About four o’clock in the morning, we got a ring down for a multiple victim pediatric trauma. That is a strange time of night for kids to be out and about so our curiosities were pricked, wondering what the story would be.

As it turned out, the kids in the car had been visiting their father for the holidays. Mom had picked them up and was driving them home when they were in a nasty single-car crash on the freeway. The paramedics brought all four of them to us: the mother and her three kids.

My first patient was the big brother, age ten. He had been seated in the front seat next to his mother. It was immediately obvious that had a broken femur (thigh bone.) An x-ray confirmed the fracture but we had to do a lot of other studies to make sure he had no other serious injuries. He was very cool and brave given the pain he was in and the excitement of being in a car that rolled over on the freeway.

My next patient was the eight-year-old sister who was pretty banged up and also needed studies to make sure she had no serious injuries. After testing, she got admitted to the hospital for observation though nothing life threatening turned up on the testing. She also was very brave.

The three-year-old brother was hardly injured because he had been in a car seat. He was released to relatives. Their drunken mother also had no serious injuries and was released to Highway Patrol to go to jail for drunken driving.

Anyone who gets arrested for drunk driving has good reason to be bummed out. Besides those feelings, can you imagine how that mother felt knowing that her decision to drink and drive had resulted in her children being injured? No wonder she was crying as they led her off in hand cuffs.

Dr Andrea turned her yellow Tad Bag into The Magic School Bus and dressed up as Mrs. Frizzle.

They really look like the real thing, don’t you think?

These were originally made with margarine. Though I grew up on Imperial, I have not bought margarine for thirty years. I use butter.

In the grocery store, they have Heath toffee bits, which were good in these cookies. At Cash and Carry, I bought a bag of Heath bits that are made of the entire Heath bar, including the chocolate. They made these cookies even chocolatier, which I like. The original called for vanilla pudding rather than the malted milk powder which made them less malty. Shari liked the texture better that way.

Adapted From:

Confessions of a Cookbook Queen, among others

 Yield:

36

 Ingredients:

1 cup butter, at room temperature

½ cup granulated sugar

½ cup packed brown sugar

2 large eggs

1 cup malt powder (like Carnation)

2 teaspoons vanilla extract

1 cup oats

2¼ cup all-purpose flour, 10 ounces

½ teaspoon salt

2 teaspoons baking soda

1 cup Whoppers, chopped coarsely

1 cup toffee bits

 Directions:

1. Heat oven to 350 degrees.

2. In the bowl of a mixer, beat butter and sugars until fluffy, about 2 minutes.

3. Add eggs, one at a time, beating until well mixed after each.

4. Add pudding mix and vanilla. Beat until mixed in.

5. In a medium bowl, combine oats, flour, salt, and baking soda. Add to the butter mixture. Beat until combined.

6. Fold in Whoppers and toffee bits.

7. Form into 2 tablespoon balls. Place on prepared baking sheets.

8. Bake about 12 minutes or until edges turn golden brown.

9. Let set on sheet for about 3 or 4 minutes and then remove to a cooling rack.

Here is a counter full, ready to go to the emergency department on Thursday night.

Our neighbors, Tom and Tori have a granddaughter named Claire. Here she is on Halloween in her chicken costume and her Tad Bag for collecting all of her treats.

Here is the bag I made for Tom and Tori. How do you think the bag will look on their bike?

This is a Better Homes and Gardens recipe. The tahini (sesame seed paste) gives them an interesting flavor that compliments the chocolate. The sesame seeds add a fun little crunch. When I baked them, they were a lot flatter than the picture in the cookbook we bought at Home Depot. They were also sticky on the bottom so didn’t travel very well to the hospital. They got eaten!

 Ingredients:

8 
ounces semisweet chocolate

2 
tablespoons butter

3 
tablespoons tahini

2/3 cup all-purpose flour

½ teaspoon baking powder

½ teaspoon salt

2 
eggs

¾ cup packed brown sugar

1 
teaspoon vanilla

½ cup sesame seeds, toasted

 Directions:

1. In a small saucepan melt chocolate and butter over low heat, stirring frequently until smooth. (I like to use a double boiler.) Remove from heat. Stir in tahini. Set aside.

