Edible biology

Proteases are fun! A protease is an enzyme that breaks down protein by destroying the linkages between amino acids. Proteases destroy those linkages, which are called peptide bonds, via hydrolysis, in which the oxygen of one of our cells' oh-so-abundant water molecules stuffs its way into a chemical bond, booting off one of the components (in not-quite-accurate layman's terms, that is, but it'll do).  One of the more interesting things about many proteases is the catalytic triad, or a trio of amino acids that work together to catalyze, or speed up, this hydrolysis. Their chemical and biological mechanisms are pretty nifty (particularly the classic serine-histidine-aspartate triad), but what is even cooler is that species all over the genetic map possess proteases with catalytic triads in a beautiful example of convergent evolution. What this means is that the catalytic triad arose independently about two dozen times because of the sheer chemical elegance of those arrangement(s). Even better, some species of protease-packed plants are edible.

Kiwi, papaya, and pineapple are some of the most notable protease-containing foods; nota bene that none of them can be set in gelatin unless canned or otherwise preserved first, since the peptide bonds that give gelatin its structure will rapidly be destroyed. Industrially, the papaya protease--conveniently named papain--is used as a meat tenderizer. Ficin, a protease derived from the fig tree itself rather than the fruit, can also do this.

"Yes, Hannah," you're saying. "I know all about papain, and pineapple's ability to dissolve gelatin has been the bane of housewives since the 1950s." Fine. But did you know that everyone's favorite rhizome also contains a protease?

Ginger protease, or zingibain, can actually be used to make a milk pudding (or cheese, but that's another story). Here's how it works: normally, milk proteins called caseins aggregate into balls called micelles. Micelles of any sort have hydrophilic, or water-friendly, components on the outside, and hydrophobic components pointing inward. In this case, kappa-casein (heretofore written as K-casein) is on the outside of the micelles. Zingipain cleaves K-casein (specifically, at a proline residue), leaving a hydrophobic component called para-K-casein behind... and all of a sudden, those beautiful micelles stick together, and the milk sets.

Unfortunately, zingibain is a fairly tim'rous beastie. If heated above 150 Farenheit, it denatures--or loses its structure--almost completely, per this paper.  It also degrades fairly quickly; the half-life is only 20 minutes at about 85 degrees Farenheit, but according to this paper, the addition of simple ascorbic acid--also known as vitamin C--dramatically increases that half-life. The science of that phenomenon is adequately explained in both the citations above.

That first paper also mentions that zingibain has its peak activity in a very narrow temperature window of 60 to 65 Celsius... and yet I saw so many recipes for this that called for milk to be "nearly simmering" or something like that. Sheesh. Break out the candy thermometer!

Ginger milk pudding

325 mL milk
40 g sugar
37 g ginger juice

In a small saucepan, mix the milk and sugar. Heat gently; you want to add the ginger juice at a target temperature of 145F. Meanwhile, grate the ginger (I used my delightful microplane) and squeeze out the juice using your hands, cheesecloth, or a strainer. When the milk and sugar are at the appropriate temperature, pour the ginger juice in over the surface of the milk and do not stir. Allow to set for about seven minutes, and enjoy the sweet taste of science.

Holiday indulgences

...and more than a month after Thanksgiving, we're back. A bit of a vacation replete with food and reading (This essay by Bob Shacochis perfectly encapsulates emptiness and heart-wrenching loss; no need to have a particular yen for children to appreciate it.) turned into a big distraction! Christmas first:

Not everything from Intern Thanksgiving ended up in photos, but luckily, dessert--always the most important course--got captured.

Nusstorte, served with a spicy pecan popcorn praline.

Cranberry tarts, served with whipped orange goat cheese crema.

The nusstorte got a redux at Christmas. Here were all the courses, minus the lemon pepper leek soup and my uncle's brined turkey:

With cranberry-satsuma compote, a variant of Mark Bittman's
frozen honey mouse that incorporated a tart creme fraiche, and
candied satsuma rind.

Chocolate-peppermint cookies dipped in dark
chocolate (tempered by my mom!) and sprinkled
with crushed candy canes.

So. Many. Orecchiette.

