The Shiksa Does Passover, Part 2 – Almond Cake

Almond Cake for Passover

In Part 1 of this series, I made a really good brisket that was not my mother-in-law’s recipe. This year, I decided to tackle dessert.

As anyone who has tried to make an unleavened dessert for Passover dinner knows, the words “baking” and “Seder” should probably not be used together in the same sentence, let alone a blog post. But dessert must be had at a Seder, and so an entire tradition of baked goods made without flour or leavening has evolved – cakes made with ground nuts, dense chocolate tortes and macaroons are traditional. (My mother-in-law Irene makes a fabulous strawberry shortcake every year using a light sponge cake made with ground nuts.)

This recipe is modified from one I found in Jewish Cooking by Marlena Spieler. The recipes in this marvelous book hail from both Sephardic and Eastern European Jewish traditions, and the pictures are gorgeous. The original recipe, Pesach Almond Cakes, has a bit more intense almond flavor than the one I’ve posted and calls for the creation of a thin icing made with confectioner’s sugar and brandy that is poured over the almost cooked cake, which is then returned to the oven while the icing crisps.

My first attempt at the original recipe was a fallen yet delicious failure that my friends Larry and Sally graciously served at their Seder with a large spoon. (I guess La Crueset lasagna pans are not meant for baking cakes…)

On my second attempt for Mr TBTAM’s family Seder, I used the right pan but the cake still fell a tad, so I just soaked the cake with some brandy and sprinkled the final product with confectioner’s sugar. It was delicious!

If you try the original recipe and it works perfectly, do let me know how you did it so I can figure out what I did wrong (probably too many years of Catholic schooling…) I’m thinking it may have been because I used the American measurements rather than the original metric ones, so I am posting only the metric units for you.

A few pieces of advice: (1) Don’t open the oven door to peek. (2) It may take longer than the stated time depending on your oven. Be sure the middle is set before you take the pan out to sprinkle the brandy on top. (3) Make sure the cake is really, really cooled before cutting it. (4) Finally, it will be difficult to get out the squares out of the pan unless you have a small cookie spatula, which I did not have, but Irene did.

Of course, the fact that this recipe needs so much advice only speaks to the difficulty of making unleavened baked goods. Then again, getting the Israelites out of Egypt was no small task…

Almond Cake for Passover
  • 350 grams cups ground almonds
  • 50 grams matzo meal
  • ¼ tsp salt
  • 30 ml vegetable oil (I used canola oil)
  • 250 grams sugar
  • 300 grams brown sugar
  • 3 eggs, separated
  • 1 tsp almond extract
  • 1 tsp vanilla extract
  • 150 ml orange juice
  • 75 ml brandy for the batter
  • 50-75 ml brandy for soaking the cake
  • Confectioner’s sugar

Preheat the oven to 350 degrees Fahrenheit. Lightly grease a 12×15 inch rectangular cake pan.

Whisk the ground almonds, matzo meal and salt together in a large size bowl.

Lightly whisk the oil, egg yolks, sugars, vanilla, almond extract and 75 ml brandy in another bowl.

Beat the egg whites in a small deep bowl till stiff.

Stir the oil-egg yolk-sugar mixture into the almond mixture. Fold 1/3 of the egg whites into the batter, then fold in the rest. Pour the mixture into the prepared cake pan and bake for 30 mins till nicely set and lightly browned. (Mine took longer than 30 mins.)

Remove the cake from the oven and soak it with the rest of the brandy (A little spray bottle would work well, or you could just sprinkle or brush it – I still haven’t figured out the best way to do this). Pop it back into the oven for another 10 minutes, then remove it to a rack to cool.

Cool the cake in the pan. When completely cool, sprinkle with confectioner’s sugar. To serve, cut into squares in the pan, and use a tiny cookie spatula to remove the pieces carefully.

This is a cookie spatula

So is this

How to Talk to Your Kids About Sex

It’s about taking advantage of those teachable moments that provide an opportunity for you to discuss sex with your child in a way that helps you find out what’s on their minds and also impart the values that can protect them from the consequences of beginning sexual activity too soon.

