Zippered Bags

Written by Tad. Posted in Trauma Strap Bags

Most of my bags are simple with non-closing, oblong openings. I bought some zippers and messed around making bags that would accommodate them. As us usually the case with such endeavors, the first bag was OK and each subsequent was better.

Cocoa Puffs Peanut Butter Cookies

Written by Tad. Posted in Cookies

I am always looking out for a new cookie recipe to try. One thing that will catch my attention is a weird ingredient. That is what caught my attention in this recipe.

Adapted from: Raley’s/Nob Hill Magazine

Serving Size: 24

 Ingredients:

1 cup brown sugar

1/2 cup peanut butter

1/2 cup butter, softened

1 teaspoon vanilla

1 large egg

1  1/4 cups flour

1 teaspoon soda

2 cups Cocoa Puffs Cereal

2 cups chocolate chips

2 teaspoons shortening

 

Directions:

1. Heat oven to 350°F.

2. Line two baking sheets with parchment paper.

3. With a mixer on high, whip peanut butter and butter. Stir in sugar. Stir in vanilla and egg. Mix until creamy.

4. Combine flour and baking soda. Stir into sugar mixture.

5. Stir in cereal just until combined.

6. Shape into balls and place on prepared cookie sheets about 2 inches apart.

7. Bake for 10 to 12 minutes or until light golden brown.

8. Remove to racks to cool completely.

9. Place chocolate chips and shortening in double boiler over boiling water.

10. Stir while heating until melted and smooth.

11. Remove from heat and continue to stir while it cools some more.

12. Dip half of cooled cookie in chocolate, scrape the excess off the bottom and place on wax paper to dry.

 Notes:

Original recipe called for microwaving the chocolate and shortening which does work. I just like the control of the double boiler better.

I have made these buy just throwing in the unmelted chocolate chips with the cereal and omitting the shortening. They were good but the were much richer and more impressive to look at and eat when dipped in the melted chocolate.

People in ED went crazy over them though no one could guess they had Cocoa Puffs in them. I tripled the batch for ED.

98-Year-Old Lady Chews Off Her Fingers

Written by Tad. Posted in Kooks

This is, word for word, the note I wrote on this patient’s chart:

Family members called the ambulance when they found the patient chewing on her fingers today. The patient is demented, bedridden and completely dependent for all of her care. She was reportedly more agitated lately including spitting and chewing on things like her blankets. She had no history of self-mutilation but today the patient’s temporary caretaker found her chewing on her hands. The daughter, who normally cares for the patient, is ill herself and hospitalized elsewhere.

On the left hand, fingers 2 to 5 (index, long, ring and pinky) have extensive soft tissue damage. The fifth finger is essentially chewed off with just a strip of tissue left attaching it to the hand. Bones are visible in the other fingers with considerable amount of soft tissue damage present.

The patient went to the operating room for amputation of the fingers.

Chewy Cherry Chocolate Cookies

Written by Tad. Posted in Cookies

I don’t remember where I got this recipe but it is one of our favorites. The chocolate is rich but not too dark. They are nice and sweet but the tartness of the cherries contrasts the sweetness very nicely. They have a great texture. I buy several bags of the dried cherries at Costco when they have them. They don’t spread out too much and are firm enough to survive the trip to the emergency department.

Serving Size: 60 cookies

 Ingredients:

3 cups flour, 13 1/2 ounces

1 cup cocoa, 2 3/4 ounces

1 1/2 teaspoons baking powder

3/4 teaspoon baking soda

3/4 teaspoon salt

3 cups sugar

1 cup butter, softened

1 tablespoon vanilla

3 large eggs

2 cups dried cherries, 14 ounces

2 cups chocolate chips, 14 ounces

 Directions:

1. Heat oven to 350 degrees

2. Combine flour, cocoa, baking powder, baking soda, and salt. Set aside. (I like to do this with my fingers. It just feels good.)

3. Place sugar and butter in a large bowl. Beat with a mixer at high speed until well blended.

4. Add vanilla and eggs. Beat well.

5. With mixer on low speed, gradually add flour mixture. Beat just until combined.

6. Stir in cherries and chocolate chips until just combined.

7. Place scoops of cookie dough 2 inches apart onto prepared baking sheets.

8. Bake for 12 minutes or just until set. Remove from oven. Cool on pans until set.

 

Diagonal Bags

Written by Tad. Posted in Trauma Strap Bags

I am most proud of a couple of these I made. Part of the reason is they turned out really nice. In addition, it was really a pain to make them. Getting the diagonal straps to line up evenly was difficult. Then I had to get the tube that forms the sides be the right size for the bottom. Pat, one of our dayshift nurses, got the best one and every time I see her carrying it, I am quite pleased and tell her she has the best bag I ever made.