Creamy roasted tomato sauce, mixed roasted vegetables, and
the orecchiette tossed with the best herb sauce ever. I wish
I'd gotten a picture of just the sauce; it was a gorgeous shade
of jade-green. No recipe, of course, but it involved fresh basil,
thyme, oregano, and briefly blanched spinach.

Mixed greens with olives, mixed orange supremes
(Cara Cara, blood, and satsuma), caramelized fennel,
and an orange-fennel vinaigrette with basil oil.

I'm a little over the cranberry/citrus/nut spectrum of desserts. The piloncillo, vanilla, and chilies I got from Mexico and the spices my best friend brought me from Zanzibar beckon.

Happy post-call day!

I mean... Thanksgiving... yeah...

This is horrifying. Few of these things actually sound appealing in any way. Luckily, while I'm post-call on the actual day, stay tuned for some Friday Ersatz Thanksgiving goodies that don't include "casserole" in their names!

Breakaway, breakdown

omgomgomg Lady Macbeth of the Mtsensk is coming to the Met! Except... how am I going to find time to go if I can't even find time to post? All my non-Bellevue hours have gone to the gym, or to journaling, or to reading*, or, to be fair, to cooking. I haven't worked at any other city hospital, but this one... this one can get under your skin. Could it be the constant need--not medical, but social--of so many people with whom it can feel impossible to relate? Or is it the more quotidian sleep deprivation that plagues all interns? There's just something that, at the end of the day, makes me crave a selfish withdrawal inward, even when it comes to posting a few silly, superficial thoughts on an amateur food bloog.

Somehow, though, there has been time for tiny pears (Seckel pears, to be exact), made into peppery ginger scones:

And mini chocolate babka:

Spreading rich cinnamon-chocolate filling over a yeasted dough...

And a spur-of-the-moment rosemary, grape, and feta focaccia:

And then, because I am me, I ate the remaining pound of grapes.

Now, what do I make for my last weekend on Bellevue floors, macarons or mini nusstorten?

*Here, read this creepy tale!

(Title of this post being an allusion to this story.)

Where does the time go?

So... CCU. Yeah. Wow. Look, apples!

This circle contains such varieties as Enterprize, Liberty, TFO-1 (not as delicious as I'd hoped, given the exciting name), and Summergold. In one of my very few free days, I also found this massive Japanese radish that tasted great with apple and a miso-honey dressing.

Enough of produce, though. Andy recently earned a great academic distinction and, when asked how he wanted to celebrate, answered, "With nougat." Well, sir, then nougat you shall have.

I actually think the hazelnut mastiha nougat was the least delicious component of these homemade fancy Snickers. Out of impatience, I poured on the cayenne caramel layer before the nougat had fully dried, so it stayed kind of sticky even after the bars had set overnight.

There is a dollar store nearby that inexplicably sells Wilton candy molds for five to ten dollars. I seriously considered buying one in order to make these, but couldn't get over the stupidity of stuffing another implement into my overstuffed kitchen, so settled for ugly candy bars. Plus, I'm not sure if the dukkah and candied orange peel would have stuck had I used a mold. Next time, I may cut the bars before putting on the final layer of chocolate (super-dark 75%) so they look more like a real Snickers.

Of course, since candy for dinner is not healthful, I also made ravioli with a pumpkin, mascarpone, and harissa filling, and a spicy spinach fennel bechamel.

So good for you, I know.

Grown-up Snickers

Quality dark (very dark) chocolate
Dukkah (homemade, kicking around from when I made this amazing recipe)
Thinly sliced candied orange peel (I made my own in the microwave)

Line an 8x8 metal baking pan with parchment paper, molded tightly to the pan. Melt some chocolate (about 1/2 to 2/3 cup) and spread in an even layer on the bottom of the pan. Allow to cool completely, at least 1.5 hours, before you start the nougat.

Hazelnut nougat
1 cup granulated sugar
1/3 cup honey
1/4 cup water
1 large egg white
1/2 tsp vanilla extract
pinch salt
I cup chopped toasted hazelnuts
Optional: 3-4 grains mastiha

Over medium-low heat, whisk the honey, sugar, and water in a small saucepan until the sugar is melted. Cook without stirring until the syrup reaches 248F. Meanwhile, beat the egg white until it forms stiff peaks. When the syrup is ready, slowly pour into the egg white with the beater running (for which I used a stand mixture with the whisk attachment). Continue to beat until the candy is stiff but spreadable and lukewarm to room temperature. Fold in the nuts, salt, and vanilla, and spread over your first chocolate layer. Alternatively, only fold in the salt and vanilla, then sprinkle the nuts on top after you've spread it in (if you prefer to have the nuts embedded in the caramel). Allow to set completely--and here was my mistake, so please let it set for at least 6 hours--before preparing the caramel.

