San Francisco Sourdough Reflexology

Cannot wait to serve this bread to my neighbors tonight. Finally have my thumb back on the social pulse of Rochester, (hopefully not occluding with the pressure) the epicenter of which happens to be usually hovering around Southtown (a neighborhood some call Slatterly), and today there is much festivity! Johnny Mango’s this afternoon for a song; backyard around our campfire next to the sadly chicken-less coop for a block party kickoff; house to house as the neighbors desire for a progressive dinner. Here’s Izzy watching my tomatoes grow and waiting for guests to arrive. Beyond, a nice group home for chickens if you know of any looking for cheap housing.

For my culinary contribution, these loaves of sourdough bread, I was basically on call last night. I’m pretty sure the bread dough paged me at 2am. This bread is not for the EasyBake chef—it is for the kamikazee boulanger. Longest recipe ever, but worth the result.

San Francisco Sourdough Reflexology

Adapted from the Village Baker

This recipe takes several refreshments—which means you need to get your sourdough starter hyped and producing complex molecules that taste and smell right, which means that you will be getting up in the middle of the night to tend to it.

Refreshment #One

1/2 cup (approximately) of sourdough starter
1/2 cup very warm water
1 cup flour

Place the starter in a small mixing bowl, and add the warm water. With a fork, mash the starter around in the water until it softens and begins to dissolve, and continue mixing and beating it (like a batter) until the consistency of the liquid is smooth.

Add flour to the liquid a little at a time, and blend it in. Eventually the liquid will become a paste, and then a dough. Turn it out onto a lightly floured surface, scraping out the drier bits of dough and remnants of flour. Knead the dough mixture until it is smooth.

Place the resulting ball of dough in a bowl, cover with a damp cloth, and leave in a warm, draft-free place to rise.

Allow this dough to rise for six hours or more, which, for me, meant 2am.

Refreshment #Two

The sponge from the previous refreshment
3/4 cup cool water
1 3/4 cup flour

Place the sponge in a bowl, and pour the water over it. Mash the starter around in the water with a fork, as before, until it softens and dissolves, and continue beating the mixture until it becomes a liquid of smooth consistency.

Gradually add the flour to the mixture, blending it with the fork. As the mixture thickens, you may wish to switch over to stirring with a wooden spoon. When the mixture has transformed from liquid into dough, turn it out onto a lightly floured surface, scraping the remnants out of the bowl, and knead it for a couple of minutes, until its consistency is smooth.

Place the ball of dough in a bowl, cover with a damp cloth, and place in a warm, draft-free place to rise for another six hours.

Refreshment #Three

All of the sponge from the previous refreshment
2 1/4 cups of lukewarm water
5 cups flour
1 Tbsp + 1 tsp salt
Mix the sponge and the water together thoroughly, until the resulting liquid has a smooth consistency. Gradually add four cups of the flour and the salt and mix it in.

When all of the flour is blended in, leave the dough in its mixing bowl to sit for fifteen minutes or so to allow autolysis (a process in which all of the gluten strands relax and align–a miracle) to occur.

Knead the dough until it has a smooth consistency, without lumps. Allow it to rise for four or five hours. Then, you are ready to proof!

Pinch off a ball of the dough and roll it tight, placing it in a water-filled jar.

(This is a new technique to me…a bit of an experiment. In theory, when the ball of dough rises, the bread is ready to bake.) I only share it because I think it actually worked quite well. I’ll let you know if there are ever breads for which this technique fails. It actually saved me some time. For my second rising, I was going to let the loaves rise another 2 hours when the ball rose… I think it takes into account the ambient specifics better than the recipe’s blanket estimate “8 hours” or whatever. What you will. When you start, the ball should sink to the bottom.

