Definitely forgot my own anniversary.

It's okay. Andy did, too. His belated present:

Cotton and paper are the traditional second-anniversary gifts,
per the American and British systems respectively.

Pesach starts tonight. I should have made something unleavened, but I really wanted to try out a specific idea I had: more healthful knish.

These have silken tofu in the filling and olive oil in the (whole-wheat) crust. Of course, an actually nutritionally sound knish would have to weigh less than 12.5 ounces.

Hey, you don't eat carbs wrapped in carbs every day*. Might as well go for broke.

Hippie knish
(Makes either 8 huge ones or many, many normal ones)

Filling
2 lbs potatoes
1 lb silken tofu, drained, liquid reserved
1/3 cup chopped scallions
salt and pepper to taste

Peel and boil the potatoes until very tender. Mash to your desired consistency and mix in the tofu. Steam at the bottom of the potato-boilin' pot at medium-high heat; removing moisture from mashed potatoes makes them fluffier. Mix in the scallions and add salt and pepper to taste.

Dough
1/2 cup olive oil
1 cup tofu liquid + water
1 tbsp apple cider vinegar
1/2 tsp salt
4 cups flour
turmeric to taste

Take your tofu liquid and add regular water to make a cup. Add olive oil, salt, and apple cider vinegar. Stir in flour, a cup at a time, just until blended. Add turmeric to taste and finish kneading the dough just until smooth. Divide into some number of balls (I did 8; 16 would not go amiss) and refrigerate for 20-30  minutes. On a floured surface, roll each ball into a very thin circle and plop some potato filling in the middle. Fold the dough attractively around it. Brush with egg wash if you like. Bake at 375 for 30-45 minutes, or until golden brown.

*Hopefully.

Soft embalmer of the still midnight

I usually try to practice what I preach, medically speaking. Things like "don't smoke" and "eat dessert only a couple times a week" and "try to cut down to one dime bag a day" aren't a problem, but I consistently fail at "biting your nails can increase your risk for paronychiae" and "if you're interested in improving your sleep without the use of medication, here are some tips for good sleep hygiene." Case in point: my desk chair isn't all that comfortable, so I usually do my work recumbent in bed.

Bear with me while I get to the relevant part of this story. So there's a girl who lives on my floor and periodically leaves large bags of clothing by the industrial-sized recycling bins down the hall. The clothes are always neatly folded and usually in pristine condition. Many of them are quite expensive to boot. I usually harvest what I want/what fits me and donate the rest to Goodwill or use the worn-out shirts for rags. And then a few days ago she left a pair of shoes, some assorted turtlenecks, and this:



Andy and I were mystified at first as to how one might use this. At first we thought it was a massage chair, but it has wheels*. We kept it hoping that when Andy's parents arrived on Friday, they'd be able to identify it, and sure enough, it's a kneeling chair. You put your rear on the higher platform and knees on the lower one. I look like a total dork in it, but it might be the most comfortable chair I've ever sat in. I'm already feeling its magical productivity powers; no more reclining in bed browsing Tastespotting and NEJM! I will sit at a desk like a real grown-up and Do My Work, then go to my bed-that-is-used-only-for-sleeping and have an unprecedentedly good night's rest!

Making garlic soup for dinner. Forecast tonight: 35 deg F, overcast, 0% chance of vampires.

*Awesome idea incoming: wheeled massage chairs. "Get your cardio in while giving your loved ones the massage of a lifetime!"

Amazing facts about Shel Silverstein.

He wrote the lyrics and music for most of Dr. Hook and the Medicine Show's songs. Andy has always poked fun at me for liking them*. Well, fie on him, I say! Watching Ben Folds cover "Cover of the Rolling Stone" my junior year at Brandeis was thrilling, if shamefully so.

Next order of business for the day: I'd like to point out that I don't mean to bring home medical accoutrements. It's just that every time I go to put in an IV or venipuncture or something, I grab an extra needle. Those extras wallow in my pocket until I get home and shake out my coat. Invariably, they stay at home. And so, armed with a number of 18-gauge angiocaths and a few syringes, I decorate cupcakes. Unfortunately, the Flo-coat that I purchased to make my water-soluble food dyes miscible with chocolate didn't work at all. Even just adding the Flo-coat to my chocolate made it agglutinate. By the time I figured that out, I'd used too much chocolate--and time--to attempt a batch with only the coloring. Either my Flo-coat was defective or the cheapo Nestle chocolate chunks just don't do for candy decorating. So please excuse the grainy-looking decorations. They were supposed to be pretty and glossy.

