Thursday, January 12, 2012

Mise En Place (Everything in Its Place)

      I'm passing my black cloud over to whomever wants it. It's officially up for grabs, free for the taking, and I will even consider delivering it right to your doorstep. The scales which balance the delicate "90% sheer boredom: 10% sheer terror" ratio of anesthesia-related stressors tipped unfavorably down the slippery slope of "Oh dear" to "Holy shit!" yesterday, and I. am. done.  I woke up at 0500, exactly like I do every single work day. I drank a big glass of filtered water with a teaspoon of Bragg's apple cider vinegar, sipped two cups of coffee with steamed milk, and lingered over a cup of Greek yogurt and kiwi fruit as I put the finishing touches on my blog. From the kitchen window, I could hear the rain pouring down outside, and in retrospect, I'm guessing this was probably some sort of omen. Hope springs eternal for optimists like me and I paid the rain little attention, with the exception of the concern I felt about Brad's 50+ mile commute to Atlanta in the torrential downpour. We chatted for a few moments, kissed good-bye, and then I got into the shower. As I put on my mascara and blow-dried my hair, I contemplated the strange juxtaposition between the facts that I was the designated "early out" doc, yet my assignment consisted of an oddly staggered hodge-podge of labor and delivery, the GI Lab (colonoscopies, throat scopes), the endovascular suite (!), MRI, trans-esophageal echocardiography/cardioversions, and three urology operating rooms. This particular mix of cases didn't sound too promising.
     I arrived at work around 0620, stashed my purse and raincoat inside my locker, put my lunch of ratatouille and brown rice and a container of fresh cherries into the fridge, and went to pre op my first patient. Because there was very little information in the patient's chart, I spent a great deal of time talking with him and his wife, obtaining a thorough history and documenting my observations and anesthetic plan. Vascular patients are among the sickest of all patients, and it pays to know everything that you possibly can about them. Thankfully, the patient's wife brought her diary, in which she'd recorded all of his recent health-related issues, doctor visits, procedures, tests, and medications. I find first-hand information like this extremely helpful in discerning a person's true state of cardiovascular health, especially when there are issues, like a stroke, which prevent the patient him or herself from communicating effectively with you. I then toddled off to see my first C-section patient, as well as another patient who was having an esophagoduodenoscopy in the GI Lab. I'm not going to bore you with the details of the agonizing C-section spinal, which took 40 minutes to place, nor will I subject you to a blow-by-blow description of the dance of anaphylaxis that occurred in the recovery room, necessitating full-on CPR and an emergent surgical airway, or how after all of that, an orthopedic surgeon aspirated 30 cc's of joint fluid from my swollen left knee while my friend, Brenda, a recovery room nurse, held my hand. What I'm going to tell you about is the meal I ended up cooking for Brad and myself last night.
    It had gotten close to 6 p.m., and the window of opportunity for preparing a home-cooked dinner was growing narrower by the second. Should we just say "screw it" and go out to eat? I wasn't feeling terribly inspired; my knee was starting to ache, and I was still re-hashing the series of unpleasant events from my day at work. I surveyed the kitchen, overcome by a complete lack of motivation. I wasn't excited by anything in the refrigerator or pantry. My thoughts wandered to the laundry that needed to be washed and folded, the unopened mail, and today's blog, which I hadn't yet started working on. The dogs were begging to come in from outside, and I didn't feel like dealing with their hyperactivity. My ambivalence was starting to suffocate me.
     I knew I was entering the downward spiral into a major what-am-I-going-to-cook suckfest when, in a moment of clarity, I grabbed six sweet potatoes from their bin and started peeling away. I would make sweet potato soup. I plopped them into a pot of water, turned the flame up to "high", and simmered them for about 20 minutes until they were tender. While the potatoes were cooking, I proofed some yeast, and dumped some sprouted wheat and whole-spelt flours into the bowl of my 25 year old food processor, the plan being to make a quick, crusty boule of bread. I've had trouble substituting spelt flour in this bread recipe before. I thought about it, and decided to try and circumvent the spelt's lack of gluten-mediated