Mocha Marshmallow Cookies

Written by Tad. Posted in Cookies

I love caramel. I have been trying for years to make good cookies containing or tasting like caramel. I have tried caramelizing the sugar, which was a huge pain and changed the flavor but didn’t give that wonderful chew that caramel candy has. I bought caramel-flavored syrup, which was horrible. I added caramel ice cream sauce in place of maple syrup, which tasted good but I was not pleased with the texture. The best I have ever been able to do is buy a Peter’s caramel log from Cash and Carry, cut off pieces and plop one on top of each cookie a couple of minutes before they come out of the oven. This was especially fabulous with the coconut version of Tad’s Oatmeal Chocolate Chip cookies.

This recipe is fun because the marshmallows melt and caramelize while they bake.

Recipe adapted from: Raley’s/Nob Hill Magazine

Yield: 48

 Ingredients:

20 ounce chocolate chips, divided

1 cup butter

2 cups sugar

1 tablespoon vanilla

4 large eggs

3 cups flour, 13.5 ounces

2 tablespoon coffee grounds or espresso powder

1 teaspoon baking powder

3 cups miniature marshmallows

Directions:

1. Heat oven to 350 degrees.

2. Melt butter and 10 ounces of chocolate chips in microwave until melted but not hot. Stir to combine. Set aside.

3. Stir together sugar, eggs and vanilla until smooth and fluffy.

4. Stir in chocolate mixture.

5. In separate bowl, combine flour, baking powder and coffee.

6. Combine butter mixture and flour mixture.

7. Stir in remaining chocolate chips and marshmallows.

8. Scoop onto prepared baking sheets.

9. Bake 10 to 12 minutes.

Note:

The original recipe called for refrigerating the dough. When I did this, it came out hard as a rock. If you are going to refrigerate them, you need to scoop them first.

 

Impaled on Tree-trimming Equipment

Written by Tad. Posted in Kooks

A young Hispanic man came in telling the nurse he had fallen and been poked in the buttock four days before. He was worried the wound might now be infected.

When I reviewed the story with him, he corroborated the nurse’s note, adding nothing else. Though I speak Spanish fluently, I didn’t have the vocabulary to understand just what it was he landed on. I decided it probably didn’t really matter.

At my instruction, he pulled down his pants and rolled over. He showed me a puncture wound on his left buttock. It was healing nicely and showed no signs of infection.

As I went to reassure him there was no infection, a little something prompted me to wonder if there might be something else going on. I asked him if he thought it possible that a piece of whatever he landed on might have broken off inside him. He answered affirmatively and I sent him off for an x-ray of the area. I had the idea there might be a small chip of metal under his skin causing him some discomfort.

A few minutes later, the x-ray technician called me in to have a look at the x-ray. She was as amazed as I was to see the outline of a metal bar almost an inch in diameter that looked like a round file. One end was right under the skin where he had the wound. The other end disappeared off the film heading towards his pelvis.

We called him back to x-ray where more films showed the metal went clear up into his pelvis. The other end of the file was sitting right in the middle of his bladder!

When I went to show him the x-rays and explain my plan to get it out, I asked him if he had been having any blood in his urine to which he sheepishly admitted.

I called the urologist to our assistance. They took him to the operating room and put him to sleep. They passed a scope into his bladder and took pictures, which he later shared with me. They showed the file coming up out of the floor of his bladder like an empty flagpole. He then cut into the patient’s buttock, grabbed the file with some pliers and, with some effort, pulled it out. The scope was then reinserted to make sure no repair was needed. He was kept in the hospital for a couple of days and left, good as new.

When I see things like this, I frequently ask myself, “What if…?”

He landed on this huge bar with such force it went up through his skin, the muscle of his buttock and the floor of the pelvis before it broke off. It entered the pelvis just off the midline. Had it passed through the center, it could have destroyed many important midline structures. The base of the penis with its blood supply and nerves important for erectile function, the urethra where the urine passes from the bladder to the penis, the prostate, and the rectum were all at great risk in an injury like this. He might have suffered some injury that could have caused him a lot of trouble for the rest of his life. Instead, he was just fine. I wonder how much he appreciates what good luck accompanied the bad luck that caused his injury that day.

Large and Small

Written by Tad. Posted in Trauma Strap Bags

This week, I thought I would show the largest and smallest bags I ever made. The size of the large one was determined by the mesh materiel with a draw string I salvaged from another bag. It ended up so huge, I didn’t know what the heck to do with it. Then one of our registration clerks said she would like a large bag for her kids beach stuff. Viola. An appreciative home for it.

The small bag was made to hold just what we need to take to the gym: car keys, wallet, phones, gym passes, gloves.

Salty-sweet Butter Pecan Cookies

Written by Tad. Posted in Cookies

I don’t really like butterscotch chips or pecans but they are fabulous in these wonderful cookies!

