Monday, July 27, 2009

Leaks in the system

It is surprising to me that people still show indignation at the fact that human beings will avoid cost to themselves. Here’s yet another way to avoid buying costly improvements to your hospital, thereby compromising your anesthesia providers.

While anesthetic gases are not well studied enough to clinically prove harmful, there are anecdotal studies that show a larger number of spontaneous abortions among anesthesia providers. Additionally, full dose anesthetics are known to be teratogenic. There is still a question whether over the long term they are carcinogenic.

OSHA makes guidelines for the amount of anesthetic gas allowed to be in an OR throughout the day (2ppm of halogenated agents with 100% O2, 0.5ppm of halogenated agent with N2O and 25ppm of N2O alone all over an 8 hour period). Apparently, hospitals have found a sneaky way to avoid getting real numbers. They take samples from ORs not in use, or before the day starts or after all the cases are over. This is the time when the least escape gases are present.

Monday, June 8, 2009

drunken rambling

School is taxing. So far only in anxiety. The first exam i took was as i expected actually. It was very practice based and structured like undergraduate NCLEX nursing exam full of absolutes and lacking all substance or clinical. ML and i spent a good hour discussing the disappointment with the "IL program." It turns out it's no different. But these are things i expected. Being in such a highly specialized field changes a lot of things you would expect. Though in defense, i have some really challenging classes. Pathophys, for instance, is over my head hard, which is rare these days in medical info.

Unfortunately (or fortunate for you) some of us care about knowing some of the finer points, and thus, want to read more. I take it with less intensity. ML really thinks that it's important. I love it for research, but know that we'll never see the say, the finer opiods...oh, i learned about one of those and i was amazed that there is a more potent opiod than Fentanyl.....that's mind boggling to me.

It's *extremely specialized* all of it. Some people will argue that this is crazy that you can prescribe meds without knowing all of them....but *who can?* The field of medicine is so vast, that the only choice anymore is to specialize in one tiny part of the bigger picture. I have an *enormous* amount of respect for primary and emergency providers, b/c they must weedle down the components to their "specialty" for referrals. Some people seem to think this is a cop out. Maybe in a broader picture, but to look at so many disciplines and appropriately choose the specialty is nothing short of amazing (if done correctly). Plus you have to deal with all the BS sniffles that make it a completely thankless job.....

Anesthesia, it turns out.....is *amazingly* specialized. But it's not new to me, who has chose n weird professions from the beginnning....full of nepotism, and favoritism and questionable legal status and all that it entails....i don't quite know why i'm drawn to these weird "border" professions. But i simply am.

Currently i am distracted by "purple screen" on the Star trek (the original) view screen. Turns out purple is as bad a color as red. Oh wait.....there's the red.....

Incidentally, i thought that the Van Pelt was my dream library....it turns out it is the fine arts library. It reminds me of the library in Dublin....full of beautiful caves and quiet and solemn.....full of stained glass and dreams of being full of mystery. I think i'll study there more often. It enforces a quiet that nowhere else on campus does. Houston Hall is cool, too...but in a loud fireplace and fun kind of way. I call it "Penn's Hunting Lodge...." without the dead animals on the walls.

Our A/C works.
I hope hell has A/C, too.

Oh! and i got to play 4 square in Rittenhouse tonight. I miss 4 Square and am *incredibly* glad it has stayed acitve in the 2 years i was gone. A line of 20 players! wooooooo!
Oh and favorite gelateria: Capogiro. Make sure that if you come visit i take you to have the most amazing cold food you've *ever* had.

Tuesday, March 24, 2009

Making ze first corn chowder

Because i seem to rarely post, i decided that i would try just writing about *anything*, even the mundane, to get myself back to regular writing. Here goes....a recipe attempt, my discoveries and my decisions for future attempts.

(This conveniently also helps me remember things that i know that i won't write down and then i'll make the same mistakes again.....so it's more than just a little slf-serving.