2. In a small bowl combine flour, baking powder, and salt. Set aside.

3. In a large mixing bowl beat eggs until frothy. Add brown sugar and vanilla. Beat until well combined and light.

4. Beat in chocolate mixture.

5. Beat in flour mixture, just until combined.

6. Cover dough. Chill about 30 minutes, until easy to handle. (It took longer for mine to get solid enough to be able to handle it but I made a triple batch.)

7. Heat oven to 350 degrees F. Roll dough into 2 tablespoon-sized balls. Roll balls in sesame seeds to coat. (I coated only the tops.) Place on cookie sheets 2 inches apart. Bake 10 to 12 minutes, until puffed and set on the bottoms. (Mine didn’t puff and didn’t set on the bottoms.) Transfer cookies to wire rack. Cool completely.

Notes:

Makes about 18 cookies. I tripled the batch to take to the emergency department.

I found the tahini in the kosher section of our grocery store. You might have to get it in a Middle Eastern food store or, of course, online.

The paramedics who brought in this middle-aged patient said she frequently calls 911 with the same symptoms. This time, however, neither dispatch nor the medics could understand her. Her husband allegedly refused to talk to the medics and police who responded to the emergency call.

When I interviewed the patient, she said, “Yes” to every physical complaint. Except for having a cough, it was obvious her condition was not new. I was unable to understand why she specifically felt she needed to come to the emergency department that night.

According to the patient’s medical record, she suffered for years with daily episodes of debilitating muscle spasms. Typically, her back muscles would tighten and then the spasms would spread to her extremities. This usually occurred in early mornings. The patient had been unsuccessfully treated with various muscle relaxants. Multiple blood tests, CT scans and MRIs were all normal. Finally, a blood test came back positive for Anti-GAD 65 antibodies, and the patient’s regular doctor diagnosed her with Stiff-Person Syndrome. However, no treatment relieved her symptoms.

It’s a real challenge taking care of a patient like this in the emergency department. If someone has some strange disease we have never heard of before, we wonder what bad complication the patient might have and what testing might be helpful. We don’t want to admit the patient to the hospital unnecessarily, but we are nervous to send the patient home, thinking we might miss something.

In this case, we tested her blood and urine and did a chest x-ray to make sure she didn’t have some sort of infection. All turned out normal. Eventually, we were able to get her husband to come in and vouch that she was at her baseline “normal.” He took her home.

What is Stiff-Person Syndrome? Stiff-person syndrome (SPS) is a rare neurological disorder. It is characterized by muscle rigidity in the trunk and limbs and a heightened sensitivity to noise, touch, and emotional distress, which can set off muscle spasms.

Abnormal postures, often hunched over and stiffened, are characteristic of the disorder. People with SPS can be too disabled to walk or move. They are often afraid to leave the house because street noises, such as the sound of a horn, can trigger spasms and falls. SPS affects twice as many women as men. It is frequently associated with other autoimmune diseases such as diabetes, thyroiditis, vitiligo, and pernicious anemia. Scientists don’t yet understand what causes SPS, but research indicates it is the result of an autoimmune response gone awry in the brain and spinal cord. The disorder is often misdiagnosed as Parkinson’s disease, multiple sclerosis, fibromyalgia, psychosomatic illness, anxiety or phobia.

A definitive diagnosis can be made with a blood test that measures the level of antibodies against glutamic acid decarboxylase (GAD) in the blood. GAD is an enzyme involved in the synthesis of an important neurotransmitter in the brain.

Check out http://en.wikipedia.org/wiki/Stiff-Person_Syndrome for more information on this amazing and sad condition.

Virginia brought her lunch to work in a Tad Bag. When she went to the break room for lunch, she found someone had dumped her lunch out and stole her bag! When I heard about this, I made her a new bag.

An eighty-six-year-old lady came in by ambulance with a report of having passed out at home.

When I walked in the room, her two sons were at the bedside. I recognized both of them. Rafael had been a tech in our emergency department years ago. His brother, Cesar, called me by name as I approached them. He had also worked at our hospital in the past. The two were very attentive and gave me their mother’s history.

The patient’s initial evaluation was pretty straightforward. She denied any pain or losing any blood. She had been pretty healthy her whole life. She was pale and her blood pressure was low.

