A patient has been visiting our emergency department a lot lately. He is a permanent resident of a psychiatric care facility and he likes to stick thinks in his rectum. The staff at the facility have to keep everything away from him or he will spirit it away and insert it. Fortunately, most of the things he gets ahold of are small and don’t need to be removed, like a glue stick or a cap to a pen. When this happens and the staff of the care facility find out about it, they send him to us. We just send him back home to poo.

In this case, he was able to get a hold of a can of shaving cream. He had to be taken to the operating room where the surgeons were able to remove it once he was asleep and relaxed. Sometimes, it is not possible to take the object out via the way it was inserted and it is necessary to cut into the abdomen to remove it. The patient ends up with a colostomy for a while, then a second operation in a few months to take down the colostomy.

As in so many areas of the country, we have a lot of trouble with methamphetamine abuse. It was not always so. Years ago, the drug of choice in our fair city was phencyclidine or PCP. It is what we refer to as a dissociative drug, meaning that it chemically disconnects the brain from the rest of the body. People who took too much PCP were especially difficult to take care of because they could act crazy, sometimes with apparently superhuman strength.

One night the medics and police brought in one such patient. It took several fire fighters, medics and police to get him tied to the gurney with leather restraints.

After heavy sedation to control his thrashing, he slept for hours. When he woke up, he denied any psychiatric or drug abuse history. He said everything started that night after he finished off a partially smoked joint he found sitting around the apartment. He denied knowing there might have been PCP in the joint though that was a common way to ingest it.

As I was discharging him, he asked me if using a Vick’s nasal inhaler would help clear the PCP from his system. I had never heard of that before. The fact that he would ask such a thing called into question his insistence that his PCP ingestion was completely accidental.

I have told you about RAFT, Resource Area for Teachers. One day, we were there looking around and talked with a man who was there looking for material to sew into bags. At the time, he was sewing bags for homeless people. I gave him straps to use for his project.

I have lately been in contact with Richard again. He is sewing bags for poor Navajos in Ship Rock New Mexico. When he came for pick up several bags of straps, he left a sample of his work as a thank you to me. Here is a picture of the bag he left. I like the way it folds in on itself when you hold it by the handles.

The blogger, who posted this on The Cackling Cookie, said she would try to make them thumbprint rather than sandwich cookies. I tried them both ways. For the sandwiches, I made each cookie from only a tablespoon of dough. For the thumbprints, I made each cookie from two tablespoons of dough. Even though I pressed a nice indentation in them prior to baking, I had to press the center again as soon as they came out of the oven.* Since the marshmallow cream runs, the sandwich cookies were a mess unless eaten immediately whereas the thumbprints were a lot neater.**

Recipe By:

https://cacklingcookie.wordpress.com

Yield:

34 sandwiches

Ingredients:

2¼ cups flour
1 teaspoon baking soda
1 cup unsalted butter, softened
¾ cup brown sugar
¼ cup sugar
3 ounces instant chocolate pudding mix
2 eggs
1 teaspoon vanilla
12 ounces milk chocolate chips***
7 ounces marshmallow cream

Directions:

1. Heat oven to 350°.

2. Line baking sheets with parchment.

3. Combine the flour and baking soda. Set aside.

4. In a large bowl, cream together butter and sugars.

5. Beat in instant pudding mix until blended.

6. Stir in eggs and vanilla.

7. Stir in flour mixture.

8. Stir in chocolate chips.

9. Place one tablespoon balls of dough onto prepared baking sheets.

10. Bake 10-12 minutes until edges are golden brown. They may still look a little under-done. Once they are comfortable to touch, transfer to a cooling rack.

11. Sandwich a heaping tablespoon of marshmallow cream between two cookies. Continue with the remaining cookies until done.

Notes:

*
 

**

*** I made them with mini-chocolate chips because little cookies don’t tolerate the big chips as well and because the base of these cookies is not very chocolaty, having only the pudding to  contribute chocolate flavor, so they do really well with semi-sweet chocolate rather than milk chocolate.

Last week, I posted a picture of the doctor that delivered our new grandson. Here is a picture of the nurse, Liz, who helped our daughter-in-law, Elizabeth labor. She seems happy with her Tad Bag.

Quite a few people suffer from seizures because they have epilepsy. Other medical conditions can also cause seizures. For example, we frequently see alcohol withdrawal seizures since we see so many people with alcohol addiction.

We recently had a patient with bad alcohol withdrawal symptoms. He was doing pretty well with the treatment we had given him and was waiting to be admitted to a bed upstairs. Suddenly, I heard a nurse call, “Dr. Tad, we need you in Room 17, STAT!” I knew I would find the patient seizing, but I was not prepared with the how horrible his seizure was. Though I may have seen hundreds of seizures in my professional career, this was, without a doubt, the worst I have ever seen.

