Easy as Fudge, Four Ingredient Fudge Pops

Greetings from the faraway lands of third year of residency.  I’m busy.  This is the fourth month in a row that I have to get to work at 5am.  I took advantage of the business to put myself on a diet and start exercising to keep myself sane.  And I lost 15 pounds. 

I was never fat, but as happens to most of us, I used to be much thinner.  A couple of months ago, I was reading the 2011 Medscape survey of practicing OB GYNs across the country.  I was shocked at how few docs in my age group exercised and that almost 40% of all OB/Gyns were overweight.  As I am now half done with residency and starting to prepare for life as a practitioner, I want to be healthy and have good habits.

It is amazing how much more energy I have back at my high school weight.  Exercising is easier, and eating vegetables, lean proteins and whole grains doesn’t bottom me out, so I spend less time feeling like I got runover by a Texas truck.   People at work ask me how I lost so much weight, and really the answer is simple.  I downloaded an app for my phone called Lose It that helps you track your daily caloric intake.  I ate between 1300-1500 calories a day for 2 months and exercised.

Now I’m trying to keep a happy balance.  I am back to a 2000 calorie diet, but keeping healthy habits that got me here.  Still, this girl can’t cut out dessert.  So, here is something delicious and rich, but less dangerous than two dozen cookies.   I figure that each of these fudge pops is about 120 calories apiece, but made only from real ingredients. And they couldn’t be easier.  No guar gum or any of that crap. 

Luscious fudge pops

4oz high quality dark chocolate (I just love Callebaut and you can buy blocks at Whole Foods)

1 12 oz can fat free evaporated milk

2 tbsp brown sugar

1 tsp vanilla

Popscicle molds (we bought ours at Target)

Cut the chocolate into fine shards or small pieces.  Over a simmering pot of water on medium heat, place a well fitting bowl with the milk and chocolate.  Whisk continuously until the chocolate is completely melted and the mixture is smooth.  Whisk in the sugar and the vanilla and pour the mixture into your popsicle molds and freeze until hard, about 4 hours or more.  To dislodge, run the pops under warm water for a few seconds.  

Chocolate Dipped Hazelnut Lace Cookies

It's been a while since I posted a nice cookie recipe.  Well this is certainly one I'm proud of.  You’ve gotta make these cookies.  Chewy and crispy, nutty and buttery, bathed in chocolate, these are worth the time.  I based them on the Lacey’s cookies, which are tubs of heaven at Whole Foods, purchased to soothe the pain of a busy night at the hospital.  The cookies capture the same lacelike look, with a slightly less sweet and chewier mouthfeel.  I used Rice Krispies for most of the starch, keeping an airy quality. 

These cookies are very candy-like, in fact the first step is the same as making toffee. In the humid and already hot days of Texas spring, they are best stored in the fridge.  The whipped egg white, which I realized if done by hand takes the same amount of time as a kitchen aid with the right whisk, adds a meringue like quality.  They need to be baked just perfectly, between 6-8 minutes until the edges are darkened but not burnt otherwise the texture isn’t right.  

Makes ~18 cookie sandwiches or 3 dozen unadorned cookies

1/2 cup hazelnuts

2 cups Rice Krispy

1 stick butter

1/2 cup packed brown sugar

1/4 cup honey

1/4 cup cream

Pinch salt

Tsp vanilla

1/4 cup flour

Pinch cream of tartar

1 egg white

6 oz chocolate (dark or milk)

Preheat the oven to 350.  Chop the hazelnuts until they are fine.  In a large bowl combine the cereal and the hazelnuts.  Over medium high heat in a heavy saucepan, combine the butter, sugar, honey and cream.  Bring to a boil and let boil for one minute.  Turn off the heat, allow to cool slightly, and whisk in the flour, salt, vanilla and cream of tartar.  In a small bowl, whisk the egg white until it makes soft peaks.  Add a small amount of the warm butter mixture to the egg and fold in.  Fold the rest of the butter mixture into the egg.  Combine the butter and egg mixture with the cereal and hazelnuts.  On a baking sheet lined with a silicon mat or parchment paper, add a heaping teaspoon of batter, spacing at least 2 inches between cookies as they spread when baked.  Bake for 6-8 minutes until the cookie is lacey and the edges are dark brown but not burnt.  Allow to cool, then transfer to a baking rack. 

