The Aquachile Rounds
- andreweschmd
- Mar 7
- 4 min read
By Andrew Esch, MD
The Palliative Lens
There are a lot of ways to measure whether a place is good to work.
Health systems tend to prefer metrics.
Productivity dashboards
Engagement surveys
Annual modules about teamwork narrated by someone who sounds like they recorded it inside a porta potty
But the truth is that the real test of a workplace is much simpler.
It’s whether people actually want to spend time together.
A Place You Want to Show Up To
For the last decade and a half, I’ve been fortunate to work in places I genuinely love. More importantly, I’ve been lucky to work with people I’ve come to care about deeply.
That feels almost subversive in modern medicine.
We’ve all worked in places where the culture felt like a slow leak of energy. Where everyone was competent but guarded. Where conversations revolved around documentation templates, staffing shortages, and who forgot to click the right box in the EMR.
And then sometimes you land somewhere different.
A place where the nurses know the patients in ways the chart never will.
Where the social workers catch the emotional undercurrents before anyone else sees them.
Where the pharmacists quietly prevent disasters every single day.
Where the physicians understand that being the “captain of the ship” mostly means listening carefully to the people who are actually steering it.
When a team works well, it doesn’t feel like hierarchy. It feels like collaboration.
And oddly enough, some of the best conversations about medicine don’t happen in conference rooms.
They happen at the nurses’ station, in the hallway, in between patients, small moments that remind you why you love what you do.
A Busy Clinic and Aquachile
Every so often, those conversations drift toward food.
Friday clinic was one of those days. We were triple booked, and the patients were sick. In a brief moment of catching our breath, the conversation drifted toward weekend plans.
I was headed to my daughter Olivia's regatta.
Damarys had a date night at the casino with her husband.
Sarah was working on applications for PA school.
Roxy was cooking dinner for her husband that night and planned to make aquachile.
The funny thing is that once aquachile entered the conversation, it spread through the team like a consult note.
If you’ve never had aquachile, it’s a bright, citrus-driven dish from Mexico made with raw shrimp cured in lime juice with chiles, cucumber, onion, and herbs.
Cold.
Sharp.
Refreshing.
The culinary equivalent of opening the windows after a long winter.
Everyone had an opinion.
“Can’t ever add too much lime.”
“Use serrano and jalapeño peppers.”
“Cucumber is non-negotiable.”
“You absolutely have to add a splash of soy sauce.”
Medicine, it turns out, is not the only field where people hold strong views.
A Simple Aquachile Recipe
Here’s the version that seemed to reach the closest thing to interdisciplinary consensus:
Ingredients
1 pound fresh shrimp, peeled and deveined
Juice of 6–8 limes
2–3 serrano peppers, thinly sliced
½ red onion, thinly sliced
1 cucumber, peeled and sliced
Small handful of cilantro
Salt
Optional: splash of soy sauce or Maggi seasoning
Optional: avocado slices
Method
Slice the shrimp in half lengthwise.
Place in a shallow bowl and cover with lime juice.
Add serranos, onion, cucumber, cilantro, and salt.
Refrigerate for about 10–15 minutes, until the shrimp turns opaque.
Taste and adjust lime, salt, and heat.
Serve immediately with tortilla chips or tostadas.
Preferably with people you like.
What Food and Medicine Have in Common
Talking about food teaches you something medicine occasionally forgets.
No one ingredient makes the dish.
The lime matters.
The shrimp matters.
The chiles matter.
But if any one of them decides they’re the only thing that matters, the whole thing falls apart.
Teams in medicine work the same way.
A good ICU nurse can see deterioration hours before a physician.
A social worker can uncover the one family dynamic that changes the entire care plan.
A pharmacist can prevent a medication cascade nobody else noticed.
A chaplain can ask the question that reframes the entire conversation.
The best clinicians understand this instinctively.
They know that the smartest move in medicine is often to pause and ask:
“What are you seeing that I’m not?”
The Real Reason We Stay
People often think clinicians stay in jobs because of salary, prestige, or academic titles.
Sometimes those things matter.
But more often we stay because of people.
The nurse who knows exactly how to calm a terrified patient.
The social worker who navigates impossible family situations with grace.
The colleague who quietly takes your consult when your day is falling apart.
And occasionally because someone is making aquachile for their husband that night.
The Things That Actually Sustain Us
Medicine can be heavy work.
We see suffering every day.We carry other people’s fear, uncertainty, and grief.
What sustains clinicians over decades isn’t just resilience training or wellness modules.
The best teams in medicine don’t just function well.
They actually like each other.
One Final Thought
If you’re lucky enough to work somewhere you love, don’t take it for granted.
Protect it.
Build it.
Feed it—sometimes literally.
Because the truth is that good medicine is rarely the product of a single brilliant individual. It’s the product of people who trust one another enough to work together.
And occasionally argue about the correct amount of lime in aquachile.
Which, for the record, is more than you think.
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