A Rooftop Dinner

A recent trip to New York City left me many fond memories, including fantasies of a fabulous rooftop dinner hosted by my friend Kristina who is attending Columbia University School of Nursing.
We all know that a rooftop dinner means three things: delicious food, a great view, and delightful company.  This post is a tribute to delightful company, a shout-out to all my friends new and old.

Thanks ladies for a wonderful weekend.

A specific thanks to the friends who speak encouragement into my life. 

(For more fun, check out Jenna's blog! She's the cutie in the dress.)

On our way to Ellis Island.

He was so amazing!  ; )

George Washington Bridge, NYC

 

Check out Cindy's blog, (on the left).  Her video-blogging about life in NYC cracks me up.

Thoughts on rooftop dinners?
Thoughts on friends?  
Don't you love these corny posts?  *wink*

Friday is such a promising day; let's see what the weekend brings!

Cheers,

Rachel

Lesson 6: Changing Hats

flickr photo from splinkyhoo

The dietetic internship goes on: first week on the Intensive Care Units (ICU) is over!  Learning-induced headache?  Yes.  Excited to work this weekend?  No.  Thankful for the amazing ICU staff?  Yes.  These nurses and docs are the best!

The ICU houses the very sickest patients in the hospital-those most likely to need breathing support, fluid stability, and pain control.  From a nutrition standpoint, many of these patients need feedings through tubes and IV catheters.  Calculating IV nutrition is a new role, and a new hat that I'm adding to my closet.

(Photos from a NYC trip last month.  Pardon my randomness.)

People often ask me, "What is a dietitian?  What are you learning in the hospital?"  Earlier I wrote about a dietitian's contribution within the larger medical team.  As a member of this team, a dietitian must don different hats depending on the situation.
Examples From the Hat Rack:

• Educator:  (A unique role that doctors do not have time to do!)  In a few brief minutes, dietitians provide knowledge and application on a variety of topics spanning carbohydrate foods for a newly diagnosed diabetic, to food safety instructions post kidney transplantation.  No poking, no prodding, just talking.  And I love the talking!
• Cheerleader: After 10 days of nausea and vomiting, a patient wakes up with an appetite.  What to do?  A dietitian pulls out her pom poms to cheer her on, shouting out tips and encouragement to optimize eating and nutrition.    
• Nutrition Support: Sometimes a patient needs IV nutrition or tube feeding because they cannot eat.  That's when a dietitian whips out their calculator to calculate and concoct a feeding formula to meet a patient's individual protein, calorie, and fat needs.  I like doing this work.
• Consultant: A man with cerebral palsy is admitted with breathing problems and a mysterious 40 pound weight gain in recent months.  While the doctors tend to his respiratory needs, a dietitian is consulted to assess the weight situation.  What are the specific energy and protein needs for a man with cerebral palsy (they are actually decreased due to less muscle mass and activity)?  How much weight, if any, should this patient lose?  Dietitians use their expertise to investigate and provide recommendations for the medical team.

Note: This is based on my opinions and experiences thus far at Tufts Medical Center.  Outside of the hospital, dietitians enjoy a variety of roles in diverse settings which may include outpatient clinics, private practice consulting, sports nutrition, research, public health, culinary arts, corporate wellness, and food industry.

Have a fabulous Friday.

Rach
ps- Thanks for bearing with my journal entries and absurd titles.  I love sharing my thoughts, and I also want to promote the field of clinical dietetics!

Lesson 5: Teaching Hospitals-Team Kaleidoscope

flickr photo from dalefarwalker

In the hospital, I'm learning that nutrition is merely one contributing color in a constantly rotating kaleidoscope of patient care.  A dietitian's unique expertise is but one viewpoint tossed amongst the various shapes and perspectives of the other doctors, medical students, nurses, technicians, physicians assistants, social workers, case managers, unit coordinators, physical therapists (who did I miss?).  This multidisciplinary team is really quite beautiful, yet it demands quick flexibility and clear communication.  A single event-one abnormal X-ray finding, a new IV infection, a hold-up in insurance approval-is enough to rotate the scope and send us all topsy-turvy as we shuffle into new positions. 

Despite the inefficiencies, I love the teaching hospital setting.  Although I still struggle to confidently communicate my nutrition recommendations to the residents.  I think the trick is learning how to frame my recommendations within the context of the larger medical plan.  I see myself as one bead (preferably canary yellow!) in this pattern of color, and it is my job to quickly fall into place with each changing scape.
What are your thoughts about teaching hospitals?  Do you mind the inefficiency?

Boston Harbor.  It's been a beautiful summer.

What did you do this weekend?

I went to Ikea for the first time in over a year!  Way too much stimulation for this little heart of mine...afterwards I felt short of breath and pleasantly giddy.

