Archive for July, 2013
You will see ginger come up a lot in my recipes. I think it is exotic and very interesting. It also goes with a lot of flavors. My standard ginger cookie is Taku Ginger Cookies. They taste great and the texture is to die for. This recipe also tastes great and has the wonderful dark chocolate chips to go along with the ginger. They don’t have that same killer texture the Takus do but they are very good. Go for it!
2 cups flour
2½ teaspoons ground ginger
2 teaspoons baking soda
¼ teaspoon salt
1 teaspoon cinnamon
¼ teaspoon ground cloves
1 tablespoon cocoa powder
½ cup dark brown sugar
¾ cup granulated sugar, divided*
½ cup butter
¼ cup shortening
1 large egg
¼ cup molasses
1 teaspoon vanilla
½ cup crystallized ginger, chopped
1 cup dark chocolate chunks (a bittersweet chocolate bar cut into chunks)**
1. Combine first 7 ingredients in a bowl and whisk to blend. Mix in crystallized ginger. Set aside.
2. Using electric mixer, cream butter, shortening and brown sugar and ¼ cup granulated sugar until fluffy, about 2-3 minutes.
3. Beat in egg, molasses and vanilla.
4. Add flour mixture and mix just until blended.
5. Stir in chocolate.
6. Cover and refrigerate about 45-60 minutes.***
7. Heat oven to 350 degrees.
8. Spoon the remaining ½ cup sugar into a plate.*
9. Scoop 2 tablespoon balls of the dough. Roll in sugar to coat completely.
10. Place balls on cookie sheets covered with parchment paper and space 2 inches apart. Bake cookies until cracked on top but still soft to touch, about 10-12 minutes. Let set on cookie sheet about 2-3 minutes, then remove to cooling rack.
* Rather than regular granulated sugar, I dip these in large sugar crystals such as Sprinkle King, KingsBlingz White Diamond Crystalz. I get them online at SupplyVillage.com.
** I use bittersweet chocolate chips.
*** I find this step to be unnecessary if you use a cookie scoop. You have to handle the balls carefully when you dip them in the sugar but it works. It is definitely easier to roll them in the sugar when the dough is chilled.
A young adult man came in as a trauma alert. He was very drunk and obviously injured. The alcohol-induced lack of cooperation made his trauma evaluation difficult and complicated. He had to be sedated to keep him from harming the staff while we removed his bloodied clothing and performed tests to rule out serious injury. Eventually, all of his x-rays and scans came back normal and he was left to sleep off both his alcohol and the sedatives he was given.
Some time later, I heard a commotion and went to see what was going on. As I rounded the corner into the hallway adjacent to his room, I saw the patient, naked except for the protective collar he still had around his neck, standing in the hall. His IV tubing was trailing behind him into the room and he was hollering curses at everyone who was trying to get him to go back into the room and onto the gurney.
Immediately in front of him, sitting on a gurney in the hallway, was a young family: Mom, Dad and a seven-year-old daughter. When the drunk, crazy, naked guy came out of the room into the hall, he was standing right in front of them, hollering with dried blood on his face, arms and chest. The poor family looked like they were watching a horror film, frozen with eyes and mouths agape. The parents were so stunned they didn’t even think to protect the little girl from this amazing site.
A pair of Sherriff’s deputies happened to be guarding a prisoner nearby and quickly took the patient back into the room. They pinned him, face down, on the gurney and handcuffed his hands behind his back until hospital security arrived and got him into leather restraints.
I later learned the patient had awoken and asked the nurse where his Chihuahua dog was. When the nurse told him he came in with no dog, the patient blew up, tried to strike the nurse and cried that his dog was the only thing he had in the world. He then got up and headed off to find the dog. That is how he ended up naked and screaming in the hallway.
A few hours later, he was ready for reevaluation. I took off his collar, rechecked his neck and sent him off to look for his dog, sober and dejected.
It should be obvious from looking through my previously posted recipes that I am not really hung up on avoiding ingestion of animal products. This caught my eye because it used coconut oil and avocado in place of butter and eggs. They are rich and chocolatey and, of course, can be made vegan if that pleases you.
