Tuesdays with Dorie 4 of 15

I didn't participate in last week's TWD - marshmallows just aren't my thing - even homemade. But this week's selection... WOW!

Amanda of slow like honey has chosen…

Bill’s Big Carrot Cake on pages 253-255

It is fantastic.

Cake baking is always a challenge - at least for me - at a mile high. Altitude has such an effect on leavening. The barometric pressure is so much less here that cakes will rise too high and lose their structure... I usually end up with a flat mess, or a dry and crumbly fiasco - It will rise too high and fall or won't be cohesive and crumble to bits.
Which is really a shame, because I've loved baking cakes in the past. My g'ma Fannie was a big-time cake baker... There was always a fresh cake in her kitchen when I would go visit on Sunday afternoons. She lived in the deep south so the cake was always accompanied by sweet tea. Yummo... good times, good times. I've tried making some of my favorites of hers, but just haven't had the success that she did.
Finally, a year or so ago, I took a class on baking at altitude - it was really pretty simple, reduce the leavening ( sugar, salt, baking powder) and increase the liquid/density ( water or oil - or add sour cream!) Since then, my baking has been a little more successful. But it always requires a little adjusting an I never really know how it will turn out.

This was no exception....
I realized that the carrots were going to give the cake the density that is required without adding my standard sour cream so that part was easy. I was a little distracted when I was making the cake realizing I had forgotten several key ingredients I had to make a dash to the store mid cake-making and ended up forgetting to add the salt and cinnamon - bummer. I remembered to cut down the baking powder, but forgot to decrease the sugar which I guess was ok since I totally excluded the salt.




The recipe recommended turning the cake and changing racks halfway through the baking time - which I did, but I may have moved them a little early - not sure, anyway two of the three cakes fell a little. you can see the slight sinking in the middle that I tried to disguise with more frosting in the divot. Yea, the middle of the slice was the best because it had the most of the yummy, and I mean YUMMY, cream cheese frosting. My only complaint is that there really wasn't enough.

I really think that leaving out the salt and cinnamon left the cake slightly bland and one dimensional - but only slightly... All-in-all this cake was a huge hit. Some friends came over for dessert Sunday evening and all loved it. The rest I took to work on Monday and folks really loved it. It didn't hurt that it happened to be a gals birthday so someone else brought in a store bought carrot cake - mine won the side-by-side comparison.

Now go check out the real bakers blogroll over at TWD

Here's the recipe for those of you looking for a lightly spiced (or not, if you forget a few ingredients) carrot cake with decadent cream cheese frosting with a tiny hint of lemon... so good!

Bill's Big Carrot Cake
Baking: From My Home to Yours by Dorie Greenspan

Yields 10 servings

Ingredients:

For the cake:
2 cups all purpose flour
2 teaspoons baking powder
2 teaspoons baking soda
2 teaspoons ground cinnamon
¾ teaspoon salt
3 cups grated carrots (about 9 carrots, you can grate them in food processor fitted w/ a shredding a blade or use a box grater)
1 cup coarsely chopped walnuts or pecans
1 cup shredded coconut (sweetened or unsweetened)
½ cup moist, plump raisins (dark or golden) or dried cranberries
2 cups sugar
1 cup canola oil
4 large eggs

For the frosting:
8 ounces cream cheese, room temperature
1 stick ( 8 tablespoons) unsalted butter, at room temperature
1 pound or 3 and ¾ cups confectioners' sugar, sifted
1 tablespoon fresh lemon juice or ½ teaspoon pure lemon extract
½ cup shredded coconut (optional)
Finely chopped toasted nuts and/or toasted shredded coconut (optional)

Getting ready:
Position the racks to divide the oven into thirds and preheat the oven to 325 degrees Fahrenheit. Butter three 9-x-2-inch round cake pans, flour the insides, and tap out the excess. Put the two pans on one baking sheet and one on another.

