We rarely have pediatric deaths in the emergency department and some of my most painful emergency physician memories are of having to tell parents their child is dead.
We had a three-year-old die this last week. The father brought him in lifeless. We started CPR, put a tube in his airway to press oxygen into his lungs and gave injections of adrenalin to try to get his heart started again.
As do most dead people, he stayed dead. He was one of those “syndrome kids.” He was born with severe physical and mental abnormalities. As a result, he was destined to die and early death like this. That realization blunted the pain in seeing him dead. The pain was also dulled by the realization that he was really dead when he arrived and there was nothing I could have done about it. Still, it was heart wrenching to be with the father as he held the body of his unfortunate son.
While we were trying to revive the patient, I noticed he had obviously been given some sort of a red, sugary, fruity cough syrup sometime before he died. He had vomited so it was all over his face and in his hair. I inadvertently got some of it on myself and the smell of it kind of haunted me for the rest of the shift.
We were invited to an open house by our friends, Tammy and Alex. We went to offer best wishes to their daughter, Ashley, before she left to do missionary work in Moscow. There, we had these cookies, which were made by their friend, Nigella Lawson. They were so good, I insisted they get me the recipe. These are very rich and decadent.
4 ounces bittersweet chocolate
½ cup butter
½ cup sugar
1 cup brown sugar
½ cup flour, 2.25 ounces
3 tablespoons cocoa
1 teaspoon baking soda
¼ teaspoon salt
1 teaspoon vanilla
1 large egg, cold
12 ounces bittersweet chocolate chips
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 in egg and vanilla.
5. Stir in butter/chocolate mixture.
6. Stir in chocolate chips.
7. Form into 2 tablespoon-sized balls and place on baking sheets covered in parchment paper.
8. Bake for about 18 minutes.
1. I have baked them at 325 degrees in the middle of my oven for 18 minutes and they were great. I also baked them at 300 degrees on convection for 18 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 to prevent over-cooking. Don’t over cook them!
2. They are amazing with Breyer’s Natural Vanilla ice cream and Mrs. Richards caramel sauce. Just killer.
3. If you want to back off on the chocolate a bit, you can use semi-sweet chocolate and semi-sweet chocolate chips. The cookies are not as dark, of course, and don’t compromise much on the texture.
This is the very first bag I ever made. My wife, Shari, still uses it as a back up bag and won’t think of getting rid of it because it was my very first. It was weaved where as most of my bags now are made with the straps sewn in parallel. When it got dirty, I recommended Shari throw it in the washing machine. She did so, hesitantly, and it came out great.
My patient was a man who had torsion of his testicle, resulting in the testicle being dead and needing to be removed surgically. I called the urologist in to see and admit him for surgery.
After seeing the patient, the urologist came up to me and told me the patient had refused to talk to him about surgery or even to let himself be examined.
This really puzzled me. Since the patient was primarily Spanish speaking, I asked if the urologist had used an interpreter. He said the patient’s English was good enough that an interpreter was not needed. This made me nervous. I told him if the patient were refusing surgery, it would make sense to use an interpreter to make sure the patient really understood the risks associated with his decision.
Anyway, as it turns out, the urologist had looked for a patient named Garcia and had gone into the room of a different man named Garcia who was there for chest pain! True, this man primarily spoke English but he also had nothing wrong with his testicle and was not about to talk to anyone about getting his cut off! Fortunately, we were able to identify the mistake, get the urologist to the correct Mr. Garcia and get the right man admitted for surgery.
He was a most pitiful man. He was about sixty-years-old and had suffered a stroke in the past. He was in the emergency department after being found down drunk and unable to walk. Because of his previous stoke, he had a big challenge walking – even with his cane. It didn’t take too much booze to make him quite unstable. He needed no medical treatment and didn’t even need to be in the emergency department at all.
We frequently let people like this sleep the night in the hall, partly from empathy and partly from worry they might injure themselves in a fall or being hit by a car after they leave. The problem with this man staying was that he was so stinky. He was wet with several doses of his own urine, which made him smell most awful. He filled the department with a burning, foul stench. It was not fair to other patients, their families or the ED staff to have him around.
