Angry Patients and Arrabbiata Sauce

Sometimes, patients can express anger quite simply.

In medicine, you get quite used to dealing with angry patients. Sometimes patients are angry because they’re frustrated with care they received in the past. Other times, patients think that by yelling, they can bully the physician or nurse into doing what they’d prefer (whether or not it’s providing them with prescription drugs or lying to their insurance companies)…though you can probably imagine that as person like me yells back. 😉

And then, you have the patients who are just plain sassy.

I was recently on a consult month, which means that we’re asked by primary medicine and surgery teams to see their patients as “experts” in a certain organ system. For this consult, we were asked to see a patient who was currently intubated.

Patients are at different levels of “awakeness” when they’re intubated. Some patients are completely sedated, others are able to follow simple commands, while still others are awake enough that they can write responses to your questions.

As part of our assessment of an intubated patient, we need to determine how “awake” they are. If we already know the patient isn’t at the writing stage, we’ll normally ask patients questions and see if they can respond appropriately.

Fellow: Sir, squeeze my hand if you can hear me right now.

*patient squeezes hand*

Fellow: Sir, squeeze my hand if you are in a hospital right now.

*patient squeezes hand*

Fellow: Sir, squeeze my hand if the sky is orange.

The patient did not squeeze his hand. Instead, he glared (or as well as you can glare with an endotracheal tube in your moth) and slowly raised his hand towards our fellow.

Only his middle finger was pointing towards the sky.

Simple Gestures Arrabbiata Sauce

because everyone knows how to show displeasure

Ingredients

  • 1 lb hot Italian sausage (removed from casing if that’s the only way you can find it)
  • 1 lb lean ground turkey
  • 1 tbsp olive oil
  • 1 really large onion or two medium onions, diced
  • 3 tbsp minced garlic (feel free to add more if you’d like)
  • 2 large cans diced tomatoes
  • 1 small can whole tomatoes
  • 1/4 c sugar
  • 1 c red wine
  • 2 tsp red pepper flakes (again, feel fee to add more to kick up the spice)
  • 1 tbsp dried oregano
  • 1 tbsp dried basil
  • Salt
  • Pepper

How-to

  1. In a large saute pan, brown sausage and turkey. Drain the fat and put into a really large crock pot (if it’s the largest size you can find, that’s the way to go. I know it might seem crazy to have a crock pot that big, but you can cook an ENTIRE CHICKEN, enough chili for a party, or enough of this sauce to last you for a few family dinners. Or, in my case, enough to have friends over for one meal.).
  2. In the same saucepan, add in the olive oil over medium heat. Add in the onions until they start to sweat. Add in the garlic and saute until they become translucent. Add these to the crock pot.
  3. Pour in the 2 large cans of tomatoes. Add in the smaller can of whole tomatoes after breaking up by squeezing with your hands (get out that anger!).
  4. Stir in sugar, wine, red pepper flakes, oregano, and basil.
  5. Cook on low for 6 hours or until your entire house smells of delicious tomato sauce.
  6. Salt and pepper to taste. Serve over a good large pasta with ridges (see the rigatoni, above!). Top with some freshly grated parmesan and my family’s favorite- cottage cheese (yes, I know it sounds weird, but that’s how we do it in my house. It’s the only way I’ll eat cottage cheese).

P.S. This sauce freezes beautifully!

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Snowcows and Steakhouse Leftovers

Sometimes nicknames get lost in translation.

I went to a teeny-tiny engineering school in the middle of Lake Superior for college. While the area is known for its magnificent fall colors, hiking, boating, and winter sports, it’s also known for the sheer lack of females.

In particular, my college class had a ratio of 8 guys to 1 girl.  The overall college was 3 guys: 1 girl at the time (it’s since improved). And still, the odds were not always in your favor. “The odds are good, but the good are odd” is a phrase that could definitely be applied to some of my male counterparts.

