Meet Mayo Med

The Official Blog of Mayo Clinic School of Medicine

Posts (4)

Apr 8, 2015 · Calzones: Proceed as Indicated

Just three weeks into my general surgery rotation, I have continually been given the privilege to “close”, or stitch shut, the incision. It sounds like I might be a reserve star pitcher, but really, it’s the grunt work OR job for medical students. Since I’m not allowed to do anything more exciting at this point—like stitch any visceral organs shut—I thought I would practice my suturing skills on a calzone.

A calzone with sutures

Calzone with sutures (makes enough for 3 calzones)

Ingredients for the Basic Pizza Dough

  • 1-cup sourdough starter
  • 1 1/4 cups water, at room temperature
  • 2 tbsp. extra-virgin olive oil
  • 2 cups (22 oz.) bread flour, plus more for dusting (used all-purpose)
  • 2 cups whole-wheat flour
  • 1 1/2 tsp. salt
  • Olive oil or non-stick cooking spray for greasing the bowl
  • For the Extras
    • 3 cups pizza sauce (I use marinara)
    • 4 ounces mozzarella, shredded
    • 8 ounces sliced pepperoni
    • 3 tablespoons grated Parmesan

DIRECTIONS

  1. Measure the warm water and oil into a bowl and add the sourdough starter.
  2. Add flour and salt to the liquid ingredients. Knead until the dough is smooth and elastic for about 5 minutes. Form the dough into a ball, drop in a deep oiled bowl, and cover with plastic wrap. Let rise until doubled in size, about 1 1/2 to 2 hours. Press the dough to deflate it.
  3. Shape into smooth round ball and cover with a damp cloth. Let dough relax for at least 10 minutes (no more than 30 minutes).
  4. Brush rolled out dough with oil. Spread 1 cup tomato sauce even over dough round, leaving ½ inch border. Sprinkle one half with 1-cup mozzarella, and cover with pepperoni, or topping of choice. Fold in half and scrub in.
  5. Find a needle driver and pick-ups.
  6. Closing a calzone has long been a tricky practice fraught with error. In my previous iterations of this effort, I have tried a folding pleat technique. Prep your calzone with conscious sedation (talking gently to it will work if you don’t have Versed and fentanyl) and instead of betadyne, rub the belly or exposed area with olive oil in a circular fashion (always move from clean to dirty).
  7. Now, I tried several different types of silk, but braided Ethicon 2-0 non-absorbable had the best tension and well withstood the oven temperatures. I also experimented with three different suture patterns, subcuticular stitch, interrupted horizontal mattress stitch, and, the best—continuous running stitch.
  8. When your stitches are in, slide the calzone on a peel (covered with corn meal) onto pizza stone (which you should have heated for at least 30 minutes at 500 degrees) and bake for 8 to 12 minutes. Remove pizza from oven and sprinkle with Parmesan or more mozzarella.
  9. Repeat with the two other rounds. Enjoy!

Just remember—remove the sutures to eat the calzone. Or before you bring it to a party. Unless it is a party full of surgeons. Then they are all going to want you in their OR.

calzone1

calzone2calzone3calzone4

 

 

 

 

 

calz5calzone6

cal7

calzone8

 

 

 

 

 


 

 Rachel is a fourth year medical student at Mayo, where she practices narrative medicine, food and jazz as personal subspecialties on her way to a career in psychiatry. A girl from Portland, OR, she is (as you might suspect) rather granola, and you can follow her foodie adventures with her not-so-vegetarian bulldog and vegan backyard chickens on Twitter @hammer_rachel.

Feb 25, 2015 · Sourdough Lungs: An Anatomy Primer

It has occurred to me, late in the game, that all of this time I could have been using my bread baking not only as catharsis but also as a study device. Bread can be more than nutrition; it can be education. Let me explain.

Because I spent the last week in the ICU and was constantly doing chest X-rays and fussing with tracheostomy collars and ventilators, it got me thinking about the lungs. I considered making a ventilator in a square pan, but that seemed a bit square. Going for the anatomical, I decided instead to make bread lungs. It made the most sense to create a pull-apart bread recipe, to better represent the lobes of the lungs, and, because I am on a surgical rotation week after next, to practice my lobectomy. Kudos to any pathologists out there who can make apt diagnoses as to the health of these lungs.

Bread as Lung Loaves

Bread as Lung Loaves

Pull-Apart Wheat Bread Lungs

  • 1 1/4 cups lukewarm water (85°F to 95°F)
  • 1 cup sourdough starter
  • 1 cup warm whole milk (105°F to 115°F)
  • 2 tablespoons honey
  • 1 tablespoon salt
  • 1/4 cup olive oil
  • 2 1/2 cups whole wheat flour
  • 1 tablespoon unsweetened cocoa powder
  • 3 1/2 cups bread flour

Warm milk, stir in honey and salt, then add olive oil. Add 1 1/2 cups of whole wheat flour and stir. Then stir and pour in the entire starter. Mix in raisins and walnuts, then cover the bowl. Let the dough rise and double in volume in a warm draft-free area and spray a baking sheet.

