Saturday, December 30, 2006

London on a budget

Frugal Traveler

A Family Vacation in London, Guided by Scrooge

Ed Alcock for The New York Times

A London icon, a double-decker bus, on its route.

Published: April 23, 2006

COZY and warm under a thick duvet in the small duplex I had rented for a long weekend in central London, I suddenly awoke to a strange, high-pitched moan. It was my 10-year-old daughter flailing around on the air mattress she was sharing with her younger brother in the downstairs living room.

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Ed Alcock for The New York Times

A guided tour at the Tower of London.

Her cry was followed by a call for help. "It's so c-c-c-cold," she wailed, a fact confirmed by my husband when he reached the bottom of the spiral staircase. Next to our younger children's blow-up bed, our 14-year-old daughter shivered on the couch.

"Honey," my husband yelled up to me sarcastically as he began frantically turning up space heaters. "I think it's time for you to consider that it is not possible for a family of five to visit London for three nights and four days on a budget of £1,000!"

In dollars, that comes to roughly $445 a day, including lodging, in the third-most expensive city in the world after Tokyo and Osaka (New York seems positively cheap at No. 13), and at that chilly 2 a.m. moment, I thought he might just have a point.

But I was determined to prove him wrong, along with the Transport for London clerk who laughed at me when, seeking advice about the cheapest way to get around the city, I told him my total family budget.

In most European capitals, a budget of a little more than $400 a day for a family of five would be a relative snap. In Paris, comfortable hotels for well under $100 a night can be found even near the Eiffel Tower. In Rome, delicious pasta or grilled pizza can be had for as little as $8 a person, and in Barcelona, a single subway journey is less than $2, all well within the means of even the most cash-starved traveler.

But London, where my family and I have lived for the last seven years, is an altogether different challenge. Hotel rooms for under $250 a night are almost impossible to come by, and a restaurant dinner can easily wipe out a full day's food budget in less than two hours. A recent night out with my husband (casual dinner, movie and a short cab ride home) set us back more than £75, not including the babysitter.

So could a family of five, limited to that four-day budget of £1,000 ($1,780 at $1.78 to the pound) spend a vacation in London without feeling as poor as Tiny Tim? Several weeks ago, starting on a Thursday afternoon, and ending on Sunday evening, our family — experiencing London as tourists — was determined to find out.

The first step, besides quickly weaning my children off the occasional cabs they like to take, was to find affordable lodging.

After spending an entire day on the Internet, I was beginning to think our only affordable option was going to be a youth hostel when I remembered a Web site I had heard about from a friend: Vacation Rental by Owner, or VRBO.com. The site had several decent-looking properties that fell within our price range, including the one I ended up renting: a clean, modern duplex apartment right near the Tower of London and just a block from the Thames. The price: £114 a night. Though no palace, it was incredibly tidy, minimally but beautifully decorated (including a few antiques) and for a couple or family with one child able to sleep alone on the large downstairs sofa, it would actually have been quite luxurious. Our larger family, however, found the space more limited (when the air mattress was set up, we could not physically move around the downstairs).

Although the broken television upset my 9-year-old son's cartoon viewing, everything else, from the wide selection of teas to the well-stocked bathroom (baskets of shampoos and soaps, including kids' shampoo) was more than acceptable (and, once we turned up the heat, comfortable).

The next morning, acceptance turned to smugness as we strolled by the hotel across the street, a place where the cheapest double room cost £280 a night, with breakfast an additional £19.50 per person. (We had stocked up on groceries for breakfast most mornings at a nearby store for a total of £11.80.)

SO far, so good.

With calculator in hand, we set out — me, eagerly; my family less so. The first challenge was transportation. In a city where a 10-minute cab ride can easily set you back £15 or more, we bought unlimited four-day off-peak Travelcards (£54.40 for our family of five) that would give us free run of the city's underground trains and buses.

Westminster Abbey was our first stop, and our first indication that the cheapest option is often the best one. After buying a family ticket (£22), we plunked down another £15 for the five sound audios. That was £1 per person less than we would have been charged for the guided tour, and it was a good deal. The group tour was crowded with adults who would have towered over our children as they tried to peek at the various sights, and whose questions about the people buried here — among them Charles Dickens and Queen Elizabeth I — would have sorely tested their patience.

Afterward, we headed to the West End for lunch. The last restaurant meal we had eaten as a family — an upscale pub lunch — had set us back £80. My worst fear was that too many expenses like that would send us for our final evening to the Hare Krishna center, where a friend said they give free vegetarian meals on Sunday nights if you dance with them for a half hour before dinner.

Luckily, a poor art student — is there any other kind? — had recommended the Stockpot on Old Compton Street. It was perfect: a classic British cafe featuring dishes like expertly prepared fish and chips and bangers and mash. With dessert, the entire meal for the five of us cost just £31.46, including the 10-percent service charge. Why had we not discovered this place seven years ago?

