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.
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
-woke up dizzy
-sat on edge of bed
-got online and video chat so people could watch me, make sure I was OK
-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
-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)
-nauseas – didn’t throw up – just wretched
-headache left front behind eye
-took Naprosyn Sodium (just one)
-went to sleep
-eyesight still messed up
-woke up feeling better
-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
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.
1½ cups all-purpose flour
1 teaspoon baking powder
½ teaspoon baking soda
½ teaspoon salt
½ cup butter, softened
¾ cup sugar
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.
During fresh peach season, we buy then buy the lug directly from the orchards between Sacramento and where our parents live in Paradise. Like tomatoes, I really only enjoy eating peaches this way. Call me a peach snob. Here is something fun to do if you have a few that are not prime for eating. I would never waste a perfectly good peach by making it into a cookie.
2 cups + 2 tablespoons all-purpose flour
3/4 teaspoon salt
1/2 teaspoon baking soda
1/2 cup unsalted butter, softened
1/2 cup granulated sugar
1/2 cup packed light brown sugar
1 large egg
1/2 teaspoon vanilla extract
2 large ripe peaches, peeled, pitted, and cut into 1/4-inch pieces
1/3 cup peach preserves
3 tablespoons sanding sugar
1/4 teaspoon ground cinnamon
1. Heat oven to 375°F. Line baking sheets with silicone liners or parchment paper.
2. Whisk together the flour, salt, and baking soda. Set aside.
3. Using an electric mixer on medium speed, beat the butter, sugar, and brown sugar until light and fluffy. Add the egg and vanilla, and mix well.
4. Reduce mixer speed to low. Add flour mixture, mixing just until combined.
5. Add the peaches and preserves, mixing just until combined.
6. Drop 2 tablespoon balls of the dough onto prepared pans, leaving about 2 inches between cookies.
7. Combine the sanding sugar and cinnamon. Sprinkle each cookie with about 1/8 teaspoon of the cinnamon-sugar.
8. Bake 11-13 minutes, or until golden brown and just set. Cool on the pans for 5 minutes. Then, carefully transfer the cookies to wire racks to cool completely.
A young woman brought her brother in for psychiatric evaluation. She told me he had been acting strangely and gave me her written account of what had been going on. She was a bit compulsive in the way she documented things and, you can tell, was not primarily English-speaking. Still, if you can be patient enough to read through this, you will get an interesting insight into this man’s mental illness and the trouble it caused his family.
When the sister said she was comfortable that they were all safe with him at home, we discharged them with information on how to get him some psychiatric help.
Here is a recreation of the “log” she kept and shared with me:
Log – JC (I am not using his real initials) – Summary
One Page Summary – August 2016
Weight: 150 lbs.
Education: BA degree Nuclear and Computer Engineering from UC Berkley in 20–
Career: Started working for S——— in 2016
Lives with: Wife, 4-year-old son, mom-in-law
Medications: none. Currently refuses to see any doctors.
Drugs or Alcohol uses: none. No history of drug or alcohol abuse
When he was working at a computer chip company, he said to the family that his boss taps his phone, knows where is was going, someone is watching and needs to close the blinds and install security cameras. Family had talked to him and lay out all the reasons why his boss would not do such thing. He was convinced at first. Family asked him to quit and he quitted, and stayed home with baby son and mom-in-law for about 2 years. He seemed fine most of the time but every few months, he will bring up issue of being watched and his phone being tapped.
Started telling family that his in-laws are hurting-poisoning him and irritated that rich people controlling everyone and buying everyone’s mind, so everyone is scared to speak up. We talked to him but he cannot be convinced. He has these strong feelings about one week and increased to couple of times per week. He then said that it is his wife, B, who is hurting and poisoning.
July – August 2016
J has symptoms of bipolar disorder which includes: daily extreme mood changes, strong feelings of irritability and anger, avoid friends and social activities, decline sleep, having delusional thoughts, persecutory paranoia, episodes of hypomania daily and mania almost every other day. He refuses that there is anything wrong with him and everyone including doctors are all against him. He said he does not have paranoia because he is not that type of people. He now strongly feels that his wife is harming him, including poisoning him, throwing stuff to his head. He yells at her almost daily for hurting him and threatens to hurt her and the son if they try to hurt him.
