Why I Cook--A Heartfelt Manifesto

Being a medical student isn’t exactly an easy task.  Certainly there were months where I goofed off, ignored my duties, and just enjoyed life.  But there were also months, lots of months, where I went to the hospital at 4:45 in the morning, barely ate lunch, and felt like a complete, total and utter idiot all day.  I would come home, collapse on the couch at 7:30 and feel like my soul had been slowly devoured by my seeming lack of purpose on the hospital team, overwhelmed by the extent of disease and suffering that I was bearing witness to all day.  When I would try and talk about struggles with classmates or teammates, they would often dampen these deep feelings and say “that’s just part of medicine”.

Don’t get me wrong, I loved medical school.  It was an incredible experience to learn such a depth and breadth of information so quickly.  It was amazing to see myself grow in my abilities to manage patients.  It was awesome as a 4th year to teach the 3rd years how to evaluate a post-surgical patient on Gynecologic Oncology, and to give an effective assessment and plan.  When I was called to a room with a sick patient alone, I at least could feel confident at the first steps to take to manage their illness.  It was a great opportunity to work with a variety of people at all levels of training and meet so many incredible patients who were struggling with debilitating diseases.  It was fantastic to improve my presentations and feel like I could communicate less emotionally and more effectively than I ever could before. 

Even so, medical school can make you feel really unimportant.  Every exam you do is repeated, every note you write scrutinized, every patient you see is asked the same question at least twice.  I’m not complaining; I think that medical education is extremely effective and that no medical student should have any real power.  My point is that it’s important to feel important. 

It’s important, no matter how tired you are, to come home and have a hobby.  It’s important to do something that has nothing at all to do with your job (no matter how hard I try to make food and medicine related) that keeps your hands and mind active but that you can mentally drift in and out of.  It doesn’t matter what this is.  If you love working out, go to the gym.  If you like crossword puzzles, do that.   Dr. Bates, a plastic surgeon in Arkansas loves to quilt and blog about it. 

I don’t cook because it’s healthier than eating out.  I don’t cook because it’s cheaper.  I appreciate these benefits, but these are peripheral rewards.  I cook because I love to cook, it’s easy and fun, and it makes me feel good about myself.  I love the surprise of opening the fridge and discovering half an onion and some chicken and making a delicious and warm meal.  I love the sensation of running my knife through a red pepper, and I love the feel of mashing up raw meatloaf with my bare hands.

Don’t cook because somebody else tells you you should.  Cook because you love to, and because you love to feed the people around you.  Yeah, it might be healthier, or not, if you bake a lot like I do.  If you don’t like to cook, then don’t.  There are plenty of other ways to find food. 

My advice for all of you, whether you’re doctors or not, is to find a hobby that is just for you, and make sure YOU like doing it no matter whatever anybody else tells you to do.  Find your hobby and do it.  No matter how much you eat or how little you exercise, as long as you have things that you like to do, being happy, productive and fulfilled is the healthiest thing you can do for yourself.

 I’m sure I’m not alone in feeling overwhelming pressure to be skinny with perfect test scores, friendships, communication skills, a clean bedroom and a happy family life.  I have to remind myself that I have survived medical school and done a good job, which in itself is an enormous feat.  I’m not perfect, but I love to cook and I love what I do, and for right now, that’s good enough.

The Green Stuff

Oof, I’ve been thinking a lot about the green stuff lately.  A couple of weeks ago, we had our financial aid exit counseling sponsored by multiple corporate groups (including the army) for managing student loans and massive debt.  My medical school class of 140 students borrowed over $16 million for four years of private medical education. 

In 2007, seemingly unbeknownst to me and my friends, although I do remember a bit of buzz from the more politically attuned legion of students, George W passed legislation enacted in 2009 that federal loans cannot be deferred through residency anymore.  Residency does pay a modest but decent salary, but certainly not any glamorous wages, particularly for the amount of hours worked.  The terms of repayment are fair and based on a resident’s income, but interest rates are not that low and debt multiplies fast. 

Looking at the match list from my class, I am convinced that high debt steers medical students towards more lucrative specialties.  The data, however, is not convincing as I would have thought.  A 2005 study published in Academic Medicine showed that indebtedness slightly decreased senior medical students’ likelihood to pursue primary care; the correlation was even greater if the student had more than $150,000 in loans [1].  However, a 2006 study of 2022 senior medical students showed that there was no correlation between debt amount and specialty choice [2].  Even so, it is very hard to explain the primary care shortage without looking at the sky-rocketing cost of medical school. 

If debt only slightly affects career choice, it has also been shown to affect physicians’ lives long after graduating.  A 2009 study in the Annals of Surgery of 550 academic surgeons reported that many surgeons felt that their academic debt affected their academic productivity, career choices and quality of life [3]. 

I certainly am not worried about living on a budget and spending within my means, but growing up is hard!  Responsibilities beyond my professional obligations are accumulating rapidly.  I can barely do laundry.  And I certainly can’t keep my room clean.  Now I have to keep track of my cash and make sure I don’t forget to pay the loan man.  Yeah, I know I sound like a big baby crying about things that every adult confronts.  WAAAH!

Fortunately, spring is here and the attainable green stuff is popping up all over.  No, money still doesn’t grow on trees, but broccoli grows on stalks and you get to eat it.  This broccoli dish that I threw together last week is bright, light and easy and is a great accompaniment to pasta, chicken or really anything else.  Raisins seem like a strange thing in vegetables, but they add the slightest bit of sweetness and mellow out with the salty, acidic accompaniment of the broccoli.  Plus, they were sitting on the counter and I need to get rid of them.  Isn’t that the biggest motivator for eating anything?

The green stuff (broccoli with raisins and pine nuts)

1 bunch of broccoli, rinsed, trimmed into crowns with ~1 inch of stalk
½ tbsp butter
½ tbsp olive oil
1/2 tsp salt
2 tbsp raisins
2 tbsp vermouth, sherry, white wine or water
2 tbsp pine nuts, walnuts, sliced almonds (any nuts really, optional)
Juice of 1/2 lemon

Rinse broccoli and cut into florets.  Over medium high heat in sauté pan, melt butter and oil.  Add florets and raisins, cook until slightly brighter green, about 3 minutes.  Add vermouth, cover another 2 minutes.  Add pinenuts, sauté for another minute, dress with lemon and serve. 

