one tequila, two tequila, three tequila, floor?

Alright.  We didn't actually have THAT much tequila in Tequila, but we did have a generous serving of the Jalisco region's prized product at Mundo Cuervo, the Jose Cuervo Distillery.  We visited the region with some of our fellow medical Spanish classmates and had a really great day.


The drive itself was long, but full of photo worthy scenery.  The land was covered in blue agave and was a sight to see.

Upon arrival, we walked around the beautiful little town.  We strolled through the outdoor market, snapped photos in front of the cathedral, and wandered around the Cuervo distillery.

 

For lunch, we visited the town's central market, complete with several different eateries ready to be enjoyed.  Earlier, I had asked someone which place was their favorite and he pointed us to Conchome.  For lunch we had meat marinated in tequila that we wrapped in fresh tortillas.  How fresh you ask?

Here is the lady making the tortillas just across the market.

And here are the tortillas on our table.

After lunch, it was time for our tour.  Tequila is made from the blue agave plant.  After taking off the leaves, you are left with a "pineapple" which is pressed to remove the juice.  The left over fibers are recycled into cookies and paper.  The foodie in me wondered how the same ingredient that can make paper can also make tasty cookies.  So of course I bought them at the store and will let you know when I find out. 

 
Back to the tequila.  The liquid is then processed into alcohol.  The first batch produced is 55% alc. vol.  The distillery isn't allowed to sell it, but they were allowed to let us taste it.  As one could imagine, it tasted like rubbing alcohol and left that warm burn in my throat.  We continued to learn about the aging process and resulting 35% alc. vol.  Blanco is aged a few days in oak barrels, Reposado a few months, and Anejo a few years giving them progressively more complex and smoother flavors.  The highlight of the tour was learning to taste tequila.  First, you swirl the tequila in the glass a few times and look for drops to form and drip down the glass.  This lets you know the tequila is safe to drink.  Then you tilt the glass and smell the tequila at the bottom, middle, and top of the glass.  Finally, you taste. But it's not ordinary taste.  You breath in through your nose, take a sip, hold it in your mouth 4-5 seconds, swallow, and then breath out through your mouth.  Pretty cool.

After all that learning, we called it a day with margaritas on the patio before heading back to Guadalajara. 

making friends at clinic

At clinic this week, Claire and I had the chance to get two know some awesome UAG medical students.  Here's a photo of us after eating some delicious tacos, gringas, and quesadillas at Tacos Nortenos.  Dinner was filled with spicy salsa and more yummy grilled meat.  You can't go wrong with a fresh tortilla, grilled asada, chopped onions and cilantro, and a drizzle of spicy salsa. 

We followed the deliciousness with ice cream made from ferrero roucher chocolates.  Two scoops of rich chocolate ice cream with plenty of chocolate and hazelnut pieces was a great way to end our first week of clinic.

El dolor de estomago

Today, I finally had that moment we've all known was coming where I realized how much I've actually learned this past year.  There was no big "ah, ha"; medicine just seemed natural.  Claire and I were at clinic today, watching the UAG medical students fumble through a patient history.  The patient was a 22 year old female coming in with stomach pain.  As she's describing her symptoms, I'm trying to pick up as much of the language as possible.  Finally, I watch her move her hands from the center of her abdomen to her right side as she describes how the pain has moved since it first began.  Immediately, I knew it was an appendicitis.

We followed her into the doctor's office and listened to the patient answer more questions.  Upon physical exam, the doctor touched an area of her abdomen referred to as McBurney's point.  The patient cried out in pain.  The doctor then bent the patient's right leg, and the diagnosis was confirmed.  She had an appendicitis and needed to immediately go to the hospital.

After the patient left, the doctor asked us for a differential diagnosis.  What else could have been wrong with this patient?  As we stumbled through our differential in Spanish, I didn't care that we were failing miserably.  What mattered was that I finally realized and appreciated how much I've learned this past year.  I know how to take a history, I know how to do a physical exam, I can present patients to doctors, and I can synthesize symptoms into a classical diagnosis.  Amazing.

There is more to this stomach ache story.  Some would consider it a sin, but I have been in Mexico one week and had not eaten tacos.  So, what was I going to do?  Skip the provided lunch with the host family and find me some tacos.  Now, none of us actually got a stomach ache, but upon eating 6 tacos each, the potential for stomach aches was there.  Deliciously fresh tortillas, several different meats (chorizo, carnaza, pastor, asada y lengua), onions, cilantro, a few salsas, and an ice cold manzanita later, I was a happy girl.

