The Cost of a “Free” Lunch

Posted on March 9, 2026 by marylbrandt

When I was in medical school it was common practice for drug companies to buy everyone in our class a doctor’s bag, stethoscope, and even an otoscope. (For reference, these are “gifts” that would currently cost well over $100 each). We didn’t think anything of it at the time – It had been this way for decades and was considered completely normal. Pharmaceutical company “gifts” were also part of my residency, mostly food brought to our clinic or lounge and “free meals” at fancy restaurants in exchange for a presentation about their newest (and most expensive) drug or device. (Not to mention the thousands of pads of paper and pens that were left in every clinic.)

“What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the patient in front of me, the one who asks whether there is a cheaper alternative, whether the coupon will still work next month, or whether they can wait until payday to fill the prescription.”
Timothy Lesaca.

Timothy Lesaca is a private practice psychiatrist who no longer accepts pharmaceutical-sponsored lunches in his office and wrote this essay to explain why. Reading his story made me think about my own decision to not accept gifts from drug reps and, in particular, the event that started me down that road…

I was getting ready to leave the hospital when a friend (and fellow chief resident) called…

“Where are you?”

“I’m still at the hospital.”

“You should come over to the [name of hotel across the street from the hospital]”

“What’s going on?”

“There’s a great dinner being put on by [name of a company that sells antibiotics]. You can stay for the food if you have time, but the important thing is that all you have to do is sign in and they give you a hundred dollar bill!”

“Thanks!”

And then it hit me…

The next day, I called my dad (who taught business ethics at the University of Texas) to tell him the story and discuss how uneasy the whole thing had made me feel. He listened carefully, paused and then said, “You know, that reminds me of a story.”

Winston Churchill was invited to a formal dinner and, being the guest of honor, was seated next to a “very important” woman who happened to be an insufferable jerk. He put up with her for most of the dinner but finally couldn’t take it anymore. He turned to her and asked “Madame, would you sleep with me for a million dollars?” She was flustered but with his reassurance that it was just a thought experiment she finally responded “Well, yes, I suppose I would.” He then asked “Would you sleep with me for twenty dollars?” This time she was really insulted and in a huff asked “What do you think I am? A prostitute?” To which he responded “We’ve already established that… Now we are bickering over the price.“

Medicine is filled with moral injury, that horrible feeling when you know the right thing to do but work in a system that doesn’t let you do it. That’s why, when faced with a clear moral dilemma that you can control (no matter how small), it’s important to summon your moral courage to do the right thing. Those little choices are how we calibrate our moral compasses, how we remember what we believe – and who we are trying to become.

Every single choice we make, no matter how small, is the ground where who we are meets what is in the world.
Wayne Muller

Medicine for hard times, Al dente music, and Pasta heresy

Posted on March 4, 2026 by marylbrandt

Medicine for your soul

Music, poetry, and art can be medicine for unsettling, violent times. Take a moment to seek beauty today (and every day). It will help to settle your soul in the face of what we are all experiencing right now.

Free access to 60,000 works of art in the National Gallery. They also have a wonderful Chrome extension that randomly chooses a piece of art to display anytime you open a new tab on your computer.

Poem of the day from the Poetry Foundation

#CareForTheHealers, a playlist started during COVID but that seems appropriate now, too.

Al dente pasta

Today’s delightful trivia… Barilla has Spotify playlists for each type of pasta they make that can be used as a timer for that specific pasta.

While we are on pasta….

Since good food (and especially pasta) can also be good medicine… Have you discovered this technique?

You can cook pasta in the sauce (or just a little water) without having to boil a huge pot of water.

Click here for the recipe – Jamie Oliver’s one pan pasta al limone

Click here for the recipe – Single Skillet Spaghetti

Joy is an Act of Resistance

Posted on March 1, 2026 by marylbrandt

“Where there is cake, there is hope. And there is always cake.”
Dean Koontz

Hard times call for sweet things, particularly if they are easy to make and really, really good. This week I had a small culinary epiphany… Clafouti, (which is one of my favorite desserts ) is a cousin to the delicious dessert known as a Dutch Baby as well as a new favorite dessert of mine (and Christopher Kimball), Pan de Elote.

What they have in common is that they are all “blender cakes”.

Here’s the basic blueprint – a little bit of flour (of your choice), some eggs, some liquid, a sweetener (as much or little as you want) and various flavorings. They all go into a blender before being poured into a pan to be cooked.