Sated, we headed to the Half Price Ticket Booth in Leicester Square, hoping to find some cheap theater tickets for that night. Sadly, the hit musical "Mary Poppins" was not on the board showing available shows, but Shakespeare's "Measure for Measure," in a well-reviewed production playing at the famed National Theater, was. Ten minutes later, we had scored five tickets for seats in the upper circle. (Total cost: £90 pounds, about £20 off the full price.)

The rest of the afternoon was spent wandering through the British Museum, home of both the Elgin Marbles and the Rosetta Stone (free, though we again sprung for the audio tour, at a total cost of £13), and then on to nearby Covent Garden, where the kids were entertained by the street jugglers, opera singers and pantomimes.

Our pretheater dinner was at Chuen Cheng Ku in Chinatown, a stone's throw from Leicester Square, where we ordered plate after plate of steaming dim sum and half a crispy aromatic duck with a basket of extra pancakes for a total of £60.10, including two glasses of wine.

Then it was on to "Measure for Measure." Unfortunately, though extremely well-acted, this production turned out to be an untraditional production of Shakespeare's classic, one that opened with one of the play's characters performing a simulated sex act. I quickly moved to cover the eyes of my 10-year-old and 9-year-old and anxiously wondered what my 14-year-old was thinking. (Note to myself: read the reviews of a play before taking the kids.)

We decided the next morning to splurge on one breakfast out — after all, the full English breakfast is a famous meal — and so headed to the Star Café in Soho, where for £25.20 we feasted on eggs, bacon and sausages along with grilled tomatoes and baked beans. We spent the day checking out some of the more popular tourist attractions that were within our budget (the Tower of London, at £43 for a family ticket; the Globe Theater at £25), and skipping those that did not. (The London Eye would have cost us £40.95, even with the 10 percent online reservation discount, and Madame Tussaud's Wax Museum and adjoining planetarium would have been £107.95 for the five of us!)

We wandered — free — along the scenic south bank of the Thames, stopping in at the sprawling Borough Market, a food lover's paradise, where we spent £12.60 on snacks like smoked prawns wrapped in tortillas, steak sandwiches smothered with mushrooms and huge double-fudge brownies, and then visiting the area's many galleries.

After an early dinner (£56.03) at Tas Pide, a popular Anatolian restaurant that serves meze of hot and cold starters (hummus, tabbouleh and falafel) with endless baskets of sliced bread, as well as pides (pizzalike main courses of dough baked in a wood fire and filled with everything from sun-dried apricots and hellim cheese to chicken with red pepper and spinach), we headed to the Tate Modern (free), which stays open until 10 p.m on Friday and Saturday.

While my husband and I wandered through the galleries upstairs, checking out works by Rothko, Dali and Warhol, the three children played hide-and-seek among the current interactive ground floor installation of 14,000 stacked white cardboard boxes.

It seemed only fair that our agenda should be less cultural and more child-friendly the next day. We headed, inevitably, I suppose, to Buckingham Palace. It is with some embarrassment that I admit that my children had never seen the Changing of the Guard. Finally, the moment had come to experience this free pageantry. The historic ceremony, performed every day in the spring and summer, and every other day in the autumn and winter at 11:30 a.m., was both frustrating (the crowds were 10 people deep around the gate) and fantastic (the kids loved the synchronized marching and poker-faced guards).

After a brisk walk through St. James's Park and the adjacent Green Park, we used our travelcards to pick up one of only two Routemaster Heritage buses still crisscrossing the streets of London. These original London double-deckers (the Routemasters date back to the 1960's) are worth catching — they pass by St. Paul's Cathedral, Royal Albert Hall, Fleet Street and Trafalgar Square. Take the No. 9 or 15, but make sure it is marked "Heritage." What's more, it is much cheaper than the commercial hop-on-hop-off Big Bus in London, which costs £20 per adult and £10 per child per day.

We got off in Knightsbridge and followed the crowds into Harrods. After a quick run-though of the famed department store (all looking; no buying), we purchased a picnic lunch (£14) in the Food Halls. We ate by the nearby Serpentine, the lake that runs through Hyde Park, before deciding to rent one of the rowboats available at the boathouse for a half hour of family fun (£9.99).

Afterward, while the girls in our family spent £26.50 at Kensington Palace, which houses among other treasures a royal ceremonial dress collection that includes many of Princess Diana's favorites, the boys headed instead to the nearby (free) Peter Pan Playground, complete with an Indian Village with tepees and totem poles.

That evening's activity consisted of window-shopping on Kensington High Street and a meal at Wagamama, a trendy spot that serves Japanese noodle and rice dishes at communal tables. For only £50, thanks to a well-priced kid's menu, we enjoyed miso soups, dumplings, and various rice and noodle dishes filled with chicken, seafood and an array of vegetables.

