Author Archive

The Dissection

Written by Tad. Posted in Kooks

In honor of Halloween, I wanted to share a case that came into Charity Hospital when I was resident there. It is one of the most bizarre cases I ever came across and impossible for me to explain.

A woman in her twenties was brought in by ambulance. She was almost comatose because of a combination of drugs and alcohol. She had been found by her roommate naked in bed with “something wrong with her eye.” What we saw was that someone had taken a scalpel and dissected her eye. The lids had both been cut off in a circle around the boney edge of her eye socket. The fatty tissue, eye muscles and everything else around her eyeball had been carefully removed without damaging the eyeball itself. It was clean and the bleeding had been controlled just as it might have been in the operating room. All that was left was her eyeball, still hooked on by the nerve running back into her skull. Her pupil reacted normally, so the assumption was that when she woke up she would have normal vision. However, she would not be able to move her eye or keep it moist by blinking. The specialists said that nothing could be done to save the eye. She would have to have a perfectly good eye removed and some sort of a skin graft placed over the open tissue.

I never heard if they ever found any suspects or more clarification of why or how this happened. Another item to add to your list of reasons to not get smashed on drugs and alcohol.

Caramel-Stuffed Chocolate Chip Cookies

Written by Tad. Posted in Cookies

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Shari found this in a magazine while waiting to get her hair cut.

Recipe By:

Martha Stewart

Ingredients:

3 cups unbleached all-purpose flour
1½  cups packed light-brown sugar
½ cup granulated sugar
1 teaspoon baking powder
¾ teaspoon baking soda
1 teaspoon kosher salt
1 cup cold unsalted butter, cut into 1/2-inch pieces
12 ounces semisweet chocolate chips
2 large eggs, room temperature
1 teaspoon pure vanilla extract
24 caramels, such as Kraft, halved *SEE NOTE

Directions:

1. Heat oven to 375 degrees, with racks in top and middle.

2. In the bowl of a mixer fitted with the paddle attachment, beat together flour, both sugars, baking powder, baking soda, and salt.

3. Add butter. Beat on medium speed until combined but some pea-size butter chunks remain.

4. Add chocolate chips. Beat until combined.

5. Beat in eggs, one at a time, and vanilla.

6. Line 2 baking sheets with parchment. Scoop dough into 4-ounce balls (each about 1/3 cup.) Bake a deep, wide hollow in each center. Enclose 3 pieces of caramel in each. Roll back into a ball. Place 6 balls on each sheet. Freeze 15 minutes.

7. Bake, with one sheet on each rack, 10 minutes. Reduce heat to 350 degrees. Swap sheet positions and rotate each sheet 180 degrees. Bake until centers are almost but not completely set (press gently on tops with your fingers to check), about 7 minutes more. Remove from oven. Bang sheets on a counter a few times to create cracks in tops of cookies. Place sheets on a wire rack. Let cool completely.

Notes:

I don’t like Kraft caramels so replaced them with 15 grams of Peter’s caramel in each cookie.

Sharks Bag

Written by Tad. Posted in Trauma Strap Bags

My daughter and son-in-law gave me some teal-colored straps. I decided to make a Sharks bag. I looked at hundreds of Sharks images on the internet, trying to get inspired. I was not happy with how it first turned out so I also bought some white straps and figured out how to make teeth. I am quite pleased, actually, with how it turned out.

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I put the obligatory buckle down the side.

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Brownie Crisps

Written by Tad. Posted in Cookies

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Shari made a coconut cream pie for Thanksgiving. Great recipe. Ask if you want it. Anyway, I went looking for cookie recipes that would use up the 7 egg whites left over from the pie. This is what I came up with and, I think their efforts to reproduce that crunch and chew of the brownie edges came pretty close. They are easy to make and very satisfying to eat.

Recipe By:

King Arthur Flour

Ingredients:

½ cup all-purpose flour
¼ teaspoon salt
¼ teaspoon baking soda
2 large egg whites
1 cup sugar
2 tablespoons cocoa powder
½ teaspoon espresso powder
¼ cup vegetable oil
½ teaspoon vanilla extract
1 tablespoon nonfat dry milk powder
1 cup chocolate chips

Directions:

1. Heat oven to 325 degrees Fahrenheit. Prepare a baking sheet by covering it with a greased sheet of baking parchment.

2. Whisk together flour, salt, and baking soda. Set aside.

3. In medium-sized bowl, whisk egg whites until frothy.

4. Add sugar, cocoa powder, espresso powder, oil, and vanilla. Beat until smooth.

5. Whisk in milk powder, then flour mixture.

6. Stir in chocolate chips.

7. Scoop 2 tablespoon blobs of the dough onto the prepared baking sheet, leaving plenty of room for them to spread.

8. Bake  for 25 minutes.

A Woman from Utah

Written by Tad. Posted in Kooks

A woman from Utah was visiting a friend in New Orleans when they had some sort of a falling out. For reasons unknown to me, this falling out resulted in her being committed to the Crisis Intervention Unit (CIU) at Charity Hospital, where I was spending a month to learn more about psychiatric emergencies. I was told that her three-year-old son was taken into protective custody when she was committed to the psychiatric unit.