To make the cake:
Whisk the flour, baking powder, baking soda, cinnamon and salt. In another bowl, stir together the carrots, chopped nuts, coconut, and raisins.
Working with a stand mixer, preferably fitted with a paddle attachment, or with a hand mixer in a large bowl, beat the sugar and oil together on a medium speed until smooth. Add the eggs one by one and continue to beat until the batter is even smoother. Reduce the speed to low and add the flour mixture, mixing only until the dry ingredients disappear. Gently mix the chunky ingredients. Divide the batter among the baking pans.
Bake for 40-50 minutes, rotating the pans from top to bottom and front to back at the midway point, until a thin knife inserted into the centers comes out clean. The cakes will have just started to come away from the sides of the pans. Transfer the cakes to cooling racks and cool for about 5 minutes, then run a knife around the sides of the cakes and unmold them. Invert and cool to room temperature right side up.
The cakes can be wrapped airtight and kept at room temperature overnight or frozen for up to 2 months.

To make the frosting:
Working with a stand mixer, preferably fitted with a paddle attachment or with a hand mixer in a large bowl, beat the cream cheese and butter together until smooth and creamy. Gradually add the sugar and continue to beat until the frosting is velvety smooth. Beat in the lemon juice or extract.
If you'd like coconut in the filling, scoop about half of the frosting and stir the coconut into this position.

To assemble the cake:
Put one layer top side up on a cardboard cake round or a cake plate protected by strips of wax or parchment paper. If you added the coconut to the frosting, use half of the coconut frosting to generously cover the first layer (or generously cover with plain frosting). Use an offset spatula or a spoon to smooth the frosting all the way to the edges of the layer. Top with the second layer, this time placing the cake stop side down, and frost with the remainder of the coconut frosting or plain frosting. Top with the last layer, right side up, and frost the top- and the sides- of the cake. Finish the top with swirls of frosting. If you want to top the cake with toasted nuts or coconut, sprinkle them on now while the frosting is soft.
Refrigerate the cake for 30 minutes, just to set the frosting before serving.

Serving:
This cake can be served as soon as the frosting is set. It can also wait, at room temperature and covered with a cake keeper overnight. The cake is best served in thick slices at room temperature and while it's good plain, it's even better with vanilla ice cream or some lemon curd.

Storing:
The cake will keep at room temperature for 2 to 3 days. It can also be frozen. Freeze it uncovered, then when it's firm, wrap airtight and freeze for up to 2 months. Defrost, still wrapped, overnight in the refrigerator.

Sunday insomnia

So what does one do when struck with insomnia? I woke Sunday morning at 3am worrying about the weeds in my backyard... really what are you going to do about weeds at 3am? So after dozing in and out and tossing and turning for another 1 1/2 hours, I decided to throw in the towel and start my day - at 4:30 am!
After a nice breakfast and warm cup of coffee (my favorite part of morning), I packed up the poodles and headed to the dog park. We were there before 7 am. The light and shadows were pretty fun and not too many people were there yet.

Oh, the expectant faces...

Lannie likes to wear her shorts to the park.

It's really hard to keep all 4 paws on the ground.

A drink and a shake.

Zippy the pinhead and his pooch.

"How you doin'?"

Sophie is just not ready to go - it took a little coaxing to get her back in the car - see if you can find her in this photo...

Easy Saturday Morning

A yummy cup of coffee (or two), the hope of carrot cake to come, and...
Sophie here for a weekend sleep-over.
Sophie's tummy is a little upset so a little honey is on menu today.
Have a great Saturday.

Tuesdays with Dorie 3 of 13

The Most Extraordinary French Lemon Cream Tart
From Baking from My Home to Yours
By Dorie Greenspan

This weeks assignment for TWD was suggested by

Mary from Starting from Scratch.

This weekly baking adventure really is expanding my repertoire. Flan and now lemon cream tart, I never would have chosen these on my own.... and speaking of that, next week's recipe selection is marshmallows!

