My Christmas WishList

Dear Santa,
For Christmas this year, I'd like 5-10 acres of clean, green land.  Some of it should be wooded, preferably with a couple dozen sugar maples... and some of it should be open to the sky, ready to receive our seedlings and goat kids in the Springtime.  A mature orchard somewhere in there couldn't hurt, but if not... just the room to plant some apple, pear, cherry, peach and fig trees would be more than adequate.  A few hills would be nice.
I want a garden large enough to feed our little family of two through most of the year.
I want neighbors, close enough to befriend, far enough to not be scared away or otherwise disturbed by our parties.
I'd love to have a small running spring-fed stream, one that we could build a very small dam in to make the waterfowl happy and to harvest a small amount of hydroelectric power from.
I'd like a well with clean, delicious water.
I want two hives of bees, a couple of goats, maybe even a trio of sheep, a pair of angora rabbits to breed, and the chance to have a rooster in our flock so our girls can hatch out their own eggs. 
I'd like a modest house, with a good roof, dry basement and well-maintained electrical, water and heating systems.  I'd like a wood stove.  I'd like hardwood floors and draft-less windows.  I'd like a bathtub.  I'd like a kitchen large enough to can our tomato harvest in.   I'd like a room with high enough ceilings to hang our silks... if not in the house, then in the barn.
Yes, I'd like a barn.  Nothing too fancy, mind you!  Just a sound building to keep our creatures safe and warm on those winter nights, a place to store hay and to milk goats. 
I want the room to make a beautiful and functional workshop for my Honeybunch.  I'd like to help him build a kickwheel and a kiln.  I'd like for him to be able to use his drill press, and a lathe, and his welder.  I'd like to have the space and time to learn these things myself, Santa.
I want all of this, within reasonable driving distance of both of our places of employment, within our reasonable price range, and in an area without exorbitant taxes.

I know it sounds like a lot.  But I've been a really, REALLY good girl this year.  Seriously!!!!!

See one, do one, teach one.

That's a phrase I heard over and over again in nursing school, describing how to best become proficient with your clinical skills.  A mere 6 months after I finished my orientation as a new nurse at my hospital, I'm now orienting the next generation of newbies.  It's strange, and unnerving, to be looked at as an "experienced" nurse by the young ladies I've been a preceptor for this past week... I don't feel like an experienced nurse.  I still feel really green!

Tomorrow is Thanksgiving, and we'll be braving some awful traffic to join Honeybunch's family for a meal.  My sister is currently half a world away in Israel visiting our father and won't return until Sunday, and my mother has to work the holiday evening shift.  So, we'll celebrate with my half of the family later in the weekend.  I love having an excuse to feast more than once, especially on hearty comfort foods like sweet potatoes, green beans, sweet corn, mashed potatoes, macaroni and cheese, stuffing (made veggie style outside of the turkey by my ever thoughtful mother)... my mouth is watering just thinking of it. 

I hope you all have a wonderful holiday, full of gratitude and spent with the people you love.

Brussel Sprouts!

I loooovvve lovelovelovelove brussel sprouts.   Love them.  That's right, I'm in THAT camp.  Folks are very much divided when it comes to these little miniature cabbages.  Many claim to hate them.  I used to be one of them.  But then I realized that they could be prepared in a way other than boiling them to DEATH to the point of being bitter mushy nasty bits of poo. 

Now I am a proud sprout-lover. 

You may be too, if you get some nice fresh tender green brussel sprouts and try roasting them like this.  I find them to be crispy, salty, addictive and more delightful with each biteful (that rhymed!), very much like popcorn, actually.

Roasted Garlic Brussel Sprouts

Wash well.  Trim the stem ends and remove the tougher outer leaves.  Slice in half lengthwise.  Peel some fresh garlic cloves and coarsely chop.  Preheat oven to 400 degrees.  Heat some olive oil in a cast iron skillet over medium heat.  Place the sprouts cut side down in the skillet, toss in the garlic, and cook until browned.  Transfer the whole skillet into the oven and bake, shaking the pan occasionally to stir 'em up, until browned all over to a nice deep golden color.  A little bit of blackened outer leaves doesn't hurt at all.  Remove from oven, sprinkle with garlic salt, and you'll find yourself eating a week's worth of brassicas in one sitting. 

Good instincts

"You have good instincts." 

One of my coworkers told me that this morning.  It's probably one of the best compliments I could ask for as a nurse.  It says, "you're not just clinically competent, you're in tune with what's going in with your patients and you act on that knowledge judiciously."  Except it says that in four nice neat little words.

The woman I'd been caring for who inspired this comment was in her 60s, and in generally poor health.  She had emphysema and heart failure, diabetes and high blood pressure, the usually cocktail of chronic ailments that turn a local citizen into a "frequent flier" at our hospital.  This time she has gone into respiratory failure at her nursing facility, and was intubated and in our ICU for a few days before they stablized her, pulled out the breathing tube, and sent her up to our floor for further monitoring. 

