Recipe Adapted from:

Home-Tested Cookie Recipes

Ingredients:

3 ½ cups flour, 15.75 ounces
½ teaspoon salt
1 teaspoon baking powder
1 ½ teaspoon soda
½ cup butter, at room temperature
½ cup shortening
1 cup sugar
1 cup brown sugar
2 large eggs
1 tablespoon vanilla
½ teaspoon coconut flavoring
½ cup caramel topping
1 cup macadamia nuts, chopped
1 cup chocolate chips
1 cup shredded coconut

 Directions:

1. Heat oven to 300 degrees.

2. Combine flour, salt, baking powder and soda. Set aside.

3. Cream butter, shortening and sugars until creamy.

4. Beat in eggs, vanilla, coconut flavoring and ice cream topping until fluffy.

5. With mixer on low, gradually stir flour mixture into butter mixture until just combined.

6. Stir in nuts, chocolate chips and coconut.

7. Drop in 2 tablespoon balls on parchment-lined baking sheets.

8. Bake 16 to 20 minutes or until just golden brown.

Notes:

The caramel sauce and cooking them at low temperature give these tasty guys a very nice texture and chew. The idea of adding coconut flavoring came from my Aunt Mabel June. Makes about 60 cookies.

I went to see a 31-year-old man who was complaining of headaches and a bump on his scalp just above the forehead. The bump on his scalp was unusual. It was red and tender. It looked and felt kind of like an abscess though it is unusual for someone to develop an abscess on that part of the scalp.

A good way to find out if a bump in the skin is an abscess is to poke a needle into it and aspirate with a syringe to see if any pus comes out. I recommended this to the patient and he agreed.

I got a needle and syringe then wiped the bump with an alcohol swab. I poked the needle into the skin over the bump and pulled back on the plunger. I then slowly advanced the needle, watching for pus. I knew if the needle hit the skull and no pus came back in the syringe it was not an abscess.

But, the needle never hit the skull. Just as I realized this, the syringe started to fill up with liquid. It was not the yucky, thick pus I was expecting from an abscess, but clear, colorless liquid. Cerebral spinal fluid. The fluid that bathes and supports the brain inside the skull. I had poked a needle through his skull!

Shaken, I told the patient what happened. I then ordered x-rays, which clearly showed there was no skull under the lump.

I made arrangements for the patient to be watched in the hospital since I had potentially contaminated his cerebral spinal fluid. This put him at risk of an infection around the brain.

As it turned out, he got no infection and was later diagnosed as having an eosinophilic granuloma or Langerhans cell histiocytosis. This rare condition caused the replacement of normal skull tissue with a tumor that caused the bump on his head.

http://en.wikipedia.org/wiki/Langerhans_cell_histiocytosis

Uncle Boyd and Aunt Betty

Uncle Leonard

Bruce and Sandy

Chip and Debbie

Christy. Where is Keoki?

I pick up the chart of a man in his early forties. “Rectal pain” is the chief complaint.

When I enter the room, the patient is standing in the corner, dressed in a hospital gown and looking rather glum. I introduce myself and ask how I can help him. He mumbles enough of a non-specific answer for me to understand he has something stuck in his rectum that he can’t get out.

I invite him to bend over the exam table as I turn to get some gloves.

Turning back to him, gloves on hands, I pull the gown away from his backside. Sticking out of his anus is the end of a broomstick about a foot long. This surprises me somewhat. I touch it and the patient moans in pain.

“How long has this been in there?” I ask.

“Mmmmm. Four days,” is the reply.

I explain to the patient that we clearly need to give him pain medicine and also something to help him relax before trying to get the stick out. I then excuse myself and pass orders on to the nurse to get this started.

Once the patient is medicated, I return to the room and, again, don gloves. This time, the patient is comfortable enough that he only moans as I pull the stick out. Interesting. The other end of the stick is wrapped in twine. I’m trying to figure this out when the patient looks up at the stick and groggily asks, “Where’s the rest of it?”

An x-ray reveals the outline of a large, penis-shaped dildo stuck in the patient’s rectum. Now, I think I understand what happened. The patient wanted to get the dildo farther into his rectum, so he put it on the end of a broomstick. However, the broomstick was smaller than the inside of the hollow dildo so he wrapped the stick with twine until it fit snuggly inside the dildo and would not come off.

What he failed to consider was what would happen when the dildo was all the way up inside his rectum. Once his anus closed down over the dildo onto the broomstick, it was stuck and couldn’t be pulled back out again.

The poor guy, too embarrassed to seek help, had been sitting – or not sitting – around the house for four days, in miserable discomfort, with that thing stuck in there.

I will blog more in the future on rectal foreign bodies as it is a recurrent and interesting subject in the emergency department. Sometimes, we are able to get them out in the ED. Other times, as in this case, we are unable to do so. In those situations, we call the surgeons. With the patient asleep, and with access to tools they have in the operating room, the surgeons are often able to pull the object out. But, not always. Sometimes, as in this case, the surgeon actually has to cut the abdomen open for removal.

Please don’t ask me why people do this. I never ask. You will just have to use your imagination or go online for more specific information.

Recipe Adapted from:

Home-Tested Cookie Recipes

Ingredients:

2½ cup flour
1 teaspoon salt
1 tablespoon baking soda
1 cup butter, at room temperature
1½ cups pistachio ice cream
1 tablespoon vanilla
½ cup sugar
¾ cup brown sugar, packed
1 small box instant pistachio pudding
1 large egg
12 ounces chocolate chips
4 ounces pistachios, coarsely chopped

 Directions:

1. Heat oven to 375 degrees.

2. Combine flour, salt and soda. Set aside.

3. Beat butter, ice cream, vanilla, sugars and pudding mix. It may look kind of curdled at this point. Don’t worry. Stir in eggs.

4. With mixer on low, stir in flour mixture until just combined.

5. Stir in chocolate chips and nuts.

6. Drop in 2 tablespoon balls in prepared baking sheets.

7. Bake about 10 minutes until brown. This is one of those recipes where they look over-done when they are not. Even when brown, they are still soft.

8. Cool on wire racks.

Notes:

Original recipe called for vanilla pudding and had no nuts. They really were not very pistachioy. I changed the pudding and added the nuts which helped a lot. I was thinking of adding some green food coloring. Maybe next time.