The patient was a large, though not overly obese man. He was on his back on the hospital gurney in his boxers and was jerking so violently he almost lifted himself off the bed with each jerk. His face was purple and blood oozed out of his mouth from where he bit his tongue. As the seizure continued, he became incontinent. Stool and urine seeped out of his underwear directly onto the thin black mattress, the bed sheet having been pulled off by his violent shaking.

As the seizure subsided, he started to breath with short, cough-like exhalations. With each breath, he spattered blood and spit all over the room and everyone there. By the time a nurse arrived with an injection to stop the seizure, it had already stopped, as they usually do.

Pretty soon he was awake, his tongue quit bleeding, we had him cleaned up and he was on his way upstairs.

While thrifting last week, my wife came across a little cookbook, Festive Foods, published in 1971 but the City Public Service Board of the Wisconsin Gas Company. Most of the recipes looked like they came from 1971 and were not very interesting to me. This one caught my attention, however, and it is worth making. The ingredients are not weird but interesting and the cookie is sweet and chewy, as the name implies. To poke fun at the pretentious $250 Cookies, my wife recommended I change the name to “Twenty-seven Cent Cookies” since that is what she paid for the cook book.

Recipe by:

Adapted from Festive Foods, City Public Service Board, Wisconsin Gas Company

Yield:

38

Ingredients:

2 cups flour
1 teaspoon baking soda
½ teaspoon baking powder
1 teaspoon salt
1 cup butter, softened
1 cup sugar
1 cup brown sugar
2 eggs
½ teaspoon almond extract
½ teaspoon coconut extract
2 teaspoons vanilla
½ cup sweetened condensed milk
1 cup nuts, finally chopped (optional)
1 cup dates, minced
1 cup coconut
2 cups oats
2 cups corn flakes

Directions:

1. Heat oven to 350 degrees. Cover baking sheets with parchment.

2. Combine flour, soda, baking powder and salt. Set aside.

3. Cream butter until smooth and fluffy. Gradually beat in sugars.

4. Beat in eggs, extracts and sweetened condensed milk.

5. Mix in flour mixture.

6. Mix in nuts, dates, coconut and dates.

7. Gently stir in corn flakes.

8. Drop in 2 tablespoon balls onto prepared baking sheets. Bake about 12 minutes until bottoms and edges are browning. Cool for 2 minutes before removing to a rack to cool completely.

On October 5th, we became grandparents for the first time. Here is a picture of Hunter, Elizabeth, (his mom,) and Dr. Christine, who delivered him. Are they happy about the baby or the Tad Bag?

A 35-year-old man was working for a tree trimming service. He was chipping tree branches when the chipper kicked back at him. A two-foot long palm frond impaled his right forearm. The medics transported him with the palm frond carefully fixed in the position in which they found it. He was taken to the operating room to remove it then clean and repair the wound.

A 46-year-old ironworker was building a rebar wall when it collapsed under him. He ended up pinned under a twisted pile of rebar with a one-inch diameter rebar piercing his right biceps. The medics cut the rebar off on both ends and transported him with it carefully fixed in the position in which they found it.

When he got to the emergency department, he was soaking wet from the water the medics used to keep the rebar cool as they cut it. He was taken to the operating room to remove it then clean and repair the wound.

A middle-aged man was working on his car when it fell off the jacks and threw a tire iron, driving it into the palm side of his wrist and out the back of his hand. The medics transported him with the tire iron carefully fixed in the position in which they found it. He was taken to the operating room to remove it then clean and repair the wound.

A 3 year-old boy stepped on a small metal toy rocking chair. One of the rockers stuck into his foot. His family freaked out and called 911. The medics transported him with the rocking chair carefully fixed in the position in which they found it. I easily pulled it out and sent him home.

When I approached a fifty-year old woman and asked her why she was had come to the emergency department, she handed me this note:

abdomen very swollen

intense pain lower left abdomen below belly button

area sensitive to touch

low grade fever usually it runs btw 95.4 to 96.8, highest reading 100.08

occasional nauseasness

every bone, hair, fingernail and all other parts of body in pain, moving is painful and slow

sharp shooting pains in random places on body, back, elbow knuckles toes, knee, etc.

severe cramps from gas and burps

starving but can’t eat

severe headache

disgusting taste in mouth and brushing isn’t helping

tounge all white and I brushed twice

chills

hot flashes

no medications taken other than occasional vitamins and asprin rarely

no smoking

no drugs

drink about a bottle or 2 of wine a month and/or 1-5 mixed drinks

avoid processed foods but not a perfect diet

drink 1-5 sodas per month and mostly as a mixer

do you have a good old fashioned manual thermometer I could have, just broke mine!