A soup for Today- Vegan Curry Red Lentil Soup

A Soup for Today.

Aspen, Colorado January 2013

Today I found out I matched in pediatric residency.  On Friday I find out where exactly I will be.  The anticipation makes me feel like life is on hold.  Jacob and I aren't sleeping much these days as we await what our next 3 years will look like.  This morning as I awaited the news that I officially matched, I felt frozen- I could not do anything or make any decisions.  What better for de-frosting myself than cooking up a new soup?  This recipe is from Cookie and Kate (http://cookieandkate.com) a great cooking blog. It certainly did the trick- though it is a bit more labor intensive than some of my other soups as the dicing can become arduous.



Vegan Curried Red Lentil Soup 

Ingredients:

• 1 tablespoon olive oil

• 1 piece (about 2 inches) fresh ginger, peeled and finely chopped

• 6 garlic cloves, finely chopped (about 2 tablespoons)

• 1 large shallot, finely chopped (1/4 cup)

• 2 large carrots, peeled and finely diced (about 1 cup)

• 1 1/4 teaspoon salt

• 2 teaspoons curry powder ( i used green curry paste)

• 3/4 cup unsweetened coconut milk (reduced fat or regular) *be sure to shake and mix canned milk well*

• 5 cups water

• 1 cup dried red lentils, picked over and rinsed

• 1/3 cup coarsely chopped tart dried cherries (preferably organic unsweetened)

• 3 tablespoons finely chopped cilantro stems, plus 3 tablespoons cilantro leaves for garnish

Instructions:
1) First prep all ingredients as above (chop, dice, peel etc)
2) put oil into pot and heat on medium
3) Add carrots, garlic, ginger, shallot and half of salt and let cook while stirring for 5-10 minutes until shallots transluscent
4) Add curry powder or paste and stir for another minute
5) Add 1/2 cup coconut milk + water, bring to a boil, cover and reduce heat to simmer
6) Cook 8-10 min until carrots/lentils are soft
7) set aside 2 cups of soup.  Strain these two cups leaving only solid ingredients in a separate bowl and recombining liquid with the remaining soup.
8) With a hand immersion blender blend the remaining soup in a glass bowl.
9) recombine the soup with that set aside
10) Add most of the cherries, leaving some for garnish, and all of the cilantro stems
11) When ready to serve separate into 4 bowls, garnishing with remaining coconut milk, cilantro leaves and cherries.

This past week I gave the dvar torah at my minyan- this is what I said:

We are midway between purim and pesach.  Between a time of celebration, high energy, and partying to one of cleansing, renewal and lower energy.  Being a purim baby and an admirer of springtime, these few weeks have always been filled with lots to do.  Prepare for my birthday, prepare for pesach, prepare to come out of winter hibernation.  However this time in between the celebration and renewal, there is not really much to be done. 

This week parshat vayak’hel-pekudei can be summed up in three main parts.

1-   Moses assembles the people of Israel and reiterates to them the commandment to observe Shabbat

2-   He conveys gods instructions in making the mishkan; The tabernacle, or portable sanctuary in which the Jews carried the Ark of the Covenant through the desert.

3-   The people of Israel donate the required material (gold, furnishings, garments etc) in abundance so much so that moses has to tell them to stop giving.

Stop giving? How often do we hear that?  I took this to be more of a metaphor to stop doing and reflect on what has already been done.  As young professional urbanities living in one of the most strung out cities in the world- I’m sure we can all use this reminder.  In the age of yoga and meditation the act of being and reflection, instead of doing all of the time, has now begun to catch on.  Numerous studies have proven that mindfulness and meditation lead to better health outcomes, they decrease anxiety, our perception of pain, and our blood pressure readings.  Perhaps Moses was giving us further instructions on life---- just chill out.  Take this time to clear our minds before we clear our closets in two weeks. 

