Man Assaults Woman

Written by Tad. Posted in Cookies

A 40-year-old woman presented saying a man attacked her earlier in the day. He pulled her legs, kicked her back and cut her with a knife on her arms, legs and chest.

Most of the time, when a woman comes in after being assaulted, she is pretty upset. In this case, my patient was upbeat and pleasant. She  didn’t act very worried that she might actually be injured very badly.

When I looked her over carefully to evaluate her for possible injuries, all I saw was multiple superficial abrasions on the insides of both forearms, across her abdominal wall and both breasts. It was clear they were just scratches and not cuts from a knife. It was also clear from their position, shape and symmetry that they were self-inflicted.

I gently confronted her with my impressions but she continued to steadfastly deny she had caused the scratches or that she had any desire to hurt herself. I recommended she go talk to a psychiatrist but she refused. Had I really thought she was a danger to herself, I would have put her on a psychiatric hold and sent he to psychiatry anyway but I felt this was just strange attention-getting behavior, though I could never get her to admit it.

I had the police come and take a report since she continued to state she had been assaulted. I then sent her on her way, leaving me wondering what was really going on.

Waffle Iron Cookies

Written by Tad. Posted in Cookies

I recently shared a recipe I got from a Daughters of the Utah Pioneers cookbook my wife got from our friend, Louise. This is the only other recipe in that book that was unusual enough to interest me. Who every heard of cooking cookies in a waffle iron rather than baking them? Obviously, they look like no other cookie you have ever seen before. We only have a Belgian waffler you heat on the cooktop. I am pretty sure the author (Mary Nordin) used a regular waffle iron, which would probably be a bit easier.

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Recipe By:

Adapted from Daughters of Utah Pioneeer Cookbook

Ingredients:

1¼ cups sugar
6 eggs
1 cup butter, melted and cooled
1 tablespoon vanilla, ** SEE NOTE
½ teaspoon salt
2 tablespoons baking powder
5 cups flour, 22 ounce
½ cup cocoa (optional)
Directions:

1. Heat waffle iron to medium heat. Oil with cooking spray as needed.

2. Sift together dry ingredients. Set aside.

3. Beat together sugar and eggs.

4. Stir in butter and vanilla.

5. Stir in dry ingredients.

6. Place about 2 tablespoons of dough onto hot waffle iron. Close lid. Cook about a minute or until browned and cooked through.

7. Frost or coat in powdered sugar.

Note:

** Substitute ½ teaspoon anise oil

Yellow and Green Bag

Written by Tad. Posted in Trauma Strap Bags

Most of the trauma straps that come into our department are nine feet long and two inches wide. They are made of nylon or some similar material. Occasionally, straps come in from somewhere outside our county that are different. They are made of the same material as seat belts, which are heavier, smoother and finer than our normal straps.

This bag is first for me in two ways. It is the first time I have actually used the seat belt straps to make a bag and, this one has olive green as an accent. I had never had that color before one showed up this last week.

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Sorry the picture doesn’t do the dark green justice. Believe me, though, it is not black and it looks great with the bright yellow.

 

Uncontrollable Eye Movements

Written by Tad. Posted in Kooks

A twenty-two-year-old woman was brought to the emergency department by her mother for “uncontrollable eye movements.” The patient said, “Every time I close my eyes, my eyes will roll back in my head and I can’t stop them from moving.” She also had uncontrollable twitching all over her body. This had been going on for three weeks and was getting worse, causing trouble sleeping.

She had been to see her primary care doctor who prescribed something for sleep and referred her to a neurologist. Since she seemed to be getting worse, her mother didn’t want to wait for the neurology appointment and brought her to see me.