Judy of Judy’s Gross Eats has chosen…

Marshmallows on pages 404-405

Home made marshmallows - I didn't even know there was such a thing.
Well, anyway, this weekly challenge has sent me in new directions that I really appreciate. This week's lesson was in the area of the crust. The recipe suggests using a food processor which I do not own. I do, however, own a pastry cutter-thingy so I used that instead. My problem came when all the butter was cut in and it still seemed like a pile of flour, just slightly grainy-er. So, being my uneducated self, I added and 2nd egg yolk and a dab of water until it could at least hold together when smashed. The result was a slightly strange, slightly yolky tasting crust that apparently no one but myself noticed. Despite my heavy-handed manipulations, it stayed pretty light and flaky. But, I do wonder what happened.
The cream went together pretty well - a challenge to continue stirring over a double boiler while constantly checking the thermometer for temperature. Some people on the site had some difficulty getting the temp to 180 degrees, but mine went pretty true to the recipe and after stirring about 8-10 min the thermometer hit 180. In my infinite wisdom and my apparent inability to leave a recipe alone, I added a wee touch of orange flower water - I love that stuff and it will often add a different layer of flavor to a dish, or a cup of tea. I don't know if it was the flower water or something else, but to my tongue the lemon cream had a distinctly odd after-taste. My official tasters - one of whom was a little frightened by the amount of butter she saw me add to the cream - the tasters loved the lemony taste and couldn't understand the funky taste that I tasted.... All in all, not my favorite, although the idea of a tart lemon tart was appealing and I thought it pretty. Maybe I'll try it again without the orange flower water and see if I like it better (but really it was less than a teaspoon...).


Here's the recipe:

The Most Extraordinary French Lemon Cream Tart

1 cup sugar
Grated zest of 3 lemons
4 large eggs
¾ c fresh lemon juice (from 4-5 lemons)
2 sticks plus 5 T butter (10 ½ ounces) unsalted butter, cut into tablespoon size pieces, at room temperature.
1 9-inch tart shell made with sweet tart dough (see below).

Getting ready:
Have a instant-read thermometer, a strainer and a blender (1st choice) or food processor at hand. Bring a few inches of water to a simmer in a saucepan.

Put the sugar and zest in a large heatproof bowl that can be set over the pan of simmering water. Off the heat, rub the sugar and zest together between your fingers until the sugar is moist, grainy, and very aromatic. Whisk in the eggs, followed by the lemon juice.

Set the bowl over the pan and start stirring with the whisk as soon as the mixture fees tepid to the touch. Cook the lemon cream until it reaches 180 degrees F. As you whisk- you whisk constantly to keep the eggs from scrambling- you’ll see that the cream will start out light and foamy, then the bubbles will get bigger, and then, as it gets closer to 180F, it will start to thicken and the whisk will leave tracks. Heads up at this point- the tracks mean the cream is almost ready. Don’t stop whisking or checking the temperature, and have patience- depending on how much heat you’re giving the cream, getting to temp may take as long as 10 minutes (note: TWD bakers report average of 20-30 and up to 40 minutes for this step…..and sometimes it never got above 160F but turned out ok!!)

As soon as it reaches 180F, remove the cream from the heat and strain it into the container of the lender (or food processor); discard the zest. Let the cream stand, stirring occasionally, until it cools to 140 degrees F, about 10 minutes.

Turn the blender to high (or turn on the processor) and, with the machine going, add the butter about 5 pieces at a time. Scrape down the sides of the container as needed as you incorporate the butter. Once the butter is in, keep the machine going- to get the perfect light, airy texture of lemon-cream dreams, you must continue to bend the cream for another 3 minutes. If your machine protests, and gets a bit too hot, work in 1-minute intervals, giving the machine a little rest between beats.

Pour the cream into a container, press a piece of plastic wrap against the surface to create an airtight seal and refrigerate at least 4 hours, or overnight. (the cream will keep in the fridge for 4 days or, tightly sealed, in the freezer for up to 2 months; thaw it overnight in the refrigerator)

When you are ready to assemble the tart, just whisk the cream to loosen it and spoon it into the tart shell. Serve the tart, or refrigerate until needed.





Sweet Tart Dough
1 ½ cups all purpose flour
½ cup confectioners’ sugar
¼ tsp salt
1 stick plus 1 tablespoon (9 T) very cold (or frozen) unsalted butter, cut into small pieces
1 large egg yolk

Put the flour, sugar, and salt in a food processor and pulse a couple of times to combine. Scatter the pieces of butter over the dry ingredients and pulse until the butter is coarsely cut in- you should have some pieces the size of oatmeal fakes and others the size of peas. Stir the yolk, just to break it up, and add it a little at a time, pulsing after each addition. When the egg is in, process in long pulses- about 10 seconds each- until the dough, which will look granular soon after the egg is added, forms clumps and curds. Just before you reach this stage, the sound of the machine working the dough will change- heads up. Turn the dough out onto a work surface and, very lightly and sparingly, knead the dough just to incorporate and dry ingredients that might have escaped mixing.