Cheers for Monday!
Rachel

Hospital Rotations Lesson 4: Destination Competency

flickr photo from Digital Explorer

At 70 mph, the hospital rotations are flying by.  8 weeks ago I was standing in the parkling lot, my head filled with nutrition theories, my arms loaded with textbooks.  But then I stepped from the parking lot onto the hospital floors, and that's when the journey began.
On this road trip I picture myself in a red '94 Jeep Wrangler (oh how I miss this car), driving through the practical lessons of nutrition care in a hospital setting.  With 4 weeks left, I'm keeping my eyes on the final destination.  Destination Competency.

Two thoughts.  (Thankfully a blog is both a journal and an information space!)
1. Embrace the U-Turns
Four weeks ago I got pulled to the side of the road and gently informed that my performance on the hospital floors needed to improve.  In particular, I was mistakenly pushing myself to see more patients per day, but failing to properly tailor my nutrition notes for each individual's specific care.  Increased quantity, with decreased quality.  Yup, time for a U-turn.
I didn't cry in that meeting (although later I smeared a patient's medical chart with a few watery sniffles).  In reality, anyone can take a wrong turn, but we are thankful for the roadsigns that guide us.  A change of direction can be a blessing.
2. Drive Solo 
Sometimes I get distracted by the other cars on the road.  I compare myself to other grad students, med students, dietetic interns, and friends.  Although I love my trusty Jeep, it has a broken tapedeck and no air-conditioning; I get easily discouraged when flashy BMWs and cute mini-Coopers whiz by in the left lane.  "How come I'm such a slower learner?"  "I wish I was a witty communicator so that patiens would like me."   Hush hush.  This is when I repeat to myself:  "Girl, just learn what you are supposed to learn.  Be earnest, be wholehearted.  Be thankful for the opportunities God has given you.  Accept criticism, embrace the U-turns.  Keep your eyes on the destination, and chug ahead."
With this attitude, I'm free to take off the hard top (convertible!), turn up the music, and enjoy the ride.

Update: 4 weeks left of adult inpatient!  This week I'm finishing the General Medicine and Oncology/Hematology/Bone Marrow Transplant floors.  I absolutely loved these floors and will be sad to leave them.

New Read

Better: A Surgeon's Notes on Performance

by Atul Gawande (author of Complications and The Checklist Manifesto)

published 2007

Insightful and amusing.  I'm enjoying a new understanding of insurance battles, a new appreciation of hand sanitizer pumps, and a new view of patients as human beings rather than a mere diagnosis.  

Check out Gawande's latest article in The New Yorker about the use of modern medicine in terminal illness.  This sobering article gives me new zeal as a future clinician!

Thanks for listening.

Happy Thursday,
Rach

Three Friendly Beets. One Pot of Soup.

Confession: I used to be an avid beet-hater.  In my defense, I think we all agree that beets are alarmingly red.  They stain the cutting board, they stain your fingers, and they most certainly will stain your favorite white shirt.  In grade school, I had one unpleasant encounter with the canned variety that left me cautious and wary for years to come.
However a few months ago I had my first taste of fresh beets, lightly steamed and tastefully scattered over a spring salad.  Redness!  Sweetness!  Delicious softness!  I was charmed.

The story gets better.  Last week I received three beets in my weekly CSA veggie and fruit delivery.  (This summer I signed up for a Community Supported Agriculture share through New Entry Sustainable Farming Project.  For a whopping $55 I get to share a small delivery of weekly produce from local farms in Massachusetts.)  As you can imagine, I was excited to receive these three friendly beets, and even more joyous with the beautiful pot of soup that soon followed.

(The kale and chives are from the CSA share too!)

Ukranian Red Borscht Soup
Modified from Original recipe at Allrecipes.com

1 package (16 oz) chicken sausage
3 medium Beets
1 cup baby carrots, sliced
2 medium potatoes, cubed
1 Tablespoon vegetable oil
1 medium onion, chopped
1 (6oz) can tomato paste
3/4 cup water
1 cup chopped kale (originally cabbage)
1 (8oz) can diced tomatoes, drained
4 cloves garlic, minced
salt and pepper, to taste
1 teaspoon white sugar, to taste
Top with plain nonfat yogurt (original recipes calls for sour cream)
Garnish with minced chives (original recipe calls for parsley)

Directions: 

• Cook sausage in a skillet over medium heat.  Remove and set aside.
• Fill large pot halfway with water (about 2 quarts).  Bring to boil.  Add sausage.  Add beets, and cook until half-way soft.  
• Add carrots and potatoes.  Cook until tender, about 10 minutes.  Add kale.  Add diced tomatoes.
• Heat oil in a skillet over medium heat.  Add onion and cook until tender.  Stir in tomato paste and water to blend with onions.  Transfer to the pot.
• Add raw chopped garlic to the soup.   Cover and turn off heat.  Let stand for 5 minutes.
• Taste and season with salt, pepper, and sugar.
• Garnish with plain yogurt and fresh chives.

This sweet soup is best enjoyed with a hunk of crunchy bread, something with a dense crumb useful for sopping up plenty of bright red broth.  I am a new enthusiast for the Whole Foods Bakery, which has turned into an expensive habit since I always find myself meandering from the bakery to the cheese counter.  This week I paired my beet soup with their hearty Seeduction Bread, pictured below.

