A 47-year-old man came in with so many complaints that, after I listed them, there was no more space to write on the chart. Here they are:
Exposed to various contaminations: oil, paint, varnish, and ZEC for several days.
Banged his knuckle.
Trouble with ventilation: the heater in his house contaminated with fumes.
Comet cleanser used to clean the sink caused fumes that caused him to almost pass out.
Tide and garden chemicals that were by the heater were pumped through the heater.
Left nasal pain for 2 days since he picked it.
Painters’ soap up left nose.
Spitting up “crap.”
Varnish comes in through the windows from outside the house because of the cold weather.
Contaminations in food, coffee and water.
Vomiting and coughing up brown varnish.
Numbness in hands.
Spitting up soda after using Comet.
Finding pockets of air with varnish in them all around the house. Unable to ventilate the house so it just keeps coming back in.
Washer and dryer cause his body to vibrate.
Gets sick while smoking cigarettes and marijuana.
Feels better after putting hydrogen peroxide on his hand.
Decrease in bowel transit time.
Has “fatigue points” on his legs that are sore.
His van clogs up with “smog cast” that he can’t clear out.
As I have said in the past, I really don’t like white chips. I think they taste like medicine and think it is wrong to even connect the word chocolate to them. Still, I am not so closed minded that I do not try a new recipe just because it calls for white chips. What caught my attention on this recipe was the box of coconut-flavored pudding. Truth be told, I was not expecting them to be very good. I think the white chips go pretty well with the coconut and I am not sure what the pudding does for them. Anyway, they are fun, easy to make and come out very uniform and pretty, which is very satisfying.
1 cup unsalted butter, at room temperature
¾ cup brown sugar
¼ cup granulated sugar
3.4 ounce package Coconut Creme instant pudding mix (Jell-O Brand)
2 large eggs
1 teaspoon vanilla extract
2¼ cups all-purpose flour
1 teaspoon baking soda
½ teaspoon salt
1 cup sweetened shredded coconut
2 cups white chocolate chunks or chips
1. Heat oven to 350 degrees. Line a baking sheet with parchment paper or silicone baking mat and set aside.
2. Using a mixer, beat together butter and sugars until creamy.
3. Stir in pudding mix, eggs, and vanilla extract.
4. In a medium bowl, whisk together the flour, baking soda, and salt.
5. Add the dry ingredients to the wet ingredients and mix until just combined.
6. Stir in the coconut and white chocolate chunks.
7. Drop cookie dough by rounded tablespoons onto prepared baking sheet. Bake for 10-12 minutes, or until slight golden and set. Remove cookies from oven and let cool on baking sheet for two minutes. Transfer to a cooling rack and cool completely.
We all search for patterns in life. It is the way our brains allow us to navigate this crazy, complicated existence. As I have saved interesting cases over the years, I have been sensitive to certain patterns, coincidences.
Here are some stories that are not that amazing, on their own. But the coincidences are just too good to not notice and celebrate.
Two Febrile Seizures
Some young children suffer convulsions when they have a fever. It is not really known why this happens or why it doesn’t happen to older children or adults. Fortunately, it is a benign condition though it does scare the socks off of uninitiated parents. It is not a rare condition but most children who have a fever obviously do not suffer seizures. If one sibling in a family has had a febrile seizure, there is an increased risk that other siblings might also have one.
One night a young mother and father brought their two children into the emergency department for evaluation after both suffered febrile seizures the same day. I was wondering how in the world you would calculate the likelihood of that happening but it is amazingly unlikely.
I was taking care of a seventeen-year-old girl. She was a troubled soul being cleared for methamphetamine abuse so she could go to custody. The officer said she was a runaway and would be going back to Sparks, Nevada as soon as they could make the arrangements.
When I heard that, I told her I used to live in Sparks. I said, “I went to Alice Maxwell Elementary School.”
“So did I,” she said. Then she told me she lived on Sbragia Way! That is only three blocks away from our old house on 1165 Vance Way.
Now, what is the chance that I would have a patient who went to Alice Maxwell and even stranger that we would put it together?
Last week, in the middle of the night, I was hustling around seeing patients. When it was time to go see someone new, I noted two new patients had been placed in beds 1A and 1B, next to each other in the same room. I also noted they were both 3 month-old babies with fever. “Twins,” I thought.
Then I noted they had different last names. Of course, that slowed me down so I decided to check dates of birth. One was born 5/20 and the other 5/21. “Twins, one born just before, the other just after midnight? But with different names?”
Next, I decided to check the street addresses as a quick check. Wow. They both lived on the same street. As I went in to talk to the mother of the two kids, a boy and a girl, I was really interested to see what the story was.
In room 1A, I found a single mother with a baby girl. “Where is the other baby?” I asked. The mother gave me a confounded look and I am sure I was giving the same sort of look back at her. This forced me to do what I should have done in the beginning, check carefully until I understood what was up. Yes, different names, born one day apart, both with fevers, both lived on 9th street. But, Lucinda Garcia lived on 6353 8th Street and Jose Ramirez lived on 2735 8th Street! So, at the same time of the night, two babies with fevers, Hispanic names, born on consecutive days and lived on the same street were placed in the same room for me to care for. It is an amazing coincidence. Call me weird but I really like that sort of thing.