To press the dough into the pan: butter a 9-inch fluted tart pan with a removable bottom. Press the dough evenly over the bottom and up the sides of the pan, using all but one little piece of dough, which you should save in the refrigerator to patch any cracks after the crust is baked. Don’t be too heavy handed- press the crust in so that the edges of the pieces cling to one another, but not so hard that the crust loses its crumbly texture. Freeze the crust for at least 30 minutes, preferable longer, before baking.

To partially or fully bake the crust: center a rack in the center of the oven and preheat to 375 degrees F.

Butter the shiny side of aluminum foil and fit the foil, buttered side down, against the crust. (since you froze it, you can bake it without weights). Put the tart pan on a baking sheet and bake the crust for 25 minutes. Carefully remove the foil. If the crust has puffed, carefully press it down with the back of a spoon. For partially baked crust, patch the crust if necessary, then transfer the crust to a cooling rack. To fully bake the crust, bake for another 8 minutes or so, or until it is firm and golden brown. Transfer pan to a rack and cool the crust to room temperature before filling.

Enjoy, and join us...

Kampong Chhnong hospital

Some of you may remember that I went with this group to Cambodia on a medical mission trip to provide specialty cardiac care to the people there. I was there for two weeks in February and at times it seems like it was yesterday, and at others, like it was years ago.
It has been a while and memories are starting to fade a bit, but I'll visit Cambodia with you as I look through some of my photos.
The last post on Cambodia was about or trip to Kampong Chhnong - a province outside Phnom Penh. We went with the express purpose of delivering medical supplies to the hospital there. The hospital is growing and had construction of a few buildings happening while we were there, and we were there on a national holiday, so the placed felt a little deserted. The buildings we did walk through were the maternity ward,
the emergency area and the surgical area


This is the delivery room - quite sparse it seems, and not too sterile














Healthy mom and babies - how would you like to sleep on those hospital beds?















Sweet, wee newborn

















This is the surgical suite which I didn't think seemed too bad, but I'm never in the OR so I'm certainly not an expert.
One of the medical supplies that we gave to them were disposable spinal needles - apparently they are expensive and hard to come by so they clean and reuse them. Chances are they will continue to clean and reuse the ones we brought them as well, but now they'll have a new supply.














This is the entrance to their emergency area ( I think their written language is beautiful). This was the only place that was busy and it was filled to overflow. Some patients were in beds on the porch. The care of the sick is still left much to families for providing cleaning, food, toileting - it's pretty interesting.















Here's a family caring for their ill family member that was lying in the bed. The blue basin is filled with ice. Ice is the main pain killer used over there - no morphine after surgery, just a bag of ice on your belly!


















This is a peek into the emergency area - not quite as cush as our hospitals, eh?



















And BTW, I was told today of a documentary entitled "Holly"
I'm sad that I missed this event, but Friday evening a woman named Somaly Mam was in Denver at the viewing of this film. She has an amazing story (click on her name to be taken to a story written about her in the Denver Post). This woman was sold into a brothel by her grandfather at the age of 9. She has spent her adult life trying to save at risk girls from her fate. It sounds amazing and I hope to make it to the film before it leaves.

Tuesdays With Dorie: 2 of 11

Sunday is the day I typically bake ( funny, I said “typically”) Ok, Sunday is the day that if I were to bake, it would likely happen then. This week the chosen recipe from TWD is Gooey Chocolate Cakes.

So Sunday evening I was just to the stage where you had to stir in the dry ingredients and then carefully add the chocolate mixture when the doorbell rings, and chaos insues for the next half hour. Visitors, tasters, all showing up and the dogs going bonkers – they love company.

I had friends coming to share my dessert, then another friend came to check out my basement finishing – in progress. He raised all sorts of questions about the structural integrity and potential code violations and left my nerves rather jangly. chocolate - the perfect antidote! BTW -I spoke to the contractor the Monday and he allayed my fears by either agreeing to fix some things or explaining why the way he did them is ok – very patient man, ‘cause I’m a little anxious about this thing. (Sometimes I wonder why I had to mess with a good thing. The house has been standing steady for 99 years, why at the dawn of it’s 100 birthday did I decide to remove a structural wall? Sheeesh...)