That fabulous video up there is from Planned Parenthood of NYC, and is filled with great tips, including a technique called the Four Steps that you can use when your kids ask the tough questions –

The Four Steps Technique

1. Normalize and Validate – “That’s an interesting question.”, and “What makes you ask me this today?” – this gives you context as to why the issue is on their mind.
2. Ask what they think the answer is – that let’s you know how much they know (or don’t know) on the topic at hand.
3. Give and honest answer in sync with your values. And finally,
4. Check for understanding.

I’ll never forget how I first learned about sex.

I was in 4th or 5th grade and I had a friend whose mom was single. This puzzled me, since every parent I knew was married (those were the days, huh?), so I asked my Mom how this could be so. My big brother, who happened to be standing there, whispered “That’s a sin!” Mom hushed him up, then brought me right upstairs to her bedroom, where she pulled out “The book” from her bureau drawer. (I don’t remember the name of it, but it was biologically correct.)

Right then and there, using the book as her guide, Mom gave me the 411 on the birds and the bees. Then she gave me the book to read. And although Mom surely imparted her values to me in that conversation, she was very careful not to judge my friend’s mom. I remember leaving the conversation mostly feeling sorry for her that she had to raise a child on her own, while we had this great family and a Dad who piled us into the station wagon and took us to the Drive-In movies.

A teachable moment, indeed. Thanks, Mom!
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You can also view the video in Spanish

Family Planning in an Economic Crisis

Cristina Page explains why vasectomy rates are up, and writes one of the best editorials in support of family planning that I’ve ever read.

Family planning is nothing less than a foundation on which many Americans build sturdy, responsible lives. Regardless of political affiliation, that’s exactly what many are struggling to do right now. Those who have lost their jobs and health insurance are in great need of family planning. They’re also, alarmingly, the ones with the least access to it. Meanwhile Republicans openly mock attempts to include family planning as a part of the economic recovery, actively work to defund Planned Parenthood, promote policies that encourage health care workers to deny patients access to contraception, and defend programs that withhold basic information about contraception to sexually active teens. (Then they’re baffled to find the number of teen parents spiked during the Bush years.)

Read it, then send it to everyone you know.

Grand Rounds – When Things Go Awry

Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston, and author of the excellent blog Running a Hospital, is hosting grand rounds this week. A champion of transparency in healthcare who walks the walk and talks the talk at his own insitution, Levy asked medical bloggers and patients to post about their experiences on both sides of the exam table when things go wrong in healthcare.

Head on over for a gread read.

The V-Word

The Onion has a hilarious article this week that epitomizes our relationship to the word Vagina. (Hat tip to Rachel).
Renowned Hoo-Ha Doctor Wins Nobel Prize For Medical Advancements Down There.

STOCKHOLM—In recognition of her groundbreaking work treating life- threatening diseases of the privates, renowned hoo-ha specialist Dr. Victoria Lazoff was awarded the Nobel Prize in Lady Medicine this week.

The world’s foremost authority on ailments down south, Lazoff led a team of cutting-edge hoo-ha doctors to develop new strategies for detecting abnormal growth in…you know, that area.

What makes this article so funny is that it’s so true. We’ll do anything to avoid saying the word vagina, won’t we?

Of course, my sisters and I don’t call it Hoo-Hah. That’s too silly. We call it Virginia. (As in Yes Virginia, there is a Santa Claus… Oh, never mind….)

Seriously, though, why do we hate to say the word “Vagina”?

I think I have it figured out. Vagina is just not an easy word to say. Try it – Vagina.

Your mouth has to open for the “Va”, then go to the pucker of the soft G and then to the vertical open of the long I then back open for the “na” at the end. It’s a work out.

Now try saying it over and over again out loud – vagina, vagina, vagina, vagina…. It’s exhausting, right?

But guess what? It’s easier if you say it softly. Go ahead, try it – Vagina, vagina, vagina, vagina…

See? It wants you to say it softly. (Vagina)

Which has got me thinking that maybe the word vagina is just not meant to be spoken outside of an intimate conversation.