 ...clearly, we all were.   

Estoy en Mexico!!

That's right.  I'm in Guadalajara taking a medical Spanish course at UAG.  I've only been here for 6 days but I've already learned so much (it's actually really hard not to write this post in Spanish seeing as how I'm thinking of the words in Spanish but typing in English). 

I came here with two of my good friends from medical school, Kasey and Claire, and we are having a wonderful time.  We arrived on Thursday and were already on a bus headed to Puerto Vallarta on Friday.  I can never say no to some quality beach time. 

Mis amigas y yo

Now since this is supposed to be a food related blog, it's important I talk about our meals in PV.  What were some of our first meals in Mexico? 

Chilaquiles with eggs (aka tortilla chips drowned in salsa, cheese and cream) with a cup of oh so fresh coffee.

Mole.  Need I say more?

A refreshing beach snack of mangos and jicama with chile and limes.

You are probably thinking yum (or que rico depending on your current location) and you would be correct.  Even though we were in a bit of a rush to get to PV, we couldn't have asked for a better weekend.  The weather was perfect, the sun was shining, and the ocean was inviting.  We got some of our first cat calls while walking along the boardwalk.  A few favorites of ours were "Hola Charlie's Angels" and "Do you need three Mexican Body Guards?"  Our trip quickly came to an end so our last night in PV, we watched the sun set while enjoying margaritas on a patio overlooking the ocean.  Life is tough...

I promise I came to Guadalajara to study Spanish.  I'm taking intermediate grammar and medical Spanish courses for four hours every day.  The classes are incredibly fast paced but the teachers are amazing!  By the end of the program, it's pretty realistic to say that I will be able to do an entire history, exam, and assessment in Spanish.  After class, we walk back to our house for lunch.  Lunch is quite the event here since it is the most important meal of the day.  It's not unusual to have three courses, all washed down with aguas frescas.  All of our weekday meals are prepared by Marisol who is essentially the woman who runs the entire household.  There are 5 students staying here and she certainly has her hands full, but her meals never disappoint.  Everyone speaks Spanish and are continually patient as we learn to speak (and understand) Spanish. 

After lunch, we rush back to campus so we can catch our rides to clinic.  Claire and I are at the same clinic.  We've only seen a few patients so far, but it's been fun listening to the patients describe their symptoms and watching the doctor interact with her patients.  Medicine is more casual and friendly here.  The patient is seen in the doctor's office, complete with the doctor's desk and examining table.  Our doctor teaches UAG medical students and seems excited to start working with us.  Next week the UAG medical students will no longer be at clinic and our doctor is going to be relying on us to complete patient intake. 
 
This weekend we plan on exploring downtown Guadalajara, hunting down tortas ahogadas, and going on a tequila tasting tour.  It's going to be an awesome few weeks.  Adios!!

New mixer? Time to make pizza dough.

Monday was yet another quiz day.  I was really worried about this one and I have no idea why.  Maybe it was all the male and female hormone cycles I had to learn or the dozens of causes of meningitis.  (Side note: always cook your pork because if you ingest eggs infected by a little parasite called taenia solium you are in a lot of trouble!).  Anyways, it could also be the fact that this was the second to last quiz marking the near end of my first year and I am beginning to realize how quickly life is passing me by.

But the point is, when I worry, I bake.  Still trying to use my mixer in every way, shape and form, I decided to make pizza.  I've never made pizza dough.  The pizza dough at Trader Joe's is just so ridiculously convenient and inexpensive that I never feel the need to mix, knead, and proof dough.  Especially when yeast can be so finicky.  However, I was too excited to use the dough attachment for the mixer.  And so, I made pizza dough using Tyler Florence's recipe.  The mixer made a beautiful dough (yes, I thought it was beautiful).  I left it in the bowl, covered it with a towel, and put it in a warm place to rise.  After an hour, nothing was happening and I had to get to class.  So, I wrapped it in a blanket, put it in the oven, and hoped for the best.  Two hours later, I had my roommate take the dough out and put it in the fridge.  When I came home, the dough had doubled in size and was gorgeous!

Moving on to taste, the dough made a great pizza.  It was a little salty, but for the sweetness of the toppings, the two worked well together.  Since I like combining sweet and savory, the next time I make the pizza I plan on adding prosciutto and arugula.  Either way, the pizza was delicious and I'll definitely be making it again. 

