Tuesday, February 14, 2012

Simple Comfort Food

I have to admit.

I am one of those health care providers who notoriously does not take great care of herself. It's not that I don't want to eat when I'm working. It's just that I don't always have time. I like to be at a stopping point or at least a moment of solace.

As other midwives and nurses know there are days where your feet hit the ground running and they don't stop until your shift or call is over. A favorite medical assistant of mine used to say to me, on days where my schedule was booked and double booked, hope you have your roller skates on! These are the days where I don't eat or drink anything and am so busy I even forget to pee!

So needless to say, at the end of a shift like that I need to carb load. Not the best thing to do at 8 pm or midnight, I know, but after running a marathon on labor and delivery up and down the halls this midwife likes to unwind with a large bowl of whole wheat penne.

I dress it simply but deliciously with my concoction of olive oil, crushed red pepper, sea salt, and shaved Parmesan - all to taste. Then I curl up with the penne and my laptop and watch an episode of Sex and the City.

Comfort food for the belly and soul.

Wednesday, February 8, 2012

The Turtle Sign

We found an incredible spot to call home in the Caribbean.  It's a cottage that is actually built into the ruins of a Danish school house from the 1840s.  To top it off, we inherited some neighbors when we moved in - 8 Red Footed Tortoises who live in the rest of the ruins which is essentially our backyard.
They are fun to watch and feed and I think they have become quite fond of us too since they associate us with food.

But this post is not about these turtles.  I wish I was talking about a cute turtle sign, a picture of a turtle swimming or eating.  I'm talking about something that happens in childbirth.  No recipes today, just a midwife talkin' birth.

Birth is messy.  And rarely textbook.

After being a midwife for 5 years, the order of things gets easier to read but it's still hard to know when the birthing goddesses will throw you a curve ball.  These curve balls can be nice, like a first time mom coming in at 8 or 9 centimeters, or they can be wicked, like the dreaded shoulder dystocia.

In a shoulder dystocia, the baby's head comes out - but sometimes not all the way, maybe the chin is still waiting there - and then immediately does something called the turtle sign.  The turtle sign is where the head sinks back in close to the perineum, like a turtle slinking back into it's shell.
 After the head emerges, this is usually where the rest of the baby easily slips out.  With a dystocia, something is holding the baby up and it typically is the anterior shoulder that's not coming down.  Then we have a set of maneuvers and positions we do until we get the baby out.  It may seem chaotic to a women or family involved (and maybe sometimes it is) but midwives, doctors, and nurses practice for these emergencies.

Some of these dystocias are mild and some are severe.  None are fun.   They all leave you with a sigh of relief when the baby comes out and cries quickly and vigorously, waving his or her arms around wildly.  One of the hardest thing about obstetric emergencies is that they are sometimes unpredictable, so while you have to always be prepared, as a midwife you also need to keep in mind that most of the time birth is normal and healthy.

I had the amazing opportunity to work with a home birth midwife as part of my clinicals for midwifery school.  So the first 8 babies I delivered were all at the women's homes.  In fact the first baby I delivered was on a water bed, which is not an easy feat.  I always remember this midwife talking about the process of becoming a more seasoned midwife.  As a newbie all you can see during a birth is the baby's head, and can focus on nothing else.  Then as you get more experienced you can start focusing on other things - like the fact that thereis a women there, her face, her feelings, the baby's heart rate, the feel of the room.

This applies to emergencies as well.  With your first shoulder dystocia, your inner monologue is going something like this, " Oh my god, oh my god, oh my god." After awhile that may be going on in the background after 45 seconds or so, but I've drowned it out with my steps and the faith that most of these babies will come out unharmed.

My scope of attention has expanded since I was a new midwife, not to say I'm an expert.  I still and always will have much to learn from others - both colleagues and especially women.  But I can do the maneuvers, call out instructions, and hear what's going on around me.

Oh and breathe too - that's important.

For my days off I will stick to these turtle signs  - signs of impending cuteness.

Tuesday, January 31, 2012

Ode to the Tomato

There is really nothing like a good tomato.

I learned at a young age that I loved tomatoes and that a good one can be hard to find.  We used to get farm stand tomatoes at a place up the road from our house, but it unfortunately became a Walgreens.  Until college the only respite I found from the mealy, unripe tomatoes at the grocery store was the introduction of the Ugly Ripe heirloom tomatoes to Publix Supermarkets.

Then I was introduced to farmer's market and slowly learned more about the pleasure and importance of getting your produce locally.  My tomato addiction then skyrocketed when we grew our own cherry tomatoes 2 summers ago in New England.  I can eat them like candy.

So imagine my excitement to learn that tomato season in St Croix starts in December and is now going full force.  We got the best of New England's growing season and then we move to the tropics and get to experience the deliciousness of tomato peak season again.

There are many ways that I like to eat tomatoes.  Cherry tomatoes straight from the Ziploc bag I bought them at the farm stand in, popped one after another into my mouth on the ride home.  This amazing Fresh Tomato Lasagna that has a bechemel sauce that is to die for.  Panzanella salad, a green salad, in pasta, with eggs. 

But my favorite way to eat a tomato is a way I also learned at a young age, from my dad.