It's dye, not cyanosis.

The panels, all ready.

Cardamom-orange cupcakes with star anise frosting

Time is tissue!

Everyone's favorite toxic alcohol.

An ED staple.

Gratuitous picture of Malta being cute. Every time I try to
photograph her, she's either blurry or demonic-looking. Hints
on rodent photography, anyone?

Emergently delicious.

 *"Is that even a real band??" "Dude, 'Cover of the Rolling Stone' is a Known Thing." "[shrilly] What? No!"

Salt and water depleted

No matter how many times I wash or otherwise disinfect my hands while at the hospital, I still feel like some nidus of nasty ready to spread god knows what germ-laden remnants of bodily fluids over everything I touch. Between that and the fact that on most rotations there aren't lunch breaks--those mythical beasts!--legions of nurses, doctors, and medical students go for hours with nary a drop past their lips. There's a reason why the lack of bathroom breaks during surgery was never a problem, and it has nothing to do with less than savory strategies. Or surreptitious ingestion of anticholinergics.

But thanks to a certain aforementioned Rite-Aid's 99-cent sale, I can slurp down one of these puppies as soon as I come home.

The neon green and neon orange flavors are the best by far.

Speaking of salt and water, I salt-baked a whole branzino tonight! The way it works is this: pick a nice, fresh whole fish. Clean it. Stuff it with things you like--I chose black garlic, fennel, and blood orange--and pat the outside dry. For every pound and a half of fish, measure out 3.5 cups of kosher salt. Mix that with about 1 egg white per cup, or until the mixture feels like wet sand in your hands. Pack it over the fish. Bake at 375 for about 20 minutes per pound of fish, or until the crust is golden at the edges. Crack open the crust, which is the most satisfying feeling ever, peel it off, and disassemble your moist, fragrant fish.

The Things I Like

Black garlic, by the way, is just garlic that has been dried
at constant warm temperature for a very long time. It has a
funky, molassesy taste.

The stuffed product!

Covered in salt

Post-bakeage.

The freshly decrusted product

Aaand the finished plate.

N.b. If you feed blood orange to your guinea pigs, they'll look like they've been mauling knights.

I also made a black garlic, fennel, and blood orange pesto (with pine nuts and olive oil), roasted potatoes, and green beans. Lots of green beans.

Andy reminds me to mention that last night, with minimal guidance, he made truly delicious lentil tacos with chipotle yogurt sauce. He agrees that his photography skills leave something to be desired.

SO much more delicious than it looks.

An FYI to anyone in NYC: tomorrow is Free Macaron Day. I plan to indulge around my work schedule; do you?

Buzzkill

Spoiler alert: she doesn't actually make it out of arrest on any kind of semi-permanent basis.

While we're on this happy topic, please, ladies and gentlemen, ask your doctor about advance directives, and then talk to your closest family member slash health care proxy about your advance directive. Do not attempt to do this with zero guidance. The terms are nitpicky. The laws vary by state. Bad things happen (often with a dramatic dénouement in e.g. a large urban ER where medical students are watching through wide, scrub-blue eyes*), so please do this little thing to help out those who care about you.

On an actually happy note, I went to see a patient from a couple nights ago who we ended up sending upstairs. He's doing great. They repeated a minor procedure that we'd first done in the ER with a little something for the pain... except he didn't get anything for the pain the second time around. In his words, "I like you guys better." Seriously, though, I love it when they get better. Getting a patient discharged from Bellevue over the weekend is like herding cats with ADHD and jetpacks on, so I imagine he'll be home on Monday!

Andy looked over at me plaintively last night and said he craved licorice. I dragged my eyes away from the computer** long enough to suggest a trip to Rite-Aid*** for an impromptu licorice purchase. Princess Andy rejected this proposition: "But... I want your licorice!" I don't habitually keep condensed milk around, though, so I had to make him caraway, anise, and raisin buttermilk soda bread (based on this recipe) to satisfy his craving. I've ruined him.

Credit to the parenting site Babble for this photo. Mine looked
a lot like this, actually, except they got eaten too quickly to be
immortalized on "film."

Going to leave for the late shift in a bit, so I just made Andy a big pot of Cajun beans. I dare him to make the rice.