ON our last day as tourists, we headed downriver to Greenwich, to see the Royal Observatory and the National Maritime Museum (both free). It seemed the most fitting way to get there was by boat, and so we purchased, for £26, a family ticket that would allow us to take one of the river cruises from the Tower of London and return by the Docklands Light Railway, a fast automatic train introduced in London in 1987 that winds through the city's newest developments, including Canary Wharf.

After learning more than we could absorb about Royal Astronomers in the Observatory, we ate our best-value meal of the weekend at Goddard's Pie House. For £18.50 total, we each ordered a pie (steak and kidney, cheese and onion, chicken and mushroom, to name just a few) served with mashed potatoes and peas, and left stuffed.

Tired, we headed back on the Docklands Light Railway. As the children nodded off, I had tallied up our spending and was pleased to find we still had £53.42 left for our final meal. We chose Masala Zone, an inexpensive but well reviewed new Indian restaurant chain. Sharing large dishes of butter chicken, lamb korma, chickpea samosas, and prawn thali, we discussed the highlights of the long weekend with the children. My teenage daughter even apologized to me for a conversation I overheard her having on her cellphone in which she said, "You won't believe what my Mom is making me do this weekend!" Be grateful, I told them. At least we were not reduced to repeating in unison a Vaishnava mantra at the Hare Krishna Center.

When the bill came, it totaled £45.40. Without hesitation, I quickly ordered my husband and myself a second celebratory beer and pocketed my calculator. "Cheers," he said, holding up his glass. "You win."

Pinching Pounds

WHERE TO STAY

VRBO.com (Vacation Rental by Owner) provides numerous listings of vacation properties around the world for rent by their owners. In London, nearly a hundred different rental properties, including many family houses, are listed.

WHERE TO EAT

The Stockpot, 18 Old Compton Street W1, 44-20-7287-1066, serves British specialties as well as burgers, pastas and omelets. Open seven days a week, and there are several other locations.

Chuen Cheng Ku, 17 Wardour Street W1 44-20-7437-1398, in the heart of Chinatown, specializes in dim sum, which is served every day of the week.

Tas Pide, 20-22 New Globe Walk SE1, 44-20-7928-3300, an Anatolian restaurant on the South Bank, is so good it makes you want to visit Anatolia (the Asian part of Turkey) for more of the food. Open seven days a week for lunch and dinner.

Goddard's Pie House, 45 Greenwich Church Street SE10, 44-20-8293-9313, serves pies (both veggie and meat) as well as stewed or jellied eels, a Cockney specialty. Open seven days a week.

Star Cafe, 22 Great Chapel Street W1, 44-20-7437-8778, serves a traditional English breakfast from 7 a.m Monday to Friday, including a national favorite, black pudding, for those who like pig's blood with their eggs.

Wagamama, with 24 locations around the city, including 26A Kensington High Street W8, 44-20-7376-1717, has a kid's menu unlike any other — featuring mini-ramen, minichicken Katsu and deep-fried prawns.

Masala Zone, 9 Marshall Street W1F, 44-20-7287-9966, and other locations, serves excellent curries, thalis and lamb roghan josh.

JENNIFER CONLIN, who lives in London, is a frequent contributor to the Travel section.



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Friday, December 29, 2006

Avoiding Falls

Taking Steps So Aging Does Not Mean Falling

Published: December 26, 2006

Two Minnesota friends — Margaret, 79, and Davis, 84 — are a hearty pair who take an exercise walk for an hour each day. Then they return home to a kitchen that is an accident waiting to happen. On the floor are loose runners — beautiful rugs, to be sure, but a fall hazard for people of any age and especially risky for those over 65.

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Stuart Bradford

They did place slip-resistant mats under the rugs, which helped some. But the rugs still move around and can easily cause someone to trip. And when someone their age trips and falls, chances are something will break.

Falls are now the leading cause of injury-related deaths among people 65 and older, the national Centers for Disease Control and Prevention in Atlanta recently reported. The fatality rate from falls rose by more than 55 percent from 1993 to 2003, the latest year for which statistics are available. In fact, death rates from falls have risen faster than injury rates from falls, in part because people are now living to ages when frailty raises the risk that a fall will be fatal.

But neither falls nor serious injury from them is an inevitable consequence of advanced age. Brian M. Franklin, a certified athletic trainer at University Orthopedics in Atlanta, and the MetLife Foundation, in collaboration with the Atlanta centers, offer excellent suggestions for tuning up your body and your environment to prevent falls, as well as injuries from the falls that do happen.

Bodily Defenses

Knowing the underlying causes of falls suffered by older people will help you appreciate the steps experts recommend to prevent them. Heading the list of causes for otherwise healthy people is loss of muscle strength followed by diminished flexibility, which together result in instability and a decreased ability to catch yourself should you start to fall, Mr. Franklin said at a recent meeting sponsored by the American Academy of Orthopedic Surgeons and the National Athletic Trainers’ Association.