I decided on a non-meat based version from William Sonoma. I find that WS’s recipe website is a good resource to use as a base but the frustrating thing is that WS expects either a good knowledge of the cooking craft, or use of their items (so advertising is a bore) or really high quality ingredients.
I used their white sweet corn chowder recipe as a start and eliminated the things that I didn’t have at that moment (I made a quick visit to the store prior to visiting the recipe site) being thyme and fresh chives. I also chose to use fresh corn, halved the recipe except for the butter (which I think adds a little something to just about any recipe).

I also added a ready made WS seasoning (the herbs de Provencal…..it has some fennel, a touch of lavender, thyme, and basil….
I also hate celery with a bloody passion, so I exchanged red bell pepper .

Cooking the fresh corn takes a little longer if you’re just light simmering. I doubled the time to get still very crunchy corn bits.

The Herbs de Provencal sounded like a good idea, and were to some degree….if that was what you wanted to taste. Better to just stick with the one note spice of thyme probably for the future. Also, it is easy to under pepper and under salt this dish. I compensated with table spicing and adding some delicious trader joe’s Mexican cheese blend.

Served best with a hard cider or a nice light citrusy white. (I ended up with two Cabernets, so I really believe you should drink what you want ;)

Original recipe:
White Corn Chowder

Ingredients:

4 to 6 ears of white corn, husks and silk
removed

4 Tbs. (1/2 stick) unsalted butter

1/2 large yellow onion, minced

1 large celery stalk, minced

1 lb. russet potatoes, peeled and cut into
1/2-inch cubes

2 cups chicken stock

1 cup water

1 1/2 tsp. minced fresh thyme

1 cup half-and-half

Salt and freshly ground pepper, to taste

3 Tbs. thinly sliced fresh chives
Directions:

Holding each ear of corn by its pointed end and steadying its stalk end on a cutting board, cut down along the ear with a sharp knife to strip off the kernels, turning the ear with each cut. Alternatively, remove the kernels with a kernel cutter. You will need 4 cups corn kernels. Set aside.

In a large saucepan over medium heat, melt the butter. Add the onion and celery and sauté until soft, about 10 minutes. Add the potatoes, stock, water and thyme and bring to a simmer. Cover, adjust the heat to maintain a gentle simmer and cook until the potatoes are almost tender, about 8 minutes. Add the corn, cover and continue to simmer gently until the corn is tender, 3 to 5 minutes more.

Transfer about 4 cups of the soup solids to a food processor along with enough of the cooking liquid to achieve a puree. Secure the lid and cover with a kitchen towel. Process until smooth and return to the pan. Stir in the half-and-half and season with salt and pepper.

Reheat the soup gently over medium-low heat. Ladle into warmed soup bowls and garnish with the chives, dividing evenly. Serve immediately. Serves 6.

Adapted from Williams-Sonoma New American Cooking Series, California, by Janet Fletcher (Time-Life Books, 2000).

Alterations:
No thyme, instead, WS Herbs de Provencal (mistake)
Sub one red bell pepper for the celery (delicious)
No chives (no obvious difference)
Add Trader Joe’s Mexican Cheese for garnish/addition at table (there is nothing that cannot be improved with cheese)
Cooking time for corn X2 (necessary for it to not be uncooked)
Added double butter (Yum!)


Photos to be entered into record in a bit.

Monday, January 5, 2009

Born Under Punches

I feel it worthy of internet mention that i had an epiphany today about Born Under Punches by the Talking Heads. I was truly impressed today when i sat in the car singing the following lyrics and finally felt them in the deep heart of internalization:

All i want is to breathe
Won't you breathe with me
Find a little space
So we can move between
Keep one step ahead
Of Yourself.

Perhaps others have had this revelation earlier, and i've always kind of gotten it, but today its full meaning circulated, jostled my core and turned on the little light in my head.
Thanks Mr. Byrne.

Monday, September 29, 2008

Fitz Roy!

It was worth every moment of struggle, all the evil, weirdly positioned blisters, and every ache i feel from shoulders to toes. Patagonia is, hands down, the most amazing place i have ever hiked. I believe that is because everything is som much bigger in this world. The unbroken skies lay splayed out for all to have a view. One can escape people easily. One is encouraged to stray from the trail to follow moonbeams or hearts or whatever. I am feeling a loss as i come to my last day here.....i don´t really want to give this place up.

