Where do you see yourself in 10 years?

I used to think this was a good interview question, as it made the interviewee have to make some sort of commitment to a plan, and to think about and invest in the future. The other day however, I thought about what my answer to that question would have been 5 years ago (let's not even talk about 10), and where my life actually is now. Let's just say I would have flunked fortune-telling 101.
Ok, I still think there are SOME merits to this train of thought. Planning for the future allows you to have goals to work towards instead of wandering aimlessly, and thinking about the end-point does help shape the present substantially. But what does it mean when the destination reached is so different from what was planned? Does it mean the person was hopelessly deluded and way off track? Does it mean (drumroll please...) FAILURE? I don't think so. We're changing so much all the time, and 10 years is a significant proportion of a 30-year old, or even a 40-year old! Experiences shape us constantly, and our needs and wants change with every little milestone in our lives (hook-ups, break-ups, make-ups, hirings, firings, you get the idea...). We should have an idea of which direction we're heading in, but it's perfectly ok to land up somewhere else.
This is not some abstract discussion. My life has changed so much in the last year that I wouldn't even believe where I'm standing. I've made a HUGE job switch, I'm married (to a very very lovely man), living in a house of our own, and all that I thought I knew turns out to be a mystery. But I'm also happier than I've ever been, maybe even happier than I thought I could be. The whole time I was growing up, I thought that the only way to do things was to be a high-flying career woman. At the medical school interview (which WAS ten years ago!), the know-it-all-self-righteous-me was offended (!) when the old Prof asked me how I was going to juggle being needed in the hospital when my child was sick at home. The old man knew more than me about the ways of this world, because as much as I did enjoy my job, there is no fight at all as to who would win that battle.
I thought it was 'old-fashioned' to stay at home any longer than the 3 months maternity leave duration. I thought it unthinkable that I would not want a maid. I wanted to be the HOD, the CMB, heck, even a trauma surgeon! And where am I now?
I don't feel guilty or envious of my peers who passed the march exam and are now registrars. I thought I would be, but all i feel is very lucky that I had the last few months to myself, and to our little new family. I wouldn't have traded that time for anything in the world because I feel I am a better, happier person for it, and what do we live for if it's not to be happy. I had a choice and I made it. And I hope I never forget that we always have options, it was a really amazing thing to discover.

Distracted...

I've been a terrible blogger, I know.
I'm almost a month into my new job, and time really flies!
It's SO different from my old job that sometimes I wonder what I did for the last 5 years. But then I take a look around at the other doctors who used to be clinicians here, and I realise it's ok to make the change. I am happier at work, I'm pretty sure of it. I'm not missing the day-to-day life in the hospital, and not being TOTALLY disconnected via TS works out very well too.
I'm also working on a SECRET (Yes, I'm a terrible secret keeper because a real one wouldn't even have advertised that last statement) which has been sucking blogging time from here, hopefully soon to be revealed...

To tide us over (and to cheat a little),
excerpt from an e-mail I sent out in the first week of work...
"First day of work update -
I have a desk, a laptop, stationery in the drawer, and NO PATIENTS! No nurses, no medication, no needles, no monitors, no surgeons, it's a totally different universe!
There are quite a number of my classmates with me so it's not all unfamiliar, and only one of them has done any type of admin before, so we're all in the same boat.
I didn't do any "work" today, but after the briefing with my boss, I'm not really sure I'll EVER be able to do anything constructive, I don't understand half of what he's talking about!
'Deliverables', 'financing', 'macro-organisation', 'quality and operations' and 'strategic planning' don't mean much to me, I'll have to take minutes for meetings (huh?), and I'm not even sure who the perm sec for health is...
But I don't miss the old job one bit, and I think I can do this new one. I am looking forward to going to work tomorrow! (Hmmm what will I wear?)..."

Patients Like Me

I attended a Disease Management Conference at the end of last week as part of my new job. I had expected to be horrifically bored, but was instead exposed to some really wonderful updates and ideas that I would not have known if I hadn't made this switch.
One of the highlights was a speaker from Canada, Dr Alex Jadad.
I heard him speak twice, and took away two things. The first is www.patientslikeme.com. Dr Jadad spoke about how patients are empowering themselves over the internet, and how the medical profession must keep up, or lose out to the advances in technology that are passing us by. I checked out the website and am very impressed by the easy and comprehensive format, which allows the patient to enter and chart his/her progress, and also to print out a summary for the medical professional. The advantages to patients involving themselves in their care, in monitoring and in actively seeking information are almost unquantifiable.
The second session was about end-of-life care. This is a topic that really resonates with me both on a professional and a personal level. Having a loved one deteriorate in front of your eyes, slowly and painfully, is one of the sad facts of our aging population, and something that no one can adequately prepare for. How to we strike a balance between wanting to ensure the best for the person and yet respecting his autonomy, sometimes despite his apparent incompetence? Professionally, where to draw the line in resuscitative or life-support measures in the critically ill was a topic that I had a great deal of interest in from the start. Over the years however, intimate experiences with my patients and their families just made it too painful for me to watch people go through such a heart-wrenching time. I found it difficult not to bring my own emotions into it, and took the sadness and despair home. It would have been wonderful to be able to leave those feelings at work, but I have accepted that that is not the person I am, and this is not the help I can provide my patients. I will find another way to be there for them. Dr Jadad has an interesting approach to this. He doesn't leave those issues at work. He brings them home and embraces them as a human being. This takes immeasurable courage and dedication. I don't think I'm ready for that, but it is inspiring to see someone with that degree of conviction. And the results speak for themselves.
The other idea I left the conference with, tying in to the second point, is when to recognise that we have done our best, and that the patient is going to die. Our responsibility is then to facilitate this (I don't mean euthanasia) with as much dignity as possible, and with recognition that when the patient passes, his loved ones will need care and support. In summary - if death will not be a surprise, perhaps it's time to let nature take it's course.