Then there are medical factors, of which osteoarthritis — the wear-and-tear kind — is most prominent. Arthritis can make joints stiff and painful, resulting in a loss of flexibility and mobility. Some medications taken by older people can cause dizziness or sleepiness and impair balance. People who have suffered a stroke or other neurological disorder may be unable to move normally.

Other predisposing factors common among older people include cardiovascular disease and accumulated injuries that weaken the musculoskeletal system. Diminished vision caused perhaps by cataracts, glaucoma, macular degeneration or lack of proper glasses is also a factor in falls among the elderly.

And when older people fall, their weakened bones are more likely to break. As many as one woman in four and one man in 15 over the age of 50 can expect to suffer a fracture during their remaining years.

So, the first step is to build muscle strength in the thighs and trunk to increase stability. Try this simple exercise: Lie on your back on the floor and raise one leg at a time a foot off the floor, holding it there for 10 seconds. Gradually build up to 10 repetitions with each leg and you’ll see how much stronger your thigh muscles can get.

Likewise, there are easy exercises to improve balance: Gently holding the back of a sturdy chair, raise one foot off the floor, then try to let go of the chair. Once that is mastered, try it with your eyes closed, then try it standing on your toes. Tai chi is also an excellent activity proven to improve balance and reduce falls.

Daily stretches, especially of the legs and hips, can slow the loss of flexibility that can result in a fall.

People over 50 — and especially those over 65 — should have annual eye exams by an ophthalmologist and not postpone getting new glasses or undergoing cataract surgery. Corneal implants inserted when cataracts are removed can improve visual acuity better than your current glasses.

If you take medications, ask your pharmacist whether any of them, alone or in combination, may cause dizziness or sleepiness. If so, ask your doctor if a reduced dosage or another medication would be just as effective and safer.

Don’t forget “dem bones,” which need to be strong if they are to remain intact should you fall. In addition to consuming adequate amounts of calcium and vitamin D, you need to do weight-bearing exercise. Bone-benefiting exercises include walking, step and water aerobics, dancing, yoga, tai chi, hiking and resistance training. Cycling and swimming, while excellent activities especially for people with arthritis, are not as effective as walking for strengthening bones, Mr. Franklin said.

For additional guidance, see “Fall Prevention” by Gail Davies and Fran Scully (Infinity Publishing, 2006).

Environmental Protection

About half of falls occur at home, so that’s the best place to start to prevent them. To keep from slipping or tripping, the MetLife Foundation offers these tips:

Keep walking paths clear of furniture and other obstacles. Don’t leave objects like books, papers, shoes or blankets on the floor. Make sure wires are securely tacked to the floor or wall. If you have loose rugs, remove them or secure them with double-sided tape. If you are visiting a home with loose rugs, ask that they be picked up while you are there.

Keep objects off the stairs. Stairways should be well lighted, top and bottom, with overhead lights that can be switched on at either end. Stairs should be kept in good repair, with firmly attached carpeting or nonslip rubber treads on each step. Always use a handrail, and if possible install handrails on both sides of the stairway.

Improve lighting in and around your home. Switch from incandescent to fluorescent bulbs, which are brighter, last longer and cost less to operate. Place easily reachable lamps on both sides of your bed and a night light between the bedroom and bathroom. Hang lightweight curtains or shades on windows to reduce glare.

Store frequently used items in the kitchen, bedroom and bathroom on shelves that you can reach without climbing or reaching high over your head. Never stand on a chair. If you must use a stool, get one with a frame you can hold onto.

Install grab bars inside the bathtub and next to the toilet. Use a nonslip rubber mat (one with many small suction cups is best) or self-stick safety strips on the floor of the tub or shower. Use a nonslip bath mat or bathroom carpeting — tile floors are very slippery when wet.

Always wear shoes both inside and outside the house. Avoid going barefoot or walking around in socks or slippers that lack a firm nonslip sole. If you are visiting someone who frowns on shoes indoors, take along shoes that are reserved for indoor use. And if your stability is questionable, do not wear high heels.

Finally, Mr. Franklin said, know your surroundings. Learn where the booby-traps like potholes, uneven surfaces and broken pavement are located and avoid them. And don’t be shy about using a walking aid if your stability or footing is insecure.



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Wednesday, December 27, 2006

Food Stories from 2006

To Construct the Perfect Meal, Imagine a Restaurant Crawl

Photographs by Tony Cenicola/The New York Times

CLASS OF 2006 Above, the mao poe tofu, with chili peppers and minced pork, at Buddakan. Left, A Voce’s meatballs made of duck, pork and foie gras. Right, a pork chop, as served at the Little Owl.