Source:

This recipe was forwarded to me by my daughter, McKenzie. It was originally from King Arthur Flour Company

Yield:

4 dozen 3″ cookies

 Ingredients:

1  1/3 cups pecan halves

2/3 cup light brown sugar, firmly packed

2/3 cup granulated sugar

1/2 cup butter

1/2 cup vegetable shortening

1/2 teaspoon salt

1/2 teaspoon espresso powder

1 teaspoon baking soda

2 teaspoons vanilla extract

3/4 teaspoon butterscotch, vanilla-butternut, or butter-rum flavor

1 teaspoon vinegar, cider or white

1 large egg

2 cups King Arthur Unbleached All-Purpose Flour, 9 ounces

1  1/3 cups butterscotch chips, 11 ounces

2/3 cup granulated sugar

2 teaspoons salt

 

Directions:

1) Heat the oven to 375°. Prepare two baking sheets.

2) Place the pecans in a single layer in a pan and toast until darkened a bit and smelling toasty, about 8 to 9 minutes. Set aside.

3) In a large bowl, combine the brown sugar, 2/3 cup sugar, butter, shortening, salt, espresso powder, baking soda, vanilla, second flavor and vinegar. Beat until smooth and creamy.

4) Beat in the egg, again beating until smooth. Scrape the bottom and sides of the bowl with a spatula to make sure everything is thoroughly combined.

5) Mix in the flour then the chips and nuts.

6) If you’re going to refrigerate the dough, cover with plastic wrap and refrigerate for about 4 to 5 hours or overnight. Cookie dough refrigerated for 3 1/2 to 4 hours will spread moderately; chilled overnight, it will spread much less.

7) Mix the second 2/3 cup sugar and 2 teaspoons salt for the coating in a bowl. Scoop 1 1/2″ balls of dough into the sugar/salt mixture, rolling to coat. Transfer to the prepared baking sheets, leaving 2″ between them on all sides.

8 ) Bake the cookies for 10 to 11 minutes. Their edges will be chestnut brown and their tops a lighter golden brown. (For dough that’s been refrigerated, add 30 seconds to 1 minute to those baking times.) Remove them from the oven and cool on the pan until they’ve set enough to move without breaking.

 Notes:

I used regular, all purpose flour. I used raw sugar for the coating, which made them a bit crunchier. I didn’t refrigerate the dough and they came out great though the balls were a bit dicey to handle while dipping and placing on the baking sheets.

I bought the vanilla-butternut flavoring on line from, who else but King Arthur Flour Company

Abruptio Placentae

Written by Tad. Posted in Kooks

The nurse called me into the room. A thirty-year-old woman had come in by ambulance. She told the nurse she was four months pregnant and had suddenly started to bleed heavily from her vagina. She was not having a lot of pain.

When I walked in the room, she was lying on the gurney in a hospital gown that was rapidly becoming soaked with blood. Playing around the bed were the patient’s two daughters, about three years and eighteen months in age. They seemed to have enjoyed the ambulance ride and were unbothered by the excitement and all of the blood.

A lot of things happen simultaneously when I face this sort of situation. One look helps get a feeling for how sick the person is. Then vital signs come as an IV is being started and blood tests are being ordered. All of this is happening while I am talking to the patient, listening to her and feeling her abdomen.

Once I get the important information I need and get the treatment and testing started, I do a pelvic exam, which is really where the money is in a patient like this. This lady had a very large vagina and it was packed with a ton of blood and blood clots. I used a big pincher called a ring forceps with balls of gauze-wrapped cotton to remove the blood and blood clots. Over and over again I reached in, scooping blood and blood clots out which splatted onto the absorbent pad I had spread on the floor.

Eventually, I was able to get enough of the blood out to see she was still bleeding but the opening up into the uterus (womb) was still closed. That told me that even though she was bleeding heavily, she was not presently aborting. Now I knew what I needed to tell the obstetricians when I called them.

We got her vital signs fixed with IV infusions. We got blood ready for a transfusion. The obstetricians came down and did an ultrasound that showed an eighteen-week-old living fetus. They examined her down below again and found she was still bleeding. All of this pointed to abruptio placentae, which is defined as the premature separation of the placenta from the uterus.

So, the patient had a perfectly healthy baby, which she wanted, but she was going to bleed to death unless it was taken out of her. The way the OB attending physician put it to the patient was something like, “We want you to be here to take care of the two girls you already have rather than dying trying to have a third.”

The poor lady was in tears as she concented to going to the operating room to have her pregnancy aborted to save her life. Her husband was working in San Francisco and couldn’t be reached and she said she had noone else to come and support her or help her with the girls.

By the time she went to the operating room, she was stable. The girls stayed with us until morning when a social worker could come and try to get some help for them. The lady was sad but I am sure she was grateful to get medical treatment that certainly saved her life.

All of this made me think about what Rick Santorum said about why a woman shouldn’t have an abortion even if she were raped. He said something like, “It is her baby and she should accept it and love it.” I wonder if he would have advised my patient to just go ahead and die rather that have an abortion to save her life. It was very sad and very painful for that woman to have to make such a decision but it was really the only justifiable decision to be made, in my opinion.

 

 

Copyright © 2014 Bad Tad, MD