These are easy to make. They come out  firm and compact. Almost like eating candy.

Recipe By:

Elaine Thompson in Mercury News

Yield:

24

Ingredients:

½ cup butter, softened

1 can sweetened condensed milk

2 cups fine graham cracker crumbs

¾ cup flour

2 teaspoons baking powder

2 cups semisweet chocolate chips

1 cup English toffee bits

 Directions:

1. Heat oven to 375 degrees. Line cookie sheets with parchment paper.

2. Beat together butter and sweetened condensed milk.

3. Combine graham cracker crumbs, flour and baking powder. Stir into butter mixture.

4. Stir in chocolate chips and toffee bits.

5. Using a 2-tablespoon cookie scoop, drop dough onto cookie sheets.

6. Bake 10 minutes. Remove to rack to cool.

Hilary made a bag for me, black with a yellow flower. I have stollen her flower idea and have put flours on several bags. Here are the latest two which turned out pretty nice.

It takes me about as long to make the flower as it does to make the rest of the bag and I don’t really enjoy flower making as much as bag making either but I like them.

They cause me problem, though. Several people who already have a Tad Bag and were content with theirs now want new bags after seeing the flowers. No good deed goes unpunished, they say.

Here are a couple of fun activities I heard about by taking care of patients with less than good judgment. If you are bored and looking for something fun to do, you might try one of these creative activities.

Dry Ice Russian Roulette

A 13-year-old boy came in who had multiple lacerations and pieces of glass under his skin, which he suffered while playing a game. He and his friends put water and dry ice in a bottle then quickly closed the lid tightly. They then passed the bottle quickly around like a hot potato until it exploded. My patient was unlucky enough to have been holding the bottle when it exploded.

Try These Pills

Two twelve-year-old boys came in from a group home. One of them had run away from the home and while away, met a girl with a bag of unidentified pills she claimed to have found in a garbage can. He took the pills from the girl and snuck them into the home when he came back. He then shared them with his buddy in crime. They swallowed some of the pills. Others they crushed and snorted into their noses.

Somehow, the people at the home found out and dragged them in to make sure they were not going to be poisoned by their ingestions. After listening to the recent runaway tell his story, I asked him if he was embarrassed telling me what he had done.

He said, “No, because it’s true.” I listened in amazement. He took unidentifiable pills from someone he didn’t know who said she found them in the garbage. He then swallowed and snorted them and he couldn’t see why the doctor might think he was an idiot.

I have been going to share with you a pumpkin cookie recipe for quite a while. With Thanksgiving here, what better time? I looked through my recipes for pumpkin cookies and found five I had made before and a note of wanting to try pumpkin in place of maple syrup in my Maple Cranberry Oatmeal Cookies which I love and have previously shared with you.

My intention was to remember which of these five cookie recipes I had liked  best and share that with you. The problem was, I couldn’t remember so I just made all six, again. As I made them and ate them I planned to pick one to post today.

By the time I make all six of them and shared them in the emergency department on Thursday night, I had so much fun, I was not able to leave out a single one. They are all very different with different interesting ingredients, tastes and textures. Pick one and give it a try.

Truth be told, I like the Pumpkin Chocolate Chip Cookies best. Why? Well, chocolate, of course. Also, they are more firm and hold together better than the others which makes them easier to eat and transport. If you use pumpkin in cookies, they usually end up soft and cakey.

Here they are all spread out in the ED for everyone to eat and decide which they liked best.

The cranberries and zest make these cookies. I left out the nuts, as I usually do. They have a very festive smell and taste.

