I was doing my emergency medicine training in New Orleans. The nurse called me to see a teenage girl who was screaming hysterically, for no apparent reason. She was unable to talk but just cried uncontrollably.
When I was finally able to get her to relax a bit, she pointed to her ear. I looked inside and was horrified to see a cockroach that had crawled in and was unable to back out. As it tried to get out, it banged repeatedly against her eardrum, causing a terribly creepy pain.
Fortunately, there is a thin “alligator” forceps that works great to reach in the ear and grab a wayward bug. If you do it right, you can pull it out, alive and intact, very much to the horror of the patient and the satisfaction of the doctor.
Over the years, I have removed many ear bugs. One cockroach was so small it was actually running around in circles in there and we washed it out with warm water.
One night, a 42-year-old man came in complaining of having a bug in his ear. I peeked in and could see some insect body parts so the diagnosis was confirmed. I used the alligator forceps to deftly reach in, grab the bug and pull it out. As it came out of the ear canal, clasped tightly in my forceps, something else came out of the ear and ran down the man’s neck, shoulder and arm. It had just gotten to his hand by the time I reflexively slapped a spider, killing it and knocking it onto the floor.
The only thing I could figure was the spider had caught the insect and pulled it into the ear canal as a nice place to have his lunch, which I interrupted.
I know there are a million chocolate chip cookies recipes out there. I recently tried this one and decided it was good enough to share with you. I have noted in the past that melting the butter and baking at a lower temperature for a longer time makes a great texture for a chocolate chip cookie. I rediscovered this when I made these cookies. The pull-apart method of ball formation made for a really fun texture and cookies that are twice as big as the ones I usually scoop out.
Many close variations on Internet
4¼ cups unbleached all-purpose flour, (22 ounces)
1 teaspoon baking soda
1 teaspoon salt
1½ cups unsalted butter, melted and cooled until warm
2 cups packed brown sugar
1 cup granulated sugar
2 large eggs
2 egg yolks
4 teaspoons vanilla extract
3-4 cups semisweet chocolate chips
1. Heat oven to 325 degrees. Line 2 large baking sheets with parchment paper or spray them with nonstick cooking spray.
2. Whisk together flour, baking soda, and salt in a medium bowl. Set aside.
3. Mix butter and sugars until thoroughly blended.
4. Beat in eggs, egg yolks, and vanilla until combined.
5. Add dry ingredients and beat at low speed just until combined.
6. Stir in chocolate chips.
7. Roll ¼ cup of the dough into a ball. Hold the dough ball with the fingertips of both hands and pull into 2 equal halves. Rotate the halves 90 degrees and, with jagged surfaces facing up, join the halves together at their base, again forming a single ball, being careful not to smooth the dough’s uneven surface. Place the formed dough balls on the prepared baking sheets, jagged surface up, spacing them 2½ inches apart.
8. Bake until the cookies are light golden grown and the outer edges start to harden yet the centers are still soft and puffy, 15 to 18 minutes, rotating the baking sheets front to back and top to bottom halfway through the baking time. Cool the cookies on the sheets.
A 26-year-old man was brought to the emergency department by his aunt. He said he had trouble sleeping and, because of that, had a “nightfall problem.” (See footnote.) He said all he needed was a sleeping pill. He seemed grumpy and was not really cooperative in telling me what was going on. The aunt was the one who gave me the interesting details about their sad situation.
After getting a degree in accounting six months earlier, he had been unable to get a job. The aunt felt sorry for him and took him in. She was providing him a place to stay and all his meals. She planned on this being a temporary arrangement until he got a job.
Since he moved in with his aunt, he had not even tried to get a job. He took over her family room where he spent his time, day and night, watching TV. He wouldn’t let her use the remote to watch the TV herself. Sometimes, he would sit for long periods of time throwing a basketball against the wall, banging it over and over again. Despite all the aunt did for him, he was demanding and unappreciative. And he didn’t sleep. The patient would not corroborate what his aunt said, but neither did he deny it.
My heart really went out to these people, especially the aunt. I wanted to help them and carefully considered my options. If he had been suicidal, I would have immediately sent him to see a psychiatrist. Since his condition didn’t immediately put him or anyone else at risk, I discharged him to go home. I gave him a prescription to help him relax and sleep. I also provided information about community resources where both the patient and his aunt could seek more long-term assistance.
