Stained Glass Cookies

Now marks the one year birthday of OB Cookie.  It's been a crazy year.  Last year I was sitting on my couch, freezing my butt off, thinking of things to keep me busy during dead time as a fourth year.  Now, thankfully, it's not so cold.  I'm definitely not sitting on the couch nearly as much, although I do fall asleep on it frequently.

I'm calling these cookies stained glass cookies.  They are loaded with little pieces of sour candies and they turned out really pretty.  They are tart with great textural contrast as well.  So happy birthday blog! I've had a bunch of fun writing here, and even if posts are more sparse than before, I'm not giving up quite yet.


Stained Glass Cookies

2 sticks unsalted butter at room temp
3/4 cup granulated sugar
1 egg
1 tsp vanilla
zest and juice of one lime and one tangerine
2 1/2 cups all purpose flour
1/2 tsp salt
8 oz sour candies cut in small pieces and tossed in 1 tbsp flour to prevent sticking

Beat butter and sugar until light and fluffy.  Add vanilla, citrus, egg.  Beat until well combined.  Add flour and salt.  Mix until well combined.  Add candies.  Divide dough into 2 pieces.  Roll each piece into a 2 inch thick log and shape into a square (or a roll).  Put into freezer to form dough for about 1/2 hour.  Leave other half in freezer (depending on how many you want). Pre-heat oven to 350.  Carefully slice cookies with a serrated knife into 1/4 inch thick slices as candy pieces can be fragile and place on baking sheet.  Bake cookies for 15 minutes or until golden brown.

Happy New Year

I’ve started to write a million blog posts but I haven’t quite been able to finish.  As much as I wanted to celebrate the holidays with y’all, I just couldn’t.   I feel in desperate need for free time lately.  The good thing--intern year is officially half over.  It’s pretty incredible to think about how much I’ve learned in the past six months and how much I’ve seen.  I have delivered over 50 babies and done 30 C-sections, and that’s just in the 3 months that I was on obstetrics.

The past couple months I’ve been off service on internal medicine.  I had to take my white coat out of the bag to start the rotation.  I’m learning a lot and the people are very nice, but I’m just homesick in a lot of ways.  I haven’t had enough time to see my family in quite some time, and I really miss OB.  I was just starting to feel happy and comfortable as an intern in obstetrics as I switched to something completely new and different; it felt like starting all over again.

I love being a doctor, but it’s really hard.  It’s not the hours or the daily grind of the work per se, it’s just that being a doctor is now synonymous with being me.  Work isn’t just work when it involves life and death.  It isn’t just your job when you catch an exhausted mother’s beautiful newborn in your hands.  It isn’t just a vocation when you declare a 32 year old dead from a horrible cancer on New Year’s Eve and tell his family that he isn’t there anymore as they look at you with their hopes shattered. 

People that aren’t in residency have said “you knew what you were getting into when you signed up for this.”  But how could I, or anybody in residency truly anticipate what would this would be like?  It’s an incredibly surreal experience.  The highs are unbelievably amazing and the lows are ship sinking.  Sure I knew I would work a lot, watch people die, and be far away from home.  The fact of the matter is that the amount of emotional, physical and intellectual energy expended as an intern cannot be quantified or described.

This post wasn’t meant to depress people or to have somebody send out a suicide watch.  I’ll be fine--in fact I’ll be great.  For my New Year’s resolution, I don’t want to change anything.  I can’t spend my whole life feeling bad about all the stuff I didn’t do.  I just want to keep the resolve to be myself even with constricted time and limited sleep--happy, loud and proud.  I dare you all to do the same. 

Haikus to Internal Medicine

Oops, I kind of disappeared.  No worries, I'm around, just got busy.  Doing internal medicine right now.  While I might have liked it in medical school, no more.  I miss the operating room.  

Haikus to Internal Medicine

Pager, I hate you

You beep constantly at home

You are here to stay

Thirty hour call

You suck. I am so sleepy

Who invented this?