Thomas Keller's Chicken

Finally, some pics. But we polished it all off in no time. Today we had our chicken with onions, flatbread, avocado and baby spinach. Linghams chili sauce added the finishing touch. Delicious.

Chocolate almond torte with chocolate ganache, aka Eugene's birthday cake

To be eaten with Vanilla Ice Cream.

From JoyofBaking.com

200 grams bittersweet chocolate, chopped (I used Lindt 65%)

150 grams unsalted butter, cut into small pieces

150 grams granulated white sugar, divided

4 large eggs, separated

1/2 teaspoon pure vanilla extract

100 grams finely ground almond meal

1/4 teaspoon cream of tartar

Preheat oven to 190 degrees C and line an 8 inch (20 cm) springform pan with parchment paper. Set aside.

Separate the cold eggs, placing the egg yolks in one bowl and the egg whites in another. Cover with plastic wrap and let stand until they reach room temperature (about 30 minutes).

Melt the chopped chocolate and butter in a stainless steel bowl placed over a saucepan of simmering water. Once melted, remove from heat.

Meanwhile place the egg yolks and 1/2 cup (100 grams) granulated white sugar in the bowl of your electric mixer, fitted with the paddle attachment. Cream the yolks and sugar until pale and thick (about 2 to 3 minutes). Beat in the melted chocolate mixture and vanilla extract. Fold in the ground almonds.

In a clean bowl, place the egg whites and whisk until foamy. Add the cream of tartar and continue whisking until soft peaks form. Gradually sprinkle in the remaining 1/4 cup (50 grams) sugar and whisk until stiff peak forms. Fold about 1/4 of the whites into the chocolate batter to lighten it. Quickly fold in the rest of the whites and mix only until incorporated.

Pour the batter into the prepared pan and bake for about 45 to 50 minutes or until a toothpick inserted in the center of the cake has a few moist crumbs. Remove from oven and cool on a wire rack.

When cool apply Glaze (from Chocolate and Zucchini).

Melt 200g dark chocolate (I used 65% Lindt again) in a bowl set over a saucepan of simmering water, stirring with a spoon from time to time to help it melt.

When completely melted, remove from heat and add in 200ml of whipping cream, stirring as you pour, and until completely incorporated.

Let the ganache rest a little, until thickened to the desired consistency, about 15 minutes.

Pour the ganache on top of the cake, and spread it on with the back of a spoon, letting it ripple onto the sides between the tin and the cake. Refrigerate for at least an hour, then run a hot knife around the side of the tin and loosen the sides. Carefully lift the cake up using the parchment paper, and serve on a cake board.

Heavenly.

The BEST Roast Chicken

This chicken is SO good, that I have no pictures of it. But I will keep trying to get that elusive shot of the perfect bird before the greedy people come in. (unfortunately, my husband is both an expert bird photographer, and a greedy person. Conflict of interest.)

Just follow as is, definitely truss the bird, but I'm not sure about the comment about fighting for the chicken butt....
Have not served it with mustard, but the chicken is ALWAYS finished with fingers, not cutlery.

Thank you Thomas Keller... (and epicurious.com)

Tarte Tatin

Otherwise called Fancy Apple Pie with not enough crust (so say the Queks).

At least it was beautiful...

Tarte Tatin (largely from Gourmet, March 2001)

1 frozen puff pastry sheet (I used Pampas all-butter), thawed
1/2 stick (1/4 of a block of Anchor butter) unsalted butter, softened
1/2 cup sugar (I used brown but next time will go for half-white, half-brown)
7 to 9 apples (I used a mix of granny smiths and some first red ones), peeled, cored, and cut into 6s (or 8s for large specimens)

Preheat oven to 230°C.

Spread butter thickly on bottom and side of skillet and pour sugar evenly over bottom. Cook until sugar melts into the butter and starts to bubble gently. Arrange as many apples as will fit on sugar, packing them tightly in concentric circles.

Cook apples over moderately high heat, undisturbed, until juices are deep golden and bubbling, 18 to 25 minutes.

Put skillet in middle of oven over a piece of foil to catch any drips. Bake 15 minutes, then remove from oven and lay pastry over apples.

Bake tart until pastry is browned, 20 to 25 minutes. Transfer skillet to a rack and cool at least 10 minutes.

Just before serving, invert a platter with lip over skillet and, using potholders to hold skillet and plate tightly together, invert tart onto platter. Replace any apples that stick to skillet. Serve immediately.