Monday, August 26, 2013

You can't handle the truth!

Dr. Ali and I were talking about our recent (constant) staffing problems last night. I said I couldn't figure out why a unit with patients with things like GBS and big MCA strokes (one makes you not breathe, the other can make you have fatal heart arrhythmias without warning) wasn't considered a priority in staffing. I mean, we had a code a couple of weeks ago when some poor sod went into ventricular fibrillation (non-medical definition: your heart quits beating and just shivers: very bad), and only one nurse on the floor. It was touch-and-go, but we got said poor sod coded, stabilized, and later discharged.

Dr. A. told me something he'd heard earlier this week from a VP of development: that the neurocritical care unit is only important in that we bring in money for the neurosurgical service.

(Imagine me standing there, open-mouthed, silent.)


Sunnydale General is supposedly going for a comprehensive stroke certification, but the department that handles everything from strokes requiring TPA to non-surgical neurological emergencies is considered worthwhile only because we send the occasional patient to the surgery guys for a cartotid endarterectomy or aneurysm clipping.

I asked Dr. Ali how he'd responded. He told me he'd told the VP of development that our unit was making plenty of money on its own, thanks, and that he didn't like to refer patients for surgeries that weren't proven to work. (That last is some obscure insult referencing some sort of study on CEAs, I guess; I don't know the details.) It was a calm, intellectual burn from one doc to another.

Still, to be told flat out that the unit that you're working on, that you've been helping to develop for umpteen years, isn't considered important by the big uppity-ups. . . .is disheartening. Although it does explain why we're having such a hard time getting funding for equipment and staff.

In other news, I worked with a patient care aide this weekend who was concerned about her ability to get a job after she graduates nursing school in December. She's been doing externships and internships and has great grades, but hasn't even had a nibble on the job front.

We went over all the things she was doing right, and all the things she might be doing wrong, and then I took a look at her resume.

She's graduating from a for-profit school that is not accredited.

Again, imagine me standing there, open-mouthed and silent.

This woman will owe more than $50,000 for two years' worth of classes from a school that lacks even the most basic accreditation from any authority. She therefore will not be able to get a job anywhere but the LTAC that employs her part-time now, and maybe not even them, as an RN. Add to that that her chances of getting into a decent nursing school for a BSN are practically nil, except if she goes back to Consolidated Larnin' Collidge, and she's screwed.

I can't. . .I can't even. Talk about predatory marketing: they promised her that in just under two years, she'd have earning potential that nobody in her family has ever had. They told her that the job market for nurses is hot, which it is--provided you've got a degree from a recognized school and are willing to slog for a few years. They then helped her get loans that are about four times what I paid for a degree from an accredited program, but didn't happen to mention that a) the interest rates are huge, and b) her education would be worth practically nothing.

She's not stupid, but she's not well-educated. She's poor, she's got a GED, and she took the only offer she got. She's a hard worker and driven as hell, but she's hobbled herself with a bullshit "degree" from a place that has classes in a storefront.

It was a demoralizing week at work.

Thursday, August 01, 2013

A late-summer, end-of-summer treat: fried green tomatoes.

I did not learn to make these when I was growing up. As far as I can remember, my Sainted Mother, being more or less a Yankee, never fried a green tomato, let alone okra or the leftovers of grits that had been left to become solid in the refrigerator.

At some point in the last ten years, though, I learned to make fried green tomatoes. They're not economical--very few people have enough tomato plants that finding a use for them is necessary, at the end of the season. They're not Paleo, or Atkins, or Clean--they're something you make as a special treat, to serve with fresh mozarella or shrimp or sausages, or just on their own, as soon as they come out of the pan.

They are purely Southern, in the sense that some version of FGTs extend from West Virginia all the way to Arizona. They are best made with green tomatoes found, by chance, at the farmer's market: the kind you get at the grocery store don't have enough flavor. Grab a half-dozen or so, stock up on cornmeal and breadcrumbs and fat, and go at it.

(This recipe can be made gluten free by the substitution of rice flour for the flour and gluten-free breadcrumbs for the breadcrumbs. Don't waste your money on panko; get the cheapest breadcrumbs you can find at the grocery store, or make your own from heels and odds of bread you've stored in your freezer. A blender helps here.)