So when we hear it in a crowd, or spoken too loudly, or in mixed company, we get uncomfortable.

But What About the Vagina Monologues?

Hasn’t that play removed the taboo on the word Vagina by now? Brought it out of the closet and into the vernacular?

I’m not so sure. (And here’s where the Feminists kick me out of the club…)

My five sisters and I went to see the Vagina Monologues a few years back. We even had front row seats. No one was more suprised than me to find that despite the fact that I talk about this stuff all day with my patients, and say the word vagina at least 20 times an hour, I was very uncomfortable sitting in that audience. More so even than my sisters. It all seemed so – personal.

Save it for your shrink! I wanted to yell out. I don’t want to know this about you. Really. This is Broadway, after all, and I paid a lot of money for this ticket. Couldn’t you just sing “I Enjoy Being a Girl“, or something?

Of course, if one of these women were to tell me that stuff in my office, I’d jump right into the discussion. It seems right in a doctor’s office. And I think I could read it in a book or memoir. After all, a book is really a conversation between two people – the writer and the reader. (Just like me and you….)

But listening to vagina talk, right there on a stage, before hundreds of strangers (including a few men), it seemed – well, wrong.

Which is not to say that women should not learn about their vaginas, and feel comfortable with their vaginas and love their vaginas and all that. Because they should. And they should feel comfortable saying the word vagina.

But maybe the whole world doesn’t need to hear it.

Vagina.

So go ahead, say it.

But say it softly. And keep it private.

The Painting that Inspired Another Masterpiece

Mortin Lauridsen, the composer of the unspeakably beautiful choral work O Magnum Mysterium, writes in the WSJ of how the structure of his work was inspired by Francisco de Zurbarán’s “Still Life With Lemons, Oranges and a Rose“.

In composing music to these inspirational words about Christ’s birth and the veneration of the Virgin Mary, I sought to impart, as Zurbarán did before me, a transforming spiritual experience within what I call “a quiet song of profound inner joy.” I wanted this piece to resonate immediately and deeply into the core of the listener, to illumine through sound.

I had the privilege to sing Lauridsen’s O Magnum Mysterium last year with my Chorus. It is not an easy piece to sing – the soprano part spans the range, and requires the breath control to hold a note at low volume without a lot of vibrato. I’d sing it again tomorrow if given the opportunity.

de Zurbaran’s painting is on view at the Frick until May 10 as part of the Masterpieces in European Painting from the Norton Simon Museum Exhibit.

If you’ve never been to the Frick, it is one of New York’s gems – an intimate, stately and beautiful museum that reminds me of a miniature version of the Tate in London in the days before it changed to compete with the Tate Modern. (If that makes any sense…) They don’t allow kids under 10 into the Frick, but the guard let me daughter sneak in a few years back becuase she had a sketch book and we were going there to draw. I still remember that day as one of our best together.
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You can listen to Lauridsen’s choral work by clicking on the links embedded above.
Thanks to fellow soprano Kathleen for the tip…

It’s a Good Time to Buy a New Car

Big Bro’s Car

My big brother – the penny pinching ex-airline pilot Uber-Saver and investor, who never bought a newspaper because he could read the used ones left on the airline seats by the passengers, who drove an old used car without a radio for years and lived almost as long with an empty dining room because he was too cheap to buy a table and chairs, and who moved his entire IRA to cash a little over a year ago – just bought a new car.

He paid $7,990.

That’s right – a brand new car for just under $8K.

Here’s the breakdown –

He bought a Chevy Cobalt LS/XFE with air conditioning, OnStar, 80 days of XM radio, 3 yr bumper-to-bumper/5 yr 100,000 mile warranty and 5 yr roadside assistance. But no power windows. (He is my brother, after all…)

MSRP $15,650, Invoice 14,995
Dealer rebates brought the price down to $9,995
Minus $3,000 in points on his GM credit Card
End Price $6,995
Add in tax and Transfer – Final Price $7990

Oh yeah, there’s one more thing – he’s getting 36 MPG.
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Photo from Myride.com

Estrogens Found in Bottled Water

Mineral water has been found to be contaminated with estrogens.