I am not a big raisin fan. Still, on occasion, I have eaten an oatmeal raisin cookie that was just delicious. What I like is a chewy texture, almost like eating candy and not too spicy. I offer to you my best effort so far to achieve that sweet chewiness that goes so well with raisins.
2 cups butter
1 ½ cups sugar
1 ½ cups brown sugar
½ cup honey
1 tablespoon vanilla
3 cups flour, 13.5 ounces
2 teaspoons soda
2 teaspoons cinnamon
3 cups oats, 9.5 ounces
3 cups raisins
1. Heat oven to 300 degrees.
2. Cream melted butter, sugars and honey until combined.
3. Beat in eggs and vanilla.
4. In separate bowl, sift together flour, soda and cinnamon.
5. Stir flour mixture into sugar mixture.
6. Stir in oats and raisin.
7. Form into 2 tablespoon balls on parchment-lined cookie sheets.
8. Bake 20 minutes or until just turning brown on the bottom and around the edges.
I have not had a chance to do much sewing recently. This week, I finally had a chance to make up some bags for some friends who had asked.
Tara, one of our physician assistants, asked for a large orange and black, which I view as my “classic” bag.
Chris, one of our emergency techs, asked for a large one with a flower for someone special.
Here are the bags I got to sew this week.
Another S’mores Cookie recipe. What I really like about this, over all the others I have tried, is that it really resembles campfire S’mores. The cookie is the the most grahamy I have made. The gelatin-free marshmallows don’t melt but keep their presence as actual marshmallows. The milk chocolate is present like a Hershey bar. And they look fabulous, don’t you think?
2 cups graham cracker crumbs
1½ cups flour
1 teaspoon baking soda
½ teaspoon salt
1 cup butter, softened
¾ cup sugar
¾ cup firmly packed brown sugar
1 teaspoon vanilla
1 bag gelatin-free marshmallows, cut in half*
bulk milk chocolate, gently melted and tempered**
1. Heat oven to 350° F.
2. Combine graham cracker crumbs, flour, baking soda and salt in small bowl. Set aside.
3. Beat butter, granulated sugar and brown sugar in large mixer bowl until creamy.
4. Beat in eggs and vanilla extract.
5. Gradually beat in flour mixture.
6. Scoop a tablespoon of dough onto parchment lined baking sheet. Flatten.
7. Place half-marshmallow in the center of the flattened dough ball.
8. Scoop another tablespoon of dough and press it onto and around the marshmallow, sealing the edges all around.
9. Bake for 12 to 14 minutes or until set. Cool for 2 minutes on baking sheets. Remove to wire racks to cool completely.
10. When completely cool, dip the bottoms of the cookies into the tempered chocolate to cover the bottom and a bit up the sides. Wipe the excess chocolate off before placing on waxed paper to cool completely.
* I bought these at Whole Foods.
** If you are not familiar with tempering chocolate, it is not hard. Here are a couple of references for you to chew over.
The medics brought in a middle-aged woman who was in cardiac arrest. Her husband had found her down and called 911. The medics found her in arrest, started CPR, injected her with adrenalin and brought her to us.
When medics bring in such a patient, it causes quite stir in the emergency department. Pretty much everyone stops what he is doing and goes to help. The patient has to be transferred onto our gurney, chest compressions continued and oxygen has to be blown down into the lungs. The patient has to be hooked up to the cardiac monitor and checked to see if there is any sign the heart has started beating again. All of this has to be done as fast as possible and the more hands helping, the faster it gets done.
As everyone was pitching in doing all these things for this lady, I turned my attention to her airway. It was obvious right away that, during CPR, she had vomited and there was liquid vomit in her mouth and the back of her throat. I suctioned that out, looked in with a laryngoscope* which is a curved, lighted blade designed to move the tongue out of the way to be able to see the vocal cords**. Once the cords are seen, a tube can be passed through them in order to get oxygen-carrying air down into the lungs and keep vomit out***.
As soon as I had got the tube in place, I turned my attention to the patient’s heart. I asked that CPR be paused while I looked at the monitor, listened for heart sounds and felt for a pulse. Not finding any evidence the heart was beating, I put an ultrasound probe on the chest wall, over the heart, and confirmed no cardiac activity. She was dead.
I took a minute to look over her, to make sure I hadn’t missed anything. I thanked everyone for helping so efficiently, then went to write a note about what had happened.
As I was sitting at my desk, the registration clerk came to me and told me the patient’s husband had arrived with a boy who looked to be about twelve years old.
“He knows,” she said.
In reply to my quizzical look, she told me the husband had asked her if his wife was alright. When she told him she had not been taking care of the patient but she would have the doctor talk to him, he turned to the boy and said, “She’s dead.”
After the husband and son were escorted to the Family Room, I went to meet them. I introduced myself, made sure he was the husband, then told them she was dead. I told them the medics had done everything they could to revive her but that she was already dead when she got to us.
“No!” the man hollered as he stood and threw his head down into his hands. “No!”
He then collapsed back onto the couch and moaned with his eyes closed and his hands on his pained face.
The boy leaned over his father, put one hand on his arm, patted him gently on the back and said, “It’s OK, Papa. It’s OK.”
Going and telling someone that his or her loved one is dead is one of the worst parts of my job. I never know what to expect. I certainly was not expecting this and it made my interaction with them especially poignant.
** Here is what I see when I get a good look at the vocal cards. The endotracheal tube is passed between them, through the opening.
***Here is what the tube looks like.