Saturday, October 31, 2009

The Joys of India


Just What the Doctor(s) Ordered
By James Tarbox, MD and Lowell Chang, MD

Two [trips] in a [month], I bet you think that’s pretty clever don’t you boy.

Having returned from a trans-hemispheric trip to Peru, I laid down to rest for a few hours. I then dumped out my suitcase and replaced my missionary worn clothes. After being in Cleveland for fifteen hours, Michelle and I were off to India.

During the 15 hour flight from Newark to New Delhi, yes this really occurred and no it didn’t take 23 hours or a layover in Frankfurt, Heathrow or Abu Dhabi as I was asked several times, I made a decision that I would both relish and regret. The stewardess asked if I would want American or Indian cuisine for my meal before landing. Indian food of course, and whoever is Continental’s chef for international cuisine, I give props. The paneer (cheese) and aloo (potatoes) were very tasty in a nice tomato curry. They didn’t hold back on the spices much to my surprise and enjoyment. As I ate it, I thought I would’ve been happy to have eaten this at a good Indian restaurant in the US.

Our flight was scheduled to land at 8:40pm India time and I didn’t know how long it was going to take to get through customs or if our airport shuttle would be on time to enjoy dinner at The Great Kabab Factory. One of my friends from Delhi says he goes there all the time when he returns home, which sounded like good advice to me. Lo and behold, we arrived at the Radisson by 9:30pm and I tipped the driver 100 rupees for what was considered a complimentary ride. I haven’t seen someone with a smile that big since I last watched Jim Carrey in a movie years ago. I later learned that I probably doubled the driver’s salary for the month with that tip. Too bad I didn’t learn this until arriving in Kolkata four days later for my friend’s wedding after dispensing several thousand rupees worth of tips. Consider me a goodwill ambassador.

After we checked in, the first question I asked the Radisson was if The Great Kabab Factory was still open. They responded happily by pointing us in the right direction. Some cheerful hostesses and waiters greeted us, and we sat in an elegant, vast dining area with a vaulted dome ceiling and black pillars. An overly persistent waiter finally twisted my arm into ordering a bottle of wine. Another waiter took our order in which I got the non-vegetarian feast, Michelle the vegetarian.

Soon our table was surrounded by joyful staff bring all assortments of kababs. At this restaurant, dishes included Galouti kabab (minced lamb…or mutton as Indians say infused with spices), Peshawari Murgh Tikka (succulent chunks of chicken coated in spices), Macchi Tikka Khada Masala (luscious fish), Logan ki Boti (a mutton dish that I will mention more of below), Prawn Hara Dhaniya (shrimp), and Barrah Kabab (cubed lamb chop).

I sampled some of Michelle’s vegetarian kababs which included a Tandoori Paneer Tikka and Dakshini aloo among others. Michelle started tasting the non-vegetarian dishes since they did not contain beef. The waiters caught on and soon our plates were filling up with all sorts of tasty morsels.

I sat there as the waiter now supplied the Logan ki Boti sampling from the kitchen. The sumptuous lamb stewed in a fiery hot red-orange curry would soon melt away in my mouth. I tried to remember the last time I ate something that spicy, yet I wanted to eat more despite my mouth and stomach threatening to strike. The mutton was so tender; I could cut it with the handle of my fork. The spices were almost overpowering, yet invigorating. Apparently, the mutton is braised in a sauce containing chilies, onions, saffron, coriander, cashews, and a dash of mint. I’m sure my dopamine receptors were on full throttle.

Two more delectable kababs to go, then onto the main course, I thought. Not so fast my friend. The waiters kept showing up at our tables offering more of these finest meats. The kabab appetizer is all you can eat!!! Why didn’t I know this?? Why did I have to eat that scrumptious entrĂ©e on the plane??!! No offense to Continental, but The Great Kabab Factory definitely lives up to their phrase: “Where the kabab is king!”