elasticity by adding some extra yeast and an egg to the liquid ingredients. I had a near-snafu during the thirty minute initial rise. I'd turned the oven on to 200 degrees Fahrenheit for a minute, just to warm it up inside to activate the yeast, but after placing the covered bowl of bread dough inside, I got busy washing dishes and forgot to turn it off. When the "pre-heated" timer sounded after a few minutes, I audibly groaned "Oh no!", along with another choice exclamation  which I'll leave to your imagination. Immediately, I whisked the dough from the oven. As I blasted the bottom of the metal dough bowl with cold water, the entire sticky blob almost slipped into the sink. Had my black cloud followed me home, into my own kitchen? Reflexly, I jerked the bowl upward, deftly flipping the dough back inside, simultaneously managing to salvage the bread and redeem myself as an amateur baker.
     As the bread rose, I turned my attention to the kale I had sitting in the salad spinner. I'd already stemmed and rinsed it, and after giving it a couple of spins, I scooped it into a big bowl, seasoning it with a few shakes of sea salt and white pepper. After drizzling the kale with olive oil, I spread it out on a baking sheet, ready to roast. Once the sweet potatoes had finished cooking, I drained them and set them aside. In my favorite green cast-iron enameled Dutch oven, I browned some onion, celery and fresh ginger, very slowly over low heat, later adding the cooked potatoes and a couple of cups of vegetable stock. I let this mixture simmer for a few minutes as I seasoned it with salt, pepper, cinnamon, nutmeg, roasted cumin, turmeric, cayenne, and red stamp pepper. I pureed the hot soup in my Vita Mix blender, and I'm telling you, that machine is worth its weight in gold. In seconds, I had silky smooth potage with a minimum of effort or clean-up. I rinsed out the big green pot before transferring the soup back into it, letting it come back to barely a simmer. When the dough had finished rising, I took it from its bowl, shaped it into a round loaf, patted its top with a little flour before slashing a circle around the perimeter, and placed the boule into the oven to bake for 50 minutes. I suddenly remembered that I had a ripe avocado in the fridge, as well as some grape tomatoes. I diced up the avocado, leaving the tomatoes whole, and made a simple salad accented with salt, pepper, a generous squeeze of lime juice and fresh flat leaf parsley. The kale went into the oven about 30 minutes after the bread, and around this time, Brad walked in. It was just after seven-thirty, and although he was tired from his long drive, he was visibly pleased by the rich scent of the sweet potato soup bubbling on top of the stove, the earthy aroma of the baking bread, and the fragrant, jewel-like kale, which was roasting to a perfect crisp alongside it. The kitchen smelled like heaven. We ate like kings, slathering the toothsome hot bread with cultured butter, savoring the contrast of the creamy spiced soup, the freshness and smoothness of the citrus-kissed avocado and juicy tomatoes, and the salty, crunchy kale.
     Days like yesterday remind me why I love to cook. It's funny, because the way I cook is a lot like the way I give anesthesia. I focus on true quality, instead of employing a cookbook approach. Putting together a meal on the spur of the moment takes creativity, vision, planning, and organization of resources, a concept known to serious cooks as mise en place. Exactly like a well-planned anesthesic in the operating room, mise en place is essential to the success of any endeavor in the kitchen. Although it is work, there is something extremely satisfying about conceptualizing a dish, spending a few minutes preparing all the necessary ingredients beforehand, and then seeing it all come together beautifully. This affords me plenty of time to deal with the snags which inevitably arise. My ingredients at work yesterday included epinephrine, corticosteroids, Benadryl, copious IV fluids, Versed, labetalol, propofol and succhinylcholine. In conceiving and planning each item's individual use, I was able to avert total disaster. There are always two ways of looking at a situation, I suppose. Although it doesn't appear to have followed me home, my black cloud is still on the chopping block. I am SO not an adrenaline-junkie. Despite being extremely competent in managing emergencies like yesterday's, I can do without the excitement, the organized chaos involved in coding a person who's dying, the inevitable clash of physicians' egos, and the fear of losing a patient on the table. I guess I'm just a mise en place kind of girl.
    

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