With such patients, we usually offer to let them shower and then find them some clean clothes to wear. In this case, he refused to take a shower or get new clothes. When told he had to leave if he didn’t clean up, he said he would just wait in the waiting room. I told him that was not an option because he was too smelly. So, he grabbed his cane and walked out into the cold, dark night. He chose to stay wet and foul rather than accept the offer of a hot shower, clean clothes and a warm place to sleep the night. It really makes you wonder what makes some people tick, doesn’t it?
I only recently learned about Speculoos. We went to Bruges Waffles and Frites* in Salt Lake City for breakfast. One of the options is Speculoos and crème fraiche on your waffle. It was so good, I had to get some at home. I found it online at The Belgium Shop.** I have subsequently seen it at Trader Joe’s.
My daughter-in-law came across this recipe online*** and forwarded it to me so I tried it right away.
Speculoos is a kind of crispy cookie made in the Netherlands. They grind the cookies up and mix them with something to make a spread that looks a lot like peanut butter. These are good but you have to spread a generous amount of Speculoos on the cookies to make them really interesting.
The irony fails to escape me: grinding cookies into a paste to be used to make cookies.
2 dozen cookies
1 ½ cups all-purpose flour
1 teaspoon baking soda
½ teaspoon salt
½ cup unsalted butter, at room temperature
6 tablespoons granulated sugar
6 tablespoons brown sugar, packed
1 large egg, at room temperature
1 teaspoon vanilla
½ cup Speculoos spread
1 cup chocolate chips
Additional Speculoos for filling
Heat oven to 350 degrees and line a baking sheet with parchment paper.
In a medium bowl, whisk together flour, baking soda, and salt. Set aside.
In a stand mixer or with a hand mixer, cream butter and sugars until light and fluffy. Stir in egg, vanilla and ½ cup Speculoos.
With the mixer on low, add the flour mixture to the butter mixture. Mix just until incorporated.
Stir in the chocolate chips.
Using a spoon or small ice cream scoop, drop about 2 tablespoon-sized balls of dough onto the parchment paper.
Bake 8 to 10 minutes until the cookies are lightly browned around the edges.
Transfer the cookies to a wire rack to cool completely. If desired, make sandwich cookies by spooning more Speculoos in between two cookies. (Highly recommended.)
My Patient of the Week was really a Mother of the Week. On Wednesday night, I cared for a fourteen-year-old girl who came in with a report of having been found unconscious with her pants down. My evaluations allowed me to feel comfortable she was very drunk and not ill in any other way. In doing so, it was hard to not notice this drunk-as-a-skunk pubescent teen had neck tattoos. I couldn’t help but ask myself, “What the heck kind of a parent would let his fourteen-year-old daughter get neck tattoos?
My plan was to watch her closely until she woke up and then call in the Sexual Assault Response Team (SART) to do an exam on her. Soon thereafter, I was told her mother had arrived. The nurse came up to me and told me the patient was awake and pulling out her IV and the mother wanted to know when she could take her daughter home.
When I went into the room, I found a woman about thirty-five years old with an infant girl on her lap. Other than the sparkles in her eye shadow, there was nothing particularly unusual about her appearance.
I reviewed the known facts with the mother. Her daughter had been found abandoned by her “friends,” unconscious because of drinking too much alcohol. Her pants had been pulled down and there was no way for me to determine if she had been molested or not. I recommended a SART exam be done to make sure her daughter had not been sexually assaulted.
First, the mother turned to the girl and asked her if anything happened to her. When the girl said, “No,” the mother passed that answer to me. I pressed the mother, pointing out there was no way her daughter could know what happened as she was unconscious. The mother then asked the girl how she could know nothing happened and the girl just repeated that nothing happened.
Since the mother was unable to convince the child she needed a rape exam, the mother then turned to rationalization. The first thought Mom used to minimize the significance of all of this was to say that nothing could have happened because the girl’s pants were so tight there was no way anyone could have gotten them down.
The whole conversation was too convoluted for me to be able to reproduce it all but it was amazing to see how little concern the mother showed, how she tried to present everything in the most positive light and how she let the girl decide everything even though the girl was clearly impaired and irrational. After I pointed this out to them and made clear the implications of their decision to leave, off they went, apparently undisturbed by anything that had happened or been said.