Vicodin, Thank You Very Much

Written by Tad. Posted in Kooks

One night this week, one of my physician assistants came to me frustrated that the patient he had gone to see had run him off, saying he wanted another doctor. Matt had addressed two complaints the patient had: difficulty urinating and a nagging cough. When the patient went on to more complaints, including shoulder pain he had been suffering with for over a year, Matt recommended he take up these more chronic problems with his primary care physician. That is when the patient ran Matt off.

It was now my turn. I found an elderly man asleep on a gurney wearing sunglasses and a beret pulled down over his face. I introduced myself and went over his first two problems. When I asked him if he had any other concerns, he told me about his shoulder pain, for which his primary care doctor usually gave him Vicodin. He then said all he wanted was to be treated with sympathy.

I asked him if he had come for sympathy or for Vicodin. He calmly answered, “Vicodin would be fine, thank you very much.”

This all took place in the hall right in the busiest part of the emergency department and as soon as he answered my question, I was surrounded by suppressed laughs. I had not intended my question to be comical. I’m sure he didn’t intend his answer to be funny either, but, together, they made everyone laugh. This was especially funny to staff surrounded every day by people looking for opioids for their chronic aches and pains.


Lemon Semolina Cookies

Written by Tad. Posted in Cookies

Semolina is made from hard durham wheat. It is cooked, dried then ground. It looks and feels kind of like corn meal. It gives these cookies an interesting texture. They are soft and very lemony.


Hunter enjoys one after a spaghetti lunch.


Recipe By:

Adapted from




3 large lemons
½ pound unsalted butter
½ teaspoon vanilla extract
2 cups sugar
1 teaspoon salt
1 egg
3 cups semolina
1 cup all-purpose flour
To dust the cookies
½ cup sugar


1. Using a grater, grate lemon peels, removing only the yellow part. Set aside. *See notes.


2. Squeeze juice from the lemons. Set aside.

3. Combine butter, vanilla, sugar and salt in an electric mixer fitted with a paddle. Beat until creamy.

4. Add egg, ½ cup lemon juice and grated rind. Beat until incorporated.

5. Reserve any extra lemon juice for another use.

6. Decrease speed to slow. Add semolina and flour, beating until just incorporated.

7. Cover with plastic wrap and chill in the refrigerator for 1 hour.

8. Heat oven to 325°F.

9. Scoop dough into 2 tablespoon balls. Roll each ball in sugar then place on greased baking sheets.** See notes.

10. Flatten each ball to about ½ inch thick. *** See notes.


11. Bake cookies on the middle rack of an oven for about 14 minutes, or until the surface starts to crack. They will not start to brown.

12.  Remove from the oven and let cool before removing from baking sheet.



*This finely grated citrus peel is called zest. I have a zester, specifically made for this job. It works ever so much better than a regular grater.

**I almost always use parchment baking papers but these didn’t come off the papers well at all.

*** My preferred method to do this: Butter the bottom of a drinking glass. Dip it into sugar. Gently flatten a dough ball to desired thickness. Re-dip in sugar before flattening the next ball.

Aussie Yo Yo Biscuits

Written by Tad. Posted in Cookies

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When Shari and I went to Sydney in 2016, we hung out with our Australian friends, Rachel and Richard, who recommended several classic Australian treats for us to try. This is the one that I came home and made. They are shortbread cookies and the icing makes them. Dr. Al’ai, one of our emergency physicians, went crazy over them, saying they were just like a cookie he remembers from his childhood in the Philippines.

Recipe By:




For the biscuits:
1 cup unsalted butter, 250gm, at room temperature
1/2 cup, powdered sugar, 80 gm
2 cups all-purpose flour, 250 gm
1/2 cup custard powder, 80 gm. *see notes
For the buttercream:
1/4 cup unsalted butter, at room temperature
1 cup powdered sugar, 160 gm ** see notes
1 teaspoon vanilla extract


1. Heat oven to 350°F. Line two baking trays with parchment.

2. To make the biscuit dough:

3. Using an electric mixer with paddle attachment, beat butter and sugar until combined.

4. Sift flour and custard powder into the butter mixture. Mix gently until the dry ingredients are fully absorbed into the butter mixture to form a dough.

5. Wrap dough in plastic wrap and allow it to rest at room temperature for about 15 mins. If the dough is too soft to roll, place it in the fridge instead and allow it to rest for 15-30 mins or until the dough is slightly firm (but not too firm.) (I found refrigeration to be unnecessary.)

6. Scoop mixture into 1 tablespoon balls.


Place on prepared trays and press down with the back of a fork.


Bake for about 15 mins or until their edges are light golden. Remove from the oven and allow to cool on the baking tray for about 10 mins. Transfer onto a wire rack and allow the biscuits to cool completely.

7. While the biscuits are cooling, make the buttercream. Using an electric mixer with paddle attachment, beat butter, sugar and vanilla until light and fluffy.

8. When biscuits are cooled completely, sandwich two biscuits (back to back) with a dollop of buttercream in the middle.


Originally from the book, Country Women’s Association of Australia (CWA): Biscuits and Slices, contributed by Alisa Bond from Riverside Branch Tasmania.