In discussing the positive effects of not doing more I am reminded of a recent article I read about parenting adult children.  The premise of the article was a mother contemplating how best to be a parent now that her children were grown and no longer needed her in the same capacity they once did.  She mentioned several arguments she had with her now adult children when she would give them suggestions for what they should do to solve the problems they presented her.  One day, her son stopped the argument and said mom I know you are trying to help me but the best way you can help me is to just be there for me, and stop trying to do for me.

As a medical student, I spent part of my curriculum learning communication skills.  While the old fashioned paternalistic view of medicine has changed to be more patient centered, so have our communication styles.  It is now faux pa to tell patients what to do, rather it has proven more effective and beneficial to have the patient tell us more while we engage in reflective listening.  Using a technique called motivational interviewing, many in the psychology world may be familiar with, we work together with the patient to motivate them to change.  By doing less, and being more present, providers can now gain more information while building a more cooperative relationship.

It seems fitting to me that this parsha started with the commandment of Shabbat and ended with telling us to stop giving more.  While Shabbat provides an avenue to stop doing and just be, we are reminded of the importance of doing this on a daily basis.  So I challenge you in the days in between purim and pesach- how can you incorporate this mantra of doing less, being more present, and reflecting more?

Finding peace with acceptance- Simple Delicious Chicken

Shenandoah National Park April 2012

Bed a) I don't want to die.  I'm worried about what will be. Please do what you can.

Bed b) I just want to die. I'm worried about what will be. Please do what you can.

The dichotomy of desires around death are brought to a forefront in the hospital.  People come who are dying from a terminal illness, while others come because they tried to end their own lives before their bodies were ready.  The separation of mind body here is striking.  I am one to be a big believer in mind-body connection, but it must be agknowledged that in some situations this theory is limited.  Our will to live can only go so far, and our bodies will to live can only survive so much.  Faced with these two patients on the same day I found myself confused with my role as a healthcare provider for them is.  When we take the hippocratic oath (which I will take next year upon graduating), we sign on to do what we can to achieve optimal health for our patients.  The medical ethics behind such notions as assisted suicide, when that might be in the best interest of our patient, is one that society has shut down as unquestionable.  Our duty has become to keep patients alive.  However, we have made great strides in this arena with the advent of palliative care models that are now integrated into hospitals and home healthcare settings.  The idea being that at some point we have to stop fighting and just be.  Accepting death and living out your last days in peace and comfort is difficult for both the providers and family.

In taking this theory and applying it to the day to day I find that sometimes we have to accept things we don't like instead of fighting against them.  There are things in each of our lives that we want to change that are perhaps out of our own control.  Sometimes the peace and serenity comes from just accepting, even embracing and just being at peace with how things are.

Finding Peace with Acceptance- Simple Delicious Chicken

This chicken is moist, delicious and super easy to make!

1 cut up whole chicken 

Olive Oil

1 cup of white wine

1 box of Shitake mushrooms chopped up

3 cloves of garlic diced

1 white or yellow onion diced

Bunch of Sage chopped up

Mixed herb seasoning

Salt

Preset oven to 450 degrees

1) Line a baking pan with parchment paper (this way chicken doesn't stick to pan)

2) wash and dry chicken then place evenly on parchment paper

3) Rub chicken with enough olive oil to coat

4) sprinkle herb seasoning and a pinch of salt over chicken

5) cover chicken with onions, garlic, mushrooms and sage

6) pour 1/2 cupish white wine and a dash of olive oil over the whole concoction

7) bake in oven for one hour; taking out at 30 minutes and ladling some of the juice over the chicken to keep moist and putting back in for 30 minutes until brown and crisp

Taking life as it comes

Two of my patients refocused my attention on living in the moment this week.  In a week when we were bombarded with information regarding planning next year and the next 4 years of our lives post medical school and into residency, I needed to be refocused on the here and now.