So easy.

So fast.

So delicious.

You’re welcome!

Here are the three blender cakes I’ve cooked and can attest to…

This is my favorite clafouti recipe. Clafouti is traditionally made with cherries, but berries, pears and other fruits work well, too. I often add nuts (usually slivered almonds) as well.

Source (and a different recipe for Dutch Baby pancakes)

A Dutch Baby is almost identical to a clafouti in terms of the ingredients, but you add the fruit afterwards. Here’s the NY Times recipe for a classic sweet Dutch baby. You can also make a savory Dutch Baby if you are looking for a fast dinner.

Photo source – https://muybuenoblog.com/mexican-skillet-corn-cake/

And then there is the life changing, amazing Pan de Elote or “Mexican Corn Bread”. (which has nothing to do with the cornbread most of us know). My favorite recipe for Pan de Elote calls for fresh corn, but frozen or canned work well, especially for those of us who don’t have a lot of extra time to cook.

Here’s a few more blender cakes that look easy (and fast) that are on my list to try!

Whole orange blender cake (yup, skin, seeds and all). It goes without saying that whole lemon blender cake exists, too.

Vanilla blender cake is basically a sponge cake, but most recipes say it has the moist crumb of Japanese sponge cake (which is not at all a problem!) Adding fruit like peaches or bananas is an option, too.

Bolo de Cenoura (Brazilian carrot cake) No carrot grating required, usually topped with chocolate… what could go wrong?

It’s not just dessert… Joy is an act of resistance.

#Delight, Ending Hunger, and Why Science Matters

Posted on February 24, 2026 by marylbrandt

#Delight

Noticing things that delight you is a life changing practice that I first learned about reading Ross Gay’s work. (If you haven’t read any of his books, I’d start with The Book of Delights.)

And then there is 1000 Awesome Things, a blog that catalogues (as it promises!) awesome things that usually go unnoticed, but warrant celebration.

“Joy is an act of resistance.”
Toi Derricotte

Scarcity is a choice, not a condition

The socioeconomic issues we face today aren’t new, so maybe it’s not a surprise that we struggle to even imagine a world where hunger, homelessness, and illness are faced with kindness and equity… which is why I was so intrigued with this article by Swapan Samanta, an economist who uses mathematics to understand social inequities.

“They [the prophets of five major religions] knew that food is never just food, that meals reveal the soul of a civilization, that the way we eat together – or fail to – determines whether we survive or collapse. Ancient wisdom and modern mathematics point to the same truth…Scarcity is a choice, not a condition.”

We can’t solve problems by using the same kind of thinking we used when we created them.
Albert Einstein

A reminder that today’s dogma is tomorrow’s history…

There was a beautifully designed study published this week that, for those of us who care (or have cared) for premature newborns is important.

For those not in medicine… the ductus arteriosus is a one of the necessary shunts around the lungs when babies are in the womb. (You don’t want blood going to the lungs which can’t oxygenate the blood because the baby isn’t breathing yet.) At the moment of birth, all that has to change… and pretty quickly. In term babies, it starts immediately, and the closure is done by 48-72 hours. In premature babies, it can take longer. And, in rare cases, it doesn’t close at all. When it stays open, we call it a patent ductus arteriosus (PDA).

Since the first surgical closure in 1938, PDAs have been closed by surgery, catheters, and medications. Over the last several decades there has been a progression in which way was the “right” way (and when it should be done). To summarize the overall trend, we began to move away from surgery and towards less invasive catheter and/or pharmacologic closure. Like all good research, there were lots of studies that preceded and led to the work published this week – which showed that just waiting (without medicines, surgery, or catheter closure) had the same outcome (a composite of death and/or bronchopulmonary dysplasia at 36 weeks) when compared to using medicines to close the PDA. Importantly, it also showed that the overall death rate was less in the babies who were just observed.

No difference in early death or lung disease, and a higher survival without any direct treatment.

This is why we do science.

This is why funding science is so very important.

p.s. Here’s another example of dogma becoming history… Surgically removing colons to cure schizophrenia. (😳)

Ash Wednesday (for those who practice and those who are curious)

Posted on February 19, 2026 by marylbrandt

It may have been different for you, but as a child Lent was never explained to me in a way that made sense … and I had lots of questions:

What is a Liturgical year??? (I grew up in a Protestant church so this was never really explained)
Why 40 days? (except it’s really 46?)
Why do we call it Lent?
Why “give up” something? (And why is chocolate always on the list?)

