From The Board to Bored—a month of sleep

This month has definitely been a change of pace.  From running around non-stop, I’ve switched from the crazy county to the cushy private hospital.  From not eating to over-eating, watching movies and napping, the mania has definitely ended. 

I’m really tired.  That’s that.  I was feeling really good, but I’m positive that even with a week vacation thrown in there, there is no way I’ve caught up on sleep constantly flipping from days to nights and working my tail off.   I’ve had a little mini-vacation at home and I’ve found myself surprisingly waking up at 11 or noon everyday.  I have only slept until noon once in my life before.

Is the concept of sleep debt real?  Scientists argue that, in fact, yes, sleep debt is a true concept.  In one recent study, scientists chronically sleep deprived a study arm of subjects, similar to resident hours.  They found that even if those subjects slept 10 hours one weekend, they were only wakeful for a few hours before performance again began to decline [1].   An editorial article in Scientific American suggests that it is possible to regain sleep debt, however it must be done hour per hour of sleep lost [2]. 

HA! Even after 3 ½ months of residency, I’m positive that the amount of sleep I need will never be reconciled.  However, my body is telling me to relax, so I oblige.   Another perk of a couple of extra hours of free time is time in the kitchen.  I made lovely little ravioli “pillows” the other night.  This recipe takes a bit more work, but the simple, rich fall flavors are certainly worth it.   You don’t need a pasta maker, in fact I found having a pasta maker to be equal work to simply giving it a go with the rolling pin. 

Butternut squash ravioli pillows

Pasta

1 cup semolina flour

¾ cup all purpose flour

1 egg and 2 egg yolks

1 tsp salt

Glug olive oil

Water as needed

Filling

1lb ricotta

¾ lb butternut squash cut in half

12 sage leaves

¼ tsp nutmeg

¼ cup grated parmesan

Pinch red pepper flakes

1 tsp salt

1 egg

To top

1tbsp butter

1tbsp olive oil

~6 sage leafs

2 tbsp pine nuts

salt, pepper and parmesan cheese to taste

To make pasta:  In bowl add flour and salt and combine.  Make well and add oil, eggs and yolks.  With fork, start to combine.  Bring together with hands.  Add water as needed to bring the dough together so it is slightly moist but not tacky.  Knead with hands a couple of times and then either keep kneading with hands or transfer to Kitchen Aid with kneading attachment.  You can add water or flour depending on whether is dry or wet.  Knead for about 10 minutes or until dough is smooth and very stretchy.  Break dough into about 4 pieces and either roll with pasta maker or the OLD FASHIONED way, with a rolling pin until dough is thin enough to be slightly transparent. 

To make filling: Preheat oven to 400.  Place sliced squash on baking sheet.  Bake until very tender, about 1 hr.  In cast iron pan or other heavy bottom pan, coat with vegetable and olive oil and heat until oil is rippling and smoking.  Add sage leaves and fry until starting to brown and crispy.  Drain on paper towel.  In bowl place ricotta, egg, sage, nutmeg, parmesan, salt and pepper flakes and mix.  Once squash is cooked, remove from oven and mash with fork.  Add to filling. 

Put about a tablespoon of filling on the dough and fold in half crimping down with water to seal the edges.  Cut the raviolis with either a cutter, a crimping roller, a pizza cutter or simply scissors.   Add to a pot of boiling, salted water and cook until water reboils about 2-3 minutes.

In pan, heat up oil and butter, add pine nuts and sage.  Add raviolis and toss.

1. Cohen, DA, et al.   Uncovering residual effects of chronic sleep loss on human performance. Sci Transl Med. 2010 Jan 13;2(14):14ra3.

2. http://www.scientificamerican.com/article.cfm?id=fact-or-fiction-can-you-catch-up-on-sleep

Suturing dinner—herbed ricotta chicken roulades

Still alive!  I’m a week and a half into it all.  Seems like a lot longer.  I feel like I know a whole lot more than I did just a week ago and that each day gets a bit more manageable.  Even so, as more straightforward patients seem easier, I am given more responsibility with more complicated patients.  I’m learning how to rule out ectopic pregnancies, diagnose all kinds of infections, and how to do endometrial biopsies.  I have become the queen of speculum exams; I even found somebody’s cervix in the dark as the exam room had no light besides the overhead lamp.

Along with responsibilities in the hospital on the job, we are required, thankfully, to perfect our surgical skills outside of the operating room.   We have a test in September on our knot tying and suturing (a fancy word for sewing).  Even though I grew up sewing, I definitely did not do so on a curved needle.  When you suture in the operating room, you hold the needle with a tool called a needle driver, which pushes the needle through the tissue.  I can do it, but I’m awfully slow.

Along with practicing in our surgical skills lab, I brought home some suture from the hospital to practice at home.  What better way to practice sewing flesh than on dinner?  Sewing meat simulates the operating environment a lot more accurately than the dry toys that we practice on.  Besides, when you make a lovely roulade, it keeps everything together really nicely—much better than interrupted knots. 