I watched the patient closely while asking detailed questions about her symptoms and medical history. All the while, I was forming and refining mental lists and questions for myself. After practicing emergency medicine for over thirty years, most of this takes place quickly and subconsciously, but it looks like this…

  • What might cause something like this? Stroke, seizure, trauma, toxicity to medications or environmental substances, neurological conditions like multiple sclerosis, etc.
  • Of the items on that list, what might happen to a twenty-two-year-old, healthy woman? What might come on rather slowly and get worse over three weeks?
  • What might cause these symptoms and only these symptoms so there is no fever, headache, problems with equilibrium or vision, etc?
  • Knowing what I know about the nervous system, the muscles that move the eyes and human behavior, can I find something on the list that might be a realistic consideration in the case of this patient?
  • Is there some sort of laboratory test or imaging study that might help refine the list further?

The patient told me nothing that would help me understand what was going on. She had no past medical history. No psychiatric history. No drug or alcohol use. No exposure to toxins. No seizures or loss of consciousness. Nothing else. She already had blood testing and a CT scan of her brain that were normal.

While we were talking, the young woman sat on the side of the gurney. Everything about her presentation seemed normal: her mental status, hearing and speech. She showed none of the twitching her mother had described. She seemed completely comfortable with her eyes hidden behind dark sunglasses.

When I asked her to remove the glasses, her eyes rolled up so far only the whites, or sclerae, showed. Her eyes moved back and forth up under her half-closed lids.

After a minute or so of this eye rolling, she closed her eyes. I could see they quit moving from side to side and returned to a normal position behind her closed lids. After a few seconds of rest, she would again open her eyes, roll them up, and move them back and forth under her lids. This continued for as long as I was examining her face. As soon as she was allowed to do so, she put back on her sunglasses, which hid her eyes from view.

I asked the patient to perform a couple of simple tasks that test brain or neurological function, things like walking a straight line and moving her pointing finger back and forth between her nose and my finger. When doing these tests, the patient’s eyes came out from under her eyelids and she performed the tasks perfectly. Then, when the test was finished, her eyes rolled back up again.

By the time I was through examining this young woman, I was sure she was fine. I had no idea why she was moving here eyes in this strange way and there was no way to know for sure. Maybe she had some psychological issue that was stressing her out and causing symptoms that had no underlying physical disorder. Maybe she liked the attention and just loved having a concerned mother take her places where everyone paid close attention to her. I don’t know.

Before discharging the patient with reassurance and something stronger to help her sleep, I stopped and ask myself, one last time, if I might be fooling myself and missing something. This last consideration has helped me many times over the years as I try to do a very difficult job.

In the end, the patient put back on her sunglasses, the mother had all of her questions answered, they were assured that the patient would be fine until she could get to see the neurologist, and off they went with me wondering how it was all going to end up.

 

 

I’m Losing Sperm Every Day

Written by Tad. Posted in Kooks

A 35-year-old man came in saying, “I’m losing sperm every day.” He said it was because he was masturbating too much. He said he masturbated so much he was unable to get an erection any more. He masturbated so much he vomited. This was causing him to lose strength and he felt like something was going to burst inside. He said he would wake up in the morning and if he didn’t masturbate, he would vomit and feel sick. He had been having this problem for many years and never talked to anyone about it in the past. He said he didn’t dare talk to his psychiatrist about this because she was female.

There was nothing I could do for him, of course, other than listen and try to help him see that talking to his psychiatrist about this would be a good idea. I also talked positively, saying that she could probably help him, though I was not so sure that was true.

Millet Cookies

Written by Tad. Posted in Cookies

Sometimes, I get inspiration for a new cookies recipe based on what I have that I want to get rid of. I had some corn flour and freeze-dried corn so I made Momofuku Corn Cookies last week for choir. I had forgotten how WONDERFUL they are! If you have not tried them, take a look at the recipe on my blog.

This week, I decided to get rid of some millet  we have had around for a long time. I don’t even remember why I bought it. When you go online and look for cookies containing weird things, you almost always end up in the “health food” or “gluten-free” worlds. That was certainly true as I looked for a millet recipe. Most that I found called for millet flour, usually as a gluten-free replacement for wheat. This recipe caught my attention because, as you can tell by looking at the ingredients, it is neither “health food” nor “gluten-free.” The millet is also roasted and used whole, rather than ground into flour. That interested me and I was not disappointed.

 

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Close up of millet grain.

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A great looking dough ball!

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And an interesting-looking cookie!

