Folks, ummm, it’s been nuts in the ED. Nuts.
As a bit of background, our ED is exceptionally well-ordered. We have a great director and are generously staffed with plenty of ancillary staff. Us residents do a few rotations at the other, traditionally lower-income ED in town (in truth, the town is painfully poor and both EDs have an unusually high number of uninsured patients, but our hospital provides more specialist services and is thus better funded), and the difference is night and day. Expected wait times at our ED, previous to this surge, were about 30 minutes, and as someone who has worked in more than a handful of hospitals at this time, that is miraculous.
Recently though, for unknown reasons, whoa! Everyone needs and wants care. It must be a statewide thing, because transfers have doubled. Those of you who have worked in food services doubtless know the term, “in the weeds,” and that is where we are consistently at. When I come on shift, we have 20-40 patients in the waiting room, which we patiently clear, but more keep coming. It feels like this when I walk through the waiting room:
This is in many ways fantastic for a resident because there’s plenty to see and lots to do (5 LPs in the last weeks! multiple crash airways!) but also exhausting. I worked 6 shifts this week, and each has gone over by many hours. Part of it is my fault, because I need to learn to chart more efficiently, but part of it is simply volume and acuity – generally as a shift winds down you leave new patients that will require long workups to the incoming staff, but if someone shows up sick as stink, of course you have to see them.
Also, frankly, it can be scary. I of course still have supervision, but I’m more trusted than prior and everyone is overwhelmed so sometimes I’ll see and stabilize someone and no other doctor will see them for quite some time. I’ve done multiple LPs at this time where my attending just pokes their head in mid-procedure, sees that the CSF is flowing, and walks out. I haven’t had a bad outcome yet that I’m aware of, mostly because my attendings are very conscientious and check up on me (even if they’re very polite and surreptitious about it) but of course I leave every shift second guessing myself and wondering what I should have done differently. It makes me a little scared to be an attending – I’m walking in the spiderweb; cue cool spider pictures from vacation:
I had a 4 straight shifts in a row run this week, and all of them ran way over. I prioritized sleep, and still lost on that front. Feeding myself fell by the wayside and there were 3 days in there when I ate nothing but snap peas, coffee, almonds, pasta, and whatever unfortunate junk food people brought (damn you communal atmosphere of the ED!).
Cue chilaquiles! My stepfather in Mexico taught me to make these, but since he’s been doing this since he was tall enough to reach the stove, plus our interaction was hindered by language barriers, the jist I got of his instruction was basically “put these ingredients in a pot, blend them, and then cook them with chips.” I checked the internet before trying to replicate, lest something had been lost in translation, but he was right – this dish is really simple. Besides being pretty easy, they’re junk-food-y enough that they aren’t a hard sell even when you have the exhausted stupids that tell you to eat horrible food (seriously, when I am sleep deprived, my brain makes really unfortunate suggestions and I wish I could just turn it off), but also include enough okay stuff that they don’t perpetuate the carb cycle of exhaustion/bad choices/misery.
Chilaquiles are generally made with a red or green sauce. I honestly prefer the red, but have not found a good source for the suggested chiles in the base, so I’ve been making green sauce. This rotates around the tomatillo. For those of you not in the know, this is a tomatillo. It looks like a tomato that has survived far too long and has delicate skin, like a 99 year old.
Naked, however, it looks like a dumpy green tomato. They’re sticky without their skins and will need a rinse.
The shucked and rinsed tomatillos go into a pot with some pretty basic ingredients that you probably already have hanging around your kitchen. That poor ugly pale one on the bottom left is not how a tomatillo should look, but my grocery store is somewhat limited. Sigh.
In go bay leaves and oregano. I didn’t add salt because the broth I added later was not low-sodium, but you can adjust accordingly.
Corn tortillas are sliced. This is one of the great benefits of this recipe – corn tortillas come in enormous packages! If I were my Tapatio stepfather, this would not be a problem, because I would eat corn-tortilla friendly foods at least 2 meals a day and would thus work through a pack before they got crumbly. Alternatively, I would buy my damned tortillas made fresh, in exactly the quantity I wanted. However, since neither is likely to happen here, every pack of corn tortillas I buy is excessive to my needs for a taco dinner, or even a taco dinner plus breakfast taco follow-up. My freezer is already full of enchilada casseroles. Guess what this recipe does? It uses up those leftover tortillas that are too stale to effectively hold taco insides, so my freezer isn’t full of half packs of stale tortillas!
Since taking this photo I have tried making the chips in the oven, and I am not going back. Fried adds a bit more flavor, but a lot more fat and hassle, and honestly since they get amply sauced, I don’t miss the difference. Baked (with a little bit of oil) FTW!
Also since my first foray into chilaquiles I’ve tried roasting rather than boiling the ingredients. I don’t know that I can tell the difference – maybe a little more flavor if roasted? I wouldn’t say either is easier though, so you do you (both versions are available in the recipe).
The final product is scrumdiddlyumptious. If you really wanted to gild the lily (I generally do), you could add a dollop of sour cream or yogurt. The dish stands on its own, with bean and eggs supposedly optional, but who are we kidding, it’s better with them so optimize your damned food. Enjoy!
- 1 lb tomatillos
- 2 jalapenos
- 4 garlic cloves
- 1 medium white onion
- 1 1/2 cups+ vegetable broth (more for boiled version)
- 1 teaspoon oregano
- 1 large bay leaf
- 1/2 teaspoon pepper
- Peel and husk the tomatillos. Peel and quarter the onion. Halve and stem the jalapenos.
- For the boiled sauce, peel the garlic and place it in a pot with the remaining ingredients with vegetable broth to cover plus 1". Boil 10 minutes. Strain, reserving cooking liquid. Cool, then blend with 1 1/2 cups cooking liquid.
- For the roasted sauce place all items (including garlic with skins on) on a foil-lined baking sheet. Bake at 450 degrees until tomatillos are soft and onions are browned, approximately 20 minutes, turning once. Place all (after removing skins from garlic) in a blender with 1 1/2 cups of vegetable broth as well as the pepper, bay leaf and oregano. Add salt if the vegetable broth was unsalted and blend.
- Place the sauce in a saucepan and bring to a boil. Reduce heat to a simmer and cook 5 minutes, adding more liquid if desired. Add the chips and cook an additional 5 minutes at a simmer. Serve warm.
- To fry chips heat 1/2" of vegetable oil over medium, then add sliced tortillas. Watch like a hawk as they like to burn. They will likely take 1-2 minutes per side to brown. Drain on a paper towel.
- To bake chips toss the sliced tortillas with 1 1/2 tablespoons vegetable oil. Bake at 450 degrees until browned, about 4 minutes per side.