1. Rosenblatt, RA.; Andrilla, CH. “The impact of U.S. medical students' debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire.” Academic Medicine, v. 80 issue 9, 2005, p. 815-9.
2. Kahn, MJ., et al. “Is medical student choice of a primary care residency influenced by debt?.” MedGenMed, v. 8 issue 4, 2006, p. 18.
3. Kibbe, MR., et al. “Effect of educational debt on career and quality of life among academic surgeons.” Annals of Surgery, v. 249 issue 2, 2009, p. 342-8.

Time to Uproot

I’m feeling a little stuck right now.  I think since match day I’ve lost my motivation.  That match day envelope contained my entire future.  The day after match day I received a Fed-Ex envelope requesting my scrubs sizes, my white coat inscription and my vacation requests.  Being a doctor is no longer some fantasy, some far away goal that I’ve been slowly working towards for the past ten years.  My MD is coming fast, and it’s about to slap me in the face.

As excited as I am to leave Cleveland, I am mourning the end of my Midwestern life.  I will miss the cool summers, the proximity to my family, and most importantly, all the people I have met here from classmates to friends to mentors to patients.  It will be a drastic change to transform from medical student to doctor since the only difference I see in myself is two more letters on my white coat. 

More than anything, I hate moving.  The act of sorting through all of one’s things and carrying them down three flights of stairs and back up again is not only emotionally dreadful, but physically exhausting.  Psychologists show that moving is a draining time in people’s lives.

In a survey of 111 relocating professionals in the UK, well over 75% of the subjects found the experience to be somewhat stressful to very stressful [1].  Those moving great distances and those who had spouses who needed to find new jobs (that's us!) had significantly more stress than those moving short distances and spouses that did not need to find jobs. Another study conducted in England showed that between those moving, those that were greater prepared before they moved had better post-move adjustment [2]. 

Whether I’m ready or not, it’s time to pull up my roots and plant them in the hot Texas soil.  They’ll probably grow faster there anyway.  The potato is as uprooted as I am, and I’ve invited him for a warm dinner. 

Fortunately, the potato makes delicious soup for a cold, rainy, disgusting Cleveland day like yesterday.  There’s nothing better to make than a slow soup to un-stick my stuck self hour by hour.  I started with chicken bones that have been accumulating in my freezer, simmered them leisurely into stock, and then strained the stock to cook with hearty vegetables.  The soup was pureed and topped with a vinaigrette of bacon, green onions, white wine vinegar and olive oil which gave a nice boost of texture and flavor. 

Let me tell you guys, if you’re going to make any of the recipes on this silly blog, make this one!  My fiancé pooh-poohed the idea of potato soup and then ate three whole bowls and licked them clean…and then took the leftovers for lunch.  Simplicity and heart taste the most delicious.

Uprooted Potato Soup

7 cups chicken stock (try not to use canned broth, recipe below) or water
1 tbsp butter
1 large onion diced
1 large carrot diced
1 rib celery diced
3 cloves garlic diced
1 sprig rosemary chopped
1 tsp salt
6 medium potatoes peeled and diced into 1” pieces
1 cup low fat sour cream
Salt and pepper to taste

For vinaigrette
4 pieces thick cut bacon (optional)
3 green onions finely chopped
3 tbsp white wine vinegar
1 tbsp olive oil

Chicken stock
2-3 lbs chicken bones (I have accumulated about 3 chicken carcasses from roast chickens over time.  Don’t throw them away!  If you don’t have these, you can use chicken backs.  They make great stock and are very cheap)
1 rib celery
½ onion
1 tsp salt
1 carrot
Sprig rosemary, sprig thyme
10-12 cups water

To make stock
Preheat oven to 425.  Place chicken pieces on baking sheet and bake until golden brown (I just put them in frozen and they turned out great) about 35-45 minutes.  Add chicken and all other ingredients to large stockpot.  Bring water to boil, boil for one minute and reduce heat to low.  Cover, and cook for 4-6 hours until flavorful. 

To make soup
Add 1 tbsp butter to large pot on medium high heat.  Melt butter, add carrots, onion, celery, garlic, herbs and salt.  Sauté veggies until onions are soft, about 10 minutes.  Add potatoes and stock.  Cook on medium high until potatoes are very tender, about 20 minutes.  Turn off heat, add sour cream and puree in blender or with immersion blender. 

To make vinaigrette
Cook bacon until crispy on medium high heat.  Strain on paper towel and chop into small pieces.  To small bowl stir onions, bacon, vinegar, add oil and add 1 tbsp to the top of each bowl of soup.

1. Munton, A.  Job Relocation, Stress and the Family.  1990.  Journal of Organizational Behavior.  11; 5: 401-406.
2. Martin. R.  Adjusting to job relocation: Relocation preparation can reduce relocation stress.  1999.  Journal of Occupational and Organizational Psychology.  72;2: 231-235.

It's About Time

Today I received the beloved email “Congratulations, you have matched.”  Phew.  And YEEHAW!  Somebody wants me, I’m going to have a job, and best of all, I’m going to be a doctor at an academic institution.  The killer part of this whole process is that I don’t find out until Thursday WHERE I matched.  While there are only 72 hours until I will know, I am positive that these three days will feel like an eternity.  Every second my watch seems stuck, with barely enough inertia to move forward, and then, if by force and luck, it ticks again. 

How can these three days, when they have the exact same amount of hours and minutes, feel so different than an average three days during a regular week?  The perception of time is so dependendent on the anticipation of things to come and awareness of the clock.  Think about when you put a stick of butter in the microwave for 30 seconds and watch the fat molecules liquefy while the digital clock ticks down second by second.  The 30 seconds feel like a year.  You want melted butter, and you will have to wait.

Time is a crucial variable in medicine.  Because perception of time is so tinged by emotion and adrenaline, this explains why parents when witnessing a seizure of their child will say it lasted for five minutes, when truly the event was probably much shorter (you know, I really can’t find a source for this.  I looked and looked for a study but I heard an ER doc say it once.  This might not be true, but I like to think it is.  Evidence based medicine, I’m sorry).  This is also why it is important to time contractions of labor with a clock.  We experience time constantly, but we are almost incapable of understanding and interpreting it without the aid of the sun or technology. 

To have the clock be your friend, this is a dinner that you can whip up fast.  I know a lot of the recipes I’ve been posting lately have been complicated and pretty unhealthy.  I think it’s the moment to leave you with something quick and light.  That way, you can enjoy your time with your food in front of you, and not watch it slowly roasting in the oven.  It will give you a few more minutes to obsess about your future and to worry about your past.  No regrets!  You did the best you could, and if you didn’t, then you have a lifetime to do better.