Over a pot of simmering water on medium heat, add a snug mixing bowl and chopped up chocolate.  Stir constantly until barely melted.  Smear a teaspoon or so on a cookie and immediately sandwich another cookie on top.  Allow to cool and then place in the fridge for the chocolate to harden.  Enjoy!

Texas v. Planned Parenthood

Poor Planned Parenthood.  I’m not a particularly political person, however I do care deeply about the health of women.  The de-frocking of Planned Parenthood by the Komen foundation, a Dallas based organization, is just another step that Texas took to halt preventive care for Texan women. The defunding of Planned Parenthood by Susan G Komen highlights the tragic rift that already happened between preventive health care and politics in Texas, written about today in the New York Times regarding Title X.

Last year, Texas legislature attempted to pass a bill that would halt all funding for the Women’s Health Program, a Medicaid associated program that provides annual exams and contraception for all reproductive age women that qualify, simply because Planned Parenthood participated in the Women’s Health Program.  This puts programs such as where I work in a bind.   The funding is in serious jeopardy of being eliminated completely. 

According to the Texas Health and Human Services Commission, the Women’s Health Program saves Texas at least $20 million a year.  By providing an annual exam, contraception, STD screening and cancer screening, patients also get their blood pressure checked, are screened for domestic violence and substance abuse and connected into a hospital system. 

As a second year resident in my training in OB/GYN at one of the busiest county hospitals in the country, Parkland Hospital in Dallas, I’ve seen a lot.  Parkland is a massive safety net for north Texas, catering to women of all races, creeds, nationalities and ages.  Parkland Hospital takes care of over 10,000 pregnant women a year alone, at a cost much below the national average, yet manages to have excellent outcomes including one of the lowest pre-term birth rates in the country.

Parkland maximizes utilization of state programs that fund preventive care. The Texas Medicaid Women’s Health Program allows uninsured women below a certain income level to qualify for annual well women exams and reproductive health maintenance.  Outlying clinics staffed by nurse practitioners provide these vital services.

Beginning last year, under financial and political pressure, Governor Rick Perry attempted to cut funding to the Women’s Health Program because the Women’s Health Program also funded Planned Parenthood.  Planned Parenthood, although providing abortion services, focuses on “[helping people] make responsible choices about their sexual and reproductive health”.  The main focus of Planned Parenthood in fact parallels Parkland’s ideals of health care by promoting prevention through screening and education.  (Parkland does not perform abortions.)

The consequences spell disaster.  Already, with decreased funding to family planning clinics in the Parkland Health system, the number of patients crowding the Women’s Emergency Room at Parkland has steadily increased for both low and high acuity issues.  Compared to a low cost preventive visit to a family planning clinic, the cost of an ER visit charges a base of about $1500.  The state eats this bill, as patients cannot pay.  Without preventive care or contraception, the unplanned pregnancy rate will rise, placing increased burden on a breaking Medicaid system.

Regardless of individual opinions of abortion, taxes or politics, I hope we can all agree that having healthy women who get pregnant when they want to is an important goal.   How did we let a bunch of stuffy men in suits and really ugly sweater vests start to hack away at women’s rights that we have been fighting for the last 100 years?

I am pro-choice but not pro-abortion.  I would love for every pregnancy to be loved.  Abstinence is a great option, and should be taught, however people are not going to stop having sex.  Our evolutionary drive to reproduce is stronger than morals or politics.  If we as a country of parents, educators and health care providers could teach our children, students and patients about safe sex and provide them with mental and physical resources to make healthy decisions for themselves, then we would reduce the abortion rate.