When they left, I hoped they would find help. If not, I wondered if the aunt would kick him out before he finally did something that would really get him in trouble. One thing about emergency medicine, I usually don’t get the answers to questions like that.
* This was the first time I had heard of nightfall in men. http://www.articlesfactory.com/articles/health/what-does-one-mean-by-nightfall-in-men.html
Unfortunately, a lot of the sad things I witness in my job come about because of alcohol abuse. Here are a couple of examples.
A thirty-five-year-old man came in burned. He was very drunk and had fallen asleep on a mattress in a homeless encampment. His cigarette caught the mattress on fire and by the time anyone noticed, he was badly burned.
A review of his hospital records showed he had recently been discharged from our burn unit after a prolonged stay there because of burns suffered in exactly the same scenario.
In addition to being very intoxicated, he had multiple serious burns on his previously normal skin as well as where he had received skin grafts during his previous admission.
He was admitted, again, to the burn unit.
A 34-year-old man was out drinking with friends. He got tired, so he decided to climb into a garbage dumpster and get a little sleep. In the middle of the night, he woke up as the dumpster was being emptied into a garbage truck. The compacter in the truck then smashed him multiple times. He managed to crawl to the top of the truck where a motorist saw him and stopped the garbage truck driver. 911 was called and he was taken to the emergency department.
In addition to being very intoxicated, he had bruises, lacerations, blood in his urine and a fractured pelvis.
I do most of my shopping at our neighborhood Nob Hill. They publish a magazine designed to get you to buy more stuff from their store to go into their recipes. I always look through it. This week, they had a recipe I thought sounded very interesting. I like sunflower seeds but have never seen a cookie recipe like this. Cookies always smell good coming out of the oven but it was fun to have that cookie aroma veiled in the nutty aroma of sunflower seeds.
½ cup butter, softened
½ cup sunflower seed butter
1 cup brown sugar
½ cup sugar
1 tablespoon vanilla extract
2 cups flour
¼ cup unsweetened cocoa powder
1 teaspoon baking soda
¼ teaspoon salt
1 cup Nestle Toll House DelightFulls Caramel Filled Morsels*
¾ cup roasted, salted sunflower seeds
1. Stir together butter and sunflower seed butter in a large bowl.
2. Beat in sugars.
3. Beat in vanilla and eggs.
4. Stir in flour, cocoa, baking soda and salt.
5. Stir in caramel morsels.
6. Cover and chill for at least 1 hour.
7. Heat oven to 350°F.
8. Line 2 baking sheets with parchment paper.
9. Roll dough into 1½-inch balls. Roll each ball in sunflower seeds then place on baking sheets.
10. Bake for 12 to 15 minutes.
* Though this recipe was in the Nob Hill magazine, I had to go to Safeway to find these.
Making blue bags is different from making orange or yellow bags because the straps are not nine feet long. They are short and I have to use a different technique in sewing them. In this case, I made six bags at one time and tried to make them as identical as possible. Usually, my “no two bags are identical” approach is like a badge of honor. In this case, I was able to make them all very similar, though not identical, of course, since they are made of discarded materials.
A 33-year-old man was brought in by his family because of bizarre behavior. They said he had a mental breakdown years ago but had no psychiatric problems or known substance abuse since then.
The family said he was constantly swearing at people and being argumentative. He had also been drinking heavily, which was unusual for him.
I found him to be loud and aggressive. He would not talk with me but demanded I go outside with him to fight. He got more agitated as we talked until he pulled down his pants, defecated in his hand and threw the feces on the floor.
After appropriate sedation, he was taken to emergency psychiatry.
A man in his early twenties came in by ambulance complaining of abdominal pain, nausea and vomiting. I see people all the time with those complaints so I was expecting to see someone with food poisoning, an intestinal virus or something like that. This was different.
The patient told me that after defecating, he scratched an itch on his face by wiping his index finger across his upper lip and nostrils. It was only then he realized his finger was dirty and he had rubbed feces on his face. He immediately developed crampy abdominal pain, nausea and vomiting. By the time I saw him, he had washed up and was feeling fine.