I was called to the trauma room in the middle of the night.  The medics were just moving a patient from their gurney onto ours. They reported he had been drinking and maybe doing other drugs at home. His family had seen him fall onto a glass table, breaking the glass and cutting his forehead.

During transport, the patient was excessively agitated and combative. Besides being strapped down to the spine board with the usual trauma straps and brace on his neck, he had leather restraints on all of his extremities and had been handcuffed to the board by police called to the scene.

He was a heavy, middle-aged man. His clothes, face, arms and bare feet were covered in blood. He was swearing and mocking everyone who was trying to help him. He spit in the face of one of the paramedics who was trying to stop the bleeding by pressing gauze against the large laceration in the middle of his forehead.

This sort of situation causes lots of problems in the emergency department. The patient may actually have serious injuries that might not be identified if he does not allow appropriate testing. Something has to be done to gain control of a very uncontrolled situation.

After calling out a list of instructions to the staff, I took his bloodied right arm, twisted it to keep it straight and held it to allow Fernando, the nurse, to start an IV. It was all I could do to keep him from pinching me with his bloodied hand while facilitating the catheter placement into his vein. Fernando then injected him with lorazepam, a potent tranquilizer.

The first dose had no effect. He was still thrashing and hollering. After the second dose, I was able to relax my hold on his arm. A third dose allowed us to start a more thorough, head-to-toe evaluation, looking for serious injuries. Though more relaxed, he continued to be uncooperative and demand to be let free.

Suddenly I noticed something changed. He went stiff, stopped breathing and started to turn purple. I told everyone to stop what they were doing so I could figure out what was going on. Everyone was immediately quiet with intense attention focused on his new condition.

I looked at the cardiac monitor and checked his blood pressure and pulse. No answer there. Next, I tried a “sternal rub.” This means making a fist and digging a knuckle into the front of the chest, purposefully causing pain. He did not respond. He was getting more purple.

As I quickly considered what to do next, the patient let out a huge breath, tried to sit up and screamed, “Psycho!” at the top of his lungs. He then fell back on the gurney and laughed hysterically.

I was almost frozen by the complex set of emotions that welled up inside of me. I was obviously relieved to know he was all right. I was filled with that indignation anyone feels when he recognizes he has been played the fool. I also could not help but see how funny it all was, in a sick and sad way. Drunks are profoundly sad yet they do and say things that are unavoidably perceived as funny. I found myself moved to laugh at something that was really very sad.

He continued to laugh and laugh, apparently enjoying the fact that he had played a very good trick on us all. He then allowed us to sew up his face and scan his head. He spent the rest of the night with us, mostly sleeping. By morning, he was sober enough to skulk out of the emergency department and head home.

Thanks to Becca and Ivan for sharing this great celebration of a Tad Bag.

I don’t drink coffee and have never been a real fan of the flavor. As I have matured, I have been developing a taste for it, especially if it is subtle and, of course, combined with chocolate. When I first saw this recipe, I thought, “1/3 of a cup of instant coffee? That is a lot!”

When I mixed these up and tasted the dough, I thought, “I am not going to like these because they are too strongly flavored of coffee.” But, the cookies are really good. They are dense and firm but moist.

Be careful not to over-toast your almonds or that toasted nut taste will overshadow the coffee and chocolate balance.

Ingredients:

¾ cup blanched slivered almonds

1/3 cup instant coffee granules

2 tablespoons hot water

2 2/3 cups all-purpose flour

¾ teaspoon baking soda

½ teaspoon salt

½ cup butter, softened

1 ¼ cups white sugar

1 teaspoon vanilla extract

2 eggs

2 cups semi-sweet chocolate chips

 Directions:

1. Heat oven to 350 degrees F.

2. Toast almonds in oven for 5-10 minutes or until brown.

3. Dissolve coffee in 2 tablespoons hot water. Set aside.

4. In a separate bowl, combine flour, baking soda and salt. Set aside.

5. Beat butter and sugar in an electric mixer at a medium to high speed until fluffy.

6. Stir coffee, vanilla and eggs into butter mixture. Mix well.

7. Reduce speed to low and slowly pour flour mixture into the butter mixture. Mix just until combined.

8. Fold in chocolate chips and almonds.

9. Drop dough by 2 tablespoon cookie scoop onto an ungreased or parchment-lined cookie sheet.

10. Bake about 10 minutes.

Recently, I became aware that some servers were identifying badtadmd.com emails as spam. Several people had not been getting notifications of my postings. If you have not been being notified of my postings, please make sure the emails from my site are not in your spam folder.

What do you think all of his fellow accountants will think of Aaron’s unusual bag for his laptop?

Last week we did a neck story. Let’s do another this week.

A man called 911 and said he stabbed his girlfriend. When the medics arrived, there was no man. They found a twenty-five-year-old woman, unresponsive, with a needle, hooked onto a syringe, stuck in her neck.

Medics often find drug paraphernalia when addicts go unconscious after shooting up. In this case, no paraphernalia was found and there didn’t seem to have been anything in the syringe. In route to the ED, the patient suddenly woke up and went crazy in the back of the ambulance.

She was like no woman I have ever seen. She was a body builder who admitted to taking steroids, and she had HUGE muscles. Seriously, she was so totally muscle bound she was unable to put her arms down to her side! She walked like she had a watermelon between her legs. Her breasts were small and tight under her sports bra, and her muscles and tattoos were very visible under her wife-beater T-shirt.

The patient was intoxicated, but that didn’t seem to explain all of her very strange behavior. She claimed to not remember what had happened to her. She reported nearly uncontrollable feelings of rage causing her to feel like punching the wall or another person. She continuously paced around, unable to sit still.

