The Living Hospital

A hospital is like a living, breathing organism, and the bigger it is the more people and parts are required to keep it together. One thing the recent debacle on The View has shown, is that none of us do our job in a vacuum. So when Joy Behar made her idiotic and condescending comments about Miss Colorado’s “doctor’s stethoscope” she had no idea she would be insulting not just nurses, but the millions of others of professionals who use stethoscopes everyday to do their job. #nursesunite and #showmeyourstethoscope have really shown remarkably well how much passion and dedication people have for this field. There are so many people who make it possible for me to do my job everyday, I wanted to take a little space here to lay them out and thank them.

Environmental services. Not only do they keep our fancy hospital spotless but most of them are among the kindest people working in the hospital, and I am privileged to know them.

Security. Who I know will come and protect me from screaming patients who are trying to assault me and the nurses and PCTs.

Nutrition Services. Several of the gentleman who deliver food are so nice that many patients will ask after them when they are leaving the hospital.

Lab techs. Helping to get all the vital tests patients need.

Patient Care Techs. Unsung heroes. Helping patients eat, go to the bathroom, sit with elderly and combative patients, and many other jobs. They have very difficult jobs doing laborious work for not a lot of pay, they work very closely with patients and build up bonds with them, and they deserve a lot of credit.

Hospital Unit Coordinator: a special category for them because they are really helpful on each unit and really friendly HUCs make your day better.

Social Workers and Case Managers. Always put upon trying to get patients out of the hospital faster and faster. Having to deal with wretched insurance companies. Trying to help steer anxious and despondent families through the process of going to a nursing home- which is now routine and not the exception. We rely on them a great deal.

Therapists: speech, PT, OT; helping our patients regain their functions, sometimes after completely devastating stroke or illness.

Pharmacists: we deal with ever more complicated medications especially with more people living longer and having more diseases and renal and liver problems- our pharmacists are essential partners in working out of medication strategies for patients

Chaplain: this is an obvious need. We see much loss and sorrow in the hospital and we need all the support for families possible.

Porters/Transportation: getting our patients safely from place to place

Radiology techs: especially when we need important tests done really quickly on very sick patients- awesome.

Nurses: the backbone of the hospital. Providing the one on one 24 hour care to patients. As physicians we may only physically round in a patient’s room for 5-10 minutes. We rely on our nurses to be our eyes and ears. Is the blood pressure dropping? Did they spike a fever? Have they urinated all day? Crucial information that the nurse will notice and relay to us.  Is the patient breathing harder? What do their lungs sound like? The nurse will be the one at the bedside that moment to listen and tell me so we can make a plan together. Do we have a critically ill patient we know is going to die? In that case I will have come in, talked to the family, comforted them and the patient- but who is in the room when the patient’s heart stops beating? Not me, the nurse. She or he will call me and let me know, but they will be the ones with that patient and family in those final moments. Indispensable.

Advanced practitioners: working alongside physicians in many different capacities to treat patients. Including PAs and NPs, there is a very broad range of skill sets and duties.

And that leaves doctors. There are a lot of us in a lot of different specialties coming together to figure out solutions on really sick and complicated patients. Without all the other people above, though, we’d just be blowing a lot of hot air.

Roasted Beet and Grain Salad with Citrus Vinaigrette


I had never eaten a beet until maybe two years ago.  Same with brussel sprouts.  Oh, what I was missing all my life!  I now eat both whenever I can.  I have only recently taken to tackling the beet at home, but I needn’t have worried. Roasting beets is just like roasting anything else- it is easy as pie.  And the end result is so so so delicious!  You can use the roasted beets for any recipe you like, or just eat them right out of the oven when they are cooled down.  In this absolutely delightful salad, they shine alongside all the other ingredients.  This salad is just a marvel of bright acidity, and I love it.  I only slightly tweaked this one from the original recipe, which comes from The Grocery Cafe at Deer Valley Resort.

Serves 4.  Takes 1 hour fifteen minutes (including roasting time on the beets).