In an attempt to make the most of my hiking time, i ended up hiking to the highest point newa the collusus without actually requiring climbing gear. It took 8 hours round trip, and that was hauling a bit at the end. I only stopped to eat a quick lunch and take some photos up top....Laguna de los tres is currently a snow covered ice skating rink (despite my history of stupidity in the wild, i didn´t run down to test the ice...).

I can´t help but think about strange things when i hike. For instance, i thought about damsel fish protecting their eggs in San Pedro, Belize and me able to fight with them with my finger (without really being an agressor that wanted to eat their babies). I suppose it´s a back door reminder that there are places in the world to which i would return in a heart beat. El Calafate ranks high on the list.....Actually, i´m ready to buy property here. But eventually, if its exponential growth continues, it will be as frustrating as any other vacation destination.

As of today, i have had more lamb than i have had in my lifetime before this, and i don´t want anymore salami and cheese sandwiches for a long time.

Last night i also made an amazing discovery: my hotel room has mirror defrosters so that when you shower, you don´t keep it steamy. Talk about awesome. Not to mention there is this awesome little bench that looks out over the lake with comfy pillows and a light by which to read.

Hertz rented me such an awesome car, the door handle broke on the driver side. Woo hoo! good thing i´m limber.

I still suck at Spanish.
I met another woodpecker, red eyed birds, little birds with long beaks plucking bugs out of stumps, ibisses, plovers, and a falcon attacking two little birds in flight. I heard this crazy whooshing sound and there they were above me. Still, there have been no tiny deer and no puma. =(

Saturday, September 27, 2008

moreno glacier, asadors, new friends

Hiking atop the Moreno glacier is otherworldly. Having hiked on top of a glacier (twice) i can tell you it´s not like hiking in either the US or in Austria. The longest glacier and that of Mount Ranier must move more slowly than those of Argentina and Chile. Today i sat and listened as the Moreno glacier moaned to itself and cleaved giant piece into its glacial lake in protest of the sun and the heat of the day. Whereas the glaciers i´ve seen before seem relatively stable and friendly, this glacier seems like it´s ready to throw anyone who might set foot in the wrong spot.

That´s not entirely fair to say of course. These glaciers seem less ready to open giant crevasses under you if you step carefully.

Doing the ¨big icë¨tour was fun. I met some awesome people, and saw some things i´ve never seen before. Giant lagoons in ice are just one. Then there were the holes that seemed to come from no where and lead to the caverns and floes below. Some dove 100 meters under the ice. Drinking glacial water could make me consider drinking water only forever. The mountains rose around us, and naming glaciers here is simple. There is a north branch, an east branch and a main branch of the moreno glacier, instead of the Kautz and the renauld and etc, for each little outcropping or part of a glacier.

I can´t get over the delay of sound. That and simply the enormity of the things. They are like nothing you will ever meet, unless you travel to Greenland or Anarctica. It is impossible to explain what it looks like as you approach, or sitting atop a cliff next to this monster.

I met some lovely people: Glyn, from Wales, overly tall and with a prize-winning beard, who can name the longest Welsh town visited by train. It´s so long that all i can remember is go go gough which means red cave...but there´s something about a saint and some colors other than red and some crazy war that led to the name i can´t remember. There is Lance who both has friends in Japanese prisons and who likes to create fishtank ecosystems in his spare time and who can tell unrivaled, captivating stories of people and places. And there´s Ella who charms with her confidence and presence and can make you laugh and feel honored to know her just by smiling at you.

Yesterday we attempted a view of Fitz Roy. That bloody mountain stayed veiled in cloud an sleeting rain for us all day, despite a persistence through rain and long walks. I´m determined to find him tomorrow.

At the end of yesterday we found an Asador which serves barbacued meat. We all ordered the Patagonian specialty of lamb. Was it just a long day of hiking, or is mountain lamb the best thing ever? It even made the Malbec taste nice. Sorry Marty, still can´t find a heart for the special grape that makes Argentina famous.