We are eliminating a program that saves money, increases patient choice, reduces unwanted expensive pregnancies and reduces abortion.  Even though abortion only encompasses 3% of the services provided by Planned Parenthood, sadly the almost 100% of women will be affected that participate in the Women’s Health Program.  The results of undermining Planned Parenthood—Unplanned (and very expensive) Parenthood.

Pickling it up--Italian style grilled spring veggie pickles

As my resident life advances and becomes more surgical, having clamped through my first few hysterectomies, tied and cut dozens of tubes of postpartum women, and delivered hundreds of babies abdominally through C-sections, I have had my share of complications.  My wise attending told me “if you haven’t had a complication from surgery, you haven’t done enough surgery.”

The inability to always prevent complications unsettles me.  An adverse outcome during a case provokes a feeling of desperation.  Sometimes I just feel like a stupid jerk that doesn’t want to operate anymore.  But I have to get over myself, because I’m going to be doing surgery for the rest of my life, and no matter how much I study and practice, things aren’t always going to go right. I am lucky to have great teachers who have coached me through fixing mistakes and counseling patients postoperatively. 

Thank god I have the kitchen.  Complications arise all the time, under-whipped egg whites, a cake that falls apart the second you invert it, awful tasting crab sauce, and overcooked T bones.  The beauty of the kitchen is the cauliflower won’t bleed, the chicken doesn’t need its ureters anymore (does a chicken even have ureters?), and best of all, there’s always Chipotle.

When I find myself in a funk at work, stressed or depressed, nothing distracts me like the kitchen, my improvised operating room.  Just like surgery, I gather my supplies, wash my hands, gown in an apron and begin.  The knife courses through pork fat and onions, on my feet for hours.   

The comparison between chefs and surgeons has been made more than once.  Both jobs heat up quickly, promote distended bladders and last long hours.   The stakes separate the two.  Kitchen failures are frustrating, sometimes depressing, but rarely scary or life changing.  I’m just fine with that. 

I’ll keep my day job and my hobbies separate, enjoying pickles in edible instead of existential forms.  These Italian style pickles with grilled spring vegetables taste salty, sour, oily and herby.  They make a great snack.  They are beautiful on their own or served over toast with ricotta for a wonderful bruschetta.  They would also taste great in a pasta salad, over grilled fish or a plethora of other foods.  They take a little effort, but they last for weeks.  I use a grill pan to grill the asparagus and eggplant, however roasting them in the oven or over an open grill would produce equally tasty results.

The veggies I use in the recipe below are just what I had in my fridge.  Surely other vegetables such as fennel, carrots, or zucchini would also be delicious.   The pickles do not taste sweet at all, the sugar merely softens the blow of the vinegar and salt, as does the water. 

Pickled Grilled Spring Veggies Italian Style

Half an eggplant

10 spears asparagus

1 red onion

½ head of cauliflower

2 ribs celery

4 birds eye chiles or other peppers

2 cloves garlic smashed

10 black peppercorns

½ tsp fennel seeds

½ tsp dried oregano

¼ cup chopped fresh parsley

¼ cup chopped fresh basil

1 ½ cup white vinegar

½ cup red wine vinegar

1 cup water

¼ cup plus 2 tbsp kosher salt

¼ cup sugar

½ cup canola oil, ¼ cup olive oil

olive oil and salt for grilling vegetables

To grill the eggplant, asparagus and onion:  Slice the eggplant into thin slices.  Cut off the woody end of the asparagus.  Cut the onion in half.  Salt and oil the veggies.  Over medium high heat on a grill pan, cook the vegetables in batches until they have grill marks and begin to soften, however they do not have to be completely cooked.  Cut the eggplant rounds in half, cut the asparagus into 1 inch pieces and slice the onions in strips.  Set aside.

Cut the cauliflower into small pieces and chop the celery.  Slice the chiles, keeping the seeds.  Over medium high heat in a medium pot, add the garlic, chiles, peppercorns, fennel and oregano until fragrant but not burnt, about 20 seconds.  Add the vinegars, water, sugar and salt and bring to a boil.  Add the basil, parsley, celery and cauliflower and cook for another 5 minutes. 