*Ouch. Next up, rhabdo urine as the wine-dark sea.
**Not working, oh no. I have caught a severe case of unproductivitis and hope to be cured soon and plugging away at my article and a presentation for next week.
***Have I written about this Rite-Aid before?

Not safe for appetite.

Hide your bananas no longer, ladies and gentlemen. They're now letting me sew up real people, unsupervised*. Protip: people skin holds a stitch better than banana skin, even if you have to use chromic gut sometimes.

Other camouflaged-for-privacy-reasons patient protips: small children may be shockingly fastidious and therefore disapprove of even a little plaster dust on their otherwise pristine clothing; it's a red flag if you ask your patient about their pain and they sweep their body from knees to neck and say "all over here"; and the people around you can in fact see the bright-eyed, bushy-tailed joy in your eyes when the words "major cellulitis" or "really juicy abscess" are uttered in your presence.

So I've been reading the oldest entries from The Underwear Drawer***, and I'm so titillated when I recognize NYC-specific medical tidbits. Short call at [Upper East Side Hospital]? I know exactly where you're talking about, ma'am. And that picture is definitely from my favorite stall at the farmer's market.

No cooking tonight. The orthopedists gave me free food.

*This patient's lawyer was in the room while I worked on him. I wish I could make this stuff up. There was a good reason to keep the lawyer in there, though, which I can't tell you because that would be too much of a privacy issue, but trust me in that it was a good reason that had nothing to do with the fact that I'm a student who can't be trusted not to accidentally give someone a lidocaine a-line**.
**I am completely and totally kidding. Drawing back on my syringes like a boss.
***Major doctor crush on this woman. For the uninitiated, a doctor crush is an intellectual, totally aromantic crush on a particularly smart and/or witty and/or educational physician person that makes you want to duckling after them all day long and bask in their amazingness. Am I the only one who gets these?

Stitching bananas

As far as I'm concerned, fresh fruit is the pinnacle of gastronomy... with the exception of ripe bananas.  Unripe bananas are higher in starch than their jaundiced counterparts and thus have a somewhat lower glycemic index. On the other hand, since the body is not so good at breaking down and absorbing those plant starches, the undigested starch can cause a mild osmotic diarrhea, similar to that caused by the xylitol or sorbitol in "sugar-free" candies and chewing gum. On the other other hand, they have a firmer texture and pleasantly grassy taste than mushy, cloyingly sweet ripe bananas, which, for the record, are among the fruits that suffer most from inbreeding and destruction of unique and subtle cultivars.

Most importantly, they're better for suturing practice! Firmer, less friable skins, you see, are easier to stitch up. I'm less than naturally talented when it comes to manual skills, so these bananas are making a noble sacrifice in the name of medical education. The backstory for how the banana came by its laceration: When the lights in the supermarket go off for the night, the great battle between the bananas and apples begins. The apples have cleverly recruited the nopales as their chief allies. Though many have been neutered by conscientious suppliers, some hale and hearty nopales retain at least a few of their potent spines. This particular banana is a young private who threw herself in front of a colonel to protect him from a killing blow.

Like I said, manual skills: not my thing.

More practice is needed. I'm also working on the vertical and horizontal mattress stitches, and fueling my efforts with vegetarian eggs Benedict using Alton Brown's hollandaise recipe.

Hollandaise, for the uninitiated, is one of the French sauces de bas, or mother sauces. It's an emulsion of butter in egg yolk, with a touch of lemon juice and pepper. In the interests of avoiding an anxiety attack, I'm refusing to calculate how many calories are in the portion I just made.

And who'd have thought there's such a thing as Canadian fake'n? I'm not too impressed--it's somewhat generic-tasting--but the dish wouldn't have been eggs Benedict without it.

English muffins

1 1/2 cups whole wheat flour

2 1/2 cups all-purpose flour

1 tablespoon gluten

1 tablespoon sourdough starter (somewhat optional)

1 3/4 cup buttermilk at 110 degrees

1 egg

2 1/2 tablespoons sugar

1 1/4 tsp salt

3 tbsp melted butter

2 1/4 tsp yeast

semolina for dusting

Mix the melted butter, warm buttermilk, starter, and yeast. Let sit 10-15 minutes, or until the yeast blooms. Add the remaining ingredients and mix until the dough is smooth and pliable. Set in a warm place to rise about 2 hours, or until doubled. Punch down and divide into two-ounce portions; dust with semolina flour. Flatten and rest for 20 minutes while you heat a cast-iron skillet or griddle to medium-low with scant canola oil therein. Cook 10-12 minutes on each side, or until deeply browned.