2 dozen cookies
1¼ cups all-purpose flour
1 teaspoon baking powder
½ teaspoon sea salt
2/3 cup Dutch processed cocoa
¼ cup coconut oil
¼ cup mashed avocado
¼ cup granulated sugar
½ cup brown sugar
1 teaspoon vanilla extract
1/3 cup almond milk*
½ cup vegan chocolate chips*
1. Heat oven to 350 degrees. Line large baking sheet with a Silpat baking mat or parchment paper and set aside.
2. In medium bowl, whisk together flour, baking powder, salt, and cocoa. Set aside.
3. In bowl of a stand mixer, beat coconut oil, avocado, and sugars together until creamy and smooth, about 2-3 minutes. Stir in vanilla extract.
4. With the mixer on low, mix in half the flour mixture.
5. Mix in milk.
6. Mix in remaining flour mixture.
7. Stir in chocolate chips.
8. Form cookie dough into 2-tablespoon balls and place on prepared baking sheet, about 2 inches apart. Slightly flatten the cookies with the palm of your hand or a spatula.** Bake cookies for 10 minutes, or until set around the edges, but still soft in the center. Let the cookies cool on the baking sheet for two minutes. Transfer to a wire cooling rack and cool completely.
* For simplicity, I used regular milk and chocolate chips so mine were not really vegan.
** I used my favorite method of flattening cookies: Butter the bottom of a drinking glass. Dip bottom of glass in sugar. Flatten the dough ball. Dip in sugar again before repeating.
One of the main jobs I have in running the emergency department is what we call “disposition.” That means getting people out of the department so others can come in and be cared for. Most of the time, this is simple. They either go home or they get admitted to the hospital. Some times, it is not so simple and takes a lot of work, time, creativity and patience to find a good place for someone to go. Here is a story of one such patient.
A 68-year-old man presented from a board and care facility. He was reported to be hyperventilating and not able to talk appropriately. He had a history of developmental delay and schizophrenia.
I found him agitated and hyperventilating. I ordered laboratory testing and sedation.
After being sedated, he responded to questions with answers like, “Elvis Presley” and “Bing Crosby.” He also started singing Christmas songs and other songs like “When They Call the Roll Up Yonder” and “Mine Eyes Have Seen the Glory of the Coming of the Lord.”
Because he had caused so much trouble at the board and care home, the managers refused to take him back. I had to find somewhere else for him to go.
I will present a time line that shows what I had to go through and how much time it took in order for me to get this guy out of my emergency department that evening.
5:05 The patient arrived in our emergency department and his work up began.
8:40 His labs came back normal. He was calm and cooperative. I called Emergency Psychiatry and
with the charge nurse. He said he would call back.
9:00 The Emergency Psychiatry charge nurse never called back so I called him again. He told me to call
back and talk to the doctor.
9:10 I called back and talked with the doctor, who told me the patient was not a good candidate for their
facility and recommended I try to find another psychiatric facility that would take him.
9:30 I talked with the charge nurse at a local psychiatric facility. She said she would call me back.
9:50 I talked with that charge nurse again. They refuse to take the patient in transfer. They offered no
10:00 I talked with someone at another local hospital with a psychiatric facility. They said they would
get back to me.
10:20 I talked with them again. They also refused patient.
10:20 I talked with the patient’s doctor in a city about an hour away who refused to take the patient in
transfer. He recommended I send the patient to our psychiatric unit.
10:30 I talked, again, with the charge nurse at Emergency Psychiatry who accepted the patient.
10:40 The charge nurse at Emergency Psychiatry called me back and asked that I document all of my
efforts to place the patient elsewhere.
11:10 The patient leaves for Emergency Psychiatry.
So, it took six hours and ten phone calls to make sure this man was safe for discharge and find a place for him to go. You can imagine what a disruption this was to the care I was trying to provide to all my other patients and how frustrated I got. This is an example of what I have to endure to do my job.
I have been faithfully posting to this site every week. I recently changed hosts. I subsequently learned that no one was being advised of new posts. I am making this posting as a test to see if we are back in business again. Hope you enjoy catching up with BadTadMD.com!
I worked in the kitchen at our church girls camp for several summers. Along with other general kitchen work, I was the cookie baker. It was there I became friends with Heather Judd. She shared this wonderful recipe with me. I don’t know why it has taken me so long to share it with you. Like most cookies that have a lot of real chocolate and a little flour, they are very rich, fudgey and cook up with a shiny, cracked surface. Though this recipe called for them to be “Giant,” I made them scooped with my usual 2-tablespoon scooper and they turned out great for sharing in the emergency department.
