Archive for September, 2013
Someone told my wife her favorite cookie shop was Anthony’s in San Francisco. When we looked at their website, they listed Cookies and Cream as one of their cookies. I had come across cookies and cream cookie recipes before but this time I really went looking. There are many different cookies and cream cookie recipes out there. I had a bit of a hard time trying these because it just doesn’t make any sense, really, to buy lousy cookies, crush them and put them in your home made cookies which you hope will be delicious. I finally decided to give them a try. Here is the recipe I picked to try, adjusted only a bit by me.
¾ cup butter, at room temperature
½ cup brown sugar
½ cup granulated sugar
1 teaspoon vanilla
4.2 ounces Cookies and Cream pudding mix
1 teaspoon baking soda
2¼ cups all-purpose flour
¼ teaspoon salt
8 Oreo cookies, roughly chopped or crushed
5 ounces white chocolate chips
5 ounces semi-sweet chocolate chips
1. Heat oven to 350 degrees.
2. Combine pudding mix, baking soda, flour and salt. Set aside.
3. In a large bowl, cream together the butter and both sugars until light and fluffy.
4. Add eggs and vanilla. Mix until completely combined.
5. Add flour mixture and mix until combined.
6. Fold in the Oreos, white and semi-sweet chips.
7. Form dough into 2 tablespoon-sized balls. Place 2 inches apart on parchment-lined baking sheet. Bake about 12 minutes, or until set.
They don’t brown very much so if you leave them in until they are brown, they will be over cooked.
How to Stay Skinny
Mr. Alvarez was forty-seven. He came in right at the first of my shift with confusion and a history of having used methamphetamines. He was so agitated he had to be restrained with leather straps on all four of his extremities and had to be given a lot of sedatives before he finally fell asleep. All testing done on him was normal except for having methamphetamines in his urine.
He was later more calm but when I tried to get him up to see if he could be discharged, he was paranoid and kept asking me if it was safe and telling me he was going to die.
It took him all night long to clear him enough to be discharged. I started my “Why You Should Not Use Drugs” speech by asking him why he used drugs. I like that question because there is really no good answer to justify drug use. His answer was one I had not heard before and it kind of disarmed me. “I use meth to loose weight,” he replied.
I merely pointed out all the problems he had because of using meth. I gave him my opinion that it was not worth it, even to keep skinny. I provided him with a list of community resources to help him get off meth. Off he went.
The next night, just as the shift was starting, medics rolled in with an agitated patient in four point leather restraints. Who do you think it was but Mr. Alvarez? He was in exactly the same condition he had been in twenty-four hours earlier. He, again, had to be physically and chemically restrained after which he fell asleep and was not ready to be discharged until just before I went home in the morning. He claimed to have no memory of either night’s events. He also denied that he was a slow learner.
A Man of the World
My patient of the week was in his mid-forties and came in by ambulance, worried about chest pain and a fast heartbeat. He was one of those drunks that make you wonder if he is a jerk who just happens to be drunk or if he is just obnoxious because he is drunk. Either way, he was so rude, he really got under my skin despite my best efforts to prevent it.
He wore a cheesy, “I’m smarter than you are” sort of a smile all the time. He went on and on about how things were so much better in his homeland of Great Brittan. He told me he had been a soldier in England and he “knew better,” whatever that meant. He treated me with contempt when I told him a normal heart rate was up to 100 beats per minute. “Any corpsman in the British Army knows a normal heart rate is between 60 and 80,” he corrected me.
I tried to be as pleasant with him as I could as we went through the necessary steps of getting him feeling better and making sure his complaints wouldn’t require him to be admitted to the hospital. After going over his prescriptions and discharge instructions, I asked, as I try always to do, if there was anything else I could do for him or if he had any questions. “Yes,” he responded. “What’s the deal with the ponytail?”
You can imagine how that affects me. I don’t think there is any “deal with the ponytail.” The question was completely inappropriate and, by then, I was totally fed up with him. My patience exhausted, I said, “You are a sick man,” and walked away. He yelled after me, “Why do you hate the English so much?” I didn’t bother to reply.
The next night, I was starting my shift. As I was taking report from the outgoing doctor, something came up that caused me to tell him the story of my interaction with this man. As luck would have it, just as I was telling the story, who should come in by ambulance but the same guy? This time he was there because he told someone he overdosed on the very same medicine I had prescribed for him the night before.
After we made sure he was not poisoned from any overdose he may have taken, I again had the chance to bid him goodbye. I explained the police had put him on a psychiatric hold so he was going from the medical emergency department to the psychiatric emergency department to get help to keep him from committing suicide. When I told him he had no choice, he asked, “Oh, so this is a police state then?” He went off about not needing to go to emergency psychiatry because he was a “man of the world” and “a soldier.” By then, I was so sick of it, I told him off. “You are just a sad drunk,” I bluntly told him. He went off again about what a wonderful person he was and I repeated, “You are just a sad drunk.”
Off he went to talk to the psychiatrist. Though he told me he was headed back home to England the next week, I somehow had the feeling that would not be the last time I would get to clinically interact with Mr. Smith.
Lisa and Gina came as traveling nurses to work in our emergency department while we implemented a new computer system. Not only did they help us out at work, they became BadTadMD fans, contributing cookie recipes and positive comments. When they left, they gave me these homemade hot pads as parting gifts. Every time I bake, I think of them.
I should do a better job of keeping track of how I come across my recipes. I may have come up with this when I was looking for cookies with coconut oil in them. Anyway, these make delicious cookies but they are soft and moist so don’t travel well.
