These are more complicated to make than a lot of cookies but they came out striking looking and are delicious.

Recipe By:

Sunset

Yield:

12

Ingredients:

COOKIES
1 cup flour
½ cup unsweetened cocoa powder
1/4 teaspoon salt
1/2 cup unsalted butter, at room temperature
2/3 cup granulated sugar
1 large egg yolk
1 tablespoon heavy whipping cream
1 teaspoon vanilla extract
1/2 cup sparkling sugar or powdered sugar for rolling, or just leave plain

CARAMEL* see notes
1 cup granulated sugar
6 tablespoons unsalted butter, cut into tbsp.-size chunks
1/2 cup heavy cream
1/4 teaspoon fine sea salt, plus about 1/2 tsp. for sprinkling

Directions:

1. Make cookies: Heat oven to 350°.

2. Sift flour, cocoa powder, and salt into a bowl. Set aside.

3. In another bowl with a mixer on medium speed, beat butter and granulated sugar until pale and fluffy.

4. Reduce speed to low and add egg yolk, cream, and vanilla.

5. Gradually beat in flour mixture.

6. Scoop dough into rounded 2-tablespoon portions and roll into balls. Roll balls in sparkling or powdered sugar to coat. Place 2 inches apart on parchment paper-lined baking sheets.

7. With end of a thick-handled wooden spoon, gently press an indentation into center of each cookie. (I use a cork that we have had in our kitchen for years. I don’t think it has any other reason than to make thumbprint cookies.)

8. Bake until cookies are just set, about 10 minutes. (The depressions tend to fill in a bit as they bake, so as soon as they’re out of the oven, give them another press with the spoon if necessary.) Slide parchment with cookies onto cooling racks and let cool. If you’ve used powdered sugar, sift a little more onto the cookies.

9. Make caramel: Put granulated sugar in a large nonstick frying pan; spread evenly. Heat over medium-high heat, stirring constantly with a wooden spoon. Sugar will form clumps but eventually will melt and turn into a dark, amber-colored liquid, about 6 minutes.

10. As soon as it’s liquefied, reduce heat to medium-low. Stir in butter until incorporated.

11. Stirring constantly, drizzle in cream. Boil 1 minute, stirring. Remove from heat and stir in 1/4 teaspoon sea salt. Scrape into a bowl and let cool completely.

12. Assemble cookies: Spoon about a teaspoon of caramel into each cookie. Sprinkle with a few grains of sea salt.

Notes:

You’ll have more caramel than you need, but that’s never a bad thing–it’s great on ice cream. Don’t be tempted to cook a half-batch of caramel, as it won’t cook right and will seize up.

I used the Peter’s Caramel block I had in the cupboard. Shari shaped a 12-gram discs of caramel for each cookie. Three minutes before they were to be cooked, I took the baking sheet out of the oven, placed a caramel disc on each cookie then returned them to the oven to finish cooking. I sprinkled the sea salt on when they came out.

My mother-in-law says, “Things always come in threes.” I don’t believe that but I can’t help notice coincidences in my practice. Usually, it involves looking for different patients with similar illnesses or injuries. In this first case, it was infant twins who shared three identical abnormalities.

Mom brought in her fraternal (not identical) twin daughters for fevers. They had been sick about the same period of time. I diagnosed both with urinary tract infections. It was kind of a surprise that the two of them would come down with an infection like that at the same time. I also noticed they both had umbilical hernias and were tongue-tied. Umbilical hernias are hernias at the belly button. They are not at all unusual in kids this age but it was certainly an interesting coincidence that they both had them. To be tongue-tied means that the frenulum (the small fold of skin beneath the tongue) is too short or tight. This keeps a person from being able to stick his or her tongue out normally. It is usually treated with a minor procedure where the doctor numbs and snips the frenulum, releasing the tongue to stick out normally.

It seemed to me quite a coincidence that both of these sisters had the same three abnormalities.

