Archive for April, 2013

Shortness of Breath

Written by Tad. Posted in Kooks

A 22-year-old lady with no medical history presented with lower abdominal pain and shortness of breath. She had been seen the day before by one of our physician assistants who diagnosed her with bronchitis and prescribed erythromycin. She came back because she was getting worse.

When I went in the room, I saw a trim young woman who was hyperventilating and clearly in distress. As I talked with her, she relaxed and became quite comfortable. Her physical examination was normal except for an obviously distended abdomen. Just as I went to examine her abdomen more closely, it tightened up and she started to hyperventilate again. Getting the big picture, it became clear to me she was in labor. Her contractions were causing her pain and distress leading to hyperventilation. She had no breathing problem at all. She was about to have a baby.

When I shared my impression with her, she became very upset. She said there was no way she was pregnant. She had normal periods every month and could not possibly be pregnant.

As she told me this, her abdomen softened and she relaxed. I realized I could be wrong so I excused myself to go and get a Doppler, which is an electronic listening device that can detect blood flowing and turn it into sound. When I placed it over her abdomen, the rapid swoosh, swoosh, swoosh of a baby’s heartbeat was clearly audible. I told her she was, indeed, going to having a baby.

“No!” she screamed, and started to sob. I tried to comfort her, which was not helpful. I told her we were sending her up to labor and delivery. She made no response but continued to cry.

As she was leaving, I asked if there were anyone with her. Between sobs, she told me her mother was in the waiting room, but cried, “Don’t tell my mother!”

“You think she’s not going to find out?” I asked. She collapsed back on the gurney and sobbed uncontrollably. Off she went to labor and delivery.

When I told the mother the news, she was subdued but didn’t seem really surprised. When I asked her if she had not noticed her daughter getting big, she said, “We just thought she was gaining weight.”

 

Winner of the First Annual Get a Bag Contest

Written by Tad. Posted in Trauma Strap Bags, Uncategorized

Thanks to everyone who contributed to my first annual Get a Bag Contest  I announced last month. A lot of people sent in many wonderful ideas. Some of them like sexy night wear and prom dresses will probably stay on the drawing board indefinitely but some of the others have my mind going already!

Anya is the winner of the contest. She sent in a lot of great ideas and here is what I made with one of them. It is a belt case that will hold both my Leatherman and my trauma shears, which I usually hang from a retractable key ring on my belt. As I have mentioned before, sewing little things is pretty tricky and I had to go through several tries before I got it right. Big problem: no room for one of my BadTadMD patches!

 

Thick and Chewy Triple-Chocolate Cookies

Written by Tad. Posted in Cookies

As I have said, there are many chocolate cookie recipes. This one stands out for being very rich and moist. I heard “brownie” several times as they were being devoured at work last week. This amount of coffee gives them a little extra bite, along with rich chocolate, but it was subtle enough that few people even detected they were “mocha.”

Source:

Baking Illustrated

Yield:

About 42 cookies

Ingredients:

2 cups (10 ounces) all-purpose flour

½ cup (1½ ounces) Dutch-processed cocoa powder

2 teaspoons baking powder

½ teaspoon salt

16 ounces semisweet chocolate, chopped

4 large eggs

2 teaspoons vanilla extract

2 teaspoons instant coffee or espresso powder

10 tablespoons unsalted butter, softened but still cool

1½ cups packed (10½ ounces) light brown sugar

½ cup (3½ ounces) granulated sugar

12 ounces (about 2 cups) semisweet chocolate chips

1. Sift together the flour, cocoa, baking powder, and salt in a medium bowl. Set aside.

2. Melt the chocolate in a medium heatproof bowl set over a pan of almost-simmering water, stirring once or twice, until smooth; remove from the heat. (Alternatively, you could melt the chocolate in the microwave. If you do so, be really careful not to burn it. I use a double boiler.) Set aside.

3. In a small bowl, beat the eggs and vanilla lightly with a fork, sprinkle the coffee powder over to dissolve, and set aside.

4. Either by hand or with an electric mixer, beat the butter at medium speed until smooth and creamy. Beat in the sugars until combined. The mixture will look granular.

5. Reduce the speed to low and gradually beat in the egg mixture until incorporated.

6. Add the chocolate in a steady stream and beat until combined.

7. Scrape the bottom and sides of the bowl with a rubber spatula. With the mixer at low speed, add the dry ingredients and mix until just combined. Do not overbeat.

