I picked this recipe to try because we had a couple of bags of potato chips we got from a Nob Hill promotion. Since we don’t eat very many plain potato chips, I thought this would be a great chance to get rid of some of them. When it came time to crush and put in the potato chips, I grabbed a bag of chips, crushed and measured them with abandon. I was at the point of throwing them in with the rest of the ingredients when I noticed: Spicy Jalapeño! Part of me wanted to proceed, but since I had never made them before, I decided it was not fair to make such a change the first try. Next time, I may use them and substitute lime juice and zest for the lemon and see how they come out. Watch out for those!

Recipe By:

Mercury News

Yield:

72

Ingredients:

16 ounces butter

1 cup sugar

3½ cups flour

1 cup crushed regular potato chips

2 teaspoons vanilla

2 teaspoons fresh lemon zest

2 tablespoons fresh lemon juice

Powdered sugar, for dusting

 Directions:

1. Heat oven to 375 degrees.

2. Using an electric mixer, cream together butter and sugar.

3. Add flour, vanilla, lemon zest and juice. Mix well.

4. Stir in  potato chips.

5. Form dough into 6 dozen small balls.* Place on ungreased baking sheets. Flatten each cookie with a fork.**

6. Bake cookies for 12 to 15 minutes, watching closely, as the cookies will brown quickly. Remove from oven and place on wire rack.

7. Sprinkle with powdered sugar while still hot.

 Notes:

*I used my usual 2 tablespoon scoop and it made only half as many cookies.

** I didn’t flatten them and they came out fine. Perhaps with potato chips that were crisper or in larger pieces, this would be an issue.

When I got to work at 11:00 PM, I was greeted by loud screams coming from two women recently arrived in the emergency department. Since they both spent the night with me, I would like to describe them as an interesting exercise in compare and contrast.

The first patient was nineteen. She had been drinking and had caused some public disturbance, so police were called to the scene. In these situations, the police have the choice of arresting people and taking them to jail or turning them over to the paramedics to bring to the emergency department. In this case, the patient was put on a psychiatric hold and sent to us. In the emergency department, she continued to scream and cause such a disturbance that the previous doctor on duty ordered her a strong sedative. Soon after my arrival, she was sleeping soundly and I removed the leather restraints that had been necessary when she had been disruptive.

She was a thin young woman who might have weighed a hundred pounds. She had interestingly colored hair, lousy tattoos and scars on both of her wrists and forearms where she had obviously cut herself in the past. After carefully checking her out, I decided all she needed was to sleep off her excess alcohol ingestion and the sedative she received for her uncontrollable behavior and screaming.

The second lady was thirty-five-years-old. She, also, had been delivered to us after causing some sort of commotion in the community. When she arrived in the ED, she was screaming so loudly and shrilly that she was nicknamed “The Pterodactyl” by the doctor on duty. She, too, was given a sedative.

While the first woman looked anorexic, this short lady weighed at least three hundred pounds. Once she fell asleep, she caused almost as much commotion with her sleeping as she had earlier with her screaming. Because of her obesity and her sedation, she snored badly. Her breathing was like a constant series of snorts. Each inspiration caused her huge body to jump and her fat to jiggle. As with the first lady, I determined she just needed to sleep off the drugs she had taken as well as those she had been given.

While the first lady quietly slept, the second lady’s breathing caused quite a disturbance. It was loud and annoying. More importantly, it was so labored it made everyone nervous she was either going to have her oxygen levels drop dangerously low or stop breathing altogether.

A tool made perfectly for this situation is called a nasal trumpet.* It is a soft rubber tube lubricated with KY jelly that is gently passed into the patient’s nose. When in place, the inside end sits down behind the tongue and the outside end, which spreads like a trumpet’s bell, rests against the nostril. The nasal trumpet prevents snoring by allowing air to pass more easily behind the tongue.

In this case, it worked wonderfully. The patient winced and reached for it when I put it in her nose, but she immediately fell back asleep, breathing comfortably and allowing every one to relax.

At intervals throughout the night, however, she would rouse somewhat and, vaguely aware something was in her nose, reach up and pull out the nasal trumpet. She would then go into the same labored, worrisome breathing pattern she had before. So, I would replace the trumpet.

This is how we passed the night. The little lady sleeping soundly and quietly. The big lady snorting, moaning, and flopping around on the gurney. They were in the hall across from my documentation area so we could keep a close eye on them.

Every hour or so, I would check to make sure they were not getting worse, hoping for some improvement in mental status that would allow them to be discharged.

