Post-Call/Pre-Call Saturday Fabulousness

Call is a necessary evil in the world of medicine.  Patients don’t stop delivering, problems don’t disappear, and consults don’t stop coming in just because it’s after 6pm or a weekend. In a hospital, someone has to be around to take care of patients 24 hours a day, 7 days a week.  Enter the concept of “call,” which is basically covering any duties beyond the Monday through Friday 7am-6pm normal work day.  In my world of OB/GYN “call” is a bit of a misnomer – we aren’t hanging out at home “on call”, waiting to be called in.  We are at the hospital when we take call, readily on hand in case a patient needs an emergent cesarean section or a trip to the OR for a ruptured ectopic.  You may not always see us doctors, but someone is always there, haunting the halls, making sure everyone on the service is doing okay.

Usually we try to space out 24 hour calls, taking turns at the responsibility of living in the hospital, in order to ensure the maintenance of sanity.  There is only so much sleep deprivation and stress a human body can handle.  While some of our senior colleagues bemoan the advent of work hour restrictions and the more humane treatment of residents, I have to say these are good developments in medical training.  As someone who has been awake for 36 hours straight, I can confirm there is a certain point of fatigue at which I become unsafe to practice medicine.  Incorporating a degree of balance into medical training keeps patients safe and residents happy, decreasing errors and burnout alike.

Sometimes, however, you just gotta deal with a lot of call.

This is how I found myself on Saturday, post-call from a 24 hour shift on Friday, and pre-call before another 24 hour shift on Sunday.  In these situations, I find it is important to make something fabulous happen to avoid spiraling into the depths of despair.  If life becomes a dreary slog of work – sleep – work, it’s easy to feel unhealthy, unbalanced, and depressed.

Step 1 of my Saturday fabulousness was, indeed, sleep – you can’t feel fabulous when you are tired!  I showered off the hospital, closed my black-out curtains, and kicked my husband out of the apartment for 5 hours of glorious, undisturbed rest.  (Don’t worry – he went off to do “man tasks” and did not resent the temporary eviction).

Step 2 was to work out.  Whenever I wake up from a nap post-call I feel pretty awful, my brain fuzzy and my body stiff.  Some sort of physical activity to get my blood pumping and endorphins flowing always, without fail, makes me feel dramatically better.  My local gym is closed on Saturdays, so I pulled up a 60 minute HIIT workout on Fitness Blender and got my body moving.  By the end, I was sweating, sore, and alert.  It felt wonderful!

Step 3 for battling the depression of call-overload: get pretty.  Shower, put on real-people clothes, put on a touch of make up.  Maybe go crazy and wear heels, even if you’re just in your own house.  I want to feel like a normal person, even if it’s only for a few hours before I need to head back to bed for additional pre-call sleep.  It’s hard not to feel good when you look good!

Step 4 – now that you feel fabulous again, do something fabulous!  We could have gone out, and sometimes we do, but this Saturday it seemed like too much work.  Instead, Brian and I decided to turn our apartment into a fine-dining establishment.  We love to cook, and we really love to cook together.  So we threw on some music, lit all of our numerous candles, and got to it.

As an appetizer, I created a cheeseboard for the two of us to nibble while we were cooking.  Among other things, I was starving, having not eaten since breakfast and also having worked out – I needed food ASAP, and few things make me happier than good wine with good cheese!  I usually try to serve at least 3 different cheeses on my cheeseboards, and I like to have yummy accompaniments, like fruit, nuts, and different crackers.

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Cheeseboard for two!

For this particular cheeseboard, I selected a sheep milk cheese (bottom left – Mitica Cordobes from Whole Foods), a Roth Kase Private Reserve cow milk cheese (top right, also from Whole foods), and a goat Chèvre from Trader Joe’s served with a blackberry-walnut jam (top left).  I added some grapes, blackberries, and pistachios, as well as a wheat cracker and an olive-fig cracker.  We opened a bottle of Merlot from Paso Robles to sip as we enjoyed our cheese and prepared the rest of our dinner.

I made a salad of arugula and spinach with tomatoes, cucumber, pistachios, dried currants, and crumbled goat cheese.  I find the best way to do salads is to dress the greens and plate them first, then add the remainder of your ingredients.  This makes sure your salad looks attractive, and keeps all the additional goodies from collecting at the bottom of your mixing bowl.  For the dressing, I drizzled EVOO and aged balsamic from The Olive Press over the greens and tossed in some sea salt and fresh ground pepper.  If you use high quality oil and vinegar, you really don’t need much more for a truly delicious salad dressing!