In a jiffy-springtime pasta (sorry the picture is really boring and horrible today.  I was honestly in a hurry to get to the bar and celebrate and I let it slide.  I will do better next time)

½ lb whole wheat linguine

2 tbsp olive oil

1 shallot diced finely

2 cloves garlic diced

1 bunch asparagus with tips trimmed, cut into ½ inch pieces

¼ cup pine nuts

¼ chopped parsley

1 tsp fresh rosemary

1/3 cup grated parmesan

Zest from 1 lemon

Juice from lemon

1 cup grape tomatoes

Boil pasta in salted water as directed.  Reserve 1 cup of pasta water when cooked.  In skillet, heat 2 tbsp olive oil and sauté shallot until transluscent.  Add garlic, asparagus, and rosemary until asparagus becomes bright and tender, about 5 minutes.  Add parsley, pine nuts, lemon zest and let parsley wilt about 1 minute.  Add grape tomatoes and cook for one more minute.  Add pasta with reserved water, parmesan cheese and lemon juice, mix to combine and serve. 

Torte Reform

Unfailingly, each time I tell somebody that I’m doing OB/GYN, the first thing that they tell me is either, “Ooh babies” or “You’re brave--the malpractice insurance.” I’m naïve. I chose OB/GYN because I am passionate about the field, and because of my love, I feel willing to pay the high insurance and face the threat of lawsuits. Because the only obstetricians I know are part of an academic practice that covers malpractice insurance, they don’t openly discuss, at least with me, their fear of lawsuits. Even so, I think the dread of bad obstetrical outcomes is palpable in each decision that is made on a labor and delivery unit.

I know next to nothing about the legal system. However, I think as a physician I should learn some basics as lawsuits will most likely, unfortunately, be part of my life. Many healthcare practitioners have told me “tort reform is the answer” and I just nodded my head. I have no clue what tort reform is. According to the Agency for Healthcare Research and Quality, “torts are civil wrongs where the injured person asks for monetary damages from an individual in a situation where there is no contractual relationship.” Thus, tort reform includes legislation that caps payments for non-economic damages when a patient sues a doctor and wins.

As of 2003, 23 states had some tort reform legislated into their government. There is evidence to suggest that tort reform is effective at curbing malpractice fees. For example, in California, legislation was passed in 1975 to lower malpractice costs; by 2000 their insurance premiums increased by 167% whereas in the rest of the nation, fees increased tremendously by 505% [1]. It has also been shown that in California, defensive medicine is less employed and that health care costs are 5-9% lower without significant change in patient outcomes [2].

One of my favorite blogs, Academic OB/GYN, written by Dr. Nicholas Fogelson, recently discussed the importance of change within the country’s legal system in order to produce better obstetrical outcomes over the long term. This is in response to the recent National Institute of Health’s Vaginal Birth After Caesarian (VBAC) Consensus that convened this week. VBAC is a highly contended subject; having a vaginal delivery after a previous caesarian puts a woman at a low but existing risk of the uterus rupturing from the C-section scar being stressed during labor.

Many obstetricians refuse to do VBAC because of fear of litigation due to the risk of uterine rupture. The consensus concluded that VBAC trial was shown to be a safe option for most women [3]. Dr. Fogelson suggests that the apprehension to perform VBAC might be assuaged by “mini-tort reform” in which patients sign a release that in case of a uterine rupture during VBAC, they waive their right to sue. While this is a provocative idea, requiring unlikely consensus and collaboration among a highly divided obstetrical profession, I am not informed or experienced enough to have my own personal convictions on the topic.

I am so protected and coddled as a medical student. I have no concept of what it feels like to be the final decision maker in stressful or liable situations. It is easy to be idealistically devoted to vaginal delivery for every woman who desires it, but to take a stance on the complex and heavily weighted decisions that obstetricians make would be unfair. I do feel with full fervor, however, that it is important to do what is safest and best for our patients. Letting the terror of litigation overrun an entire field of medicine is expensive and can potentially produce worse patient outcomes.

What I am certain about and can propose however, is TORTE reform. As a rich intermediary between a pie and a cookie, this is one topic that there is only one right answer: YES! Tortes are traditionally made with eggs, sugar and nuts. In this recipe, which I very loosely based on a linzertorte, I’ve reformed the composition to have a Southern tinge as a dedication to the pecan pie. The dough is made from chopped pecans and almonds, as is the filling in a pecan pie with mixed nuts spiked with brandy, and it is topped with a gooey chocolate ganache. This is one torte reform we can all agree on (unless you don’t like nuts or chocolate; nobody will ever completely agree).

Nutty Torte Reform with Chocolate on Top

For the crust
½ cup blanched almonds
½ cup pecans
6 tbsp butter cut into cubes, kept cold
1/8 tsp salt
¾ cup cake flour
½ cup powdered sugar
1 egg yolk

For the filling
2 eggs
¼ cup walnuts
¼ cup pecans
¼ cup blanched almonds
(or you could do ¾ cup pecans or use other nuts such as macadamia nuts or hazelnuts)
1/3 cup brown sugar
1/3 cup corn syrup
2 tbsp brandy
2 tsp vanilla
Pinch of salt
Pinch of cinnamon
1 tbsp heavy cream

10 inch tart pan

For the chocolate ganache
1 cup chocolate chips
¾ cup heavy cream
Splash of brandy

Preheat oven to 400 degrees. Toast almonds and pecans for crust in oven for 7 minutes or until golden and fragrant. Toast the nuts for the filling on a separate baking sheet. Allow to cool. Blend in food processor for 30 seconds or until mealy but don’t overwork or it will start to look more like nut butter. Add flour, sugar and salt, pulse a couple of times to blend. Add egg and butter, pulse until blended. With hands, gently bring dough into ball and press into disc, don’t overwork, refrigerate for at least an hour.

Preheat the oven to 300 degrees. On a floured surface with parchment paper, roll out dough. If the dough becomes too sticky, you can press it into the tart pan with your fingers. Prick dough with fork and bake for about 15 minutes. While baking, whisk together filling ingredients. Once crust has started to brown, remove from oven, add filling and bake for another 25 minutes until filling has solidified and crust is brown. Allow to cool.

Over simmering double boiler, whisk together chocolate and cream until blended, add splash of brandy and pour over top of torte while cooling. Refrigerate for a few hours and eat!