Anyway, because of all the activity, I forgot to take photos. But, I’ll just tell you that the gooey chocolate cakes were a hit. Rich and chocolatey...and gooey. Served with a little French vanilla ice cream - scrumpdillyiscious! There was one left that I happened to eat tonight, so I remembered to take a picture before I finished it off (see above - lousy photo, but it's all I've got). It didn’t have that oozy goo that was came out Sunday because it had been refrigerated and reheated. As Dorie describes, it was more like a bon bon with a firmer outside and a soft middle. It was still scrumptious.

Dorie recommends you put the batter in a disposable aluminum muffin tin – I went ahead and used ramekins because I wasn’t sure how many folks would show up for the tasting and I was going to freeze the batter of the excess cakes. As it turned out, the recipe only made enough for 4 ramekins,¾ c sized ramekins, smallish ramekins, only 4. Not sure how that happened, because it was supposed to fill 6. Regardless there was plenty to go around, none were frozen, and there’s one left for my dessert tonight.
As a slight variation, I used 2 oz of chocolate infused with pasilla chili and cayanne pepper. It had just a hint of chili spice in the cake and was wonderful.
















next week's recipe:

Mary of Starting From Scratch has chosen…

The Most Extraordinary French Lemon Cream Tart on pages 331-333

Here's this week's recipe:

Gooey Chocolate Cake
1/3 cup all-purpose flour
3 tablespoons unsweetened cocoa powder
¼ teaspoon salt
5 ounces bittersweet chocolate,
4 ounces coarsely chopped,
1 ounce very finely chopped
1 stick (8 tablespoons) unsalted butter, cut into 8 pieces
2 large eggs, at room temperature
1 large egg yolk, at room temperature
6 tablespoons of sugar
Getting ready: Center a rack in the oven and preheat the oven to 400 degrees F. butter (or spray – it’s easier) 6 cups of a regular-size muffin pan, preferably a disposable aluminum foil pan, dust the insides with flour and tap out the excess. Put the muffin pan on a baking sheet.
Sift the flour, cocoa and salt together.
Set a heatproof bowl over a saucepan of gently simmering water, put the coarsely chopped chocolate and the butter in the bowl and stir occasionally over the simmering water just until they are melted – you don’t want them to get so hot that the butter separates. Remove the bowl from the pan of water.
In a large bowl, whisk the eggs and yolk until homogenous. Add the sugar and whisk until well blended, about 2 minutes. Add the dry ingredients and, still using the whisk, stir (don’t beat) them into the eggs. Little by little, and using a light hand, stir in the melted chocolate and butter. Divide the batter evenly among the muffin cups and sprinkle the finely chopped chocolate over the batter.
Bake the cakes for 13 minutes. Transfer them, still on the baking sheet, to a rack to cool for 3 minutes. (There is no way to test that these cakes are properly baked, because the inside remains liquid.)
Line a cutting board with a silicone baking mat or parchment or wax paper, and, after the 3-minute rest, unmold the cakes onto the board. Use a wide metal spatula to lift the cakes onto dessert plates.

Bon appetit

...and join us next week. sign up here

Tuesdays With Dorie: 1 of 10

I realize I've left you all hanging from the Cambodia trip - it was so amazing and so much more to tell you. But let me interrupt to let you know about another little thing I'm doing.

I've always enjoyed baking, there's something about homemade desserts that add a special touch - a feeling of warmth, of home. I've been missing that feeling lately and longing for it deeply. When I was reading Ms Greenspan's blog and she was talking about a new internet group "Tuesdays with Dorie" I had to check it out. It's a growing group of some of the most amazing baker's - can't believe I actually joined them, but I did.



We will take a recipe a week from one of my favorite dessert books : Dorie Greenspan's "Baking from my Home to Yours". I adore this book, discovered it around Christmas 2006 when looking for Christmas cookie recipes and fell in love with some in this book. So far everything I've made from "Baking" has turned out yummy.




Including this week's selection for the group - Caramel-topped Flan.

pay no attention the unevenness of the flan, the slightly lumpy texture, or the lack of color in the caramel topping - it tasted good and lessons were learned

This was my first attempt at anything flan-like or custardy. They have always intimidated me a little since my culinary skills are so limited. ~By-the-way, I am WAY over my head in this group, really, really not worthy to be among their ranks 'cause after scootin' around their blogs - they are some awesome cooks. You should seriously check them out.

