the patients on the floor that we had made NPO (read: nothing by mouth) that overnight in preparation for procedures later in the day.

As the day went on, however, I started to feel a bit more reflective. I realized that much of the eating I do during the day is purely social, and that even through the first six and a half weeks of my surgery rotation I had rarely experienced hunger. Part of this is because the operating room is as engrossing as it is consuming, but part of it is because I’ve already eaten several meals before the first case starts and can rest assured that I will eat again as soon as I get out. As clinic wrapped up and I started to feel a little irritable, I reminded myself that later in the evening I would have a delicious feast. I must admit I felt a little petulant as I complained to a friend about my hunger on a day during which I was supposed to reflect on global food shortages and my own relative position of privilege.

When the time came to break the fast, I wondered what it would be like to repeat this sequence of events every day for a month, or to be unable to eat after surgery waiting for the doctors to give the okay. To be honest, I still can’t imagine it, even after fasting myself for a day. But empathy, as Dr. Mangrulkar so eloquently pointed out during his reflections, doesn’t require that I experience exactly what my Muslim colleagues, or my patients experience, it is, according to Wikipedia, simply “the capacity to recognize and, to some extent, share feelings … that are being experienced by another.”

Almost through…

From Dose of Reality:

I apologize for the serious lack of posts that have happened in the past two months. It's hard to believe that I'm already almost 1/3 of the way through my M3 year.Although I have been having all kinds of eye-opening and interesting surgical experiences, I have not had enough eye-closing sleep experiences to allow me to post regularly. Please anticipate the resumption of regularly-scheduled posts this weekend. You can look forward to insights like “I enjoy sleeping…a lot.” and “I really like being in the OR, but I’m really looking forward to an outpatient month in September.” Stay tuned…

Yellow with butterflies

It turns out that if you rotate with the vascular surgery service, you will likely spend some time watching angiograms, which allow you to look at the patient’s blood vessels using some kind of contrast and a CT scanner. It also turns out that a CT scanner uses ionizing radiation, which although it’s not terrible to have small doses and the benefit of the study often outweighs the harm, it’s generally not a good idea to expose yourself to it unnecessarily. Finally, it turns out that when you visit in CVC OR #8 for an angiogram, you get to wear one of the extra sets of lead garments to protect your precious reproductive organs, and all of the smallest ones are yellow, with butterflies. Oh, and did I mention that everyone else will be scrubbed in and covering their lead garments with sterile gowns, while you stand to the side behind a sheet of lead infused glass looking yellow and covered with butterflies? Also, sometimes when you grab an extra thyroid collar from the rack of guest lead garments to protect your neck, it will actually belong to someone named Mary and be embroidered with her name…

Different way of making rural doctors:

This New York Times Article describes a new medical school opening in Salina, Kansas, with 8 students in their first class. In exchange for a debt-free medical education, these students will at least start their careers in rural areas. Although much has been made of an upcoming physician shortage in the US, it is only occasionally mentioned that there is already a grave shortage of physicians practicing in rural areas. Previous approaches to the problem are described in the article:

Some are using incentives like guaranteeing admission or forgiving loans to students who commit to practicing in small communities…Others are recruiting students from rural areas and giving their applications preference, in the hope that they will return after graduating. And a number of schools encourage students to spend one year or more training in rural areas.

I found the emphasis that the article made about being rooted in a community to be particularly insightful. They recognized that when students spend 4+ years training in a city, particularly during formative post-college years, they are likely to develop strong social ties (including finding spouses) to that area. I’ll be interested to follow how this small school in rural Kansas succeeds at training and retaining rural doctors.

Puppy Visit!

Approximately 2 days into my surgery rotation it became clear that I was not going to be able to lavish on Walter the love and attention that he requires. I have been spending 12-17 hours in the hospital (as I think I mentioned in my last post, sorry for the whining), and no matter how many people came over to walk him during the day, that still left him with too much time in his crate alone. I panicked a bit, but then called on the cast of thousands who have volunteered to help with him, and set up some puppy foster care for the month of July. He rotated with each my dad and mom for about a week each, and then came home to me on Tuesday. He’s heading over to Natalie’s house for next week, but his brief visit home has coincided brilliantly with my week of subspecialty urology rotation (read: week of awesome hours).