Loaves separated into lobules

Loaves separated into lobules

Now for the educational fun—shaping. How many lungs does a normal person have? Separate the dough into two equal sections.

How many lobes are in the right lung? Three (Right Upper, Right Middle, and Right Lower) The right lower lobe should be the biggest, and the right middle the smallest, so section the dough appropriately. The left lung has two lobes (Left Upper and Left Lower). Why? Because the heart bears leftward due to the heavy gravity on the muscular left ventricle.

Okay—now to assemble the pull-apart lobes—refer to the following anatomical diagram (also for review for you medical students out there)

Lung Anatomy

Lung Anatomy

On the right side, you need to form the horizontal fissure between the right upper and middle lobes, and the oblique fissure between the top two and right lower lobe. The left is easy. Just angle the oblique fissure toward the cardiac notch. If you want to be a real gunner, and I am not, you could create medially some crystallized ginger hilum with the pulmonary arteries, veins, and main bronchi. For medical students, don’t forget the RALS rule (pulmonary artery in Right is Anterior to the bronchi and in Left it is Superior—that’ll save you on the anatomy lab practical).

Okay, enough nerdiness, time to bake!

The loaves ready to bake

The loaves ready to bake

Transfer lungs to prepared pan, being careful not to deflate—no one wants atelectatic bread. Cover the loaf and let it rise in a warm draft-free area for about 45 minutes. Meanwhile, preheat your oven to 500°F and spray with water to help with crusting. Next place the bread in the oven, lower the temperature to 400°F, and bake until crusty. Finally, cool it on the pan and then on the rack completely.

Cooled down loaves

Cooled down loaves

I’d say this patient was a smoker. It’s because of the glaze–one whole egg mixed with 2 tbsp milk (optional). Perform lobectomy and enjoy while you study!

 Rachel is a fourth year medical student at Mayo, where she practices narrative medicine, food and jazz as personal subspecialties on her way to a career in psychiatry. A girl from Portland, OR, she is (as you might suspect) rather granola, and you can follow her foodie adventures with her not-so-vegetarian bulldog and vegan backyard chickens on Twitter @hammer_rachel.

Dec 17, 2014 · DBT - The Tastier Version!

bean-brownie-batterI’ll admit sometimes I eat brownies for breakfast. If they happen to be out, and I’m whirling through the kitchen to get dressed and upright on the moped and into the hospital, I’ll grab a brownie and chase it with a pot of coffee.

I’m getting help. Actually, I’ve invented my own Crisis Hotline for others. I call it Dialectical Brownie Therapy (DBT), an adaptation of a cognitive treatment known as dialectical behavioral therapy, and I’ve been learning to practice on my current psychiatry rotation. For my version of DBT, as in real Dialectical Behavior Therapy, the goal is to seek a synthesis between two extremes, between feeling overly controlled and feeling out of control.

When I eat brownies for breakfast, I get caught in the Hegelian dialectic between 1) my own out of control emotional vulnerability of wanting the goodness of a gooey brownie regardless of the health consequences and 2) the over controlling invalidating environment that shames me for wanting to eat chocolate for breakfast and oversimplifies the ease of reaching for the banana or granola instead. I get caught between blaming myself and blaming others for the problem of brownies for breakfast. Only after significant work at distress tolerance did I arrive at a revolutionary conclusion: I am fine to have brownies for breakfast (acceptance) AND the brownies need to be radically different, healthier (challenge).This is the fundamental approach to DBT—be both entirely supportive of yourself and entirely challenging—at the same time. I love a good paradox. This is also the mark of a good teacher, and, consequently, the mark of a good doctor.  Support students/patients while you challenge them. Constant support AND unrelenting challenge. So, I put a can of black beans and ¼ cup of flax seeds into this chocolaty pan of goodness. Now my brownie breakfast has protein and fiber and I can eat them with peace and sublime satisfaction.

Dialectical Brownie Therapy: Bean and Flax Brownies (Recipe adapted from the HyVee Seasons Fall 2013 magazine. Theory adapted from Marsha Linehan, PhD, and Hegel)

  • 1 (15 ounce) can black beans, rinsed and drained
  • 1/4 cup flax seeds
  • 1 1/2 cup  semi-sweet chocolate chips
  • 1/4 cup  unsalted butter
  • 3/4 cup  olive oil
  • 1 3/4 cup  sugar
  • 1 tablespoon vanilla extract
  • 3 large eggs
  • 1 1/3 cups all-purpose flour
  • 1/2 cup plus 2 tbsp. unsweetened cocoa powder
  • 1 teaspoon baking powder
  • 1/4 teaspoon salt
  • 1/2 cup  mini semi-sweet chocolate chips

Preheat oven to 350 degrees. Grease a 9-by-13-inch pan with non-stick cooking spray.