You will need:

A large frying pan. Cast iron is best, but anything NOT non-stick will work.

A spatula or pancake turner.

Two large plates and a shallow bowl.

A fork. A knife. A horizontal surface onto which to slice the tomatoes.

Salt, breadcrumbs, cornmeal, pepper, at least three eggs, and a whole lot of oil or Crisco. Also four to six green tomatoes, the most symmetrical and greenest you can find.

To begin:

Obtain your tomatoes. Wash them briefly under cold running water and slice their ends off. Be miserly in slicing off the blossom end, as it's the most tender part, and promiscuous in slicing off the stem end. Green tomatoes have not yet formed a tough core, but who wants to eat stem? Now slice the tomatoes.

Some people swear by thick slices, at least a half-inch. I find I get better results with thinner slices--anything from a quarter-inch to almost paper-thin, depending on my mood and skill with the knife.

After slicing your fruit, lay them flat on a large plate or cutting board and salt them. You don't have to go nuts with the salt; this step is meant to draw out the extra juice and keep the breading from getting soggy. While they're sweating on the cutting board or plate, set up your breading station: on the first plate, dump a good amount of plain flour. On the second, dump equal amounts of breadcrumbs and corn meal, mixed well. I use a blender to do this because I am FANCY.

In the shallow bowl, mix up as many egg whites as you can scrounge up. Do not use whole eggs for this; the fat in the yolk will make your tomatoes soggy.

Now melt some Crisco (or lard) or heat up some vegetable oil (not olive!) (not butter!) (bacon grease is okay and traditional) in your frypan. You want it hot enough that a little pinch of flour sizzles when you toss it in there. Keep the heat at medium or medium-high. A half-inch of melted fat in the pan is the right amount. Too much and you'll end up with soggy, greasy tomatoes. Too little, and the fat will suck off all the cornmeal and burn.

Take your sliced tomatoes and pepper them. Press them gently into the flour. You want them coated with flour on each flat side. Don't worry about the edges where the skin is; they'll take care of themselves. (I do not recommend shaking the tomatoes with flour in a bag, as this will cause the innards of the tomatoes to fall out. Take the time to press them into the flour and you'll be much happier.)

Now dip them into the egg white. This will make your fingers gooey. Coat them with the breadcrumb-and-cornmeal mixture and set them aside in a single layer to wait for frying.

When the fat is hot, place five or so tomato slices into it. You want them to be uncrowded and in a single layer. Let them sit and sizzle until you see that they're beginning to get brown up the sides. Turn them carefully and allow to sizzle for a couple minutes more--the second side takes much, much less time than the first.

Remove to paper towels, (or do what the finest cook I know does: use slices of cheap white bread in place of paper towels. Use those bread slices to drain everything from bacon to fish, and then, at the end of a week or so, grill them by themselves and serve them with lots of ham gravy) and drain.

Continue in this way until the fat starts to smell like burning cornmeal. When that happens, stop everything. Take the pan off the heat and let it cool for a half-hour or so (your tomatoes will wait, I promise), then pour the fat out of the pan and replace it with clean fat. This step is essential. Otherwise, you'll end up with burnt-tasting FGTs.

You can eat them out of hand. You can layer them with slices of good mild cheese, or grate a tiny amount of good hard goat-cheese over them. You can cover them with shrimp or ham or sausage gravy. You can, if you like, layer them in a casserole with fresh sliced zucchini and ripe tomatoes and a little grilled eggplant and call it Southern Ratatouille, but I won't eat it.

They are best eaten as they are, with extra salt if you need it, off a plate, on a porch or in a kitchen in the middle of the dog days, below the Mason-Dixon line. You can fry okra or catfish if you have any cornmeal left over and feel very virtuous about not wasting food. I layer them with fresh mozzarella if I'm feeling fancy, or throw them into a roll with mayo, lettuce, and cheese and call it an FGT po-boy.

But most often I eat them as they come out of the pan, crisp and tangy and citrusy. These are the perfect bridge food between the humid hot horrible summer days of August and the crisper fall days to come. Enjoy.