Speaking of coincidences…

One night, a young man was dancing. While doing so, he thrust his arm into the air, causing a dislocation of his shoulder with the arm stuck straight up in the air. Shoulder dislocation is a pretty common injury we see in the emergency department. That it happened when he was dancing was really unusual as the shoulder usually dislocates because of a fall or other injury that involves more energy. Also, a shoulder dislocation usually results in the patient’s arm hanging down at his or her side. Having it dislocate so it is locked with the arm pointing straight up in the air is also very unusual. I gave him pain medicine and sedatives. I was then able to easily get his arm back in the socket again.

Two nights later, another young man came in with his shoulder dislocated and stuck up over his head. Rather than dancing, this happened when he rolled over in his sleep. It sounds crazy but there are people whose shoulders can just pop out of joint, even from rolling over in bed. Usually this joint instability arises from previous dislocations which damage the supporting structures of the joint leaving it subject to easily popping out. This often needs to be corrected with surgery. Again, they usually present with the patient’s arm down to his or her side. That he also had his shoulder locked with his arm pointing up only two nights after the other guy is quite a coincidence.

You can imagine my mother-in-law would have had me keeping my eyes out for that third shoulder dislocation with the arm pointing up in the air, but it never happened.

I am coming down to the bottom of a bin of random lengths of straps. I had just enough of this type of orange and yellow to come up with this pair.

Most of the trauma straps end with the end folded back and sewn to itself. As time has gone by, I have saved the ends of a bunch of straps. The other day, as I have been moved by Covid-19 isolation to get organized, I decided to use a bunch of the ends in bags, using them in a random fashion. Here is what they looked like.

Sometimes, people in the emergency department would ask me to make eggs-free cookies. Other than coconut macaroons, it was hard to come up with something for them. Here is an egg-free cookie that is lovely to look at and delicious to eat.

Recipe By:

Food Network.com

Ingredients:

1½ cups unsweetened coconut flakes, divided
½ cup granulated sugar
12 tablespoons unsalted butter
¼ cup packed dark brown sugar
½ teaspoon salt
½ teaspoon baking soda
½ teaspoon pure coconut extract
½ cup rolled oats
1 cup all-purpose flour
2 ounces semisweet chocolate, chopped (I used more)

Directions:

1. Position racks in the upper and lower thirds of the oven and preheat to 350˚ F. Line 2 baking sheets with parchment paper.

2. Toast the coconut in the oven or on the stove top until browned but not burned. Combine 1/2 cup coconut flakes with the granulated sugar in a blender and process until the sugar is finely ground and the coconut is in very small pieces. Set aside.

3.  Put the butter in a large microwave-safe bowl and microwave until melted. Let cool slightly.

4. Stir in the coconut-sugar mixture, brown sugar, salt, baking soda and coconut extract. Then stir in the oats. Add the flour and ½ cup coconut flakes and stir to combine.

5. Scoop heaping tablespoonfuls of dough and gently shape into 2-tablespoon balls. Arrange about 2 inches apart on the baking sheets. Bake, switching the pans halfway through, until the cookies are set around the edges and the centers are puffy, 16 to 18 minutes. Let cool 3 to 5 minutes on the pans, then remove to a rack to cool completely.

6. Put the chocolate in a microwave-safe bowl and microwave in 30-second intervals, stirring, until melted and smooth. Transfer to a small resealable plastic bag and snip a corner. Drizzle the chocolate over the cookies, then sprinkle with the toasted coconut. Let the chocolate set, 10 to 15 minutes.

Police were called to a home where a naked 27-year-old man was causing a disturbance. He reportedly threw a dresser at the police when they tried to subdue him. To keep him safe and protect those caring for him, he was hogtied. To hogtie someone, the police cuff the wrists behind the person’s back and cuff the ankles. Then, the wrist cuffs and the ankle cuffs are connected together, behind, with a third set of cuffs, forcing the subject into a position with his back arched and his ankles fastened to his wrists behind his back. After restraining this man, the police loaded him in their squad car and headed for the emergency department.

I was called out to the ambulance loading dock because the police and ED staff were having trouble getting him out of the back of the police car. Hogtied, naked, sweaty and still fighting, he had thrown himself forward, off the back seat. His head was wedged under the back of the front seat with his rear up in the air. All I saw when I peeked into the car was his naked butt with his scrotum sticking up by his crack.