My family does a great job of wearing him out:

He’ll be spending most of August rotating around (I’ll be e-mailing this week… you know who you are…), but I’m really enjoying having him back…

Biking during Surgery

From Dose of Reality:

While I do sometimes wish it were possible to actually be on my bike in the operating room, as I’d be a lot more comfortable if I were moving around, that is not the subject of this post. Instead, I’m finally admitting publically that although my dedication to physical fitness in general and to cycling in particular is quite strong, spending 13-17 hours/day in the hospital is enough to overcome that dedication. Here is a graph representing my ranking on Bike Journal since the second week of M3 year:You will notice that during outpatient pediatrics there was a pretty good climb, indicating that I was, in general, biking more than the average person on the website. From early June until the end of June I stayed roughly the same, suggesting that I was keeping pace with the cyclists around me on the list, and then the 4th of July weekend showed a substantial spike. This was due to two long rides that led me to rack up nearly 90 miles in a single weekend!

First, on Saturday I rode to Chelsea with Morgan and Yorgos, two new M3 friends who love their bikes and share my love of delicious food. We rode through Dexter and into Chelsea, stopped for an early lunch and some ice cream, and then headed home. This was my first ride on new thinner, higher pressure tires, and it was awesome. We ate at Zou Zou's:

Second, on the Monday holiday Alicia and I reprised a bike ride we did back in 2008 and headed over to St. Clair to bike up the river and have lunch at the Quay Street Brewing Company in Port Huron.

Instead of returning by the same route as we did that time, we followed the entire recommended route for a total of just under 49 miles. It was delightful. On that same ride, my bike odometer turned to 2000 miles:

The following day I started my surgery rotation. This corresponds with the precipitous drop you see on my chart at the top. I did start riding my bike to the hospital last week, but that’s only 1 mile each way. Even on my days off I’m tired enough and have enough errands to run and laundry to do that long rides seem like a distant dream. I suppose it’s worth remembering that the saving grace here is that it’s July, and I dislike being hot and sweaty. My surgery rotation will continue through August, and it should get easier in terms of hours as it gets cooler through the fall. Here’s to a September and October full of long and wonderful rides…

Obviously an oncoming train

From Dose of Reality:

I finished my pediatrics rotation on Friday, and I took my first shelf exam ever. I think that if I had to describe the test in one word it would be “random.” I had expected it to be challenging (which it was), and long (which it wasn’t, at least in my opinion), but I didn’t account for how disconcerting it would be to have all of the questions all jumbled up. All of my textbooks march neatly through the organ systems, and even the cumulative practice questions at the back of Pediatrics Blueprints didn’t seem nearly as random as the exam was. I have no good way to really self-assess my performance on the exam; I definitely didn’t get all of the questions right, but I’m optimistic that I did well enough to pass. I may have also spent a little time in the morning before the exam looking up the remediation policy just in case… Suffice it to say it’s pretty generous – I don’t think this would be the first time on this blog that I gave thanks that it is difficult to fail out of medical school. Once you’re in they really want you to finish, so you get second chances even when you mess stuff up. In any case, I would have to say that even without knowing my grade I would consider my first rotation was a success.I learned a lot about how the hospital works, as well as about how I work as a medical student, and I even learned a bit (I hope!) about pediatrics.

Now I’m enjoying my first switch weekend of M3 year, and while it feels like I’ve emerged from the dark into the beautiful sunlight of July, I know that this coming week is probably one of the bigger trains I’ll face in this tunnel of a year. Big enough to illuminate a whole weekend… I went on a 40 mile bike ride this morning with new med school friends, and have more outdoor fun planned for the rest of the weekend. On Tuesday, I have a full day of surgery orientation, and Wednesday will bring the start of a new rotation: a new schedule, a new set of objectives, and a new group of colleagues and instructors. I think I’ll wait and think about that on Wednesday…

Hello summer…

It’s been warm here, and while it’s cooled down substantially today, the search for all things refreshing has been unending. It seems appropriate to celebrate the official start of summer by sharing something cool and delicious with you. Enter Ashley and her knowledge of many things foreign and fancy. When I had dinner with her last weekend she introduced me to the concept of a shandy, a grown-up Arnold Palmer that is half lemonade and half beer. Apparently it is a dainty lady’s drink in Britain… The combination of Oberon and a really good lemonade was really fantastic and, although many beer lovers are probably judging me right now, I would mix them again in a heartbeat.