The day I turned 28 I had a conversation with an 82 yo patient my team was caring for;

“Ive been in the hospital a few weeks now. I have a problem in my lungs.” He told me how he used to smoke and drink back in the day, and now he’s just taking it as it comes.  “That’s all you can do”, he said.  He told me he’s 82 years old and has lived a good life.  Life is about giving and taking, he’s given all he has to give and now he’s just taking it as it comes.  Mr. B told me lots of people say you shouldn’t smoke or drink, but they die young sometimes too.  "You never know what’s going to happen, so you have to just take life as it comes."

Sand Dunes of Northern Michigan

The last day of my internal medicine rotation at this hospital I decided I'd spend my free afternoon sitting with a patient I had grown fond of;

Mr.N was severely demented, not oriented to person, time, or place, but every once in a while he had these breakthrough moments where I felt like we were connecting.  Each morning when I woke him up to accomplish my duties of finding out how he was feeling and completing a physical exam, he would pop his eyes open and smile "well hello there, good morning to you too!" Throughout the exam he'd  usually babble things I couldn't piece together- "how do you feel today sir?" "I feel wonderful, hot diggity dog- do you see that over there I'm going to get it!" Together we would laugh, maybe not about the same thing, but hey we were laughing!  Perhaps we couldn't cure his end stage lung cancer, and perhaps he didn't know what was going on, but he was happy and we could help him laugh.  This afternoon when I came in just to talk to him, I let him ramble about the most obscure topics and just put my hand on his as he laughed.  After a few moments he turned to me with a look of intention and started to cry. "I have been looking for the way all this time, and because of you I have found it."  Together we sat in silence for a few moments as he cried and I held his hand.  I'm not really sure what was going through his mind at that time, but I know that somehow an emotion was evoked merely by the presence and touch of another human being.

This week the NYTimes ran a piece on the effect of human touch and presence on the emotions of another human being.  Several studies have proven that mere touch and empathy can be as effective or even more so than the use of traditional pharmacological methods.

A reflection on death and dying in the hospital

I almost met death today. He was looming in the air. I could feel his presence leave right before I arrived in the morning and linger after I left in the afternoon.  It wasn’t me he was visiting but I still felt blown away. 

When I first arrived to the hospital my resident greeted me in a chipper voice, “good morning- have you ever pronounced someone dead? Want to come do it.” Sure it was 6 am, seemed like a perfectly normal way to start your day!?! So off we went through the tortuous halls, up and down the stairs until we reached our destination.  The moment we walked in the room I was reminded of my cadaver, how I was able to cope with knowing she was dead because she looked so dead and felt so dead.  I always thought it was the formaldehyde they shot through her veins prior to our first meeting.  But here I was meeting this man for the first time, and he was formaldehyde free, only a short while since his life had ended and yet he looked just like the expression “you look like you got the wind knocked out of you”.   Pale and glazed over, I did not have to feel for his pulse to know his soul had left his body.  We did our ABCs (Airway, Breathing, and Circulation check), closed his eyes, called out the time and marched on to attend to those patients whose life was still present.

Hospitals are funny places- are they there for people to heal? No I’ve learned they are more a place of stabilization- make sure the patients are not in any acute danger, ship them out to heal at home under the care of their GPs, and hope that someone will be home with them for the healing process.  This concept was a surprise for me, it wasn’t what I had hoped or imagined.  I find I have such difficulty letting patients go without a clear diagnosis, prognosis or solution.