Puree black beans and flax seeds until smooth. This will look so gross. Practice self-soothing.

bean-brownie-ick

Place puree, semi-sweet chocolate, and butter in a large heat-safe bowl over pot of boiling water. Whisk until melted, add olive oil and eggs one at a time. Mix thoroughly, remove from heat.

bean-brownie-chocolate

In a large bowl, sift flour, cocoa powder, baking powder and salt. Mix. Add chocolate mixture to flour mixture and stir. Pour into baking pan and smooth top. Sprinkle mini chocolate chips on top.

bean-brownie-batter

Bake brownies for 35 minutes. They may seem underdone but they will continue to bake in the pan after being removed from oven.

Each time I bring one of these brownies to my lips I get the warm fuzzies knowing how supportive I am being of myself. The brownies can be healthier still—maybe next time I make these, I’ll add bananas or something.

By appropriating the acronym for my silly brownie blog post, I mean no disrespect, and wish to convey no satire. I have high esteem for the real DBT and think the whole world and their grandmothers should practice these skills on the regular.

 

Rachel is a fourth year medical student at Mayo, where she practices narrative medicine, food and jazz as personal subspecialties on her way to a career in psychiatry. A girl from Portland, OR, she is (as you might suspect) rather granola, and you can follow her foodie adventures with her not-so-vegetarian bulldog and vegan backyard chickens on Twitter @hammer_rachel.

Oct 28, 2014 · Keeping Surgeons Nice with Maple Pumpkin Spice!

oatmeal-cookiesSo I was scrubbed in on a colon operation the other day, and the senior resident had been teasing me for bringing my sourdough starter with me to Florida for my surgery rotation. No one understands how important fresh bread is to my sense of well-being. The attending colorectal surgeon, who is a lovely, soft-spoken man, muttered very quietly, “If you make oatmeal raisin cookies, you get an A on this rotation.” I don’t need much of an excuse to bake something new, and this recipe I cobbled together from a bunch of different sources is definitely worth an Honors grade in surgery. As such, I am taking the man at his word, and of course I used the baking process as an opportunity to study:

Maple Pumpkin Spice Oatmeal Raisin Colon Cookies Recipe

  • 1 1/2 cups all-purpose flour
  • 1 teaspoon ground cinnamon
  • 1 teaspoon freshly grated nutmeg
  • 1 teaspoon ground ginger
  • 1 teaspoon ground cumin (key secret ingredient)
  • a pinch ground cloves
  • a pinch chili powder (KEY! But don’t tell anyone you put this in, they’ll never know)
  • 1/2 teaspoon baking soda
  • 1/2 teaspoon salt
  • 2 sticks (1 cup) unsalted butter, softened
  • 1 cup packed brown sugar
  • 1 cup granulated sugar
  • 1 large egg
  • 1 teaspoon vanilla
  • 3 cups quick maple flavored oats
  • 1 cup raisins

Preheat oven to 375°F. Sift together flour, spices, baking soda, and salt in a bowl. In a second bowl beat together butter and sugar until fluffy and then beat the egg and vanilla in. Combine the two mixtures, add rolled oats and raisins.

Now for the medical education and silliness, there is an artistic element to this recipe that I have designed in tribute to my attending:

colon-cookie-log

Take your average cookie dough size bolus and roll it into a log. Twist the log into a question mark —which are, of course, the hepatic and splenic flexures of the large bowel. You do not need the Lines of Toldt to support the colon here, only parchment paper.

colon-anatomy-picture

If you are an over-achiever, you could also form little humps for haustra and create three longitudinal grooves for the teniae coli or make little dingle-ball epiploic appendages. But that might be a bit too aesthetically suggestive and might cause your cookie-eaters to regurgitate a little.

colon-cookie-doughcolon-cookies

And, as happened with mine, once you bake them, the meticulously shaped colons will all just flatten into little butt shapes, which, is a rather humorous and appropriate transformation.

colon-cookie-anal-fissure

Inspect the serosa for perforations or thickenings suggestive of malignancy or Crohn’s skip lesions. You’d have to do a cookie colonoscopy to check for ulcerative colitis, because that disease involves just the mucosa, and I don’t have the equipment for that (patent pending). If you accidentally tear the cookie colon, don’t worry, just divert the bowel into a stoma and leave a Hartmann’s pouch– give a day of post-op antibiotics to decrease the risk of peritonitis. Okay, that’s enough studying. Time to eat the cookies!

Bake for 10-12 minutes, cool, and serve. YUM!

Don’t worry, you are not what you eat—but do eat fiber to keep yourself from ever having to visit the colorectal OR. No fiber = diverticulosis (very difficult to see the outpouchings in cookie colon imaging). So in regards to colon health, these cookies are pretty good for dessert! And they taste amazing—the pumpkin spice and cumin/chili powder are key ingredients, believe me.

Best feedback ever—my attending ate six of them in a row. Definitely will pass surgery with flair.

 

Rachel is a fourth year medical student at Mayo, where she practices narrative medicine, food and jazz as personal subspecialties on her way to a career in psychiatry. A girl from Portland, OR, she is (as you might suspect) rather granola, and you can follow her foodie adventures with her not-so-vegetarian bulldog and vegan backyard chickens on Twitter @hammer_rachel.

Contact Us · Privacy Policy