Fast forward to this morning, when I was describing this drink to someone else, and couldn’t remember the name. Entering “half lemonade half beer” into Google to try to find it, I discovered not only the Wikipedia page for Shandy, but also a Huffington Post article about cocktails made with beer. Because the lead slide was about a spicy Mexican beer cocktail called a michelada, I was somewhat dubious due to my experience with “Chips and Salsa” Beer:

It was not delicious … I’ve concluded that beer should not be spicy. It is not refreshing to have your drink leave a hot burning taste in your mouth…

Looking past the michelada, however, I’m interested to try the Lambic Sangria recipe from Chow. Let me know what you think of any of these if you try them, as I’m eager to explore new beverage options, as well as dodging bullets when I can.

While I suspect that this new knowledge will not get me out of looking like a little kid (with my Shirley Temple) or like a confirmed member of the ladies who love ladies club (with my beer, which never looks dainty at a wedding or other fancy occasion), I suppose I could at least try to ask for a shandy at my next dressy occasion, and hope it comes in a glass that looks like everyone else’s cocktails. Regardless of any long-term possibilities, I will be making these all summer long!

CSA Weeks 2 and 3

M3 year seems to be getting the better of me in terms of blog posts, but I wanted to share more of the CSA bounty photos… Here is the haul from two weeks ago:

And then this week (minus the strawberries I devoured before taking the photo):

I made a really delicious saag paneer, which was a little complicated but so worth it for the deliciousness.

Also amazing but much simpler is a yogurt chutney that I love, both because it is delicious and because it accommodates almost any greens/herbs left over in the refrigerator and the end of the week.

Yogurt Chutney with Pureed Greens
Adapted from 1,000 Indian Recipes by Neelam Batra

1 teaspoon Chaat Masala (I like the MDH brand, as it contains too many different things for me to make it myself)
4 quarter-sized slices of peeled fresh ginger
3-4 scallions, chopped
1 green chile or a sprinkling of dried ground cayenne
2 cups coarsely chopped fresh herbs in any proportion (I’ve tried cilantro, mint, parsley, dill, basil, peppermint, lemon balm… I've considered adding a little spinach or kale as well...)
2 tablespoons fresh lemon juice
1 teaspoon salt (or to taste)
1/2 teaspoon ground black pepper
1 cup nonfat plain yogurt

In the food processor, mince together the ginger, scallions, and green chile (if you’re using a fresh one). Set aside a few fresh herbs for garnish if you like, and add the rest of the fresh herbs and lemon juice, and process until smooth. Add the chaat masala, salt, pepper, and cayenne (if you’re using dried). Add half the yogurt and blend until smooth. Artfully stir this mixture into the other half of the yogurt, or process the rest of the yogurt into the chutney, depending on how much time you have and how you wish to serve it. Garnish with the fresh herbs if you like.

Enjoy as a dip for vegetables, chips, and breads, as an accent with lentils, or as a side with potatoes. Yum!

Status/post week one

From Dose of Reality:

I started writing this post last week, but couldn’t find the time to finish it until today… I’m finding inpatient to be much more challenging in terms of finding time for everything. The math:

24 hours in a day

- 10-12 hours in the hospital

- 7 hours of sleeping

5-7 hours in which to do everything else

Since “everything else” includes taking care of the dog, eating, bathing, and walking to and from the hospital, there are really only a few short hours in which to fit in studying, exercising, cooking, and maintaining any kind of social life. Given my limited time, I think I may be sticking with the list format blog posts for a while… Lessons learned:

• It can be difficult not to cry on rounds. This is not, as you might have initially imagined, because it is embarrassing not to know the answers to questions posed to you about your patients. Although that is difficult, I got over it pretty quickly when I realized I knew almost nothing. Instead, sometimes on rounds you have to see parents describing how worried they have been about their children’s health. Watching a parent cry during rounds was one of the hardest things I’ve done this year. I’d never met the patient before, and I knew it would have been inappropriate for me to start bawling, but I still had to work pretty hard not to let the tears slip out.


• Scheduling social events for your days off is important. As much as it seems like a great idea to spend the entire day and night catching up on reading and practice questions (which does, in fact, always sound like a great idea), having a really inflexible schedule can be isolating and lonely.


• Mom makes awesome quiche that is delicious when reheated in the hospital. Enough said. Thanks mom!