So for dinner tonight I made herbed ricotta and tomato stuffed chicken breast roulades with a yummy zucchini orzo on the side.  The only problem was that the suture was flesh colored and thus was difficult to find in the chicken.  I might have swallowed a knot.  If you don’t have suture and a needle driver you could use regular needle and thread, or just use toothpicks or kitchen string to tie it up.  If you are like me and trying to get better at sewing, this is a delicious way to improve.

 Herbed Ricotta and Tomato Chicken Roulades

3 large boneless skinless chicken breasts

½ cup all purpose flour

15 oz reduced fat ricotta

½ tsp fresh rosemary

2 tbsp fresh parsley

2-3 tbsp fresh basil

3 cloves garlic

½ shallot

¼ cup parmesan cheese grated

2 tomatoes thinly sliced

1 tbsp butter

2 tbsp olive oil

~1 cup white wine

2 tbsp balsamic vinegar

Cut chicken breasts in half horizontally and pound down until about 1/8-1/4 inch thick.  Dredge in salted and pepper flour.  Chop herbs, shallot and garlic finely, mix in with ricotta.   Add parmesan, salt, pepper and a splash of olive oil to ricotta mixture.  With each breast, spread a thin layer of cheese and a few slices of tomato.  Roll up widthwise and sew or tie up.  Preheat large skillet or dutch over over medium high heat.  Add olive oil and butter and sear chicken breasts for 3-4 minutes.  Add white wine to cover breasts about half way up, cover and reduce heat to medium low.  Cook until chicken cooked through, about 15 minutes.  Remove chicken from pan, add another tsp or so of salt to the sauce, add balsamic vinegar.  Turn heat up to medium high and cook sauce until reduced by about 50%.  Strain and serve with chicken.

Lemony Zucchini Orzo

½ lb orzo pasta

1 medium sized zucchini, grated

2 cloves garlic finely diced

1 medium shallot finely diced

Juice of one lemon

Splash of white wine

Salt and pepper

¼ cup grated parmesan cheese

Cook orzo in salted water according to instructions.  Over medium high heat in about 2 tbsp olive oil, sauté garlic, shallot and zucchini until zucchini cooked through about 5 minutes.  Turn heat off, add orzo, white wine, lemon juice, pepper and cheese.  Stir to combine and serve. 

In the Garden with Grandpa

I just got back from an amazing extended weekend at my five year Middlebury College reunion bookended by time with my young-acting grandfather in upstate New York.  By the way he behaves you wouldn’t know he’s 84 years old.  He’s jubilant and astoundingly healthy—he doesn’t even take any pills.

The most wonderful thing he’s done in the past five years with his partner, Gail, is plant a particularly large organic garden on the back lot of his old house.  Together, they have composted, seeded, tilled, planted, pruned and picked an incredible variety of fruits and vegetables.  Gail told me that although they had tomato blight last summer two years ago they donated over 300 pounds of tomatoes to the food bank.  That’s a lot of manual labor for two people expected by society to be blankly staring at a TV screen somewhere, frail and unable to productively contribute to the community.

I feel incredibly lucky to have such a great model of aging right in my family.  If I am blessed to make it that far in life, I can only hope I have half the energy and half of the good health that my grandfather does.  In fact, I think he might have more energy and be in better physical shape than I am at a ripe age of 26.   My grandfather proves that aging, although often categorized as a disease, might slow you down, but it can’t stop you just because you walk a bit slower, see a little worse, are deafer than a goldfish, or have weaker bones or sorer joints. 

Obviously, there is no fountain of youth, but five hours a day with a shovel can definitely slow down the clock.  One study of over 1200 aging Swedish men showed that intense gardening and other leisure activity is correlated with decreased mortality.  These findings positively support that intense physical activity is good at keeping us alive [1].

Yesterday, I was spoiled by a morning of planting, weeding and plucking up young beets, scapes and rhubarb that we crafted into a delicious feast including my favorite beet recipe.  I spent all weekend eating fresh kale from the garden which was sublime and quickly morphed into a delicious raw salad.   Even though I ate this salad two or three times, I couldn’t get enough, and made my own spin on it in my Dallas kitchen by crafting it into a pasta dish.  By simply adding a bit of hot pasta water and the hot pasta, the kale wilted just ever so slightly.  Dinner came together in 15 minutes and I ate it on the porch with a fascinating book, some bossa nova and a couple of glasses of white wine. 

Linguine with wilted kale

4-5 leaves kale chopped into edible pieces
2 cloves raw garlic minced
¼ cup lemon juice
½ tsp salt
¼ cup grated parmesan
¼ cup olive oil
¼ cup pasta water
½ lb whole wheat linguine

Mix all ingredients expect pasta in large bowl.  Cook pasta as directed.  When done add hot pasta water to kale and then add pasta.  Stir, add extra grated parmesan, salt and pepper to taste.  Enjoy!

Neda Agahi and Marti G. Parker.  Leisure Activities and Mortality: Does Gender Matter? J Aging Health 2008; 20; 855

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.