Her Pants Were Too Tight

Written by Tad. Posted in Kooks

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.

 

Troops Chocolate Chip Cookies

Written by Tad. Posted in Cookies

I like recipes that are simple and different and produce a great product. This recipe satisfies all three. The original recipe didn’t call for vanilla or chocolate chips but I think they are a great addition.

 

 

 

Recipe By:

San Jose Mercury News

Serving Size:

60

Ingredients:

3 cups regular oats

3 cups all purpose flour

3 cups sugar

2 cups shredded coconut

1 ¾ cups butter

6 tablespoons light corn syrup

1 ½ teaspoons baking soda

3 tablespoons boiling water

1 tablespoon vanilla

3 cups chocolate chips

 Directions:

1. Heat oven to 300 degrees.

2. Combine oats, flour, sugar and coconut. (I put them right in my Kitchenaid.)

3. Set aside.

4. Combine butter and corn syrup in saucepan.

5. Gently heat until butter melts. Set aside.

6. Mix soda in boiling water.

7. Stir soda mixture into butter mixture.

8. Stir vanilla into butter mixture.

9. Combine flour and butter mixtures.

10. Stir in chocolate chips. Watch out as they don’t mix well and tend to drop to the bottom of the pan. I usually just pour the dough out on the counter top to make sure the chocolate chips are distributed evenly in the dough as I form the balls.

11. Bake about 20 minutes until bottoms and edges just turn brown.

 Notes:

These have the most fabulous chew!

 

A Nice Note of Appreciation

Written by Tad. Posted in Trauma Strap Bags

Dear Dr. Tad,

Thank you so much for the bag that you specially made, I asked from you yesterday and you willingly gave it to me. I’m using it right now and I am so happy because I really like it and have been wanting for this ever since.

Thank you again for being so kind and generous to all of us here in the E.D. Your are one of a kind.

May the good Lord continue to bless you and your family always.

From,

Brenda, HSA II

11-7 PM shift

Bleeding Scrotum

Written by Tad. Posted in Kooks

Our Patient of the Week was 29-years-old and had to be taken down by the police with a Taser (which stands for Thomas A. Swift Electronic Rifle.) He had a long history of psychiatric problems. That night he had been drinking and maybe doing drugs before he slashed his scrotum with a razor. The paramedics reported he was talking “in several languages” but he would not talk to me.

He had very bizarre behavior and had to be tied to the gurney with leather restraints on his ankles and wrists. He made it very difficult to get a good look at his scrotum but I was able to see he had several cuts through the skin with no evidence of any injury to underlying important structures. The bleeding had pretty much stopped.

My evaluation included confirming that he was, indeed, known to be crazy and making sure he was not in need of treatment for any metabolic problems. When I offered to sew up his scrotum, he refused so the nurse dressed it as best she could.

In the mean time, the police who had been called to the scene had learned he was wanted on several warrants so they placed him under arrest. They took him and his dressed scrotum to off to jail.

Not long after he left, the emergency department charge nurse told me she had taken a call from the nurse at jail saying the patient’s scrotum was bleeding and they were sending him back. Though I was pretty sure he didn’t need to come back, I was not too surprised that a nurse at the jail wouldn’t be comfortable with a bleeding, crazy scrotum.

When he returned, he had a little blood in the dressing and no active bleeding. This confirmed my impression that he would have been fine just staying where he was. This time he let me put some stitches in the cuts. Truth be told, it was mostly for sake of the jail nurses.

We have such a focus on first aid in our society that people have a hard time believing that no cut has to be sutured. We do suturing for two reasons. One is to make for a smaller scar. I would say it was not too important in this case. The second is allow the cut to heal up faster which I am sure was of some benefit to him. But, the fact is that, given enough time, ALL cuts will eventually heal. We often hear people worried that if the cut is not sewn, it will lead to infection. Again, the truth is that suturing a cut actually increases the risk of infection.

 

Mocha (Coco)Nut Butterballs

Written by Tad. Posted in Cookies

These sound a lot like those Mexican Wedding Cookies (which I don’t like)  so the recipe made me nervous but they really are good.

