Saturday, December 27, 2014


Aziza is a Moroccan restaurant known for cocktails, sous vide skills, and a Michelin star.

The decor was a beautiful deep red, with a lux blue surrounding the bar.  We all loved the bar light fixture, which looks blown out in this pic, but was a really fun shade of blue.

You can see the time and energy they put into cocktails on the bartender's face!

Goorin hats FTW.

Great to have Ryan as an addition to the SF crew.

The beautiful Laws girls.

Their cocktails were all pretty prep-intensive.  This one was a riff on a bloody mary featuring blended red bell pepper, rye, cocchi americano, and bonal.  The other drinks were equally inventive, including one featuring hickory smoke foam on the top.

We all opted for the twelve course tasting menu.  The mark of a truly flexible restaurant and talented chef, they do accommodate dietary restrictions in their tasting menu, which is awesome for the lady.

The first course was labeled "snacks" and was like a set of three amuse bouches.

Glazed carrots with sprouted lentils.

Oyster with cucumber, tumbo seeds, and a bit of green herb on the top.

Lisa had a fried broccolini, almost like a super light tempura, with a brussels sprout and a dab of harissa.  It is amazing to see what you can do with a very simple dish that has been cooked perfectly.

Brown rice cracker egg yolk emulsion with pickled onions and chive (Lisa's).

The same egg yolk, pickled onion and chive as Lisa's but on a cracker made of fried chicken skin.

Sunchoke fritter with brown butter powder and honey -- working the salty-sweet angle hard.  This was amazing and perfectly cooked.

Deep fried potato covered with osetra caviar, creme freche pearls, and micro parsley.

Another Lisa course: grilled avocado with blood orange, heart of palm, and tumbo seeds (a.k.a. vegetarian caviar).

Smoked trout sous vide with cucumber, trout roe, amazing chive oil, and horseradish sauce.   Lisa had a really yummy tomato lentil soup paired with this course, the picture was crappy, but the soup was awesome.

This was one of the big stand-out dishes of the night, and the picture just doesn't do it justice.  Under this blanket of potato puree was a lamb belly chermoula with the most amazing sous vide egg yolk.  It was fully cooked, had a texture of custard yet retained the bright orange color, sheen, and transparency of a raw yolk.  The dish was topped with in-house rice krispies for contrasting texture.

Not knowing exactly how they were going to follow the egg dish, we were a bit leary when the couscous arrived.  This one was vegetarian and featured winter squash, pumpkin puree, cranberry, almond and harissa.  Sometimes couscous is dry and gummy, but this was sweet, soft, and had amazing texture.  We learned this can only come from intense freshness: they make their couscous in house everyday, rolling it by hand.

Basteeya is a traditional moroccan meat pie, and is one of the stand-out dishes on the Aziza a la carte menu.   For the tasting menu, the duck pie was additionally dressed with grape gel, micro turnip and tarragon powder.  It was a delightful set of flavors, and crunchy goodness.

Sometimes vegetarians lose out with tasting menus, and even with restaurant food in general.  That wasn't the case at Aziza.  In fact, Lisa's nettle barley risotto pictured above was one of the other best dishes of the evening.  The shaved apple and fennel garnish on the top was sliced impossibly thin, so it's flavor didn't overwhelm the dish.

Quail, the second main course, was very beautiful.  The play of the electric green chive oil agaisnst the harissa broth balanced by the intense green leaves and pink quail was stunning.

Lisa's second main course was perfectly cooked mushrooms and cipolini onions with more potato puree and parsnips.  At this point, she was already full and crying uncle and so the smaller portion wasn't a big deal.

Beet braised in grape juice with goat cheese and honey.  It was surprising how much the grape flavor still came through after braising.  Goat cheese + honey = heaven.

Apple sorbet, matcha (green tea) crunch, and more impossibly thinly sliced apple that was lightly pickled.  OMG what an amazingly light but flavorful dessert, the pickled apple was the best part.

The second dessert featured a ganache made with olio nuovo (very first pressing of olive oil) ganache on the plate, topped with chicory, malted milk ice cream, almond, and chocolate.   It was nuanced with subtle complexity that you don't usually find in desserts.