• Subscribing to a CSA (community supported agriculture) was a great idea. I can count on having produce at home even when I’m too busy to make it to the store. I’ve been making a lot of salad dressings to keep things interesting.


• I have learned the phrase “status/post”, and I like it. It means “after” something has been intervened on, as in, after the play-doh I put in my sister’s nose when we were little was removed, she was “a 3 year-old girl with play-doh in her nose, status/post removal.”

Apologies for the randomness of these insights (?), but I’m starting on nights in a few short hours and have some stuff to finish up before then!

Benny’s Bakery

I wanted to go for a bike ride today and decided that I didn’t need to wait for someone to be available to go with me to visit a delicious attraction outside the city limits. As I was playing around with Gmaps Pedometer (one of the best uses of Google Maps ever), I saw that I could get to Saline, MI (pronounced sal-EEN, not like contact solution) pretty easily. I promptly headed to Yelp to find somewhere to get a snack when I got there. I discovered Benny’s Bakery. I suspected from the reviews that I would be too late to get the highly sought after Saturday hot pretzel, but consoled myself with the prospect of a delicious muffin or doughnut about halfway through my ride.

My route took me through downtown Ann Arbor and scenic Lodi Township, which is “Rooted in Agriculture” according to their website.

Once I arrived in scenic downtown Saline, I quickly found the bakery, complete with a group of older gentlemen chatting about how smoking used to be considered healthy.

I confirmed that I’d missed the pretzels, and instead had a chocolate-glazed doughnut. It was really good! I also had a juice, though in retrospect this was not enough food.

It was around 11:30am (read: lunch time!) and I got back on my bike to head back to Ann Arbor. Around mile 20, still about 5 miles from home, I started to feel icky, and had to get off my bike and eat part of a Clif Bar I had thankfully tucked into my jersey pocket before I left. It was a lot warmer today than I’d planned for, and I probably didn’t have enough water OR food for my ride. Lesson learned, I rehydrated vigorously when I got home, and all was well.

Greens!

Knowing that my schedule would be pretty crazy this year, I signed up to split a CSA share from Tantre Farms with a friend. I have been looking forward to receiving a random assortment of vegetables, and finally, my friends, it has arrived!

This week’s share contained:

• Asparagus
• Radishes
• Spicy Greens Mix (arugula, Kyona/Mizuna, and red and green mustards)
• Spinach
• Tatsoi
• Lettuce
• Kale
• Green Onions
• Oregano
• Fingerling Potatoes
• Cilantro, Chives, and Parsley (which were a bonus from Allison’s garden)

You may be thinking, how does one person eat all of those items in a single week. I am thinking the same thing. I gave some of the spinach to my neighbor upstairs since I had so much, and have been trying to plan my meals around the leaf-heavy share this week. (Apparently the crazy rains have caused the spinach to try to take over the world. I’m just doing my part to keep us all safe from these crazy large plants…) My first creation:

Spinach, boiled fingerling potatoes, and capers with Dijon vinaigrette

Dressing (Feel free to estimate on these proportions… I did…)

• 1/4 cup olive oil
• 1 tablespoon Dijon mustard
• 2 tablespoons red wine vinegar
• 1 clove garlic, minced
• 1/2 teaspoon finely ground Italian seasoning
• 1/4 teaspoon salt
• ground pepper to taste

A wonderful break

This morning was one of the nicest mornings we’ve had in a long time: no rain, not too much sun, heat, or fog, and a beautiful blue sky. Alicia had identified the Tour De Lakes as a promising option for an organized ride, and I wanted to push myself to increase my distance. We signed up for the 31 mile route, and I recruited a new med school friend (!) to join us for the ride. I am feeling good about my training, and am hoping that I can at least maintain where I’m at now. With the ride this morning, my May mileage is 113.5 miles, and all of 2011 is 129.90 miles. True to form, I’ve been tracking my progress on the Bike Journal rankings. There are lots and lots of riders who aren’t riding very much, so every time I log another ride I shoot up in the rankings. While there are folks at the top of the rankings who have already biked over 10,000 miles this year, I know that’s not really reasonable for me. Here is my progress since I started making notes:

Not too shabby…

In any case, the ride this morning ended up being just over 35 miles, and it was my fastest of the season (about 13.5 miles per hour, which is fast for me, but slow for most folks on road bikes). It was really wonderful to just be outside in some nice weather, and I’m keeping my fingers crossed for this to continue!