The Liturgical Year

Like the seasons,the structure of Christian (and most other religious) worship follows the solar year. Not surprisingly, the Christian calendar has its origin in the Jewish calendar, which revolves around the Sabbath (the origin of our week) and Passover (once a year in the spring, which set the annual cycle of a year).

From before the time of Christ, the GraecoRoman world kept Saturn’s day (on what we now call Saturday) as the first day of the week. Since no other origin can be traced for the seven-day cycle, it would appear that they adopted the week from the Jewish system. The Romans did not, however, name the other days of the week definitively until the third century of the Christian era.” (The Liturgical Year – It’s Story, 2000)

Prior to the 4th century, there was no “liturgical year” as we know it now… there was only Easter (which like Passover, has a date decided by the lunar calendar). The very early church (the first 200 years) fasted to prepare for Easter, which is the practice that led to subsequent Lenten practices.

Shared by Deacon Art Bass on Facebook

The origins of “Lent”

In 313 CE Constantine, the emperor of Rome, announced that no longer would Christians in Rome be persecuted. In fact, having seen a vision of a cross on a shield in battle, he converted to Christianity and made it the official state religion of Rome. (And, as we say… the rest is history)

Prior to that time, it was not easy to be a follower of Christ. In 217, Hippolytus described what it took to become a Christian. “After being carefully screened, candidates were admitted to a three-year period as “hearers of the word.” As well as attending their own sessions of instruction, they were permitted to be present at the liturgy of the word, but not for the prayer of the faithful or for the eucharist (II, 16-19), participation in which is the privilege of the baptized members of the community.” (The Liturgical Year, Canadian Conference of Catholic Bishops, 2017)

It was only after three years of intense study and discipline that new Christians could be baptized – which always took place during the celebration of Easter. This was not a trivial decision. Those who chose to follow Christ during the first 3 centuries risked persecution, torture, and even death.

From Three Years to Forty days

It’s not surprising that after 313, when persecution of Christians was no longer permitted, that more people sought to join this new religion. It’s also not surprising that a) baptisms still took place on Easter and b) you still had to commit to study and discipline before you could be baptized.

After the time of Constantine, however, the Church found itself in a world that was less openly hostile. Converts flocked in. Gradually the strict discipline of the catechumenate, which had been a three year process, was abbreviated to be totally encompassed in the six weeks of Lent. (The Origins of the LIturgical Year, Talley, 1991)

Why 40 days? When the Council of Nicea met in 325 CE they decided to formalize the preparation to match the recorded 40 day fasts of Jesus, Moses, and Elijah.

Why Sundays are not included.

Sundays are considered a celebration of Christ’s resurrection, so they aren’t considered part of the 40 days of Lent (which is why it is actually 46 days)

Why do we call it “Lent”?

Easter and Passover both occur during a window of dates that fall in the late spring (because they are based on the lunar calendar). The word “Lent” means spring: From Merriam-Webster dictionary. The origins of “Lent” are from the “Middle English lente springtime…from Old English lencten; akin to Old High German lenzin spring”

If you are Christian (and especially if you have a Lenten practice) I hope this helps you understand why this isn’t about giving up chocolate. (Seriously). For those who follow other paths, I hope this will shed some light on some of the practices of those around you, practices that we don’t usually talk about.

Sourcehttps://christinesine.substack.com/p/spiritual-practice-clean-monday-shrove

p.s. About the ashes… Ash Wednesday is always 46 days before Easter. It’s a practice that was established during the 9th-11th century so there would be a clear beginning for Lent. It’s based on many Biblical texts about ashes being a sign of repentance.

p.p.s. I’m not an expert… so if you are, please let me know what I’ve omitted (or misrepresented).

Passive Learning in Medicine

Posted on February 11, 2026 by marylbrandt

Medical training is based on active learning – studying textbooks and articles, listening to experts, seeing patients, setting up procedures and then performing them, reading images, looking at slides. This kind of learning is straightforward – You do the task, get feedback (in a variety of ways), and then adjust to improve.

I’ve never really thought about passive learning in medicine … until I learned about this recent study from the Institute of Neuroscience at the University of Oregon that clearly showed that passive exposure improves active learning (at least in mice).

Based on my experience as a medical educator, that rings true for medical students and residents, too. Watching experts do a procedure over and over won’t ever replace learning to do the same procedure – but it does seem to be a habit embraced by superstar medical students and residents (in addition to their deliberate and very active learning).

