Last of the Blue Straps

Written by Tad. Posted in Trauma Strap Bags

I have always been limited in my bag making by what straps have been discarded in my emergency department. I recently made these bags, using the very last of the blue straps I have. So, no more blue bags.

Chocolate Peppermint Surprises

Written by Tad. Posted in Cookies

 

These cookies were billed as “Fudgy and rich, like brownies.” That is certainly true. They are very chocolatey and decadent. You can adjust the amount of dough incorporated into each cookie. The more the dough, the more fudgy they are and the subtler the mint flavor. I am excited to make them with other stuff in the center like peanut butter cups, Werther’s candies or marshmallows.

Recipe By:

Sunset

Ingredients:

¾ cup all-purpose flour
1 teaspoon baking powder
½ teaspoon kosher salt
16 ounces bittersweet chocolate (60% cacao), chopped
¼ cup unsalted butter
4 large eggs, at room temperature
1½ cups Demerara or turbinado sugar, *see notes
1 tablespoon vanilla extract
30 small peppermint patties, such as York, 1 package, about 20 ounces, unwrapped and chilled

Directions:

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

2. Put chocolate and butter in a medium-sized metal bowl and set over a saucepan of 1-inch simmering water. Bowl should not touch water. Heat, stirring occasionally, until chocolate melts and is completely smooth. Remove bowl from pan and let cool. **see notes

3. Using a stand mixer with whisk attachment, beat eggs on medium-high speed until foamy.

4. With motor running, gradually add sugar. Continue beating until mixture is light and tripled in volume, about 7 minutes.

5. Blend in cooled chocolate and vanilla, scraping bowl as needed.

6. Reduce speed to low and mix in dry ingredients until smooth. The dough will be thin, like cake batter. Chill, covered, until dough is firm enough to scoop. The original recipe said, “at least 4 hours or overnight.” When I chilled it overnight, it was so hard it was unshapable. So, it needs to be chilled to be able to work with it but watch that it not get too hard.

7. Heat oven to 350°. Line 2 baking sheets with parchment paper. Using 1-tablespoon scoop, portion a half-dozen balls of dough onto a work surface. Roll them in granulated sugar. Lightly butter the bottom of a drinking glass. Press each dough ball, with the bottom of the glass, into a disk about 2 inches wide. Repeat to make a second disk. Set a peppermint patty on one disk. Top with a second and press edges to seal. Repeat to make more cookies, spacing them about 1½ inches apart on lined baking sheets.

8. Bake 1 sheet of cookies at a time until set at edges and crackled in center, about 12-14 minutes. Let cool on baking sheets for a few minutes, then loosen from parchment with a wide spatula and transfer to wire racks to cool completely.

Notes:

*I just used granulated sugar. The original recipe says. “Light brown, partially refined Demerara and turbinado sugars have a more complex flavor than regular brown sugar. You can find them with the baking supplies at well-stocked grocery stores.” I guess my local Nob Hill is not well-stocked.

**I carefully melted them in the microwave like my dad, a master candy maker, always did.

Human Experimentation and Medical Malpractice on Mexican Children

Written by Tad. Posted in Kooks

This is a complaint that a patient submitted to Customer Service at the hospital. Customer Service sent it to me as Medical Director of our emergency department. When I would get such a complaint, it was my responsibility to look at the medical record, talk with any staff involved and reply to Customer Service.

Just for background: a spinal tap is a common procedure performed on children and adults in the emergency department. It is done to make sure they don’t have spinal meningitis, which is a serious brain infection which can kill or seriously injure the infected person if not treated repidly. To preform a lumbar puncture, a kid has to be held tightly while a little area on the lower back is numbed up. A small needle is passed between two bones in the spine to take out a sample of fluid that is then sent to the laboratory to look for signs of infection. It is not fun for the baby, the parents or the doctor. It is also not an operation nor experimentation.

This is one of many similar complaints this man made to Customer Service. Most were about Hispanics not being treated appropriately in the hospital. His complaint was so wacko, it was hard to even take it seriously as I formed a response.

Here it is. Other than removing names, it is copied word for word from his Customer Service complaint form.

 

Subject: Human Experimentation and Medical Malpractice on Mexican Children

Attn: Chief Administrator, The Medical Center

RE: Spinal tap surgery performed on 2-3-year-old Mexican Child by M.D. (non-surgeon) & assistant.

  1. Location: Emergency Room A (close to entry/exit)
  2. Time: 2-3 a.m. (morning), 2 September
  3. Condition: Non-surgical, non-hygiene; inhumane – young child screaming throughout experiment.
  4. Physician: Dr. M. and other emergency room associate (at least one.)
  5. Please note: Child and Parents spoke no English.
  6. Please note: After this inhumane butchery, Dr. M. and company celebrated for an hour between 3 and 4 a.m. in the morning. (This is the second experiment/celebration we are aware of by Dr. M. & et. al.)
  7. Immediate suspension w/o pay, arrest, imprisonment, prosecution and revocation of medical license are mandated for public safety.

