Pumpkin Beer Bread

As a lover of everything pumpkin (which you may have guessed from the pumpkin recipes I continue to make) I bought a case of Leinenkugel’s Pumpkin Ale. Though I enjoyed it, I don’t drink beer very frequently. I found a way to use at least one of the bottles left over.

I had never baked bread when I first made this. All I knew about bread was that they require yeast and some proofing time, or things like “starters.” Fortunately, this is not that kind of bread!

Ingredients

  • 12 oz. pumpkin beer (one bottle)
  • 3 cups flour
  • 1/4 cup sugar
  • 1 Tbsp baking powder
  • 1/2 tsp salt
  • 1 stick butter, melted and divided
  • 3/4 cup canned pumpkin
  • 1 Tbsp molasses
  • 1/4 tsp cinnamon
  • 1/4 tsp nutmeg
  • 1/8 tsp ginger
  • 1/8 tsp cloves
  • 1/8 tsp allspice

Instructions

1) Preheat the oven to 350 and lightly grease a 9×5 in. loaf pan.

I usually spray the pan with Pam then use a paper towel to make sure everything is coated and wipe out the excess.

2) Pour the pumpkin beer into a sauce pan and whisk vigorously for 1-2 min. (without heat) for flatten the beer.

3) Heat over medium until boiling, whisking occasionally to help keep the foaming down. Reduce by half (for about 15 min.) and set aside to cool slightly.

Don’t let it cool too much! You’ll want the pumpkin to dissolve.

4) In a large mixing bowl, whisk together the flour, sugar, baking powder, and salt.

5) In a smaller bowl (or the pan you used to flatten the beer), whisk together the beer, 2 Tbsp melted butter, canned pumpkin, molasses, and ground spices.

6) Add the pumpkin mixture to the dry ingredients. Mix with a spoon until no dry ingredients are left.

Don’t use a whisk like I did! This is not a batter, it’s a dough. It will get stuck to everything.

7) Pour half of the remaining melted butter into the loaf pan.

8) Put the dough into the pan and drizzle the remaining melted butter over the top.

9) Bake 45-55 min. until a knife can be inserted into the center and come out clean.

Final Thoughts: Isn’t it beautiful? I love the amber color. It was a nice mild flavor with hints of beer, spice, and pumpkin, but none overpoweringly so. If you really want a tasty snack, slather it with apple butter!

Choosing a Medical School

This weekend I listened to one of my favorite podcasts – Pre-med  hosted by Dr. Ryan Grey. Dr. Grey and I have actually spoken before. He’s a kind man dedicated to helping pre-meds get into medical school. He has several books, podcasts, and forums. If you’ve never listened, I highly recommend it.

The topic for discussion was stats. As pre-meds, we tend to hyper-focus on our GPA and MCAT scores. A bad grade can send us into a panic. We send questions to our advisers with “what-ifs” about how to handle a bad MCAT score before we’ve even taken it.

The problem is that these numbers are not as important as we think.

These scores are to get you through what Dr. Grey calls “the shredder.” It gets you into the pile for consideration. But from there, your application depends on a number of aspects: your personal statement, your extra-curriculars, etc. The most important consideration is your school list.

When I first started my pre-med journey, I started a list of med schools. I looked at the best-of-the-best and quickly realized that very few of them would accept my non-trad AP scores, online courses, and community college classes. Nevertheless, I made a list. I brought it to my pre-med adviser, who told me to throw it away.

Throw it away? Wasn’t I supposed to be finding my schools and working towards making it into those schools? No. I had it backwards. I was looking at schools for the wrong reasons. There’s a strategy to finding the right schools. It does not involve specific specialties or even rankings. It involves school environment, cost, city life, and competition level. If I apply to 6 California schools out of 12, I’ve already made it harder for myself. I followed my adviser’s instructions and shredded the first list. Since then I’ve made a long, long list and continue to do research.

Fortunately Dr. Grey made another (long) podcast about making your med school list. The average student applies to 14 MD schools and 9 DO schools. Though Dr. Grey recommends applying to both, I’ll likely only be applying to MD schools. I also can’t afford applying to 23 schools (think AMCAS fees, secondary fees, and travel for interviews). I’ll likely apply to somewhere between 12 to 14 schools.

My primary consideration is that as a non-traditional applicant, not all schools will be willing to accept my AP, online, and community college credits. (You can check with AMCAS’ MSAR service). After that, location and curriculum are my priorities. Without my MCAT, it’s difficult to figure out which schools may be out of my reach. For now, I’ll focus on learning about the schools.

Dr. Grey recommends you avoid basing your school list off of World News ranking, tuition costs, and residency/Match trends. Focus on finding a school where you can thrive. For me, I prefer a non-trad friendly school that accommodates to different learning styles and strives for balance between my medical training and my personal life. That may steer me away from “prestigious” and more traditional institutions like Mayo or Harvard (though those would be a bit of a reach for me anyway).