About 18 large cookies
½ cup all-purpose flour
1 teaspoon baking powder
¼ teaspoon salt
1 pound semisweet chocolate
¼ cup butter
1 ¾ cups brown sugar
4 large eggs
1 tablespoon vanilla extract
8 ounces Heath toffee chips*
1 cup walnuts or pecans, toasted and chopped (optional)
Combine flour, baking powder and salt in small bowl. Set aside.
Stir chocolate and butter in top of double boiler set over simmering water until melted and smooth. Set aside. Cool to lukewarm.
Using electric mixer, beat brown sugar and eggs in bowl until thick, about 5 minutes.
Beat in chocolate mixture and vanilla.
Stir in flour mixture.
Stir in toffee (and nuts.)
Chill batter until firm, about 45 minutes.
Heat oven to 350 degrees F. Line baking sheets with parchment paper. Drop batter by ¼ cupfuls, (or large cookie scoop) onto sheets, spacing 2 ½ inches apart. Bake just until tops are dry and cracked but cookies are still soft to touch, about 12-14 minutes. Cool on sheets.
When recipes call for the dough to be chilled, I usually skip that step. I have found that they usually do just fine without chilling if you are using a cookie scooper, as I always do. This recipe is an exception. Without chilling, the dough is runny, more like batter. It really needs to be chilled.
* Original recipe called for 5, 1.4 ounce Heath bars, chopped.
About 4:30 in the morning, I heard an overhead announcement, “Help at triage for a patient to Labor and Delivery, right now!” It was repeated with a true sense of urgency.
The last time I heard a similar page, I went out and caught a baby, just before it hit the tile floor in the waiting room.
This time, rather than finding a woman about to give birth, I found an anxious looking triage nurse and an even more frantic father-to-be. I was told the patient was still out in the car and the baby was coming.
Now, this would be exciting enough at the best of times, but the hospital is doing construction right now. So, there is no way for a car to pull up near the entrance to the emergency department. I grabbed the supply pack we use for precipitous deliveries and yelled at someone to get a wheelchair. I then hurried off, already some distance behind the father.
In order to get to the street, we had to run out the door to the curb, along a temporary sidewalk flanked by construction fencing, down an even longer sidewalk and then through a final walkway between more temporary barriers. As we came to the end of the passageway, which opened onto the street, I turned to make sure someone was following with a wheelchair.
When I turned back around, I was disturbed to not see the father. I quickly scanned the temporary patient drop off area. No one was in any of the cars. Where had he gone?
A holler drew my attention up the street where a minivan was parked around the corner, just out of my sight.
When I finally got to the minivan, the patient refused to get out, saying, in her Ethiopian-accented and limited English that the baby was coming out. I quickly sized up the situation. Her fundus (top part of the womb) was still high and no fluid seemed to be wetting her pants or the car seat. I told her it looked like she was OK and she had to get out of the car so we could help her.
With prodding, the patient allowed us to slowly help her out of the minivan and into the wheelchair, which was now parked in the flowerbed next to the curb. With some effort, as she would do nothing to help herself, we got her feet up on the little footrests. Then, I took control of the wheelchair and we headed back the way we came towards the emergency department.
The patient was clearly in distress. She was not holding on or doing anything to keep from being dumped on the ground as we went cross-country in the wheelchair through the flower beds, over the sidewalk, across the street, up the temporary sidewalks and around corners. I realized I needed to be a bit careful so that I didn’t dump her out of the chair onto the ground.
Fortunately, she stayed seated until we got her to the trauma room and the only open bed in the unit.
The staff got the patient up on the gurney and pulled off her stretch pants. I grabbed some sterile gloves and was just pulling them on as the baby squeezed out onto the gurney. I grabbed him and started drying him off while the respiratory therapist suctioned his nose and mouth.
For someone who rarely delivers a baby, the most anticipated thing is to hear it cry. A good strong cry means that the baby is not going to need any immediate care from me. After a couple of weak tries, this little boy was hollering just like I wanted to hear. Then, I was able to relax a bit, hand him off to a nurse and turn my attention to the mother. Soon, they were all off to Labor and Delivery.
It was not my doctoring that made the difference in this situation. I am sure that none of the other staff would have been so confident and aggressive in expediting the patient’s extraction from the car or her cross-country trip into the hospital. However, without that, the baby would almost certainly have been delivered into the mother’s stretch pants in a dark minivan or trodden flowerbed. Everything would probably have turned out all right anyway, but I was glad for the patient that she delivered on the gurney in the trauma room with us all there ready to handle any medical emergency that she or her new baby might have had.