When we finally got the man onto a hospital gurney, I noted he was not moving any more. A quick check showed he had no pulse and was not breathing. This changed the nature of our situation profoundly. Instead of controlling a drug-addled patient, we had a patient in cardiac arrest.

We moved him immediately off the loading dock into the closest room in the emergency department where the police reluctantly removed his cuffs. I was then able to quickly assess him and give some orders including starting CPR, inserting an IV and getting him on the monitor. Since he was not breathing, I immediately passed a breathing tube into his windpipe and got him on a ventilator. As we got all that done, his heart, which had actually not stopped but had just gone to a very slow rate, was now fast and he was starting to wake up. Though that was good news for him, it also required immediate sedation so he would not pull out his IVs and breathing tube.

A more careful examination showed him to have abrasions on his extremities where the cuffs had been placed and a dislocated elbow, which had probably been suffered at some point during the fight to restrain him. After I stabilized him for admission to the ICU, I got his elbow back in joint and splinted. His testing was all negative except for methamphetamines in his urine.

I have been going through bins of strap scraps. I found two small lengths of straps, one green and one red. Though I wouldn’t say this looks like a Christmas bag, it is Christmas time and this is the closest I am going to come to making something Christmasy.

An emergency physician, by training (and, for me, by nature) wants things to be simple and straightforward. Often, patients show up with anything but simple and straightforward complaints. Sometimes they even come in with detailed notes laying out the course of their symptoms. I am sure they think that lots of details will help the doctor get to the bottom of whatever is making them ill. In reality, at least for me, the more complicated it is, the more I am sure I will NOT get to the bottom of it.

Here is a reproduction of a note I was given by a woman one night. My reading of this is not, “I need to pay attention to all of these details.” Rather, it is “This patient clearly has more problems to deal with than asthma.” Whether it is stress or some underlying personality or psychiatric problem, I see this note as evidence that I have no chance of fixing her problems in one visit to the emergency department.

Obviously, I have changed the names and details to protect the patient’s identity.

Sally A. Williams

CONFIDENTIAL

Asthma

• Current symptoms:
  • Chest feels warm
  • Some back pain while lying down (also pinched cervical nerve)
  • Still tired and hard to get out of bed
  • Terrible dreams where I am fighting to wake up
  • Hard to get to sleep
  • Hard to stay awake during the day even when using CPAP at night
  • Use rescue inhaler with limited success
  • Started Prednisone 25milligrams on 10/29 at 9:00, with slight improvement
  • Prednisone 10mg on 10/30 at 3:00 a.m. with slight improvement
  • Prednisone 15mg on 10/30 at 1:00 p.m. with limited improvement
  • Saturations run 92 to 99, with pulse high at 100-110 (Normal saturations 98-99)
  • Saturations worse the lower I lie in bed
  • Pulse rose to 126 beats approximately 7:00p.m. on 10/30/12
  • Flow Meter done on 10/29 and 10/30 measured 350-375
  • Feet swell if I am upright for even short time, very painful by night (taken off of Aldactone 25 mg by Dr. Jones in July 2012)

HISTORY

• Started Metoprolol 25 milligram ½ tab 2 times on 9/22/12
  • Became tired and started sleeping a lot
  • Sleep was disturbed
  • Advair 500/50 didn’t seem to completely work
    • Felt winded
    • Couldn’t seem to catch my breath
  • High humidity made it worse
  • Hoarseness usually became worse about 4:00 p.m. to 7:00 p.m.
  • Started to use rescue inhaler every few days
  • Last slight flu was August 2012
  • Saw Dr. Jones on 10/19 and she changed medicine to Diltiazem 110
  • Previous private patient of Dr. Smith – diagnosis was mild asthma but worsened greatly by colds and flu and general anesthesia
  • Previous private patient of Dr. Allen – diagnosis of unknown etiology for feet swelling

Zoloft for nighttime to help keep me calm due to stress of not being able to find a job?
Aldactone 25mg. 2x

10/30/12

As I worked to seal these big blobs of cheesecake filling between the cookie dough discs, I thought they would never survive baking. I was sure they would be a huge mess but I was so wrong. They baked perfectly round with a wonderful filling. I also thought the graham cracker crumbs was a great idea. I am going to try them in my regular snickerdoodle.

