Smelly Man

Written by Tad. Posted in Kooks

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?




Speculoos Spread Chocolate Chip Cookies‬

Written by Tad. Posted in Cookies

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.)






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:



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


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.


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.


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.



1 dozen cookies


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


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.

Copyright © 2014 Bad Tad, MD