The ratio was also misleading…

  • If you subtracted the guys still dating their high school girlfriends, the ratio was 4 guys:1 girl
  • If you subtracted the computer engineers/science majors who thought that girls only existed in anime and had never spoken to a female in real life, except through a video game, the ratio was 2 guys: 1 girl
  • If you subtracted the man whores that you were sure were sources of an STD epidemic, the ratio was 1 guy: 2 girls
  • However, if you subtracted the female counterparts of the first and third lines, the ratio was still maybe 1:1.

There also was an unfortunate nickname for the girls that were less than desirable but would sleep with anyone…

Snowcows.

Anyway, it was the fall of my freshman year of college, and the grandparents and mother of the boy I was dating came to visit. During the exploration around the Upper Peninsula, we had the misfortune of stopping into a gift shop.

Now, somehow, his grandmother had heard the phrase “snowcow” (but, of course, just thought it was a cute term for any girl that went to Tech) so when she came across a cow puppet, there was logically one thing she thought of…

“Oh, here, let’s have you take a picture with this puppet! It’s two snowcows in the picture!”

I then was forced to endure a picture with said puppet, while my boyfriend at the time stood there absolutely mortified, since his grandmother had unknowingly just called me a whore.

Leftover Steakhouse Risotto

this is the only cow I’m okay being in a picture with

Ingredients

  • 4 c low sodium chicken or vegetable broth
  • 2 tbsp olive oil
  • 1 onion, finely diced
  • 4 garlic cloves, minced
  • 1 c arborio rice
  • 1 c white wine (I use a sauvignon blanc in the $8 range)
  • 1 tbsp butter
  • 2 c leftover roasted vegetables, brought to room temperature and diced into bite-size pieces
  • 1 c leftover steak, cooked rare, brought to room temperature and diced into bite-size pieces
  • 1 c grated smoked gouda (this gives it a mac-and-cheese type feel)
  • 1 tbsp steak seasoning (or more if you so desire)

How-to

  1. Bring broth to a boil, then reduce to simmer.
  2. Saute onion and garlic in olive oil in a large saucepan over medium-low to medium heat until onion is translucent (about 3-5 minutes)
  3. Add dry rice and saute for 2 minutes, stirring constantly.
  4. Add 1 c wine and stir until absorbed.
  5. Once the rice has absorbed the wine, start adding the broth, two ladles at a time. Your goal is to have this at a simmer. Stir frequently (but not constantly) until absorbed. Add more broth. This does take a while (you’re looking at about 20-30 minutes of active cooking from start to finish).
  6. Continue adding the broth at 2 ladles at a time until all the broth has been added. Add the butter.
  7. Cook, stirring almost constantly, until the risotto reaches your desired consistency (maybe another 5 minutes, tops!). Add in the leftover vegetables and steak.
  8. Turn the heat to as low as possible, then stir in the smoked gouda and steak seasoning. Remove from heat and cover for 5 minutes to let the leftovers heat up, then serve.

Psychiatrists Part 2 and Meatballs

It’s a rule in med school that residents and attendings are not allowed to ask out a medical student while they are overseeing them. Some people ignore that rule.

Now, this event occurred days after my last awkward encounter. This time, I was working in the Psych ER. This was a six hour shift in a room that was maybe 15 by 15 feet with at least 8 people occupying that space at any one time (and sometimes, more).

I was assigned to work with the resident that night, and the first thing I noticed is that there was something…wrong…with his face. Specifically, it looked like he had been attacked by a herd of clawed animals.

Which turned out to be the case.

Resident: My girlfriend just dumped me. She’s a vet. We had 8 cats that she left with me. I was holding one while I was crying and he didn’t want to be held.

Now, I like to think I’m a nice person, so I expressed my condolences. However, that was a mistake.

Resident: So, are you single?

(At this point, I’m wondering why on earth I’m getting asked this twice in one week.)

Me: Yes.

Resident: You seem like you’d be fun to date. We should get margaritas tomorrow. When are you free?

Now, this guy really wasn’t my type. Plus there was the issue of the 8 cats. Thankfully, I had an excuse up my sleeve!

Me: It’s actually med school policy that we can only have professional relationships with those that oversee us while we work with them.