In a report published in Environmental Science and Pollution Research, German scientists Martin Wagner and Jörg Oehlmann measured the estrogen activity in 20 different brands of commercially available mineral water – some bottled in glass, and others bottled in in PET or Tetra Pak plastic. (They did not give out the brand names, sorry.)

The researchers were surprised to find significant estrogenic activity in 12 of the brands, with activity the equivalent of as much as 7.5 ng/L of 17 beta-estradiol, the naturally occurring sex hormone. Estrogen activity was lower when some of these same brands of water were bottled in glass, or in plastic bottles that were deemed returnable and reusable. The researchers proposed that the estrogen activity is from xeno-estrogens leaking from the plastic bottles, or in the case of glass bottles, from plastic used in the bottling process.

To prove it, they bred snails in both the plastic and glass bottles – snails bred on plastic had higher reproductive output, a lab measure of estrogenic activity of the plastic.

Our results demonstrate a widespread contamination of mineral water with xenoestrogens that partly originates from compounds leaching from the plastic packaging material….Overall, the results indicate that a broader range of foodstuff may be contaminated with endocrine disruptors when packed in plastics.

The amount of estrogenic activity in some mineral waters is around the same amount that has been found in milk, another modern food product known to be contaminated with hormones. So if you’re only drinking hormone-free organic milk, you may want to rethink your water source as well. If you drink mineral water, glass-bottled brands may be a better bet.

I for one, will use this as just one more reason to stick to my favorite source of H20 – NYC water, straight from the tap.

APA Ends Pharma-Sponsored CME

The American Psychiatric Association has called an end to Pharma-sponsored CME and meals at their meetings. (via NY Times) Pharma-sponsored fellowships, ads in the group’s journal and exhibits at meetings will continue, however.

In the past year, two prominent academic psychiatrists have been investigated for failing to disclose drug-industry income, and the APA itself has been faced scrutiny by Congress for the close financial ties of its leadership to the pharmaceutical industry. 

The APA joins the Oregon State Association of Family Physicians, Memorial Sloan Kettering Cancer Center, and the Massachusetts Psychiatry Society in banning pharma-sponsored CME.

C’mon NAMS and ACOG – you can do it, too.

Grand Rounds is Up

Grand Rounds, the weekly best of the medical blogosphere, is hosted this week at Code Blog. It’s a very readable and well-written edition, with some great posts as well. Grab a cup of coffee and and head on over!

Vitamin D Reduces Fractures

Vitamin D, if taken regularly and in doses higher than 400 IU daily, reduces fractures by up to 20% in older adults. So say researchers in a meta-analysis published in this month’s Archives on Internal Medicine.

Previous studies on the efficacy of vitamin D in preventing fractures have shown conflicting results, with some finding a benefits and others not. A team of Swiss and American researchers hypothesized that this variability in effect might be because some studies used too low a dose of Vitamin D and others did not accurately measure whether subjects even took the Vitamin D they were given. (We call that adnerence to therapy.) In addition, many previous studies did not control for baseline vitamin D levels or measure whether levels were actually increased with therapy.

In a complicated but nicely done meta-analysis, these researchers culled the cream of the crop of randomized clinical trails of vitamin D supplementation and fracture risk. Only studies that used higher doses of vitamin D, measured blood levels of Vitamin D and assessed subjects’ adherence to therapy were included in the analysis. The researchers compared fracture risk according to vitamin D dose and levels.

What they discovered was that doses of vitamin D of 400 IU daily were not effective in preventing fracture. Higher doses were – to the tune of a 20% reduction in non-vertebral fractures and an 18% reduction in vertebral fractures in individuals over age 65. (This is actually something that has been suspected for some time now, and in fact the current recommended daily dose of Vitamin D is 800 IU daily, with some saying that we should increase that further to 1200 IU daily.)

In support of the effect, fracture reduction was related to vitamin D levels, with higher levels showing greater reduction, up to a level of 112 nmol/ml (about 40 ng/ml). The benefits of vitamin D were seen irrespective of calcium supplementation.