I got busy trying to figure out what was wrong with her. As anticipated from her appearance, she was very anemic. I needed to figure out why her blood count was low and do something about it. When we put a tube down into her stomach, it brought back blood so I figured her anemia was caused by a bleeding ulcer. I ordered a blood transfusion and continued looking for other problems.

As test results and vital signs showed she was getting worse and worse, I shared the information with the patient’s sons along with my increasing pessimism she was going to survive. All the time, I was doing everything I could to save her. At one point, we had fluids, blood and medications running in six IV catheters.

As we approached the end of my shift, the patient took a turn for the worse. The nurse noted her abdomen was distended. I checked her and, sure enough, her belly was blown up like a balloon and very firm. A quick peak with an ultrasound confirmed it was full of blood.

This changed things. Bleeding ulcers are a medical condition, cared for in the hospital by internal medicine specialists. A belly full of blood is a surgical condition. But the patient was not stable enough to even think about operating on her. She was going to die.

Even though I knew no one would operate on her, I asked a surgeon to come and see her to make sure we’d done everything we could do to save this woman’s life. The surgeon came, saw the patient briefly and told the sons there was nothing that could be done.

With the picture of futility now clear, the sons had to decide whether to have us keep making heroic efforts to save their mother or to just make her comfortable as she died. They were clearly troubled by this and still undecided when the patient was ready for transfer to a bed in intensive care. As the sons stood to leave the emergency department, I walked up to Cesar, shook his hand and gave him an abraso: the kind of hug Mexican men give each other. When I turned to Rafael, he fell on my shoulder, wrapped his arms around me and sobbed. Then, rather than release me like Cesar had done, he held me and cried. So did I.

When they walked out, I returned to my writing area, trying to get myself under control to finish up my charting. A co-worker asked how I was doing. I was surprised when I used the word “fun” to describe the experience. What I meant was that it was an emotional, human interaction made even more intense because it was with people I knew. It really was a “fun” experience.

Our friends, Tim and Cathe, took some straps and used them to keep their food storage on the shelves in case of an earthquake.

Another weird ingredient and a bit of a pain to order online or go to a weird store but well worth it. They are beautiful! I think they are delicious but Shari said they tasted like canned creamed corn. Not a very positive comment.

Recipe By:

Momofuku

 Ingredients:

1 cup butter, at room temperature

1 ½ cups sugar

1 large egg

1 1/3 cups flour, 5.85 ounces

¼ cup corn flour, 1.5 ounces

2/3 cup freeze-dried corn powder, 2.25 ounces

¾ teaspoon baking powder

¼ teaspoon baking soda

1 ½ teaspoons kosher salt

 Directions:

1. Combine butter and sugar in the bowl of a stand mixer fitted with the paddle attachment and cream together on medium-high for 2 to 3 minutes. Scrape down sides of bowl, add egg, and beat for 7 to 8 minutes.

2. Reduce mixer speed to low. Add flour, corn flour, corn powder, baking powder, baking soda, and salt. Mix just until the dough comes together, no longer than 1 minute. Scrape down the sides of the bowl. Briefly stir again.

3. Using a 2 ¾ ounce ice cream scoop (or a 1/3-cup measure), portion out the dough onto a parchment-lined sheet pan. Pat the tops of the cookie dough domes flat. Wrap the sheet pan tightly in plastic wrap and refrigerate for at least 1 hour, or up to 1 week. Do not bake your cookies from room temperature. They will not bake properly.

4. Heat oven to 350°F.

5. Arrange chilled dough balls a minimum of 4 inches apart on parchment-lined sheet pans. Bake for 18 minutes. The cookies will puff, crackle, and spread. After 18 minutes, they should be faintly browned on the edges yet still bright yellow in the center; give them an extra minute if not.

6. Cool the cookies completely on the sheet pans before transferring to a plate or to an airtight container for storage.

 Notes:

Make freeze-dried corn powder by grinding freeze-dried corn in a blender. You can find freeze-dried corn at Whole Foods. I bought mine at honeyvillegrain.com. Store the leftover powder in an airtight container so it won’t absorb moisture.

Huge cookies like they recommend are not practical for me. I use a 2-tablespoon scoop. I cooked them for 14 minutes and they had just a touch of brown around the edges.