Holiday time - recipe!

It's too late for you to do this proper justice for Thanksgiving, but for [your December holiday of choice] it's going to be just perfect.

Spinach Madeleine

A Louisiana recipe made famous in River Road Recipes from the Junior League of Baton Rouge, LA. Adjusted according to my experience.

Step 1:
2 10-oz packages frozen spinach

Cook per package directions and squeeze as dry as possible by method of choice (mesh colander, cheesecloth). Retain spinach liquor. Set both aside.

Step 2:
4 T butter
1/8 C flour (2 T)
2 T chopped onions
1/2 C evaporated milk, room temperature.
1/2 C retained spinach liquor
1 tsp Worcestershire sauce

Step 3:
6 oz Velveeta Mexican Hot
1/2 tsp black pepper
3/4 tsp garlic salt
3/4 tsp celery salt

Melt the butter over low-med heat. Add flour and stir until smooth - do not brown this roux. Increase heat to medium and add onions. Cook, stirring constantly, until onions wilt to desired mushiness (my preference is ~10 minutes). Slowly stir in the evaporated milk, retained spinach liquor, and Worcestershire sauce bit by bit. Be sure to stir constantly to avoid lump formation.

Cook down until base is thick and consistent. This is of necessity a subjective decision, but here's my guideline. My spatula is ~2 1/2 inches wide, and a double recipe of this (which is what I always make) is about 1/3" deep in the pan I use. If I drag the spatula through the base broadside-on, it takes about 4 seconds to fill in the void created. Compare to reasonably thick cake batter. Remember: better too thick than too thin; you can always dilute it at the end (using some of the rest of the spinach liquor).

Cube 6 oz of Velveeta Mexican Hot (or Mild, if your taste buds aren't up to speed - it's not blistering, but I'm more accustomed to spicy foods than a lot of, say, Northeasterners) and add it, along with celery salt, black pepper, and garlic salt, to the pan. Stir constantly until smooth and fully melted. Remove from heat and fold in spinach.

You're done with the hard part now. It can be served as-is as a spinach dip; it may be placed in a casserole dish and topped with breadcrumbs, then toasted, as a main dish. Taste is noticeably improved if you let it sit for at least a day in the refrigerator before serving, as the flavors meld. N.B.: if you choose to let it sit, remember that some liquid will leach out of the spinach overnight. This is why it is so critical to eliminate fluid at the end of Step 2.

It freezes well, which makes it great for guests that just happen to stop by - in 20 minutes, you can heat it on the stovetop (microwaving probably works just as well, but my microwave tends to burn things).

Don't be afraid to tinker. Add more jalapenos if you want more kick; add a little fresh chopped garlic to the onions if you want a little more of that. The only crucial step in replicating the dish is to make sure you cook it down to the same consistency every time at the end of step 2 - you will be amazed how much its thickness just after the liquids have been added will vary.

Chef John Folse, from whose website I originally took the recipe, has a number of other suggestions. Check them out.

Late nights

11-7 am shift tonight, tomorrow night, and the next. It's not actually all that bad - but not many people are still coming in at 5 am. Those that are unfortunately tend toward the "really bad" end of the spectrum - we just had a guy come in with a gunshot to his back and no sensation or movement below his navel. I wasn't in the room to hear, but prior experience suggests that the nefarious Some Dude was responsible for this shooting. Mr. Dude is a criminal well known to emergency personnel around the country; he is known to commit multiple offenses in cities nationwide every night.

I'll never be famous

I don't blog enough.

The adventure continues

I just heard about someone they wanted to fly in for treatment here. Unfortunately, they died at the outside hospital before our helicopter got there. It was diabetic ketoacidosis (DKA), a nasty complication of type I diabetes (which has been known as juvenile-onset or insulin-dependent, though those have become less accurate as America fattens and plenty of teens get type II diabetes, and plenty of type II's need insulin for control).