Form two tight boules with the dough and place them in separate bannetons to rise until the water-ball gets to the surface of the water. I only needed a second rising for two hours (as opposed to four– before this technique I might have waited four hours and then wondered why my loaves didn’t lift much further in the oven…)

Preheat the oven to 450ºF. I bake my bread on a baking stone in my oven, and this demands substantial preheating time. Move the freeform loaves onto a sheet of parchment paper, leaving plenty of room between them for expansion. When the oven is ready, glaze the tops of the loaves with a wash of egg white and a tablespoon of cold water. I take a spray bottle filled with water and mist the loaves. Then I slash the loaves with a very sharp knife; always choose new designs. More experimentation.

After a minute, I open the oven, slide the bread on the peel inside, and thoroughly spray the loaves with the spray bottle. The humidity helps the crust to glaze properly. When the crust is thoroughly golden-brown, after 40 minutes or so, take them out and allow the loaves to cool on a wire rack. Now, if you are unsure that your bread is done with surveying the color of the crust, you can always check for hollowness when you thump the bottom of the bread.

To test bread hollowness lately, since I’m on my neurology rotation, I have been using a reflex hammer.

Also, sometimes, a tuning fork. I assume that somewhere in there my loaves have posterior columns for sensing vibration and joint position sense, and I would hate to learn that I’ve served sourdough with tabes dorsalis to my guests. This would also raise my suspicion a bit concerning where my sourdough starter had been before she came to me… possibly San Francisco?

Pumpkin Scones

Exhaustion, I think, is a masterful teacher of surrender. So is the ground. I was in a yoga class this week and it wasn’t until shevasana (the end of class, when they let you lay on your back, palms up, eyes closed) that I came to fully appreciate the ground beneath me. So much of life is spent teetering, hovering above the earth on the tip of a toe and the edge of a heel (if you wear shoes like those I love)—we barely touch the ground. We skiff the surface of things, making the merest of contact with the terrestrial, with things grounded.

Lying flat on my back I became richly aware of the abundance of ground there is to support us. When I lie flat, assume a position of humility now and then, I get the chance to feel every part of myself being held up at once, and not by any effort of my own.

My musing today has nothing to do with what I baked, which does happen from time to time. My powers of abstraction are only so strong. But, reaching, scones do mildly resemble brains–I see sulci in them, but that’s probably just me.

Pumpkin Scones
2 cups all-purpose flour
3 T sugar
1 T baking powder
3/4 teaspoon kosher salt
1/4 cup ground ginger (I grate up a fresh ginger root if I can, more zing)
1/4 cup ground cinnamon
5 T cold butter (grated on a cheese grater)

1 cup heavy cream
1 cup canned pumpkin puree (all pumpkin, not pumpkin pie filling)
2 tablespoons pure vanilla extract

1. Preheat the oven to 425°F.
2. In a large mixing bowl, combine the flour, sugar, baking powder, salt, ginger, and cinnamon.
3. With clean hands, work the grated butter into the dry mixture until it is thoroughly incorporated and has the consistency of fine breadcrumbs.
4. Make a well in the center of the dry ingredients, and pour the heavy cream, pumpkin puree, and vanilla extract into the well. Still using your hands, combine the ingredients until all the dry mixture is wet, but do not knead!
5. Turn the mixture onto a floured surface and gather the dough together. Gently pat the dough to make a disk about 1 1/2 inches thick. using a 3-or 3 1/2- inch biscuit cutter, cut out as many scones as you can and lay them on a nonstick baking sheet. Gather the remaining dough together lightly to cut out more scones—just don’t knead the dough too much.
6. Bake the scones for about 12 minutes, or until lightly browned. Let the scones cool slightly on the baking sheet (about 20 minutes) before glazing them with whatever frosting or caramel glaze you prefer. Or not—honestly, I think they are perfect just as they are.

Don’t forget to lie down, y’all, and when you can, gaze up at the stars and feel contented in your smallness. Because if we are small, so are our problems and worries small in the grand scheme. Lay lady lay. How divine when a scone can be a moment’s enough.