Sugar bombs - a wonderfully light fried puff pastry covered in sugar.

Passion fruit gelee with hibiscus sugar coating, a pecan praline, huckleberry financier, and a chocolate truffle.

The night ended with a small takeaway of granola for each person at the table.  The granola was super yummy with a crunch fueled with buckwheat groats, more rice krisipes and a wonderful orange cinnamon tang.

The service was just as wonderful as the food.  Overall, we had an amazing time with great company.

Sunday, November 2, 2014

Kenya Consult

From time to time I get e-mails with iphone pictures of imaging studies to give second opinions on.

This one was particularly interesting so I thought I'd share.  45 yo man with 4 months of progressive weakness. Now with inability to move extremities, and a sensory level near the shoulders.

MRI as shown below (note these are phone camera captures from a lightbox, don't judge).

Post your answer in the comments, I will post the answer in the comments in a few days.

Thursday, September 25, 2014

2014 Kenya Recap

Coming to the end of another 4 week rotation in Kenya, as I reflect on what has been accomplished I'm quite pleased.

Our x-ray truck is finally operational and has visited several rural sites taking x-rays for many patients without major issues. The images are being uploaded to the PACS and are now ready for interpretation by radiologists. I've been waiting for years to write that sentence. 


I had a ton of food adventures during the four weeks including:
  • Making yogurt with Patrick and Wendy
  • Granola with Jess (fruit after baking, doh!)
  • Making Jon Laws' pickled green beans with Jess
  • A Lebanese feast prepared by Jess
  • Cucumber pickles with Patrick
  • Three amazing meals with Jane who makes everything look easy
  • One 'oven surprise'
  • Ugali that actually tastes like something edible at a Moi's Brigde choma zone (pictured above)
  • Brie and Peppered salami imported from Nairobi
  • Chili paneer from Siek Union
  • Dinner at Sanjeel complete with cheese nan and tandoori paneer 
  • A fabulous send-off dinner complete with a pumpkin cheesecake by Jess and Katy
Overall, I'm incredibly grateful for the opportunity to travel to Kenya, bring new services to patients, and have an amazing group of friends. 

Friday, September 19, 2014

Kenya Mobile X-ray Unknown Case

Our mobile X-ray truck continues to work well, which is incredibly exciting.  Today, our first patient had a really good, interesting X-ray.  

37 yo with history of Tb that was treated.  She successfully finished her course of treatment, but has persistent chest pain, which is worse with coughing.

The clinical officers here had never seen a finding like this and would have missed the diagnosis, which changed treatment.  

Leave a comment with your diagnosis :-)

Saturday, September 13, 2014

Roller Coaster Ride

It's been an exciting week on the x-ray truck. Last Friday we felt that we had sorted out all of the engineering issues and the truck was ready for general use. 

On Monday we moved the truck to AMPATH center in Eldoret and began taking x-rays of patients in earnest. We took x-rays of 9 patients and were feeling pretty great. 

Tuesday we returned to AMPATH center and only had one patient just before lunch. After exposing the patient, the CR reader malfunctioned and refused to work. I was heartbroken.

You may recall that we have two sets of equipment for the truck. The reader that we are currently using is our backup.  Last year the primary reader feel down in the truck and was damaged. It initially worked, but failed shortly after I left last year, so we've been using the backup.

Interestingly, both the primary (humpty dumpty) and the backup failed in the exact same way. Suggesting that maybe the trauma that the first reader suffered was a red herring. 

Wednesday I picked myself up by my bootstraps and Patrick and I investigated the primary reader. We are lucky to have a very good service manual and a sweet diagnostics program on the laptop.

We identified that the rollers that move the x-ray plate (kind of like film) were not moving.  After investigating many options - blown motor, seized or dirty rollers, and many other parts of the device we found the voltage parameters for the roller motor in the service manual. When we measured the voltage we realized that the motor was not getting any power. We traced the motor connection back to a set of fuses, one of which was blown. 