A few hours into this, I looked up and saw the big lady had aroused enough to sit up. She still had her eyes closed and, to my horror, had pulled off all her clothes. Her areola, the circular areas around the nipples, were as large as dinner plates. Even though she was sitting up, however, you could not see them because her huge breasts were hanging down and pressed against the tops of her thighs. Her large belly covered her crotch. So, though she was naked, none of her socially sensitive parts was visible. She couldn’t stay in the hall in that condition so we moved her to a room. For the next few hours, she kept trying to get out of bed and pull off her clothing. The whole time, she kept her eyes closed and would not respond to instructions. We assigned someone to sit with her so she would not fall and hurt herself when trying to get out of bed.

About 6:00 in the morning, the little lady sat up, asked what had happened, requested a drink of water and very nicely went off to emergency psychiatry. The other lady was still there, waiting to wake up, when I went home at 8:00.

* This is what a nasal trumpet looks like:

This shows how it fits in place, allowing air to pass behind the tongue.

*

This is the first time I put together these three colors.

Janell is happy with her new bag.

Meagan loves her Mom’s bag.

These are like other cookies with lots of chocolate and not too much butter or flour: they have kind of shiny crust that cracks and the bottoms are a bit sticky when they come off the parchment. These have a lot of “floaties” which is what I call the added things like chips and nuts and fruits. They are very rich and Baker’s Chocolate has reason to be proud of this recipe. I confess, I use Ghirardelli’s chocolate, not Baker’s. I really like them with half the nuts replaced by Craisins. That tartness is just so good in the rich chocolate.

Source:

Baker’s Chocolate and all over the Internet

Yield:

About 18 large cookies

Ingredients:

8 ounces semisweet baking chocolate

¾ cup firmly packed dark brown sugar

¼ cup butter, softened

2 large eggs

1 teaspoon vanilla

½ cup flour

¼ teaspoon baking powder

1 cup white chocolate chunks

2 cups chopped macadamias or toasted slivered almonds

Instructions:

Heat oven 350°F.

Microwave semisweet chocolate in large microwaveable bowl on high for 1½ to 2 minutes. Stir until chocolate is melted and smooth.*

Stir in sugar, butter, eggs, and vanilla until well blended.

Stir in flour and baking powder.

Stir in white chocolate and nuts.

Drop by scant ¼ cupfuls onto ungreased cookie sheets.**

Bake 13 to 14 minutes or until cookies are puffed and feel set to the touch.

Cool 1 minute. Remove from cookie sheets. Cool completely on wire racks.

Notes:

* I use a double boiler. It just makes me happier than microwaving chocolate.

** I use my usual 2 tablespoon cookie scooper and cook them for 12 minutes. They are great.

Options:

1. Omit nuts, increase flour to 3/4 cup to prevent spreading.

2. Substitute 1 cup of dried cranberries for 1 cup of  nuts.

About four o’clock in the morning, the ring down from the medics came in as “vomiting blood.” Though vomiting blood can be pretty dramatic, this ring down did not prepare me for what I saw when the patient rolled in the door.

He was a middle-aged man who woke up with blood gushing out of his mouth. The medics had no idea how to stem the dramatic bleeding, but they were wise enough to have him lean forward and use a suction catheter to keep the blood from filling his mouth and throat and choking him.

The patient was very anxious. Though he was doing his best to suction the blood as it gushed from his mouth, it was clear he was loosing the battle.

The first rule for controlling bleeding is to put pressure on the source. It seemed like the blood was coming from the roof of the patient’s mouth. So, I put on some gloves and tried to press gauze up there. This only gagged him and made him more freaked out. It did nothing to slow the bleeding.

I stepped back and took a look at the big picture. It was clear that, unless I stopped the bleeding, this man was either going to bleed to death or die from choking on his blood. Anything I might do could hasten his demise. Yet, doing nothing would have the same result.

I prepared to intubate the patient to protect his airway. Only then, could I focus on the bleeding. We gave the patient a quick-acting sedative. As soon as he went limp, I flattened the head of the bed, tilted his head back and, with a laryngoscope in my left hand, I used my right hand to suction the blood out of his mouth, trying to see the vocal cords through which my tube had to pass. I suctioned like crazy. Yet, whatever blood I removed was rapidly replaced by bright red blood welling up from somewhere deep in his mouth. When I finally caught a glimpse of the vocal cords, I dropped the suction catheter, grabbed the tube and passed it into his windpipe.

With the patient’s airway secured, I turned my focus to the bleeding. Though I could not see the exact source of it, I reasoned that applying pressure was still the best method to stop the bleeding. I repeatedly asked for gauze pads, which I crammed into the patient’s mouth, filling all the spaces.

For a moment, I felt some relief. But blood quickly soaked the gauze and started to run out of the patient’s mouth.