At midnight when we met, she was alert and pleasant, on 4L of oxygen and breathing just fine.  She slept for a few hours, periodically ringing her call bell for assistance to the commode (a consequence of the diuretics she'd been taking as treatment for her heart failure).  At 0300, I went into the room to bring medication to her roommate, and found her sitting on the edge of the bed looking short of breath.  I listened to her lungs and heard some wheezing, checked her oxygen saturation and she was at 96%, which was more than adequate for a woman with her health problems.  However, the wheezes were concerning, and  I called the respiratory therapist to give her a breathing treatment. 

After the treatment she stated she felt better, but her lung sounds did not improve.  As she sat there, I watched her became lethargic and "out of it" as she spoke to me.  Her speech was becoming slurred, and while she still followed commands when I asked her to squeeze my hands, she just wasn't with it like she had been a few minutes before.  I checked her blood pressure and it was fine.  I checked her blood sugar, and it was high but not critically so.  The rest of her vitals, including her oxygen saturation, were still within normal limits, her heart monitor showed the same rhythm that she'd been in all along. 

But something was wrong.  She was not looking, sounding, or acting like the woman I'd met a few hours before.  This was more than just the three o'clock sleepies, or an asthma exacerbation.

I asked the nurse's aide to stay with the patient as I hurried out to the front desk, and when a coworker asked what was wrong, I said "one of my patients is going weird on me," as I dialed the beeper number for the physician.  When the doc didn't answer the page right away, I called the ER looking for her.  She came to the phone and irritably said, "when I don't answer a page that means I'm with a patient".  I ignored her tone and went on to tell her that my patient was having a sudden change in mental status and becoming lethargic with slurred speech.  I told her the results of my other assessments, which were all normal, and she irritably said "her vitals are stable, I'll be there when I can get there".  I thanked her and said that I hoped she would hurry, cause the woman seemed really off to me. 

This whole process took maybe four minutes. 

I entered the room again, and found the patient to be entirely unresponsive, blue, and barely breathing.  I called for a rapid response, ran for the crash cart, and started manually ventilating her.  Soon after, the physician and respiratory therapist arrived.  As I squeezed the bag forcing air into the woman's lungs, I watched her oxygen saturation rise from 45% (BAD!!!) back into the 90% range (good!).  No longer blue, but still not breathing on her own, we worked hard to stabilize her and get her to the ICU, a place she probably should not have left in the first place.

I recounted her medical history, the events of her hospitalization thus far, and what had happened during this episode to the physician.  I started a second IV site on her and gave her a sedative to help the anesthetist intubate her so she could be hooked back up to ventilator.  We did an EKG, a chest x-ray, blood work, and arterial blood gases.  We transported her to the intensive care unit, where she was put on a ventilator and prepared for further testing, and as I gave report to the nurse taking over her care, the woman woke up and scribbled on a notepad, "why do I have this tube in me again?!".  She was back.  She was alive, she was alert, she was going to make it.  I nearly laughed with relief.  So close to death, and she had no clue what had happened to her.

The snarky doctor who was so irritated that I'd interrupted her work for a "patient going weird" caught me in the hallway, thanked me for my help and said I'd done a great job.  I took it as an apology, and silently accepted. 

Each time a patient has gone south on me so far in my career, I've known it before it happened.  Even when the numbers and tests are telling me that they are at baseline, I've known that something was seriously wrong.  I'm not saying I'm psychic, don't get me wrong.  I've just had that nagging feeling that sometime wasn't right.  Each time I could have easily made the mistake of ignoring my instincts, of choosing not to speak up for fear of being wrong and looking dumb.  But each time I've made the choice to trust my gut, to look a little deeper, to make the phone call and say, "something isn't right here, and I think we have a problem.  Here is why."  It certainly isn't a vast amount of clinical experience (though each day of school and experience on the job is certainly helping!) that is guiding me to these decisions... I haven't been at this nursing gig for long.  But I do have pretty keen intuition, and each time I have put my trust in it a life has been saved as a result. 

Sometimes it pays big to trust yourself.
Trust yourself today. 
If the weather says a low of 43 degrees, but you feel a frost coming in your bones, cover the garden. 
If something in your gut tells you to take the scenic route instead of the freeway, allow for a few extra minutes of travel time and cruise. 
You never know when your instincts could be spot on, so play it safe, and remember the initials of nurses everywhere: C.Y.A.  Cover Your Ass.

Cast iron

Up until a couple of weeks ago, I'd never cooked in cast iron.  I was a "stainless steel with copper core" gal all the way.  But with a bit of research I was reminded about the benefits of cooking in cast iron (trace iron in your foods, excellent nonstick properties with proper seasoning, even heat distribution and retention), and bought the Lodge Cast Iron "Combo Cooker" online.  I am in love.  I get such a kick out of frying up eggs in the morning, washing it with plain water after and oiling it up to a nice lovely black sheen before putting it back on the shelf.  I loved oven roasting brussel sprouts to a crisp nutty finish in it.  This weekend, I may even try to bake scones for the first time. 

