Using a name like “Cherry Garcia” will always catch your attention and I am sure raises expectations. Obviously, these cookies are not anything like the famous ice cream (which is my favorite,) but they are good. I had to look all over for cherry brandy. I finally found “cherry-flavored brandy,” at BevMo. I am not sure but I am suspicious this is like imitation cherry brandy. Since I know nothing about booze, I am not sure. If you are not up to looking all over town, I am sure they would be good with just regular cherries. I would probably skip the softening in boiling water, as well, to give the cherries more character in the cookies. I like chewy dried cherries in my cookies.
1 cup dried sour cherries
1/3 cup cherry brandy
1/2 cup unsalted butter, at room temperature
1/2 cup white sugar
1/2 cup light brown sugar, firmly packed
1 large egg
1 1/2 teaspoons vanilla extract
1/4 teaspoon almond extract
1/4 teaspoon salt
1/2 teaspoon baking soda
1 1/2 cups all-purpose flour
3/4 cup coarsely chopped white chocolate
¾ cup coarsely chopped semisweet chocolate
1/2 cup coarsely chopped macadamia nuts (optional)
1. Line two baking sheets with parchment paper.
2. Plump dried cherries by soaking them in boiling water to cover for a couple of minutes. Drain well and toss with cherry brandy.
3. Let cherries sit in brandy for a couple of hours, or even overnight for the best flavor. Drain before using.
4. Cream butter with both sugars.
5. Blend in egg, vanilla and almond extracts.
6. Fold in salt, baking soda and flour.
7. Fold in cherries, chocolates and nuts.
8. Drop in 2-tablespoon balls onto baking sheets.
9. Bake until lightly browned around the edges, 12-14 minutes.
10. Cool on racks.
We don’t have a social worker available to us on the night shift. When we have a patient who is ready for discharge but really needs the help a social worker could provide, I recommend that he or she wait until morning when the social worker gets in.
One night last week, I went home at the end of my shift leaving three patients waiting for the social worker. That was unusual and prompts me to tell you about them.
Lady from Seattle
The paramedics brought us a lady in her seventies. A Good Samaritan found her wandering around, confused, at the bus station. The police were called. They then called paramedics who brought her to the emergency department. The medics told me she had come on the Greyhound from Seattle looking for her son. She had been reported as a missing person, having left her nursing home in Seattle without telling anyone where she was going. The medics suspected her son didn’t even live in our fair city.
The patient said she had no medical complaints. She was a bit strange and had a speech impediment, but knew she was in a hospital in California. She said she had come looking for her son, though she didn’t have any contact information for him. I had no ability, in the middle of the night, to find her a place to go. So, we made her comfortable and she slept until the social worker got there in the morning.
The social worker found out her son did live here. Though he was not expecting his mother, he was glad to come to the hospital and take her to his home.
Open Heart Surgery Man
This guy was in his sixties. Two weeks earlier, he had open-heart surgery to replace a heart valve. On discharge from the hospital, it was arranged for him to go to a nursing home to recover. He came to the emergency department after leaving his skilled nursing facility earlier in the day. He told me he left because “a nurse and I didn’t see eye to eye.” He said he was not recovered from his surgery and wanted to be readmitted to the hospital until he was able to fully care for himself. When I asked him just what problems he was having, he pulled up his shirt and indignantly said, “Well, you can see this is not healed yet.” The scar he showed me running up the center of his chest was healing perfectly well. There was no sign of infection or any other complication. So, I told him there was no reason to be readmitted. However, I also told him the social worker might help him find a different option for getting the care he felt he needed. I suggested he sit in the waiting room until she arrived. As I watched him leave, I wondered what the real story was. Had he gotten upset with the nursing home and chosen to leave? Or, had he done something to get kicked out? He was irritating enough that I figured either of these could easily have been true.
As it turned out, his doctor at the nursing home had decided he didn’t need to be there any longer and had discharged him with plans to go stay with his brother. The patient didn’t want to do that so he came to the hospital to be readmitted. The social worker made arrangements for him to get to his brother’s house and off he went.
Mary Kay Man
The third patient was a man about seventy-years-old. He came in complaining of various problems and wanting to be admitted to a nursing home. He was a homeless alcoholic and nearly blind. He had an irritating, unpleasant personality and was dirty, unkept, scraggly and smelly. Then he told me he sold Mary Kay cosmetics. When he told me that, I found it hard to believe anything he said. “Who the heck would buy Mary Kay from this guy?” I asked myself. The nurse pointed out he had a whole bag of new Mary Kay products among his personal belongs, which certainly left me wondering.
When it was clear he needed no medical care, he, too, went back to the waiting room to wait for the arrival of the social worker in the morning.