Champagne Spinal Tap Fondue

A toast to the first week of neurology after which I am proud to report that I am batting a thousand in my lumbar puncture record. Three for three glistening champagne spinal taps. I credit the success to having had a surgery rotation preceding—my hand has been steadied to some degree from holding things far sharper than a 22 gauge hollow needle.

After two call nights this week, on Saturday when the hospital spit me out, a wad of blue scrubs and bleary eyes, I implored KP to gather the necessary items to celebrate my week of stellar lumbar punctures, which are, of course, the following ingredients:

Champagne Spinal Tap Fondue with French Bread

Adapted from Bon Apetit

4 teaspoons cornstarch
1 tablespoon fresh lemon juice
1 1/4 cups dry (brut) Champagne (I got the stuff from Trader Joes)
1 large shallot, chopped
2 cups coarsely grated Gruyère cheese (about 7 ounces)
1 1/3 cups coarsely grated Emmenthal cheese (about 5 ounces)
1/2 cup diced rindless Brie or Camembert cheese (about 3 ounces)
Generous pinch of ground nutmeg
Pinch of ground white pepper
1 French bread baguette, crust left on, bread cut into 1-inch cubes — to make this French Bread, keep in mind that it will take two days in advance… so if you haven’t started on the bread and you need the fondue, like now, you might need to pick up a baguette at the nearest patisserie. Otherwise, try to time things so your bread goes in the oven as your cheese goes into the melting pot. Fresh fresh fresh– tastes better.

Stir cornstarch and lemon juice in small bowl until cornstarch dissolves; set aside. Pour champagne into four test tubes and try to imagine the joy of pulling such liqueur from between two lumbar vertebrae. Contemplate for a moment your own CSF. Do you appreciate this particular bodily fluid as often as you should? I should say not. We all have a crystal geyser bathing our spine–be grateful for that which you cannot see, but which sustains your neurology. Which is, ahem, more than just your CSF. That’s as close as I’ll get to a Sunday sermon, I promise.

Combine champagne and shallot in fondue pot or heavy medium saucepan. Take a swig if you are also heading out to jazz band rehearsal, as I was this afternoon. It got me one or two riffs closer to Billie and Eva, I believe. Simmer over medium heat 2 minutes. Remove pot from heat. Add all cheeses and stir to combine. Stir in cornstarch mixture. Return fondue pot to medium heat and stir until cheeses are melted and smooth and fondue thickens and boils, about 12 minutes. Resist the urge to dip the entire baguette you just made into the cheese sauce. It’s harder than you think. Okay, I did it. Caught in the act.

Season fondue with nutmeg and white pepper. Place over candle or canned heat burner to keep warm. Serve with French bread cubes. Watch This is Spinal Tap, the movie, while you munch.

I brought this dish to my bread guru for approval. He judged it a quality product, so it stands. 5 stars. The fondue was a little too chi-chi-poo-poo, rich and fancy for my taste. If it were CSF, it would mark a concerning tap, high in protein, suggestive of meningitis or Guillain-Barre, or some other curious encephalomyelitis. But the French bread was excellent. And the fondue, just champagne and cheese. Fondue, as far as I know, is good for the nervous system. So is jazz—as such, I’ll be singing guest vocals with Driven by Rhythm at Johnny Mango’s next Sunday (Oct 13). And the Redwood Room the Friday after that (Oct 18). Bring your nerves, and I’ll work on them with the soothe of sound.

Focaccia as Motor End Plate

So surgery was a bit like going to a rave sober. It was hard not to feed off the high of the surgeons so in love with the OR and with operating. The climate buzzed ecstatic. I came out of the operating room each day singing and still throwing punches, bouncing on my toes, chanting about the secret of the Fox. I barely slept, but I barely could sleep—so thoroughly jazzed.