I have additional notes from my conversation with the patient, however they are covered here.

 

Drunken Mormon

Written by Tad. Posted in Kooks

Maybe you are tired of hearing stories about drunks, but I am afraid any blog about emergency patients is going to be full of stories about drunks. We see so many drunks it takes a pretty amazing drunk to be remembered many years later. Here is a sad one I will never forget.

An elderly woman was found in her home, intoxicated, with a half-empty vodka bottle at her bedside. It was not clear who had called the paramedics. She had no complaints and said she was in no need of medical care. She had been verbally and physically abusive to the paramedics before she arrived. She had to be restrained in the emergency department to keep her from striking our staff.

She was very thin, half naked, intoxicated, disheveled and wet with urine. She was very uncooperative and refused examination and treatment. She demanded to be let out of the restraints.  When I pointed out that she was too drunk to be trusted out of restraints, she adamantly denied being intoxicated, saying she was a Mormon and didn’t drink alcohol.

This was an interesting defense to use on me. Though she obviously had no way of knowing it, I am a practicing Mormon. This makes me very aware that most Mormons live by health standards that forbid the use of alcohol. Using Mormonism as a defense for her present situation might have worked on someone else but was clearly not going to work on me. Also, as an emergency physician, I am very familiar with signs of alcoholism and am very good at telling who is drunk. It was obvious to me that she was both an alcoholic and acutely intoxicated.

I then did what I usually do with such people: wait. I checked on her frequently, expecting that, with time, she would sober up, allowing me to be assured she had just been drunk and not in need of medical care for some other problem.

As she sobered, she admitted she had been drinking but she denied being drunk. Every time I tried to talk with her, she got upset and threatened to “cut (my) balls off.” She refused to call for anyone to come take her home.

It took all night for her to sober up.  When she was ready to leave in the morning, she continued to refuse to call for a ride. She was provided with dry clothes and allowed to leave. As she was walking out, I couldn’t resist the temptation to say to her, “Have fun reading your Book of Mormon.”

She stopped, angrily spun around and flipped me off before turning on her heels and walking out.

Jam Cookies

Written by Tad. Posted in Cookies

I made this with LeBonMagot White Pumpkin and Almond Murabba with Cardamom and Vanilla. (Murabba means Jam.)  It was a gift to me from my daughter, who went into a specialty store in Manhattan, where she lives, and asked the clerk for the most interesting ingredient they had that could be use in cookies. Quite a challenge to come up with a distinctive cookie recipe using jam!

Recipe By:

Mazar Cuisine

Ingredients:

1 egg
6 tablespoons sugar
1/2 cup oil
6 tablespoons butter
1 teaspoon baking powder
1 teaspoon vanilla
3 ½  cups flour
½ teaspoon salt
1/2 cup pecans, finally chopped
8 ounces jam

Directions:

1. Heat oven to 350 degrees.

2. Beat egg and sugar.

3. Beat in oil, butter, baking powder, vanilla and salt.

4. Stir in flour, in intervals.

5. Spray 9×13 inch baking pan with cooking spray.

6. Press dough flat into baking pan.

7. Spread evenly with jam.

8. Spread nuts evenly over jam.

9. Bake 35 minutes.

Bag with Green Stripe

Written by Tad. Posted in Trauma Strap Bags

What do you do with a single short strap of olive green strapping? It came off of an old, discarded “spider strap.” This is what I came up with. As with so many of my bags, they are one-of-a-kinds that can’t be reproduced.

Vomiting Bright Red Blood

Written by Tad. Posted in Kooks

Vomiting Blood

A 22-year-old man came in saying he had been vomiting blood for several hours. He also had abdominal pain, felt weak and dizzy. He had never had anything like this happen to him before and had no significant past medical history. He looked uncomfortable and a little pale. His abdomen was tender, his heart was beating fast and he had blood on his clothing. (See below.) All of this made me worried he was bleeding internally, probably from an ulcer in his stomach.

I told him I was going to ask the nurse to start an IV and draw some blood tests. I also explained the need to put a tube through his nose into his stomach to see if he were still bleeding. He agreed to this potentially life-saving course and I went on to see my next patient.

A few minutes later, I was approached by the nurse. As she was getting ready to pass the tube into his stomach, she got additional history. The patient had eaten nothing in the last twenty-four hours but Flamin’ Hot Cheetos. I then took a second look at the “blood” on his pants and tested it. No blood. Just pure Flamin’ Hot Cheetos juice.

