Becca is one of this blog’s biggest fans. On December 20, 2012, she hosted a badtadmd.com party at her house. She invited several other blog followers who were required to bring cookies made from one of my recipes. I gave her a couple of bags to raffle off. I even showed up with my family for a brief visit and to draw the names of the lucky bag winners. It was a lot of fun.

Here are the party animals who came for the fun.

Veronica won a bag.

So did Lindsay

The cookies were beautiful!

Becca gets a hug. Philip looking on.

Recipe By:

Mercury News

 Serving Size:

60

Ingredients:

2 large eggs

1 cup brown sugar

1/3 cup milk

1/3 cup canola oil

2 cups  flour

1 teaspoon baking powder

½ teaspoon salt

½ teaspoon cinnamon

¼ teaspoon soda

¼ teaspoon nutmeg

2 cups chocolate chips

1 cup oats

1 cup carrots, grated

1 cup raisins

Directions:

1. Heat oven to 350 degrees.

2. Beat together eggs, sugar, milk and oil.

3. Combine flour, baking powder, salt, cinnamon, soda, nutmeg.

4. Combine flour mixture and egg mixture.

5. Mix well.

6. Stir in chips, oats, carrots and raisins.

7. Use two tablespoon cookie scoop to form into balls on baking sheets covered with parchment.

8. Bake about 14 minutes.

Notes:

The carrots, raisins and oats give them a lot of texture. The are cake-like.

Early in the morning, a couple brought in their three-week-old baby girl. She was not breathing or moving. We started CPR, placed IVs and put a tube into her windpipe to breath for her. This is a big challenge in such a little person but all went smoothly. We then gave her medicines to get her heart beating again. It seemed like she was stabilizing when she just crumped and died, in spite of all we could do to save her.

Having little kids die is always hard. The pediatric intern was in tears and everyone was upset. The family seemed in shock. I did the best I could to help everyone deal with their emotions but I only had so much time as I had to turn back to my busy emergency department and get on to the needs of the other patients. The family was given as much privacy and peace as was possible to allow them to begin to grieve.

When someone dies, the charge nurse calls and talks to the coroner who decides what to do with the body. The body is released when there are no worries about why the patient died, no need for an autopsy and the patient’s doctor will sign the death certificate. Alternatively, the coroner can take custody of the body until the cause of death has been determined, usually through an autopsy.

In this case, the coroner decided the baby probably died of naturally causes and the body could be released. I spent quite a bit of time on the phone telling him I wasn’t comfortable with that decision. I told him we didn’t know why the kid died and they should do an autopsy. I specifically mentioned we had no way of knowing the kid had not been abused.

He wouldn’t change his mind and released the body. The parents refused permission for an autopsy. I was frustrated but felt I had done all I could do.

A few days later in the paper, there appeared an article stating that they arrested the baby’s father for killing her. I guess the radiologists noticed old rib fractures on the chest x-ray. That led to an autopsy that showed a skull fracture as well. There was no evidence of trauma on the outside of the body that would have given us a clue. That is not unusual for babies with trauma.

This case shows many of the challenges we face as emergency physicians. The medical part of the case was challenging. It is hard to provide critical care to such a little person. If the medical care is difficult, the social elements were even more so. Many of these challenges are out of my control, which leads to frustrations. In this case, had there been no visible rib fractures on the x-ray, no justice would have been done. This realization is very painful to me and makes the emotional part of my job even more challenging.

This was a Pillsbury Bake Off recipe* but it is in many other places on the Internet like Cooks.com. The cookie is just a basic shortbread so the filling and icing really make them.

I leave out the nuts, of course. Since I always like cookies better without the nuts, I usually make them first without nuts and only try them with nuts later if it seems like they are missing something. These are not missing anything.