Now I’m on neurology, and each day I feel like I’m going into the intense atmosphere of Chess Tournament National Finals. My glasses are taped. What move are you going to do next, Lyle? Do left right confusion! No, do naming. Better yet, test stereognosis. Do a Romberg’s! So many possible moves. So many eponymous places a lesion could be–only one right answer.

I made this focaccia bread last week in Florida, at a time when I was contemplating pitting edema. But now I’m thinking about neuromuscular junctions and how this bread resembles a motor end plate. With cheese.

Focaccia as Motor End Plate

Adapted from The Village Baker

1 cup sourdough starter

6 cups organic, unbleached white (or all-purpose) flour

2 cups water

1 teaspoon malt extract or 1/2 teaspoon honey

4 teaspoons fine sea salt

1 1/2 tablespoons olive oil

Warm 1 cup of the water. Mix in the sourdough starter. Dissolve the honey or malt extract in the diluted sourdough mixture.

Place half of the rest of the flour and half of the salt in a food processor and pulse to mix (or just knead by hand—I always do.) Add the sourdough and malt extract mixture. Pulse the processor to combine the ingredients, then slowly add half of the remaining water through the feed tube while the processor is running. Process the mixture for between 30 seconds and one minute. The dough should be wet and sticky. In the last 10 seconds of processing, pour half of the olive oil through the feed tube.

Empty the dough into a large bowl and combine the remainder of the ingredients in the food processor to make a dough in the same way.

Combine both batches in the bowl by mixing them together with a wooden spoon or plastic dough scraper.

Let the dough rise, covered, in a warm place for 1 hour.

While the dough is rising, combine the olive oil, salt, chopped garlic, and sage leaves.

2 cups extra virgin olive oil

2 teaspoon salt

8 cloves garlic, chopped

24 whole leaves fresh sage

Place equal amounts in 2 medium-sized bowls and set them aside.

Turn out the risen dough onto a well-floured worktable and divide the dough in half. The pieces will be wet and sticky, but use a little extra flour and round them up into tight balls. Place each piece in a separate bowl. Roll the dough balls around in the oil mixture and set them aside, still in the oil, to rise for between 3 and 4 hours. The dough will have almost tripled in size and be very soft and airy.

Remove the balls of dough from the oil and transfer them onto large cookie sheets that have a rim at least 1/2 inch high. With the palms of the hands and with your fingers open wide, spread the dough out to about 12 inches by 18 inches, and about 3/8 inch thick. The dough may spring back. If so, let it relax for a few minutes, then repeat the stretching process. Pour the remaining oil, along with the sage, garlic, and salt over the top of the dough. I put both of the batches on the same baking sheet because I was short on time, that is why they are so tall!

Set the focacce aside, covered, to rise for 1 hour. When they have risen, poke the dough with the fingertips several times.

As you poke in tedium, talk yourself through how a neuron depolarizes and releases neurotransmitters at the axon terminal. Imagine your finger is the axon, the dough is the motor end plate of the receiving muscle fiber.

Bake in a 400 degree oven for between 15 and 17 minutes, or until they are golden brown.

You could take little roasted garlic pieces and try to fit them into the receptor sites on the focaccia bread and quiz yourself on neurotransmitter pharmacology if you too are a medical student. I wouldn’t tell anyone. Serve to over-exhausted general surgery residents for an act of good karma.

As featured with my favorite Sourdough community: http://sourdoughsurprises.blogspot.com/

Writing as Laparotomy

Returned home to Fuchsia and Lime this morning to find a chocolate cake sweetly plugging a husband-sized hole. The cake will probably only hold the gap for another 24 hours, and then we’re in trouble. I need you far more badly than Portland does, KP. Meanwhile, I am enjoying Izzy’s tail wagging and face licking while I grind the sand that is still stuck between my toes deep into the fibers of this Minnesota living room carpet—a small attempt to bring Jacksonville into the frozen north.