Pizza Dough
Ingredients
1 package active dry yeast
1 t sugar
1 cup warm water
1 T salt
extra virgin olive oil
3 cups of flour (plus a little more for dusting)

Directions
1.  In the bowl of a standing electric mixer fitted with a dough hook, combine the yeast, sugar, and warm water; stir gently to dissolve. Let the mixture stand until the yeast comes alive and starts to foam, about 5 to 10 minutes.
2.  Turn the mixer on low and add the salt and 2 tablespoons of olive oil. Add the flour, a little at a time, mixing at the lowest speed until all the flour has been incorporated. When the dough starts to come together, increase the speed to medium; stop the machine periodically to scrape the dough off the hook. Mix until the dough gathers into a ball.
3.  Form the dough into a round and place in a lightly oiled bowl, turn it over to coat. Cover with plastic wrap or a damp towel and let it rise in a warm spot until doubled in size, about 1 hour.
4. Once the dough is domed and spongy, turn it out onto a lightly floured counter. Divide the dough into three equal pieces. Cover and let rest for 10 minutes so it will be easier to roll out. Roll dough out into desired size and thickness.

Fig and Ricotta Pizza, adapted from Eats Well With Others

Pizza Dough
Extra Virgin Olive Oil
1 1/2 cups fresh ricotta
10-15 dried figs, cut into chunks
2 tomatoes, seeded and cut into chunks
A few slices of prosciutto
3 tbsp maple syrup
3 tbsp balsamic vinegar
Arugula

1. Preheat the oven to 525.
2. In a small skillet, heat the maple syrup and balsamic vinegar until boiling.  Simmer until thickened and reduced by half, about 3-5 minutes.
3.  On the rolled out pizza, drizzle with olive oil.  Spread the ricotta.  Place a few slices of prosciutto on cheese.  Sprinkle with dried figs and tomato pieces.  Drizzle liberally with maple balsamic reduction.  Put in the oven and bake for 10-15 minutes or until the bottom is light brown.  Top with arugula dressed in olive oil and enjoy!

The creation of Maple-Bacon scones

A few days ago, I got THE kitchen appliance, the item many home cooks dream about: a KitchenAid Stand Mixer.  In order to properly welcome the newest addition to the family, I needed to make something deliciously epic.  What did I make you ask?  Maple-Bacon scones.

 My med school friends are obsessed with all things bacon.  Here's a sampling of the bacon obsession: maple-bacon donuts delivered from Voodoo Donuts in Portland, bacon crusted burgers from our very own Dad's Kitchen in Sacramento (featured on Foodnetwork!), maple bacon cupcakes (a Sunday treat from a local cupcake shop), and a special bacon patty on top of cheeseburgers from Hodad's in San Diego (see photos below; the sunset and excitement of the start of our Baja spring break didn't hurt).

Ethan and Alex enjoying their burgers; I'm in the background digging for some fries

So, in honor of my new baby the maple-bacon scone making happened.  They were delicious!  Like all good scones, they were light and fluffy.  Not too sweet, just enough bacon, and the perfect breakfast food with a hot cup of coffee.  I adapted a maple scone recipe from Barefoot Contessa and here it is:

Ingredients:
5 cups of all-purpose flour plus more for dusting
2 T baking powder
2 T granulated sugar
2 t salt
1 pound (4 sticks) cold unsalted butter cut into small cubes
1/2 cup cold buttermilk
1/2 cup pure maple syrup
4 extra-large eggs lightly beaten
1 extra-large egg beaten with 1 tablespoon milk or water, for egg wash
1 lb cooked bacon (2 strips reserved, the rest chopped small), reserve 2 t bacon grease
1/4 cups confectioners' sugar (for the glaze)
1/2 cup pure maple syrup (for the glaze)
1 1/2 t pure vanilla extract (for the glaze)

Directions:
1.  Preheat the oven to 400 degrees.with rack in center. In the bowl of an electric mixer fitted with the paddle attachment, combine all-purpose flour, baking powder, sugar, and salt. Blend butter in at the lowest speed, and mix until butter is in pea-size pieces. In a medium bowl, combine buttermilk, maple syrup, and 4 eggs; mix to combine. Add egg mixture to flour mixture. Mix until just blended. Add chopped bacon.  The dough may be sticky.
2.  Place dough on a well-floured surface. Roll dough out to a 3/4- to 1-inch thickness with a well-floured rolling pin (there will be lumps of butter in dough). Cut into desired shape, and place on a parchment-lined baking sheet.