Let me explain something about Kenya: shops here are much different than in the US. They tend to be locally owned and randomly supplied by unreliable distributors.  There is no Home Depot or Lowes, no The hardware stores tend to be very specialized (one is best for bolts, another for metal, another for wood).  There is a local walmart equivalent, but there is certainly no guarantee that even a simple fuse would be easy to find.  So, finding even a simple fuse could take weeks for the uninitiated.

Luckily, I have a secret weapon: Patrick. Patrick has lived and worked in Eldoret and has solved so many of these challenges that he knew exactly which store could help us. We dropped by just before lunch; 10 minutes and 60 shillings later ($0.90) we had two new fuses plus several backups.

We took the fuses back to the workshop and installed them. Both readers sprang back to life and worked flawlessly.  It was hard to contain our excitement. 

Friday, the truck made a successful visit to a rural clinic (Turbo). Joe was also working at the clinic and it was great to be able to read X-rays for him.  We were able to x-ray another 8 patients. The truck made it to and from the clinic without troubles.  

Stay Tuned: next week we are looking forward to traveling to a more remote site with rougher roads to see how things fare. 

Sunday, September 7, 2014

The Little Generator That Could

I spent most of the first week working on the X-ray Truck.  I'm happy to announce that Patrick has the biggest engineering challenges related to generator.

The power issues and X-ray machine errors boiled down to a generator that couldn't respond fast enough to the short and hard power requirements of the X-ray machine.  Patrick tells me that the technical term for this is power factor correction.  Most people solve this with a much larger generator (heavier, more fuel, etc) than is required based on initial calculations.  We were stuck with the existing generator vs making major truck changes, so we made this generator work.  

The two most important fixes were: proper setting of the generator governor, and installation of a 1500W immersion heater that allows us to load the generator prior to firing the X-ray machine.  Patrick did a really beautiful job rigging up the heater so that the heater is engaged by the radiographer immediately prior to firing the x-ray machine just by pushing a small button near the doorway.

We're going to test patients at AMPATH centre tomorrow, and then roll out into the field.  We still face many logistical challenges regarding uploading and storing images, but we're making important strides.

Tuesday, September 2, 2014

Some Things Change, Others Not So Much


Nairobi has a Porsche dealership close to Ole Sereni
The new international terminal at JKIA is built and it looks beautiful - lots of glass, open architecture.

Not So Much

Passport/VISA line is still super disorganized even in the new beautiful building.
The early flight from Nairobi to Eldoret is very early.
The Kenyan Registrars are amazingly engaged learners.
I still have amazing friends in Kenya, it's a wonderful place to be.

Sunday, June 29, 2014

Rimini Afternoons - Faenza

Faience Plate Garofano.jpg
"Faience Plate Garofano". Licensed under CC BY-SA 2.5 via Wikimedia Commons.

Diane, before we left made a tiny little post-it with side trips.  One of them was the town of Faenza, which is known for ceramics.  There are over 40 ceramics workshops in Faenza and some big production houses as well.  Through the power of the internet we sifted through workshops and settled on two that looked like they would have some fun stuff.

The first shop that we stopped at: was run by an Italian woman with really pretty fantastic English.  When we first walked through the door, it was a pure workshop and I was really wondering whether we were going to be successful in our hunt for artifacts. That was until she walked us upstairs, where she had a massive collection of bowls - score!

Ms. Vignoli's art centers around two techniques: copper reduction, and hand painting with both a fine liquid slip as well as with glaze.  She showed us her kiln which was covered in jet black residue and explained that in order to reduce copper, you add sugar and alcohol when the kiln is very hot.  The reduction turns blue-green copper (right plate) to beautiful hues of iridescent red and orange (left plate). You can also see the very thin slip on the right plate that they pipe onto the surface to create texture.

Ms. Vignoli was happy to say that her designs were about to come to the US market, which she was quite excited about.  She wondered if we knew of a store called Home Goods......she also told us that she produced some place settings for Dior, which was an interesting dichotomy.  Our wallets a little lighter, we left to find the other workshop which was only a short walk away.