Published: December 27, 2006

I DIDN'T have a perfect meal in 2006, although it wasn't for lack of trying. I eagerly ventured forth: to the Lower East Side and the Upper East Side, to the meatpacking district (more times than I care to remember) and the theater district. I traveled in a fashion to China and Japan, Turkey and, of course, France. My bouche was duly amused, and I soon lost count of the petits fours put before me.

But I can easily construct that dream dinner, if I just allow myself to collapse the city's geography, the world's ethnic traditions and all 12 months of the year. To take a starter from this restaurant, a main course from that one, a savory high point from October, a sweet interlude from March.

The meal would begin with one of the best dishes at Boqueria, which brought tapas and other Spanish traditions to Chelsea. It's a salad of seared baby squid, fried breakfast radishes, fried chickpeas and baby arugula that stages a deft interplay of textures — bouncy, crunchy, spongy — and flavors, some rounded, others sharp.

For a second course I'm at L'Atelier de Joël Robuchon, in the Four Seasons Hotel, looking at a vivid work of art. It's a translucent globe with meticulous layers of colors and ingredients: a band of orange sea urchin roe at the bottom, then a band of snowy cauliflower cream above it, and on the surface of that, green pinpricks of parsley mayonnaise.

The next dish doesn't follow logically, but I'm in the realm of fantasy here. A Voce, just off Madison Square Park, unveils freshly made agnolotti with braised duck leg and salty Parmesan inside. The pasta is covered with a foie gras sauce, which is in turn striped with a vin cotto and balsamic vinegar glaze that cuts its richness.

In this reverie I have room for more, and I tackle the big pork chop from the Little Owl, a West Village refuge that leaves just enough fat around the edges of the grilled meat, medium-rare and juicy. I'm in pig heaven.

And then I'm in TriBeCa's answer to Austria, which is to say I'm at Blaue Gans. While I struggle to pronounce the dessert in front of me, I have no trouble falling in love with it. It's a gigantic pancake called a kaiserschmarren, and it has come through a blizzard of powdered sugar. I wonder if I can somehow keep it this warm and soft until morning. It has the makings of a perfect breakfast as well.

By certain measures the past year wasn't a great one for New York restaurants. Not one of the newcomers in 2006 earned four stars, and some of the promising arrivals, like Morimoto and Craftsteak, both on a stretch of lower 10th Avenue that emerged as the city's latest restaurant row, turned out to be disappointing.

But there was variety, adventure, comfort: a surfeit of pleasures from chefs and restaurateurs who were establishing themselves, stretching themselves or sustaining performances that didn't need improvement.

The best restaurant I reviewed in 2006? That would be Jean Georges, which celebrated its ninth birthday in March. It wasn't breaking new ground, and it certainly wasn't flawless: not one of my meals there hit the unfettered high of a night at Masa. But its food proved that Jean-Georges Vongerichten, no matter how overextended, could still stage a sweet-tart, cool-fiery drama better than anybody else. And he could do it in miniature. I flash back to one of the amuse-bouches I had, a crab beignet in which pineapple claimed the spotlight for one moment, only to surrender it to pink peppercorn the next.

My favorite new restaurant in 2006? I'd have to go with A Voce, despite the noise, despite the weird lights bathing those eccentric towers of what look like Lincoln Logs against one wall. A Voce affirmed that the chef Andrew Carmellini's superior work at Café Boulud through the years was no fluke. It showed that he could segue from French to Italian without losing a step or a beat, and it concocted the city's best meatballs, made with duck, pork and foie gras. And it did all of that with insanely comfortable chairs and a near absence of pomp.

Two runners-up — Del Posto, which actually opened in the final days of 2005 but didn't receive its big reviews until this year, and L'Atelier — just didn't feel as easy to settle into or as comfortable in their own skins.

L'Atelier has an awkward location in a back corner of the Four Seasons. It's also pitilessly expensive. Nonetheless it's a showcase for dazzling cooking and inspired partnerships, like the caramelized eel and smoked foie gras in a compactly layered cake. Its menu reads like an encyclopedia of luxuries: the lobster inside ravioli made from thinly sliced turnip; the langoustine cradled by pastry so thin it's translucent. We had to wait many years for Mr. Robuchon to come to New York, and we were rewarded.

The grandness, the stiffness and the tinkling piano music at Del Posto sometimes got in the way of the seductive food from Mario Batali, Lidia Bastianich and Mark Ladner, the executive chef. But the food itself could be sublime, an honest and earnest attempt to showcase the elegant dimensions of Italian cuisine without being overly precious.

Once I got past the homeliness of Ureña — and that was no easy feat — I saw beauty in much of what its chef and owner, Alex Ureña, was doing. He confidently channeled the progressive, foamy spirit of Barcelona, folding an ethereal chorizo and truffle mousse into the center of a brick of short ribs. That spirit got ample play in 2006, participating in the magic of the best dishes at Degustation, an often enchanting East Village nook with just 16 seats at a U-shaped counter.