As I talked to her, it was impossible to really understand what had happened to her. Nothing she told me made any sense and she contradicted herself as well as the reports I received from the ambulance personnel and nurses. She had Borderline Personality Disorder. “Borderline” doesn’t mean “almost a problem” but means more like “almost completely nuts.” There was no effective treatment for personality disorders so it was not clear to me what the psychiatrists were going to do for her. She was still in the CIU when I finished my shift and went home.

When the patient’s mother in Utah found out the patient had been committed to the psychiatric ward, she called the local leader of her church and asked him to intervene to win her daughter’s release. A friend of mine, Doug, was an ophthalmology resident at Charity Hospital and a member of the same church. He was asked by the local church leader to go see if he could get the patient out of the psych ward. When someone was willing to take responsibility for the patient, the people in the CIU were only too happy to let her go. Doug took her to a mid-range hotel not far from the hospital. He used church funds to pay for a room and gave her additional money for food and incidentals. Once the mother knew the patient was free, she bought a ticket for her daughter to fly back to Utah. The patient was told that someone would come and take her to the airport the next morning.

Later that night, while at a dinner at the church with his family, Doug got a call from the manager of the hotel. He was told the woman had taken the money she was given and had purchased booze with it, which she was using to try to seduce any man who passed by as she swam naked in the hotel swimming pool. The manager told Doug the woman was no longer welcome at the hotel and he needed to come pick her up.

When Doug got to the hotel, the police were there but refused to take the patient into custody because the hotel manager was not interested in pressing charges. The only thing that Doug could think to do was to try to get her back to the CIU. When it was clear that the police were not going to hold her, she told Doug to “F— off” and set out down the street, with clothes on, I believe.

I have no idea what happened after that. It certainly made me appreciate that Doug was willing to do so much to try to help her. It also made me very empathetic for the mother and left me to only imagine what kind of grief this crazy woman had caused her family because of her mental illness. As I have said so many times over the years, “Mental illness is just the worst.”

 

Monster Cookies

Written by Tad. Posted in Cookies

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The recipe for Monster Cookies came into our family from Jessie, college buddy and BFF of our daughter, Hilary. She didn’t use a specific recipe, just grabbed one off the Internet, so that’s I what I did. Here it is, adjusted a bit for my taste. I don’t really care for peanut butter cookies but these are good.

Recipe By:

Adapted from Paula Deen

Yield:

44

Ingredients:

3 eggs
1¼ cups packed light brown sugar
1 cup granulated sugar
½ teaspoon salt
2 teaspoons baking soda
1 teaspoon vanilla extract
12 ounces creamy peanut butter
½ cup butter, softened
½ cup M&Ms
½ cup chocolate chips
¼ cup raisins, optional
4½ cups oatmeal

Directions:

1. Heat oven to 350 degrees F. Line cookie sheets with parchment paper or nonstick baking mats.

2. In bowl of a stand mixer, combine eggs and sugars. Mix well.

3. Add salt, baking soda, vanilla, peanut butter, and butter. Mix well.

4. Stir in M&Ms, chocolate chips, raisins and oatmeal.

5. Drop 2-tablespoon balls of dough onto prepared cookie sheets. Flatten them a little with your fingers.

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6. Bake 14-16 minutes. Let stand about 3 minutes before transferring to wire racks to cool. *See notes.

Notes:

Original recipe called for 8-10 minutes. I found them to have a much better chew and hold together better when cooked long enough that the bottoms started to brown. This is one of those rare cookies that doesn’t seem to suffer much if they are cooked longer.

Yoga Mat Wrap for Sandy

Written by Tad. Posted in Trauma Strap Bags

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My son’s mother-in-law asked if I could make a bag for her yoga mat. I wondered if something other than a bag might work better. What I came up with was a wrap. The wrap rolls around the rolled-up pad. It closes with Velcro and can be thrown over her shoulder. I think it came out pretty nice

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And so does Hunter.