It takes a lot to impress me as far as cookware goes.  During high school I worked for a kitchen supply store for several years, and learned the ins and outs of gadgetry and gimmicks.  I learned to tell the difference between the (insert famous TV chef name here) flimsy metal CRAP and the professional grade, "with you untl you die" good stuff. We sold cast iron there too, and I remember learning of its alleged benefits shortly after starting my job there, but no one ever bought it... so I was never sold on it either.  It sat on the shelves, dusty and forgotten behind the gleaming stainless, copper and nonstick cookware sets.  I assumed it was outdated.

How wrong I was.

The most incredible thing about cast iron is that it releases food beautifully, but there is no synthetic nonstick coating to scratch off.  I own a nonstick skillet by ScanPan that has treated me very well, and in return I have come to love it... to the point of absolute neurosis, carefully watching anyone else who was cooking it in to be certain that NO METAL ever touched its lovely grey surface.  Even with that level of care, I'm seeing little nicks in the coating here and there, probably just from jostling with other dishes or utentils in the sink during washing.  It has lasted a few years, but probably won't make it too much longer before the coating gets damaged enough to be a nuisance, and then a hazard. 

My $40 investment in cast iron will outlive me.  I enjoy that idea, however morbid it may be.

Spicy Pumpkin Soup

I HAD to share this recipe with y'all, as it is my new favorite pumpkin soup recipe and I cannot stop eating it.  A friend of mine brought it to a potluck and I hadn't been able to stop thinking about it for weeks, so I obtained the recipe from her and finally made a batch of it myself yesterday. So.  Damn.  Good.  Whatever you do, don't skip the relish... it really makes the soup what it is.


Spicy Pumpkin Soup




* 2 tablespoons butter

* 2 bay leafs
* 1 medium yellow onion, finely chopped

* Salt and pepper to taste

* Pinch of cayenne
* 3 tablespoons all-purpose flour

* 2 teaspoons poultry seasoning

* 1 teaspoons ground thyme

* 3-6 teaspoons hot sauce
* 6 cups vegetable stock

* 28 oz pumpkin puree (or butternut squash, I've found!)

* 2 cups heavy cream (I used whole milk with success)

* 1/2 teaspoon freshly grated nutmeg

Relish:

* 1 crisp Granny Smith, coursely chopped

* 1/4 -1/2 red onion, finely chopped (I used a shallot and it was delicious)

* 2 tablespoons lemon juice

* 1/2 cup dried sweetened cranberries, chopped

* 1 teaspoon chili powder

* 2 teaspoons honey

* 1/2 teaspoon ground cinnamon



Directions
Heat a medium soup pot over medium to medium high heat. Add and melt the butter. Add bay and onion. Season with salt and pepper. Cook 6 or 7 minutes, until tender. Add flour, poultry seasoning and hot sauce, to taste, then cook flour a minute. Whisk in stock and bring liquid to a bubble. Whisk in pumpkin in large spoonfuls. Simmer soup 10-15 minutes to thicken a bit then add in cream and nutmeg. Reduce heat to low and keep warm until ready to serve.

Halloween

... is over.  Already.  How is that possible?  This year has gone by too fast.  We turned the calendar over to November, and all of a sudden winter is here, with a killing frost this morning and several comforters piled up on the bed.  Someone pulled the curtain on Autumn.  I cannot help but be a bit melancholy about it.

We had a busy and fun Halloween weekend, and I'm happy to say that we terrified many a small child with our circus themed "haunted house" of sorts that we set up for the trick-or-treaters at our friend's house.  We all dressed up as creepy clowns and performed circus tricks in the yard while others jumped out of hiding places to make kids and adults alike squeal and jump out of their skins. 

Since we have yet to turn the heat on so far this year, I'm finding every excuse I can to turn on the oven.  Today I'm baking challah.  This recipe has gotten rave reviews, and I thought I'd share it so you too can heat up your kitchens and eat egg and butter-rich bread during these long dark evenings.

Challah

Combine 5 c flour and 2 tsp salt in a bowl.  I sometimes use 1 cup of whole wheat... there is a little something of a sacrifice in texture, but it makes me feel a bit less guilty about the next step....
Melt 6 tbsp of butter and let cool slightly.
Mix 7 oz warm water and a packet of yeast together with 2 tbsp sugar.
Make a well in the flour mixture and add butter, yeast mixture, and two eggs. 
Stir until forms a ball, knead until elastic and smooth, lightly coat bowl in oil/butter, turning ball of dough to coat, and let rise until doubled in bulk.
Punch down, form 3 or more strands of dough and plait together, pinching ends and tucking under to keep from unfurling. Let rise on a greased baking sheet until doubled in bulk.
Preheat oven to 400 degrees.
Mix the yolk of an egg with a tbsp of water, brush top of loaf and sprinkle with poppy seeds.
Bake at 400 degrees until deeply golden and hollow-sounding when tapped on the bottom.
Let cool before slicing (or, as I prefer, pulling apart in peices with your hands) if you can control yourself.