Recipe By:

Diningaround.com

 Ingredients:

½ cup butter, softened

1 cup white sugar

1 teaspoon vanilla extract

1 large egg

1 cup canned or cooked and pureed pumpkin

2 ¼ cups all-purpose flour

2 teaspoons baking powder

1 teaspoon baking soda

½ teaspoon salt

1 cup fresh cranberries, each cut in half

1 teaspoon ground cinnamon

1 tablespoon orange zest

½ cup chopped walnuts

 Directions:

1. Heat oven to 375 degrees F. Grease cookie sheets or cover with baking parchment.

2. In a large mixing bowl, cream butter and sugar until light and fluffy.

3. Beat in vanilla, egg and pumpkin.

4. Sift together flour, baking powder, baking soda, salt and cinnamon. Stir into sugar mixture until well blended.

5. Stir in orange zest and walnuts.

6. Drop by teaspoonfuls onto cookie sheets.

7. Bake for 10 to 12 minutes.

Of all the pumpkin cookies I have made, these had the most integrity and were the least likely to be soft and cakey. They tasted a lot like a pumpkin chocolate chip Harvest Loaf recipe we make. Very good!

Recipe By:

Mercury News

 Serving Size:

48

 Ingredients:

2 cups flour

2 ½ cups oats

1 teaspoon soda

1 ½ teaspoons cinnamon

½ teaspoon salt

1 cup butter, softened

1 ½ cup brown sugar

¾ cup sugar

1 large egg

1 ½ teaspoon vanilla

1 cup canned pumpkin

1 ½ cups chocolate chips

Directions:

1. Heat oven to 350 degrees.

2. Combine flour, oats, soda, cinnamon, salt. Set aside.

3. Combine butter and sugars.

4. Stir egg, vanilla and pumpkin into sugar mixture.

5. Stir flour mixture into pumpkin mixture.

6. Stir in chocolate chips.

7. Bake 13 minutes.

I don’t really like white chips and this much nutmeg is a bit bitter so I didn’t like these as much as others but they look really cool and folks in the ED liked them.

Recipe By:

Mercury News

 Serving Size:

36

 Ingredients:

2 teaspoons cinnamon

1 teaspoon nutmeg

1 cup oats

12 ounces white chocolate chips

1 cup brown sugar, packed

½ cup sugar

16 ounces canned pumpkin

½ teaspoon salt

1 large egg

1 teaspoon vanilla

2 cups flour

1 teaspoon soda

 Directions:

1. Heat oven to 375 degrees.

2. Cream sugars, pumpkin, salt, egg and vanilla.

3. Mix in remaining ingredients except chips.

4. Stir in chips.

5. Bake 12 minutes.

 Notes:

Consider adding 1 tsp ginger and 1/2 tsp cloves next time.

These are very soft so are tricky to ice so don’t make the icing too stiff. The icing makes them!

Recipe By:

I got it from Hilary but it’s all over the Internet

 Ingredients:

1 cup butter, softened

1/2 cup white sugar

1/2 cup brown sugar

1 cup canned pumpkin

1 large egg

1 teaspoon vanilla

1 teaspoon baking soda

1 tablespoon cinnamon

1/2 teaspoon ground cloves

1/2 teaspoon nutmeg

1/2 teaspoon ginger

1/2 teaspoon salt

2 cups all-purpose flour

3 tablespoons butter

1/4 cup heavy cream

1 cup confectioners’ sugar

1 teaspoon vanilla

1/2 cup packed brown sugar

1 pinch salt

 Directions:

1. Preheat oven to 350 degrees.

2. In a large bowl, cream together n 1 cup butter 1/2 cup white sugar and 1/2 cup brown sugar. Add eggs and 1 teaspoon vanilla. Mix well. Stir in pumpkin.

3. In medium bowl, sift together the baking soda, cinnamon, cloves, nutmeg, ginger, 1/2 teaspoon salt and flour. Add to pumpkin mixture and mix well.

4. Drop by 2-tablespoon-sized balls onto a lightly greased or parchment-covered cookie sheet. Bake for 10-12 minutes.

5.   To make frosting: In a medium saucepan, combine 3 tablespoons butter, cream, and 1/2 cup brown sugar over medium heat.

6.  Cook, stirring occasionally, until mixture just begins to boil.

7. Remove from heat and stir in  1 teaspoon vanilla.

8.  Cool then stir in confectioner’s sugar.

9. Spread frosting over cooled cookies.

Not too imaginative a name. These are moist. I used almonds buy like them better without the nuts, as is usually the case for me.