After eating a few more kababs, I’m succumbed to the main course wondering if I could finish it as well. They served each of us a biryani (a rice dish with spices and chicken in my case) and two types of dals (spiced lentils). That biryani was the best I’d ever had; no wonder my friend from Gujarat had such a tough time explaining how different they were in the US and from home. I had to hold off on the aloo toori because there were four different desserts still to arrive which included: jalebi with rabri, pista phirnee (rice, sugar, water, almond, and pistachio mixture), rasmadhuri (soft cheese in a creamy, sweet milk sauce and almonds), and tinka kulfi (like an ice cream popsicle). The jalebi seems like India’s alternative to a funnel cake, except the fried dough is of thinner circumference and the design more ornate and circular.

After eating one of the most delicious and tasty meals of my life, I was finally able to appreciate why all my friends from India had a hard time explaining what real, authentic Indian food is like. The complexity of flavors that hits your mouth is like nothing you’ve probably ever tried before. I used to not understand when my Indian friends would downplay the spice level of food in the US, keep in mind I’m discussing flavor and not hotness per the Scoville scale. To put it in perspective, every dish I had was probably three to ten times the amount of spices as the domestic fare. In the US, you can ask for your Indian food to be spicy, but there’s a catch. It may get hotter due to the addition of red peppers or other chilies, but it’s not the same as the taste explosion you get from adding ten times the amount of onions, ginger, garlic, turmeric, coriander, butter or oil. Yes… oil, that’s when I knew I was getting the real deal. When I got to the bottom of the bowl of one of my murgh (chicken) dishes, and the entire bottom of the bowl has a centimeter layer of oil. Man… that is good. Do keep in mind, if you want your food to be hot as well, India will happily oblige with more red and green chilies that you ever thought possible in a meal.

The next morning in Delhi, we rented a taxi for the day and saw the Qutb Minar, Bahai lotus temple, and Humayan’s tomb. We ate at a local restaurant called Pindi for lunch which served some excellent murgh, sag (spinach) paneer, and stuffed naans. Then, off to the India Gate, Parliament, Raj Path, Red Fort, and the Jama Masjid.

After that tour de force in sightseeing, we arrived at Bukhara a little before 7:00pm which is located in the ITC Maurya Sheraton Hotel. The door wasn’t even open yet, so we rested in a sitting lounge that had nice carpets and interesting Renaissance paintings on the ceiling.

Once entering the restaurant, we were greeted by more cheerful hosts and waiters. The walls are made of stone and there are dark red columns and carpets everywhere. Our table consisted of two semi-low set chairs with cushions and two knee high tree stumps. I was ok with this because at times I do eat like a Tyrannosaurus rex perched over my meal.

Bukhara is famous for being rated as the top Asian restaurant in the world, as well as, one of the Top 50 restaurants in the world by Restaurant Magazine a few years ago. They also relish the fact that Bill Clinton stayed at the hotel just to eat at this restaurant, the waiter mentioned this twice. Little did he know I already knew this bit of information. He also mentioned that they have the best dal and lamb in all of Delhi. Check off round number 2 for me.

When I first perused the menu, I immediately ordered the dal bukhara. I next wished to get the Sikandari raan which is a braised, whole lamb leg, but the waiter said it was too much food for one person, even two. Did he not know who he was talking to??!! Well, I took his advice and ordered the lamb seekh kebab (note the slight change in spelling) which I would later lament as my second poor food related decision on this trip. Michelle ordered paneer tikka and tandoori aloo which are cooked in an Earth oven.

The dal is a mixture of black lentils, ginger, garlic, tomatoes, cream, and butter simmer overnight (or 24 hours per the waiter) and arrives at your table in a good size ceramic bowl. After eating this delectable morsel of artery clogging goodness with keema (mutton) stuffed naan, I can honestly say that I have never had better dal…EVER. The extraordinary thick, creamy, roasted texture and the perfect combination of spices all brought together by the slow cooking make this dish one not to miss. I sometimes wonder why I didn’t purchase some bottles to bring home, apparently they sell the stuff.