For the medically aware: FSG 1890. Gap was 40. No word on pH.

For the laymen: a normal FSG (=finger-stick glucose) is around 100. With most diabetics, we aim to keep it at or below 150 (as a practical matter). "Bad" is around 180. "Really bad" is around 220. She was an order of magnitude out from normal. Gap (short for anion gap) is sodium - (chloride + bicarbonate), and should be <12. It reflects unmeasured negative ions in the blood, which mostly consist of proteins in normal people. In DKA, it's high because their blood is full of acids that are negatively charged at blood pH.

Anyway, a regular bout of DKA is FSG of 500 with a gap of maybe 20. (At least, that's the case here. YMMV.)

Sunday

It's Sunday. It's a nice day out; the sun keeps playing with the clouds, which is as it should be. Two days until the election starts. Hopefully, it will end soon thereafter, but I don't hold out much hope, given that the DNC has already sent out teams of lawyers and mapped out preliminary strategies.

This isn't likely to be a strongly political blog. To use Steven den Beste's categorization, I'm more thinker than linker, because I just don't have the time to stay up to date on everything that's going on to the point that I can do a better job than [your choice of pundit/news/whatever]. And frankly, though I do have some strong opinions, I'm just not into doing that thing here - this should be fun, not work, and not a place that I vent.

I am human, however, and this is one of the times that it will get the better of me. If you don't like politics, or you don't like my politics, consider yourself warned. Charming stories return later.

I sort-of understand the Bush hatred. Sort of. As in, I know that he pushes all the wrong buttons on some people, and they just can't bear the thought that he's still sucking up their oxygen. But why that justifies the kind of stuff that's happened over the past year or so - the suave sleight-of-hand of F9/11, 60 Minutes airing a story based on blisteringly obvious fakes, the idiotic Lancet story estimating 100k deaths in Iraq, and all the other ones that aren't coming to mind right now - that I just don't get. It's as if the traditional media had a death wish.

In the past, I always assumed that the liberal bias of the traditional media (no comments about this, please, folks; the existence of Fox News doesn't mean that CNN isn't liberal) was limited primarily to op-ed's and the choice of which stories to cover. I always thought that, when the story was being researched, they were quite honest about the process. Boy, was I wrong. I now generally assume that anything reported in certain sectors of the press (NY Times and CBS being the most prominent, but by no means alone) that's more sophisticated than "x killed y last night, and police have arrested x" is likely to be a politically motivated hit piece on somebody. Maybe not GWB. Maybe not even a Republican. But definitely someone.

Why? It's televised seppuku. It will, at best, warm the hearts of those who can't stand the guy already. It will confirm the opposition's belief that the news is biased against them and can't be trusted. And it will drive away swing voters. That's a lesson the Republicans learned in the aftermath of 1996.

Actually, it's a great time for one of my favorite political sayings: despite eight years of inestimably valuable education from William J. Clinton, the Democratic Party didn't learn a damned thing. The Republicans did. Bush, in particular, did, and in spades. Why? I'm not sure we'll ever know. I remain convinced that I will never see another person with the raw political acumen of Bill Clinton. If I do, I'll lay a huge chunk of money down at Tradesports that he (or she) gets elected.

Anyway, it's infuriating, patently obvious, and counterproductive. (And there you have it folks. Pure, unadulterated wisdom. I mean, I couldn't possibly be wrong. It wouldn't be me.)

No.More.Ellipses.

That's the plural of ellipsis, not ellipse. I just noticed that I used them in the title of the blog and 2 of the first 3 entries. Must Not Do So. Must Vary Style. (See? Great ripoff of Helen Fielding there.)

How the world does change...

Medical school is a great learning experience, and I've enjoyed most of it. There are, however, some significant downsides. Chief among these is extended penury. Some people go to extremes - I remember a few of my classmates selling plasma every two weeks so that they'd have spare money. I'm not afraid of needles (I've donated over 3 gallons of blood), but it's just not worth that.