So, instead of a potentially life-threatening hemorrhage, he had a bad stomach ache from eating too many Flamin’ Hot Cheetos. We gave him some IV fluids and some medicines to make him feel better. We sent him home, admonishing him to be a little more wise with his diet in the future.

Chocolate Chocolate Chip Shortbread Cookies

Written by Tad. Posted in Cookies

If you look through the many recipes on this blog, you might notice that dry, crumbly cookies are not well represented. I think it was the “chocolate-chocolate chip” part of the recipe title that caught my attention. Plus, I just wanted to try something new. Chocolatey and buttery. Good combination.

Recipe By:

Mercury News

Yield:

48

Ingredients:

1½ cups unbleached all-purpose flour
½ cup unsweetened Dutch process cocoa powder, such as Droste or Hershey’s European Style
½ teaspoon baking powder
¼ teaspoon salt
½ pound unsalted butter, softened
1 cup powdered sugar
1 cup miniature semisweet chocolate chips
4 ounces chopped white chocolate, Callebaut or Baker’s premium preferred

Directions:

1. Heat oven to 300 degrees. Line two baking sheets with parchment paper.

2. In a medium mixing bowl, mix together flour, cocoa, baking powder and salt.

3. Using an electric mixer, cream butter and sugar until smooth and light. Add sugar, increase speed to medium and beat until the mixture is smooth, about 1 minute.

4. Decrease speed to low and add flour mixture. Mix, scraping down the bowl sides as needed, until flour is completely incorporated into the dough and the dough holds together, about 2 minutes.

5. Stir in chocolate chips by hand.

6. Divide dough in half. Working on wax paper, press each piece into a 7-by-5-inch rectangle, about ½-inch thick. Use a large, sharp knife to cut each piece of dough into eight strips, each about 5⁄8 inch wide. Cut each strip into three cookies, each about 2¼ inches long. Use a wide spatula to transfer the cookies to the prepared baking sheet, placing them an inch apart. Bake cookies for 25 minutes.

7. The tops of the cookies will change from shiny to dull. Cool on cookie sheets for 10 minutes, then transfer to wire racks to cool completely.

8. Melt the white chocolate. This can be done in the top of a double boiler or in a 175-degree oven.

9. Remove from heat as soon as the chocolate melts and stir until smooth.

10. Spoon white chocolate over one end of each cookie, covering about a third of the cookie and letting any excess drip back into the chocolate bowl. Cool on rack until chocolate is firm.

Tad Bag in Poland

Written by Tad. Posted in Trauma Strap Bags

 

Rafal, a good friend and nurse from the emergency department, sent me these pictures of him visiting his hometown of Krakow, Poland. I’m pretty sure that’s the furthest a Tad Bag has traveled and come back with a picture to show for it.

Pinworms

Written by Tad. Posted in Kooks

A young man came in about 3:00 in the morning worried he had overdosed on medicine for pinworms. He said he was standing in front of a convenience store when a passerby noticed him “itching my butt.” The other man told the patient he probably had pinworms. The other guy also said he just happened to have some pinworm medicine, which he offered to my patient. After taking one of the pills, my patient started getting worried he had overdosed, though he had no symptoms. He came to the emergency department and brought the pill bottle with him.

What he said he took was Worm-Ex. It is a broad-spectrum antiparasitic. This formulation was from Mexico and was specifically made for treating roosters used in cock fighting. Hence, the rooster logo on the nice yellow pill.* The bottle was clearly marked (in Spanish): For Veterinary Use.

 

The ingredients in the pill can also be used to treat parasitic infections in people so there was not a real worry about toxicity from taking medicine designed for animals. Also, the pills were for treating a rooster so you can rightly assume the dose was well below what one would prescribe to a human who needed to take the same medicine.

I explained to my patient that he had no reason to worry. The medicine was safe for humans to take and he took a very low dose. Though he had been unwise to take the medicine given to him by some guy in front of a convenience store, it was not dangerous and he need not worry at all about the consequences of his unwise decision.

This did not reassure him at all. He insisted that we pump his stomach as he was sure he was going to be poisoned. I questioned him some more as to why he was so worried. He insisted he had only taken one of these pills and nothing else. He assured me he had not wanted to hurt himself.

I tried all the logic I could think of to get him to see that, if he just took one of these pills, he had nothing to worry about. No matter what I said, he kept insisting that he was poisoned and needed his stomach pumped. By the time this went on for a while, I started to wonder if anything he was telling me was true. The idea that someone would see you itching your butt in front of a convenience store in the middle of the night, diagnose you with pin worms and just happen to have pinworm medicine to offer you just seemed too crazy to be true. But, was what really happened just as crazy? We will never know because he adamantly stuck to his original story and persistently refused to be reassured that he was not poisoned. He left a very unhappy patient with a very puzzled doctor.

 

 

Copyright © 2014 Bad Tad, MD