Pour the hot liquid in a large jar over the grilled vegetables.  Float the oil on top, if the oil does not cover the vegetables, add more.  Allow to cool on the countertop and then refrigerate overnight. 

Playing vegan with miso glazed acorn squash and soba noodles

In December after a week of steak eating, cookie baking and face stuffing, unfortunately much prior to Christmas, I decided to become a vegan.  Now I only could do it for a week, as my love for dairy, eggs and meat should be obvious.  But, I can assuredly say that I felt much better.  I had a lot more energy and was less hungry.

This blog is definitely in need of more vegetables.  I love eating vegetarian fare, but somehow steamed broccoli with lemon juice just never seems sexy enough.  Of course my husband never even touched this dish, but that’s ok because sometimes I need things for myself.

White miso paste has a very rich, salty and sweet taste to it. I cut the squash in half and then cut very thin slices with a sharp knife.  Then I painted the glaze of miso, maple, soy and sesame on and roasted the squash in a hot oven until it was bubbling. 

To make this a complete meal, I made a miso sauce to toss buckwheat soba noodles.  This is delicious hot or cold.   Now I know the pictures aren't pretty, but this is good. Playing vegan is fun sometimes!

Maple miso roasted acorn squash with soba noodles

For the squash

½ acorn squash

2 tbsp white miso paste

1 tbsp maple syrup

1 tbsp olive oil

2 tbsp soy sauce

drizzle sesame oil

For the noodles

2 tbsp miso paste

¼ cup hot water

2 tbsp grated ginger

1/2 garlic clove, grated

2 scallions finely chopped

drizzle sesame oil

1 package soba noodles

Preheat the oven to 400.  Cut the squash in half, then cut thin strips of squash, cutting those in half as well.  Mix the glaze and paint on with a pastry brush.  Bake the squash until it is golden brown and bubbling about 20 minutes. 

For the noodles.  Make the noodles according to the directions.  Combine the rest of the ingredients and toss with the hot noodles and squash.  

What The Hell Am I Doing?

As my husband and I try and make a long term financial plan for paying off my almost $200,000 in loans from medical school, I sit here wondering, why did I pay 200 grand so that I can get peed on, pooped on, bled on, screamed at and sworn at? I’ve delivered a baby without gloves on (it was an emergency).  I’ve been kicked so hard I almost fell off the bed.  In one hour this fall, two patients in our women’s emergency room looked me in the eye and screamed “F*&^ you!”  That occurred at 2 AM, probably on a Friday, after I spent all night running a busy emergency room rife with women with ectopic pregnancies, miscarriages, wound infections, pelvic inflammatory disease, cancer and all other varieties of disaster.  And I’m sure I often deserve a giant cursing out, you see I’m not always the most lovely human on the planet, but I can assure you that I did nothing but ask both those women simple questions that set them off. 

Why did I sacrifice my twenties, my weekends, holidays, and sleeping at night to take care of screaming, crying women? I didn’t have a bridal shower because I only had one weekend off in the six months before my wedding. My husband got off work early for Valentine’s Day and surprised me at home, so we could actually share the dinner that I was going to leave in the fridge for him before I had to run to the hospital.  I’m working at a job that pays less than medical school costs and without my husband couldn’t pay it back.  The interest rate alone is 6.8%, accruing thousands of dollars a month.  

The funny thing about all of the drawbacks to being a doctor is that I’ve never been happier.  Really.  Obviously I’m a little sick, but that’s ok.  I can’t remember a time that I’ve felt to be so proud of who I am and what I do, and I enjoy going to work almost everyday.  Even on the most horrible, body fluid filled, back straining day, I go home with a sense of satisfaction.   I’ve never been so determined to learn so that I can take good care of people. 

I don’t have to sit at a desk or sit in long meetings.  My office is the hospital floor, labor and delivery, clinic and the emergency room.  I’m on my feet.  I get to learn how to operate and perform all kinds of procedures.  I get to meet amazing people every day, and I get to work with all sorts from medical assistants, nurses, OR techs, medical students, other residents, fellows, attendings, patients and families.  I get to teach and learn at the same time.   I have an amazing group of peers going through the same thing that can find humor in just about anything. 