In terms of the New York dining scene's evolution, it was a year of counters — at Degustation, L'Atelier and Room 4 Dessert. These restaurants responded to diners' ever-growing curiosity about their food by putting them closer to it. And the proliferation of unconventional seating arrangements — the high tables at Boqueria, the communal tables there and elsewhere — spoke to the distance that restaurants continued to travel away from formality and tradition.

It was a year when chefs' allusions to downscale favorites in upscale dishes became more frequent. Mr. Robuchon constructed sliders of Kobe beef and foie gras, while Joey Campanaro, the Little Owl's chef, made them with meatballs of beef, veal and pork. The desserts at Bouchon Bakery, which extended the chef Thomas Keller's reach in the Time Warner Center, included a gargantuan version of a Nutter Butter cookie. I split it with a friend, though I would have been more content to devour it on my own.

Bouchon Bakery — under a Samsung sign, not walled off from the mall all around it — underscored restaurateurs' awareness of the range of experiences that diners craved. Some wanted a tuna sandwich with a dignified pedigree as they sprinted from Sephora to Tourneau, and were willing to pay $13.25 for Bouchon's. Some cared as much about what they were drinking as eating, and new restaurants like Café d'Alsace, with more than 100 beers and ales, and Trestle on Tenth, with a wine list remarkable for its adventurousness and affordability, were among the growing number of places that took that into account.

In 2006 there were steaks and more steaks: hangers and strips, grass-fed and corn-fed, in smartly decorated rooms that exploded steakhouse norms. There was also a bevy of brussels sprouts: roasted and braised, beside scallops at the Café at Country and flecked with bacon at Cafe Cluny, another addition to the West Village.

Greek food got inventive makeovers, most notably at the new restaurants DonaParea. Parea hewed as well to a less welcome theme of 2006, also clangorously evident at Cafe Cluny and A Voce: eating out seemed to be louder than ever. and

The year held surprises. Memorable meals popped up where they were least expected. Among the Asian amusement parks that glittered into view, Buddakan promised to be the most insufferable: 15,000 square feet on the edge of the meatpacking district, more than 300 seats, one showy design element upon another.

But it served a mao poe tofu, fiery with Thai chili peppers and rich with minced pork, that was one of the best treatments of the dish I'd ever had. Steamed red snapper with lily bulb and black fungus mushrooms testified to a team of cooks, led by the chef, Michael Schulson, working with more care than they probably had to. Buddakan even did something different with the core of an obligatorily molten chocolate cake. What oozed from the center was white chocolate ganache.

I had some terrific dishes at Telepan, on the Upper West Side. I had some terrific times at Dressler, in the Williamsburg section of Brooklyn, a borough whose dining scene kept getting better.

But some of my happiest evenings were spent in places that had been around a good long while. At the unlucky age of 13, Picholine arrested its decline by reinvigorating its menu, which included another homey-haute meditation, a sous vide version of chicken Kiev with liquid foie gras instead of butter inside.

I found myself drawn time and again to the plain dining room at Spicy & Tasty, unable to get its vibrant dishes, lustrous with red chili oil and sesame oil, buzzing with Sichuan peppercorns, out of my mind. It has been around for many years, first in one spot in the Flushing section of Queens and now in another, and it's as good an example as anything that dawned in 2006 of what makes dining in this city so heady, year in and year out.

With little fanfare, it charts an affordable journey to exotic sensations. I can still feel my tongue tingle and my mouth blaze with each bite of shredded lamb in fresh hot pepper. I can still see the pale green color of the restaurant's impossibly fluffy scallion and egg fried rice.

Maybe I need to revise my ideal meal, find interludes into which these dishes can be wedged. Maybe I just need to keep eating.



Check Out My Other Blogs (click on blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Tuesday, December 26, 2006

End-of-life care

Op-Ed Contributor

The Most-Avoided Conversation in Medicine

Published: December 26, 2006

Boston

J. R. was an auto mechanic of French Canadian descent with a perfectly square gap between his two front teeth and the slightly off-kilter face of a retired boxer. Soon after I met him on the surgical ward, after he had been found to have cancer, he developed a habit of planting himself in front of me whenever I got within 100 feet of his room, to spin stories about his life, wax poetic about his girlfriend, and offer free auto-repair advice.

I thought we had caught the tumor in J. R.’s colon early, but in the operating room we found that the cancer had grown into his pelvic sidewalls. After surgery, when I began to tell him that some of his cancer remained, he stopped me. “Hey, Doc,” he said. “I know I’m going to be fine because you did my surgery.”

J. R. sent me a Christmas card that year, but I could not bring myself to write back. I told myself that I was too busy, when in fact I was afraid to acknowledge that J. R. was dying. Patient deaths, for many doctors, represent a kind of failure, and so without really thinking, we look the other way.