* I bought Bird’s Custard Powder online from Amazon Prime but Rachel told me she saw it at Whole Foods.  Also note that Corine, our daughter’s mother-in-law, from Canada, says this is the key to perfect Nanaimo Bars!


** I alway sift my powdered sugar when making icing. It is just easier to get it smooth.



Written by Tad. Posted in Kooks

A sixty-year-old woman came in by ambulance. The nurse entered “abdominal pain, flank pain” as the chief complaint. The nurse advised me that the patient was deaf and only spoke Spanish, so I grabbed some paper and a clipboard before going in the room.

I introduced myself and showed her my name badge so she would know my name. She motioned that she was deaf. I smiled, nodded, and pointed to my “Hablo Español” button as well. I then wrote on the paper, “Que pasa?” (What’s going on?)

She took the clipboard and started writing. “This isn’t going to be too bad,” I thought to myself.

When she returned the clipboard, I saw she had written, “Susana,” which was her name. That was about the best we did. With her reading my lips and using her sketchy Spanish, I was finally able to learn that she was, indeed, deaf. She only spoke Spanish and didn’t know any sign language. She also had never gone to school and didn’t read or write. On top of that, no family member had come in with her; someone who, I hoped, would be better able to communicate with her than I was.

Usually in medicine, we rely a lot on the history to start figuring out what is the matter with someone. In this case, through lip reading and pantomime, I was able to understand that she was having pain in her lower abdomen and flank. That was about the best we could do. I examined her and ordered tests, doing more tests than I might normally have to do since I didn’t want to miss something.

The tests all came back normal, her pain was controlled with the medicine I gave her and we were finally able to get hold of a family member who came in and helped get her discharged.

When it comes to communication challenges, it is hard to beat a non-English speaking patient who is deaf and doesn’t sign, read or write.

Diabetic Type II

Written by Tad. Posted in Kooks

Some people really want their doctor to know the exact details of their symptoms. This often leads to extended written accounts of details patients believe will help with their diagnosis. Here is a reproduction of a written note a patient brought in to help outline his symptoms. If you have a hard time following it, I do to. In the end, we found nothing wrong and the patient left without a diagnosis. As I sent him off to follow up with his primary care doctor, feeling sure he had no emergency, I wondered if someone, someday, will find a strange medical condition to explain the symptoms or if it was all just mental. This is not an unusual thought as I discharge people. It seems mental to me but I don’t know everything.


Diabetic Type II
Off meds long time
#’s run in 200’s

Wed 7/6

3:30 AM

-woke up dizzy
-sat on edge of bed
-got online and video chat so people could watch me, make sure I was OK

4:00 PM

-eyesight got strange
-couldn’t see part of right side of vision. close one eye can see OK. close other eye see OK. both eyes – missing right side view

4:30 PM

-right side of lips (top + bottom) went numb for a little while. right arm and leg got weak and shaky
-only lasted a little while then lips ok again + arm/leg ok too (no shaky)

4:45 PM

-nauseas – didn’t throw up – just wretched

5:30 AM

-headache left front behind eye
-took Naprosyn Sodium (just one)

6:00 AM

-went to sleep
-eyesight still messed up

10:00 AM

-woke up feeling better
-no headache
-eyesight ok (but bright spots)


-bright spot/line in right eye fading but still there
afternoon       -small headache
-took Naprosyn – headache faded away

1 periods of dizziness

Rhubarb Sour Cream Cookies

Written by Tad. Posted in Cookies

DSC04222 DSC04226

My friend, Jill, offered me some rhubarb. I had NO experience cooking with these tangy, fibrous stalks with poisonous leaves. Still, my mind when right to, “rhubarb cookies.”

Here is what I came up with. Because of the sour cream, they very soft, even hard to pick up. The rhubarb cooked up well and was, indeed, a tangy, interesting addition to the tender cookies.

Recipe By:





1½ cups all-purpose flour
1 teaspoon baking powder
½ teaspoon baking soda
½ teaspoon salt
½ cup butter, softened
¾ cup sugar
1 egg
¾ cup sour cream
½ teaspoon vanilla extract
2 cups rhubarb, diced


1. Heat oven to 350 degrees F. Line two baking sheets with parchment paper.

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

3. In large bowl, beat butter and sugar with an electric mixer until light and fluffy.

4. Beat in egg.

5. Beat in sour cream and vanilla until well-combined.

6. Add 1/3 of the flour mixture and beat until combined.

7. Add another 1/3 of the flour mixture beat until combined

8. Add remainder of lower and beat until combined.

9. Stir in rhubarb.

10. Drop 2 tablespoon balls of batter onto prepared baking sheets, spacing them about 2 inches apart.


11. Bake 10 to 12 minutes, until the edges of the cookies start to brown and the tops of the cookies get a little color. Let cool slightly, then remove to a rack to cool completely.

Three Black Bags

Written by Tad. Posted in Trauma Strap Bags

Black straps are prized as only a few come through the department. Three of our nurses set a goal to get black bags and started saving every black strap they could get their hands on. Here are the bags I made for them.

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Copyright © 2014 Bad Tad, MD