A fresh ripe tomato is delicious just as is, sliced, sprinkled with salt and pepper.  I prefer to eat it straight from the cutting board with my hands, while still standing at the counter.  Completely satisfying as a mid afternoon snack or while cooking dinner.

In recent years I've started using sea salt and freshly ground black pepper.  The small amount of spice brings out the sweetness of the beautifully ripe tomato perfectly. 

Below is a pictorial account of the Best Way to Eat a Ripe Tomato.

Thursday, January 26, 2012

Baking and Baby Catchin' in the Caribbean

So a lot has happened in a year.

We moved.  To a tropical island in the Caribbean.  St Croix in the US Virgin Islands to be exact.  So I now bring into the world tiny Cruzans, who prefer reggae to nursery rhymes.

One lovely vista, from the easternmost point on the island.

It is definitely different.  I still work in a hospital, one that is working hard to get up to state side standards, but we do work with slightly less.  There are some things we just don't have because they are too expensive and some things we seem to run out of.  Another interesting thing is that patients are charged for each individual thing, down to gloves or gauze.  It sure does make you think about conserving items.

Babies still come out the same way down here and I have had some lovely births.  There are epidurals, but in the two months since I have been working here I have not yet had a patient who had one.  This is multifaceted.  The reason I like is that woman here come in knowing they can do it without and then just do.  It's amazing what your body can do when you eliminate something as an option.  Another reason is lack of availability and/or willingness of anesthesia to do it.  This is the reason I don't like.  Some of the anesthesiologists won't do epidurals and then some won't do it based on type of insurance.  Medicaid in the VI has some major financial issues and runs out of money early in the year, leaving the hospitals with the only choice of providing free care to Medicaid patients.  This leads to the hospital having less money, etc.  So some anesthesiologists will not do the service if they feel like they won't get paid.  It is an unfair reality here.

More on birthing differences in the VI later.

J and I also just got hitched!  It was lovely and perfect.  An intimate affair with immediate family and close friends, the beach, a farm, and good food.  The good food part was a must.  I was determined to eat and enjoy the food and beverages.

We did hire a caterer for the appetizers and dinner but I wanted part of it to be homemade by us.  So we made all the desserts!  J is not a fan of traditional wedding cake, so we made the decision early on that we would do a pie table and when St Croix became our new home and wedding location, my sister (also an avid baker) suggested we shoot for tropical style desserts.

So the day before the wedding, my mom, my sister, 3 close friends and I did some major baking. There is something so satisfying about the act of baking these desserts together and then watching people enjoy them the next day.  This is, of course, one of my favorite parts about cooking for others!  Also, communal cooking kind of rocks - it's easier and much more fun than cooking solo.

We made a Pumpkin Cheesecake (not really tropical but J's favorite), Lime and Ginger Cheesecake (no-bake and very refreshing), French Coconut Pie, Coconut Cream Pie with Chocolate Crust, and a Banana Cake with Dark Chocolate and Crystallized Ginger which my sister made into an amazing layer cake held together and topped with a Chocolate Ganache.

Photo courtesy of Jeremy Cooke

I love that word- ganache.  It just sounds delicious.  We actually saved the top layer of the banana cake - it's wrapped up and in the freezer for our 1 year anniversary.

The banana cake is actually from Molly Wizenberg's drool inducing Banana Bread with Chocolate Chunks and Crystallized Ginger Recipe.  She has a vegan version on her recipe index, but the one I always use is from her book - A Homemade Life.  I have never met another banana bread recipe like this.  In the past I have made it into muffins and it comes out incredibly moist, so it seemed ideal for a cake.  The bananas were local - some picked from a farm up the road from us and some from a Rasta run street side fruit stand when I realized we were a bit low.

The Pumpkin Cheesecake is a riff off of The Cheesecake Factory's recipe found here.  I adapted the Lime and Ginger Cheesecake from the Mango, Lime and Ginger Cheesecake found in Woman's Day.  The Coconut Cream Pie with Chocolate Crust was found by my sister on Martha's website (as in Stewart).

The one that I'm going to share with you today is an incredibly simple, yet rich French Coconut Pie.  This recipe was given to me by by mother.  She had been given the recipe by a friend years ago and raved about the resulting pie.

French Coconut Pie
1 1/2 cup sugar
6 oz canned coconut (be sure this is canned coconut and not coconut milk or cream of coconut)
1/4 lb (1 stick) butter
3 eggs
1 tablespoon vinegar
1 teaspoon salt

Pie Crust- I used half of this Pate Brisee recipe from Martha Stewart
1 1/4 cups all-purpose flour
1/2 teaspoon salt
1 stick (1/2 cup) unsalted butter, cold, cut into small cubes
1/8 cup ice water, plus more if needed

Make pate brisee according to recipe and set aside in fridge for an hour prior to use.

Preheat oven to 350 degrees.

Mix filling ingredients together in a medium sized bowl.  Roll out pie crust and press into a pie or tart pan.  Cut off excess and crimp edges.  Place filling in unbaked pie shell and place in oven.

Bake at 350 for 40 minutes to 1hour in the center of oven.   Baking time varies depending on how the oven runs so watch

French Coconut Pie can be enjoyed warm or cold.  It is very rich, so cut small pieces.  It is even better on the second day.