For the salad itself:

4 cups of arugala

2 large beets (any color and variety will do just fine)

1/2 cup of goat cheese

3/4 cup of barley or farro or wheat berries

For the candied pecans:

3/4 cup raw pecans

2 tablespoons maple syrup

2 tablespoons sugar

For the citrus vinaigrette:

2 lemons juiced and zested

2 oranges juiced and zested

1 clove garlic finely minced

1/4 cup agave nector

1 cup olive oil

1 tablespoon Dijon mustard


To roast the beets turn oven to 375 degrees.  Start a pot of water boiling now as well for your grains. Place each trimmed and washed beet in a packet of tin foil with olive oil and salt.  Place in the oven.  Leave about 45 minutes for smaller golden beets.  60 minutes for larger red beets.  Cook your grains according to directions of what you are using.  Barley takes quite a while to cook at least 30 minutes, so don’t forget to start it early. While the beets are roasting and your grain is cooking, you can continue with the other components, see below.


When you remove your beets they will be soft and succulent.


Let the beets cool.  Then peel them- wear gloves or you will get beet juice all over you!


Give them a uniform small dice and set aside in a bowl.  Take pictures of them to show off to your friends, they are beautiful!


You can get your nuts candied in the oven at the same time your beets are roasting in there.  Place them on a baking sheet, mix with the syrup and sugar and place into oven for about 20 minutes.


While everything else is on the timer, do your vinaigrette.  Place all components above into food processor and blend until smooth.  Place into bottle and set into fridge.


To plate: start with a bed of grains.  Top with arugula, which has been lightly coated with the dressing.  Next goes the beets, candied pecans, and goat cheese- crumble and evenly sprinkle over the salad.  Give the top an even drizzle of vinaigrette, and mwah!  So beautiful, lets look at it again.  And it tastes even better!


I put my extra beets, nuts, and barley into jars and tupperware so I can continue to eat them into the next week.  Since I am the only vegetarian in my house, I am the only one eating this recipe, and I will eat it multiple times in the next few days.  I look forward to it greatly, this has to be one of my top salads I’ve eaten.

** Adapted from a dish served at Grocery Cafe at Deer Valley and recipe found at Love and Olive Oil

Roasted Beet and Farro Salad with Citrus Vinaigrette

Spicy Mac and Cheese with Cauliflower, Cashew Cheese, and Spinach


This is a recipe my husband, Rob, and I have been tweaking for awhile. The original recipe was just a basic mac n cheese and we’ve been adding to it to make it healthier as time has gone on. It still has a good amount of regular ol cheese in it, but we have rounded it out with more nutritious ingredients. I haven’t been able to make the leap to the vegan only version of this recipe with no cheese, but this is a big improvement from the original heavy cream and cheese-only versions.

Serves 6-8. Takes about 2 hours.


1 package spiral shaped pasta- roughly 14-16 ounces. I like Barilla Protein Plus as it has an excellent protein content. This time we used trottole since it was what we had around.

1 head cauliflower chopped roughly

1 cup cashew cheese. To make this soak 2 cups cashews in water for at least 2 hours. Then put in food processor with juice of 1/2 lemon, 2 tablespoons nutritional yeast, splash of olive oil, and one pinch each salt and pepper. Blend until smooth. You can make this ahead and keep in the fridge until you use it.

4 cups grated cheese. We use a mix of chipotle Gouda and extra sharp white cheddar

2 1/2 cups skim milk

4 large handfuls fresh spinach roughly chopped

EVOO- total a cup for whole recipe

1/4 cup flour

2 cups panko breadcrumbs

1/4 cups Parmesan cheese, grated

2 tablespoons fresh parsley, minced

4 cloves garlic, minced

Spices: crushed red pepper, smoked paprika, cayenne pepper and salt and pepper


Place two large pots of water to boil on the stove. In one cook the pasta until it’s al dente. Take it off, rinse in cold water, and set aside. In the other pot cook the cauliflower until it is just softened.  While these are cooking, heat a sauté pan with a splash of olive oil. Add the minced garlic and cook for 1-2 minutes. Add your chopped spinach and cook down until wilted, about 3 minutes. Take off the heat and set aside.