1. Hellinger F et al. Malpractice Awards on the Geographic Distribution of Physicians. 2003. US Department of Health and Human Services Agency for Healthcare Research and Qualtiy. http://www.ahrq.gov/research/tortcaps/tortcaps.pdf
2. Kessler, David and McClellan, Mark “Do Doctors Practice Defensive Medicine?” The
Quarterly Journal of Economics, vol. 111, Issue 2, May 1996, pp. 353-390.
3. http://consensus.nih.gov/2010/vbacstatement.htm

It isn’t always as it looks—the case of the savory cheesecake

In medical school we are always taught the classic presentation, the triad of symptoms, and the pentad of problems when we try and diagnose a disease. To uncover pathology is simply pattern recognition. For example when a patient presents with appendicitis, we expect to find pain in the lower right part of the abdomen, a fever, no appetite, nausea, and vomiting.

Unfortunately, medicine is not so simple. As it turns out, the classic presentation is probably less common than the atypical presentation. Many of the physical exam signs that we rely on to make a diagnosis are not reliable. In the excellent series “The Rational Clinical Exam” published in the 90’s and early 2000’s by JAMA, the authors reviewed literature focusing on the utility of different physical exam signs.

When a patient thinks they have strep throat, for example, the only signs or symptoms that help rule in strep throat are presence of exudates in the throat and recent exposure to somebody with strep throat [1]. Having a sore throat or fevers, the “classic presentation” is not predictive of strep infection, although fever can help secondarily guide the diagnosis in the absence of other signs.

Conversely, oftentimes what appears to be a classic presentation of one disease turns out to be something else, or is labeled idiopathic (another way of saying that “We have no idea!”) One of the hardest things I had to cope with in the clinical years of medical school was how many times there was simply no explanation for why somebody was sick. After watching so many episodes of House, I had assumed that everything would culminate in the diagnostic climax of a happenstance realization: “Did you say cheese? Hmmmm, as the resident pensively braces her chin. It must be Kawasaki’s disease!”

What’s true in the hospital can also be true in the kitchen. Things are not always as they seem. This recipe is for a savory cheesecake. Perhaps upon initial examination it appears to be dessert. But look closer. That green layer isn’t pistachios or mint. It’s spinach and chard. On top is a layer of red peppers and tomato, on top of that a layer of roasted yellow pepper, carrot and saffron. It isn’t dessert, but dinner! The beauty of the savory cheesecake is that it can be eaten for breakfast, lunch or dinner, hot or cold. It can be served as an appetizer or a main course. To warn you though, this is not light on calories, time, or dishes. It is however, rich, filling, and extremely appealing.

It isn't always as it looks--the three layer savory cheesecake (recipe cont...)

Uncertainty Soup

The last couple of weeks have been wrought with anxiety.  Match day is only two weeks away.  I have full intellectual capacity to understand that my chances of matching are extremely high and that wherever I end up I will get excellent training. 

Emotionally though, I’m a wreck from the uncertainty of it all.  Not only does my life depend on the match, but my fiance’s life completely weighs on it. He has an established career where we live, and he is willing to give it up to support me.  I’ve been constantly up at three in the morning strangled by my down comforter from turning around it forty times, I’m highly dependent on carbohydrates, and I appreciate a cold beer like never before. 

I’m certainly not alone in feeling nervous and frantic.  My guess is that 80% of senior medical students in the US feel exactly the same way that I do.  But we have to snap out of it!

Being a doctor is equivalent to uncertainty.  Every diagnosis, prognosis, and treatment decision that we make as physicians has the potential to be incorrect and can be extremely harmful. We have to counsel patients on the risks and benefits of procedures, and be able to handle the possibility of a disaster.  The ability to deal with this daily struggle and accept the chance of error is critical to becoming a successful, happy doctor. 

Studies show that when physicians that struggle with uncertainty they can provide substandard care [1,2].  A Swiss survey of about 1200 doctors in varying levels of medical experience showed that stress about uncertainty was highest in women, those with relatively few years of experience, and those in surgical sub-specialties.  Similar results were shown previously by Gerrity, an expert on uncertainty. The study illustrated that stress with uncertainty was directly related to lower job satisfaction and perceptions in abilities to make decisions.

Compared to the uncertainty that we will face on a daily basis, hopefully this puts the stress from match into perspective.  Good luck on getting through the next couple of weeks.  We’ll know soon enough.  No matter how stressed you are, one thing to be certain about is what to make for dinner.  This hearty, spicy, red soup is chock full of roasted red peppers and tomatoes.  It is easy, vegetarian, and is the perfect antidote to stress.  It’s topped with homemade garlicky croutons.  Simply delicious.

 

Certainly make this Roasted Red Pepper Tomato Soup

4 red peppers halved and seeded

2 medium/large shallots diced

2 medium carrots diced

1 sprig fresh thyme

1 sprig fresh rosemary taken off stalk and chopped

4 cloves garlic

2 tbsp olive oil

6 oz can tomato paste

1 ½ tbsp sriracha

1 cup dry vermouth or sherry

28 oz can diced/crushed tomatoes

2 tsp salt

1 tsp brown sugar

3 cups water

1 cup half and half

Juice from ½ lemon

For croutons

1 round loaf sourdough

¼ cup olive oil

½ tbs salt

¼ cup grated parmesan

1 tbsp paprika

4 cloves garlic smashed into paste

1 sprig fresh rosemary finely chopped

Preheat the broiler.  On a large broiling pan or cookie sheet place red pepper halves skin side up, and press down to evenly expose all parts. Broil peppers until completely charred on skin side, about 10-15 minutes.  When done, peel charred skin which should come off easily and dice.  Preheat large pot on medium heat and add olive oil.  Add shallots and garlic.  Salt and cook, stirring frequently until carrots are tender and shallots are translucent, about 10 minutes.  Increase heat, add sriracha and tomato paste and cook for 2-3 minutes.  Add vermouth, diced tomatoes, red peppers, salt, brown sugar and water.  Bring to a boil, and reduce heat to medium, simmer for about 10 minutes to meld flavors.  Turn off heat, add lemon juice and half and half.  With immersion blender or blender, blend until all large chunks are gone.  Serve with croutons.

To make croutons:

Preheat oven to 400.  Cube bread to about 1x1x1 inches.  In large bowl add olive oil, garlic, paprika, parmesan, salt and rosemary.  Stir to combine.  Add bread and stir to coat all pieces.  On large cookie sheet, spread bread cubes.  Bake until crispy and brown, about 15 minutes.  Serve on top of soup.

