Archive for April, 2012
Our Patient of the Week was 29-years-old and had to be taken down by the police with a Taser (which stands for Thomas A. Swift Electronic Rifle.) He had a long history of psychiatric problems. That night he had been drinking and maybe doing drugs before he slashed his scrotum with a razor. The paramedics reported he was talking “in several languages” but he would not talk to me.
He had very bizarre behavior and had to be tied to the gurney with leather restraints on his ankles and wrists. He made it very difficult to get a good look at his scrotum but I was able to see he had several cuts through the skin with no evidence of any injury to underlying important structures. The bleeding had pretty much stopped.
My evaluation included confirming that he was, indeed, known to be crazy and making sure he was not in need of treatment for any metabolic problems. When I offered to sew up his scrotum, he refused so the nurse dressed it as best she could.
In the mean time, the police who had been called to the scene had learned he was wanted on several warrants so they placed him under arrest. They took him and his dressed scrotum to off to jail.
Not long after he left, the emergency department charge nurse told me she had taken a call from the nurse at jail saying the patient’s scrotum was bleeding and they were sending him back. Though I was pretty sure he didn’t need to come back, I was not too surprised that a nurse at the jail wouldn’t be comfortable with a bleeding, crazy scrotum.
When he returned, he had a little blood in the dressing and no active bleeding. This confirmed my impression that he would have been fine just staying where he was. This time he let me put some stitches in the cuts. Truth be told, it was mostly for sake of the jail nurses.
We have such a focus on first aid in our society that people have a hard time believing that no cut has to be sutured. We do suturing for two reasons. One is to make for a smaller scar. I would say it was not too important in this case. The second is allow the cut to heal up faster which I am sure was of some benefit to him. But, the fact is that, given enough time, ALL cuts will eventually heal. We often hear people worried that if the cut is not sewn, it will lead to infection. Again, the truth is that suturing a cut actually increases the risk of infection.
These sound a lot like those Mexican Wedding Cookies (which I don’t like) so the recipe made me nervous but they really are good.
1 dozen cookies
1 cup butter, softened
½ cup white granulated sugar
1 teaspoon vanilla extract
1 tablespoon instant coffee powder
¼ cup cocoa powder
¼ teaspoon salt
1 ¾ cups all-purpose flour, 8 ounces
1 ½ cups finely chopped pecans or shredded coconut
Heat oven to 325°F. Place rack in middle position.
Combine butter, white sugar, vanilla extract, instant coffee powder, cocoa powder, and salt. Mix well.
Add the flour in half-cup increments, mixing after each addition.
Stir in the nuts or coconut and make sure everything is evenly distributed.
Use a 2 tablespoon scooper to form balls. Place them on prepared baking sheets.
Bake for about 12 minutes, until they are set. Do not over bake!
Move the cookies to a wire rack. Let them cool completely.
When completely cool, dip in powdered sugar to coat.
Years ago, my in-laws took us on a cruise in Alaska. As a side trip, they flew us out of Juneau to Taku Glacier Lodge for dinner. I was not very excited about that much hassle and expense for a touristy dinner but everything we ate there was just fabulous. So good, in fact, that I bought their little cookbook from the gift store. Having this recipe has been worth the whole trip.
I usually scoop my cookies with a 2-tablespoon scooper but I use a 1-tablespoon scoop for these.
The dough is soft so you have to handle the balls carefully as you drop them in the sugar then place them on the baking sheets.
I like to cook them until they are just a bit crunchy on the edges but chewy in the center. They are really good.
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.
I have used raw sugar but what really makes these cookies is using something like KingsBlingz White Diamond Crystalz, which I get at http://www.dutchvalleyfoods.com/.
One night, I had an amazing patient. It is hard to do justice in a note like this just how amazingly bizarre he was. He came in by police at about 6:00 in the morning. I sat and listened for maybe half an hour while he told me his story.
He developed complications of gastric banding surgery. He was in a Veterans Administration hospital in city across the state for six months before being transferred to a VA hospital close to us where he had been for a year! He told me about how the police had arrived at his hospital room the day before as the doctors pulled out his IVs and drains. He was taken in hand cuffs to jail where he was booked on warrants for old misdemeanors. He told the most pitiful story of illness, innocence and victimization.
As I read through the papers that came with him, there was quite a different story. He was believed to be a sociopath who was malingering in the hospital in order to not go to jail for his felony warrants. He told them he was unable to eat anything so they were giving him total parenteral nutrition (TPN), which means everything you need for survival intravenously. When he was found to be gaining weight, they searched his room and found hidden food. The report went over other crazy stuff they had been putting up with for a year and half with the guy.
On the way to the jail, he told them he felt ill so they took him to another hospital near us where he got evaluated, cleared and sent on to jail. As soon as he got to the jail, the nurse who evaluated him decided he was too sick for jail and refused him, sending him to us. So, after a year and a half in a hospital, being deemed safe for discharge then going to a second hospital where he was deemed safe for jail he is now in my ED. For an emergency physician, this is a nightmare.
I looked at all of his stuff and sent him back to jail. I am told he refused to walk or to sit up on the bench in the custody van so he was taken back on the floor of the van, handcuffed to the underside of the bench. I am sure that was not the last time we will be seeing this guy.
The other night the paramedics brought in a woman with burns on most of her scalp. The medics said when they got to the residence, the patient was screaming hysterically. They could see a fire had been burning in the fireplace and some partially burned wood was scattered out onto the hearth. The fire appeared to have been recently put out and there was water in and around the fireplace as well as on the carpet, the couch and the patient. When the medics asked the patient what happened, all she would say was, “I have lice!” The best they could guess from looking at the scene was she had put her head inside the fireplace to burn her hair in order to get rid of the lice. Water had then apparently been used to douse her and the fire.
By the time she arrived in the emergency department, she had stopped screaming because the medics had given her morphine. Now she could not keep her eyes open and was unable to answer questions.
She certainly painted a pathetic picture. She was very obese, had no teeth and her tongue kind of stuck out as she snored. Some of her hair had obviously been cut off near the scalp before this event. Most of the scalp and her ears were burned.
I reviewed records from previous visits, which showed she was diagnosed with schizophrenia. Her urine drug screen showed she had taken phencyclidine, also known as PCP or angel dust. That is just the worst combination: a drug that makes you crazy taken by a crazy person.
The burns were not severe enough for her to be admitted to the burn unit so we cleaned her up, dressed her head and sent her to the psychiatric emergency department.
A real cookie-baking snob wouldn’t even look at a recipe like this, let alone make them and like them. This is as easy as cookie baking gets and they are really fun. I don’t like cake mixes. I don’t like white chips. Yet I really like these. Give them a try!
Recipe By: San Jose Mercury News
Serving Size: 24
1 box chocolate cake mix with pudding
2 large eggs
½ cup canola oil
1 tablespoon vanilla
1 cup nuts, chopped (optional)
1 cup coconut
1 1/2 cup white chocolate chips
1. Heat oven to 350 degrees.
2. Mix all ingredients together.
3. Bake for 12-13 minutes.
Watch out because the chips tend to separate out and go to the bottom. I actually have to dump the dough out of the KitchenAid then mix it up and scoop it from the counter to keep the chips evenly distributed in the dough.
They are tender and people frequently comment on them being like brownies.