I am not the only doctor who has had difficulty dealing with dying patients. Researchers who in the mid-1990s observed more than 9,000 seriously ill patients in five American teaching hospitals found substantial shortcomings in the care of the dying. More than a third spent at least 10 of their last days in intensive care. Among patients who remained conscious until death, half suffered moderate to severe pain. And fewer than half of their physicians knew whether or not their patients wanted to avoid cardiopulmonary resuscitation.

The researchers then made a multimillion-dollar effort to improve communication between patients and doctors on end-of-life care. They generated frequent reports to physicians on patients’ expected survival and hired specially trained nurses to talk with patients, families, physicians and hospital staff about prognoses, pain control and advance care planning.

Yet after two years, the problems they had identified were undiminished. The changes in practice had done nothing to get physicians to better communicate with dying patients. As the investigators wrote, the doctors “did not wish to directly confront problems or face choices.”

This study — called the Support trial — was a wake-up call for the medical profession. Physician leaders responded by creating specialized curriculums in end-of-life care, and licensing boards widened their competency requirements to include this expertise. Professional organizations issued mandates to improve standards of care for the terminally ill, while hospitals began offering more palliative care consultation services. Interest in end-of-life care surged; by early 2005, the American Academy of Hospice and Palliative Medicine grew to more than 2,000 members, from only 250 in 1988.

Still, many of us remain unwilling to talk with patients about death.

In a recent Harvard survey, nearly half of attending physicians at teaching hospitals refused to participate in a 25-minute telephone interview to discuss end-of-life care education. The most cited reason? They were not interested in the study. Other reasons included being too busy, refusing to participate without payment, or believing that end-of-life care had no relevance to their work.

J. R. continued writing to me every Christmas for three years longer than I would have expected, given the extent of his tumor. Then one year there was no card, and none the next year or the one after. After four years, I found the courage to write to him, and a month later, his girlfriend replied. J. R. had died but had managed to marry her first and to send me that last Christmas card.

And I was left wondering how I, and all doctors, could ever do better by our dying patients.

I think there is a simple way to change. We could add one question to every discussion we have about patients with terminal illnesses: “How good is this patient’s end-of-life care?”

The forums for posing this question are plentiful in medicine. Every morning and late afternoon, physicians in hospitals “round” on their patients, discussing their decisions in small groups or writing progress notes on patients’ charts. Doctors hold “grand rounds” (lectures before their colleagues) monthly or weekly, and in academic centers, physicians hold regular teaching conferences.

If in these settings we could bring ourselves to ask about each patient’s end-of-life care, we could influence one another in a more personal way than the Support study did. And while we might not get all the details right at first, we would grow more familiar with advance directives and pain treatment and learn to manage our patients’ resuscitation wishes.

We also might find ourselves — as I have found myself with patients since J. R. — one step closer to being the compassionate doctors we have always dreamed of becoming.

Pauline W. Chen is the author of the forthcoming “Final Exam: A Surgeon’s Reflections on Mortality.”

Tips



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Monday, December 25, 2006

Yucatan Eco-Tourism

Adventurer

On the Yucatán Coast, a Maze and a Challenge

Adriana Zehbrauskas for The New York Times

Cameron Boyd, left, and Manual Galindo at the Sian Ka’an Biosphere Reserve, south of the Maya ruins at Tulum, Mexico. Mr. Boyd owns a Sian Ka’an resort and tour organization; Mr. Galindo is a guide.

Published: December 22, 2006

THE million spindly legs of a mangrove swamp surrounded and sequestered the three of us, and they all looked the same. Sunlight illuminated idle water. Birds flew above, free.

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Yucatan Peninsula Travel Guide

Adriana Zehbrauskas for The New York Times

Palapas at Centro Ecológico Sian Ka’an.

Adriana Zehbrauskas for The New York Times

A beach at Sian Ka’an.

Adriana Zehbrauskas for The New York Times

A swimming break during a boat tour.

“It’s dead,” Cameron Boyd said, sitting stalled in a kayak, holding a G.P.S. device to the sky. “Batteries are dead.”

We were two hours into an exploratory kayak expedition, miles deep and a little lost in a labyrinth of mangroves. The wilds of Sian Ka’an Biosphere Reserve, a 1.3-million-acre park in eastern Quintana Roo, Mexico, stretched off from all points of the compass. Tulum, a bright and happy tourist town, was miles to the north. The coast — palapas, piña coladas and turquoise waves — was east.

But not another soul was in the swamp.

“The sun’s to the east, we know that,” said Manual Galindo, the head guide with Centro Ecológico Sian Ka’an or Cesiak, an organization that operates a resort and runs tours in the area. “We need to head back toward the sun.”

Mr. Boyd, a native of Boston who is the owner and founder of Cesiak, and Mr. Galindo are no strangers to the swamp’s tight turns and look-alike passageways. Sian Ka’an, which is among Mexico’s largest parks, has obsessed both men for years with its crocodiles, bonefish and birds. Their kayaks follow ancient Maya trade routes, and ruins undoubtedly exist undiscovered in the reaches farther in and to the west.