The researchers recommend that future studies of Vitamin D and fracture risk use higher doses and longer duration of therapy, and measure both adherence to therapy and serum levels of vitamin D.

Take Home Message

Vitamin D indeed appears to be effective in reducing fracture risks, provided you adhere to your treatment and take over 400 IU daily. I’d recommend 800 IU daily. (And 1200 IU won’t hurt you…)

I’ve been measuring vitamin D levels in my patients with low bone mass, and have been not surprised to find that most of them are deficient. I love that I have an intervention for them that is both safe and inexpensive.
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Prevention of Nonvertebral Fractures With Oral Vitamin D and Dose Dependency. A Meta-analysis of Randomized Controlled Trials. Heike A. Bischoff-Ferrari, DrPH; Walter C. Willett, DrPH; John B. Wong, MD; Andreas E. Stuck, MD; Hannes B. Staehelin, MD; E. John Orav, PhD; Anna Thoma, MD; Douglas P. Kiel, MD; Jana Henschkowski, MD. Arch Intern Med. 2009;169(6):551-561.

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11/30/10 UPDATE

New IOM guidelines recommend vitamin D intake of 600 IU daily for adults up to age 70, and 800 IU daily for those age 71 and older.

Tickler Systems and Thoughts on Mandating the EMR

Sometimes I feel like Elmo…

Dinosaur Doc posted awhile back about how she managed to keep track of a patient who was failing to follow through on a mammogram. Dino holds the charts of patients with pending studies on a special shelf in the file room, where they stay till the study comes back.

Dino’s got a tried and true tickler system, and it works.

My Old Paper Tickler System

I had a my own little tickler system before we went to an Electronic Medical Record. For labs and path, I had a cloth-bound log book, where my tech simply checked off the results as they came back each day before handing the pile of reports over to me for review. If the results didn’t come back, she called the lab. For radiology, we had a series of manila forders, one for each month of the year. When a radiology test was scheduled, the third NCR copy of the requisition was slipped into the pocket corresponding to the month in which the test was to be performed. As results came back, my secretary pulled the requisistions for the folder, and at the end of the month, anything left in the folder was overdue, and we contacted the patient. On my desk, I had a rack for the charts for patients who worried me or from whom I was waiting for call backs, and the chart stayed there until the issue was resolved or the game of phone tag was over.

My system was simple, it was fast and efficient, and it worked.

Tickling with the EMR

I’ve been electronic almost 3 years now, and have to admit, I still miss my old tickler system. What I’ve replaced it with is a bit more complicated. Here’s how it works (and anyone who has ideas on how I can do it better, please feel free to comment) –

Labs
This part’s easy. Most of my patients have labwork at our hospital, and the few who don’t go to Quest or Lab Corp, both of whom can send results electronically to our lab. I just head into my In Box to see their results. I go to the Overdue Results Folder once a week, sort it by type of test, and forward the overdue tests to my secretary. She then calls the lab or the patient (who occasionally skips out without their bloodwork).

If I am unable to reach a patient on the first try about an abnormal result in my In Box, I forward that result to myself as a Result Note, and those notes stay in a separate folder on the desktop till I hear back from the patient.

Rads
I handle radiology results in my In Box the same way as labs. But overdue rads are a whole ‘nuther story.

You see, our radiology system doesn’t really talk to our outpatient EMR as well as the lab does. It sends text files over to my In-Box, sometimes matching it to an order, but very often not, so it often fails to “done” my order. In addition, our system holds my orders by date of order, not date scheduled, and labels them overdue at some fixed point after the order date. Since we order routine mammograms months in advance, and because pelvic sonograms often have to wait for the next menstrual cycle to be optimal, every mammogram and sonogram I order becomes “overdue” at some point in our system. It makes for a very big and, for all intents and purposes, useless radiology tickler system.
Whenever I get a free day, I head into the Overdue Results Folder for a big cleanout, scanning each patient’s chart to see if the overdue test actually did come back and forwarding the ones not done to my secretary so she can call the radiologist before she sends a note or calls the patient. There is nothing I hate more than wading through an overdue folder filled with mostly things that are actually not overdue.