8. Fold in the chocolate chips. Cover with plastic wrap and let stand at room temperature until the consistency is scoopable and fudge-like, about 30 minutes.

9. Meanwhile, adjust the oven racks to the upper- and lower-middle positions and heat the oven to 350 degrees. Line 2 baking sheets with parchment paper. Scoop the dough onto the prepared baking sheets with a 1¾-inch ice cream scoop, spacing the mounds of dough about 1½ inches apart.

10. Bake until the edges of the cookies have just begun to set but the centers are still very soft, about 10 minutes, rotating the baking sheets front to back and top to bottom halfway through the baking time. Cool the cookies on the sheets about 10 minutes, slide the parchment with cookies onto wire racks, and cool to room temperature.

Notes:

I tried them without refrigerating the dough and they came out fine.

I used a 2 tablespoon cookie scoop and they were a good size. They don’t flatten out a lot but don’t need to be flattened before baking.

Crazy Person’s Transportation

Written by Tad. Posted in Kooks

This bike has been leaning against the wall behind the emergency department for weeks. It must have belonged to someone who came in and either stayed in the hospital, left without it or died. It was dark when I took the liberty to take these pictures with my phone but you can get the idea of how it was decorated.

Better-than-Brownies Chocolate Cookies

Written by Tad. Posted in Cookies

There are a million chocolate cookie recipes. I grew up with chocolate crinkles which are dipped in powdered sugar then baked. Here is one I tried recently and it is hard to beat if you like rich, smooth chocolate. My wife said they are more like mousse cookies. Someone at choir said they are like pudding. They are also not hard to make and are beautiful with a fabulous cracked shell. They are delicious with my favorite vanilla ice cream: Breyer’s Natural Vanilla.

Source:

http://www.browneyedbaker.com/ (Adapted from Culinography)

 Yield:

36

Ingredientes:

16 ounces bittersweet chocolate, chopped

4 tablespoons unsalted butter, at room temperature

4 eggs

1 1/3 cups granulated sugar

1 teaspoon vanilla extract

½ cup all-purpose flour
 (That’s right! Only a half cup!)

½ teaspoon baking powder

1 cup semisweet or bittersweet chocolate chips

1. Heat oven to 350°F. Line large baking sheets with parchment paper of a silicone baking mat.

2. Put the chocolate and butter in a heatproof bowl and set it over a saucepan of barely simmering water, stirring occasionally, until completely melted and smooth. (I use a double boiler.)

3. In the meantime, stir together the eggs, vanilla and sugar in a medium bowl. Set aside.

4. In a small bowl, sift together the flour and baking powder. Set aside.

5. Add the melted chocolate mixture to the egg mixture and stir to combine well.

6. Slowly add the dry ingredients, folding them into the batter.

7. Stir in the chocolate chips.

6. Scoop 2 tablespoon balls of dough onto prepared baking sheets. Bake for 10-12 minutes or until they are just firm on the outside. Like brownies, do not overbake! Leave to cool completely on the baking sheets.

My Dick Turns Green

Written by Tad. Posted in Kooks

I looked up and saw a new patient listed on the white board. The complaint written by the nurse was “urinating green.”

“I wonder what he has taken to make his urine have a green color,” I wondered to myself.

In the room, I found a 38-year-old man who told me he penis had been turning green for five days and it was getting worse. He complained of burning when he urinated. The rest of the history was unremarkable.

I asked him to show me what he was talking about. After examining him, found nothing wrong and told him it looked normal to me.

“It only happens after I piss,” was his response.

I handed him a urinal and turned by back while he urinated. When he was finished, I turned back around and again inspected him. When I pointed out that it still looked normal, he said, “You gotta see it in the sunlight, Doc.” Since it was about 4:00 in the morning that was not an option so I went back to asking more questions.

As it turned out, about a week prior to his visit, he had unprotected sex with someone he viewed as suspect. Since then, he had been worried he might have caught something from her and had been watching for evidence of infection. This had worked on his brain to the point that he was having symptoms and seeing things that were not real. I reassured him and sent him on the way with a recommendation that he use condoms.

Natasha and Her Bag Headed for Houston

Written by Tad. Posted in Trauma Strap Bags

Natacha is headed to Houston to do an aerospace fellowship. She will be learning how to be a doctor for astronauts and other NASA folks. She will now be able to do so with a nice Tad Bag. Is she happy about getting the bag or about leaving for Houston?

 

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