Potassium, you

Are always low, I am sick

Of repleting you

EKG, no clue

How to interpret you but

I pretend to know

Volume overload

Bores me, they should sell lasix

Over the counter

Sticking needles in

Fluid collections is fun

Cytology pending

Black and White Cloud Pudding

It's been an interesting month.  I wrote about my experiences as a "black cloud" and what that means as a resident here on Kevin MD.  In honor of my first post to KevinMD, an awesome medical blog with significant collaboration from health professionals all over the country, and my new black cloud status, I made a dark chocolate and whipped cream pudding parfait.


The dense, rich chocolate pudding is layered with a fluffy white cloud of homemade whipped cream.  Are you a black or a white cloud?

Dark Chocolate Pudding and Whipped Cream Parfait
(pudding recipe adopted from Bon Appetit)

For the pudding:
1/2 cup sugar
1/3 cup unsweetened cocoa powder
2 tbsp cornstarch
1/4 tsp salt
1 3/4 cups milk divided
1/4 cup heavy whipping cream
3 oz very dark chocolate (such as 88% cocoa) finely chopped
1 tsp vanilla extract

For the whipped cream:
1 cup chilled heavy whipping cream
1 tsp vanilla
3 tablespoons powdered sugar

Whisk sugar, cocoa, cornstarch and sal tot a blend in a heavy medium saucepan.  Gradually add 1/3 cup milk, whisking until smooth paste.  Whisk in remaining milk and cream.  Using wooden spoon or heatproof spatula, stir mixture constantly over medium heat, scraping bottom and sides of pain until pudding thickens and begins to bubble at edges, about 5 minutes.  Add chocolate; stir until mixture is smooth.  Remove from heat and stir in vanilla.  Allow to cool to room temperature and then refrigerate.

For whipped cream, in chilled bowl, whip ingredients until stiff peaks form.

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

Full Moon Pies

AAOOOOOOOOOOOOOOO!  The 23rd is a full moon.  Time to get your werewolf self ready for the big howl.  Besides bringing out beasts and goblins, full moons are thought in the obstetrical world to bring out babies.  As an already overworked and overwrought poor little intern running around labor and delivery, this can’t be a good thing.

But are full moons actually related to the onset of labor? Most studies suggest that, in fact, they are not.  A 1979 study of 11,681 live births at UCLA hospital showed that there was no correlation of lunar cycle to births.  These results were reproduced in a smaller study of 3706 births in the 1990s in New York City.  However, some studies suggest otherwise.  One small Italian study suggests that there might be a small effect on multiparous patients (those that have had more than one baby) with the lunar cycle. 

Not only is tonight/tomorrow (the calendar says tomorrow but it looks full tonight) a full moon, but it is also a harvest moon.  Besides being a great Neil Young album, a harvest moon is when there is a full moon at the autumnal equinox.  Supposedly the harvest moon appears bigger and brighter than a normal full moon.  Time to get out the scythe and start farming.  

To celebrate the full moon, I made a traditional southern classic, the moon pie.  A moon pie is 2 graham cracker cookies filled with marshmallow and topped with chocolate.  To celebrate my day off, I made my own graham crackers and my own marshmallow.  Although it seems difficult, it isn't too tough.  Just takes a candy thermometer. Graham crackers require graham flour, which I know some people have had trouble finding.  I like Bob's Red Mill which is in the health food section with the other whole grains.

Full Moon Pies

For the cookies (adapted from Martha Stewart's baking)

1 1/2 cups all purpose flour

1 1/2 cups graham flour

1tsp baking soda

2 tbs cocoa powder

1/2 tsp salt

1 1/2 sticks unsalted butter at room temp

3/4 cup packed light brown sugar

2 tbsp honey

Preheat oven to 350.  Combine flour, baking soda, cocoa powder and salt and set aside.  In mixer, beat sugar, honey and butter until fluffy.  Slowly mix in flour, stir to combine.  On floured surface roll out cookies thin about 1/8 inch and cut with 1.5 inch round cookie cutter (or glass or jar which is what I used).  Place on baking sheet and bake about 7 minutes until brown and crisp.  