Sian Ka’an — “born of the sky” in the Maya language spoken in the region today — spans about 70 miles of the Yucatán Peninsula’s Caribbean coast, stretching inland as a pan-flat preserve of lagoon, jungle and swamp. Its white sand beaches are paradisiacal, wild and undeveloped. Human presence in the area dates back more than 2,000 years, the open water and swamp channels connecting jungle villages with ancient coastal ports.

Stout limestone temples, etched with Maya markings, still stand undisturbed on hummocks of high ground. Mexico designated Sian Ka’an Biosphere Reserve a national park in 1986; Unesco designated it a World Heritage Site a year later.

But traces of such recognition are absent beyond the preserve’s single visitor center. Indeed, a trip to the park’s interior — a primordial, buzzing environment of birds and bugs and impenetrable jungle brush — is an unfettered wilderness adventure.

Sian Ka’an has few hiking trails or signs and little infrastructure in general. Most of its 40,000 or so annual visitors see the wilderness from the seat of a motorboat, skimming past stingrays and manatees as they head deep into the mangroves to fly-fish or watch the birds.

Wildlife in Sian Ka’an is dense. Sea turtles nest on its beaches. Crocodiles and crabs swim among the mangroves. Monkeys, pumas, tapirs, jaguars and, oddly, whitetail deer roam its jungles.

My view of Sian Ka’an, from the seat of a sea kayak, was a quiet and intimate look into life in the preserve. The swift keel of the boat cut quickly and soundlessly through tannin-tinted water. Mangroves and grass brushed the bow. Huge, gangly and colorful birds — roseate spoonbill, tiger heron, osprey, ibis, boat-billed heron, among dozens of others — sat undisturbed as I slid in near nests or beneath tree-branch perches, which rocked in the tropical breeze.

On the morning of our kayak expedition — a Tuesday in late November — Mr. Boyd, Mr. Galindo and I got up to watch the sunrise over the Caribbean. Waves lulled on the shore. A blaze-orange ball peeked up from the horizon.

By 6:30 a.m., our kayaks were in Sian Ka’an’s northernmost lagoon, which is a quarter-mile west of the ocean over a thin strip of land.

Three miles of open water panned ahead.

“Paddle hard, and we’ll be to the mangroves in less than an hour,” Mr. Boyd said.

The objective — to scout a series of circuitous channels through the mangroves in a little-explored portion of the park — was culled from a computer screen at Cesiak’s headquarters. Satellite photographs on Google Earth had revealed long lanes cutting back to hummocks, high ground, grassy marsh and vine-choked mysteries.

“I dream about finding access to a freshwater spring surrounded by hardwoods,” Mr. Boyd said. Crocodiles and long-lost ruins were tops on my list.

Sediment stirred as the kayaks tracked through shallow water. Bubbles rose from the muck.

The boats — a sleek single-seater and a tandem kayak — left little wake on the lagoon’s glassy plane. Paddles dipped and pulled for an hour to the edge of the swamp.

A CHANNEL starts up here,” Mr. Galindo said, pointing toward a wall of woody arms. Mr. Boyd switched on his G.P.S. as we entered the maze, digital bread crumbs blipping a route of return.

The air changed as we went in, turning warm and sulfur-smelling. Our boats veered and twisted. The channel snaked along, sun swinging around in the sky.

“Dead end,” Mr. Boyd yelled out. “Head back.” We spun to return, but soon we were mixed up. Each turn in the mangroves was a mirror of the last.

Then Mr. Boyd’s G.P.S. went dead.

“I hope you know how to get out,” Mr. Galindo said, smiling at his boss.

Sian Ka’an was quiet. The sky was big and blank. Stingrays swam by, flying underwater, skimming the muck.

“I’m going to stand up for a look,” Mr. Galindo said, balancing in the kayak’s cockpit, straining to see over sticks and leaves.

The adventure became finding our way back out. We paddled slowly, drifting, pausing, peering down passageways like children lost in a cornfield.

But the two men had been turned around in the swamp before; the day’s disorientation added only minor drama to the morning’s voyage.

“Let’s keep heading right,” Mr. Boyd said, motioning toward a gap in the vegetation. “We’ll start recognizing things again soon.”

Sian Ka’an was still, alien. Ten thousand years of collected sediment — a red and golden brew of putrescence under two feet of brackish water — clouded with each paddle stoke. I pictured artifacts below, jewels dropped from canoes.

Fish tails poked from the water’s surface. Birds broke branches on the bank nearby.

A half-hour later, our boats poked back into the big water of the lagoon. A dozen ragged dots — bird-choked plots of mangrove — sat scattered on water to the east.

Rain fell in the distance, a slant of gray on far blue sky. But the sun seared the water ahead, a flickering glare, a plate of gold shimmering in the light.



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