We rounded on half of our patients in the morning and left the more long-term cliental for the afternoon.   After my afternoon slump  (that often occurs post prandially during our lunchtime lectures) my team shuttled off to round on the afternoon patients.  Outside the room of the first patient a resident filled us in on his overnight activities and what the plan of care was from here out.  “Ok shall we go see him?”  The attending asked.  One behind the other we filed into his room and surrounded the bed looking down at him.  “So how do the tests look?” the patient asked.  “The tests came out alright, the cancer has remained stable.” “Oh that’s great news, I’m so glad to hear it.  So where do we go from here?” “Well sir, your cancer is pretty far along, the treatment we could give you now would only be palliative- it would help with some of the symptoms you have been having but it won’t cure the disease. “ “Well I want to continue the treatment, if everything looks good right now we might as well keep trying to fight it.” “Ok sir, we can continue to give you the chemotherapy, but I think its important that you understand the cancer will not ever be beat, just slowed a little bit.” “ You know you are the first person who has said this to me, everyone has beat around the bush and no one has been honest about my prognosis.” “I’m sorry, I’m sure this is hard for you.” “It’s alright”. And then we moved on to the next 3 patients, having similar conversations with each of them.  Shuffling from one to the next no one spoke in between, we just delivered the bad news and moved on- leaving the patient alone in his room.   

After seeing all of the patients our attending went back to his office and we (students and residents) went back to our team room.  Everyone started working away on the computer to get things done.  “I’m sorry I know you guys are working- but I’m having a hard time with processing what just happened.” “What do you mean?” “I mean how do you guys deal with telling so many people they have terminal cancer? It’s really sad.” “I guess we just become callous to it, don’t really internalize it and move on with our day.” Oh ok.....(is that really what I'm supposed to do?)

The View from my house when I lived in Puyo Ecuador.

Wisdom of the Sages- Rosemary Sage Sweet Potatoes Beets + Garlic

For those of you who follow the news, you might be aware of the current battle in congress over contraceptive access.  I recently wrote the following Op-Ed that was featured in Mother Jones about 2 weeks ago, so I thought I'd share it with you- and of course a recipe to accompany :)

 A few weeks ago, I had a conversation with the Democratic staff of the House Oversight and Government Reform Committee.  They were looking for a medical student to testify at an upcoming hearing on contraception—would I be that student? 

Ultimately, the Committee chose to invite a student at Georgetown Law Center as their witness—but neither of was given a chance to address the Committee.  Chairman Darrell Issa refused to seat Sandra Fluke because, in his view, the hearing was “not about reproductive rights but instead about the administration’s actions.”  The hearing was quite clearly a reaction to the Obama Administration’s decision to require church-affiliated organizations to provide insurance coverage for contraception.  Ms. Fluke would have been the only woman on the panel.

I suspect that, even if I had been invited, I would not have had the opportunity to address Congress.  But if I had, here is what I would have said:

Mr. Chairman, Ranking Member Cummings, and Ladies and Gentlemen of the Committee—

It is a privilege to sit here before you and be able to address you, the men and women who make up the membership of this committee.  As I look beside me, however, it must be recognized that I am the sole female on this panel—a collection of witnesses you have asked discuss access to medication that is only prescribed to women. 

If this hearing had been called to discuss the issue of access to erectile dysfunction medication and the panel here consisted solely of women, I would have also argued that your decision was, at best, irrational.

My gender notwithstanding, I hope to present two rational, evidence-based arguments in support of our responsibility to assure that women have access to contraception.  There are other arguments we could discuss, but these two highlight the absurdity of obstructing the use of certain classes of safe, effective medications.

First, contraception provides this country with measurable health and economic benefits that have nothing to do with sexual activity.  Although they are called “oral contraceptive pills” (OCPs), synthetic estrogen and progesterone are now among the most widely prescribed medications in America.  Is that because more women are sexually active?  No.  It is because these medications have helped millions of women with a diverse array of medical concerns.  They are now prescribed for acne, endometriosis, polycystic ovarian syndrome, and as a means of protecting women who are particularly at risk for certain diseases such as ovarian cancer.  The health risks involved when access to these drugs is blocked is very real.  For example, without OCPs a woman with polycystic ovarian syndrome is exposed to unopposed estrogen, placing her at higher risk for endometrial cancer. 