 

Recipe By:

cakespy.com

Yield:

30

Ingredients:

1 cup millet
1 cup cashews, coarsely chopped*
1½ cups whole wheat flour
½ teaspoon baking soda
1 teaspoon salt
1 cup unsalted butter, softened
1 cup light brown sugar, packed
2 large eggs
1 teaspoon vanilla
1 cup chocolate chips

Directions:

1. Heat oven to 350 degrees. Line two baking sheets with parchment paper.

2. Toast nuts and millet on a baking sheet while the oven heats. Because they toast at different rates,  scatter the cashews on the sheet and let them toast for about 5 minutes. Add millet, then let the whole tray toast for five more minutes.**

3. Remove from  oven. Set aside to cool.

4. In a medium bowl, sift together  flour, baking soda, and salt. Set aside.

5. Cream butter in a stand mixer until nice and fluffy, 3 to 5 minutes. Add the brown sugar and continue to mix until it becomes fluffy again, 3 to 5 more minutes.

6. Add  eggs one at a time, briefly mixing after each addition until incorporated. Stir in vanilla.

7. Add dry ingredients to the butter mixture, mixing as minimally as possible until everything is incorporated.

8. Add millet, cashews and chocolate morsels. Fold gently into the dough until evenly incorporated.

9. Scoop 2 tablespoon balls of dough onto prepared baking sheets.

10. Bake 12 to 15 minutes, or until toasty on the edges and set in the center. Remove from oven. Let cool on the baking sheet for a minute or so before transferring to wire racks to cool completely.

Notes:

* My Nob Hill didn’t have raw cashews so I bought roasted, unsalted nuts and only roasted the millet.

** I kept waiting for the millet to look or smell toasty but even after 15 minutes that didn’t happen. Next time, I would just toast them for 5 minutes and be done. Does that much toasting even make a difference? Good question for future experimenting!

Bad Parenting

Written by Tad. Posted in Kooks

As a parent, I realize what a difficult job parenting is. Yet, at the hospital, I often see people who are clearly making bad parenting choices. Here are a couple of recent examples:

 

Twelve-Year-Old Girl with Discharge

The mother brought her twelve-year-old daughter in with a foul smelling vaginal discharge. There is really no way for a girl to have such a discharge other than from a sexually transmitted disease. This fact directs our evaluation of a girl with this complaint.

As I asked questions, the girl wouldn’t give any details and the mother seemed offended that we would ask her daughter such “personal questions.” When we tried to get the mother out of the room to give the girl a chance to open up a bit, the mother got upset and refused to leave. It seemed she was paranoid that we were going to do something to her daughter, something she felt determined to protect her daughter from.

The female nurse and I tried repeatedly to help the mother understand that we were there to help them, that her daughter probably had something that needed treatment and we really needed to find out what was going on. Still, the mother refused to let the girl be examined or tested.

At times like this, my fallback response goes something like this: “You brought your daughter here because you are worried about her. We are offering to help, yet you are refusing to let us do that. When you decided to come here today, what were you hoping we would be able to do for you?” In this case, the mother had no answer to my question. Rather than prompting some positive reflection, as I hoped, it just seemed to frustrate her. She left, saying she would take her daughter to their pediatrician.

As they walked out, I was presented with a dilemma. Did this mother’s refusal to allow us to diagnose and treat what was almost certainly a sexually transmitted disease constitute child endangerment? Should I call the police or send a report to Child Protective Services?

In the end, I decided to send an email to their pediatrician and let her try to help. I felt this would be better in dealing with this mother than having authorities come down on her. Who knows if I made the right decision or not.

 

Tattooed Girl

First, let me say that I don’t like tattoos. I am not morally opposed to them, I just don’t find them appealing. I have also talked to too many older people who express some remorse at having been tattooed in youthful exuberance. With time, both the images and their meanings blur. The permanent nature of tattoos would keep me from deciding to have one myself.

With that background, you can imagine my thoughts when I cared for a fifteen-year-old girl with abdominal pain who was COVERED with tattoos: hands, arms, chest, back, abdomen, and legs. Her face was about the only part of her body that I looked at that didn’t have tattoos on it.