Recipe By:

Food Network.com

Yield:

12

Ingredients:

Cheesecake Filling
8 ounces cream cheese, softened
1 cup confectioners’ sugar
Generous pinch salt
1 teaspoon vanilla extract

Cookie Dough
1½ cups all-purpose flour
½ cup honey graham cracker crumbs
4 ounces softened butter
½ cup white sugar
¼ cup light brown sugar, packed
2 teaspoons vanilla extract
½ teaspoon salt
½ teaspoon baking soda
¼ teaspoon baking powder
¼ teaspoon ground cinnamon
1 egg

Coating
¼ cup white sugar
¼ cup honey-graham cracker crumbs
4 teaspoons ground cinnamon

Directions:

1. To make the cheesecake filling, using the bowl of your stand mixer, add all of the ingredients and blend on low to combine. Scrape the bowl and beater and mix on medium speed until smooth, about 30 seconds. Portion the cream cheese mixture onto a parchment-lined plate in heaping tablespoon portions, making 12 scoops total. Freeze at least one hour. (I had to keep the balls in the freezer and take them out only one at a time as I stuffed the cookies. They really need to stay frozen.)

2. To make the cookies, using a medium bowl, whisk together the flour and graham cracker crumbs and set aside.

3. In the bowl of your stand mixer fitted with the paddle attachment combine the softened butter, white sugar, brown sugar, vanilla, salt, baking soda, baking powder and cinnamon. Mix on low to combine. Raise the mixer to medium speed and beat until smooth, 1-2 minutes. Scrape the bowl and beat the mixture for another few seconds.

4. Beat the egg into the sugar mixture, mixing on medium speed until combined, about 30 seconds.

5. Add the flour and graham mixture to the mixer bowl and mix on low until combined.

6. Portion the dough onto a parchment-lined sheet in heaping tablespoon portions, making 24 scoops total. Refrigerate at least 1 hour.

7. Make the graham cinnamon sugar by combining all ingredients in a small bowl.

8. Heat your oven to 350 degrees and line two half-sheet pans with parchment.

9. Take one cookie dough portion and flatten it in your hands into a 2-inch disk.

10. Place a frozen portion of cream cheese on top.

11. Top with another portion of cookie dough, pinching the edges of the dough together to encase the cream cheese. Roll the dough in your palms slightly, and then roll the dough in the cinnamon sugar to coat. Repeat with the remaining dough to make 12 filled cookie dough portions. Roll all portions of cookie dough in the cinnamon sugar and then place 6 dough balls on each half-sheet pan. Don’t flatten the dough balls. Bake until puffed and golden around the edges, turning the pans about halfway through baking, about 17-18 minutes. Cool and enjoy! (I usually enjoy cookies best right our of the oven but these really do need to cool before being eaten.)

Made these for Covid-19 indulgence. The recipe didn’t call for the chocolate chips but I would certainly add them. They were rich and tasty.

Ingredients:

½ cup butter, softened
¾ cup brown sugar
1 cup sugar
½ teaspoon salt
1½ teaspoons vanilla
2 eggs
2¼ cups all purpose flour
1 teaspoon baking soda
8 ounces toffee bits
12 ounces chocolate chips (optional)

Directions:

1. Heat oven to 350 degrees. Line cookie sheets with parchment paper.

2. Sift together flour, baking soda and salt, set aside.

3. In your mixer, cream butter until fluffy, about 2 minutes.

4. Mis in sugars and vanilla.

5. Stir in eggs.

6. Gradually mix in flour mixture until incorporated.

7. Fold in toffee bits and chocolate chips.

8. Drop by 2 tablespoon balls onto parchment-lined baking sheets.

9. Bake 9-11 minutes or until slightly brown. Cool on wire racks.