Don’t bake these if you want a subtle, light cookie. These really get in your mouth. First, the flavors. Chocolate from lots of cocoa. Smoke from chipotles and smoky sea salt. Bight from chipotle and black pepper. Oh, and some cinnamon. Then, they are pretty sweet and quite salty. Don’t plan on eating more than one.
8 sandwich cookies
1½ cups sifted all-purpose flour, 4.5 ounces
¾ cup sifted unsweetened high quality cocoa powder, 2.25 ounces
1 teaspoon ground cinnamon
½ teaspoon ground chipotle pepper (or ⅛ teaspoon smoked paprika or cayenne)
½ teaspoon kosher salt
¼ teaspoon ground black pepper
½ cup unsalted butter, softened
1 cup granulated sugar
2 teaspoons pure vanilla extract
1 tablespoon cocoa nibs, chopped (optional)
1 cup cream
½ cup sugar
¼ cup water
Pinch of cream of tartar
½ teaspoon smoked or sea salt
1. Heat oven to 325 degrees. Cut parchment to fit baking sheet(s).
2. Sift together flour, cocoa, cinnamon, chipotle, salt and pepper.
3. Using electric mixer, cream butter and 1 cup sugar for 3 minutes. Add egg and vanilla. Mix until blended.
4. Add dry ingredients and cocoa nibs. Beat on low speed just until incorporated. Don’t over mix.
5. Shape dough into 2 disks. Wrap in plastic wrap. Freeze dough for 10 minutes to firm. (I didn’t find this to be needed.)
6. Using a rolling pin, roll out dough ¼-inch thick. Using a cutter, cut out cookies. Transfer to prepared baking sheets. Bake until cookies are soft to the touch and no longer shiny, 8 to 10 minutes. Cool on pans for 2 minutes. Transfer to a rack to finish cooling.
7. For caramel sauce: In small saucepan set over medium heat, reduce the cream to ¾ cup. Set aside.
8. In another small saucepan, combine sugar, water and cream of tartar. Bring to a boil — do not stir — and cook until the caramel turns an amber color. (You can do this on high heat but just watch because the time from amber to burnt is very short.) Remove from heat.
9. Carefully add reduced cream and smoked salt, stirring until smooth. Cool completely.
10. To assemble: Place a dollop of caramel on a cookie. Top with a second cookie to form a sandwich. Repeat with remaining cookies.
Make sure to reduce the cream to at least ¾ cup. If the cream is too runny, the caramel will be, too, and they will be a mess. I even had to add some powdered sugar to them caramel one time to keep it from running out of the cookies.
I had two patients from a single car crash. He was the driver and she was the front seat passenger. Neither was wearing a seat belt. She told us that he was very drunk and went to get in the car to drive away. Though she was also drunk, she was afraid to have him drive while being so drunk so she jumped in the car with him “to make sure he was OK.” He caused a crash in which they were both seriously injured and brought to the emergency department.
We, in the emergency department, are all in favor of designated drivers but I am pretty sure that the people who came up with the idea of a designated driver did not were not thinking of a Designated Passenger.
A middle-aged man had so much to drink before climbing into the hot tub at the hotel that he soon slumped under the water and nearly drowned before other guests noticed him. They pulled him out, started CPR and called 911.
Because of the effects of the alcohol and the near drowning, he had to be placed on a ventilator and be admitted to intensive care. He had a significant chance of having permanent brain damage or even dying because of the lack of oxygen to his brain while he was under the water.
A few years ago, our kids took us to eat Belgium waffles at Bruges Waffles & Frites in downtown Salt Lake City. One option to top the waffles was speculoos cookie butter. Every since that tasty introduction, speculoos cookie butter has been a part of our lives. When we first started to eat it, I had to order it online. Now, we can buy it at our local Nob Hill or Trader Joe’s. It is basically peanut butter made by grinding vegetable oil with crunchy speculoos cookies instead of peanuts. Here is a recipe to try to reproduce those spicy, crunchy cookies.