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Spinach and arugula salad with EVOO and balsamic.

While I was preparing the cheese and the salad, Brian was working on our main entree.  He prepared a soy-ginger glaze that he poured over some beautiful salmon filets, and took them out to grill on a cedar plank.  I tossed some asparagus spears in olive oil, sprinkled them with sea salt and fresh ground pepper, and added some finely chopped shallots.  The key to good asparagus is to turn off the heat before the asparagus is fully cooked; it will continue to cook in the hot pan while you are waiting to plate, and you end up with a flavorful, crisp asparagus as opposed to a soggy, mushy mess.  When we were done, we had a restaurant quality meal that we had prepared ourselves.

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Grilled soy-ginger salmon with asparagus.

We added some fresh bread warmed in the oven with more of the delicious Olive Press EVOO and balsamic for dipping, and poured more of our lovely Merlot.  It was from a winery in Breckenridge, Colorado, though the grapes were sourced from Paso Robles.  The wine was very fruit-forward with prominent notes of blackberry and black plum.  It was soft on the palate and pleasant to drink, and it went well with our meal.

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A date at home!

We sat down for our home-prepared meal and enjoyed each other’s company in the warm glow of candle light.  We had a lovely evening, and I felt relaxed, loved, healthy, and happy.  I felt as though balance had been restored to my life, and I felt ready to tackle another 24 hour call with grace and good will.  When you work a lot, you have to make fabulous happen, whatever that looks like for you.  The next time you are feeling downtrodden and overworked, take a moment to do whatever you need to do to feel normal again, and keep your inner spark sparkling!

Discovering HIIT

I have spent the majority of my life as an endurance athlete.  I started swimming when I was 5 years old, and as a distance freestyler I averaged 8,000-10,000 yards a practice, 9 – 10 practices a week, starting when I was 12.  I always loved running, and when I injured my shoulder at the age of 13 and needed to stay out of the water for a year, I took up cross country.  Until I started Residency 3 years ago, I was still swimming 90 minutes 5-6 days a week and running here and there for fun.  In my mind, a workout wasn’t a workout unless it took at least an hour.

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Swimming, my favorite thing!

Enter Residency.  For those who have never had the privilege to experience it, Residency is basically modern day indentured servitude.  You pretty much lose control of your life.  You work insane hours for meager pay (once, as an intern, I calculated my hourly wage – it was barely above the state minimum).  You are regularly criticized and rarely praised.  Most of your time off is spent studying, performing required research or quality improvement studies, or sleeping.  Finding time to swim or run for an hour a day?  Ha, right.  I think maybe the most dedicated, who don’t live with a significant other, potentially could.  Despite my endorphin addiction and pretty determined dedication, though, I found I couldn’t.  I was getting older and 4 hours of sleep a night wasn’t cutting it anymore.  I was newly married and actually rather liked spending time with my husband.  And I was so terrified of screwing up and hurting someone that I spent any residual time reading about medicine.

I swam when I could and ran when I could, but I started to feel depressed.  Exercise has been such a huge part of my life that without it, I just feel gross and unhealthy.  The one good thing about being a resident is that your job is not sedentary – you run around all over the hospital – so I got a FitBit and felt a little better about myself when I realized that I was walking so many steps and getting in so many flights.

As I moved through residency and graduated from internship, things got a little better.  I became a more confident and efficient doctor, and I passed the torch of intern scut to the new batch of bright-eyed and eager recent medical school grads.  I started having a bit more time to workout, and on certain rotations I was actually able to get back into decent swimming shape.  At the end of 2 months of swimming 1 hour 4 days a week, for example, I was actually starting to make repeat 100s freestyle on 1:10!  I would feel amazing – healthy, vital, fast, strong, and happy.  Then, however, I’d be back on a really hard rotation with more demanding hours, and I would lose that wonderful feeling.

Like all good 30-somethings of this modern era, I spend an inordinate amount of time on Facebook.  Standing in line at the grocery store, sitting at a stoplight, brushing my teeth (yep, guilty!), I “like” and comment and post pictures with the best of them.  It was on Facebook that I, the endurance athlete who scoffs at the idea of a 24 minute “workout,” started to see a lot of adds for this new exercise concept called HIIT – high intensity interval training.  Things like Body Boss kept popping up on my feed, promising better fitness and body tone with just 24 minutes, 3 days a week!  I initially ignored it, but it was so relentlessly in my face that I eventually decided to see what this HIIT stuff was all about.