Along these same lines, from a public health standpoint, OCP prescriptions allow more women to attend school and work without having to use previously used sick days for debilitating premenstrual cramps.  By denying women diagnosed with dysmenorrhea (painful cramps) or menorrhagia (excessively heavy blood flow) the option of birth control pills, we deny them the current gold standard for treatment.  All evidence suggests that health care providers should use these tools to treat female patients.  In a nation that has invested such a large portion of funding—about two percent of our annual budget—towards medical research, it is unfortunate that some would ignore this research-based conclusion. 

Second, although we may disagree as to the benefits of family planning, we should all recognize that, in this country, it is a doctor’s obligation to present a patient with a wide range of reasonable medical choices. 

I recently completed a rotation in the nursery of a nearby hospital whose policy is not to offer contraceptives to women.  As I was discharging new mothers—most of whom were immigrants, or poor, or both, with little idea of where to go and what to do after they and their newborns left our care—I was not able to present them with a fair range of options. 

Many studies have shown that it is beneficial for women to use some sort of birth control for the first year after delivery.  Becoming pregnant any sooner puts the mother, her current child, and the future infant at risk for adverse health outcomes.  I struggled to bite my tongue as these mothers left without this important medical advice—information that I freely and routinely provide to other patients at other hospitals.   How could this hospital, whose goal is to provide the best healthcare to its patients, deny these women that information?

Regardless of where you stand religiously on the use of contraception, as medical students in the year 2012, we are taught that it is our responsibility as healthcare professionals to provide “patient centered care.”  We have moved away from the paternalistic view of “doctor knows all,” to presenting the evidence and options to patients in order to come to healthcare decisions together as a team.  Without presenting the full spectrum of available options, we are reverting back to a paternalistic view that physicians (or politicians) “know” what is best.   That view, in my opinion, is wrong.

-       Yonit Lax

MD Candidate | Class of 2013
The George Washington University
School of Medicine and Health Sciences 

Photo Courtesy of Planned Parenthood: The Chosen Witnesses at the Hearing

Wisdom of the Sages- Rosemary Sage Sweet Potatoes, Beets + Garlic

This is absolutely delicious, I make it often to accompany meals or as a snack for the week.  The whole garlic roasted together melts in your mouth and the sage gives it a perfect edge.


Ingredients: ( 3- 4 servings)

Pre-cooking

3 Sweet Potatoes cubed
3 Beets cubed
6 Whole Cloves of garlic unpeeled
1 bunch of Sage
Handful of Rosemary
Olive Oil - just enough to coat

Instructions


1) Preheat Oven to 425
2) Line a baking dish with parchment paper
3) Mix together all ingredients
4) Bake for approx 45 minutes

Rosemary-Sage Sweet Potatoes Beets + Garlic
(Sorry if they seem scarce, I may have picked at these before taking the picture....oops)

Fishing for Reflections- Baked Mediterranean Tilapia

I started this blog during what is considered the easiest of clinical rotations.  I had the least amount of hours and did not have to take a national standardized exam.  It has been rather easy to maintain the blog, continue cooking and hold true to my goal of being present in the moment.  Starting tomorrow my schedule will flip and I will begin a rotation that only gives me 4 days off a month.

In trying to pack everything in that I could during my last weekend off, I felt myself becoming anxious.  I found it difficult to make decisions, wavered back and forth and then felt guilty about if it was the right one.  It was the anticipation of what is coming next that heightened my emotions- I was no longer feeling present.  I found that verbalizing my concerns to friends allowed me to reflect more quickly and redirect my thoughts to being in the moment.

It is a custom in my family to share the best and the worst thing that happened all week at dinner on Friday night.  I've continued this tradition at my own Shabbat (Friday night) dinners with friends.  Reflection out loud allows one to further internalize and understand thoughts, while bringing people at the table closer together.  It is one of my favorite traditions.

This week I hosted 7 friends for a meal filled with reflections, good food and good company.