1. Bovier, P., &  Perneger, T. (2007). Stress from uncertainty from graduation to retirement--a population-based study of Swiss physicians. Journal of General Internal Medicine, 22(5), 632-8.
2. Gerrity, M., DeVellis, R.,  & Earp, J. (1990). Physicians' reactions to uncertainty in patient care. A new measure and new insights. Medical Care, 28(8), 724-36.

Maple syrup pork roulade--homage a Maillard

You could say that Camille Maillard got me into medical school. He also helped to get me through it. Disregard the fact that he was born over 100 years before me, in France, and died alone while on a jury in Paris in 1936. While I adore the other Frenchman of his time notably Debussy, Ravel and Saint-Saens who certainly provided sexier and more impassioned contributions to society, Camille Maillard’s work brought me to the laboratory and taught me the importance of diligence, mentorship and hard work.

Camille Maillard penned the Maillard reaction, the long chain of reactions between an amino acid or protein and a sugar. The chain reaction results in browning and formation of complex chemical compounds called advanced glycation end products. While this all seems drab and dreary, in fact the Maillard reaction is an important player in both food and medicine.

The Maillard reaction explains why a chicken turns brown and delicious when you slather it with maple syrup or honey and bake it (although this is also due to caramelization which is a different chemical process). The reaction also has important implications in diseases such as diabetes. When we measure the hemoglobin A1C to keep track of how well somebody controls their diabetes, we measure an end-product of the Maillard reaction. Much of the end organ damage in diabetes can be contributed to excess glucose reacting with proteins in the microvasculature.

My work with the Maillard reaction involved test tubes—lots of them. There were enough test tubes full of solutions in varying shades of brown, champagne and yellowish beige to swear off of test tubes for life after I finished college. The research was repetitive and I don’t think I was very good at it. The experience wasn’t apparently life-changing.

What made my research exceptional was my wonderful mentor. He treated me as a peer, worked with me in the lab, and even washed my test tubes (which is so SO embarrassing…I’m sorry Roger!) I felt encouraged to keep going, to keep track of my work, and I to write that damn thesis. Hey Rog, will you make me write my medical school one too? When I started slacking he gently suggested getting back on it, and when I was really lazy he got mad and I deserved it. When I wanted to play piano for a term instead of do lab work, he let me, and when it was time to give a 20 minute presentation on my research, he stayed late repeatedly and made me practice.

I always knew I was lucky to have such a dedicated teacher. While I’ve had plenty of guidance and support in medical school, there’s nothing that even broaches the level of professional companionship of my undergraduate education. As I soon find out where I will spend the next four years of intensive training, I can only hope to have mentors that care not only about the work that I do, but about the beliefs, values and interests I have. I wish for everybody reading to have somebody a few years ahead to pick you up, guide you through, and seriously hurt you if you start acting like an idiot.

The following recipe is more complicated and time consuming than the average one that I post, but the result is spectacularly beautiful and delicious. It embodies the maple syrupy spiciness of New England (where I went to college) and it utilizes Dr. Maillard’s work with an overnight sugary marinade to promote slow browning before the meat is baked. It is a meal unto itself, and should be used for a celebration of someone special. The recipe ideally takes two days, so plan ahead! If you don’t eat pork, you could always use chicken breasts, just make mini-rolls applying similar principles.

Why Chai?—caffeine as medicine

Believe it or not, I got through medical school without a caffeine dependency.  While a lot of my friends have an IV drip straight from the espresso machine, I try and keep my intake to a minimum.  Most people feel better after a rich morning coffee.  I’m already wired. You’ve seen me dancing post-call doing backflips down the hall (I wish I could do backflips).  Coffee makes me want to jump out of my skin. 

Even though I am caffeine averse, this psychostimulant has a variety of therapeutic purposes.  For all the joking and wishing, there actually is an intravenous form of caffeine in the hospital.  Overworking residents is not one of the indicated uses. 

One of my most vivid memories from medical school was when I learned how to do electroconvulsive therapy on my psychiatry rotation.  Caffeine is sometimes given during ECT because it lowers the seizure threshold and increases seizure time.  When a psychiatrist hands you two electrical probes and tells you to press the button, you have to comply!  ECT has been developed into a humane, extremely effective treatment of refractory depression and has helped many people that medicine doesn’t touch.  Thankfully, it’s nothing like the old movies like One Flew Over the Coo Coo’s Nest where the batty psychoanalyst straps the patient down and vigorously shocks him into prolonged convulsions.   

Caffeine also plays an interesting role in headaches and pain.  When in combination with either acetaminophen (Tylenol) or aspirin, the amount of analgesic needed to relieve headaches is reduced by about 40% 1.  Caffeine also works as an adjuvant to acetaminophen and aspirin and provides greater relief when in combination than alone; this is why people love Excedrin. 

The relationship between headaches and caffeine is complex, considering the most common symptom of caffeine withdrawal is headache 2.  A recent study of over 50,000 Norwegians found that zinged up Scandinavians were more likely to have infrequent headaches than those that did not drink coffee, although causality cannot be establish and there are many confounding factors 3. 

If you have a headache, a caffeinated treat might just do the trick.  Homemade chai is easy, rich and delicious.  Mine has a huge punch from loose leaf Darjeeling tea so it is definitely powerful stuff.  It lacks the cloyingly sweet and overpowering cinnamon kick that the boxed stuff has, and it makes your apartment, barn, trailer, home, abode or dwelling smell unbelievable.  If you still don’t feel better, throw some Advil in for some crimson chai. 



PS, this stuff is REALLY strong because I just drank it.  My hands are shaking from the caffeine overload.  What's on TV at 2am? 

Chai (makes about 6 cups)

15 black peppercorns
8 green cardamom pods
15 cloves
2 medium cinnamon sticks (plus more for serving)
2 inches ginger root peeled
1 bay leaf
4 cups water
2 cups milk
4 tablespoons loose-leaf Darjeeling tea (about 8-10 teabags or 0.8 oz)
3 tbsp honey
1 tbsp sugar

Add peppercorns, cardamom, cloves, cinnamon, ginger and bay leaf to mortar and pestle and give a couple of good pounds.  If you don’t have one, you can put everything in a plastic bag and smash with a frying pan or something else heavy.  Put spices in water on high and bring to boil, after boils, reduce heat to low, simmer, covered for about 20 minutes.