So I tutor high school students. It's a pretty profitable gig - $40/hr. There's obviously not a gigantic amount of demand at that price, but I have a secret weapon - I'm one of perhaps 2-3 people in the city who tutor physics and calculus. Physics has always been my bread and butter, though I've done well enough with chemistry, algebra, trig, and biology. I'll even do history if need be. (No English. None.)

It's a nice steady flow; I can usually count on about $40-$100 a week average during the school year (but after the first 9 weeks - the first report card is usually the one that scares the parents). I branched out during college and started doing computer work on the side. I managed to score some small but profitable accounts with small businesses and individuals that just need a few hours a year of my time, whether for setting up a new machine or adding a firewall or whatever. Relation between these two subjects? I ended up securing the WiFi setup of a family I'm tutoring in. They had just brought the thing home. I got the daughter's laptop and set it up. Lo and behold, she's installed Firefox, just as I told her to. Furthermore, she's set her home page to her Xanga blog.

I'm pushing 30 (I know, I know, one foot in the grave, other one's on a banana peel). People didn't have cell phones when I was in high school. We occasionally got to borrow one that had free nights/weekends, and it was a bag phone (see #3) at that. Now they have blogs and camera phones.

I love technology. I just wish I had more of it.

So this whole blog thing...

I'm ending a month in the MICU (M=medical, instead of surgical or neuro ICU) today. It's been a good one for the most part. The ICU is one of those places that really separates docs and nurses from the rest of the population, in a way that isn't easy to describe to someone not in the field.

Imagine this: Your uncle just got admitted to the hospital with heart failure - he couldn't breathe. He's had several heart attacks, and he takes about 15 medications. He comes up to a regular patient floor, but he just keeps getting worse despite treatment.

Now he comes to us. He'll need to be intubated (have a breathing tube inserted) and put on a ventilator. He'll get an extra IV or two, just in case we need it, and maybe we'll put in a line to access the major veins right next to his heart. To you, it's Uncle Frank. To us, well, he's an 85 yo WM c/o increasing SOB c h/o MIx4 and CHF, EF 20, sedated and intubated on ACMV 400/14/60% c PEEP 5. We get so that the tubes and the lines don't even exist to us, really; we can see the patient beneath all that, and it doesn't always occur to us that those things would bother someone else. After all, they're commonplace to us. In the OR, nearly everybody looks like this.

You, on the other hand, just see Uncle Frank. We can spout numbers all day, about how his chances of leaving the hospital are vanishingly small - his heart just isn't strong enough. But all you remember is that he was fine last week.

I could say it's sad, but that's not entirely true. It's sad when these people are in their 40s and 50s, but for an 85 year old man who's been fighting a losing battle for 20 years , it seems more like a well-deserved rest. I'm not sure what to think; I became pretty inured to misery, pain, and death, but this is one of the situations where you really treat the family much more than the patient. Rewarding, but still depressing - nobody likes being the bearer of bad news.

A weekend off, and Monday I start in the ER, 3-11pm shift. I've apparently taunted the gods too much, as one of my weekends is when I do the 11pm-7am shift (Friday, Saturday, and Sunday), and another is the 7am-3pm shift (Saturday, Sunday, and Monday). It's not as though I don't have time off, but my wife is a medical student too, and right now she gets regular weekends. At least I'm off for Thanksgiving (nearly a full week, actually; fair compensation, I suppose, for losing two weekends completely).

Introduction

The name says it all: I'm Bunny Powered. And when I say I'm bunny powered, I mean me, and not any sick, twisted ideas you might have about what the bunny might be powering in my nightstand drawer. Though he might be powering that, too.

So I'm a medical student, 4th year, in the South, going into anesthesia. That's probably enough personal detail for now.

Theoretically I have all sorts of interesting things to post about. Today will not be that day. Aren't you interested? Email me if you care.