The menu:
Pea Soup
Beet + Leek Salad
Roasted Brussels Sprout
Garlic + Sage Roasted Sweet Potatoes + Beets
Mjadera
Mediterranean Baked Tilapia
Gluten Free Peanut Turtle Cookies



















Mediterranean Baked Tilapia adapted from Jamie Oliver's Baked White Fish


This recipe is so easy and it makes the fish taste so yummy! Tilapia is cheap and readily available.  I did try to make this once with frozen fish and it was a bit too fishy so fresh fish is always preferred.




Ingredients
3 cloves of garlic minced
Small bunch of basil
Olive Oil
2x 400g can of plum tomatoes (with salt)
4 pieces of Tilapia (or any white fish)
Handful of Black kalmata pitted olives
1 tablespoon of capers (drained)

Baked Mediterranean Tilapia

Method
Preheat oven to 425
Make sauce:
1) Pick basil leaves and set aside while finely slicing the stalks
2) Add enough olive oil to coat a large pan and put on medium heat
3) Add garlic + basil stalks
4) Sautee until garlic is soft but not browned
5) Add canned tomatoes + simmer on low heat for 30 minutes
6) Break and mush tomatoes with wooden spoon

Prepare fish:
1) Pour sauce onto parchment paper lined roasting dish over the fish
2) Squash olives and cut in half
3) Sprinkle olives, capers and basil leaves over the fish
4) Cook in oven for 15 minutes

Dinner for one- Green Eggs and Hummus Wrap

Horseback Riding Through Ireland

There has been a lot published recently about the growing trend in our generation to live alone or remain single much later and longer than any generation before us.  The rhetoric has skimped along the sensitive area of you are single- why? to the I am single- what's wrong with that? Many have linked the growing trend to women's lib and how the independent woman no longer needs a man in a financial manner, or a technical manner now with the advent of IVF.  Others have begun to blame men for not being educated or hard working enough, remaining in a teenage state of mind beyond the time when most women are looking for serious committed partners.  I think we might be missing the boat a bit with these accusations.  Perhaps it is more related to our difficulty to connect with other people at the same level we once did.  Communities are beginning to dwindle as individualism is thriving.

We are now raising a culture where dating on the Internet is more normal than meeting at a party. People spend hours upon hours looking at people's profiles instead of going out and surrounding themselves with people doing activities they enjoy doing.  Now I am not one to ridicule online dating, many people I know have met their lifelong partners online.  But I am a proponent of more community building.  It is the communities of people I have surrounded myself with that have challenged me to be a better person.

Once a week I get together with my college girlfriends for a meal and discussion centered around something intentional.  I so look forward to this sacred time and hope to carry the tradition forward no matter where I live in the future.

But for the times when I am flying solo I find comfort in a simple dinner for one.

* After originally writing this the following article came out in the NYTIMES: The Talent Society. Funny how many of the same notions David Brooks wrote about...*

This dish was inspired by my roommate.  It's super easy, nutritious, easy on the wallet and light on the calories.  Perfect for the "I don't know what to eat tonight" kinda night.

Green Eggs and Hummus Wrap

Ingredients

Brown Rice Tortilla
(Trader Joes or Food For Life)
1 egg
a bunch of greens (Collard, Kale or Chard) broken into pieces
1/4 Bell pepper (chose color of your liking)
Hummus (I like Trader Joe's Mediterranean-Hummus )

Directions
1. Heat frying pan on medium heat
2. Spray Olive oil or put a drop to coat
3. Crack an egg (or two if you are hungry)
4. On the other side of the frying pan put the bunch of greens
5. Sprinkle with your favorite spices (garlic powder or all purpose work well)
6. Flip egg once it is cooked well enough to flip
7. Cover with tortilla and flip the whole thing after 1 minute when egg is cooked
8. Turn off heat
9. Put greens on top of egg in tortilla
10. Place bell pepper on top of greens
11. Finish with a dollop of hummus

Green Eggs and Hummus Wrap

12. That's a wrap!