Anyway, I thought the coconut version sounded real good so that's the one I made. I've never caramelized sugar so really didn't know how to do it and after stirring and stirring to keep the sugar from burning, I finally gave up on the rich amber color that was on her flan in the book. (turns out that to caramelize sugar you put it on med-high heat and let it cook without stirring, but with a watchful eye to avoid burning).

The flan was actually fairly easy to make,but was very exciting since I'd never entered this domain of baking. I mean caramelzing, whisking without the kitchen aid, baking in a water bath... all new.

I was a little hasty at first and although the recipe specifically states that the flan should cool in the fridge for 4 hrs after cooling to room temp - I couldn't help myself I ate one warm. big mistake, way to eggy tasting. The flan needs time to settle and for the flavors to merge. It tasted way, way better after a day in the fridge.

It also turns out that you don't use convection setting for flan - I figured it out after 40 minutes or so of baking and turned it to conventional bake and it took another 30 minutes - it should have taken 30-40 total. (in a few months I'll have this new oven figured out!)

BTW: for the week of April 1
(week #11)

Leigh of Lemon Tartlet has chosen…

Gooey Chocolate Cakes on pages 261-262

Here's the recipe for caramel-topped flan!


For the Caramel
1/3 cup sugar
3 tbsp water
squirt of fresh lemon juice

For the Flan
1-1/2 cups heavy cream
1-1/4 cups whole milk
3 large eggs
2 large egg yolks
1/2 cup sugar
1 tsp pure vanilla extract

Getting Ready: Center a rack in the oven and preheat the oven to 350 degrees F. Line a roasting pan or a 9-x-13-inch baking pan with a double thickness of paper towels. Fill a teakettle with water and put it on to boil; when the water boils, turn off the heat.

Put a metal 8-x-2-inch round cake pan-not a nonstick one-in the oven to heat while you prepare the caramel.

To Make the Caramel: Stir the sugar, water and lemon juice together in a small heavy-bottomed saucepan. Put the pan over medium-high heat and cook until the sugar becomes an amber-colored caramel, about 5 minutes-remove the pan from the heat at the first whiff of smoke.

Remove the cake pan from the oven and, working with oven mitts, pour the caramel into the pan and immediately tilt the pan to spread the caramel evenly over the bottom; set the pan aside.

To Make the Flan: Bring the cream and milk just to a boil.

Meanwhile, in a 2-quart glass measuring cup or in a bowl, whisk together the eggs, yolks and sugar. Whisk vigorously for a minute or two, and then stir in the vanilla. Still whisking, drizzle in about one quarter of the hot liquid-this will temper, or warm, the eggs so they won't curdle. Whisking all the while, slowly pour in the remainder of the hot cream and milk. Using a large spoon, skim off the bubbles and foam that you worked up.

Put the caramel-lined cake pan in the roasting pan. Pour the custard into the cake pan and slide the setup into the oven. Very carefully pour enough hot water from the kettle into the roasting pan to come halfway up the sides of the cake pan. (Don't worry if this sets the cake pan afloat.) Bake the flan for about 35 minutes, or until the top puffs a bit and is golden here and there. A knife inserted into the center of the flan should come out clean.

Remove the roasting pan from the oven, transfer the cake pan to a cooking rack and run a knife between the flan and the sides of the pan to loosen it. Let the flan cool to room temperature on the rack, then loosely cover and refrigerate for at least 4 hours.

When ready to serve, once more, run a knife between the flan and the pan. Choose a rimmed serving platter, place the platter over the cake pan, quickly flip the platter and pan over and remove the cake pan-the flan will shimmy out and the caramel sauce will coat the custard.

Yield: 6 to 8 Servings

my modifications:
13.5 oz unsweetened coconut milk and eliminate the cream, reduce the milk to 1 c.
I also baked it in 6 - 6 oz ramikins.

I hope you make it. And better yet, come join the group!

.