I dedicate this recipe to my dear childhood friend Ashley.  From my earliest memories in grade school, she has been a faithful beet fan, a remarkable charateristic that I never appreciated until recently.  Hey Ash, I've finally converted!  I can't wait to eat some beets with you.  

Love beets?  Hate beets?  
What do you think about beet soup?
Happy Monday,
Rach

Veg Out for Breakfast!

One of the blessings of the blogosphere is mingling with new friends and colleagues.  These past few months it has been my pleasure to meet Carlene Helble, a dietetics student at James Madison University and fellow blogger.  I am excited to feature her as my first guest on Coconut Crumbs.  Check out what she has to say about Veggies for Breakfast! 

Veg Out for Breakfast!
Written by Carlene Helble, Elite Nutrition Intern 
“Here’s your wake-up call: breakfast eaters tend to be leaner and more successful at maintaining a healthy weight than people who miss their morning meal.”  This quote from Ellie Krieger’s website says it all!  Breakfast is extremely important, but even those who are on track with breakfast sometimes get stuck in a menu rut: cereal, perhaps a banana?  How often do you throw some nutrient dense veggies into your morning meal?

National Public Radio recently published a fantastic article on the lack of American vegetable intake at breakfast, comparing it against some delicious options across the globe that did contain vegetables. Here are some easy ways to make changes, and even ‘go global’ in the morning:

Omelets can be good.  But for a more filling meal with less calories plus a serving or two of veggies, try some scrambled eggs with chopped spinach, mushrooms, and tomatoes. Think of the egg as a ‘topping’ and let the vegetables shine. The great thing about this idea is the vegetables are interchangeable. Feel like some asparagus? No problem! A vegetable scramble can be easily personalized.

Another great way to get more vegetables at breakfast is with smoothies; perfect for an on-the-go meal. One smoothie that seems to be a favorite is the ‘green monster’, which consists of kale or spinach, blended with fruit, milk, and sometimes chia seeds. (Check out this website dedicated to green monster smoothies!)

One suggestion NPR gave was for a traditional Argentine dish: a breakfast tart with summer squash, red peppers, and a basil crust. This is definitely on my ‘to make’ list, especially with summer produce on the way!

Sources: 
Ellie Krieger http://www.foodnetwork.com/healthy-eating/the-best-start-to-your-day/index.html 
NPR http://www.npr.org/templates/story/story.php?storyId=126911529

Carlene is a senior dietetics student at James Madison University, and the president of the student dietetics association.  This summer she is interning with an inpatient RD and a private practice RD, while also continuing to write about nutrition and health.  This next spring she will be applying for dietetic internships!

Check out more of her writing (and obsession with food) at the following sites:

HerCampus

Balanced Health and Nutrition

All Access Internships Blog

Thank you Carlene!

What do you think about veggies in the morning? 

I'm inspired to try this greenmonster breakfast smoothie!

-Rachel 

Rajma, The Indian "Chili"

My roommate is back from Washington D.C., and The Indian Diaries are in full swing!  Today's special is Rajma, a traditional North Indian dish made with kidney beans.  Rajma's spunky spicy flavor makes it the Indian version of American chili.  Or more likely, our hearty stew is probably the American version of India's Rajma. 

Rajma, The Recipe
1 cup kidney beans*

1 small yellow onion, finely chopped

1 large tomato, pureed (in blender)

1 tsp chopped garlic 

1 tsp fresh ginger, chopped

1.5 tsp turmeric powder

1.5 tsp coriander powder

1 tsp chili powder

½ tsp garam masala
1 tsp cumin powder 

salt to taste

2 Tbsp oil

*can make with canned kidney beans (no cooking required) or with dried beans.  The following recipe uses dried beans, soaked overnight, and cooked in a pressure cooker.

1. Pour 2 Tbsp oil into the pressure cooker.  Once hot, add garlic and ginger. 
2. Lightly stir for a few seconds and add onion.  Cook onion on medium heat until transparent, but be careful not to burn.
3. Add tomato.  Add spices (turmeric, coriander, chili, garam masala and salt).  Cook down and stir until the mixture becomes a spicy paste.  
4. Add 1 cup kidney beans and 3.5 cups water.
5. Cover pressure cooker and cook on medium heat until you hear the cooker whistle.  This may take 20-30 minutes.
6. After the whistle, turn off heat but let beans cook for another 10 minutes.  Once pressure has decreased, take off the cover and evaluate.  Kidney beans may need more water if you want a soupy consistency.  Beans may need more cooking if you want a chunky consistency.

Eat with:

Rice, naan, or roti

Optional: Sliced persian cucumbers (smaller than English variety)

Optional: Plain yogurt.

Rajma is a hallmark of Indian cuisine, a suitable componant for any social gathering.  My roommate states, "It is loved by everyone.  You won't find someone in India who doesn't enjoy this dish."  It is served with basmati rice, all year long.  

Very yummy.  All the credit goes to my rommate! *Applause*

Feel free to leave a comment telling her what you think!

Thank you.  Happy Friday!

Rachel