6/6/2016 Sunday 12 PM
He held down P (the son) to put alcohol on his scraped knee. He insist that there are microwave length that controls all this. We argued very loud and he accused me of killing people, accused B of using atomic bombs and army trucks.
7/15/2016 Friday 10 PM
He took a picture of his scraped knee and insisted that it was serious, badly swollen, internal, microwave laser tissue penetration. Need to report to Obama. Everything is bought and everyone else is scared to say anything, everything is cover up including doctors. Everyone needs to be educated to a high-level and accessible. I don’t want to live a scared life like you all. You are all brainwashed.
7/16/2016 Saturday 8 AM
He posted on Facebook “Imagine life in a country that is constantly at war, surveillance, and creates artificial news. There’s gotta be a better way and I know I’m not the only one that feels this way.”
7/17/2016 Sunday 9:30 PM
He posted on Facebook “Thank you everyone for your care and kindness. I will keep a positive thinking going forward.”
7/18/2016 Monday 2 PM
Posted “Feeling cool about Usesome” which is an article about high-ranking intelligence officer making artificial news and destroying massive mankind.
7/20/2016 Wednesday 4 PM to 8 PM
He posted on Facebook “Got sick? Got resistors, capacitor, F T?”
7/23/2016 Saturday 12 AM to 3 AM
He and I talked for over two hours about various topics from “What do you think of B, rich people ruling everything, interviewing for the new job is beneficial because involve learning new thing, what if Mom and Dad and I were taken advantage, what would I do?” I told him that “That must be a scary feeling.” He said “Never mind” and changed subject. I asked him how his knee, what did the doctor say. He did not answer me.
7/24/2016 Sunday 12 AM
He posted on Facebook “<3ing.” Kicks bathroom door open and held up fist to B, eyes wide open. He said “You poisoned me, you and your coworker poisoned pool water and made me go into pool with P. My legs are handicap now. I don’t want to you.” B said violence is not going to help and sat down to talk to him. He calmed down and B was able to talk to him in a calm way. He listened and talked, lasted over an hour, then went to sleep.
7/25/2016 Monday 9 PM
He mixed cement and worked on the basketball hoop at 9 PM at night, shouting to B to help and asking mom-in-law to stay inside. At midnight, posted on Facebook a bunch of Chinese sentences that no one can make any sense. Like random Chinese words being put together to try to say something evil inside of someone.
8/2/2016 Tuesday throughout the day
P is sick. He said someone pressed button. J asked P to eat, P has no appetite and didn’t want to eat. He told P if he didn’t eat, he can die. He said at one point to P that P only needs to learn math and English and don’t need to learn anything else because he can teach him everything else.
8/4/2016 Thursday day
He said he was hypnotized, someone shot him. Caused by phone microwave. Felt that hair had blown by wind so he was hypnotized. Must be B who used pollen. She gets pollen everywhere. She is together with high school friends and large corporations like cops, FBI. He went out with P and Dad and ran into bad freeway traffic, he said someone messed with us. Someone messed with mom too because mom ran into traffic going home after work.
8/5/2016 Friday morning
He yell at B and said to sell the house, B caused T to pull wisdom teeth, she caused T to move away from San Francisco. He stopped after P started crying. I talked to him right after this episode and he acted normal. He asked me if I have already gotten my wisdom teeth off, I told him no because it was just a consultation. He said that they are getting ready to leave the house to bring P out.
He had a long talk with Mom mainly complaining about rich people ruling everyone else. There are smart people sifting all the stupid people out. Stupid people receive small incentive, so they comply and work like slaves. He was calm and had no episode.
8/7/2016 Sunday 9 PM
On the car ride home, he complained to B about her being a betrayed person. After arriving home he and P played and P accidentally poke J’s eyes. J said to P, you are trying to hurt me, I will kill you so you can’t hurt everyone in the society. He pulled B out of bed, dragged her down two flights of stairs and pulled her into the kitchen and pointed to a cockroach and accused her of poisoning him. After B tell him that it is not an issue when there are insects around, and Mom-in-law said a few positive things to calm him. They sat down and he saw her looking through her phone and he told her not to call 911. He asked if they are going to get a divorce and whether she is contacting a lawyer. He said “we can talk about it here and you don’t have to talk to lawyer.” Mom-in law-said it’s late and they should all go to sleep. He insisted to sleep with P in P’s room. She sleeps in their own master bedroom. Everyone went to bed. From 12:40 AM to 2 AM, he texted to a Family Group chat “Be careful, and evil is acting up again. My wife just put something in my drink. The family history going back hundreds of years are all traitor. Targeting all Chinese people, kissing ass to non-Chinese people, be careful, this 200-year-old issue still happens today, don’t fight within each other, needs to collaborate together. Is everyone around just sick for a long time?” When B was getting ready for work in the morning, he came to her room and said “I’m checking what the traitor is up to.”