First of all, it is amazing a mother would let a kid tattoo herself so extensively. What is the chance a fifteen-year-old is not going to have buyer’s remorse some day when she looks at her body tattooed with images she thought were cool when she was so young?

Another issue is money. I work in a public hospital. Most of our patients are poor and unable to pay for their medical care. It is amazing to wonder where people get money to pay for all the tattooing.

I think it is sad that a mother would spend money on tattoos, money she might not be able to afford. I think it is crazy that the child be allowed to make irreversible decisions, which she might one day regret. I also think it is a sad comment on a tattoo artist who would, even with parental consent, tattoo such a young person.

 

 

Record Setting

Written by Tad. Posted in Kooks

A two-day-old baby who was brought to the emergency department for being “fussy.” As a newborn, the baby had been discharged from the hospital only 5 hours before. This was record-setting! He was my youngest patient ever (except for those I personally delivered.) He was also the patient with the shortest time from hospital discharge to his first visit to the emergency department.

When I walked into the room, a young mother was standing by the gurney. A woman I presumed was the grandmother was also standing there, holding the little baby. The baby was definitely fussy. He was twisting his head to one side and making sucking motions with his mouth.

I spent only a minute talking with them before pointing out that the baby’s behavior showed he was obviously hungry. I suggested they feed him and then I would return to check him.

“How much should we feed him?” the grandmother asked. When I told her to feed him until he didn’t want any more, they expressed surprise. They said they had been told in the hospital to make sure not to feed him more than 20 milliliters so he wouldn’t vomit.

So, either from what they were told or what they misunderstood, they had been purposefully holding back on the amount they were feeding the baby.

My problem was they did not believe me when I tried to help them see that a hungry baby needs to be fed. My advice was at odds with what they understood from the hospital nursing staff. Finally, I called the Pediatrics resident to come spend some time with Mom and Grandma so they were comfortable feeding the poor kid. Once the baby had a full belly, he was fine and off they went. Hopefully, it would be more than five hours before they came back again.

 

Oreo Cheesecake Cookies

Written by Tad. Posted in Cookies

Some time ago, I posted a recipe for Cookies and Cream Cookies. At that time, my daughter-in-law, Elizabeth, sent me a recipe for Oreo Cheesecake Cookies. I just came across that recipe, which I had misplaced. I had Oreo crumbs left over from a holiday chocolate pie crust and cream cheese also left over from the holidays so this was perfect. It made me nervous that they had neither eggs nor leavening, but they turned out great. They are super rich and very interesting in appearance. They are also easy to make.

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Recipe from:

Elizabeth via tablefortwoblog.com

Yield:

16 cookies

Ingredients:

½ cup butter, at room temperature
3 ounces cream cheese, at room temperature
1 cup granulated sugar
1 teaspoon vanilla extract
1 cup flour
½ cup mini chocolate chips
1 cup crushed Oreos, about 10 cookies

Directions:

1. Heat oven to 375 degrees. Line baking sheets with silicone baking mats or parchment paper.

2. In a food processor, process the Oreo cookies until they’re fine crumbs. Set aside.

3. In the bowl of a stand mixer, cream together butter and cream cheese until smooth.

4. Add sugar and vanilla extract. Beat until well incorporated.

5. Gently mix in flour.

6. Stir in chocolate chips with a spatula.

7. Using a two-tablespoon cookie scoop, form into balls. Roll each ball in Oreo crumbs, covering the dough well.

8. Place balls on prepared cookie sheet.

9. Bake 12-15 minutes.

10. Remove from oven when you see  the edges are just getting browned. Let cool on baking sheet for 5 minutes then transfer to cool completely on a wire rack.

Latest Donation to RAFT

Written by Tad. Posted in Trauma Strap Bags

I just made my first strap delivery to RAFT in 2015. I dropped off 1541 trauma straps that I have kept from going into the trash in the last few months. Here is what they looked like in the back of my car.

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Copyright © 2014 Bad Tad, MD