“The core insight here is appealing precisely because it’s so easy to act on. Passive exposure costs almost nothing. No extra willpower, no additional scheduled practice time, no special equipment. You just need to put yourself in contact with the material you’re learning.”
Source

How can you add a little passive learning to your day (in addition to rereading and highlighting notes or listening to a recorded lecture)?

Just listen. The ideal way to take advantage of the didactic courses in the first two years of medical school (and subsequently in clinical rotations and residency) is to engage actively with the material during the lecture. (Yes, I’m serious… and here is how to do it). But if you find yourself unable to really engage it turns out that “just listening” (i.e. being a passive learner) isn’t a complete waste of time. You can also attend departmental Grand Rounds or other interesting lectures as a first year medical student (Most of them are before your classes start or during lunch). You won’t understand much… until you do (which is always exciting!) . You can find a list of these lectures on every hospital and medical school website (Here’s an example from Baylor College of Medicine). These are public lectures so you won’t be out of place. If anything, they will be delighted there are basic science students interested enough to attend. (p.s. there is often food, too…)

Just watch. “Shadow” in the first two years of medical school…ask senior students or residents (who will ask their attendings) if you can watch surgery, follow someone in clinic, or go on rounds with a team. When you are on a rotation, “just watch” surgeries that you aren’t assigned to (which is a lot easier in minimally invasive procedures because you can watch it on a screen). The same goes for “just watching” a pathologist looking at slides, or a radiologist reading images, etc. You can also take advantage of YouTube to “just watch” videos of procedures, how to do a physical exam, etc, etc.

Passive exposure will never replace active learning (a really important point!) but just watching and just listening aren’t a waste of time… and may help make active learning a bit easier.

3.5% of us is all it will take (plus some words to soothe)

Posted on January 28, 2026 by marylbrandt

“Nonviolent protests are twice as likely to succeed as armed conflicts – and those engaging a threshold of 3.5% of the population have never failed to bring about change.” (Robson, 2019)

Take care of yourself

“There are no more ancient bookends than sunrise and sunset. For millennia we have lived between their cycles. We have come to internalize their rhythm. Unconsciously we are aware of them even if we do not see them. My ancestors taught that it was important to acknowledge these daily transformations: the promise of a new beginning and the invitation to a deep rest. Hope and peace. We live in the balance between sunrise and sunset. We live between expectation and fulfillment. I will greet the sun when I first see it and I will embrace the night when it comes quietly to claim me. I will search for wisdom between the bookends of time.”

The Rt. Rev. Steven Charleston

Walk With Me

Posted on January 25, 2026 by marylbrandt

This is the text of the sermon I was to give today. Like many churches in the path of this weekend’s severe winter storm, we cancelled our in-person services to keep each other safe.

The text for these thoughts is Matthew 4:12-23, and, in particular, these verses:

As he walked by the Sea of Galilee, he saw two brothers, Simon, who is called Peter, and Andrew his brother, casting a net into the sea—for they were fishers. And he said to them, “Follow me, and I will make you fishers of people.” Immediately they left their nets and followed him. As he went from there, he saw two other brothers, James son of Zebedee and his brother John, in the boat with their father Zebedee, mending their nets, and he called them. Immediately they left the boat and their father and followed him. Jesus went throughout all Galilee, teaching in their synagogues and proclaiming the good news of the kingdom and curing every disease and every sickness among the people.

The video at the end is meant to be played as an integral part of the sermon.

The Calling of Peter and Andrew, Duccio, 1308-1311

“Follow me”

When Jesus spoke these words roughly 2000 years ago, he didn’t say them in English. I know that’s obvious, but it bears repeating. Jesus spoke Aramaic with his family and friends. He was able to read Hebrew, which was the language of the temple, and he spoke Greek, which was the common language of the Roman Empire (which is why the gospels were written in Greek). When the gospel according to Matthew was written, “akoloutheō” (ah-ko-loo-THEH-oh) was the word used for “follow”.

Akoloutheo is also the root of the English word “acolyte”. That association may help us understand what Jesus actually meant when he said “Follow me” because an acolyte is “a person who attends or assists a leader”. Its modern use is mostly related to the church; Acolytes are the people you see every Sunday preparing the communion table, lighting the candles, and carrying the cross.