When cauliflower can be easily pierced with a fork, remove from heat, drain, and place in food processor. Add a splash of skim milk, a splash of olive oil, a pinch of salt and pepper and blend until smooth. Now add the cashew cheese to the food processor and again blend until smooth.  Place this mixture in a bowl, stir in your wilted spinach, and place bowl in the fridge until later.


In a bowl, combine breadcrumbs, parsley, Parmesan cheese, and olive oil to coat the crumbs. When well coated place mixture into the sauté pan you used before on medium heat. Toast these while stirring every few minutes, for 10-15 minutes until a nice light brown.  Turn your oven on to 375 to preheat.


While those are toasting, start your bechamel sauce.  In a large sauce pot stir together 1/4 cup olive oil with 1/4 cup flour to make a roux. A whisk is the best tool to use here. Add your flour gradually while stirring constantly. Don’t leave it unattended.


Next, slowly add 2 cups of skim milk, stirring continuously throughout. You should end up with a smooth and thick creamy sauce. Now add your cauliflower, cashew, and spinach mixture from the fridge and stir until smoothly blended. Your cheese goes in next, again stirring constantly. Add the spices to the mix- a teaspoon each cayenne, smoked paprika, crushed red pepper. Finally, add up to 1/2 cup milk to thin the sauce to desired consistency.


Get your pasta and stir into the sauce, coating evenly. Then place in casserole dish and top with breadcrumbs.  Bake for roughly 20 minutes and you are ready to serve!


This holds up extremely well for leftovers. Just add a touch of milk when you reheat in the microwave.

Pasta with Spinach, Chickpeas, and Burrata


I bought some wonderful fresh Burrata cheese at the grocery store the other day (right at my regular Kroger store, not at a specialty market!).  I had a couple of recipes in mind when I bought it, but when I found it in my fridge I had gone through all my freshly purchased tomatoes.  It was a rainy and gray day outside, so I had no intention of running out to the store.  I have made a similar pasta with chickpeas and spinach before, so I thought incorporating it into this nice lemony recipe would work out well.  It is a quick dish and the lemon and creamy Burrata really pair well together with the other elements.

Serves 4. Takes 20-30 minutes.


One container of fresh Burrata cheese (A good ricotta cheese or fresh mozzarella could be substituted instead)

One bag of pasta- I used trofie pasta but any small twisted shaped pasta would do

4 cloves garlic, minced

1 tablespoon butter

1/4 cup olive oil

2-3 large handfuls spinach, roughly chopped

1/2 can chickpeas (15 ounce) drained and rinsed

One handful of toasted nuts- I used pine nuts but almonds would work as well

1 lemon: juice the lemon and set aside juice.  Zest the outside of the lemon and set aside zest.

1 pinch each: salt, pepper, crushed red pepper


Place a large pot of water to boil.  Cook your pasta until al dente and then drain and rinse in cold water and set aside until later.

On medium heat skillet, Melt butter and add the olive oil.  When heated, add garlic and cook for about one minute, until turning golden.  At this point, add your spinach and chickpeas to the pan. Mix and cook down for 2-3 minutes.


After your spinach has wilted down, add lemon zest, salt, pepper, crushed red pepper, and your toasted nuts.  Stir and let cook for another minute. Now get your pasta and add it into the pan.  Coat the pasta with sauce and let sit on low heat.  Add your lemon juice to the pan and mix all together, letting cook for a minute or two.


Ready to plate and eat!  Just throw a few dollops of that beautiful Burrata on top and stir it up as you go!

** This was adapted from a recipe on Epicurious:

A Good Death

Starting off my medical musings talking about death may not be the way to reel people in, but the concept of a death and dying is one that you cannot avoid when you are a physician.  For most of our patients it is something that they never think about until all of a sudden it is upon them or a loved one.  Even those with known terminal diagnoses are still be taken aback by that moment of finality when you tell them that no, there is really nothing left we can do- this is the end.