1¼ cup all-purpose flour
1/3 cup cocoa powder, unsweetened
1 teaspoon baking soda
1 teaspoon baking powder
⅛ teaspoons salt
6 tablespoons unsalted butter, at room temperature
3 tablespoons coconut oil
½ cup granulated sugar
½ cup light brown sugar, packed
1 large egg
1½ teaspoon pure vanilla
1 cup shredded coconut. unsweetened*
1 cup old fashioned rolled oats
1 cup semi-sweet chocolate chips
1. Heat oven to 350ºF.
2. Combine flour, cocoa powder, baking soda, baking powder, and salt. Set aside.
3. In an electric mixer, cream together butter, coconut oil, and sugars. Scrape down the sides. Add egg and vanilla. Mix to combine.
4. On a low speed, gradually mix in flour mixture, until incorporated.
5. Mix in shredded coconut and oats.
6. Mix in chocolate chips. The dough will be pretty solid.
7. Form into balls of about 2 tablespoons and place on sheets lined with parchment paper.
8. Bake about 11 minutes. Remove from oven and let cool for about 2 minutes more on the sheet then remove and place on a cooling rack to finish cooling.
* I used sweetened.
I tried these with and without adding 3/4 teaspoon coconut flavoring. Of course, they were more coconuty with the added flavoring but I liked them better without it.
In my job, I get to see the good and bad side of most everything in life. Pregnancy is so often a thing of excitement and hope. It has its darker side, as well. Here are a couple of stories that don’t exactly exemplify a positive perspective of pregnancy.
None of My pregnancies was Planned
I was helping a thirty-two year old woman who was having pain and bleeding in early pregnancy. It was her seventh time being pregnant. Knowing whether a woman wanted to be pregnant is helpful in making decisions about how to deal with what might turn out to be a miscarriage so I asked, “Is this a planned pregnancy?” In answer to my question, she said, “None of my pregnancies was planned.”
For some reason, that really hit me. One of the reasons the role of women in our society has changed so much is their ability to control their reproduction. It just seems crazy to me that a poor woman with no insurance and questionable ability to care for seven children would take the “None of my pregnancies was planned” approach to life. Where is the desire to be in control? Where is the drive to get your life to play out the way you want it to? Where is the feeling of responsibility? Such important decisions being left up to chance in this modern age makes no sense to me.
Of course, in these situations, all of this just goes on in my head. It is not my place to lecture someone like this nor do I think confronting would make any difference.
Something More than Pregnancy
The other pregnant patient was a fourteen-year-old girl. She was thirteen weeks pregnant and came to the emergency department with her mother when she started to have some spotting of blood from her vagina. Her mother was worried she might be having a miscarriage. She denied any other complaints.
She had never been pregnant before and never had a pelvic or vaginal exam before. I took a few minutes explaining why we needed to do the exam to make sure everything was OK with her baby. I also told her just what I was going to do so she would know what to expect.
The first part of the exam is the speculum exam. A speculum is gently introduced into the vagina then spread open inside. The goal is to see the cervix or opening into the uterus or womb. As I peer inside, I am looking to see if there is any blood and if the opening is closed or not. In this case, rather than see blood, I saw a nasty vaginal discharge. When I asked her if she had noticed it, she said she had but had not told her mother about it.
Usually, such a discharge in a young woman is caused by some sort of a sexually transmitted disease. There is a pretty long list of germs that people share when they have sex and we test for most of them. In this case, she hit the jackpot with two. The laboratory reported that she was infected with both trichomonas* and chlamydia.** So, whoever was responsible for her being pregnant also left behind a bonus for her to deal with.
One of my wife’s coworkers brought her a big basket of ripe figs. When I saw them, I went right to work looking for a fig cookie recipe. Most are for filled cookies, like Fig Newtons. They usually call for dried figs. I had to look for a while to find one that called for fresh figs and looked like something I would like. These have cloves in them, which I found in many of the fig cookie recipes. The fig and clove combine for a very interesting flavor. They are soft and cake-like.
12 fresh figs (a little over a cup for the figs I had)
½ cup white sugar
2 tablespoons unsalted butter
½ cup vegetable shortening
1 large egg
1½ cups flour
½ cup oatmeal
¼ teaspoon baking soda
½ teaspoon baking powder
½ teaspoon salt
¼ teaspoon ground cloves
Heat oven to 350 degrees F.
Combine flour, oatmeal, salt, cloves, baking powder and baking soda. Set aside.
Wash figs, cut off stems, cut into quarters.
Placing figs in a mixing bowl, along with the sugar. Shake to coat well.
Mix in egg, butter and shortening.
Stir dry ingredients into the butter mixture.
Drop dough in 2 tablespoon balls onto a greased or parchment-lined baking sheet.
Bake 12 to 15 minutes, until the edges turn brown. Remove to cool.
Like Father, Like Son
Two trauma patients came in from the same accident. Both were driving cars that ran head-on into each other. One patient was a middle-aged man who was very intoxicated but fortunately had only minor injuries. The other patient was also drunk and suffered only minor injuries. He also happened to be the son of the first man. They both went off to jail in the same police car.
Luckie Hong was a toddler with a respiratory infection. We were mildly entertained by the name and even more so when the intern helping me take care of him told me her dog was named Lucky. Then, when the pediatrician came to admit Luckie to the hospital, she told us she had a pet parrot named Lucky. Name of the day was “Luckie(y)”
He Pulls Out All the Time
When I was living in Alabama, I worked one shift when I saw two different 17-year-old girls claiming they couldn’t possibly be pregnant because their husbands “pull out all the time.”