Third week in a row with yellow and black stripes. This one is a bit different.

Here are three true stories about something that happened to the patient before he or she arrived in the emergency department.

Ambulance Taxi

A 69-year-old man was out in public and needed a ride so he called a cab. When the cabby refused to take his watch in payment for the planned ride, an argument ensued and the cabbie left. The man then fell to the ground and feigned being ill. A passerby took pity on him and called an ambulance that took him to the emergency department. He told me what happened and asked that I find him a board-and-care home where he could live. He had no medical complaint and expected no medical care.

Resurrection with Oxygen

Our emergency department is the base station for the County Emergency Medical System. This means paramedics call us if they need any guidance.

One night, I took a call from frustrated medics. They were on the scene with an eighty-five-year-old lady who had been seen by reliable bystanders to be down and not breathing for two hours. The medics got there and found her to be dead. When they wanted to pronounce her dead and call the coroner, a daughter, who was present, objected. She wanted the patient transferred to the university hospital and placed on oxygen for three days. She claimed to be a nurse and said she had experience causing her to believe this therapy would help her mother.

The medics put the daughter on the phone and I talked with her. I tried to get her to see that her mother was dead and there was nothing that could be done about it. She didn’t want to believe me and was not happy when I instructed to medics to call the coroner.

Ipecac Followed by Water

When I was practicing in Alabama, I worked in a hospital that also served as the medical command for the County Emergency Medical System. At that time, any treatment given by the paramedics had to be ordered by the doctor at the hospital. If the medics wanted to give a medicine to a patient in the ambulance, they had to call us for permission to do so.

One night, I got a call from the medics saying they had a patient who had just overdosed on pills. As was the procedure then, I ordered a dose of a medicine called syrup of ipecac, which was given to cause the patient to vomit. After the medicine is taken the patient was supposed to drink several glasses of water until the onset of vomiting. So, over the radio I ordered, “ipecac followed by water.”

Soon they arrived at the hospital and I was puzzled to find the patient was wet. The medic gave the patient the ipecac to drink then threw a glass of water over him.

I have been having a lot of fun lately with black and yellow stripes. Last week was wide yellow stripes with tabs, there is one with thin yellow stripes.

You will see ginger come up a lot in my recipes. I think it is exotic and very interesting. It also goes with a lot of flavors. My standard ginger cookie is Taku Ginger Cookies. They taste great and the texture is to die for. This recipe also tastes great and has the wonderful dark chocolate chips to go along with the ginger. They don’t have that same killer texture  the Takus do but they are very good. Go for it!

Recipe By:

diningaround.com

 Yield:

27 cookies

 Ingredients:

2 cups flour

2½ teaspoons ground ginger

2 teaspoons baking soda

¼ teaspoon salt

1 teaspoon cinnamon

¼ teaspoon ground cloves

1 tablespoon cocoa powder

½ cup dark brown sugar

¾ cup granulated sugar, divided*

½ cup butter

¼ cup shortening

1 large egg

¼ cup molasses

1 teaspoon vanilla

½ cup crystallized ginger, chopped

1 cup dark chocolate chunks (a bittersweet chocolate bar cut into chunks)**

Directions:

1. Combine first 7 ingredients in a bowl and whisk to blend. Mix in crystallized ginger. Set aside.

2. Using electric mixer, cream butter, shortening and brown sugar and ¼ cup granulated sugar until fluffy, about 2-3 minutes.

3. Beat in egg, molasses and vanilla.

4. Add flour mixture and mix just until blended.

5. Stir in chocolate.

6. Cover and refrigerate about 45-60 minutes.***

7. Heat oven to 350 degrees.

8. Spoon the remaining ½ cup sugar into a plate.*

9. Scoop 2 tablespoon balls of the dough. Roll in sugar to coat completely.

10. Place balls on cookie sheets covered with parchment paper and space 2 inches apart. Bake cookies until cracked on top but still soft to touch, about 10-12 minutes. Let set on cookie sheet about 2-3 minutes, then remove to cooling rack.

Notes:

* Rather than regular granulated sugar, I dip these in large sugar crystals such as Sprinkle King, KingsBlingz White Diamond Crystalz. I get them online at SupplyVillage.com.

** I use bittersweet chocolate chips.

*** I find this step to be unnecessary if you use a cookie scoop. You have to handle the balls carefully when you dip them in the sugar but it works. It is definitely easier to roll them in the sugar when the dough is chilled.

A young adult man came in as a trauma alert. He was very drunk and obviously injured. The alcohol-induced lack of cooperation made his trauma evaluation difficult and complicated. He had to be sedated to keep him from harming the staff while we removed his bloodied clothing and performed tests to rule out serious injury. Eventually, all of his x-rays and scans came back normal and he was left to sleep off both his alcohol and the sedatives he was given.

Some time later, I heard a commotion and went to see what was going on. As I rounded the corner into the hallway adjacent to his room, I saw the patient, naked except for the protective collar he still had around his neck, standing in the hall. His IV tubing was trailing behind him into the room and he was hollering curses at everyone who was trying to get him to go back into the room and onto the gurney.

Immediately in front of him, sitting on a gurney in the hallway, was a young family: Mom, Dad and a seven-year-old daughter. When the drunk, crazy, naked guy came out of the room into the hall, he was standing right in front of them, hollering with dried blood on his face, arms and chest. The poor family looked like they were watching a horror film, frozen with eyes and mouths agape. The parents were so stunned they didn’t even think to protect the little girl from this amazing site.