The concept of HIIT has been around forever.  But for those of you who are new to this concept, the idea is that you pretty much kill yourself with short bursts of really hard exercise with active recovery in between for an average duration of 25-30 minutes.  Because the activity is very high intensity, it’s an efficient way to work out: you burn more calories in a 28 minute HIIT workout than you do in 1 hour on the elliptical.  Best of all, the majority of HIIT workouts require little more than a small rectangle of space to perform, so you can do the workouts, well, anywhere.  According to the American Society of Sports Medicine, HIIT training has been shown to improve:

  • Aerobic and anaerobic fitness
  • Blood pressure
  • Cardiovascular health
  • Insulin sensitivity (in fact, there are tons of publications advocating HIIT training for Type II diabetics)
  • Cholesterol profiles
  • Abdominal fat and body weight while maintaining muscle mass

Hmm…a highly effective workout routine that I can do at home in 30 minutes?  I had to try this!

Unwilling to pay for something I wasn’t yet 100% sold on, I went to the internet.  Just google “HIIT workout” and you will find hundreds of free workouts for your body-destroying enjoyment.  I pulled up a 28 minute workout from Fitness Blenderinwardly still not entirely convinced.  After a 5 minute warm up, I spent the next 20 minutes performing explosive movements for 20 seconds at a time with 10 seconds of active rest (such as a boxer shuffle) in between.  I squatted, lunged, jumped, and pushed-up until every muscle in my body screamed in protest, my heart pounding in my ears and my breath coming in ragged gasps.  At the end I stood hunched, hands on my knees, dripping sweat onto my living room carpet.  I couldn’t believe it had only been 25 minutes – it had felt like forever!

Okay, I admitted as I obediently performed the cool down portion of the workout.  That was hard.  And I was hooked!  HIIT has become a way for me to feed the endorphin monster, to maintain that strong and healthy feeling, on a minimal time budget.

I created a *free* account on Fitness Blender, which was started by a husband and wife team of personal trainers who thought that fitness should be accessible to everyone, no matter what their income (how can you not already love these people?!).   Fitness Blender has a TON of free full-length workout videos ranging in difficulty from 1-5 and in duration from 20 – 90 minutes.  You can pull up workouts that use equipment, but there are hundreds of workouts that require nothing more than an internet connection and an 6 x 4 ft rectangle of floor space.  I love their workouts because 1) they are both really encouraging instructors, 2) they have a visual and audio timer so you know when to go hard and when to do your active rest, and 3) they have the decency to also get a little tired at the end of a grueling level 4 or level 5 workout.  It’s just nice to know, when you feel like you are about to die, that even the uber fit personal trainer leading your workout is a wee bit winded.

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Kelli and Daniel, egalitarian founders of Fitness Blender.

I believe it is still important to do other forms of aerobic exercise.  I haven’t given up swimming, for example – swimming is still my #1 choice for exercise and always will be.  Whenever I have the time to swim, I greedily snatch the opportunity.  Running, too.  However, on those days when I don’t have the time, or when it’s 100 degrees in Redlands and running would put me at risk for heat stroke, I happily log on to Fitness Blender and get my HIIT on, feeling awesome and exhausted 30 minutes later.

If you haven’t given HIIT a try, you really should, especially if you are low on time and want to improve your fitness level.  Let Kelli and Daniel of Fitness Blender make you a convert!

 

 

 

 

 

Building A Beautiful Vegetable Crudite Platter

Confession: I have a slight obsession with cheese boards.  From designing them to serving them to eating them, cheese boards make me very happy…especially when paired with a delicious bottle of wine.  But I’ve been doing a lot of them lately, and decided to try my hand at something new.

Not only are vegetable crudité platters a very healthy option to serve at a party, they can also be edible art.  What better way to wow your guests than a beautifully crafted, colorful spread to be nibbled and munched at, guilt-free?  Added bonus?  Super easy!

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One of my recent creations. Attractive, delicious, and healthy!

A successful crudité platter requires 2 key elements:

  • Fresh veggies
  • Tasty dips

You can always throw on some extra goodies, such as crackers, pita chips, Greek dolma, dried fruit, nuts, even (of course) cheese!  I think a herby chevre is a great option in this case as it can be spread on crackers and topped with veggies.