Helping patients and their families at the end of life is at once the most difficult and rewarding part of my job.  The moment when you look a person and their loved ones in the eye and tell them that they are going to die is one of the most intimate things you will ever do.  Many times the person who is actually dying will be too sick to understand and their family will be listening in their stead. Each person and family needs to be told in a different way, because each person will cope with this news differently.  Some people will want all the news broken at once, so they can grieve completely and plan.  Some will want it delivered in stages and small doses, to preserve hope for as long as possible.  Every sentence out of your mouth is a litmus test for how to continue proceeding and to build up the relationship you have started with the patient and their family.  If you say the wrong thing, and you lose them, that bond is hard to build back up.  In those moments, it is very important to find out what the patient would want done at the end of life.  What does a good death mean to them?  For the vast majority of people it is not dying while in the ICU on a ventilator, but that is where a lot of these conversations take place- once that has already happened.

One of the hardest things to do as a caregiver is to stop giving care.  We are trained to “fix” and “do.”  Many times it is easiest to continue to press onward indefinitely then to really step back and look at what then end result is.  If the cardiology doctors have the patient’s heart stabilized with anti-arrhythmic medication, the pulmonary doctors have their breathing stabilized with a ventilator machine, the gastroenterology doctors have their gastrointestinal bleeding stabilized with a proton pump inhibitor, the infectious disease doctors have their bacteremia stabilized with antibiotics, the orthopedic doctors pinned their broken hip, the hematology doctors are transfusing blood and platelets every day, and the patient is getting nutrition through an orogastric feeding tube- then everything can drift forward indefinitely.  The questions we have to ask ourselves as physicians are: will this patient recover? What will their quality of life be like if they do? In this way we can have informed discussions with patients’ families about decision making.

The problem is that many times the prognosis is far from cut and dry.  When a person has been very ill, we sometimes cannot tell how much function they will recover. Will they be able to speak, eat, sit up, walk again?  It will sometimes be weeks and even months before we have a full idea of their outlook.  These uncertain cases are the most difficult ones for us as physicians.  Other very challenging cases are ones in which we can clearly see that a patient will not recover from a devastating injury or illness.  Many times these patients are already very ill in the ICU and the decision is made to withdraw life support.  This is a complicated process in its own right that has many regulations in place that vary from state to state.

Each of these scenarios have a common thread.  They require communication, in spades, between the doctor and the patient and/or family.  This is one of the biggest barriers to making sure that people can have a good death.  Time.  To talk to your patients in the office about code status and living wills takes time.  To talk to every patient who comes in to the hospital in depth about code status takes time.  Time is something we doctors have very little of to spare, and it limits our ability to fully engage in these discussions with our patients.

Most patients I admit to the hospital have never heard the words “code status” before.  These are patients with severe chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, diabetes, peripheral vascular disease leading to amputated limbs.  In other words- very sick people, but their understanding of their own illnesses is limited and skewed.  What does this mean in terms of their thoughts about death? It means that the 75 year old patient with COPD who is chronically on 4 liters of oxygen has not thought through needing to get resuscitated or intubated or the possibility of a tracheostomy- even though that would be a permanent fixture and he could be comatose on the ventilator for the rest of his life.  It means that the 80 year old patient with CHF whose heart pumps at only 10% of normal strength continues to want full resuscitative measures even though she states she never wants to end up “a vegetable.” If asked outright, both of these patients would tell you they would like to die at home with family around them. Both patients have high risk factors for impaired quality of life after CPR and for CPR to not be successful due to their severe chronic conditions; meaning, if they were to ever need CPR the chances of them recovering afterwards without any long term problems are poor.  CPR works well on people who are healthy and young.  As you age and the more medical problems you have, the less likely it is to be successful.  The more likely that if you need CPR you will wake up with more debility and problems that you started with, along with many broken ribs.

