Archive for December, 2013
A Sad Super Bowl Party
A fifteen-year-old girl was at a Super Bowl party at a friend’s house just up the street from where I live. She took the friend’s go-cart out for a ride on the street with another kid on the back. She lost control, ran the go-cart up under a parked car and died in the accident. What a tragedy for this young girl, her friend, and her family who thought she was safe watching football.
A Seizure or Not?
A twenty-two-year-old-man came in after crashing a go-cart into a wall.
He made it back to his home where someone called 911. The medics arrived and found him at home having a pseudoseizure (a false seizure.*) In the emergency department, he reported having seizures since childhood but said he was never treated for them. This seemed strange to me, as most people with life-long seizure disorders have been on medicine at some time.
He seemed to be uninjured in the go-cart crash.
He would not cooperate with our efforts to help him and he refused the CT scan I ordered. When his parents arrived, he would not talk with them or even allow them in the room.
I finally discharged him and he walked out, though it was unclear if he joined his family in the waiting room or left by another route, avoiding them.
It made me wonder what was really going on in his life and brain.
These are not sugar cookies with coconut. They are cookies make with coconut sugar. They also have coconut oil. Some might say this makes them healthier than if they were made with butter and sugar. You can decide.
21 tablespoons coconut oil
½ cup sugar
½ cup dark brown sugar
3½ cups coconut sugar
4 cups flour, 21 ounces
1 teaspoon soda
½ teaspoon baking powder
1 teaspoon salt
2 large eggs
2 large egg yolks
2 tablespoons vanilla
1. Heat oven to 350 degrees.
2. Mix together sugar and ½ cup brown sugar. Set aside.
3. Mix together flour, soda, baking powder and salt. Set aside.
4. Mix together 3½ cups coconut sugar and coconut oil until well combined.
5. Stir in eggs, egg yolks and vanilla until well combined.
6. Stir in flour mixture until well combined.
7. Form into balls about 2 tablespoons in size. Roll dough balls in sugar/brown sugar mixture.
8. Bake 12 to 14 minutes until edges are just browned set but centers are still soft.
Consider adding coconut.
I had a half bag of cacao nibs left over from a previous cookie adventure. I went looking for an interesting recipe to us them in and came up with this one. I toasted the cacao nibs to give them win interesting flavor, slightly coffee-like.
2¼ cups all-purpose flour
1 teaspoon baking soda
½ pound unsalted butter, melted and still warm
¾ cup granulated sugar
¾ cup lightly packed brown sugar
¾ teaspoon salt
2 large eggs
1 teaspoon vanilla extract
2/3 cup roasted cocoa nibs
1 cup finely chopped walnuts*
1 cup dried currants or raisins
1. Whisk the flour and baking soda together thoroughly.
2. In a large bowl, combine the melted butter, sugars and salt. Stir in eggs and vanilla. Stir in the flour mixture just until the dry ingredients are moistened, then stir in the nibs, nuts and currants. If possible, cover and chill the dough for at least two hours, preferably overnight.**
3. Position oven racks in the upper and lower thirds of the oven; preheat oven to 375 degrees. Remove dough from the refrigerator to soften.
4. Scoop up two tablespoon balls of dough and place them 2 inches apart on ungreased cookie sheets. Bake 8 to 10 minutes, rotating the sheets from top to bottom and front to back about halfway through, or until cookies are golden brown at the edges and no longer look wet on top.
5. Use a metal pancake turner to transfer the cookies to a wire rack to cool completely.
* I used pecans.
* I didn’t refrigerate them.
I recently took care of two interesting cases that came from the jail on the same night. You never know what will come into the emergency department and the jail is a very interesting source of our patients.
Keep Patient Away from Toilet Paper
A 39-year-old man came in from custody for evaluation. He had tried, unsuccessfully, to hang himself with some sort of a plastic ligature. He was found to be uninjured and was sent back to jail… but not for long.
After getting back to his cell, he spent some time twisting toilet paper into a rope of sorts, which he used to try, again, to strangle himself. He was returned to the emergency department and, again, was found to be uninjured.
When I discharged him to go back to jail on a suicide watch, my instructions were, “Keep patient away from toilet paper.”
I wonder if they followed my instructions.
Something Unnatural in the Eye
A 33-year-old woman came in complaining of left eye pain. She told me someone had “put something unnatural” in her eye a year ago and she had been having eye pains, like a knife stabbing into it, every since. She had never seen a doctor about it. The reason she was there that night was that she had been arrested and, during medical screening at jail, mentioned it to the nurse. The nurse sent her straight to the emergency department in the middle of the night for evaluation.