Last night, we danced. We ran along the dark shore and kicked at the black frothy tongue of the sea like something of a last laugh. It is strange to stand in the thin strip of sand between the wild ocean and the coiffured gardens of beachfront properties all glowing warm from inside. To stand still in this space on the moonlit sand in such a way, one feels the suffocation of choice. The angle of lean away from what is, for most, the easy answer– security. Sometimes I think I fear entropy as though it were a disease–a problem needing a fix–rather than what it simply is: the bare and tumbling way of things. There are times, like when I take in the ocean, that it seduces me.

What I most love about surgery is the exploratory laparotomy—because laparotomy, as a state of mind, is also why I love writing. Incisive words are incisions for thoughts. The necessary approach to good writing involves removing layer after layer of fat and fascia to expose what lies beneath, to see what really needs knowing. Socrates said the unexamined life is not worth living. So ex-lap everything. Writers, take the page to the OR everytime.

Case in point: even your bread benefits from laparotomy— the cut down will help it expand and rise.

Whole Wheat Bread with Crystallized Pecans
1 1/2 cups warm buttermilk (105°F to 115°F)
1/4 cup (1/2 stick) unsalted butter, melted, cooled
3 tablespoons sugar
1 cup sourdough starter
3/4 cup whole wheat flour
1 1/2 teaspoons salt
3 cups (or more) unbleached all purpose flour
1/4 cup chopped crystallized pecan (or you could use ginger if you have it, would taste bomb—to see how to crystallize pecans look here)

Combine buttermilk, butter and sugar in large bowl. Sprinkle yeast over. Let stand until yeast dissolves, about 8 minutes. Mix in whole wheat flour and salt, then 2 1/2 cups all purpose flour, 1/2 cup at a time. Stir until soft dough forms. Continue adding all purpose flour 1/4 cup at a time if dough is very sticky. Mix in crystallized pecans or ginger. Lightly flour work surface with 1/2 cup flour. Turn dough out onto work surface; knead until smooth and elastic, about 8 minutes. Meditate on a sonnet. Do NOT use kneading time to work out your To Do list. That is a waste of Zen.

Butter large bowl; add dough and turn to coat with butter. Cover bowl with plastic wrap. Let dough rise in warm draft-free area until almost doubled in volume, about 1 1/2 hours. Punch dough down; turn out onto work surface. Roll dough into a boule. Make an incision from the xiphoid process to the umbilicus, spare the umbilicus, and proceed along the linea alba to the pubic symphysis of the loaf.

Cover with damp towel. Let rise in warm draft-free area until almost doubled in volume, about 40 minutes.
Preheat oven to 375°F. Bake bread until golden, about 35 minutes. Cool 10 minutes on rack. Remove from pan; cool.

Goodbye palm trees.

Goodbye Casa Marina.

Goodbye fond swimsuit.

Goodbye Waffle House. You are an oasis at 2:30a to medical students who stomped their Shelf Exam sorrows into the dance floor.

Goodbye, Jacksonville sun and sand. Goodbye sea shells in my hand.

Maple Bread Pudding with Pralines

I’m afraid this last week of surgery finds me spiraling into heavier and heavier contemplation. What if these are the last opportunities I’ll have to touch bowel, to fire an anastomotic stapler, to stitch long incisions closed, to stand for seventeen hours around an open abdomen and enjoy the time passing as though we are gathered around a beachside campfire instead of a broken body—the operation itself like camaraderie around a hearth?

I know that the experience I have had on general surgery has been made anomalously pleasant by the brilliant and kind company with whom I have had the pleasure to keep—and who I will miss, every one. The longer I live, the more my sense of home resembles a haphazard collection of shells. Some chipped, some polished to pearl.

The words of Marilynne Robinson, which are ever in my throat, seem to clasp ahold tighter in the light of this new experience, however brief– the privileged perspective only the work of surgery can lend a human being—

Every spirit passing through the world fingers the tangible and mars the mutable, and finally, has come to look and not to buy.