Today, after spending my entire Sunday cleaning up the Overdue Results Folder, I came up with an idea, and I can’t wait to try it tomorrow to see if it works. I’m going to order all my radiology as future orders, with an anticipated date around the time I expect it to be done. (I don’t know why I didn’t think of this before…) Of course, it’s now going to take me longer to place these orders, but I am hoping it will save me time at the back end and give me back a meaningful radiology tickler system.

Path
As for pathology, those reports come back quickly and pair nicely with their orders. But they lose their formatting when they come over from the path lab system to the EMR. Gone are the nice paragraphs separating the meat from the gravy, making it difficult to scan a report quickly to determine if it is normal or abnormal. As a result, I’ve actually missed a few abnormals since we went live with the EMR. Fortunately, our path lab still sends us a paper printout once a month of all our abnormal pap smears, and I caught my mistakes right away. Good old paper…..

Good Old Paper
Speaking of which, I find I still need a paper tickler system for those few patients I don’t want to lose track of. It’s quite a complex system – a lined paper pad that I keep on my desk. If I see a patient I am worried about, or get back a mammogram or abnormal pap that needs follow up testing, I write the patient’s name on the pad with a little box next to it. That box gets checked off when I get her colposcopy or breast biopsy results back, or whenever the issue at hand is resolved. I work through that list every 3-4 weeks or so, crossing things off and recopying the few remaining items to a new page in the pad to start all over again.

I wish our EMR would let me create my own folders for tracking my problem patients this way, but it does not. So I use paper.

I am not writing this post to whine or complain (Well, maybe a little…)


Our EMR is fantastic, and our programmers are top notch. As I sit in my bed at night reviewing labs or catching up on that day’s notes, or catch a medication interaction that I would have missed in the old days, I am forever grateful for the fact that my practice is electronic.

The problem remains, however, that we are still struggling to get our EMR optimized. It’s a patchwork created from different systems, each designed to do what they do well, but not necessarily all speaking the same language. As a clinician, I remain frustrated that we still can’t get them to talk fluently to one another. And that is why, in my humble opinion, we are not yet ready for mandated electronic medical records.

Because if we can’t even get our own internal institutional systems to talk smoothly with one another, how are we going to link up all our institutions electronically?

A Government-mandated EMR or Tower of Babel?

The current EMR did not just spring up anew one bright day. It has evolved over decades – decades in which the laboratories, radiology practices, hospital billing systems and some upstart clinical practices each took their operations to the computer, using propietary software systems developed specifically for their own niche. Dermatology and infertility practices each have online systems that were designed for the kinds of work flows unique to their business. Hospitals also have their own inpatient systems, which don’t necessarily translate easily into the physician office, and vice versa.

With all these separate systems out there, and more coming every day, I think we need to stop and take a deep breath before our national quest for an EMR becomes a government-mandated Tower of Babel. I don’t think any doc should be mandated to have an EMR until we have EMRs that can talk to one another. And our initial investment should not spending money on willy-nilly mandated installation of Walmart’s and other vendor’s systems, but on first developing a unified code and language to be used for all EMRs. Then we can see which of the currently used systems will fit into that paradigm, and spend our dollars tweaking existing systems or scrapping them for new ones that are up to code.

Perhaps we can take our cues from the banking systems. Those systems all talk to one another with a common language that has to work, or someone loses money. I don’t know how theses systems evolved, who set the standards or how they got universal agreement, but someone out there must know. Let’s get those guys onto our medical records task forces and see what they come up with.

Until then, I’ll be plowing through my Patchwork EMR Tickler system…

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Did You Know?

Okay, I’m probably very late to this party, but I just discovered this video (Thanks, Annette!) and had to share it in case any one else out there hasn’t seen it yet.

Did You Know? is based on a Powerpoint presentation called “Shift Happens”, created in 2006 for a faculty meeting by Karl Fisch, director of technology for Arapahoe High School outside of Denver –

I was hoping by telling some of these “stories” to our faculty, I could get them thinking about – and discussing with each other – the world our students are entering. To get them to really think about what our students are going to need to be successful in the 21st century, and then how that might impact what they do in their classrooms.