Add milk and tea, simmer for another 5 minutes.  Strain with mesh strainer or cheesecloth add honey and sugar.   Serve with cinnamon stick and enjoy.




Shapiro, RE. 2008. Caffeine and headaches. Current Pain and Headache Reports 12, no. 4:311-5.

Juliano, LM. and RR Griffiths. 2004. A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacologia 176, no. 1:1-29.

Hagen, K., et al. 2009. High dietary caffeine consumption is associated with a modest increase in headache prevalence: results from the Head-HUNT Study. The Journal of Headache and Pain 10, no. 3:153-9.

A shout out to kraut

For all you science geeks out there, remember when we used to sit in the lab looking at things under the microscope?  My junior year of college in my microbiology class, my lab group of three decided that we would isolate a virus from a bacterial strain that grew from sauerkraut.  Thinking back on this, attempting to isolate a virus FROM an isolated bacterium in a basic science lab was probably not a smart idea, and the experiment most definitely failed.  So did the sauerkraut.  What started out as about 5 lbs of raw shredded cabbage in an industrial bucket with salt dumped on it turned into a smelly, moldy, microbiologic disaster.

While most people find gross memories scarring and unappetizing, for me they ignite my hunger.  (This does not include any foods that have actually made me sick.  I will never eat Hot Sauce Williams again…or drink lemon-lime Gatorade.)  I always came out starving from gross anatomy class the first year of medical school, and the operating room reminds me of BBQ—in a good way.  Probably, I’m just hungry all of the time and it can be challenging to carve out lunch time in the hospital. Grossness becomes a regular part of life, and I just eat around it. 

The sauerkraut incident should have turned me off from fermented salty, acidic cabbage, but alas, it only made me want more.  Of course, we all know that I love bitter vegetables.  Sauerkraut has its health benefits too.  The brining of cabbage brings out cancer fighting compounds that are vitamin C derivatives.  A recent study shows that cabbages grown in winter have the highest concentration of ascorbigen, one of these cancer fighting compounds 1.  Who knew that winter could actually provide health benefits?   

On a slightly more disturbing note, I also found this study titled “Use of human urine fertilizer in cultivation of cabbage—impacts on chemical, microbial and flavor quality.”2  Supposedly, peeing on your plants is an excellent and delicious way to fertilize them.  This might just be the motivation to go organic (although urine is probably organic anyway).  Maybe I’ll just start eating pesticides.

Nothing about this post should convince you to eat sauerkraut.  If you have read this far, you are probably gagging, nauseated, or revolted.  Eat it anyway!  In this recipe I make a whole chicken cut up and cooked in sauerkraut, beer and veggies.  It’s a hearty winter dinner just for you, and your friends, and your drunken downstairs neighbors.


Chicken with sauerkraut and beer

One onion diced
One carrot diced
One pound sauerkraut drained (I rinsed mine but I wish I hadn’t…I like the acidic kick)
2 slices bacon chopped (if you don’t eat pork just use butter or olive oil instead)
¼ tsp red pepper flakes
¼ tsp fennel seeds
¼ tsp salt
¼ tsp ground allspice
¼ tsp ground cloves
1 ½ tbsp brown sugar
Pepper to taste
One whole chicken cut into thighs, wings, and breasts (to cut up a chicken look here, or just buy whichever pieces of chicken you like…this recipe is better for chicken with bones)
One 12 oz bottle of stout beer
Sour cream to top

Cook bacon over medium high heat in dutch oven or other large cooking vessel.  Put bacon on paper towels and drain excess fat.  Leave about 2 tablespoons.  Over medium high heat, sauté onions and carrots until translucent and soft, about 8 minutes.  Add red pepper, fennel, allspice and cloves.

Add sauerkraut and saute for another 1-2 minutes.

Add brown sugar, bacon, salt and beer and allow to cook for about 5 minutes.  Meanwhile, preheat cast iron pan with about 2 tbsp canola oil and brown chicken for about 8 minutes.  If you are using a whole chicken, cook the thighs and legs first, add the wings and breasts a few minutes later.  Add chicken to dutch oven, cover, and simmer over medium heat until chicken is cooked through about 12 minutes.  Serve over brown rice, noodles or mashed potatoes and top with a generous dollop of sour cream.

Martinez-Villaluenga, C., et al. 2009. Influence of fermentation conditions on glucosinolates, ascorbigen, and ascorbic acid content in white cabbage (Brassica oleracea var. capitata cv. Taler) cultivated in different seasons. Journal of Food Science 74, no. 1:C62-7.

Pradhan, SK., et al. 2007. Use of human urine fertilizer in cultivation of cabbage (Brassica oleracea)--impacts on chemical, microbial, and flavor quality. Journal of Agricultural and Food Chemistry 55, no. 21:8657-63.

A salute to air travel

I am recently returning from a short jaunt to New Hampshire. Since embarking on my approximately 30th flight since September, I’ve been thinking a lot about flying. The turbulence exacerbates my irregular pulse, the turbid air recycling makes me nauseous, and the company on the plane can sometimes be exceedingly obnoxious (quoting entire choruses of Jimmy Buffet songs while professing the pathetic level of your love life and talking about your bankrupt houseboat casino to unsuspecting strangers is never a good idea). But none of these things bothers me as much about flying as the fact that in May, I will be a doctor.

Only at 30,000 feet could it really mean so much to be a physician. For example, if there were a medical emergency at the Cleveland Symphony, there are probably between 300 and 500 physicians of various specialties ready to run to the rescue before the patient was carted off to the hospital approximately 500 feet away. Contrast that to the isolating altitudes of the airplane, where there may not be any health care providers at all and the presenting pathology could range from heart attacks to labor to seizures.

“Are there any doctors on the plane?” as I sheepishly raise my hand…am I really (or will I really be) that person? Even though in the hospital as a new intern my life will be extremely challenging and exact responsibilities such as writing orders, performing procedures, and signing my own notes (no co-sign!), never will I be without some sort of supervision within earshot. But in a few months, I will take the Hippocratic Oath and with that oath, it will be my duty to at least try to do no harm.

Unfortunately, there is not much good data on the topic as airlines have variable reporting standards for medical incidents. According to a recent review paper, a medical emergency occurs in about 1 out of 10,000-40,000 passengers, and on overseas flights there is a doctor on the plane about 85% of the time1. (Yay, doctors get to travel!) The most common presenting complaints are fainting, followed by abdominal symptoms, followed by cardiac problems 2. Doctors are not legally required to offer assistance in the US or Canada, but are in Europe. Regardless, they are well protected on flights by Good Samaritan laws, and thus should volunteer unless they feel that they for some reason are unable or exceedingly inebriated.

