This is the third of a series of emergency coincidences that were interesting to me.

Double Achilles’ Trouble

The Achilles tendon is the largest tendon in the body. It hooks the calf muscles to the heel.

There is a risk that it will rupture or tear during athletic activities, especially with jumping or sudden movements of acceleration or deceleration. It is more common in athletes and people who have conditions that lead to less-than-healthy tendons, like diabetes, vascular disease or certain rheumatologic conditions. About 7 people in 100,000 with suffer a ruptured Achilles’ tendon.

One day, I took care of a 50-year-old obese diabetic woman who was running to catch a bus when she tore both of her Achilles’ tendons at the same time. That is a coincidence for someone with very bad luck.

Two Self-Inflicted Stab Wounds to the Abdomen

During one shift, I took care of two people who both tried to commit suicide by stabbing themselves in the abdomen. I will tell their stories by using the exact words I wrote in their medical records that night:

“This 46-year-old man with psychosis became despondent and injured himself at some hour during the night. He was found on the floor of his board-and-care facility with a laceration of the left neck and a laceration of the abdomen with viscera (guts) coming out if it. The report to us is that he was actually pulling his intestine out of the hole in his abdomen. The patient is either unwilling or unable to give a more specific history about what is going on.”

The patient was taken to the operating room to put his guts back inside him.

“A 32-year-old man got upset when his mother tried to stop him from smoking so he decided he wanted to kill himself and stabbed himself in the abdomen. He arrives in the emergency department by ambulance with a complaint of abdominal pain secondary to the stab wounds.”

The patient was found to have two stab wounds into his abdominal cavity. He also was taken to the operating room to make sure none of his internal organs was injured.

The ends of some trauma straps are sewn back on themselves, forming tabs. Here is another way I used those tabs for decorative purposes. Thanks to Shari for the idea.

Here is the front.

Close up of front

Back

I have tried a few different recipes to combine chile and lime with a chocolate cookie. This is the best I have come up with yet. You can adjust the amount of chile powder you use, depending on how much of a burn you want them to have. These cookies are very easy to make so it is not that much extra trouble to frost them and they are worth the extra effort involved. Don’t be afraid of the chile.  I took them to the emergency department and to choir and no one complained they were to hot.

Serving Size:

24

Ingredients:

Cookies:

4 ounces bittersweet chocolate

½ cup butter

½ cup sugar

1 cup brown sugar

½ cup flour, 2.25 ounces

3 tablespoons cocoa

¾ teaspoon cinnamon

1-1½ teaspoons ancho chile powder

1 teaspoon baking soda

¼ teaspoon salt

1 teaspoon vanilla

1 large egg, cold

12 ounces semisweet chocolate chips

Lime Butter Cream Frosting

2 cups powdered sugar, sifted

2 tablespoons fresh limejuice

½ teaspoon lemon zest

½ cup butter, at room temperature

Directions:

1. Heat oven to 325 degrees.

2. Gently melt bittersweet chocolate and butter over double boiler or in microwave. Set aside.

3. Mix dry ingredients in bowl of electric mixer.

4. Stir egg and vanilla into dry ingredients.

5. Stir in butter/chocolate mixture.

6. Stir in chocolate chips.

7. Form into 1 tablespoon-sized balls and place on baking sheets covered in parchment paper.

8. Bake for about 14 minutes.

9. Make the frosting by beating the powdered sugar, limejuice, lime zest and butter until smooth. Add more powdered sugar as needed to make it perfectly spreadable.

10. After cookies are cool, spread some frosting on the bottom of one cookie and press the bottom of another cookie into the frosting, forming a whoopie pie.

Notes:

1.  I have baked them at 325 degrees in the middle of my oven for 14 minutes and they were great. I also baked them at 300 degrees on convection for 14 minutes as well. Every oven is different so you have to be careful, especially in chocolate cookies where you can’t use the color as a guide. Don’t over cook them!

2. If you want to back off on the chocolate a bit, you can melt semi-sweet chocolate. The cookies are not as dark, of course, and there is no compromise on the texture.

3. If you use 1 teaspoon of chile powder, you will only notice the slight burn as the cookie is just leaving your mouth. With 1½ teaspoons of chile, they have just a little burn while you are eating them. Fun!

Bible Open to Different Page

A 66-year-old woman came in by ambulance after waking up and feeling her eyes irritated and flushed. She believed another occupant of her apartment complex had sprayed her with something. No one else lived in her apartment and she saw no one. The only evidence she had of anyone having entered was that her Bible was open to a different page when she woke than when she went to sleep. She said she has no enemies and no reason to think anyone would want to harm her. Still, based on how her eyes felt and the Bible being open to a different page, she was sure that was what happened.

Blood from Eyes, Ears and Nose

A 16-year old said she felt something in her brain “pop” earlier in the evening. She came in saying she had blood come out of both of her eyes, her nose and both ears.