For the Marshmallow (from Food Network)

1/4 cup water

1/4 cup light corn syrup

3/4 cup sugar

2 egg whites

1 packet plain gelatin

2 tbsp cold water

1/4 tsp vanilla

Combine the 1/4 cup water, the corn syrup, and the sugar in a saucepan fitted with a candy thermometer. Bring to a boil and cook to "soft-ball" stage, or about 235 degrees F.

Meanwhile, in a standing mixer fitted with a whisk, whip the egg whites until soft peaks form. Sprinkle the gelatin over the 2 tablespoons water and let dissolve. When the syrup reaches 235 degrees F, remove it from the heat, add the gelatin, and mix. Pour the syrup into the whipped egg whites. Add the vanilla and continue whipping until stiff.

Transfer the mixture to a pastry bag fitted with a round tip. Pipe a "kiss" of marshmallow onto half of the cookies, and top with the rest to make sandwiches. Let set at room temperature for 2 hours.

For the Ganache

8 oz chocolate chips

1 cup heavy cream

Over double boiler on medium heat, melt chocolate and cream, stir together.  Dip cookies in ganache.  Also can make white chocolate for an extra drizzle

Abell, GO.; Greenspan, B. “Human births and the phase of the moon.” New England journal of medicine, v. 300 issue 2, 1979, p. 96.

Joshi, R.; Bharadwaj, A.; Gallousis, S.; Matthews, R. “Labor ward workload waxes and wanes with the lunar cycle, myth or reality?.” Primary Care Update for OB/GYNS, v. 5 issue 4, 1998, p. 184. 

Gabriele Ghiandoni, Roberto Secli, Marco B. L. Rocchi, Gilberto Ugolini, Does lunar position influence the time of delivery? Eur J Obstet Gynecol Reprod Biol. 1998 Mar;77(1):47-50.

Tik Tok Board Doc

This month has been awesome.  I'm what is called board doc which means I run the labor and delivery board making sure everybody has been examined, monitors are placed and all of them are delivered.  It's been a blast but it's probably the most crazy experience of my entire life.  There is no time for sitting, or eating, or thinking.  In honor of board doc, I have re-written the words to a favorite pop song, Tik Tok by Kesha.  In medical school we used to have a show Doc Opera with a very similar feel to it, and I used to direct the band.  Since there's no Doc Opera in residency, I've spent my few minutes of free time re-crafting the song.  So here ya go!




Wake up in the morning feeling oh so S%ty
I got my glasses, I’m out the door, I’m lookin oh so gritty
Before I leave, brush my teeth and I pull my hair back
Cause when I leave for the night, I ain’t coming back

I’m talking danskos on our toes toes
Scrubs instead of clothes, clothes
Blood all over ourselves, selves
Pulling out all the babies
Sewing up all the ladies
Trying to get a little bit messy

Don’t stop, make her pop
Nurse will you run my pit up high
Tonight, push it right
Till that baby sees the light
Tick tock on the clock
But the babies don’t stop, no-oh-oh no-oh-oh-oh

Don’t stop, make her pop
Turn the epidural up to high
Tonight, imma write
Notes til I see the sunlight
Tick tock on the clock
But the pager don’t stop, no-oh oh oh

Ain’t got no sense in the world but got plenty of fear
Ain’t got no food in my belly but nobody cares
Now the tasks are lining up, can I work any faster?
There are 8 million things I’m not sure I can master

I’m talking about everyone running around round
Feet never leave the ground ground
Gonna pit her if she’s moving too slow
Decels so she can’t no second miso-so
Can’t wait until she crowns crowns
Wait until she crowns crowns
Wait until she—

Don’t stop, make her pop
Nurse will you run my pit up high
Tonight, push it right
Till that baby sees the light
Tick tock on the clock
But the babies don’t stop, no-oh-oh no-oh-oh-oh

Don’t stop, make her pop
Turn the epidural up to high
Tonight, imma write
Notes til I see the sunlight
Tick tock on the clock
But the pager don’t stop, no-oh oh oh

I’m cramping up
I might break down
The heart, it pounds
FSE
With my hands in
I got it through
I think we’ll know
IUPC
Let’s build it up
Head come on down
We’re hoping for
Adequacy
With my hand in
With my hand in
Get your hand in

No the party don’t stop when I walk in