Recipe By: King Arthur Flour
1 1/2 cups King Arthur Unbleached All-Purpose Flour
1/2 cup toasted almond flour, or almond flour
1/4 teaspoon baking soda
3 1/2 teaspoons cinnamon
1/4 teaspoon nutmeg
1/8 teaspoon ginger
1/8 teaspoon white pepper
1/8 teaspoon aniseed powder
1/8 teaspoon cardamom
1/2 teaspoon salt
1/2 cup unsalted butter, at room temperature
3/4 cup granulated sugar
1 teaspoon vanilla extract
1 large egg
1. In a small bowl, combine the flours, baking soda, spices and salt. Set aside.
2. In a large mixing bowl, mix together the butter and sugar. Add the vanilla and egg. Mix until well blended.
3. Stir in the flour mixture.
4. Form the dough into two disks, wrap in plastic, and refrigerate for 2 hours or more.
5. Lightly grease (or line with parchment) two baking sheets.
6. Working with one disk at a time, roll the dough 1/8″ to 1/4″ thick.
7. Use any shape cookie cutter to cut out shapes.
8. Transfer the cookies to the prepared baking sheets and freeze for at least 30 minutes. This helps the cookies retain their shape while baking.* See Notes.
9. Fifteen minutes before baking the cookies, heat the oven to 300°F.
10. Bake the cookies for 25 to 30 minutes, until they’re light gold around the edges. Remove them from the oven, and cool them right on the pan.
My baking sheets will not fit in my freezer. I have to place the cut-out dough on a plate covered with wax paper and place the plate in the freezer.
My wife, Shari, forwarded me a link to a segment on NPR about Gambler’s Fallacy. In short, Gambler’s Fallacy refers to our brain’s tendency to see patterns in random events then thinking those patterns can predict future events.
A simple example is a gambler betting on whether a flipped coin turns up “heads.” Each coin flip has a 50:50 chance of resulting in “heads.” If, in a series of flips, “heads” come up several times in a row, the gambler thinks the next one just has to be “tails,” even though heads is still a 50:50 chance in each flip. The gambler puts all his money on “tails” since, after so many “heads” in a row, the next throw just has to be “tails.” He looses his money when “heads” comes up again.
An interesting example of the Gambler’s Fallacy played itself out in our emergency department last week.
I was seeing a 9-year-old girl who had abdominal pain for three days. From her examination and laboratory tests, it looked for all the world like she had appendicitis. Coincidentally, her 12-year old sister had just had her appendix taken out that day in our hospital.
My patient got sick the day after her sister. Her family had just kind of ignored her complaints because she had not seemed very ill and everyone’s attention was drawn to the sister who had been admitted to the hospital for surgery.
Eventually, Mom and Dad brought her to the emergency department wondering if she might also have appendicitis. Everyone taking care of her saw that she had the symptoms of appendicitis and that her abdomen was tender like you would expect in someone with appendicitis. But no one was willing to take her to the operating room and cut out her appendix because her sister had just had the same operation. It was such a big coincidence that it made everyone uncomfortable.
Still, the 9-year-old was too ill to send home, so she was admitted to the hospital for observation. The next day, it was clear she needed an operation. Operate they did and, sure enough, found her to have appendicitis.
So, two sisters both came down with appendicitis within a day or two of each other and both had an operation and were in the hospital at the same time.
Here is the link to the NPR story on Gambler’s Fallacy:
I have been thinking tonight, for some reason, about vomit. Not just vomit but also vomiting. I think I will give an overview of my life’s experience with vomit and vomiting and some highlights, if you will, of my medical experience with the same.
Our daughter-in-law, Elizabeth, claims to have never barfed in her life. I have vomited so many times that it just seems to me like a normal thing to happen to all humans. Usually vomiting is caused by eating something bad (“food poisoning”) or an intestinal virus (“stomach flu”) that you catch from another person.
It is so common that I am amazed when people come into the emergency department and think they are dying because they are vomiting. Or they want to know exactly why they are vomiting and are amazed when I am unable to tell them.
I remember the first time our son, Philip, vomited. He was about a year old. We were sitting in church and out it came, all over. I grabbed him up, put my hand over his mouth and ran out, vomit dripping behind us. I remember looking at him later in the day and feeling so sorry for him. I knew he would be fine but still felt bad for him, especially being so little and unable to understand what was happening.