A police officer came in to take a report. His reaction to the situation was a good measure of the strangeness of it all. The patient acted so abnormally and gave such bizarre answers that the officer became frustrated and gave up trying to understand what she was saying. He left, telling us to call him back if she began making more sense.

The patient’s very unusual, androgynous appearance added to the effect of her bizarre behavior. She was clearly a woman. But, she was so masculine, muscled and tattooed it was hard not to stare at her. She looked like a freak and acted like one, too. It made me wonder how much her craziness was caused by acute intoxication, underlying mental illness, or by the steroids she was taking.

I had trouble making the dough balls if the dough was a bit too soft. If any of the marshmallows are on the surface, they will melt and spread out on the baking sheet, caramelizing. That makes for a fund chew and taste but they are not so pretty as when the frozen marshmallow can be kept inside the ball.

Source:

Mrs. Fields Best Ever Cookie Book

Ingredients:

3 cups all-purpose flour

2/3 cup unsweetened cocoa powder

½ tsp. baking soda

1 cup granulated sugar, packed

1 cup light brown sugar

1 cup salted butter, softened

2 large eggs

2 tsp. vanilla extract

12 ounces mini semi-sweet chocolate chips

8 ounces mini marshmallows, frozen

Directions:

1) Heat oven to 350 degrees. Until you are ready to assemble the cookies, leave the marshmallows in the freezer. They’re way easier to work with frozen.

2) In a medium sized bowl, combine flour, cocoa, and baking soda. Set aside.

3) Using electric mixer blend butter and sugars, scraping down the sides of the bowl.

4) Add eggs and vanilla. Beat at medium speed until light and fluffy.

5) Add flour mixture and chocolate chips. Blend at low speed until combined. Batter will be very stiff.

6) Gather 4 or 5 frozen marshmallows in the palm of your hand and cover them with a heaping tablespoon of dough. Wrap the dough around the marshmallows, completely encasing them and making a 2-inch-diameter dough ball.

7) Place balls on ungreased cookie sheets, 2 inches apart (I use parchment.)

8) Bake 10-12 minutes. Cool on sheet for 2 minutes then transfer to a cool, flat surface.

KQED and The Kitchen Sisters are producing a series called The Making Of. One of their reporters came to my house and interviewed me. Here is a link to the piece they did on me:

http://blogs.kqed.org/makingof/2013/02/12/trauma-strap-bags/

I found this recipe in a cookbook my sister-in-law, Cathy, sent us for Christmas. It is called Calico Cooking from the Calico Corners fabric stores. I am not sure why a fabric store makes a cookbook but…

When I Googled the recipe, I found it all over the web including at epicurius.com.

I am too lazy to roll out logs, refrigerate and cut them. I took the unrefrigerated dough, scooped it onto the baking sheets with a 1 tablespoon cookie scoop. I then buttered the bottom of a glass, dipped it in sugar and gently flattened each dough ball to the prescribed ¼ inch thickness, redipping in sugar before flattening each subsequent ball. I also skipped the powdered sugar because it is a mess.

These cookies are firm but not dry. I wonder if some coconut flavoring, in addition to the vanilla and lemon flavoring, would have been good.

Yield:

4 dozen small cookies

Ingredients:

1 cup unsalted butter, softened

½ cup sugar

1 ½ tablespoons freshly grated lemon zest

1 teaspoon vanilla extract

½ teaspoon lemon extract

2 cups all-purpose flour

1 teaspoon baking powder

¼ teaspoon salt

1 cup sweetened flaked coconut, toasted and cooled

Confectioners’ sugar for dusting

In a bowl with an electric mixer cream the butter with the sugar until the mixture is light and fluffy.

Beat zest, vanilla, and lemon extract.

Add flour, baking powder and salt. Beat until it forms a dough.

Stir in coconut.

Chill dough for 1 hour, or until it is firm enough to handle.

Divide the dough in half. On a sheet of wax paper, form each half into an 8-inch log. Chill the logs, wrapped in the wax paper, for at least 4 hours or overnight.

Heat the oven to 300°F.

Cut the logs into ¼-inch-thick slices with a sharp knife.

Arrange the slices 2 inches apart on parchment-lined baking sheets.

Bake the cookies in the middle of the oven for 25 to 30 minutes, or until they are pale golden.

Transfer them to racks and sprinkle them generously with some of the confectioners’ sugar.

Let the cookies cool then dust them lightly with the remaining confectioners’ sugar.

We see lots of people who harm themselves. The most common ways of doing so are taking an overdose and cutting. Sometimes the cutting is in troubled people trying to let off stress rather than really trying to kill themselves. Often the cutting is more a cry for help or to get attention rather than a truly serious attempt at committing suicide.

Only occasionally do we see someone who really seems to be serious about killing himself by cutting. One such patient was a troubled young man who took a box cutter and cut his neck from one ear, across the front, over his Adam’s apple, to the other ear. He refused to say why he had done so.

The cut was really amazing. It was a serious attempt at suicide that cut down to but not into every vital structure he had in the front of his neck. I could look into the cut and see his carotid arteries, jugular veins, thyroid gland and larynx (voice box.) Somehow, he managed to perfectly expose all of these structures without injuring them other than a nick in the thyroid cartilage, which is what causes the Adam’s apple bump.

As I gazed into his wound, I was struck with how much detail I could see in his anatomy. Then it struck me there was no blood! After he cut himself, he ran through large sprinklers in a park. By the time he arrived in the emergency department, the bleeding had stopped and the wound had been washed clean in the sprinklers. It looked more like an anatomy specimen than an injured person.

He was taken to the operating room where the wound was carefully explored to make sure there were no important injuries and put him back together. He then was transferred to psychiatry.