In other words, when Jesus said “follow me” to his first disciples, it wasn’t a metaphor. It meant “walk with me, assist me, attend to me”. This sense of “hands-on” following is also present in the English word “follow”. In Old English the meaning of the word “follow” was to “accompany”. The word most likely evolved from the proto-Germanic word *full-gan, or “full-going”.

Understanding this etymology helps us with today’s reading. Because if “following” Jesus means to accompany him, to be “full-going”, to be completely invested, it’s asking for something more than most of us learned growing up in church. Because following Jesus is not just about “giving your life to Christ”, it’s about walking into the world led by a radical way of being that completely upends powers and principalities. It’s about full-on, hands-on, joy-filled discipleship to bring the kindom of God to earth as it is in heaven.

Of course they dropped their nets and left everything behind.

When Jesus said “follow me”, he was clearly instructing Simon, Andrew, James, and John to travel with him towards the kindom of God… But it also meant they could walk away from oppression.

Fishermen on a Boat. Fresco from a House Located Near a River Port of Rome. 131 AD.

Fishermen in the first century Rome weren’t what we think of today. They didn’t own their boats – and they didn’t own the fish they caught. Both their boats and the fish they caught belonged to the Emperor of Rome. When they hauled in their nets, the biggest fish went to high ranking Romans. Any remaining fish that could be sold were sold to make money for Rome. As a result, fishermen in first century Rome were as low in the social order as tax collectors. They were just collecting fish for Rome instead of coins.

Of course they dropped their nets and left everything behind.

They assisted him, attended to him, learned from him as he “went throughout all Galilee, teaching in their synagogues and proclaiming the good news of the kingdom and curing every disease and every sickness among the people.”

Word spread quickly. Crowds began to gather.

People then, like now, were hungry for good news, sick of being oppressed and frightened, desperate to be healed. They lined roads to welcome him and sat in crowds gathered to hear his teaching. They offered places for Jesus and his disciples to stay and provided them food.

James Tissot (1836-1902), “The Multiplication of the Loaves”

Can you imagine what that would look like?

It’s actually not that hard to imagine…because right now, in our country, there are crowds gathering to hear similar good news, crowds lining streets and gathering in schools and in churches to hear profound teaching on how to bring peace into our lives and the world.

For those who might not be aware, a group of Buddhist monks who live in Fort Worth left their home in October on a Walk for Peace. They are walking 2300 miles from Fort Worth to Washington DC… not to protest but to carry a simple message, one that resonates with the teachings of Christ – Peace is within each of us, a peace that passes all understanding… a peace that can heal the world.

Amen (May it be so.)

@WalkForPeace, Your Favorite Pen, and Mana from Heaven

Posted on January 23, 2026 by marylbrandt

So simple, it’s hard.

#JoyIsResistance (and so is Peace)

If you aren’t following the Walk For Peace, please do. I promise… it’s the medicine our hearts need to heal right now.

Here are the links: Instagram, Facebook, and their web page.

“Peace is a state of being. Be that”.
bhikkhu pannakara

Be honest, we all love a good pen.

(From the time I asked my team at the hospital to take the pens out of their pockets so I could take a picture of them)

Here is even more fodder for your pen habit: The 47 best pens for 2026 (via Austin Kleon)

“The seeds we plant don’t always bloom in our gardens.”

This is a truly amazing story of modern day “mana”, a shelf stable food from milk, vitamins, and peanut butter that saves lives (and lifetimes). It’s well worth the time to read.

Everyone’s hungry for something.
And maybe the answer isn’t a sermon or a program or a policy.
Maybe it’s a table. A meal. A willingness to ask.

Optical Illusions, 117 Billion Humans, and Square Poop

Posted on January 15, 2026 by marylbrandt

I find it fascinating (and important to remember) that everything we see is perceived by our brain and then translated into an image. For example…the white on the outside of these “petals” is exactly the same as the white inside (Asahi Illusion)

“It’s a very philosophical question…We do live in a virtual reality, but it’s a pragmatically useful virtual reality.”
Bruno Laeng

“Taken together, an estimated 117 billion people have collectively lived on our planet, and, of that total number, 7% are alive right now.” (Open Culture)

“Always remember that you are absolutely unique. Just like everyone else.”
Margaret Mead

Wombats have square poop! They are able to do this because of variable elasticity in the wall of their rectum (Be honest – you wondered, right?). This evolved because it is an important way for wombats to “communicate” (i.e. mark their territory) and square poop doesn’t roll off ledges.

The potential for commentary and horrible puns with this information boggles my mind… have fun!