When our daughter, McKenzie, was about the same age, she vomited grape juice on the dining room floor, which left a purple stain that was with us until we got new carpet.
Our daughter, Hilary, always seemed to vomit when we were traveling. She spent the night vomiting into a stinky pit toilet on a night fairy in Thailand when she was about eight. We never even knew she had done so until morning, when she gave told us about it. She did the same on Christmas Day in a yucky airport bathroom in Peru.
The first truly memorable vomit I remember as a medical student came when I was working at the Veterans’ Hospital. I was caring for an elderly patient who had a blockage in his rectum. Nothing could go out down below so he was vomiting stool. I would have been totally grossed out by the idea of vomiting poop but watching someone actually do it was pretty hard for a new medical student to take. I remember really feeling sorry for him as we tried to provide him some relief.
Blood causes the most exciting vomit. People with ulcers can vomit some blood, which can sometimes be dangerous, but liver patients are the ones with really scary bloody vomit. They develop esophageal varices which are swollen, engorged veins running around the lower esophagus. The blood in them is under an unusually high amount of pressure and, if they bleed, they really bleed. I am talking about huge volumes of pure blood, gushing out, uncontrollably. When this happens, it is about as scary as anything I have to deal with as an emergency physician. Someone like this can die, and die fast, so a huge effort is launched to control the bleeding and replace what is being lost. It is not unusual in this situation to end up with blood all over the patient, the bed and bedding, the curtains and walls and the healthcare providers. This is exciting vomiting.
I recently posted on this blog about the boy who had pancreatitis and we only discovered the cause when he vomited a huge pile of wriggling, waxy-looking round worms. He admitted he had vomited worms at home but had flushed them. He didn’t tell anyone because he was embarrassed. Everyone there was truly grossed out by vomiting worms.
Another noteworthy episode of vomiting came from the only patient I have ever taken care of who was struck by lightening. He was in his twenties and had apparently just finished eating a luncheon-meat sandwich before being struck by lightening while seeking shelter from a big thunderstorm.
He was lucky enough to quickly have his heart returned to a normal rhythm. As he was coming to, he vomited, which is not unusual in such a situation. What was unusual was that the sandwich meat all came out in rounds, the size of his mouth, with jagged edges from where his teeth had bitten off the meat. The fact that the meat was still in these rounds proved he had swallowed the meat without having chewed it. When he recovered, we discovered he was developmentally disabled, perhaps explaining why he would wolf down a sandwich without chewing it.
All little babies urp up their milk. This bothers some new parents who bring the baby in to the emergency department worried it might be something serious. Most of the time, it is not serious but sometimes it is. One vomiting condition that can develop in little babies is pyloric stenosis. The muscle around the opening from the stomach to the first part of the small intestine is too thick and keeps the baby’s food from passing out of the stomach. These kids get real vomiting, not just urping up. In is often described as “projectile vomiting,” to differentiate it from normal baby barfing. My parents say that when my little brother had this, he vomited so badly and lost so much weight that they were afraid he would die. Once the diagnosis is made, this is easily treated with a minor surgery and the baby is back to milk and normal baby barfing again.
I see and hear people vomit every day at work. Still, as you can see above, not all vomiting is created equal.
A friend of mine, Janine, brought me a bag of curry-flavored granola. She bought it but the curry flavor was a bit too much for her. I used it, rather than the oatmeal I usually put in my trademark chocolate chip oatmeal recipe. It was subtle but a couple of people in the emergency department immediately recognized the unusual flavor. I think I will try it again with some other kind of granola. Thanks, Janine!
Serving Size: 72
1 cup shortening
1 cup butter, softened
1 1/2 cups sugar
1 1/2 cups brown sugar
1 tablespoon vanilla
3 cups flour, 14.5 ounces
2 teaspoons soda
1 1/2 tsp cinnamon
3 cups curry-flavored granola
4 cups chocolate chips
1. Heat oven to 350 degrees.
2. Cream butter and sugars until fluffy.
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 chocolate chips and granola.
7. Form into balls on cookie sheets.
8. Bake 13 minutes or until just turning brown on the bottom and around the edges.