Would you guys like me to share my preliminary list? What are your criteria for deciding where to apply?

 

Protecting Patients from Sexual Abuse

An orthopedic surgeon and his wife recently made headlines for drugging and raping women. The NPR article makes no mention of revoking his physician’s license, though if he serves the maximum sentence (of only 30 years for possibly thousands of women!!!) it is unlikely he would be able to continue practicing. The article does make a reference to his position as a physician establishing a sense of trust in his victims.

After 2 years, prosecutors were finally able to convict Dr. Shafeeq Sheikh of raping a heavily sedated patient while she was hospitalized. He was fired from the hospital and his license was suspended. He served no jail time. Unfortunately, Texas does not require permanent revocation unless a doctor agrees or when a doctor permanently surrenders his or her license in lieu of further investigation. He could potentially re-apply in a year.

These headlines are unfortunately not uncommon. Sexual assault and rape are hot-button issues in the US right now, particularly sparking outrage when rapists and sexual predators receive little to no punishment for their actions. There should be even greater outrage against physicians who take advantage of their position and their patient’s vulnerabilities.

There are watchdog organizations focused specifically on appropriate legislation and punishment of physician-offenders. Per one website, Arizona only scored 66%, but ties Massachusetts and Ohio at number 10 best patient protection states in the country. Mississippi is the worst, and Delaware is the best.

In Delaware:

  • Duty-to-report laws require any healthcare worker aware of an offense to report the physician within 30 days, or else pay hefty fines.
  • Physicians who have committed felony sexual offenses have their licenses permanently revoked.
  • Doctors must undergo background checks with fingerprinting, updated every 6 months.

In Arizona:

  •  Incidents reported by other hospital or clinic staff do not need to be made within a specific time period, and there is no requirement to report these offenses to the medical board.
  • State law does not require revocation for any type of sexual misconduct or convictions.
  • The medical board cannot refuse to issue a license based on previous criminal acts.

In Mississippi:

  • There are no criminal laws specific to sexual misconduct for physicians.
  • State law does not require physicians to report possible violations by fellow doctors.
  • Doctors whose licenses are revoked can reapply at “reasonable intervals.”
  • State law doesn’t require revocation for any type of sexual misconduct or convictions.

Physicians are with patients at their best in worth. They establish trust with a patient, and that patient trusts their physician to provide the best care possible without taking advantage of their vulnerabilities. When a physician rapes or assaults a patient, they violate that trust and the trust future patients would have given. Those physicians guilty of such crimes have violated the fundamental vow of doctors- “Do no harm.” I cannot fathom how a felony sex offender, a rapist, would in good conscious be allowed to continue practicing.

The laws need to change. We need to make hospitals responsible for the behavior of the physicians they hire. Physicians, patients, and staff should be able to anonymously and quickly report inappropriate and unacceptable behavior. The physicians responsible for these heinous acts should be punished severely, including the loss of their right to practice medicine.

Does anyone have any suggestions on how to get Arizona laws regarding license revocation altered?

Reading List: Smoke Gets in Your Eyes

I majored in Anthropology during college. (That’s the study of human beings for those of you who have never heard of it). Coursework can be focused on anything from the cultures of modern people to the evolution of the human being from our ancient ancestors. During my junior year, I enrolled in a class called “Death & Dying: a Cross-Cultural Perspective.”

The course covered the various religious and cultural practices and beliefs of people around the world, as well as how they had evolved over time. “Smoke Gets in Your Eyes: And Other Lessons from the Crematory” by Caitlin Doughty reminds me greatly of this class. The author recounts her first job in the “death industry,” cleaning and cremating bodies at a funeral home in San Francisco, followed by building her career in the funeral industry.

Image result for smoke gets in your eyes book

Her book offers the reader a glimpse the evolution of her experience with death: from young child to experienced funeral director. Then, finally, she ends with the founding of the Order of the Good Death, a “death positive” organization of people who want our modern culture to embrace death and encourage environmentally-friendly and natural funerary practices.

Though it may seem a macabre topic, physicians cannot avoid death. This is a topic she even covers in her book. She meets a medical-school professor who laments that his students do not want to deliver the news of a fatal diagnosis. His reasoning is that they fear their own death, and therefore do not want to confront their patient’s mortality (so as to avoid confronting their own).

My father’s side of the family does not avoid the topic of death. My grandmother (still living) enjoys exploring cemeteries and eating lunch on one of the benches. My father has always been explicitly clear on what he expects for his “funeral.” I guess you could say my family is fairly death positive. We prefer to be cremated and scattered or perhaps buried in one of the “green” tree pods that have been popular on the internet.