Assaulted in Waiting Room

Written by Tad. Posted in Kooks

A.L. was a 65-year-old man who came in complaining of having been assaulted. This was not any ordinary assault. It took place while sitting in our waiting room. But, wait. Let me start at the beginning.

For the last three years, A.L. had been assaulted many times by “private investigators.” They used a gas to render him unconscious, then inflicted trauma to his legs. Most of the time, the trauma was localized to his calves but, lately, they had moved above the knees. They didn’t actually land blows on him but would grind their palms into his flesh, causing localized pain and swelling. He said they did this to avoid leaving any bruises as evidence. When he woke, he always found new areas of swelling and tenderness, which he could identify by carefully feeling the flesh of his legs.

These assaults happened almost daily and sometimes up to four times per day. They could happen anywhere, including in the parking lot walking into the hospital. Often, he was alone, as when he was working in empty offices at night where he was trying to run his janitorial service. They could also happen when others were around, as in the ED waiting room. He was even assaulted while in bed with his girlfriend. When I asked him how it could be possible that someone could gas and assault him while he was sitting in our crowded waiting room, he said, “They are very sneaky. They have their methods.” The fact that no one else had ever seen this happen did nothing to cause him to doubt it took place.

He provided excruciating details about the techniques used to assault him. He meticulously described how they did all of this without leaving any evidence. He said they had, within the last month, changed to a different type of gas as they were afraid he might be getting immune to the effects of the gas previously used.

Since he was always unconscious when these attacks happened, I asked how he knew who was doing it and why they were doing so. He said he knew because he once “came to” just as they were leaving and he saw the bushes outside move as they rushed away.

When asked why someone would be doing this to him, he was evasive. It was clear he believed someone felt wronged by him and that these attacks were retribution for that wrong. He refused to elaborate on what that wrong might have been or who was having the private investigators assault him.

He said he had been to the police many times and they refused to take him seriously, which upset him. He also admitted he had been to our emergency department many times for the same thing and, again, had not felt supported in his struggles.

After talking to him for about twenty minutes, fascinated by the details and long course of his delusions, I asked him what he thought I could do for him in the emergency department. I had to ask this question several times before I got a specific answer because, rather than answer the question, he would just go back and repeat details of the assaults.

Finally, he said he wanted me to put casts on his legs so “they” couldn’t inflict any more injuries. He wanted help getting a single medical care provider who could see him each time he presented so that person could document, over time, the various injuries he suffered at the hands of his assailants.

He seemed to understand when I told him I would not be able to cast him. However, I could respond to his second requests by referring him to get a primary care provider.

Up until this time, our conversation was very calm and agreeable. That all changed when I finally told him he had paranoid delusions. That really set him off. He started to holler and swear at me, saying he was not delusional. He had evidence of everything he was telling me if someone would take him seriously and not just blow him off as everyone, up to that point, had done.

I finally had to pull out the line I use at times like this. “You know these things are true and I can’t convince you otherwise. But I also know they are not true and you can’t convince me they are. So, we will just have to leave it at that and it’s time for you to go.”

I told him his discharge papers would include directions for contacting a mental health provider and I encouraged him to do that. He left very unhappy. I had no hope he would follow my recommendation.

A few weeks later, I saw this same gentleman, again. He came in with exactly the same story and, of course, had made no effort to get any mental health assistance. I felt so sorry for him but there was, literally, nothing I could do to help him. Even listening to him didn’t help when he saw that he was not believed.

Check out this article to better understand fixed delusions. This describes my patient very well.

https://en.wikipedia.org/wiki/Delusional_disorder

 

Southwest/Ranger Cookies

Written by Tad. Posted in Cookies

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I have mentioned Alex before. He was the head cook at our church girls’ camp, where I was the baker and slave. Here is a recipe I only got from him a couple of weeks ago. They really get in your mouth with coconut, oats and Wheaties.

Recipe By:

Alex M.

Ingredients:

1 cup butter, melted
1 cup sugar
1 cup brown sugar
2 eggs
1 tablespoon vanilla
2 teaspoons baking soda
2 teaspoons baking powder
2 cups flour
1 cup coconut
2 cups oatmeal
2 cups semi-sweet chocolate chips
2 cups Wheaties

Directions:

1. Mix together in order shown above. Stir the Wheaties in by hand and gently, mixing only enough to coat them.

2. Roll or scoop into 2 tablespoon balls. Place on baking sheets covered with baking parchment.

3. Bake at 350 degrees for about 13 minutes. DO NOT OVER-BAKE! They will be soft on top and just browned on the bottoms and edges.

4. Cool on baking sheet for two minutes before placing onto cooling rack.

Copyright © 2014 Bad Tad, MD