I next bit into the seekh kebab expecting life’s goodness to continue to flow through my digestive track. I chewed, swallowed, and ate some more…and some more. I couldn’t get the lamb kebab from The Great Kabab Factory out of my head!! Theirs was better, plain and simple. The lamb at Bukhara tasted slightly overcooked and wasn’t as complex in flavor. The dish was good, don’t get me wrong, but possibly my expectations were too high. Maybe the raan at Bukhara is the answer, but I won’t be able to answer that question until another time. The paneer and aloo were also passable, but not memorable dishes. They didn’t have enough flavor and both tasted slightly overcooked as well. This surprised me since we were part of the first group of customers for the night.

Is Bukhara “arguably the finest Indian cuisine on planet Earth” as their website, bukhara.com, proclaims? I’ll give them finest dal recognition, but I honestly thought that The Great Kabab Factory had better lamb kababs, as well as an overall meal.

We would later go the Taj Mahal which is one of the most magnificent structures in the world. I still laugh when one of my friends remarked that it was just ok. Afterwards, we were off to Kolkata to celebrate one of my longtime friend’s marriages. It was the main reason for the trip and a great experience, the rest of the vacation was a bonus.

Now if I venture into Indian restaurants in the US, I can always recall the great food I had in India. Also, I can finally judge a meal and truly understand what flavors and spiciness really are.

A few additional thoughts:
1. When was the last time I had yellow cake with chocolate icing? This decade?
2. For those wondering, the lyrics at the start are modified from a Radiohead song.

- James Tarbox, MD

I would like to thank my friends who helped to review this article. If you have any questions, comments, concerns, or ideas for restaurants to visit, please e-mail us at: tarboxj@ccf.org and changl@ccf.org. Also, you can visit our blog at starboxmd.blogspot.com. Thank you.


Monday, October 26, 2009

Day (or night) in the life of a nocturnist

Ahh the sunny beaches of Seychelles. Why did I wait so long to get here? (buzz buzz buzz) Is that a fly? Surely, not here. Not on this pristine slice of beautiful Earth. (buzz buzz buzz) Dangit, fly??!! Ohh wait is that my pager? Is that the General Internal Medicine Triage Officer (GIMTO) sending me another patient? A nurse who is asking for a sleeping pill? Pain medicine that should have already been ordered? (buzz buzz) Ahh, it was only my cell phone. 2:00pm and I am still at home. Time to wake up and eat cereal.

Boy I love driving to the hospital at 4:30pm. Everyone else is trying to drive away. No rush trying to find a parking spot. What service am I working again today? Admitting would be sweet. No cross-cover, just me and my ideas on how to care for patients. Not having to worry about anyone else forgetting pain meds, zofran, or colace. Pulmonary is usually pretty nice, unless a patient goes downhill. Then, one hour of my night disappears with them. The non-teaching general internal medicine (GIM) pager has been hit or miss. Lately, the service is ballooning to 60 patients. Good for the hospital, bad for shotgun pages at 6:00pm, 10:00pm, and 4:00am. I sometimes wonder why we get 20-30 pages between 5:30 to 7:30pm. It’s an exercise in efficiency and Zen. Lastly, Kaiser, Bone Marrow, Pall Med, GI and whatever other service decides to utilize us. This pager has not been too bad in the last month. Bone Marrow seems to be coordinating their calls more often and the fellows and PAs appear to remember to adjust pain meds. I wish they would have pre-orders for fever though.

Ahh, I get to carry the GIM pager. I wonder how many pages I am going to get tonight asking if I cover GIMTO patients. Do they not realize those two little letters mean so much? (buzz buzz buzz) The first barrage of pages, and of course all the teams have signed out by 5:15pm. This patient is agitated, in restraints, and no haldol prn? The patient got switched to percocet at 3:00pm and already wants their dilaudid? A family meeting now? (buzz) First admission from the Emergency Department (ED). Nice to see they are cleaning house. Time to go to the ED. (buzz buzz) Do I know if the patient will go home tomorrow? Maybe, though I will not decide. Yes, the patient can have an extra dose of dilaudid and benadryl. Why is she not on a patient-controlled analgesia (PCA) pump? Need to transfer her to GIM 3. Well, done admitting that 90 year old for altered mental status and a history of metastatic pancreatic cancer on tube feeds and severe dementia. The only person I could contact was her granddaughter who firmly believes the patient would want everything done... ok.