A pair of Sherriff’s deputies happened to be guarding a prisoner nearby and quickly took the patient back into the room. They pinned him, face down, on the gurney and handcuffed his hands behind his back until hospital security arrived and got him into leather restraints.

I later learned the patient had awoken and asked the nurse where his Chihuahua dog was. When the nurse told him he came in with no dog, the patient blew up, tried to strike the nurse and cried that his dog was the only thing he had in the world. He then got up and headed off to find the dog. That is how he ended up naked and screaming in the hallway.

A few hours later, he was ready for reevaluation. I took off his collar, rechecked his neck and sent him off to look for his dog, sober and dejected.

I have been messing around with stiles. Here is a new bumblebee bag.

It should be obvious from looking through my previously posted recipes that I am not really hung up on avoiding ingestion of animal products. This caught my eye because it used coconut oil and avocado in place of butter and eggs. They are rich and chocolatey and, of course, can be made vegan if that pleases you.

Yield:

2 dozen cookies

Source:

twopeasintheirpod.com

Ingredients:

1¼ cups all-purpose flour
1 teaspoon baking powder
½ teaspoon sea salt
2/3 cup Dutch processed cocoa
¼ cup coconut oil
¼ cup mashed avocado
¼ cup granulated sugar
½ cup brown sugar
1 teaspoon vanilla extract
1/3 cup almond milk*
½ cup vegan chocolate chips*

Directions:

1. Heat oven to 350 degrees. Line large baking sheet with a Silpat baking mat or parchment paper and set aside.

2. In medium bowl, whisk together flour, baking powder, salt, and cocoa. Set aside.

3. In bowl of a stand mixer, beat coconut oil, avocado, and sugars together until creamy and smooth, about 2-3 minutes. Stir in vanilla extract.

4. With the mixer on low, mix in half the flour mixture.

5. Mix in milk.

6. Mix in remaining flour mixture.

7. Stir in chocolate chips.

8. Form cookie dough into 2-tablespoon balls and place on prepared baking sheet, about 2 inches apart. Slightly flatten the cookies with the palm of your hand or a spatula.** Bake cookies for 10 minutes, or until set around the edges, but still soft in the center. Let the cookies cool on the baking sheet for two minutes. Transfer to a wire cooling rack and cool completely.

Notes:

* For simplicity, I used regular milk and chocolate chips so mine were not really vegan.

** I used my favorite method of flattening cookies: Butter the bottom of a drinking glass. Dip bottom of glass in sugar. Flatten the dough ball. Dip in sugar again before repeating.

One of the main jobs I have in running the emergency department is what we call “disposition.” That means getting people out of the department so others can come in and be cared for. Most of the time, this is simple. They either go home or they get admitted to the hospital. Some times, it is not so simple and takes a lot of work, time, creativity and patience to find a good place for someone to go. Here is a story of one such patient.

A 68-year-old man presented from a board and care facility. He was reported to be hyperventilating and not able to talk appropriately. He had a history of developmental delay and schizophrenia.

I found him agitated and hyperventilating. I ordered laboratory testing and sedation.

After being sedated, he responded to questions with answers like, “Elvis Presley” and “Bing Crosby.” He also started singing Christmas songs and other songs like “When They Call the Roll Up Yonder” and “Mine Eyes Have Seen the Glory of the Coming of the Lord.”

Because he had caused so much trouble at the board and care home, the managers refused to take him back. I had to find somewhere else for him to go.

I will present a time line that shows what I had to go through and how much time it took in order for me to get this guy out of my emergency department that evening.

5:05             The patient arrived in our emergency department and his work up began.

8:40             His labs came back normal. He was calm and cooperative. I called Emergency Psychiatry and

with the charge nurse. He said he would call back.

9:00             The Emergency Psychiatry charge nurse never called back so I called him again. He told me to call

back and talk to the doctor.

9:10             I called back and talked with the doctor, who told me the patient was not a good candidate for their

facility and recommended I try to find another psychiatric facility that would take him.

9:30             I talked with the charge nurse at a local psychiatric facility. She said she would call me back.

9:50             I talked with that charge nurse again. They refuse to take the patient in transfer. They offered no

reason.

10:00           I talked with someone at another local hospital with a psychiatric facility. They said they would

get back to me.

10:20            I talked with them again. They also refused patient.

10:20            I talked with the patient’s doctor in a city about an hour away who refused to take the patient in

transfer. He recommended I send the patient to our psychiatric unit.

10:30            I talked, again, with the charge nurse at Emergency Psychiatry who accepted the patient.

10:40            The charge nurse at Emergency Psychiatry called me back and asked that I document all of my

efforts to place the patient elsewhere.

11:10             The patient leaves for Emergency Psychiatry.

So, it took six hours and ten phone calls to make sure this man was safe for discharge and find a place for him to go. You can imagine what a disruption this was to the care I was trying to provide to all my other patients and how frustrated I got. This is an example of what I have to endure to do my job.

I have been faithfully posting to this site every week. I recently changed hosts. I subsequently learned that no one was being advised of new posts. I am making this posting as a test to see if we are back in business again. Hope you enjoy catching up with BadTadMD.com!

Most of my straps are 2 inches wide. I do get some that are black and only 1.5 inches wide. I had previously only used them only for handles and trim. This time I came up with the idea of using them to make stripes with orange. I made four last night, all different sizes.