So how can we make a change?  Start talking about it, for one.  Death is something to be planned for and accounted for; it will happen to us all eventually.   The way to have a good death is to make your wishes known to your family and your doctor as early as possible. This also takes the burden of making decisions off of your family and lets them be at peace should they have to speak for you.  It is very hard on families to be placed in that position, and knowing that they are doing what you would have wanted eases the hardship.  We, as physicians, need to talk about it as well.  It is so hard to talk about bad diagnoses and prognoses, especially when there is a lot of uncertainty. I myself am still a young physician, and I am still learning.  I have had a couple bad prognosis conversations go poorly.  Even if you deliver the news as kindly, slowly, and deliberately as possible- it will be too overwhelming for some people.  There are people and families that will continue to hope for a cure right to the very end.  These cases are very heartbreaking to be a part of; the patient will almost always die in the hospital ICU after undergoing many tests and procedures and medical treatments that were futile in the end.

I recently saw a former patient’s family in the hospital.  This patient had come into the hospital in the last few days of her life.  Her family knew she had been declining, but they had not grasped yet that she was going to die quite soon.  She had advanced dementia and her nursing home had sent her into the hospital for severe dehydration and possible feeding tube placement. We all sat together and I explained to the family what was happening and that she was dying.  I asked them what she would want to do if she could tell us in that moment.  They all agreed she would want to be at home with her family.  Within the day our hospice team arranged this.  She was transported home and died the next day, surrounded by her husband, children, grandchildren, and great-grandchildren.  When I saw the patient’s family again recently, they thanked me profusely.  She otherwise would have passed away in a nursing home or at the hospital, and they were happy and relieved that they had the chance to spend her last day together at home. I accepted their thanks; I was glad I had helped her to have a good death.

Tofu, Cashew, and Vegetable Stir Fry


  I really love stir fry, but for some reason I don’t make a lot of it at home.  I never seem to be able to get the seasoning right.  I am also a huge tofu lover, but when I think about incorporating it into meals myself I just get overwhelmed.  Well- no more.  I am going to be using it more.  One reason I have trouble with it is that I always end up just totally annihilating my tofu when I go to get the water out of it.  I have a tofu press currently on route to me from Amazon as we speak, but the old book pressing/towel pressing method usually ends up with me and a lot of tofu crumbles.  Well today I really wanted to make a recipe I adapted from Anna Jones’ A Modern Way to Eat, and I wanted to do it by adding tofu to the stir fry.  So I just decided to lay down my heavy cast iron pan on it with some paper towels for about 15 minutes and let it be.  I still didn’t get all the water out of it- but it didn’t end up a crumbled pile of tofu mess, either.  So I consider it a battle won in my favor.

Serves about 4.  Time to make only 20-30 minutes.


2 tablespoons sesame oil (approximate)

A one inch piece of fresh ginger, peeled and minced

Small bunch of green onions (or scallions- they are the same thing!)

1 bunch of asparagus

1 large handful of sugar snap peas (more if you want to serve more people)

2 carrots (again, just add more veg to serve more people)

1 teaspoon Bragg’s liquid aminos (or soy sauce)

1 tablespoon CRP (crushed red pepper)

A large handful of cashews

1/2 block of extra firm tofu, sliced into 1/2 thick slices

Juice of 1/2 lime

Small handful of cilantro

You may choose to serve over rice or noodles, I prefer to eat as is.


  First, get a cast iron pan or a skillet hot with some oil to pan fry your tofu.  Canola or vegetable oil are best to use here (I made the mistake of using grapeseed oil- argh! It just spat oil everywhere!).  When the oil is hot and near its smoke point, add the tofu slices to the pan.  They should sizzle immediately on hitting the pan.  If not, it isn’t hot enough.  When they are in the pan, I seasoned mine just with cayenne pepper.


  At this point, you don’t want to bother them.  You want to let them get nice and crispy.  Let them sit for about 5-7 minutes.  If you have water left in them, you will know it- they will spurt and bubble and stick all over the pan.  When you turn them you should have a nice golden crisp.


  Yum! Let them cook about 5 more minutes on the other side then pull them and put them on a paper towel to get the oil off and cool.  When cooled down, cut into bite size squares and set aside until later.

  While the tofu is cooking, chop up all your vegetables for prep.  Your green onions into small 1/4 inch pieces, carrots into matchsticks, asparagus into one-two inch sections (discarding the ends).  Leave your snap peas whole.  Peel and mince the ginger, as stated above.