Cayenne caramel
2 tablespoons honey
3/4 cup granulated sugar
2 tablespoons water
1/4 tsp salt
1/2 tsp vanilla
1/2 cup heavy cream
2 tablespoons butter
cayenne pepper to taste (I like spicy, so I used lots!)

In a large pot or saucepan (at least 2 quarts), whisk together the sugar, water, and honey. Cook without stirring until the syrup is at 290F.

Meanwhile, mix the heavy cream, butter, and salt in a microwaveable container. Microwave until the butter is melted and the mixture is very hot, but do not allow it to boil. It should still be steaming by the time you're ready to add it to the syrup.

When the syrup is at temperature, remove it from the heat and slowly pour in the cream mixture, whisking constantly. It will bubble and sputter. When it is fully whisked in, cook without stirring over medium-high heat to 250F. Whisk in the vanilla and remove from the heat. Allow to cool for a couple minutes in the pot before you pour it over the nougat layer; it should still be spreadable, but not so hot that it melts the nougat.

Let the caramel set for at least 2.5 hours before you pour on the final chocolate layer. If you want to cut the bars first and dip them in the tempered chocolate, definitely let it set for a good 6 hours.

David Lebovitz has a great guide to tempering chocolate here. Do that, then pour over the caramel layer (or dip the bars in). Allow to set for 30 minutes or so, then sprinkle on dukkah (and a bit of sea salt if your dukkah is not salted) and some candied orange rind. Don't let it set too long or the toppings won't stick, but do wait a little while or the spices will just melt into the chocolate.

Natural medicine

I read at least two articles from each issue of the New England Journal, Neurology, and Current Infectious Disease Reports. Part of this week's reading was this case from NEJM. Told he was not a candidate for fecal transplant but still seeking relief from his symptoms, the patient performed a home fecal transplant. Home fecal transplant. HOME FECAL TRANSPLANT. I don't even want to think about how he actually performed this procedure.

Ready to eat?

This is bush basil. There are actually several cultivars that can go by that name, including spicy globe basil, Greek bush basil, and dwarf bush basil; I'm not sure which this is. All three varieties are intensely herbal and are particularly good to eat raw both because the leaves are so tiny they don't need to be torn or chopped, which can be unsightly if the edges oxidize, and because they have no trace of the bitter funk that your classic basil can get. Also, my internet research tells me that in western Africa, particularly Sierra Leone, bush basil is used as an antipyretic. Now I can work at Bellevue with no fear of Ebola!

I muddled some of it with my fancy olive oil and a drop of lemon juice for these flatbreads, and sprinkled more on top. There is also fig, fresh corn, caramelized onions deglazed with white wine, and ricotta, with a healthy sprinkle of black pepper. I put some raw bush basil leaves on top.

Using red wine vinegar and the olive oily tomato juice from yesterday's cobbler, I made a quick vinaigrette for an arugula salad topper. This is possibly the best vinaigrette ever. Make the cobbler just so you can make this vinaigrette.

Year of Hell

Incidentally my favorite of Star Trek: Voyager's "there has been a time accident and now these events never happened" episodes.

I was prepared to really hate intern year. One month later, I'm kind of really enjoying myself. There were definitely some low points*, but I feel like I did an okay job and met some interesting patients. I'm now back at Bellevue for a much less time-intensive two weeks on a palliative care elective after a benchmark weekend. I finished my rotation, hit a deadlift PR**, and cooked something fancy to boot.

[pictures of gorgeous fresh produce pending Andy's return with my laptop from his annual Big Science Meeting]

Mussels were only three dollars a pound at the Greekmarket, which means that I could get two pounds and still have large amounts of cash left to blow on fresh vegetables*** for these mussels in Thai broth. I used sweet corn kernels and husks in the base, flavored with ginger, garlic, fish sauce, Sriracha, and lemongrass. There's a bit of coconut milk in there to finish it off.

