A thirty-one-year-old woman came in by ambulance after attempting to kill herself. She was five months pregnant with her 17^th pregnancy. She said she had given birth to 2 children, had 3 abortions and 11 miscarriages. She was very depressed from the recent death of her boyfriend, who was the father of her unborn baby. She said she had recently lost sixteen other close friends and relatives to death, for a total of seventeen. This, coincidentally, was the same number of pregnancies she reported having. When she started to have some vaginal spotting earlier in the day, she was afraid she was going to have another miscarriage so she decided to kill herself.

She started by drinking a lot of alcohol, smoking excessive amounts of methamphetamine and taking an overdose of her antidepressant medicine. She then lay in the bed where her boyfriend died, hoping to join him.

When she didn’t die, she lit fires around the house and wrapped herself in a blanket, which she also lit on fire.

The fire department and paramedics arrived after the patient called a friend and revealed what she was doing. The emergency personnel found the house filled with smoke and flooded from a broken water main. The patient was in the bathtub, face down in a small amount of water. She was wrapped in a partially burned blanket, though she was not burned. When she arrived in the emergency department, she was wet, smelled of smoke and seemed intoxicated.

Because she was pregnant, had suffered some degree of smoke inhalation and possibly had some degree of near drowning, she was admitted to the hospital for overnight observation.

Last weekend, I gave my wife’s very nice bag away to my sister-in-law with a promise I would make a new one to replace it. In order to be good to my word, I spent some time this last week carefully making a bag that, with all due humility, is the nicest bag I have ever made. I was very careful at each step of construction. I wanted it to be prefect for her and, though there is no such thing as perfection in this endeavor, it is, for sure, the best bag I have ever made.

Orange with black trim. Large and symetrical

This is detail on the inside: zippered pocket with pen slots. A carabiner for car keys.

From the end, a black stripe up the side.

A 40-year-old Cambodian woman came in by ambulance complaining of whole body stiffness and inability to speak or move her neck. This was her third visit to our emergency department in a week.

Her first visit came after she was involved in a minor motor vehicle crash. She was rear ended, resulting in minor damage to her car. She developed a migraine headache after the crash so she came to our emergency department to make sure she was OK. She was found to have no serious injury and her headache had resolved by the time she left.

The evening before I saw her, she was at Bible study and was reading aloud from the scripture. As she did so, she progressively lost her ability to speak. Her voice became quieter and she had trouble breathing. She then developed stiffness in her neck that spread to her jaw and then her entire body, making her unable to walk.  After a few minutes, this resolved but she came to the emergency department to be checked again. She was interviewed and examined by a doctor and sent home, with reassurance.

I saw her on her third visit the following day. Once again, while reading, she developed difficulty breathing and body stiffness. Her family called the ambulance to bring her back to the emergency department.

As I walked into the room, I was very impressed by how miserable she was. She was stiff and shaking from head to toe. She was unable to open her mouth normally or move her neck in any direction. Though she could hardly talk, she was screaming hysterically. Her heart was racing away.

I ordered something to help her relax. I also ordered blood tests to make sure she didn’t have something unusual, like a low blood calcium level, that might explain her muscle rigidity. Fortunately, the blood tests were all normal.

When I went back to check on her, the sedative had worked perfectly to cure her stiffness and inability to speak or move her neck. Her pulse rate had returned to a normal level and she was ready to be discharged. However, she was hesitant to leave for fear she would have the symptoms again at home when she read. I proposed an easy test and asked her to read something.

As soon as she started to read, she freaked out. She started to holler loudly and have the same stiffness and shaking she had when she first arrived. He pulse shot up again as well.

After more time and another round of sedatives, her symptoms again resolved. I was finally able to get her and her very concerned family to see that the only explanation for this was a panic attack and that, with time, she would be able to return to reading again.

An 84-year-old man came in with a nosebleed. He was upset and said to the nurse, “I’m bleeding to death! Get a doctor in here to give me a shot of coagulant!”

A 42-year-old woman came in with her jaw jerking from side to side. She said this had never happened to her before and she was unable to control it. When her jaw was closed, she claimed that she couldn’t breath though she was passing air through her nose with no problem. All of her symptoms went away after she was given some Valium.

An 18-year-old man came in after having had a seizure. When he woke up, his only complaint was pain at three sites: a recently applied tattoo, a newly place nose ring and where the IV was in his arm.

A mother brought her 10-year-old daughter in for vomiting. Her main concern was that her daughter might be sick from radiation fallout from the Japanese tsunami-induced nuclear reactor melt down. As I tried to reassure her, she gave me that fearful, “you must be an idiot” look I have seen so many times when my patients (or their mothers) refuse to take my reassurances.

A 22-year-old Vietnamese man was hit in the face and cut with bottle. He had dark blood on his face and in his ear. It turned out he had no injury and the “blood” was teriyaki sauce.

A 79-year-old woman came in with constipation. She was given an enema, which resulted in a bowel movement, which, she said, was “bigger than having a baby.”

Here is a bag I made recently, blue and orange, with a different pattern.

Last week, I showed you a bag with tabs. I tried again this week. Check it out.

Last week, I shared some interesting complaints with which some of my patients presented to the emergency department. Here are a few more:

35-year-old-man complained of excessive salivation after eating bad meat.

37-year-old man complained of excessive salivation after drinking milk.

20-year-old woman was hit on the thigh by a lime that was shot out of a homemade gun designed for that very purpose.

“This is a 15-year-old female who was struck with a can of Pringles potato chips and a water bottle by her 10-year-old sister tonight. This caused her to fall over and land on her elbow. The paramedics were called and she arrived here by ambulance.”

A daughter, speaking of her 67 year-old mother: “I woke up and found her on the floor unresponsible.”

This is a pretty basic cookie with a soft texture but they hold together pretty well when bags full are taken to the emergency department.

 Recipe By:

San Jose Mercury News and all over the Internet

 Yield:

30

Ingredients:

2 cups Extra Dark Chocolate Chips (divided)

2 tablespoons water

½ cup unsalted butter, softened

1 cup sugar

½ teaspoon salt

2 large eggs

1 tablespoon vanilla extract

1 ¼ cups unsifted all-purpose flour

½ teaspoon baking soda

1 cup sliced almonds

 Directions:

1. Heat over to 350F degrees.

2. Heat one cup of chips and water in microwave for about 1 minute, stirring well until smooth.  Set aside.

3. Cream butter, sugar and salt in large mixer bowl until light.  Beat in eggs and vanilla until smooth.

4. Add melted chocolate, then mix in flour and baking soda just until incorporated. Stir in remaining chocolate chips and almonds.

5. Drop spoonfuls on parchment-lined baking sheet.  Bake for 10-11 minutes.  Tops will look cracked and crusty while centers will be soft and look under baked. Don’t over-cook them!

Here is the bag I made this week.

Think Emergency Department means “emergency?” Check out some of these ED patient complaints.

26 year-old female presented at 6:00 in the morning complaining of being weak and tired after being up all night drinking whiskey at a party.

20-year-old man presented with a chief complaint of uncontrollable farting when he gets nervous.

An adult woman came in complaining of a “virginal infection.”

18-year-old woman smelled blood in her nose for three minutes, fifteen minutes before arriving at the emergency department.

Young female claimed to have complete amnesia for everything in her life up until she saw the “emergency” sign out front.

21-year-old man came in with a self-inflicted laceration in the middle of his forehead, which he caused trying to remove a “computer chip” from his brain.

19-year-old man complained of feeling funny after taking LSD.