Journal club

Current stress level: minimally high. So why did I just laugh myself into tears watching this? That's much more characteristic of pre-Step 1 behavior.

I'm going on a stretch of night shifts, so cooked dinners may or may not be happening. But I did want to share a few recent articles:

1. I can't even think critically about this. The proposal is just too tickling.
2. This is an interesting and important subject, particularly the relapse information. Impressively long-term study, but it's not too big.
3. This dramatic case is, objectively speaking, yucky. Click with caution.
4. Investigates a complicated issue an attending was just discussing at today's toxicology conference.

Unexpected indecision

My orchid is in full bloom again!



I swear, it can tell when I'm happy. As soon as Step 1 ended and ER started, the buds popped out, and they've held up ever since. Maybe I'll go buy it some plant food as a reward. After all, the guinea pigs get ample treats; why shouldn't it?

Emergency medicine is awesome. Too awesome, in fact, for someone who was pretty positive that she was going to match into neurology and then do an ID/immunology fellowship. Updates on raging inner battle to follow.

Also awesome: Quorn burgers. I got a little spooked after I Googled them and the first ten hits were about horrible reactions to the mycoprotein therein, but Real Scientific Papers don't seem to back up the anecdatal fearmongering, so I'll continue chowing down. They're a mere 100 calories each, so I feel justified eating them with rich, buttery homemade hamburger rolls and plenty of aioli.

Horse meat not included.

Tips for baking excellent hamburger rolls: use bread flour, don't
overknead or overproof, and brush with ample, ample melted
butter before sprinkling with sesame seeds.

I also made a ridiculously good (if I do say so myself) gruyere macaroni and cheese that I couldn't photograph because Andy ate it all by the time I got home from a late shift. Just use your favorite roux and add 6 oz white cheddar and 14 oz gruyere. Tonight, for a slightly healthier option, I made miso ramen.



The picture's a little busy. I started with some (well, lots) of my last batch of frozen mushroom broth and boiled it with about half a tablespoon of garlic, a little over a tablespoon of ginger, one sliced chili, and a large spice bell full of bonito flakes. Into that went about a quarter-cup of white miso, a drizzle of soy sauce, some cooking sake, and a little extra ginger for the road. Meanwhile, I soft-boiled some eggs, cooked some bean stick noodles, and sliced up carrots, mushrooms, bell pepper, edamame, scallions, and nori.

The setup.

 Pour some broth over noodles and top with ample veggies, scallions, baked tofu, halved eggs, and nori. Sprinkle with toasted sesame oil, sriracha, and sesame seeds, and finish with bean sprouts, ground ginger, and black pepper.

It's shockingly filling. Even Andy couldn't finish a whole bowl. As usual, I didn't measure anything exactly (up to and including the broth), so please taste throughout the process and adjust the proportions prn. The broth wasn't up to my umami standards. I suspect the secret ingredient is meat.

Not as anticipated

This month was intended to convince me that I didn't want to go into emergency medicine. Unfortunately I'm having a great time so far. Maybe it's just that I'm finally back in the hospital. Step 1 and, to some extent, Sandy, had led to serious atrophy of my talkingtopatientsorius*. Bellevue is up and running--mostly**--and the Bellevue ER is about as much patient contact as a girl could ask for. Sure, we get more than our share of angry drunk people, but after only a week of shifts I've already seen an impressive and intriguing breadth of pathology, I&D'd an abscess and packed another one, ultrasounded and put a line in a viable vein in a drug user, and generally stretched my differential wings. And worn pajamas to work every day. Scrub blue brings out my eyes, man!

I put this faux quiche together relatively quickly--I've been cooking during the day in time to do my shifts at night--using a recipe from the New York Times and substituting leeks for onions. And putting a little buckwheat flour into the crust. I should have known that the promise of a waistline-friendly quiche-like substance was too good to be true. The stuff tasted great, but even after baking for 5 minutes over the maximum time and risking a burned crust, the filling broke down when I cut into it. After sitting in the fridge overnight, it firmed up nicely. Maybe it just has to be eaten cool? Either way, the creamy texture is great, and it makes me feel virtuous.

*Every med student's favorite muscle.
**I'm way too attached to this place, clearly, because I turn into a soppy mess whenever I think about what happened and how good it is to see the hospital springing back.