Maple Bread Pudding with Praline
adapted from Bon Apetite

For the praline–
Nonstick vegetable oil spray
2 cups sugar
1 cup pecans, toasted, chopped

For the bread pudding
8 large eggs
1 quart whipping cream
2/3 cup agave
1 cup maple syrup, plus more for drizzling
1 tablespoon vanilla extract
1 1-pound maple wheat bread, torn into bite-size pieces

Vanilla ice cream (optional)

For praline: Spray rimmed baking sheet with nonstick spray, or line with parchment paper. Stir sugar and 1/4 cup water in heavy small saucepan over medium heat until sugar dissolves. Increase heat to high and boil without stirring until mixture turns deep amber color, occasionally swirling pan and brushing down sides with wet pastry brush, about 7 minutes. Stir in pecans. Quickly spread nuts on prepared sheet. Cool. Chop praline into small pieces.

For bread pudding: Whisk eggs, cream, agave (you could also use sugar—the lovely PA at work gave me this because she found out she was allergic to it), 1 cup maple syrup, and vanilla in large bowl to blend. Add bread pieces; stir to coat. Let stand at room temperature 1 hour, stirring occasionally.
Preheat oven to 375°F. Butter 13x9x2-inch baking dish. Transfer bread mixture to prepared dish. Bake until puffed and golden and toothpick inserted into center comes out clean, about 40 minutes. Cool slightly. Cut into 6 to 8 pieces. Place 1 piece pudding on each plate. Place scoop of ice cream atop pudding, drizzle with maple syrup, sprinkle with praline, and serve to hungry residents who seem to never eat—so when they get the chance—Oh, let it be good.

It was good.

Food is the tangible, the mutable—the perfect metonym for that which we consume without ever really having—like time.

I love Jacksonville, and it seems Jacksonville loves me (evidence: 1) barista at Bold Bean gives me this in my foam. 2) Someone anonymously purchased me a taco at Lillie’s Cafe). The conundrum, as always, what to do with all these lovely shells of home? It is a job for a greater snail than me–I cannot possibly carry them all.

Pizza Arteries

There’s nothing like an endarterectomy to make you reconsider having pizza for dinner. This might be the last pizza I’ll ever eat. And as such, I’ve shaped it into a large abdominal aortic aneurysm in tribute to the body part it jeopardizes.

Surgery has taught me so much. For example, there’s nothing like taking surgery call to reinforce sensible undergarment selection and/or vigilance in the unpopular domain of pubic hair maintenance. You never know when you might be a trauma case—best to be ready at all times for a full-body prep. Surgery has, however, deprived me of dementia-protective sleep patterns. As a result, I’m starting to do strange and zombie-like things– like, putting on lipstick (instead of brushing my teeth) before going to bed. Perhaps this is some Freudian revelation of my truest priorities. Perhaps, too, my dreams of surgery every night (like full 8 hour operations) are signals from the gods of their subtle portents for my fate. Am I a surgeon?

Pizza Arteries

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

Measure the warm water and oil into a bowel and add the sourdough starter.
Add flour and salt to the liquid ingredients. Knead until the dough is smooth and elastic, about 5 minutes. Form the dough into a ball, put it 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.
Shape into smooth round ball and cover with a damp cloth. Let dough relax for at least 10 minutes (no more than 30 minutes)
Brush rolled out dough round with oil. This represents how all atherosclerosis begins, with a fatty streak.
This is a longitudinal representation of the aorta. Over time, as you enjoy your choices in life, smoking, eating steak and burgers and fried chicken, the combination of cholesterol and sheering forces of high blood pressure damage the intima, the inner lining, of your arteries. Plaque sticks to the rough edges, and looks exactly like hard cheese. Here is the aorta both longitudinally and in cross section:
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 whatever your toppings of choice might be. And then ruminate good and hard about what this dinner is going to do to your arteries. How, over time, if you keep this up, and you are genetically predisposed to having weak or otherwise weird connective tissue, you might be on track to get an aortic aneurysm (which, I would be happy to operate on once it reaches 5.5cm in diameter)– watch out! These tend to be asymptomatic! If you have a family history for this, consider around age 55 or 65 signing up for a CT scan.