There is a fresh Thai basil and corn salad at the bottom, then a bunch of vegetables, then the broth, then the mussels, which I steamed over a bit of the broth with some added charred husks for smoky flavor (and then discarded that portion of the broth, obviously). The bread I brushed with a lime compound butter, then grilled on my George Foreman.

Lamingtons are an Australian dessert traditionally composed of cubes of cake coated in chocolate or jam and rolled in shredded coconut. My version used a shiso cake dipped in a hard lime glaze before being rolled in sugar, with a homemade plum sauce (not the Chinese kind, the farmers market-plums-and-star-anise-and-honey kind) and Szechuan pepper custard sauce. The presentation was not what I envisioned, sadly, but that custard was beyond fantastic.

*Point one: I gained four pounds. Dammit, Kirsch, have some control.
**I'm a little proud. Plus, it'll hopefully help me rectify Point one.
***$6 of greens, $6 of herbs, plus purple carrots, heirloom tomatoes, plums, summer squash, eggplant, corn, shiitakes, and more! I may have overcelebrated my first Saturday off in a month.

Underwhelming

Huh. I'm actually... kind of really enjoying myself. That's almost a letdown after all the stress. I mean, I have definitely made some mistakes and harbor some embarrassing inefficiencies, but overall... yeah. I could get used to this.

The "sleep, cook, exercise: pick two" deal is a teeny drawback. I've gone with options A and C for the last couple days, opting for beans 'n' greens tonight and an entire head of kale with a can of tuna and half a pint of blueberries last night. Yeah. You read that right. I'm not ashamed. I'm also developing an addiction to almond milk. I steeled myself to finish off the container I bought for the protein bar recipe, anticipating the weird taste of sweatsocks traditionally associated with this kind of fare. Turns out that first of all, I'm eating enough protein bars for breakfast and lunch that the remaining almond milk will come in handy, and second of all, almond milk with blueberries is fantastic. So is almond milk in chai tea.

Final countdown

T minus eighteen hours until my first day as a doctor--specifically, as an intern, the juniormost workhorse of all hospital workhorses. I've got a few goals for this year, other than that whole "do no harm" bit. The most serious is to improve the sense of clinical intuition that all great attendings seem to have in spades. I remember the first time I (accurately) had that sensation, and how rewarding it was: a very intelligent, well-spoken, healthy and spry elderly gentleman in the ER with a couple days of "gastroenteritis" who, despite his protestations that he just felt dehydrated from all the vomiting, didn't look quite right to me. I'll spare you the HIPAA violation, but in short, he ended up being admitted to the medicine floor and quickly escalated to the ICU for something much more significant and unusual than gastroenteritis. It was incredibly gratifying to be rewarded for pursuing more thorough investigations than the chief complaint warranted on the basis of a few physical exam findings and an odd sense of disquiet.

My least serious goal: stay physically fit. The long, meandering walks I've been taking can't continue--at least not at their current frequency--but I'm determined to resist the pull of takeout and free conference food and cafeteria snacks. To help myself along both physically and financially, I've come up with a recipe for protein bars that are neither disgusting nor candy bars in disguise.

I'm sure I'm not the only one who has gone through the drugstore/grocery store/Bellevue gift shop ritual of painstakingly reading the nutrition facts of each brand of protein bar on offer, calculating protein:calorie, protein:sugar, and protein:dollar ratios. Most of them are... well, let's just say unsatisfactory, and some of the ones that aren't taste like chalk. The Bellevue gift shop has some good options, including MetRx and Protein Plus, (my personal favorite both for the taste and the absolutely fantastic ratios). But even buying Protein Plus bars in bulk, which we did to bring to Iceland, gets a little pricey. The date bars I've used in the past for on-the-wards snacking are more expensive, more messy, more time-consuming, and more carbohydratey than these puppies... I'm a convert.

WolframAlpha has a nifty function that, given ingredient inputs, will output a thorough nutrition profile of the total. These have, minus the optional chopped nuts and dried fruit but including the optional oats, about 206 calories, 20 g protein, 14 g carbs, and 10 g fat per serving. Of course, most of the 6 g of sugar comes from the chocolate chips, and most of the fat from the nut butter; if you wanted to be really crazy, you could reduce or omit those ingredients, but of course, those are the tastiest elements!