Resident: Oh come on, no one follows that anyway. Go on a date with me!

I said no. He would not get the hint. He followed me up to the cafeteria when I attempted to escape to get a soda. He followed me around that tiny room. He kept asking. I kept saying no.

Finally, after about an hour of this ridiculousness, the social workers and nurses took pity on me and sequestered me into a corner with at least 2 of them standing guard at any one time.

Get the Hint Pesto Meatballs

just leave me alone so I can eat these! shown with my tomato sauce

Ingredients

  • 1 lb ground sirloin
  • 1 lb ground veal
  • 1 large onion, diced in large chunks
  • 2 eggs
  • 3/4 c breadcrumbs
  • 1/4 c parmesan, grated
  • 1/8 c skim milk
  • 4 tbsp garlic
  • 1/8 c pesto
  • 1/4 tsp pepper

How-to

  1. Preheat oven to 350 degrees Fahrenheit.
  2. In a blender or food processor, process the onion until smooth.
  3. In a large bowl, mix together onion slurry, eggs, breadcrumbs, parmesan, milk, garlic, pesto, and pepper.
  4. Break up the meat in large chunks and add to the other ingredients. Use your hands to combine.
  5. Coat a baking sheet or roasting pan in aluminum foil (for easier cleanup, but you can skip this step if you’d like).
  6. Use a cookie scoop to form round balls and evenly space meatballs in your baking sheet or dish.
  7. Bake for 30-40 minutes or until meatballs are no longer pink in the center (or use a meat thermometer to the ground meat setting).
  8. Serve with your favorite sauce on pasta or layer with sauce and mozzarella between two pieces of bread for a delicious sub. You could also coat these in your favorite sauce for an appetizer!

Psychiatrists and Spaghetti Sauce

There are things that you just don’t want someone to say to you.

While on my Psychiatry rotation, we had two weeks of various outpatient clinics. Now, in my opinion, psychiatrists are some of the most fun doctors out there. They tend to have some of the best senses of humor and they’re always having a great time.

However, my two most awkward moments in medical school did come on behalf of the psychiatry department (and yes, I promise the next story will follow).

So here I was, sitting in addiction clinic. We had a patient end up cancelling, and that meant we had about 45 minutes to chat. We had been talking about a number of issues normally- his new son, my research, the psychiatry curriculum in medical school- and then things took a turn for the worst.

Doctor: So, why aren’t you engaged?

Me (shocked and then attempting to be tactful): Well, I’m single, so that makes it a bit hard to be engaged.

Doctor (in an understanding, reassuring tone): It’s okay, I’m sure you’ll be married by the time you’re 40. And you still should be pretty by then, too.

He then moved on to some other topic, having no idea how insulting that was.

I saw this doctor last week at a conference and he pulled me aside to tell me how I have a brilliant mind. And no, I still haven’t forgiven him.

Get a Husband Tomato Sauce

maybe I should have started making this a while ago…

Ingredients

  • 3 lbs roma tomatoes, quartered
  • Olive oil
  • Salt
  • Pepper
  • 1 large onion, diced
  • 4 tbsp minced garlic
  • 1/2 c red wine
  • 6 oz can tomato paste
  • 2 tbsp dried basil
  • 2 tbsp dried oregano
  • 3 tbsp sugar
  • Garlic salt

How-to

  1. Preheat oven to 325 degrees. Place tomatoes in a roasting pan and drizzle with olive oil. Sprinkle with salt and pepper. Roast for 1.5 hours, checking about every 20-30 minutes to make sure they aren’t burning.
  2. Place tomatoes in a food processor or blender and pulse until it reaches your desired consistency.
  3. In a large pot, saute onion in 3 tbsp olive oil over medium heat until it just starts to become translucent. Add in garlic and saute for an additional minute.
  4. Add in tomatoes, red wine, tomato paste, basil, oregano, and sugar. Simmer over medium-low heat for 30-40 minutes while flavors blend. Your home will smell amazing and neighbors might come knocking at your door.
  5. Use garlic salt and pepper to taste.