Side Note - Never use google maps in Italy, it sucks.  Waze = the shit.

We got over to this random industrial park and tried knocking on the door, and no one seemed to answer, we were a little disappointed until we saw the small bell next to the door.  We rang, and another warm Italian woman with great English came to the door.

She works in porcelain (rare in Faenza) and creates work inspired by creatures of the sea (and other delightfully creepy stuff).  We found lots of stuff that we wanted to bring home, and were happy for our emergency checking duffle for extra clothes :-)

There was a small fiasco when she realized she had forgotten her credit card reader at home, so we had to go and find an ATM, but it all worked out in the end.

We were definitely very happy that we had rented the car because otherwise we would have never made it on any of these great side trips.

Friday, June 27, 2014

Afternoons in Italy - Rimini and San Marino

In the afternoons, we ventured out into and around Rimini, as well as visting the nearby republic of San Marino, and a 2 hour drive to see the Ducati factory and museum, a visit to San Marino (the world's oldest republic), and a visit to a nearby town known for ceramics.  We also worked on eating lots of gelato.

Rimini is an Italian, Russian, and Croatian tourist destination.  It's the central town along 9 miles of beach.  The entire stretch of beach is developed with little lots of bagno (translates to bathroom).  Each bagno has activities like beach volleyball, private rooms, restaurants, bars, tons and tons of umbrellas, and of course bathrooms.  They go on forever as far as you can see.

There was a vespa get together one of the days, which made for some fun photos.  Near the center of town, there's a harbor and a pier that you can walk out along with a huge ferris wheel and cool statue at the end.

One afternoon we spent visiting San Marino which is the world's oldest republic.  Even today, it's considered it's own country which is enclosed within Italy.  They have a separate postal service, different license plates and are permitted to mint Euros with their own designs.  The old town of San Marino has a history that dates back to medieval times and it's known for it's three watchtowers, two of which serve as museums today.

San Marino is on top of a giant hill, so the views are spectacular all the way around.

More fabulous views no #instagram filters required.

The second San Marino Guard tower in the background.

Beautiful private homes along the road to the old town.

Views of Rimini and the Ocean in the background behind my beautiful travel partners.  More side trip info coming in our next post!

Monday, June 23, 2014

Ferretti Beach Hotel

We flew from Indy to JFK, which we voted US's most 3rd world airport.  Seriously, it's embarrassing when you have to walk outside to catch an international flight, WTH NYC?  Then we went from JFK to Milan.  Our flights went well and we rented a car for the drive to Rimini.  It turns out that with 3 people, renting a car was actually quite a bit cheaper than our trains would have been.  This was especially true once we took all of our side-trips.

After about a 4 hour drive, we arrived at the clean, modern Feretti Beach Hotel and checked in.  We were to stay in the same hotel of the whole trip, which turned out being pretty nice since we didn't need to repack our bags every night.  The hotel was full board, which we didn't expect to like as it's kind of against our general principles.  However, the hotel actually had decent food, and a rotating menu so we didn't get bored.

One of the highlights was the nightly salad bar which was filled, not with fake bacon bits, but with fresh roasted veggies, yummy mushrooms and several different leaves (arugula, endive, fennel, etc).  They also had these magical packaged breadsticks which were really yummy.  Instead of the ubiquitous container of ranch dressing here, there were oils and vinegars to choose from.

At dinner, first courses were nearly always some kind of pasta.  The favorite was a spinach cheese ravioli that Lisa had for dinner one night.

Secundi (second course) was usually some type of protein: fresh fish bar that you could chose from, sometimes beef, or pork, and a veggie entree that was usually OK but not great.

One of the best things about the small hotel, and nightly dining was getting to know the staff.  One of the front desk staff was particularly sweet and helpful.  The waiters were all great and it was fun to get to know their personalities throughout the week.

We spent a little more $$ than what was included in our package to upgrade our room to an ocean view with a balcony and a hot tub, which turned out to have a great view.  The hot tub wasn't all that hot, but we suffered in silence.

The hotel was a great home base for our rides, stay tuned.