For the veggies: think “color” and “fresh.”  You probably want at least 1 selection from several color groups.  Then just go to the market and purchase whatever looks the brightest and freshest.  Here are some options:

  • Green: cucumber, celery, sugar snap peas, asparagus, broccoli
  • Red: cherry tomatoes, red pepper
  • Yellow: yellow carrots, yellow pepper
  • Orange: orange carrots, orange pepper
  • Purple: purple carrots, radish (watermelon radishes are especially lovely), red Belgian endive
  • White: cauliflower, endive, fennel, jicama

For the dips: you could whip up some Green Goddess dressing from scratch…or you could make life easy and hit up your local Trader Joe’s.  With an impressive array of colorful hummus options, you can take care of this part in a snap.  I recommend selecting 2-3 different color hummus options for your crudité platter.  Some examples:

  • Trader Joe’s Beet Hummus (purple)
  • Trader Joe’s Edamame Hummus (green)
  • Trader Joe’s Tomato Basil Hummus (orange)
  • Trader Joe’s Eggplant Hummus (tan)
  • Trader Joe’s Original Hummus (tan)

Now, some tips for assembling your platter:

  • I use a mandolin set at the thickest slice setting for things like cucumbers, fennel, radishes, and carrots. You get a uniform slice and it gets done fast.
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Mandolin slicer. I suggest setting it to the thickest slice for veggie crudités.
  • You can add some extra flavor to veggies like broccoli or asparagus by doing a quick sautee: toss the veggies in olive oil, salt, and pepper and sautee for 1-2 minutes so they are still crisp but slightly cooked.
  • To take your dips from basic to “wow!” you can do some simple garnishes. Top Beet Hummus and Edamame hummus with lemon zest.  Top Tomato Basil hummus with a few Trader Joe’s sundried tomatoes and some shredded basil.  Top Eggplant Hummus or Original Hummus with some fancy olive oil and pine nuts.

Now just place your dips on the board and arrange the veggies around them.  Add in your extras and serve!

 

Hiking in Palm Springs

First off, my apologies for the cyber silence!  I had two consecutive very busy weeks on service with a whole slew of call smack in the middle, and as such my blogging endeavors were temporarily abandoned.  Let us put an end to this drought with my review of hiking in Mount San Jacinto State Park!

Due primarily to the incredible mentorship of Dr. Yevgeniya Ioffe and Dr. Linda Hong in the department of Gynecologic Oncology at Loma Linda, I had a poster accepted at the Western Association of Gynecologic Oncologists annual meeting held in Rancho Mirage June 14-17.  With the meeting coming to a close on Saturday, my lovely friend Eliza and I found ourselves looking for something athletic to do in the area.

I must briefly digress for a public service announcement.  Palm Springs is a super cute town that is at once old-timey and modern.  There are beautiful resorts, golf courses, and tons of excellent restaurants.  There’s a lot of great mid-century modern architecture and lots of outdoor activities.  However, if you haven’t been to Palm Springs in the summer, be warned that it is hot.  Like, really hot.  Like oh-my-God-my-skin-is-on-fire-and-I-think-I-might-die hot.  This is truly the desert, where temperatures of 120 degrees are common during the day, and at night maybe it cools into the 90s.  You feel like you are wilting merely lying by the pool immobile, much less attempting anything remotely resembling exercise after dawn.

There is, however, this gorgeous national park just 10 minutes away, over 8000 feet above the desert floor, where the temperature is about 30 degrees cooler.  You can go hiking, camping, and horseback riding without feeling as though you might keel over from heat stroke after 5 minutes in the ambient air.  And you get to take this really fun/slightly scary tram ride to the top.  Brilliant!  Decision made, we were on our way to the Palm Springs Aerial Tramway and Mount San Jacinto State Park, air conditioning set to Maximum Stun.

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The desert as viewed from the Palm Springs Aerial Tram.

The Palm Springs Aerial Tramway is the world’s largest rotating tram car.  It travels 2.5 miles from the desert floor to Mountain Station at 8,516 feet and takes about 8-9 minutes.   As you travel, the tram switches cables at each of 5 towers along the route, which sends the tram car swinging and evokes mild screams from any children aboard.  If you visit Palm Springs, it is an experience not to be missed!

When you arrive at the ranger station on the road to the tram, there is an attendant who directs you to a parking lot based on availability.  Some of these lots are a little ways away from the tram station, and there is a bus that will take you to the base of the tram.  However, Eliza and I are pretty fit chicks, and we couldn’t abide standing in the heat waiting for said bus.  This is how we came to be dripping with sweat when we rolled in 10 minutes later – though we did beat the bus and the masses it carried!  We picked up our tickets and boarded the tram, marveling at the views as we traveled.  The air grew blissfully cooler the higher we went, and when we arrived at Mountain Station the afternoon sunshine felt pleasant as a light breeze played across our skin.