P.S. My apologies for being gone so long! It’s a bit difficult to post without the internet or a kitchen!

Art Museums and Chicken Salads

There are things that you just don’t want to know about your teachers. You especially don’t want to see them.

French was my foreign language of choice (I also couldn’t take Spanish because I have no ability to roll my R’s, and that was a requirement at my school to take Spanish). However, due to a number of wacky circumstances, I had 8 different French teachers in 5.5 years of taking French, all of whom liked to start over at the very beginning. That essentially means that I still excel at conjugating verbs, but that’s about the extent of my skill set. (I can read some things in romance languages, though).

Okay, back from my tangent.

In high school, our teacher decided that we should take a trip to the DIA, since they were having an exhibit of French painters. We obviously all decided to go, since this was a full-day field trip and what high schooler doesn’t want to skip out on the rest of their classes?

That morning, we all hopped on the bus for our hour long trip to Detroit. To our surprise, our French teacher decided to bring her husband along on our trip.

Now, I should take a quick moment to state that my French teacher was a very socially awkward women in her mid-60s, and that her husband was a very round and also very socially awkward man in his mid-60s.

We got to the museum without any issues and spent the next few hours wandering around looking at art. However, it was soon time to move on to the next attraction, and our French teacher and her husband were nowhere to be found.

That is, until someone went and used the restroom. And reported hearing weird noises and two pairs of shoes in a stall.

We thus were all waiting outside the men’s room when my teacher’s husband, and then my teacher, emerged.

French class was very awkward for the rest of the year.

Socially Appropriate Chicken Salad

always appropriate for any occasion

Ingredients

  • 2 c chicken, shredded
  • 1 rib celery, diced
  • 1/4 c walnuts, chopped
  • 1/4 c dried cranberries
  • 1/4 c fat free greek yogurt
  • 1/4 c light mayonnaise
  • 1/4 c fat free sour cream
  • 1 tbsp tarragon
  • Salt
  • Pepper

How-to

  1. Mix together greek yogurt, mayonnaise, sour cream, and tarragon.
  2. Add in chicken, celery, walnuts, and dried cranberries. If mixture is too thick, thin out with some skim milk.
  3. Salt and pepper to taste.

Party Favors and Pizzas

What happens at a bachelorette party, should stay at a bachelorette party. Especially the party favors.

Since I’ll soon be moving to start my residency, I’m in the process of crossing a number of things off my bucket list. Because this is me we’re talking about, most of that involves eating food from some of our local restaurants.

On this particular day, I was quite exhausted (I’m still a bit worn out post-surgery) and decided that I’d cross one food off the list by ordering pizza. Now, to be honest I was more ordering pizza as an excuse to order breadsticks, but I can’t be faulted for that.

Anyway, my food finally came and I answered the door to the delivery guy, a man probably in his 60s. He was quite nice and polite at first. However, I had to set down my pizza in order to sign the receipt, giving the delivery man a view of my entire apartment.

He then got quite awkward, glared at me, yanked the receipt away from me after I signed it, and didn’t even respond to my polite “Have a nice day!”

For the life of me, I couldn’t at first figure out what had happened. My apartment was quite clean and I thought I looked rather presentable myself.

Then, I looked at the table that had been moved to right by my front door, and I realized what happened.

My delivery man was obviously put off by the large, hot pink penis straw (or “Sippy Dick,” as the bachelorette had called them) that was the only thing that was sitting on that table.

And yes, I had not noticed the presence of the penis straw on my table for 3 days…don’t ask me how that happened.

Eliminate Awkward Moments Pizza Margherita

if only I had just made my own pizza…

Ingredients

  • Pizza dough for 1 pizza (I normally use the Cuisinart recipe since that’s what I have, but any uncooked pizza dough from the store will do)- make sure you leave this on the counter for 20-30 minutes to come to room temperature.
  • Olive oil spray
  • 3 tbsp pesto
  • 1 medium tomato or 3 campari tomatoes, sliced thinly
  • 3-4 oz fresh mozzarella, sliced
  • Garlic salt
  • Pepper

How-to

  1. Preheat oven to 425 degrees.
  2. Spray pizza pan with olive oil. Take pizza dough and spread out on the pan. If it’s not stretching, give it a few minutes and try again.
  3. Spray pizza dough with olive oil (this will help the crust brown). Spread pesto over the crust up to 1in from the edge.
  4. Artfully arrange the tomato and mozzarella slices. Sprinkle with garlic salt and pepper.
  5. Bake for 14-18 minutes or until crust is crispy. Remove from oven, cut into slices, and serve.