Serving Size:

72

Ingredients:

2 cups brown sugar

2 cups canned pumpkin

1 cup salad oil

2 teaspoons vanilla

4 cups flour

2 teaspoons soda

2 teaspoons baking powder

1 teaspoon salt

2 teaspoons nutmeg

1 teaspoon cinnamon

½ teaspoon ginger

2 cups raisins

1 cup chopped nuts

Directions:

1.  Heat oven to 350 degrees.

2. Beat together brown sugar, pumpkin, oil and vanilla.

3. Sift together all dry ingredients.

4. Combine both mixtures and mix well until smooth.

5. Stir in raisins and nuts.

6. Drop by in 2 tablespoon balls onto prepared cookie sheet.

7. Bake 12-14 minutes.

A forty-three-year-old man was admitted to a different hospital in our community. There, he was found to have abdominal pain and fever. A CAT scan of his abdomen showed a mass in the pancreas and he was scheduled for further testing to determine appropriate treatment.

In order to have the test done the next day, his doctor ordered that he not have anything to eat or drink after midnight. When he asked for water, the nurse reminded him the doctor didn’t want him to have any. When further demands for water brought the same results, the patient got mad and signed out of the hospital against medical advice. Rather than leave the premises, he went down to the emergency department and pitched a fit, yelling and throwing furniture around the waiting room.

Police were called. They handcuffed the patient. Rather than take him to jail, however, they took him outside, called an ambulance, filled out a psychiatric commitment form and sent him to our emergency department.

When the patient arrived, he was not confused but was very nasty and uncooperative. When I tried to get him to tell me why he was in the emergency department, he gave me flip, evasive answers and told me to ask the people who took him there. He also demanded water to drink.

After getting very little from him that would help me understand what was going on, I called the other hospital and was filled in on the events prior to his arrival at our emergency department.

What was I to do with him? Since he was on a psychiatric hold, I couldn’t discharge him. I either needed to do further medical testing or send him straight to the psychiatric emergency department.

While I was struggling with my decision, he went crazy. At first, he only thrashed around on the bed. Because of the violent behavior he had displayed at the other hospital and toward the paramedics, he had been placed in two-point leather restraints: a thick leather band around one wrist and another around the opposite ankle, both secured to the bed. These kept him on the bed but he still had two limbs free.

As the nurse and I tried to calm him and get him to relax, he started hollering for a drink of water then started violently rocking the gurney back and forth. Each time he would throw his weight form one side to the other, two wheels of the gurney would lift a little farther off the floor. With each rock, his momentum took him a little closer to tipping over. All this time, he was hollering, “I want a drink of water!”

When the nurse and I intervened to keep the gurney from tipping over, the patient spit straight in the nurse’s face.  Then, he tried to hit and kick us with his free arm and leg.

This turned what had been a measured, calm response to his obnoxious behavior into a full take down. I was standing at the top of the gurney by his head. To keep him from spitting on the nurse again, I grabbed his sweaty, greasy head and pushed his face into the mattress. I held it there as others grabbed his free arm and leg and placed them into leather restraints as well. A sheet was placed across his chest, under his armpits and was tied to the top of the gurney. A specially designed spit mask was placed over his head, allowing him to breath but forcing him to keep his oral secretions to himself.

At this point, I would have just washed my hands of him – literally and figuratively – and sent him to psych. There was just one little problem. He had a temperature of 103 degrees! He obviously needed more medical evaluation.

After a few minutes, the patient tired of his thrashings and settled down. He even started acting almost like a normal person. He relaxed and agreed not to attack anyone. Three of his five restraints were removed and he was given a drink of water. Blood and urine tests were done and I made arrangements for him to be admitted to the hospital to figure out why he had a pancreatic mass and a fever. I am sure they will figure out what is wrong with his abdomen but I wonder if they will figure out what was wrong with his head.