As it turned out, the social worker knew this guy well from many similar previous encounters. She learned he lost his housing when he was put in jail. He came to the emergency department that night because, recently released from jail, he had nowhere to go and thought being put in a nursing home would be the easiest way to get off the streets.
The social worker give him some direction to find housing. She also clarified that he had a legit, online Mary Kay business. That helped me understand how he could sell Mary Kay without completely wrecking their brand image.
My daughter-in-law, Elizabeth forwarded this recipe to me. It is not a cheap recipe to make. I used two bottles or macadamia nuts and a big, Costco-sized bag of mangos to make a triple batch for the emergency department. So, they are not for just any cookie craving but they are wonderful for a special event.
Earthbound Farms via Elizabeth
½ cup unsalted butter, softened
½ cup packed light brown sugar
¼ cup sugar
1 teaspoon pure vanilla extract
1 ½ cups unbleached all-purpose flour
½ teaspoon baking soda
¼ teaspoon salt
1 cup white chips
1 cup dried mangos, diced
¾ cup salted macadamia nuts, chopped
1. Position rack in the middle of the oven. Heat oven to 350 degrees F. Line 2 baking sheets with parchment and set aside.
2. In a small bowl, combine flour, baking soda, and salt. Whisk to blend. Set aside.
3. In the bowl of an electric mixer, beat butter, brown and white sugars until light and fluffy, about 2 minutes.
4. Beat in egg and vanilla.
5. Add flour mixture to the egg-sugar mixture, mixing on low speed just until combined.
6. Stir in chips, mango, and nuts.
7. Form dough into 2-tablespoon balls. Arrange 12 on each baking sheet with at least 1-1/2 inches between them. Bake until just golden, about 14 minutes. Let cool completely on the baking sheets.
A middle-aged woman was discharged from the hospital after a three-day stay for treatment of injuries suffered in a car crash. Less than twelve hours later, she was back in our emergency room.
She told me her son took her to a motel room and told her they would spend three days watching TV there until they could get into “the condo.” After settling into the motel, the son left to go out for something and did not return. In trying to get to the toilet alone, she ended up on the floor and was unable to get up. So, she called the ambulance, which brought her back to the hospital.
I clarified she was there only because of not being able to care for herself and not for any new medical problem. I told her we would make her comfortable on a gurney in the hallway until morning when someone from social services could see what might be done to help her.
Feeling comfortable with that plan, I placed her at the bottom of my priority list. Normally, I would have given her little attention for the rest of the shift.
Some time later, I went into a room and smelled cigarette smoke. I asked the people on one side of the room if they had been smoking, which they credibly denied. The other lady in the room was a severely demented nursing home patient who would not be able to smoke if she wanted to. Where was that smoke coming from?
As I walked back into the hall, I noticed an orange Bic lighter on the sheet next to the lady from the motel. I approached her and asked if she had been smoking. Slowly and dramatically, she pulled her hand out from where it had been hiding between the bed and the wall. In it was a lit cigarette. Mind you, this is in California where you basically can’t smoke in any public building. On top of that, this is a hospital! And right in the center of the emergency department! We occasionally catch someone smoking in the restroom, but I have never seen anyone brazen enough to smoke right in front of us.
Anger and indignation welled up inside me. I have never been good at hiding my feelings and in this case, I did not even try. I felt it important that the lady know I was completely disgusted. I said something snotty as I took the cigarette away from her, doused it with water and threw it into the trash.
A couple of hours later, I heard heated voices coming from the area where her gurney was parked. I looked up and saw a young man in conversation with her. I assumed, correctly, that he was her son. Before I could get over to talk with them, I overheard some of their loud conversation including sentences like, “Get me the fuck out of here!” and “Just shut up!”
I wish there were some way for me to paint an adequate picture of the interpersonal pathology displayed between these two people. She showed clear signs of having a personality disorder. Everything was about her. All she could do was be indignant and nasty because she didn’t have everything exactly how she wanted it. She even lit up another cigarette and sat puffing away while her son berated her for behaving worse than his three-year-old.
I tried to intervene but soon realized I was not going to have any positive impact on the way they were dealing with each other. All I could do was give them their options: leave or wait quietly until social services could see her in the morning.
She demanded he take her to the hotel. He insisted she try to get some help. In the end, he took her away, cursing and complaining. I hate to think of how things went when they got back to the motel.
A 67-year-old man was brought in by ambulance after being found unconscious with empty alcohol and pill bottles nearby. A review of his old emergency department visits showed he had a long history of drug and alcohol abuse.