    Next, splash some of the sesame seed oil into a large skillet or wok to coat the bottom.  When heated, add the green onions and ginger to the pan.  (Try to resist just eating the fresh ginger, because it is so delicious.  Or make yourself a Moscow mule!)


  While these are cooking together for about 5 minutes, put your cashews on to toast.  You can do this either on a pan on the stove or in the oven.  My brother, the baker, was taking up the oven to cook pizza, so I used the stove-top.  Careful not to burn them if you are using this method (I cannot count how many pine nuts I have lost by this method!).


    From this point on, you are just adding the rest of the mix to your skillet or wok and letting it all come together.  Add all the vegetables to green onions and ginger with 1 teaspoon of liquid aminos or soy sauce. Add in your crushed red pepper now, too.


   Let this cook for about 5 minutes again and then add in your cashews and tofu to the mix.  Again, let cook for about 5 minutes to meld the flavors together.  If it starts to look a little dry in the pan, add a little more sesame oil or the liquid aminos (just a small splash of either).  You can add more cayenne, CRP, or even sriracha if it pleases you to spice this up.  The spice level as is without them is moderate and pleasing.  Before plating, finish in the pan with the lime juice and chopped cilantro.


  This dinner comes together very quickly.  Under 30 minutes from start to finish for everything.  A great weeknight meal.  If you want to cut out even more time, you can leave out the tofu and just do the veg and nuts as Ms. Jones does in her version.  This is really easy to mix up with whatever veg you have laying about in the fridge as well.  So easy and good!

** As stated above this was adapted from Anna Jones’ A Modern Way to Eat.  This is a great cookbook with a lot of variety, and it is all really healthy as well.  I recommend you pick it up yourself at Amazon.

Tofu Ricotta and Spinach Stuffed Shells with a Summer Vegetable Bolognese


I wanted to start off with a delicious recipe that I cobbled together from several others.  Tofu ricotta stuffed shells are pretty commonly seen and I just tweaked the filling a little bit here for my taste.  The sauce really makes this dish for me. It is a take off of what is actually supposed to be the filling from a recipe in a wonderful cookbook of April Bloomfield’s A Girl and Her Greens. I really enjoy this book but my goodness the woman loves cream and butter.  Not so great for someone trying to cut back on those things!  So I decided to flip the filling into a sauce, kick out the cream and here we go!

Serves 6-8 as a main course.  Takes about 2.5 hours to complete whole recipe.


1 box of jumbo shell pasta

3 10.5 ounce packages of cherry tomatoes

1 28 ounce can whole peeled plum tomatoes

2 ears corn

1/2 zuchinni

1/2 yellow squash

1 red onion

4 handfuls of basil

4 teaspoons kosher salt (or whatever salt you prefer)

2 pinches of ground pepper

6 cups raw spinach (divided into 2 cups and 4 cups, finely chopped)

1-4 tablespoons of crushed red pepper (per your taste, I am addicted to red pepper!)

8 cloves garlic

1/2 cup olive oil (EVOO)

2 14 ounce packages of firm or extra firm tofu

3 tablespoons nutritional yeast

Juice from 1/2 lemon

1 tablespoon dried oregano

Parmesan cheese for grating on top (if desired, can leave out)


Place a large pot of water to boil on the stove.  While heating up take all of your cherry tomatoes and cut a small slice into their outer skin with a sharp knife.  Don’t slice all the way into their centers.

Next, fill an bowl with ice water and place it next to your pot of boiling water.  Place all your cherry tomatoes in the boiling water for about 30 seconds.  Use a slotted spoon to transfer them to the ice bath after this time.  The skins should be easy to remove at this point, so take your time and peel off all the skins.  This is time consuming for all these little tomatoes; it will take about 30 minutes to just prep your tomatoes!  All this while, leave your water boiling.