Tomorrow i promise myself some delicious beef, because truly there is nothing quite like Argentinian beef. Especially when it is raised here, in Patagonia, under the shadow of these mountains and hills, free to roam hundreds of miles before being led to slaughter.

I also managed to try M&M´s famous calafate berry ice cream. It was more wondrful than promised, but had nothing on the MYM. mmmmm. merengue, caramel/dulce de leche and cream. Who could ever resist. I will return to the owner who invited us for Mate and patient conversation.

Having seen the moreno glacier, i am glad i have come at a time before the big tourism starts. I found the old trails that led to views of the glacier when only 1000 visitors a year showed up here. It was beautiful and quiet, and unlike the metal framed walkways that brought the loud families that ceased to feel awe and wonder and talked through the moaning of the glacier as it moved and churned and threw ice around in protest. In two years time, the earliest before i can return, the feel will change and it will become like any other park: full of people hoping to win a lottery, and unsatisfied with the simple pleasure of seeing something so massive and strange that it makes their heads turn and their eyes fix on something other than television sets.

Simultaneously, i am thankful to those tourists for a paved road to El Chalten. It wouldn´t exist if the number of people hadn´t exponentially grown so dramatically. Tomorrow i shall drive again to see the great Fitz Roy and his friends. Maybe i´ll catch view of the glacier Viedma again, too. Everything here is so enormous and different. Even the sky is different. I still haven´t found the southern cross and familiar constellations are missing. The clouds promise something as i write postcards from my little sitting bench in the hotel room.

I feel good about myself for bailing out a pleasant local who had managed to flatten 2 tires trying to get the crazy green rock into El Calafate for some rich bastards who wouldn´t settle for anything less. He asked if i always pick up people on the side of the road. I said only when they look desperate. Turns out that in addition to relocating large rocks, he is also an announcer on the Upsala Glacier tour on which i went. He does the English translation. No one that i have met here is anything less than amicable.

We live in a beautiful world. Truth is, i miss you. If you´re reading this, you know who you are.

Fauna count: crazy chicken, falcon hunting in tall grass that let me watch him as i cruised the local ¨highway," geese that mate for life, three kind of rodent sparrow, a "woody woodpecker" woodpecker and its mate, hares, cows, sheep, guiaca, and giant condor. Still no llama, huepac, or ostrich.

Friday, September 26, 2008

Entering El Calafate

The airport at the entrance to this part of Patagonia is about as small as that of Hayden near SBS. I mean, tiny.....thank goodness this place is full of people who speak English, because at one time, i´ll bet it was difficult to navigate this place with the microscopic command of Spanish i possess. The town is truly a mountain town in its own right--a south American village of Zermatt or Aspen, but with less pomp. The traffic here stops for pedestrians and there´s a policia control on the way in....they check to see that your lights are working and you don´t look like a drug smuggler. "where are you coming from?" and that sort of thing. Makes me wonder if El Calafate is in danger of being overrun by Banditos.

I have a hard time remembering i´m on the other side of the world, as i listen to U2 in concert and look out over the little town surrounded by some of the most beautiful landscape i can imagine.

I´ve made the best decision in three weeks for dinner: lamb ravioli. Yummmmmmy. In Pura Vida (recommended by the Moon Guide, but with no "moon" designation, the style is eclectic, santa cruz hippy: paper and star lanterns, dream catchers and local woven wear. The subdued lighting is cozy and understated and we´ve wandered into happy downtempo like Theivery Corp and others (like the French sultry sounds of the future which is right now). The ravioli is filled with a delicious tender chopped lamb and pumpkin (a popular addition to all the food here) with a bit of cheese in a handmade pasta shell. The onion and olive cream sauce compliments the larger than normal bits of genius. the pepper might have been a a little finer (whole peppercorns at times). But this is the first time i´ve seen pepper in two weeks!

They also have half bottles of wine that i didn´t see from the start. It´s a nice touch for those of us who eat alone, but would prefer to avoid drinking for those who are absent. All of the cheap wines i have had so far have been utterly drinkable. Here is the Postales del fin del Mundo cabernet. When i say it, i think of things wonderfully sweet, melancholic and pensive.