Taking care of patients, becoming an intimate part of their lives and their bodies, is a great honor.  And I exaggerate saying they all scream and cry.  Most, even though they have little and are often sick, are some of the most amazing women I have ever met, stoic and strong.  When a patient looks at me and says “thank you doctor”, at least for that moment I think I might be part of something good.

I recently got into a heated discussion with the anesthesia resident during a long surgery.  He told me that his dad, also an anesthesiologist, always wished he hadn’t gone into medicine.  This resident said that he wished he had gone into investment banking because one of his best friends already has six houses at age 32.  I told him that I loved being a resident and enjoyed taking care of patients, and that even though I have debt and might not be rich I live a very comfortable life.  He told me I would change my mind, especially once I have kids. 

I can understand why any parent who has gone through the gruel of medical training wouldn’t want their kid to endure that amount of stress.   But I can tell you for sure that I didn’t make a mistake getting peed on, pooped on, bled on, screamed at and sworn at.  There’s no better job for a science nerd and adrenaline junky.  Becoming a doctor isn’t the easiest way to get rich quick, but if my kid wants to go through all of the same pain I have, I’ll tell them to go ahead.

A Cake From My Heart to Yours

Baking a cake can cure almost any funk besides poorly controlled diabetes or gastroenteritis.  Batter is medicine for this doctor.  The oven in my house must cook out bad humors, leaving happy, sugary ones.  Licking the spoon has no age limit; in fact if I ever have kids, they’ll have to share with me. 

This is an easy Valentine’s Day cake.  Just like my mom used to make them.  Take a square pan and a round one, bake the cakes and cut the circle in half.  Attach each semicircle to the top like a diamond and frost the whole thing.  

This cake is made of champagne, Andre in fact.  Andre, which is really more like bottom of the barrel sparkling wine as many college girls could tell you, makes a very moist cake with a subtle boozy flavor. The cake and frosting are spiked with raspberry liquor.

So cuddle up with your cat, your down comforter, your iPad or whatever you love (I guess you could share with your boyfriend) and enjoy a piece of heart shaped cake.  Your mouth will thank you, although your thighs might disagree.

Champagne Raspberry Heart Cake with Cream Cheese Brown Sugar Frosting

1 8 inch square pan, greased and floured

1 8 inch round cake pan, greased and floured

For the cake

2 cups cake flour

2 tsp baking powder

¼ tsp baking soda

¼ tsp salt

1 cup sugar

1 cup oil

½ cup buttermilk

3 eggs

¾ cup champagne

2 tbsp raspberry liquor

1 tsp vanilla

For the frosting

2 8oz packages cream cheese, softened

1 stick butter, softened

½ cup sour cream

½ cup brown sugar

1 tsp vanilla

1 tbsp raspberry liquor

2 drops red food coloring

3 cups confectioner’s sugar

Preheat the oven to 350.  Sift together cake flour, baking powder, baking soda and salt in a medium bowl.  In a large mixing bowl, whisk the sugar and oil until well blended.  Whisk in the buttermilk, then add the eggs one at a time.  Whisk in the champagne, liquor and vanilla, then slowly whisk in the dry ingredients, do not overwhisk, lumps are ok.  Divide batter so both cakes are at the same level and bake until golden brown or until cake tester or toothpick comes out clean, about 25 minutes.  Allow to cool completely before frosting.

To make the frosting, beat cream cheese, butter, sour cream and brown sugar until fluffy, about 2-3 minutes.  Add vanilla and liquor.  Slowly add confectioner’s sugar until well combined, then add the food coloring and beat on high speed for another minute for a very light frosting.

To assemble the cake, using either a piece of cardboard covered with foil or a very large baking pan, release both cakes from the pan.  Cut the circle in half, placing one half on consecutive sides of the square.  Use a small amount of frosting to make a crumb layer, then generously frost the entire cake.  Allow to chill and serve.

Cake loosely adopted from Baking by Dorie Greenspan.