It is about 8:00pm. Time to eat dinner. Normally, I would bring a few sandwiches, but tonight I will make a McDonald’s run. (buzz) A sleeping pill at 9:00pm? Sure. Dinner time is usually interesting depending on who is around. Lowell is probably one of the best Asian chefs in the hospital. Another colleague always has some interesting pita sandwiches filled with Middle Eastern delights.

I’ve got some time to review cross-coverage sign out. Let’s see only 7 subspecialties notes to review, 6 BMPs, 5 chest… x… rays. 4 hemoglobins, 3 cardiac enzymes, 2 line placements, and a restraint order to be signed at 4:00am. (Using the tune from the Twelve Days of Christmas)

(buzz) You called an AMET on chest pain? Are the vitals stable… yes? Ok, I guess. I will be right there. Stat EKG, enzymes, CXR, and nitro. The patient is fine after the nitro? Let us see how the enzymes turn out.

The midnight hour approaches. 2 hours later, oh there are the stat cardiac enzymes which are negative. Should I go to the call room now, or wait for my next admission? Admitting and Kaiser still are waiting. (buzz) Am I Orange? Not since last year. Also, why does the GIM pager always get paged when Orange is asked for? No, I do not cover Kaiser. No, I do not distribute admissions, call the GIMTO.

Let us see, it is 1:30am. I wonder if I will get 3 hours of sleep. (buzz) Another patient who can not sleep? Why do they not put ambien in the water? (sleep… buzz) Yes, did someone page GIM? General Internal Medicine? (hold) No one paged me? Ok… did anyone page anyone? Yes… yes, you can give an extra dose of dilaudid.

As I nod of to sleep again, I think about all of the flexibility this job offers. I must have spent half the months of February thru April in airports while on the interview trail. Due to the great flexibility offered in scheduling shifts, by the month of May I had caught back up in work hours. I wonder how many other staff could pull that off, at least those without Audi A8s. I wonder if I’ll ever buy an Audi A8. I wonder if the chairman will ever get one. Why have I spent the last 30 minutes thinking about cars?

Time to catch some more Zzzzzzs. (sleep… … buzz) Am I covering H81-12? I don’t know. Who is the staff? Dr.? He is the GIMTO right now, not the staff. Who wrote the last note? Yes, the last primary team note in Epic. You don’t know? Look in the computer? You are not near a computer? Ok... I’ll wait. It’s Tucker? Try calling them.

(buzz) Constipation? How long has this been going on? It’s 5:00am? He’s had it for 3 days? Sure, I guess the colace will help. (buzz) The patient lost IV access. How many times have you tried? Has another nurse tried? Another nurse? Any important medications needed? Ok, wait for SWAT. (buzz) The patient is confused? I think I’m confused. Reorient. It’s 6:30am. Time to get up and make sure my patients did ok. Only paged every 30 minutes since 1:00am.

Hmm… do I want to page the GI fellow at 7:00 or 7:15am. Signout to pall med went fairly smoothly. It’s time to go home. I wonder if my driving is worse than a blood alcohol level greater than 0.1. Finally, I arrive home to my bed. I’m glad I have a four day weekend to look forward to. I can’t wait for some rest and relaxation. Five hours of sleep in the daytime, then trying for seven hours of sleep tonight. This job does have its benefits. Even if I have two tough shifts a week, I still have the weekend to recover. It seems like many colleagues are able to spend plentiful times with their families. The combination of salary, benefits, and free time is tough to beat. Plus, my pager will spend the next few days off.

Speaking of time off, visions of the beach are entering my consciousness. Hear the waves softly crashing against the shore. That sure is nice music in the background. The world is slowly fading away. Wait a second. What is that I hear? (buzz… buzz… buzz)