Pagoda on the way to Kampong Chhanong

Thurs March 21 several of us took a "field trip" to a local province, Kampong Chhnang, to visit the hospital and deliver some supplies. On the way we stopped for a photo op at this beautiful pagoda.
(To be honest we had one team member who was quite difficult and there were a few of us who needed a break - particularly me! )

It happens that the day we are there is a Buddhist holiday so there are some people there visiting their family mausoleums.
We also were visited by some of the local girls. They came up from the river whether they're homeless or just sent out to beg, we don't know.





The pagoda was beautifully painted with a lovely sculpture garden.
















A lion
















cute little monkey - didn't really see many of these.












A statue of Buddha holding a pot for rice.

















statue - light fixture, I think


















An elephant carrying the king





















There were rows of beautiful mausoleums. Some well cared for, some not












A family celebrating/ honoring their ancestors at a mausoleum










The beautiful girls that came up from the river. Rather than money, we gave them lollipops - they had mixed feelings about that - really wanted "dollars"






















Saying her thanks







I was over and over again awe-inspired. This pagoda and these girls were beautiful. The day did go on and that will be the next post. We went to the local hospital, to a village on the river, and stopped an ox cart delivering pottery... The trip was surreal.

starting

I'm starting with some random photos to get me rolling... There's so much to say it's hard to know where to start...So, I'll just start.

We went with this agency for two weeks to provide medical support for severe cardiac cases to the poor of Cambodia. There is a hospital in Phnom Penh that is for the poor people. In the past the organization has worked through this hospital but was limited in the surgeries they could perform there. Last year they were able to work in the local Heart Center which was made possible by delicate negotiations. The heart center is very much a for profit place and people are asked to pay for their procedures and surgeries before they are able to be admitted. this leaves a large majority of their population unable to have much needed surgeries and is why we are seeing congenital birth defects in 30-40 year olds that would have been repaired in infancy here in the US.
So our patients would have to register at CSI hospital, then carry their charts to us at the heart center where we would evaluate them and set them up for surgery if it was needed. My personal part was in the evaluation. I would see the patient, take a history, do a physical exam and then send them for an echocardiogram. All of this was made very interesting by the language barrier and by the fact that the murmmurs these folks had are rarely heard here in the US and I had to rely on textbook knowledge - not experience.
It's amazing that we were able to negotiate with the hospital - we brought many supplies with us and because of that they were willing to let us do open-heart surgery on these people for $1000 each - their normal charge being about $3500. Amazing. We had negotiated to do 20 surgeries over the 2 weeks we were there - the hard part being that there were many more than that who needed surgery. We simply had to postpone theirs in hopes that they'll live another year until we come back in 2009.




These little cuties are the brothers of an 8 yr old with a congenital heart defect.
The local Khmear Dr.s at the heart hospital were able to repair her PDA, patent ductus arteriosis, using a catheter through her femoral artery - therefore she didn't need open heart surgery.
She was beautiful (looks so much like her brother facing forward here) and extremely afraid of foreigners. I tried to limit my contact with her because it made her cry, but it was difficult cause she was so cute.
Luckily she did very well and was discharged from the hospital quickly and home to her village.







another shot of her brothers with their dad.
apparently he is a single dad - don't exactly know what happened to mom.













This is a woman who was a patient last year. Dr. Smith did valve replacement surgery on her then - she still has a few issues, but is doing quite well. I didn't work her up this year, but was in the office when she saw Dr. Smith. Her face lit up and it took a while to peel her off of him - not that anyone tried. she was so grateful and said that he changed her life.
That was a familiar song this trip. It's amazing the pathology these people are living with - more than once after surgery Dr. Smith said "I don't know how they were living, their hearts were in such bad shape"





















A walk around the heart center revealed this row of ambulances. I rarely hear a siren and we were on a very busy street.









This is where families stay wen their loved ones are in the hospital. they camp out on the grounds with hibachis - cook their meals and provide 24 hr care to their family member bringing them food, providing baths, toileting....














more families camping out on the grounds











An often seen sight is saffron robed monks walking down the streets . A very cool sight. Cambodia is a very Buddist country with shrines at every corner.