  At this point, set your meticulously peeled tomatoes aside for later.  While peeling tomatoes or after, cook your pasta.  Don’t cook it to mush, cook for about 8-9 minutes until al dente then take out and rinse in cold water to stop the cooking process.  After rinsing, place shells on paper towels upside down to get all the water out of them.  You may lose some to breakage (I lose about a half dozen).


  Time to start prepping the sauce.  You will use the same large pot to cook it in.  Chop up 4 cloves of garlic and the red onion.  Warm up 1/4 cup of olive oil in the pot until glistening on medium heat.  Add the red onion to the pot with a big pinch of salt.  Cook for about 6 minutes, do not burn the onions.  At this time, add the garlic to the pot.  You want to try and gently brown the garlic by itself, so push the onions to the side and cook the garlic in the oil for a minute or two.  When turning golden, mix all together, turn heat down to medium-low, and cover for 6-8 minutes.  Stir occasionally.  While this is cooking along, chop up a handful of basil.  Add to the mix while cooking and keep stirring.  Then chop up 2 cups of spinach and add it to the pot as well. All told keep it going for about another 10 minutes. The onions will really soften up and get a nice light brown color for you.


  Now you have a nice base for your sauce.  This next part will all be uncovered cooking. Time to add in your tomatoes.  Add all the fresh peeled cherry tomatoes first.  I let them simmer a little on medium heat for 5-10 minutes or so and then you need to go in and mash them up.  I use a potato masher for this.  You can use a whisk if you don’t have one, it will do with a little more effort.  If you have somebody who likes to break or smash things now is their time to shine (I call in my hubby Rob for these duties).  Keep on at it with simmering and mashing until they are all broken down into sauce consistency.  At this point, add another large pinch of salt, some pepper, another handful of chopped basil, and I add a good 2 tablespoons of crushed red pepper to spice it up.  (Less if you don’t like spice!)  While you are between smashing and stirring, you need to chop your other veg.  I do a small chop on the zuchinni and squash and I take my corn off the cob by placing it into a large bowl as shown below, so it doesn’t go flying all over the place. You will have some time during this period to also make your tofu ricotta, see below.

20150918_21 20150918_28

    Once your tomatoes are broken down in consistency, I add my canned extra tomatoes and do the same thing to smash them up.  This just helps us to add more liquid to our sauce.  After those tomatoes are also broken down, add your corn next.  Let it cook for about 5-6 minutes and then in goes the zucchini and squash.  After that, just let it simmer on medium-low heat until you are ready to put it on your pasta.

   Turn the oven on now to preheat to 400 degrees.


  The tofu ricotta comes together pretty quickly.  First, chop up 4 cloves of garlic and get them into some glistening oil in a saute pan with some red pepper flakes (if you like spicy- I do at least a tablespoon).  While that is heating give a rough chop to 4 cups of spinach. Get that into the pan with the garlic and oil and wilt down for a couple minutes.

  While the spinach is wilting, get your two tofu packs.  Get the water out by squeezing with paper towels (or you could have already had in the tofu press while you were doing all your other cooking before).  You can get it messy and crumble it, it is going into the food processor anyway.  When it is not waterlogged, place into food processor.  Add the spinach mixture from the pan.  Add oregano, lemon juice, olive oil (one to two tablespoons), two pinches salt and pepper, the nutritional yeast.  I throw in some more CRP (crushed red pepper) and a large pinch of cayenne at this point as well, but you will do just fine leaving them out. Pulse together until smooth.


    Assemble the dish to bake.  This makes enough for one 9 x 13 dish and a smaller side bowl with 6-8 shells as well.  Line them all up, place about 2 big spoonfuls of the tofu ricotta in each and place in the dish.


  Take your delicious and hearty sauce and spoon over the dish evenly.  Place into the over and bake for about 20 minutes at 400 degrees.  Remove and if you prefer, top with Parmesan (or vegan substitute) cheese.  Place back into oven at broil temperature for about 3 minutes.


  This was so good and hearty! It heats up really well for leftovers, too.

Thanks for stopping by!  Please leave any feedback and I am happy to answer questions/comments/emails!

** As noted above, I adapted part of this recipe from A Girl and her Greens.  You can (and I recommend you do) pick this up at

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