But for now, Enjoy. Bake for 12 minutes at 500 degrees. Life is short no matter what your choices are. So don’t forget to stop and look around once and awhile, like Ferris Bueller recommends. And taste widely. Enjoy. Worry. Repeat. That’s life.

Pumpkin Oatmeal Hepatic French Toast

The Pumpkin Oatmeal Wheat bread I made on Friday is bomb biggity as French Toast.

Pumpkin Oatmeal French Toast

Whisk together 2 eggs, 2/3 cup milk, and 1 ½ tsp vanilla in a shallow bowl. Sprinkle a little bit of pumpkin spice on the top of the egg mixture.

Dip a slice of your Pumpkin Spice Wheat Bread into the goodness and let it soak about ½ cm into the bread (especially if you use thick slices like me).

Have a hot greased griddle on the heat next to you, and then when it’s good and hot, throw that puppy on the griddle. Flip over when it’s cooked. Top with your maple syrup and enjoy!

I make my own syrup—like this:

Bring 1 ¼ cups water with 1 cup white sugar and ¼ cup brown sugar to a boil and keep it boiling until it is showing signs of syrupiness (can take 10-15 minutes). Then, remove from the heat, and as its cooling, add about a tsp of Mapleine or some other maple flavoring (although mapleine is the best). Store in a syrup pouring container in the fridge.

Before eating the French Toast for my leisurely Saturday morning breakfast, I arranged pieces into the right and left lobes of the liver and drew out the biliary tree and thought long and hard about cholecystitis, and choledocholithiasis and cholangitis while listening to Nat King Cole. (Yes, Celestial Seasonings is my gallbladder).

Then I hit the beach. My classmate Carson caught a crazy small crab, and we went out to seafood.

We sat on our towels facing the ocean and turned shells over in our palms, got sand into the bindings of our books, and beheld osprey diving into the sea for fish dinner. Of course, I have been soaking up as many rays as possible while trying to learn ALL of surgery. The bliss of a weekend off cannot be overstated.

Pumpkin Maple Oatmeal Wheat Bread with a Side of Spine

Like I’ve always said—Break Bread, Not Vertebrae. This bread has nothing to do with back pain but has nevertheless been garnished with several stray vertebrae, which I now own, thanks to a disaster in the Pain Clinic.

Pumpkin Maple Oatmeal Wheat Bread

2 cups whole milk

1 cup quick maple flavored oats (got mine at Target)

1 cup sourdough starter

1/2 cup mild honey

1/2 stick (1/4 cup) unsalted butter, melted and cooled, plus additional for buttering pans