More pressure. I got more gauze and packed it into his mouth. I pressed as hard as I possibly could, adding more and more gauze, until, at last, the gauze stayed white. Only then, could I relax a bit and make arrangements for the patient to be admitted to intensive care.

I later learned the patient had recently had a CT scan that showed a tumor in the roof of his mouth. Apparently, as he slept that night, the tumor invaded an artery, which caused this massive, life-threatening hemorrhage. Had he not received care in the emergence department, he would have never lived to get treatment for his cancer.

A part of medical evaluation in the emergency department is assessing what color a person is. I am not talking about race. I am talking about disease processes that make an otherwise normal person turn an abnormal color.

The most common example we see is pallor, or looking pale. This is usually caused by insufficient blood.

We also see people who are blue. Rarely, this is caused by hereditary abnormalities that cause a healthy person to be blue all the time.  In the emergency department, we are more interested in acute medical problems that turn a person blue. The most common of these is cyanosis, a blue color brought on by low oxygen levels in the blood. This happens because the blood protein, hemoglobin, is bright red when it is carrying oxygen and blue when it is not. So, if patients are unable to get their blood adequately saturated with oxygen, they turn blue.

Jaundice is an abnormal orange color of the skin and a yellowing of the white part of the eyes. It is often associated with liver or gallbladder problems. Some patients have such bad jaundice they are sometimes, with less than appropriate respect, referred to as pumpkins.

There are other color abnormalities but they are less common and more obscure.

Years ago, I took care of a woman who was dying from cancer that had spread all over her body. The cancer caused extreme liver dysfunction and profound anemia. All we could do was admit her to the hospital to keep her comfortable until she died, which was expected very soon.

This woman was an amazing bright yellow. I was very used to seeing jaundiced patients, but when I first saw her, I was set back. Then, I realized that the “normal” orange appearance of a jaundiced person is caused by two colors: the bright yellow by-products of liver disease and the red coloration from normal blood. This patient was severely anemic and did not have normal red hemoglobin, so her skin color was affected only by the bright yellow jaundice of her failing liver.

This week, I had an orange patient with another interesting story of anemia. She was a middle-aged woman who had been told years ago she had large benign tumors, called fibroids, in her womb. These caused her to have excessive vaginal bleeding and her doctor had recommended a surgical hysterectomy.

The patient did not want to have surgery, so she sought out a natural remedy for her problem. For years, she drank large volumes of carrot juice with the hope it would shrink her fibroid tumors.

She came to our emergency department with severe anemia caused by her persistent bleeding. Like the cancer patient, her abnormal color was amplified by the lack of normal blood color in her skin. But, rather than being abnormally yellow from liver disease, she was bright orange from all of the carrot juice she had consumed. See this interesting Wikipedia article on how this happens: http://en.wikipedia.org/wiki/Carotenosis

This patient was admitted to the hospital for a blood transfusion and the hysterectomy she had tried so hard to avoid.

Our neighbor, Jackie, gave us a big bag of cooking apples this week. As it turned out, I had a cookie recipe calling for apples that I had been wanting to try. I was surprised that they called for no vanilla (how can that be?) and no spice. It seems like cooked apples always come with some cinnamon, etc. These came out moist and very tender. They didn’t need either vanilla or spice, though I may try them that way next time.

Recipe By:

I had this in a clipping from some old magazine but a quick Google search came up with the same recipe all over the Internet, including one called, “Belinda’s Apple Butterscotch Oat Cookies,” to give Belinda credit due.

Yield:

40

 Ingredients:

2/3 cup shortening

½ cup butter, softened

1¾ cups brown sugar, packed

1 large egg

1 teaspoon distilled white vinegar

½ teaspoon baking soda

1½ cups all-purpose flour

½ teaspoon salt

3 cups old-fashioned oats

1½ cups cooking apples such as Braeburn

½ cup butterscotch chips

 Directions:

1. Heat oven to 375 degrees.  Line large baking sheets with parchment paper.

2. In a large bowl, combine shortening, butter and brown sugar. Beat at medium speed until fluffy.

3. Stir in egg.

4. Stir in vinegar and soda.

5. Gradually stir in flour and salt.

6. Stir in oats, apple and butterscotch chips.

7. Using a 2 tablespoon ice cream scoop per cookie, scoop dough onto prepared baking sheets, placing cookies about 2 inches apart.

8. Bake cookies in batches until edges are golden brown and centers are almost set, about 12 minutes.

9. Remove from oven. Let cool on baking sheet until cookies can be easily removed with a spatula, about 5 minutes. Remove to a wire rack and let cool completely.

Andy is the other  doctor who only works nights with me. He asked for a rectangular bag. He said he wanted a  bag more like a “regular” grocery bag. This is what I came up with.

Third week in a row with yellow and black stripes. This one is a bit different.