Thursday, March 17, 2011

Mother of invention

As I previously mentioned, I'm going to Boston for the week of spring break, which means I had to come up with a way to use up the rest of my produce. Last night I roasted basically every vegetable left in my fridge and mixed it with pasta and the little bit of cheese left. Delicious, but too haphazard to blog about. Left to use up: one avocado, one sweet potato, half a very large white onion. There were also several eggs and a lemon. Hmm.

I shall call this the croque-médecin: avocado, egg sunny-side up, and saffron-tinged caramelized onions, all on toasted sweet potato bread. After I'm done patting myself on the back for how rich and delicious it was, I'll realize that it's not healthful enough to deserve its name (mmm, copious amounts of olive oil), but for now, I'm satisfied. I couldn't find a great recipe for the bread on the Internet, so I fiddled with a recipe from the sadly defunct blog Raccoon and Lobster and came up with something quite successful. The sweet potato flavor isn't screaming at you, but it's there.

Subtly sweet potato bread
(adapted from a recipe adapted from Nancy Silverton's recipe for pumpkin bread)

8 oz cooked, mashed sweet potato (no skins; those went directly down my gullet)
8 oz water
14 oz flour
1.5 tsp salt
1 tsp yeast

Mix all the ingredients except the salt and stir well for 5 minutes or so; the dough is going to be very wet. Add the salt and continue to "knead" for another 10 minutes. A stand mixer with a dough hook would be helpful here. Coat the ball of dough in oil, put it in a bowl, cover the bowl with plastic wrap, and refrigerate for 5 to 6 hours. Take it out and put it on a piece of generously flour-dusted parchment paper. Let it rise at room temperature for 3 hours; it will probably spread somewhat, but don't freak out. Now, while I could see baking this the Jim Lahey no-knead way (preheat a heavy pot or Dutch oven, tip the dough in there, and so on), I was lazy and just popped it in a 450-degree oven for 30 minutes. Someone try the Lahey baking method and let me know how it goes, please!

And now, from the annals of medicine: I, along with another first-year, sat in on an ethics committee meeting in Bellevue. There were some interesting cases brought up, and a topic near and dear to my heart was discussed: HIV testing. New York has recently enacted some new and more lenient laws; the old ones were created in the eighties, when HIV/AIDS was incredibly stigmatized, and thus HIV testing could not be done without written consent and counseling and so on. Now, among other things, health care proxies can request that a patient be tested, and a patient can be tested anonymously if his status is unknown and a health care worker has been exposed to his blood and possibly put at risk for a variety of blood-borne infections. But there are still many states in which opt-out testing isn't an option; minors have to have parents consent to their being tested; and in which HIV testing regulations are not set forth at all.

And among the above complicated issues, there are two in particular that frustrate me: that of consent to test and that of partner notification. First of all, did you know that, in New York and several other states, patients can be tested for hepatitises (hepatiti? hepatites?) A and B without consent? The rationale, of course, is that these are manageable, chronic, infectious, life-threatening diseases that must be taken into account when managing care in all sorts of situations, as well as when counseling on behavior and lifestyle modification. But HIV remains enough of a bugbear that it is not lumped in with hepatitis*, despite the fact that it is ever-increasingly a manageable, chronic, infectious, life-threatening disease. I find this deeply unfortunate.

Speaking of deeply unfortunate, did you know that in many states, there is no legal requirement to notify contacts of patients newly diagnosed with HIV (or other sexually transmitted diseases, in fact**)? Systems for anonymous notification are in place, including systems to avert domestic violence as a result of disclosure or notification, but I'm shocked that there are still places in the country where a physician may essentially be compelled to allow someone to wander around blithely having been exposed, or under continuous risk of exposure. Yes, patient autonomy must be respected, but shouldn't it also be overridden when someone else's life may be at risk?

In any case, go here for information on your state's rules and regs!

*Some of you might disagree with the whole idea of any testing without consent. That's a whole other matter. Let me know, and we'll chat.
**Sure, chlamydia and gonorrhea are more mild diseases; they can cause infertility in women, but they're very, very rarely going to be life-threatening. Syphilis is worse than those two, but still treatable. But how is it that hepatitis doesn't merit a notification system?

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