3.  Brush tops of scones with egg wash. Bake until tops are crisp and insides are done, 20 to 25 minutes. Remove baking sheet to wire rack to cool for 5 minutes.
4.  Make the glaze: Combine confectioners' sugar, maple syrup, bacon grease, and vanilla. Drizzle each cooled scone with glaze (the warmer the scones are when glazed, the thinner the glaze will be).  Cut reserved bacon strips into desired size and a piece on top of each scone.

For the next batch, I might use 1 cup of whole wheat flour instead of 1 cup of all-purpose flour just to give the scone a little more complexity and additional flavor.  I would also use a heavier maple syrup; the grade A from Trader Joe's was good, but I think the scones could be better.

Don't get me wrong, for a first attempt these were really, really, really good.  I made them the night before, and they definitely tasted amazing the next morning after the flavors sat.  They definitely hit the spot during our 9am required epidemiology lecture.  

Stay tuned for my dining adventures in Baja.  Also, a few pictures were added to my previous post to show the cookie stuffed cookie in all its glory.

Studying for 8 hours and I still feel lucky to be here...

Every other weekend is what we call a quiz weekend.  That means my friends and I spend our Saturdays and Sundays studying at one of our favorite local coffee shops.  Biweekly quizzes forces us to stay on top of the endless amounts of information they present to us every day.  Material which this time includes gastrointestinal bacteria, viruses, and parasites, antibiotic therapies, thyroid function and disease, as well as cholesterol and hyperlipidemia.  All the good stuff that we will see time and time again in practice.  That's why this block is so much more interesting than last block; the material is finally relevant.  We're learning about infectious diseases, diabetes, high cholesterol, hormone imbalance, and how to treat those very same disorders.  I'm finally learning how to be a doctor and that requires hours of hard work.  In order to maintain the study stamina, I need to take effective study breaks.  With my friends, that usually means good food.

Saturday night, my foodie group again got together for dinner.  I don't know if it's the return of the sunny weather, drinking a good cup of coffee, or the great dinner with my friends but I've been thinking about what was said at my recent Healer's Art session.  Healer's Art is a great program offered by my school to make sure we stay connected to the humanistic side of medicine as well as retaining who we are as we go through the acculturation into medicine.  At this particular session we were asked to reflect on three simple statements every day: what surprised us today, what inspired us today, and what touched our hearts today.

What surprised me today was how amazing the dinner was.  On the menu were pulled pork sandwiches with coleslaw, good beer, and cookie stuffed cookies.  You heard me right, cookie stuffed cookies.  Last night I made these: Here's the link if you want to try them out: http://picky-palate.com/2011/01/06/oreo-stuffed-chocolate-chip-cookies/  Three delicious cookies in one is definitely worth the risk of diabetes.  The next time I bake I am going to try thin mint stuffed chocolate-chocolate chip cookies.

Cookie cheers, from left to right we have Kasey, Claire, Alex and Laura

Today, I needed inspiration to study and I got that from my friends.  Medical school is exhausting.  We are continuously on information overload.  I once heard it explained as trying to take a drink of water from a fire hose and as much as I want to learn everything, it's impossible.  For this next quiz, we have about 10 lectures of microbiology to learn.  If I don't do well on the quiz, it's not that big of a deal; that's the upside to embracing a pass/fail grading system.  However, it's scary that I can't learn all this information because it matters to my future patients.  They tell us the important stuff will come up repeatedly, but for the first time in a long time, I feel like I'm learning stuff that matters.  It's frustrating when I'm tired and don't want to study anymore or all I care about is passing the quiz.  There is no motivation or inspiration there.  That's where the inspiration comes in.  I study with my friends who continuously remind me of what's important and help me get through the craziness of medical school.  Without them, I don't know if I would be able to put in the long hours that I do and stay sane while doing it.  They remind me of why I came here and about what really matters.  It's not the quizzes, the finals, or small group exercises, it's about becoming the kind of doctor I set out to be.  That's inspiring. 

Finally I come to the part about what touched my heart today.  When you spend a day studying, there isn't much to feel warm and fuzzy about.  After a little reflection, I came to realize how lucky I am.  I am at an amazing medical school that cares about its students and training them to be compassionate and effective physicians.  My college friends and family are incredibly supportive and proud of me (another source of inspiration) and I never would have gotten this far without them.  Finally, I don't know how it happened so easily but I found a great group of people at school.  We're all going through the same thing and we help each other get through it; we can talk seriously, laugh at each others jokes, grocery shop together, cuddle up and watch movies, study, and truly enjoy each others company.  Med school is awesome.