Vision problems are a fairly common complaint in the emergency department. Eye pain can be a symptom of a serious eye problem so we always take this complaint seriously.
As I approached the patient, she was sitting comfortably with a piece of gauze loosely taped over the eye. She had 20/20 vision and my examination of her eye didn’t reveal any abnormality. I could see no reason for her pain.
As I asked her for more details about getting something unnatural in her eye, she replied with vague and unhelpful answers. When I asked if she had any past medical problems, she denied any. Her demeanor made me suspicious she had a psychiatric problem but she denied that as well.
Still wanting to make sure I was not missing anything, I went to the computer to review her past medical history and previous visits to the emergency department. This showed that she did, in deed, have a history of anxiety, bipolar affective disorder and psychosis as well as drug and alcohol abuse.
As I went back to talk with her again, I summed things up in my mind. A vague history of someone putting something unnatural in her eye. Pain for a year without seeking any medical attention. Normal visual acuity and eye examination. Pain that made no sense for any eye disorder of which I was aware. A history of psychiatric problems, though denying so. It was pretty unlikely she had an eye disorder that needed to be identified by me in the middle of the night in the emergency department.
I released her return to jail with a recommendation that they schedule a routine visit with an eye doctor.
This is transcribed exactly from a paper a patient handed me when asked about allergies. I didn’t have time to ask about just what happened when she took each of these medicines but can you imagine trying to prescribe a medicine to her with any hopes she wouldn’t have a reaction?
Bad Side Effects List
(I may have overlooked something)
They are very rich and have a wonderful, cracked surface. For chocolate lovers only.
1¼ cups flour
3 ½ tablespoons unsweetened cocoa powder
½ teaspoon baking powder
½ teaspoon salt
20 ounces bittersweet chocolate, chopped
10 tablespoons unsalted butter, softened
2¼ cups sugar
6 large eggs, at room temperature
1 tablespoon pure vanilla extract
2 cups bittersweet chocolate chips
1. Heat oven to 350 degrees. Line cookie sheets with parchment paper.
2. Sift together flour, cocoa, baking powder and salt. Set aside.
3. Melt chopped chocolate in a bowl over, but not touching, simmering water, stirring occasionally until smooth. Remove bowl from water. Cool 5 to 10 minutes. Set aside.
4. Using an electric mixer on medium, cream butter and sugar.
5. Add eggs, one at a time, mixing until incorporated.
6. On high speed, beat for a few minutes until light, creamy and pale.
7. Mix in melted chocolate and vanilla just until combined.
8. Fold in dry ingredients with a rubber spatula. Fold in chocolate chips.
9. Scoop dough quickly, before it firms up, onto prepared pans in scant 1/4-cup dollops. (It’s easiest to use a 2-ounce ice cream scoop, filled 3/4 full). Space the cookies 2 inches apart. Flatten each mound slightly with a damp hand.*
10. Bake cookies until they are evenly cracked all over the tops and softly set, 14 to 16 minutes, rotating pan halfway through. If you have 2 pans in the oven, switch them between racks, too. (If baking in batches, don’t refrigerate the scooped dough. They will not spread properly.) Cool completely before using a metal spatula to separate cookies from parchment.
* I used my 2 tablespoon scooper and didn’t flatten them and they were fine.
One Internet source recommended sprinkling them with fleur de sel after scooping.
A 47-year-old man came in with so many complaints that, after I listed them, there was no more space to write on the chart. Here they are:
Exposed to various contaminations: oil, paint, varnish, and ZEC for several days.
Banged his knuckle.
Trouble with ventilation: the heater in his house contaminated with fumes.
Comet cleanser used to clean the sink caused fumes that caused him to almost pass out.
Tide and garden chemicals that were by the heater were pumped through the heater.
Left nasal pain for 2 days since he picked it.
Painters’ soap up left nose.
Spitting up “crap.”
Varnish comes in through the windows from outside the house because of the cold weather.
Contaminations in food, coffee and water.
Vomiting and coughing up brown varnish.
Numbness in hands.
Spitting up soda after using Comet.
Finding pockets of air with varnish in them all around the house. Unable to ventilate the house so it just keeps coming back in.
Washer and dryer cause his body to vibrate.
Gets sick while smoking cigarettes and marijuana.
Feels better after putting hydrogen peroxide on his hand.
Decrease in bowel transit time.
Has “fatigue points” on his legs that are sore.
His van clogs up with “smog cast” that he can’t clear out.