Home again, home again

I know many of you have done this return flight from Asia, but I'm here to say it's much worse than going over. Strange, but going from LA to Taipei was a 14 hr flight, Taipei to San Francisco only 10, but because of the time change I didn't want to sleep too much in order to reacclimate and it seemed much longer because of it.
Regardless, we all made it home safely and in relatively good health. I got to my home at 11pm sat night took an ambien and was in bed by 11:30. Sunday is a blur - I wasn't able to stay awake. That is, until the remodelers arrived at 2 pm to begin their jackhammers (until 8pm). Apparently he got pneumonia while I was gone and was able to complete very little so they tried to make up for lost time on Sunday. Just as well, I was a waste of skin and just layed around when I wasn't sleeping.
Since arriving, Leo and Lannie haven't been out of my sight. I missed them a lot and it's great to be able to snuggle their smelly mugs again. Apparently Leo had a little, but costly mishap while I was gone and ate a pound or so of unrisien bread dough causing him a trip to the emergency room. They made him vomit and then not being sure it all came out wanted him to stay the night then the next day at our regular vet. Sad to say he was recognized and known at the emergency room - and I wonder where all my money goes!
I'm happy to say that all is well now and he's as feisty and enthusiastic as always.
I know you all want to hear more about Cambodia and that will happen, it's just when you're so far behind, you have to start somewhere so why not at the end!



Here's the progress on the basement so far. The light in the background is from the new egress window that they were able to complete while I was gone. adn the wood studs in the foreground are supporting where about 1/3 of the concrete wall is down - that's what they've been hammering away at since yesterday afternoon.

After hours and hours of travel, we have made it to Phnom Phen. Know that any attempt to describe this will not do it justice, partially from fatigue or limited writing skills, but also from lack of perspective at this point to have any of this get well-seated in my mind.
We arrived at the airport with our MANY pieces of luggage, each of us bringing one personal bag and one filled with medical supplies. We were met by Gabi, an RN on the board of CMMCJH (for brevity, I will refer to the mission group as JH from here out) who has stayed since the January trip to coordinate and build relationships with the local hospitals and staff, and also by Nary, a lovely young Cambodian woman working with JH as our local administrative liaison. After Nary choreographed our luggage into a truck and all of us into a van, we headed off.



We had a few hours before we could check into our hotel so were taken to a military complex that is being newly built that will house a medical and nursing school. JH, I believe, has been involved in creating curriculum for the schools. The buildings were closed for the day, so we just walked the grounds. From there we were taken to our hotel.















The drive was fascinating with motorbikes, trucks and cars of all sizes weaving and bobbing along the road in what looks like a death-defying dance. We did see a crowd around a lamppost where a small car had crashed. Other than that, no accidents to report (amazingly) I’ll post a few photos that I took from the second row seat in the van to attempt to give you some perspective.



























Once at the hotel and finally checked in we had one hour to unpack and freshen up after 36 hours of travel before walking to hour the hospital we’ll be working at for the next two weeks. We I went’ to my room it was still dirty. I wanted to cry, but instead went to Bernadette’s room to wash my face and change into some fresh clothes I had carried in my carry-on. Not a much needed shower, but that would come in time.
The hospital is only a short walk from the hotel. The heart hospital is quite different than any hospital in the states. There is a central courtyard filled with grass and palm trees with the cath lab, OR suite, exam rooms and patient rooms all surrounding the courtyard. Families of patients are very involved in their care and sort of live on the sidewalks of the hospital. I didn’t take many pictures there not wanting to be disrespectful.

We did meet one woman who is scheduled for surgery tomorrow (actually late today as I’m writing this after waking at 2am Mon my time- noon Denver time). She is scheduled to have an ASD (hole in her heart at the level of her atrium) repaired. However the surgery is complicated by the fact that she also has dextrocardia, which means her heart is flipped in her chest. Not life, threatening – rare!, but not life threatening, it just complicated the surgery for Dan. This woman is one of the elders of Cambodia being 63 – I can only imagine what she’s lived through after Po Pot’s reign in the 70’s

After the hospital, back to the hotel for a team meeting then finally off to dinner then a much needed night’s sleep. I was able to sleep about 6 hours before waking. ‘m now going to look over the charts of some of the people we’ll being seeing later today. Of the two I’ve looked at, one needs a lung removed after sever scarring from TB, the other needs her mitral valve fixed after scarring caused by rheumatic heart disease.

More later..
Pats to the pooches





Court yard of the hospital from first and second level