This is a salute to all my friends who will also soon be doctors. Let’s hope we were well trained enough to at least give it a go. Let’s also hope that there’s a well seasoned emergency room doctor sitting next to us. And I’m sorry to produce anxiety for all of you by writing this.

Not to worry however. There are cookies on the plane to give you energy (at least on some airlines). I leave you all with a recipe for chewy molasses cookies as a substitute for the better-than-peanuts, crunchy spice cookies offered on Delta, the worst airline in the world. May everybody have safe travels and until then…eat chewy, spice laden, richly colored cookies.

Chewy Molasses Spice Cookies Adopted from The Martha Stewart Living Cookbook

2 ½ cups all-purpose flour
2 ¼ teaspoons baking soda
½ teaspoon kosher salt
1 tbsp freshly grated ginger
½ tsp ground allspice
¼ tsp ground cloves
½ tsp ground black pepper (sounds weird but SOOO delicious)
2 sticks plus 2 tbsp unsalted butter
½ cup granulated sugar (plus more for dusting)
1 large egg
¼ cup plus 2 tbsp molasses (or if you run out of molasses as I did, sub a couple of tbsp of maple syrup)

In a medium bowl, whisk together flour, baking soda, salt, allspice, cloves and pepper, set aside.

In the bowl of an electric mixer, cream the butter, ginger, brown sugar, and white sugar until light and fluffy, about 5 minutes.

Beat in the egg and molasses. Add the flour mixture, mix until combined. Form into flat disc, wrap in plastic wrap, and chill the dough at least 2 hours. (Chilling dough is annoying but it helps shape the cookies). Preheat the oven to 350. Pour sugar into a bowl. Form the dough into 1 inch round balls (although I like them a bit bigger), roll each ball in the sugar. Place the cookies on a baking sheet, spaced about 2 inches apart. Flatten each ball with the palm of your hand into a disc. Bake the cookies until browned about 10-12 minutes.

EAT!

Cocks, R. and M Liew. 2007. Commercial aviation in-flight emergencies and the physician. Emergency medicine Australasia : EMA 19, no. 1:1-8.


Sand, M et al. 2009. Surgical and medical emergencies on board European aircraft. Critical Care. 13 (1).

And the beet goes on

So I know there aren’t a lot of beet lovers out there. I’m asking a lot to get you to like brussel sprouts AND beets. Let me say, however, that I am a fanatic. A freshly cooked beet tossed up with some lemon is the epitome of richness, sweetness and deliciousness. And not to get too grossly personal, but every time I eat beets, I think I have a urinary tract infection. My pee turns bright red. Does this happen to anyone else?

Studies show that yes, beeturia, as it is so lovingly referred to in the medical world, occurs in approximately 14% of the population. (On a side note, I just love how they named it beeturia. When you pee blood this is called hematuria; hemat- for blood and –uria for urine. I guess the medical term for beet…is beet!)

While having beeturia might seem of minor consequence, and the majority of the time it is, in some cases it can indicate something more serious. Back in the 60s when beets were groovy, British scientists studied the incidence of beeturia in patients that had no known medical problems, those with iron deficiency anemia, those with pernicious anemia (this is anemia from the inability to absorb vitamin B12 in the gut), and those with malabsorption syndromes1. They found that the incidence of beeturia was only about 14% in healthy people but around 40% for anemic or malabsorptive patients.

This phenomenon was further explored. After a group of scientists experimented on 100 impoverished grad students, starving them, feeding them liquid beets and collecting their pee in a jug, it was found that high stomach acidity and long stomach emptying time can greatly impede absorption of beet pigments2. The rest of this data was gathered through rat models. Other things that stop beet pigment absorption include intestinal iron compounds, which explain why anemia can cause beeturia3.

So, if you eat beets and you have beeturia should you freak out? Probably not; most people with beeturia have a genetic predisposition to it. If you are concerned however, you could go to your doctor and say that you read something on the internet written by a medical student that you might have anemia. Doctors love that. (Like the time in my second year of medical school that I was convinced that my fiancé had this horrible autoimmune disease ankylosing spondilitis which causes your back to fuse together and gives you horrible arthritis, just because he had back pain. He went to the doctor all freaked out, and of course he just had some muscular strain. He did two stretches and felt better.)

And if you’re not sure if you have beeturia, there’s only one way to find out. Only through experimentation of consumption can the truth be gained. So, I challenge you to make this colorful, fragrant beet recipe which is citrusy, nutty and creamy, and report back to me. Even if you hate beets, do it for the name of science.

Ingredients
4-5 medium beets
Juice of one lime and one lemon
2 tbs unsweetened almond butter (you can buy this at Trader Joe’s it’s like peanut butter but with almonds; if you can’t find it you could just use a couple of tablespoons of finely chopped up toasted almonds)
1 medium clove of garlic
2 tbsp olive oil
1 tsp salt (plus salt to cook the beets)
One ripe medium avocado

Rinse the beets (or scrub that) if they are particularly dirty. Fill a medium to large pot halfway with water. Salt the water. Cut beets in half and boil over medium high heat with covered lid for about 40 minutes or until beets are tender when pierced with a sharp knife. When beets are ready, rinse with cold water and peel with hands. Beets should peel easily and your hands will turn a beautiful crimson color (if they don’t peel easily use a vegetable peeler). Dice beets into medium sized cubes.

Dice avocados into medium sized cubes. To make dressing, mix lemon and lime juice with almond butter, garlic and salt in small bowl or glass. Then add olive oil. Dress salad and toss gently (don’t make too much fuss or the avocados will get mashed up). Enjoy!

1) WATSON, W., LUKE, R., & INALL, J. (1963). BEETURIA: ITS INCIDENCE AND A CLUE TO ITS MECHANISM. British Medical Journal, 2(5363), 971-3.

2) Watts, A., Lennard, M., Mason, S., Tucker, G., & Woods, H. (1993). Beeturia and the biological fate of beetroot pigments. Pharmacogenetics, 3(6), 302-11.