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Looking down from the tram.

We had decided to do the 5 mile Round Valley hike, and we set off toward the Ranger Station to pick up our hiking permits.  They take safety very seriously around here; when you go out on the trail, you have to first fill out a form stating where you plan to go, how many people are in your group, the type of car you drove, etc.  One copy stays at the ranger station.  The other copy you take with you, returning it only when you are back from your adventure.  At the end of the day if they are missing that second copy, the park rangers go looking for you.  It’s reassuring to know that if something happens to you, help will soon be on the way.  Safety first!

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Hiking through the forest.

We set off along a little creek, hiking up a path shaded by tall pine trees.  Within 10 minutes we were well away from civilization, the only sounds our voices and the burbles of the creek to our left.

There we were, minding our own business when we were set upon by a literal swarm of lady bugs.  From a distance they looked like gnats, but as they landed on various body parts I saw that I was, happily, mistaken.  The polka-dotted little critters were everywhere!  Tickling our arms and legs, swishing by our ears, and getting a little fresh with Eliza as one or two tried to fly into her sports bra.  What was this, lady bug mating season?!  I had never seen so many in one place!  We hurried along, swatting lady bugs out of our faces, finally emerging from the swarm and flicking the last of our erstwhile passengers off of our skin.

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Eliza, shortly after our harrowing lady bug encounter.

Having escaped the lady bug hoard, we continued traveling upwards, clambering over boulders and rock formations, greeting the occasional fellow hiker along the trail.  We crossed over the brook and the trail led away from its burbling course, curving along a gentle slope through more pine forests dotted with the occasional green meadow.  A few times we had to stop and look around when the trail seemed to disappear, always figuring it out eventually.  I was always very reassured when we came upon signage – I really did not want to end up lost out here!

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Signage! Yay!

About 3 miles into the hike the terrain changed a little.  We temporarily left the forest and found ourselves walking through a chaparral with stunning views of the surrounding mountains.  Without the shade of the forest trees it was much warmer, though still nothing like the desert floor below!  We sipped from our water bottles frequently as we took in the beauty around us, amazed that a place so peaceful and majestic existed mere minutes from the bustling resort town below.

 

The trail dipped back into the forest, and we were struck by a very loud rapping sound echoing around us.  It almost sounded like someone chopping into a tree, but there was no one in sight.  Eliza looked up and found the source of the noise – a wood pecker!  I had never seen one before.  The relentless bird rammed its pointed beak into a sturdy tree over and over again, the sound reverberating around us.  I couldn’t help but laugh in delight!  Soon other wood peckers, unseen in more distant trees, joined in, creating an incredible acoustic environment for us as we walked along.

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The beautiful Round Valley trail.

The trail eventually wound back and deposited us at the ranger station 2 hours after our departure.  We turned in our form documenting our successful return, then trudged up a steep concrete set of switchbacks leading to Mountain Station.  We enjoyed the tram ride back to the desert floor, though neither of us were particularly excited to return to the sweltering 114 degrees that had transformed our car into a sauna.  Once we had the air conditioning blasting in our hot faces, we both felt a wonderful fatigue that comes from a good athletic experience…and realized that we were absolutely famished!

We hurried back into town, desperately in search of food.  We burst into Lulu California Bistro like women on a mission, eschewing the seating hostess and making a beeline for the seat-yourself bar area.  Fresh ceviche with lime and cilantro, ahi tuna tatar served with a seaweed salad and pickled ginger, and a delicious hummus with veggies and pita were washed down with multiple glasses of ice water.  Perfection!  Lulu is one of these wonderful Palm Springs establishments that has a prolonged happy hour – meaning it’s happy hour for most of the day – and I was astonished by how inexpensive our meal was!  The food is tasty and healthy, the decor is eclectic, the service is speedy, and you can’t argue with the price.  Lulu California Bistro is definitely worth a visit the next time you find yourself in the area.

Our energy stores replenished, it was time to head back to our hotel for a much needed shower – we were both covered in a fine layer of dust and parts of our clothes were stiff with dried sweat.  We were very pleased with ourselves, and we felt wonderful!  Hiking in Mount San Jacinto State Park was an awesome way to spend the day, and I will definitely be back for more wilderness adventures in the future.