Source:

http://atebyatescrapbooking.wordpress.com/

Yield:

1 dozen cookies

Ingredients:

1 cup butter, softened

½ cup white granulated sugar

1 teaspoon vanilla extract

1 tablespoon instant coffee powder

¼ cup cocoa powder

¼ teaspoon salt

1 ¾ cups all-purpose flour, 8 ounces

1 ½ cups finely chopped pecans or shredded coconut

Powdered sugar

Directions:

Heat oven to 325°F. Place rack in middle position.

Combine butter, white sugar, vanilla extract, instant coffee powder, cocoa powder, and salt. Mix well.

Add the flour in half-cup increments, mixing after each addition.

Stir in the nuts or coconut and make sure everything is evenly distributed.

Use a 2 tablespoon scooper to form balls. Place them on prepared baking sheets.

Bake for about 12 minutes, until they are set. Do not over bake!

Move the cookies to a wire rack.  Let them cool completely.

When completely cool, dip in powdered sugar to coat.

Taku Ginger Cookies

Written by Tad. Posted in Cookies

Background:

Years ago, my in-laws took us on a cruise in Alaska. As a side trip, they flew us out of Juneau to Taku Glacier Lodge for dinner. I was not very excited about that much hassle and expense for a touristy dinner but everything we ate there was just fabulous. So good, in fact, that I bought their little cookbook from the gift store. Having this recipe has been worth the whole trip.

I usually scoop my cookies with a 2-tablespoon scooper but I use a 1-tablespoon scoop for these.

The dough is soft so you have to handle the balls carefully as you drop them in the sugar then place them on the baking sheets.

I like to cook them until they are just a bit crunchy on the edges but chewy in the center. They are really good.

Recipe adapted from:

Taku Glacier Lodge

Serving Size:

72

Ingredients:

1 cup butter, softened

1 ¾ cups sugar

¾ cup brown sugar

1 large egg

1/3 cup molasses

2 ¾ cups flour, 12.5 ounces

1 ¼ teaspoons soda

1 tablespoon cinnamon

1 tablespoon fresh ginger, peeled and grated

1 teaspoon cloves

2 teaspoons nutmeg

½ teaspoon salt

raw sugar*

 Directions:

1. Heat oven to 350 degrees.

2. Cream butter and sugars.

3. Add egg, ginger and molasses.

4. Mix well.

5. Combine dry ingredients except raw sugar.

6. Add flour mixture to butter mixture.

7. Mix until just combined.

8. Shape with small ice cream scoop.

9. Roll tops of balls in raw sugar.

10. Bake for about 13 minutes.

 Notes:

I have used raw sugar but what really makes these cookies is using something like KingsBlingz White Diamond Crystalz, which I get at http://www.dutchvalleyfoods.com/.

How Long Have You Been in the Hospital?

Written by Tad. Posted in Kooks

One night, I had an amazing patient. It is hard to do justice in a note like this just how amazingly bizarre he was. He came in by police at about 6:00 in the morning. I sat and listened for maybe half an hour while he told me his story.

He developed complications of gastric banding surgery. He was in a Veterans Administration hospital in city across the state for six months before being transferred to a VA hospital close to us where he had been for a year! He told me about how the police had arrived at his hospital room the day before as the doctors pulled out his IVs and drains. He was taken in hand cuffs to jail where he was booked on warrants for old misdemeanors. He told the most pitiful story of illness, innocence and victimization.

As I read through the papers that came with him, there was quite a different story. He was believed to be a sociopath who was malingering in the hospital in order to not go to jail for his felony warrants. He told them he was unable to eat anything so they were giving him total parenteral nutrition (TPN), which means everything you need for survival intravenously. When he was found to be gaining weight, they searched his room and found hidden food. The report went over other crazy stuff they had been putting up with for a year and half with the guy.

On the way to the jail, he told them he felt ill so they took him to another hospital near us where he got evaluated, cleared and sent on to jail. As soon as he got to the jail, the nurse who evaluated him decided he was too sick for jail and refused him, sending him to us. So, after a year and a half in a hospital, being deemed safe for discharge then going to a second hospital where he was deemed safe for jail he is now in my ED. For an emergency physician, this is a nightmare.

I looked at all of his stuff and sent him back to jail. I am told he refused to walk or to sit up on the bench in the custody van so he was taken back on the floor of the van, handcuffed to the underside of the bench. I am sure that was not the last time we will be seeing this guy.

 

Copyright © 2014 Bad Tad, MD