P.S. I graduated from medical school yesterday- I am now officially an M.D.!

Sore Throats and Spicy Pizzas

Medicine has a learning curve. Some people just take longer to catch on.

My very first rotation of my third year of medical school was family medicine. At this point, we’re probably the smartest that we will ever be in regards to biochemical processes that cause any disease to happen or any medication to work, because we have just taken Step 1….or, in other words, the worst exam anyone ever has to take in his or her life. Step 1 is easily 100 times worse than the MCAT, which is the exam you have to take to apply to medical school.

However, though we are the smartest book-wise at this moment, we have never seen a real patient before in our lives (I’m not counting any of the standardized patients who teach us how to do physical exams)…and have not, in many cases, performed a variety of medical procedures.

Which is what led to the incident in question.

As I said, I was on my family medicine rotation at a small town and was there with one of my classmates. Now, this classmate (who will be featured in a later post) could be described as quite eager but also quite awkward. And that might be the biggest understatement of this particular post.

Anyway, my classmate on this particular day came running into the clinic room to excitedly announce that his patient had a sore throat and needed a strep test. And, since this clinic was quite busy (all 4 physicians there had 2 patients booked every 15 minutes…they had 2 coworkers out on medical leave and thus were having to pick up all of their patients), and since I had performed multiple strep tests at this point, they sent me in with my classmate to provide instructions.

Now, many of us have had a strep test before. but for those of you that haven’t, what essentially happens is that one needs to swab the back of one’s throat with an elongated q-tip and stick it in a liquid that shows quickly if a patient does or does not have strep throat.

I walked into the exam room as my classmate was approaching the patient…but not with the correct swab.

I saw the patient’s eyes begin bugging out, so I quickly stepped over, grabbed the correct swab, and said, “I think that we can use a smaller swab than that, don’t you?”

What kind of swab had he grabbed, you ask? A huge swab (think of a giant cotton ball at the end of a long q-tip) that is only supposed to be used when doing a pelvic exam to clean off the cervix.

That woman had no idea how close she came to a REALLY unpleasant experience.

Kill the Sickness Spicy BBQ Chicken Pizza

the spice will kill whatever ails you

Ingredients

  • Pizza dough for 1 pizza (I normally use the Cuisinart recipe since that’s what I have, but any uncooked pizza dough from the store will do)- make sure you leave this on the counter for 20-30 minutes to come to room temperature.
  • 1 c spicy pulled chicken (or see note below)
  • Olive oil spray
  • 2 tbsp light ranch dressing
  • 2 tbsp barbeque sauce
  • 1 c 2% shredded cheddar cheese
  • 1/2 bell pepper, diced
  • 1 tsp garlic salt
  • 1 tbsp parsley

How-to

  1. Preheat oven to 425 degrees Fahrenheit.
  2. Spray pizza pan with olive oil. Take pizza dough and spread out on pan. If the dough doesn’t appear to be stretching, let it rest for a few minutes, then try again.
  3. Spread ranch dressing and barbeque sauce onto the pizza dough. Top with cheddar cheese, then the pulled chicken and bell pepper. Sprinkle with garlic salt.
  4. Bake for 14-18 minutes or until crust is crispy. Remove from oven and sprinkle with parsley. Cut into slices and serve. If desired, top with a bit of cole slaw.

Note: If you don’t have any spicy pulled chicken on hand, make a quick version- mix together 1/8 c sriracha and 1/8 c barbeque sauce and stir in 1 c shredded chicken. Cover and place in the fridge for at least 30 minutes so the flavors can get into the chicken.