He was so intoxicated there was concern he would stop breathing. So, he was intubated, which means a tube was placed into his windpipe and he was placed on a ventilator. However, other than a high alcohol level and Valium in his urine toxicology screen, nothing else turned up on his emergency department evaluation to explain his altered level of consciousness.
The intensive care consultant who came to see him wanted a CT scan of his brain. Even though there was no evidence the patient had suffered any trauma, the consultant wanted to make sure he didn’t have bleeding in his brain that would explain why he was so out of it.
Everyone was totally surprised when this picture showed up on the scan:
Here is a close up:
Let me help you understand what you are looking at here. This is a side view of the patient’s head. Only the bones show clearly. It can be seen that a nail entered his head from the front, in the middle of his forehead. As it passed back (from right to left on the image,) it went through the skin of the forehead, into the skull and through the frontal sinus, which is an air-filled space in the skull right above the eyes. The nail went in with enough force that it continued through the frontal sinus and stopped with the head of the nail pressed against the back of that same sinus. At the same time, the tip of the nail broke into the space where the brain sits. As it went in, it apparently missed injuring any important structures, sliding right under the bottom of the brain. The tip of the nail then continued out of the brain compartment and ended up in the sphenoid sinus, another air-filled cavity in the skull, back behind the nose.
A recheck of the patient’s forehead, where the nail would have entered, showed no open wound. A recheck of his old visits showed no mention of a nail in the brain. In fact, when the patient was seen two months earlier for a similar spell of intoxication, he had also had his head scanned and there was no nail there then. Because the nail did not seem to have injured his brain, it was felt that the patient’s unconsciousness was due to alcohol and Valium.
The next day, the patient woke up. He said he didn’t know he had a nail in his head and had no memory of any event that might have left him with one. He also denied any headaches or other symptoms that might be caused by having a nail in his head.
The patient was seen by a neurosurgeon who felt that, if having a nail in his skull did not bother the patient, there was no reason to remove it. The patient was discharged with referral for drug and alcohol counseling.
I am sure no one will ever understand exactly what happened. However, the best guess is that some time in the previous two months, the patient was shot in the head with a nail gun. It had been long enough for the puncture wound on the forehead to completely heal over so there was no sign left on the outside.
Beyond that, we have only more puzzling questions. Was he shot on accident at a construction work site? Did someone shoot him on purpose trying, unsuccessfully, to kill him? Did he shoot himself with a nail gun, trying to kill himself? Was he so drunk he really didn’t remember the event or was he lying when claiming to have no knowledge of what happened?
How could you get a huge nail shot into your head, have it penetrate your skin, frontal sinus, inside of the skull around the brain and out into your sphenoid sinus and never develop headaches or an infection? A truly amazing story that is hard to even believe.
When I lived in Mexico, I learned to like cajeta. It is basically caramelized goat’s milk. It comes in various flavors in bottles and can be used like our caramel sauce. Dulce de leche (sweet of milk) is all the rage in flavors now, so no big surprise, I came across a Dulce de Leche Cookie recipe. Rather than make my own dulce de leche, I bought some cajeta from our local Mexican market.
The cookie is just a basic shortbread cookie and super simple to make. The work is in the steps of thumb printing, putting in the cajeta and piping the chocolate.
Recipe adapted from:
1½ cups unsalted butter, softened
1 cup sugar
¼ teaspoon salt
3⅓ cups flour
1½ cups cajeta or dulce de leche, * SEE NOTE
½ cup chocolate chips
1 tablespoon butter
1. In the bowl of your stand mixer, cream together butter, sugar, and salt until smooth.
2. Slowly mix in flour until the dough pulls away from the bowl.
3. Roll dough into 2-tablespoon balls and place on a parchment-lined cookie sheet. Using your thumb,** press the center of the ball to create an indentation.
4. Bake at 325 for 20 minutes, until the edges of the cookie are golden brown. The cookies will have risen slightly, so re-press the indentations if needed. Cool the cookies completely on a wire rack.
5. Spoon some dulce de leche into each thumbprint.*** Melt the chocolate chips and butter in the microwave and stir until smooth. Scoop into a pastry bag and drizzle on top of the cookies.
* Here is a link for various ways to make dulce de leche from sweetened condensed milk. http://www.wikihow.com/Make-Dulce-De-Leche
**I used a cork that was just the right size to make my indentations.
*** Shari was helping me make these. She recommended that we put each cookie, after placing the cajeta, in the microwave for a few seconds until the cajeta flattened and smoothed out a bit. It made them look a lot better.
The pancreas is an organ that lies across the upper abdomen. It has two functions. First, it is where insulin is made. Children who develop diabetes usually do so because their pancreas quits making insulin.