Extra-chocolatey protein bars

30 g (1/4 to 1/3 c) raw almonds
optional: 20 g (1/4 c) oats
30 g (1/4 c) cocoa powder
1/4 c semi- or bittersweet chocolate chips (can up to 1/3 if you like a sweeter bar)
3 tablespoons nut butter (preferably not the processed, sweetened type)
3/4 c vanilla protein powder
1/2 c chocolate protein powder
nondairy milk
optional: assorted chopped nuts and dried fruit

In a food processor or blender, grind the almonds and oats, if using, until they are mostly the texture of coarse sand; you don't want it to be completely ground just yet. Add in the cocoa and chocolate chips and pulse until blended together. Dump into a bowl and add the protein powders and nut butter. Slowly add the nondairy milk, blending with a spatula, until the mixture becomes a thick, somewhat tacky dough. Line a square pan with parchment paper, with enough overhang to completely cover the pan when folded over. Sprinkle the chopped fruit/nuts on evenly, if using. Pat in the dough and fold the parchment over it. With your hands, pat and spread the dough until it completely fills the pan and covers the chopped fruit/nut layer. Freeze or refrigerate until firm, then cut into 8 pieces; I like to keep mine frozen so they stay cold until I'm ready to eat them at work.

Social media

I've been struggling with whether or not to continue this blog now that my stomach is actually MD*. There's plenty of identifying data on here, but on the other hand, nothing particularly offensive (I think... e-mail me if you disagree, of course!). Informal consultation with a few residents and one attending has convinced me that it's probably okay. A recent (er, not so recent now, I guess) position paper on the benefits and pitfalls of online activity for physicians is actually reassuring; I don't complain about patients, period, and don't plan to post anything particularly personal or embarrassing.

Unless you consider crostini of minted goat cheese spread and balsamic macerated cherries to be embarrassing.

I love macerated fruit (all fruit, in any form, to be fair). In particular, it's a great way to alter summer fruit in some way without taking away from the firm plumpness of it all like baking or stewing!

Protip: to easily halve and pit cherries, run a sharp paring knife all the way around the cherry lengthwise, then twist the two halves apart. They'll separate cleanly. Use your knife or fingers to flick the pit out of the half in which it's seated, and presto! Pitted halved cherry.

The bread is a simple country blonde from Flour Water Salt Yeast. Our super super, Peter, gave us a free window AC unit that one of his super friends didn't need, which will go a long way in increasing the frequency with which I bake, roast, and broil this summer. The bread was baked at 475, and broiled at an even higher temperature. Without the AC on, the apartment was nearly intolerable.

And now, have a bonus recipe for really good cookies.

Sesame-apricot cookies with the Momofuku technique

1 cup butter, room temperature
3/4 c white sugar
3/4 c packed brown sugar (I prefer light)
2 eggs
3/4 tsp vanilla extract (if you're not using almond, use a full tsp)
1/4 tsp almond extract
2 c flour
a scant 1 1/2 tsp salt
2 tsp baking powder
1 tsp baking soda
1/4 tsp cinnamon (can up to 1/2 for a more prominent flavor!)
1 c oats, not instant
Total of 2 c chopped dried apricots, white sesame seeds, and black sesame seeds, in your preferred ratios

Cream the butter and sugars in a stand mixer, if you have one. Add the eggs and vanilla and mix just until combined, scraping down the sides. Turn the stand mixer to medium-high speed (setting 4 on my KitchenAid) for a full 10 minutes, stopping halfway through to scrape down the sides. Add the flour, baking powder, baking soda, cinnamon, and salt, mixing just until combined, scraping down the sides. Finally, gently fold in the nuts/chocolate/fruit. Cover and chill the dough for at least 1.5 hours.

Preheat your oven to 375 F (original recipe on which I based this suggests 400, but I found that a bit too hot). Scoop out 1.5-tbsp scoops of dough onto a large cookie sheet, leaving at least 2 inches of space around each scoop. Grind a little kosher salt over the top. Bake 8-11 minutes. Note that the browning will start at the edges and rapidly move into the center; these cookies go from underdone to overdone in literally under a minute! Cool completely on the cookie sheet before serving.

*WOOOOOOOOO**
**Except I've yet to actually practice, sooo...