8/10/2016 Wednesday morning
Mom called J and first he said “Don’t worry about me. Everything is fine.” He brought P out to the playground and museum and asked mom-in-law to join too, as if nothing happened last night.
8/10/2016 Wednesday 8:30 PM
I had an hour-long conversation with him. He said B together with other unknown people from high school poisoned him for years. He asked how we feel, he said he can’t explain it, it’s just feel different. He said she brings in drugs from somewhere/someone and dosage is not severe enough to kill him but enough to make you feel different and will last 20+ years. This all came from 200 to 5000 years ago that the tradition of poisoning continues to this day. There is a group of highly educated gangster related and rich people summoned people from China to come to the US and get citizenship and turn in people for them. B is brought into that group whose job is to turn J to the highly educated people. That’s why she poisoned him. He said he already reported to FBI and Obama. He said he wants to try to make B get out of it but she is too much in already. He said he is telling me and the family because he wants us to be careful. When asked if he feels angry or frustrated, he said some time but he can’t do anything about it so just let it be. When I asked he was sad, he said no because he smiles every day. He said he wants P to be highly educated so that he will know there are people around to hurt him.
8/12/2016 Friday 3 PM
I suggested he sees a marriage therapist because his current relationship with wife, he refused and said the root cause is that she needs to stop poisoning me. Then midnight he went to her room and said she is always awake, “every time I wake up in the middle of the night, this girl is awake.”
8/15/2016 Monday 5 PM
When he came home from work, he said someone throw stuff on his head, and he went to shower right away.
Said the same as yesterday about someone throw stuff on his head. When Mom-in-law was away from the house to get groceries, he started yelling at B that she is harming his family, harming his uncle, and said parents are scared of B. And then he said to P, “if you hurt my family, I will kill you.”
8/17/2016 Wednesday 8 AM
Wrote on family group chat that someone threw stuff on his head. He said he felt something that breaks/spread apart as it lands on his head.
My wife, Shari, came up with this one while looking around the World-Wide Web. So good. Almost like eating candy.
14 tablespoons unsalted butter, divided
2 cups plus 2 tablespoons all-propose flour
1/2 teaspoon baking soda
1/4 teaspoon baking powder
1¾ cups packed brown sugar
1/2 teaspoon salt
1 large egg
1 large egg yolk
1 tablespoon vanilla extract
20-24 soft caramel candies, *Seen Notes
1. Melt 10 tablespoons butter in a 10-inch skillet over medium-high heat. Continue to cook and stir constantly until butter is dark golden brown, 1 to 3 minutes. Transfer browned butter to a large heatproof bowl. Add remaining 4 tablespoons butter (chopped) and stir until completely melted. Set aside to cool.
2. Meanwhile, heat oven to 350 F degrees. Line 2 baking sheets with parchment paper or non-stick mats. Set aside.
3. Whisk flour, baking soda, and baking powder together in medium bowl. Set aside.
4. Add brown sugar and salt to bowl with cooled butter. Whisk until combined. Add egg and yolk and vanilla. Mix until combined. Add flour mixture and mix just until completely combined.
5. Scoop 1 tablespoon of cookie dough and place a caramel on top. Add another tablespoon of dough on top of caramel. Pinch edges of dough around caramel and roll into a ball. Repeat until all remaining dough is gone.
6. Place cookies on prepared baking sheets, 3 inches apart. Sprinkle with sea salt. Bake at 350 degrees F for 11-13 minutes, until barely golden. (They will seem under-baked.) Let cool for 5 minutes before transferring to cooling rack.
Original recipe called for Kraft caramels. I don’t like Kraft caramels. I don’t know what they do to them to make them taste so nasty but I am such a caramel snob that I think it is worth it to get better caramels, even though it may be a pain. I buy a brick of Peter’s caramel from Cash and Carry. I cut off blobs about the size of a lousy Kraft caramel and envelope it with this wonderful cookie dough. Well worth the effort, in my opinion.