The other function of the pancreas is to make digestive juices, including several enzymes. These are secreted into the gut and help break down the food you eat so it can be absorbed into your body. When the pancreas gets inflamed, these digestive enzymes escape from the pancreas and end up in the blood. The diagnosis of pancreatitis, or inflammation of the pancreas, is made if these enzyme blood levels are elevated.
The most common cause of the pancreatitis we see in the emergency department is caused by drinking an excess of alcohol. If an alcoholic comes in with upper abdominal pain, nausea and vomiting, we measure the level of lipase, one of those digestive enzymes. If it is elevated, the diagnosis is pancreatitis, and we treat the patient with IV fluids and medications for pain and nausea. The patient gets nothing to eat or drink until the symptoms have resolved.
There are many other, less common causes of pancreatitis and it can also occur in children.
One night, I was taking care of a ten-year-old boy who presented with upper abdominal pain and vomiting. We see lots of kids with abdominal pain and vomiting, usually caused by food poisoning or an intestinal virus. There was something different about this boy. He seemed sicker and his abdomen was more tender than we usually see. I ordered laboratory tests that surprisingly suggested the patient had pancreatitis. The pediatrician was called to admit the patient for treatment and further testing to determine the cause of this unusual condition.
While we were waiting for the pediatrician to come see him, I heard a commotion in the patient’s room and went to see what was going on. When I walked in, a nurse and a couple of family members were talking excitedly and hustling around the room. Sitting on the gurney was the chubby patient with a miserable, embarrassed look on his face and tears running down his red cheeks. In his lap, sat a plastic basin holding a mass of squirming, waxy-colored worms he had just vomited up.
I asked him if he had vomited worms at home. He slowly nodded his head and admitted he had flushed them down the toilet before anyone could see them.
Now, there was no reason to wonder why this boy had pancreatitis. He had recently gone on vacation to Mexico and eaten food contaminated with fertilized worm eggs. The eggs hatched into larvae, which moved through the lining of his small intestine. The larvae entered his veins and floated in the blood until they got to his lungs. They then crawled up out of his lungs into the back of his throat and were swallowed. The larvae matured and filled my patient’s guts with worms, some of which he vomited up. Others crawled up into and plugged the duct that carries the pancreatic fluids from the pancreas into his intestine. When the duct was plugged with worms, the pancreatic fluids backed up and made him sick.
The worms were mating inside him and the fertilized eggs were being passed in his stool. In unsanitary conditions, the eggs might have ended up on food that another person would eat and the lifecycle of the ascaris worms would have started over again.
Due to our first-world sanitation, we almost never see such an infection, but up to a quarter of the people in the world are affected with intestinal roundworms.
Fortunately, they are easily killed with anti-parasite medications and, most likely, the boy was going to be fine. Had he lived in a part of the world with no medical care, however, his outlook would not have been so hopeful.
Here are a couple of references if you just have to read more about intestinal worms. Enjoy!
“Sweet with a bit of heat, this no-cook ice cream is a fun change from your usual ice cream sandwiches.”
When I saw this recipe in Extra, the Raley’s/Nob Hill magazine, I thought immediately of Taku Ginger Cookies, which are one of my favorites. I was a bit worried about making ice cream only from coconut milk so I replaced half of it with half and half. I gulped as I put in all that Sriracha and with good reason. I think next time I would try it with half as much hot sauce to make them a little more subtle. Still, with the pepper kick from the ice cream and the ginger kick from the Takus, they really got right in your mouth!
Nob Hill Magazine
2 cans coconut milk, 13.5 ounces each
1 cup sugar
2 tablespoons sriracha sauce
1 teaspoon vanilla
1. Whisk together coconut milk, sugar, Sriracha sauce and vanilla extract in a large bowl. Transfer to the bowl of an ice cream maker and freeze according to manufacturer’s instructions. Chill until firm.
2. Spoon equal amounts between ginger cookies. Freeze until firm.
Taku Ginger Cookies
Recipe adapted from:
Taku Glacier Lodge
1 cup butter, softened
1 ¾ cups sugar
¾ cup brown sugar
1 large egg
1/3 cup molasses
2 ¾ cups flour, 12.5 ounces
1 ¼ teaspoons soda
1 tablespoon cinnamon
1 tablespoon fresh ginger, peeled and grated
1 teaspoon cloves
2 teaspoons nutmeg
½ teaspoon salt
1. Heat oven to 350 degrees.
2. Cream butter and sugars.
3. Add egg, ginger and molasses.
4. Mix well.
5. Combine dry ingredients except raw sugar.
6. Add flour mixture to butter mixture.
7. Mix until just combined.
8. Shape with small ice cream scoop.
9. Roll tops of balls in raw sugar.
10. Bake for about 13 minutes.