My primary concern with medicine is dealing with death. I have had patients die, but never in front of me and never as the result of care that I personally provided. Physicians are face-to-face with death every day. They may prevent death, delay death, or bring death closer (whether or not this was intentional). A rotation in palliative care particularly concerns me.

Death, to me, is a private matter. I never want a large funeral with hundreds of people weeping over a preserved corpse then buried in a big, expensive box. I want to have as many parts of me donated as possible (if possible) then planted or buried in a green cemetery by private memorial with only the closest family and friends. Discussing funerals, burials, and end-of-life care seems to be something involving family and possibly friends. I feel that in palliative care I would be placing myself into an intimate situation.

Overall, I want to strive for a “good death” for my patients when necessary. I am not so naive as to believe that I can defy death in every case. In fact, in some cases I would consider a gentle, painless death to be preferable to a short, futile struggle against, say, an aggressive cancer. There are some people who want “whatever means necessary” to prolong their lives. If that’s what my patient wanted, that’s what I would provide.

Physicians are often burdened emotionally with the death of their patients as a “failure” of their care. What we must realize and accept is that death is an inevitability, especially when we place ourselves in the position of a physician. Our jobs are to treat, cure, and prevent death and disease when possible, but our job is also to assist our patients in accepting their death and providing them a dignified death that respects their personal beliefs and desires whenever possible.

Chorizo Sweet Potato Hash

Pumpkin isn’t the only thing in season right now. Sweet potatoes are a diverse ingredient that pairs well with sweet and savory flavors, whether its sweet potato pie or whole roasted sweet potatoes. I found this recipe for chorizo sweet potatoes in Food Network magazine. I’ve never cooked chorizo, but I love to eat it!

The original recipe was stuffed whole sweet potatoes, but those are more difficult to take to work, so I cut them and roasted them instead.

Ingredients:

  • 4 medium sweet potatoes
  • 1/4 cup + 1 Tbsp olive oil
  • 1 Tbsp pickling spice (I’d never heard of it either! McCormick brand is in the spice aisle at the grocery store)
  • 1 cup plain fat-free Greek yogurt (if you don’t like eating this usually, buy the single serve cups!)
  • 1 clove garlic, minced
  • kosher salt and ground pepper
  • 1/4 cup golden raisins
  • 8 oz chorizo
  • 2 Tbsp pine nuts
  • chopped fresh mint (optional)

Instructions:

1. Preheat the oven to 450. For whole potatoes, pierce all over with a fork and microwave 20-25 min. For roasted sweet potatoes, slice into bite-sized cubes. You won’t need to microwave the cubes.

2. Heat 2 Tbsp olive oil in a skillet over medium-high heat. Add the pickling spice and cook about 1 minute, until toasted.

 

3. Transfer the spiced oil to a mini food processor or spice grinder. Grind or pulse until the pickling spice is finely ground for 1 minute.

4. Transfer the oil into a bowl. Stir in the yogurt, garlic, 1 tsp salt, and some pepper. Set aside.

5. Soak the raisins in 1/2 cup warm water for about 10 minutes.

Does anyone know what this does? I think it’s to rehydrate them? Maybe it makes them softer…

6. Heat 2 Tbsp olive oil in a large skillet over medium-high heat. Add the chorizo and cook, stirring often, for 5-6 minutes. The meat should be brown and crisp.

 

Be careful when cooking this. It’s difficult to tell when the meat is fully cooked, because it has been spiced red.

7. Add the pine nuts to the meat. Cook for 30 seconds until the nuts are lightly toasted. Remove from heat.

8. Drain the raisins and stir them into the chorizo.

9. Arrange the sweet potatoes on a foil-lined baking sheet. Drizzle with olive oil, then either rub the whole sweet potatoes with salt and pepper, or sprinkle evenly over the pieces.

Roast the whole potatoes for 10 minutes OR Roast the cubes for 35-40 minutes.

10. Top the sweet potatoes with the chorizo mixture. Serve with yogurt sauce on top or on the side!

Final Thoughts: I could eat this every day! Sweet potatoes and chorizo go so well together; the sweet and spicy flavors match perfectly. And the spiced yogurt sauce brings down a little bit of the heat. The pine nuts added some much needed crunch, though I probably could have cooked them longer.

A few weeks after I made this, I had a sweet potato and chorizo breakfast skillet. I like this better.

Shadowing: MS Clinic

I’ve probably only spent 6-9 hours scribing for the neurology clinic. The provider I worked with is older than the average physician. His expertise lies in the treatment of multiple sclerosis (MS). MS is an auto-immune disease in which the body attacks the myelinating sheaths over the nerves of the nervous system. It can be diagnosed with lesions apparent on brain imaging, but symptoms vary. Usually there is some component of chronic pain, disability due to lack of coordination or difficulty with motor movement, and fatigue.