Recipe By:

Pillsbury Cookoff

Yield:

24

Ingredients:

1 ½ cups butter, softened

1 ½ cups powdered sugar

½ teaspoon salt

2 teaspoons vanilla

2 ½ cups flour, 11.25 ounces

6 ounces cream cheese

2 cups powdered sugar

1 ¼  cups  flour

1 cup walnuts, chopped

1 cup coconut

1 teaspoon vanilla

1 cup chocolate chips

¼  cup  water

¼  cup  butter

1 cup powdered sugar

Directions:

1. Heat oven to 350 degrees.

2. Cream 1 1/2 cups butter, 1 1/2 cup powdered sugar, salt, and 2 teaspoons vanilla.

3. Add 2 1/2 cups flour gradually. Mix well.

4. Shape into balls of 1 tablespoon each. Press onto ungreased cookie sheet. (I use parchment.) Make thumb print in center of each cookie. Bake 12-15 minutes until just browned around the edges. Top with filling while still warm.

5. Mix cream cheese, 2 cups powdered sugar, 1/4 cup flour, and 1 teaspoon vanilla. Stir in walnuts and coconut. Put about 2 teaspoons on each cookie while still warm.

6. Melt chocolate, water and 1/4 cup butter. (I use double boiler.)  Remove from heat.

7. Add 1 cup powdered sugar. Beat until smooth. (It will look curdled at first but will smooth out if you beat it will with a hand mixer.) Frost cooled cookies with about 1 teaspoon frosting on each cookie over filling. I put it in a quart-sized Zip-Lock bag, cut off the corner and gently squeezed the icing out over each cookie.

Notes:

* http://www.pillsbury.com/recipes/chocolate-buttersweets/08cb366f-709b-4cb3-ae56-722ea919722a

I have a couple of stories to tell you that have to do with clothes.

Always Fashionable.

The first patient was a twenty-two year old man who was drunk and crashed his car while racing. He came by ambulance, escorted by the arresting police. He was strapped to the spine board, swearing at and flipping off everyone who tried to help him. He was thrashing around so much we had to sedate him in order to perform studies on him to be sure he was not injured internally.

Several x-rays, scans and hours later, he was ready to go to jail. When he stood to go, it was clear he needed some help with his pants. In order to expose his legs, the medics had slit his long, baggy pants up the front of both legs from the hems to the waistband. When walking, they flopped around has legs so much I was afraid they would trip him. I had him lie back down, grabbed my trauma shears and cut the pant legs off about the level of the hems of his boxers. When he stood again, it was clear they were so loose might fall down when he walked so I grabbed some strips of gauze and tied a loop between the front two belt loops and synched the waist to keep it up around his hips. I was feeling really good about my efforts on his behalf until he stood again to go. The last thing he did before they handcuffed him with his arms behind his back was to grab the waistline of his newly formed shorts and tug them down off his hips so he could be fashionable as he headed off to the hoosegow.

Super commando

There is no rule saying everyone must wear underwear. Yet, I can tell you after many years of seeing people in various stages of undress that the vast majority of people in our society do so. The term for going without underwear is “going commando.” In the emergency department, when I picture going commando, I picture a dirty homeless man or a woman in a very short skirt who was beaten up by someone she expected to pay her for some services rendered. Let me tell you about one patient going commando that was a unlike any other I have ever seen.

She was a nineteen-years-old trauma patient who came in, as they usually do, all strapped down to a spine board. She was nervous but pleasant and cooperative (unlike the first guy) and was dressed in a large, thick, white terrycloth bathrobe. As we got the straps off the board and started to examine her, we realized she had nothing on under the robe at all.

The story was that she got in an argument with her boyfriend. He got mad, bolted to his car and took off. She ran out, got in her car and sped after him without bothering to get dressed. She then drove in a crazy manner that lead to the crash. Fortunately, she was not seriously injured and was soon released into the custody of the waiting Highway Patrol.

Someone referred to her as going commando to jail. Then someone else joked that she was actually going “super commando” as she walked out, hands cuffed behind her back, wearing only her white terrycloth robe.

Some more blue bags nicely placed on the bed.

I first found Ginger-Lime Chewies at Better Homes and Gardens*. I liked the zippy taste but didn’t really like the texture so I came up with my own. They are not hard to make and “get right in your mouth” as my father would say.