One her exam, she was found to have a little dried blood on her face and ears but no blood inside her nose, mouth, throat, eyes or ears.

She was completely calm and seemed to be not the slightest bit worried about what might have happened to her. She was unable to explain how she might have blood on her face but no blood inside any of the places from which she said she had been bleeding.

This is one of those cases where I wondered what the heck was really going on but will never know.

I bought these orange handles at RAFT for a buck a long time ago. The bag is made from a piece of striped material left over from a previous bag. It was very tricky to get the bottom corners. The combination of small size and curved bottom made it really difficult to manipulate the sewing machine to shape the bottom. I think I will try again with a larger size. It will have to have  another type of handle since I only had one set of orange ones.

Here are some Emergency Department coincidences that were noteworthy to me.

Three T’s

I did my internship in emergency medicine at Milton S. Hershey Medical Center in Hershey Pennsylvania. One shift, I worked with an attending physician named Ted and a senior resident named Todd. So, we had Ted, Tad and Todd on duty at one time.

Where Is My Son?

The mother was called to the emergency department after her son had been injured in a car crash. On arrival, she found the patient was not her son but had the same name. She was very relieved but wondered where her son really was.

Elderly Couple with Matching Injuries

An elderly man was driving his car with his wife riding in the front seat next to him. They were struck from the rear by a school bus. The bus hit them with such force that the bench seat in their older car was knocked back flat onto the rear seat.

When they arrived in the emergency department, she was complaining bitterly of neck pain and her neck was very tender. He was quite comfortable though he did have some neck pain and tenderness.

X-rays showed they both had fractures of their second cervical (neck) vertebrae. They were both admitted to the same room in the hospital for care of their fractures.

I had cream cheese and cacao nibs burning wholes in my refrigerator and pantry. As I looked around the Internet for some inspiration of what to do with them, I came up with this. I usually shy away from cookies I think will be crunchy but I went for these anyway and they were interesting. The cacao nibs give them a nutty texture and flavor that is interesting and goes along well with the chocolate chips. Like most shortbread cookies, these are not too sweet.

Recipe By:

Internet

 Yield:

40

 Ingredients:

4 cups all-purpose flour

1¼ teaspoons coarse salt

2 cups unsalted butter, at room temperature

6 ounces cream cheese, at room temperature

1¼ cups sugar

2 tablespoons pure vanilla extract

1½ cups mini semisweet chocolate chips

2 cups cocoa nibs

 Directions:

1. Whisk flour and salt in a large bowl. Set aside.

2. Place butter and cream cheese in the bowl of an electric mixer. Using the paddle attachment, beat on medium speed until pale and fluffy (approximately 2 minutes).

3. Add sugar and vanilla and mix until combined.

4. While mixer is running on low-speed, add flour mixture, and continue to mix until just combined.

5. Stir in mini chocolate chips.

6. Transfer half of dough to a large sheet of parchment paper. Shape into a long log about 2 inches in diameter. Roll in parchment paper. Repeat with other half of the dough. Freeze until firm, at least 30 minutes or up to 2 weeks.

7. Heat oven to 350 degrees F.

8. Unwrap one log, roll in cocoa nibs (pressing lightly to adhere), coating lightly*.

9. Cut into 1/4-inch-thick rounds. Space approximately 1 inch apart on baking sheets lined with parchment paper.

10. Bake cookies until golden around edges, 16 to 18 minutes.

11. Let cool slightly before removing from trays and letting cool completely on wire racks.

*Notes:

Mine are probably coated more heavily than those of the original recipe but I used the amount of cacao nibs they called for.

I tried again making a large bag wider at the base than at the opening, this time yellow with blue contrast.

This is the front.

And the back.

A traveling nurse in our department named Felicia asked for a black bag. This is what I came up with.

A Sad Super Bowl Party

A fifteen-year-old girl was at a Super Bowl party at a friend’s house just up the street from where I live. She took the friend’s go-cart out for a ride on the street with another kid on the back. She lost control, ran the go-cart up under a parked car and died in the accident.  What a tragedy for this young girl, her friend, and her family who thought she was safe watching football.

A Seizure or Not?

A twenty-two-year-old-man came in after crashing a go-cart into a wall.

He made it back to his home where someone called 911. The medics arrived and found him at home having a pseudoseizure (a false seizure.*) In the emergency department, he reported having seizures since childhood but said he was never treated for them. This seemed strange to me, as most people with life-long seizure disorders have been on medicine at some time.

He seemed to be uninjured in the go-cart crash.

He would not cooperate with our efforts to help him and he refused the CT scan I ordered. When his parents arrived, he would not talk with them or even allow them in the room.

I finally discharged him and he walked out, though it was unclear if he joined his family in the waiting room or left by another route, avoiding them.

It made me wonder what was really going on in his life and brain.

* http://en.wikipedia.org/wiki/Psychogenic_non-epileptic_seizures