MS is often confused with fibromyalgia (which is a clinical diagnosis not based on brain imaging). Patients with chronic pain are often over-diagnosed with MS. Though the reasoning may be unclear, it may be a last-ditch effort to diagnose a patient with something, anything that could lead to a treatment plan. Extensive work by Dr. Andrew Solomon has explored how often MS is incorrectly attributed to patients and how to improve diagnosis (as well as how to address the misdiagnosis with patients).

Chronic pain patients get a bad reputation. Some of the negative labels attributed to them are “crazy,” “attention-seeking,” or even “drug-seeking.” I have an aversion to treating chronic pain, which I suspect many pre-meds may have as well. Chronic pain is difficult to attribute to a diagnosis, difficult to treat, and nearly impossible to cure. I’m sure this aversion will resolve with more extensive shadowing and understanding of the physical factors at play.

The provider I worked with is one of the greatest people I’ve ever met, especially as a physician. There are very few people who can make such a strong, empathetic connection with patients. Clinic with him is not like a doctor’s visit, but an engaging conversation in which he and the patient discuss health and treatment options. He is first and foremost a teacher, to patients and staff.

He does not flinch in the face of complicated medical histories, patient pain and emotional struggles, or patient non-compliance. He and his patient come to a truly mutual decision regarding their health and treatment.  He does not shame patients for refusing a certain medication or procedure. The patient only has to explain their reasoning. Whatever it is, he will accept it, as long as they are willing to explain their refusal. The patient feels like they are the one deciding, not the doctor.

I wish I could properly convey the experience of his clinic. He openly admitted to treating me like a resident. In exchange for scribing, he felt he should offer me an opportunity for education. He asked questions and encouraged me to ask questions. All my fear about the lack of neurology knowledge went away. I left more confident and energized. My only disappointment is that I haven’t been able to return for more shadowing.

Have you shadowed in neurology clinic? How was your experience?

Korean Beef Meal Prep

In my junior year of college, my best friend announced she was moving to South Korea. She didn’t speak the language and knew a little about the culture, but it was still quite sudden. When she came back, she could fluently speak Korean. She also came back with an extensive knowledge of Korean food. She started taking me with her to local places, ordering food that I hadn’t heard of in a language I can’t understand. Needless to say she helped develop a love of Korean food.

Every week I make a recipe to bring to lunch for work. When I found that one of my favorite bloggers had a recipe for Korean beef, I knew I had to try it. It’s a mock-bulgogi that has quickly become one of my favorite recipes.

Ingredients:

  • 1 cup rice
  • 4 large eggs
  • 2 Tbsp olive oil
  • 2 cloves garlic, minced
  • 4 cups chopped spinach (I bought 2 bunches, but 3 might have been better.)
  • 1/4 cup brown sugar, packed
  • 1/4 cup soy sauce
  • 1 Tbsp freshly grated ginger
  • 2 tsp sesame oil
  • 1/2 tsp Sriracha (I actually used gochujang- a Korean fermented chili paste.)
  • 1 Tbsp olive oil
  • 2 cloves garlic, minced
  • 1 lb. ground beef (I always use venison of course)
  • 2 green onions, thinly sliced
  • 1/4 tsp sesame seeds

You’ll need more spinach than you think.

Instructions:

1. In a large saucepan, cook rice according to the package. Set aside.

2. Boil the eggs to desired consistency. I prefer medium-hard boiled eggs.

3. Heat olive oil in a large skillet over medium high heat. Add garlic and cook until fragrant, about 1-2 minutes. Stir in the spinach until wilted.

 

 

4. In a small bowl, whisk together the brown sugar, soy sauce, ginger, sesame oil, and Sriracha (or gochujang).

This sauce is super sticky. It will congeal if you don’t stir it every now and then.

5. Heat olive oil in a large skillet over medium high heat. Add the garlic, and cook until fragrant. Add the ground beef and cook until browned. Make sure it crumbles, then drain the fat.

 

Basically up until you add the meat, the steps are the same as how you prepare the spinach.

6. Stir in the soy sauce mixture and green onions, allow to simmer for about 2 minutes.

I stirred the sauce prior to adding it into the meat.

7. Place the rice, eggs, spinach, and ground beef mixture into meal prep containers. Garnish with green onions and sesame seeds if desired.

I left the garnish off of the food, but added a little extra gochujang to the meat. It was the perfect meal.

Final Thoughts: My dad said this was his favorite lunch I’ve ever made. I was disappointed that I didn’t make enough spinach, but since I doubled the recipe, we had plenty of food. I could eat this every week for lunch. Slightly sweet and slightly spicy, all delicious.