Scott McLeod, an associate professor at the Department of Educational Leadership and Policy Studies at Iowa State, learned about Fisch’s presentation from his students, and turned it into the video that originally went viral.

I believe in the transformative power of technology and its ability to empower individuals in ways that were unimaginable a mere decade ago. I believe that schools are approaching the point of dangerous irrelevance when it comes to preparing students adequately for their digital futures. The pace of change in schools is too slow and the pace of change in technology is too quick. I am a strong believer in public schools, but we need a new paradigm.

Sony BMG decided to take the presentation up a notch when they used it at their 2008 executive meeting, and that is the version you are seeing here.
You can read more about the data used in this video, see earlier versions, and join a discussion about educating our children for the future at the Shift Happens Wiki.

Refresh Your Grey’s Anatomy…

at the Sterile Eye, the blog of a Norwegian medical photographer, who hosts this week’s edition of Surgexperiences. For this edition of the best of the surgical blogosphere, the Sterile Eye puts down his camera, and takes us to a former age when the drawing reigned supreme…

…nothing appeals to me like the simple and effective lithographs that accompanied the early editions of the tome of anatomical knowledge that is Gray’s Anatomy. The 1918 edition is in the public domain, and is available in its entirety online. All illustrations here, relating to the submitted posts, are taken from this edition.

Head on over for a compliation of surgical posts and some great illustrations.

Schlepperd’s Pie

Actually, the real name is Shepherd’s Pie, but we call it Schlepperd’s Pie, as in “Honey, I’m home from schlepping that herd of sheep back and forth over the same godforsaken mountain for the past 3 months. What’s for dinner?”

I’ve never actually made the Schlepperd’s – That’s Mr TBTAM’s job. He’s made it at least once a month for as long as we’ve been married, having learned how to make it from his Mom, whose husband was not a shepherd but a high school math teacher, which is almost the same thing.

Schlepperd’s Pie

The Brits make it with lamb. This is the American version with beef, sometimes called cottage pie, and is a very basic recipe. Other recipes call for carrots in the pie, but we like to serve our carrots on the side so we can spice them up a bit. (This dish itself is not exactly spicy, so we like to serve it with sides that carry a bit of punch.)

5-6 large Yukon Gold potatoes
4 tbsp butter
1 cup milk, more or less
2 tbsp vegetable oil
1 large or 2 medium onions, diced (not too small)
1 green pepper, diced (not too small)
1 1/2 – 2lbs ground beef
1 cup beef broth
1 tbsp flour
Paprika
Salt and pepper to taste

Peel and cut the potatoes into quarters. (If they are all different size potatoes, cut into pieces of roughly the same size, about 2 inches across.) Place in a large pot and cover with cold water. Add a pinch or two of salt and bring to a boil. Lower the heat to a low boil and cook until potatoes are tender. (About 20 mins.)

While the potatoes are cooking, preheat your oven to 350 degrees Fahrenheit. Then grab a big saute pan and heat up a the vegetable oil. Saute the onions and pepper over medium high heat till soft, about 5 minutes. Add the ground beef and saute till it just loses it color. Add flour and cook with the meat for a minute or so, then add the beef broth and stir in till slightly thickened, about 5 minutes or so. Season generously with salt and pepper and hold while you mash your potatoes.

Drain the potatoes. Add butter and milk and mash however you like. If you’re a purist, you can pass the potatoes through a food mill or potato ricer, heat up the milk and melt the butter before adding. If you’re like us, you’ll grab an electric mixer, toss in the butter whole and add the milk as you whip. (One of these days, I’m gonna get myself a potato ricer and see what all the fuss is about…) Season generously with salt and pepper.

Spread the beef mixture evenly across the bottom of a large ungreased baking dish (We use a La Creuset roaster pan). Spread the mashed potatoes evenly over the beef, careful to keep the layers separate. Sprinkle the top generously with paprika. Bake for 30 minutes, till the meat is bubbling and the potatoes are browned and gorgeous.

If you can, let the pie rest for about 10 minutes before serving.
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We’re not the only ones who love Schlepperd’s Pie.