3) Eastwood, M., Nyhlin, H. (1995). Beeturia and colonic oxalic acid. QJM : monthly journal of the Association of Physicians, 88(10), 711-7.

the match

Oh my oh my! 2010 Match is upon us. For those of you that don't know, it's the gut-wrenching, terrifying process of trying to streamline/cram all 10-thousand something American medical school graduates into residency positions all over the country in all but a select few of the specialties. The idea seems ludicrous. The process begins as a 3rd year medical student (or before) when a medical student picks her specialty. Herein begins the compilation of board scores, grades, research, extracurricular activities, and letters of recommendation, not unlike any of the thousand other applications somebody with too much education has thrown together.

Not unlike any other CV compilation and job application, one applies and is invited for interviews. The BENEFIT of the match, and the ERAS (electronic residency application system or whatever), is that one CV is sufficient. No other essays, cover letters, nothing! And, applying is surprisingly affordable, comparing at least to medical school apps which were insanely expensive. It's something like 60 bucks for the initial fee, which includes 10 applications, then 10 dollars for each additional program, and after 20, then it's 12. Well, this part is cheap...just wait. The most fun part about the ERAS is that all of the programs are just a click away. Dreamed of moving to California? Well, click away! Thought you might want to build an igloo in Alaska as a family medicine resident? it's just one button. Click, click, click, click! Speaks one that only applied to 10 medical schools, I applied to 23 residency programs, even though I am probably way more qualified coming out of med school than into it. This makes it easy to OVER apply (as does the hysteria of the whole match process and the disbelief that you could possibly be as qualified as all those OTHER medical students at even FANCIER medical schools than yours).

Next comes the most stressful, or second most behind match, part. Awaiting interviews. You will get interviews. More than you thought. That's what everybody said to me, and I didn't believe them. Well, out of the 23 places I applied, I got 20. Way more than I could go on. And then you get to schedule them all. My medical school gives us tons of vacation time, so scheduling was only hard because I was going to various parts of the country and needed to try and get to them all in the middle of winter. Why?! WHY do they schedule interviews in the middle of blizzard season! This is not logical and adds to the stress AND fun of the whole process. I did not get stuck once. I am very lucky. Oklahoma had a blizzard this year. Nothing is guaranteed.

You buy plane tickets on your own dollar. What dollar? Yeah, who knows. Med school is expensive and demanding and demeaning, but you love it! You buy plane tickets and rental cars and call people you haven't seen for 5 years to sleep on their couch. You lose 15 lbs to fit into the suit you wore interviewing for medical school (or buy a new one). Then go! There's always a party the night before with Indian food, or so seemed the case for the obstetrical world this year, where there are residents and maybe faculty that want to "get to know you" (make sure you aren't really weird). The interview day is usually fairly long and at least 3 people will talk to you although at least in OB they want to pretend to be nice so most interviews are fairly relaxed. You'll get pretty good at talking about yourself. In fact, when you're done interviewing, you might be in a little you withdrawal.

Then, after smiling and asking the same STUPID questions 1000 times that you don't care about the answer to, eating way too many airplane peanuts, spitting a green bean over a chief resident, denting a resident's car at the dinner, almost missing your connecting flight in Vegas because you were playing the penny slots, and buying a plane ticket for the wrong day entirely and almost getting stuck in Atlanta, you're done. You make your rank list, write emails to your favorite people begging them to employ you, go on second looks if you have time/money/energy. And you're done! Phew. Wasn't that bad. Submit your list to NRMP or whatever the letters are... and certify it.

Here comes the sheer terror. The waiting. The hoping SOMEBODY liked you of the over 100 people you met enough to want to enslave you into the drudges of the hospital spending half of your life with your shoes soaked in blood and amniotic fluid. You spent about $3000 of your Uncle-Sam earned cash to land a job that pays 47 grand a year, which if you average over the 80 hour work week is about 10 bucks an hour. Yep! I'm honestly so excited.

The match seems like an archaic process. And guess what, it is! Only after a little of research, this excellent article published in JAMA (Roth, A. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912) discusses the history of the match process. It was first established in 1952: "That selection [of interns] has now been advanced on the school calendar to the beginning of the junior year and, indeed, inquiries now come to me even from sophomores. The dates of examinations and selection have been pushed farther and farther back, through the efforts of some hospitals to get ahead of others in the choice of candidates, for hospitals can exercise pressure on the selected candidates by requiring acceptance of offers of internship at once or within a short time. The student’s dilemma is understandable; if the first offer of this kind comes from a hospital of his second or third choice, he loses out entirely if he declines and is not selected later by the hospital of his first choice" (Joseph Turner 1945). This presented a significant problem to both programs and applicants as they were not making informed decisions and there was too much pressure on medical students.

The current algorithm has been the same since 1952, with few minor changes including the couples match. The algorithm, which is well explained by the NMRP is in the applicants favor. HA! Finally. This is the other awesome thing about applying to residency. The programs, for the first and last time ever, do not have the upper hand. They can rank you and recruit you, but only YOU have the final say if you rank a program or not. Well, I guess this is always the case, but as little control as you have in the match process, the programs are just as terrified that they won't match. Remember, they need you! You are the future slaves of Hospital X, the pride and joy of the hospital that will do all the scut work for the attendings. You are a valuable asset.

Between now and match day, the computer does it's little beep beep beep, 0101010101111000, a little cinnamon, a little sugar, no cream, and concocts the match list for all the programs. Supposedly it takes mere seconds for the algorithm to run. That's why you have to wait 3 weeks. I swear it's just for the NRMP to f&*# with your head in their diabolical plan to control the minds of 15,000 doctors for just a few weeks of the year. And when it spits out the hospital of your dreams and prints it on a plain white piece of paper, this functions as a contract. WHY DID YOU APPLY TO ALASKA?! You thought it would be fun. You'll know soon enough.

Match day. This year it's March 18th. So, now I just have to wait. But as I tear that envelope open and read choice #13 on the letter and start crying, I'll still be employed. In the end, that's what matters. As long as I match, I get to be a doctor, take care of people, learn how to operate, and deliver babies.

The most amazing thing about medicine is that as much as it changes, it really is the same as it was in 1952. It's a bunch of neurotic 20 somethings, waiting for the opportunity to learn from the people before them. It's being taught a beloved and semi-secret set of skills and to seek knowledge. It's to take care of people and improve the health of those around them. It's an opportunity to be at the forefront of medicine, "in the trenches" as they say, and get your hands dirty, just like they did 50 years ago. Match day is nothing more than gaining a little control on something, like medicine, that nobody can truly control. And that little morsel of order in a world of complete chaos, blood, sweat, birth and death truly stands for what gets us (or at least me) out of bed everyday.