3 cups stone-ground whole-wheat flour

About 2 cups unbleached all-purpose flour

1 ½ tablespoons pumpkin spice

1 tablespoon salt

Olive oil for oiling bowl

1 large egg, lightly beaten with 1 tablespoon water

Heat milk in a 1 1/2- to 2-quart saucepan over low heat until hot but not boiling, then remove pan from heat and stir in honey and oats. Let stand, uncovered, stirring occasionally, until cooled to warm.
Stir sourdough starter mixture, melted butter, and remaining honey into cooled oatmeal.
Stir together whole-wheat flour, 1 1/2 cups unbleached flour, and salt in a large bowl. Add oat mixture, stirring with a wooden spoon until a soft dough forms. Turn out onto a well-floured surface and knead with floured hands, adding just enough of remaining unbleached flour to keep from sticking, until dough is smooth, soft, and elastic, about 10 minutes (dough will be slightly sticky). Form dough into a ball and transfer to an oiled large bowl, turning to coat. Cover bowl loosely with plastic wrap and a kitchen towel; let rise at warm room temperature until doubled in bulk, 1 to 1 1/2 hours.
Form into a boule and then let dough rise, covered, on a piece of parchment paper draft-free place at warm room temperature until doubled in bulk, about 1 hour. In my case, I fell asleep on the desk while studying and woke up 6 hours later (3am) to find a lovely large loaf ready to get baked.
Put oven rack in middle position and preheat oven to 375°F. Lightly brush tops of loaves with some of egg wash and sprinkle with oats if you want, then bake until bread is golden and loaves sound hollow when tapped on bottom, 35 to 40 minutes.
Transfer to a rack to cool completely, about 1 1/2 hours. Arrange with a structural bouquet of vertebral bodies and spinous processes. Slice, break as you must, and enjoy.

Okay, here’s the story: What I most loved about my time in the pain clinic was witnessing near-immediate relief in patients. People limped in, hunched over, with anterior tilt if they had arthropathy or spinal stenosis, posterior tilt if they had a bulging disc, and then after a little ‘caine and steroid walked out with a smile, some nearly clicking their heels together on a new yellow brick road. Temporarily miraculous to behold.

It was in front of just such a miracle customer that the disaster happened. I asked the anaesthesiologist to show me on the model skeleton–the gorgeous, detailed, expensive model skeleton on special display in the procedure room—where exactly the facet joint, which we planned to inject for the eagerly awaiting patient, was located. The doctor, a serious and deliberate sort of man, in annoyed haste, reached after the skeleton and with one hand near the cervical area and the other on the sacrum, bent the spine to expose the lumbar joint space. It exploded.

The patient awaiting her procedure, sitting hunched on the paper-sheeted table, almost fell right off onto the floor as her physician broke a back in half with his bare hands right before her eyes. Vertebral discs flew across the room while the dinosaurish rubber vertebrae bounced along the floor. I tried an emergency surgery on the model at the front desk until the doctor grabbed the pieces from me, threw them in the trash, and proceeded to let the nurses know that I had broken the spine, grrr—medical students get blamed for everything. Dunce targets. While the nurses sweetly assured me I that would not have to pay for the broken model, I dug vertebrae out of the trash and stashed them in my white coat pockets as study loot.

In addition to making great napkin holders and dinner table centerpieces, they also make rather alluring jewelry for those who fetish Wilma Flintstone. Look for neck bling like this on Etsy. But the melodramatic supermodel facial expression that goes with? Priceless.

Calzone with Sutures

Since I’m not allowed to stitch any visceral organs yet, and rightfully so only three weeks into my general surgery rotation, I have been continually getting the privilege to “close”—which sounds like I might be a reserve star pitcher, but really, it’s the grunt work OR job for medical students—stitching closed the incision. I take certain pride in my skin stitching—it is, I believe, an important art and quite possibly the one that will in the long run get the most attention. So, the other night, when I was making dinner, I discovered a perfect opportunity to exercise my suturing skills—on a calzone.

Calzone with Sutures

Ingredients for the Basic Pizza Dough

(this will make enough dough for three rather large Calzones)

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

I like to put in chicken or a cut up bell pepper too

DIRECTIONS

Measure the warm water and oil into a bowel and add the sourdough starter.
Add flour and salt to the liquid ingredients. Knead until the dough is smooth and elastic, about 5 minutes. Form the dough into a ball, put it 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.
Shape into smooth round ball and cover with a damp cloth. Let dough relax for at least 10 minutes (no more than 30 minutes)
Brush rolled out dough round 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 whatever your toppings of choice might be. Fold in half and get scrubbed in.
Find a needle driver and pick ups.
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).
Now, I tried several different types of silk, but braided Ethicon 2-0 nonabsorbable 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.

When your stitches are in, slide the calzone on a peel (covered with corn meal) onto pizza stone (which should have been 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.
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.