Ingredients:

2 ¼ cups sugar

2 
tablespoons finely shredded lime zest

1 
tablespoon peeled, grated fresh ginger

½ cup butter, softened

½ cup shortening

2 egg yolks

1 ½ tablespoons fresh limejuice

1 
teaspoon lemon or vanilla extract

2 ¾ cups flour, 12.5 ounces

2 
teaspoons ground ginger

2 teaspoons cream of tartar

1 teaspoon baking soda

¼ teaspoon salt

Directions:

1. Position a rack in middle of oven. Heat to 400 degrees. Prepare baking sheets by lightly greasing or covering with parchment. Set aside.

2. In a food processor, combine sugar, lime zest, and fresh ginger. Cover and process for 2 to 3 minutes, scraping sides of bowl occasionally, until ginger is completely pulverized and mixture is thoroughly blended and smooth. Remove 3/4 cup, transfer to a saucer and set aside.

3. In a large bowl combine remaining sugar mixture, butter, shortening, egg yolks, lime juice and lemon or vanilla extract. Beat with an electric mixer on low, then medium speed, until very well blended and lightened in color, about 2 minutes.

4. Combine flour, ground ginger, cream of tartar, baking soda, and salt. Beat in half the flour mixture on low speed just until evenly incorporated, scraping sides of bowl occasionally. Stir in remaining flour mixture until evenly incorporated.

5. Cover and refrigerate until it is firm enough to handle.

6. Form balls of dough with a 2-tablespoon cookie scoop. Roll balls in reserved sugar mixture, coating about half the surface. Place balls, sugar side up, on prepared baking sheet.

5. Bake 6 to 8 minutes or until edges are light brown and cookies are not quite firm when gently pressed in the center. Let cool 5 minutes to firm up. Using a spatula, transfer cookies to wire rack to cool.

Notes: Here is the BH&G original: http://www.bhg.com/recipe/lime-and-ginger-chewies/

The triage nurse at the front desk makes a brief note of a patient’s chief complaint. Here are a few unusual ones.  These patients didn’t have anything interesting wrong with them but their complaints were noteworthy.

Big Time Wrestler

A professional wrestler was uninjured during his bout at the fair grounds. Afterwards, someone hit him on the back of the head with a bottle and he was brought in by ambulance, still in his wrestling costume and strapped to a spine board. He denied any symptoms. “I’ve had three concussions and I know I don’t have one now,” he assured me. He seemed to have no injury and was discharged.

Bit by a Dead Hamster

A woman called the emergency department and told the nurse a family member had been bitten by a dead hamster. She was wondering what they should do.

Bus Ride Too Far

An elderly man got on the bus to go from one town to another about 70 miles away. He fell asleep and missed his stop. He snoozed for another two hundred miles. When he finally woke up, he got off the bus in our city. Having no way to get back to where he really wanted to be, he called 911 and was brought to the emergency department.

From Hickeys to Bruises

A thirty-five-year-old woman came in complaining that her boyfriend had struck her on the back and elbow. The only abnormalities on her physical examination were the multiple hickeys she had on her neck. When asked about them, she said they also came from the boyfriend but “before this all started.”

Wanting to Look Good

A 74-year-old woman took ill and hurried to the emergency department. She said she came in sooner rather than later because she didn’t want to be a bad-looking corpse.

Caught His Penis In the Mattress

A nineteen-year-old said he cut his penis when he rolled over and caught it in the spring of an old mattress.

“It must have been a really old mattress,” I observed.

He later admitted he was “messing around with my girlfriend” when it happened but was too embarrassed to admit it.

Bit by His Cousin

A 4-year-old boy was brought in by his grandmother. He was complaining of pain in the penis.

She said she placed the boy and his 5-year-old cousin in the bathtub to bathe. The boy splashed water on his cousin. That made the cousin got mad and he bit the patient on the penis.

The boy’s penis was swollen and purple.

Certified Wart-Free

A man in his twenties came in for a certification that he had no venereal warts. His ex-girlfriend had told his present girlfriend that he had given the previous girlfriend genital warts. His present girlfriend was refusing to have sex with him until he presented her with a certification that it was safe.