I have previously stated that I am not really crazy about peanuts, peanut butter or peanut butter cookies. Sandy sent this recipe to me quite a while ago and, as I looked at it, I decided to give it a try. They are really peanutty. Don’t be set back by the recommended 15 to 18 minute cooking time. I was and tested it out. They were better at 15 minutes than 13. The filling and all the crunchy peanuts pieces set them apart from more basic peanut butter cookies.

Recipe By:

America’s Test Kitchen via my son’s Mother in Law, Sandy

Yield:

24 small sandwich cookies

 Ingredients:

Cookies

1¼ cups raw peanuts, toasted and cooled, 6¼ ounces*

¾ cup all-purpose flour

1 teaspoon baking soda

½ teaspoon salt

3 tablespoons unsalted butter, melted

½ cup creamy peanut butter

½ cup granulated sugar

½ cup packed light brown sugar

3 tablespoons whole milk

1 large egg

1 teaspoon vanilla

Filling

¾ cup creamy peanut butter

3 tablespoons unsalted butter

1 cup confectioners’ sugar

Directions:

1. Adjust oven racks to upper-middle and lower-middle positions and heat oven to 350 degrees. Line 2 baking sheets with parchment paper.

2. Pulse peanuts in food processor until finely chopped. Set aside.

3. Whisk flour, baking soda, and salt together in bowl. Set aside.

4. Whisk butter, peanut butter, granulated sugar, brown sugar, milk, egg and vanilla together in second bowl.

5. Stir flour mixture into peanut butter mixture with rubber spatula until combined. Stir in peanuts until evenly distributed.

6. Form dough into 1 tablespoon balls and place on  prepared baking sheets. Butter the bottom of a drinking glass. Dip glass into granulated sugar. Gently flatten the balls, dipping into sugar between each ball.**

7. Bake until deep golden brown and firm to touch, 15 to 18 minutes***, switching and rotating sheets halfway through baking. Let cookies cool on sheets for 5 minutes. Transfer cookies to wire rack and let cool completely, about 30 minutes.

8. FOR THE FILLING: Microwave peanut butter and butter until butter is melted and warm, about 40 seconds. Stir in confectioners’ sugar until combined.

9. TO ASSEMBLE: Place cookies upside down on work surface. Place about 1 tablespoon warm filling in center of each cookie. Place second cookie on top of filling, right side up, pressing gently until filling spreads to edges. Allow filling to set for 1 hour before serving.

 Notes:

* I used unsalted dry roasted peanuts.

** I stole this idea from a previous recipe and love it.

*** This sounded like too long to me but 15 minutes was just right for me.

The police approached a middle-aged man for being intoxicated in public. His lack of cooperation resulted in a scuffle during which he suffered a cut on the bridge of his nose. After being handcuffed, the police noted he was too drunk to walk so, rather than take him to jail, they called an ambulance and sent him to the emergency department.

When I asked him why he was there, he either didn’t remember anything or pretended not to. He said he had not been drinking and didn’t have an injury on his nose. He was fine and just wanted to go home.

I cast my eye over him from head to toe, giving myself a chance to consider that maybe he might not just be drunk but might be suffering from some other medical problem causing him to be confused. This habit of asking myself if I might be mistaken is a good thing for an emergency physician.

What I saw was an overweight man in a sweatshirt and jeans. He was untidy though not dirty except for a brown streak on the front of his right ankle, right above his sock-less shoe. The streak led down to a walnut-sized ball of poop caught behind the tongue of his shoe.

I pressed the patient about drinking, which he again denied. To counter his insistence that he was not drunk, I asked him why a sober man had pooped his pants. He looked at me and said he had not done any such thing. I pointed to the smear on his ankle and the blob on his shoe and encouraged him to reconsider.

He looked down and offhandedly said, “That’s chicken.”

“No, that used to be chicken,” I replied.

Trying to focus, he looked at his shoe, then reached down and took a pinch out of the ball. Sitting back, he slowly smeared it between his thumb and fingers, evaluating the appearance and texture. He then lifted it to his nose and sniffed. A little smile came over his face and he looked up at me with an impish expression as if to acknowledge I had been right.

Once we were agreed about the nature of the blob on his shoe, he looked around, as if wondering what to do with the mess now spread over all the fingers of his right hand. I handed him a box of tissues and, while we continued our conversation about his medical history, he tried to use the dry tissues to get the sticky stool off his fingers. In his drunken state, he only succeeded in spreading it around until he had poop on all of his fingers as well as the wad of tissues. As we talked, his attention drifted from the mess. His hands sat motionless with the dirty tissues in his lap until his nose started to run. Then, he reflexively lifted the tissue to wipe snot off his nose, leaving a smear of stool in its place.

We got a warm, wet towel and cleaned him up. Then, he rolled over and went to sleep. A few hours later, he woke up, again refused to try to call for a ride, and walked out.

As I carry bags of used trauma straps out of the emergency department, comments are often made that show people  have a vision that I make every strap into a bag. The only way I could possibly do that would be to sew bags full time. Let’s see: It takes about two hours or so to sew up a bag. It took me about six weeks to collect the last 900 straps I sent to RAFT . It takes about four straps per bag. So, if all those straps had gone into bags, I would have had to have spent about about 75 hours per week if I had sewn them all into bags! It is a good thing that RAFT will take them, to keep them out of the land fill. I would be swimming in them if they were all here at my house.

I have told you before about RAFT. It is a great place where teachers can go and buy stuff that has been discarded, mostly by industry, for use as teaching aids. Check it out at:

http://www.raftbayarea.org/membership?gclid=CNeY1qzb1L0CFc1cfgodDWYAEA

Here is the back of my car with the 900 straps I donated this week.

When we were vacationing with the kids last summer, we were in a Goodwill store, looking for treasures. As crazy as it sounds, this is one of our family’s favorite pastimes.  In the store, I found a ratty old purse and bought it for fifty cents. I came home, took the wooden handles off the purse and threw the rest of it away. After some sanding and spray painting, they were ready to put on a new bag. It turned out just right for my mom’s birthday.

Here are the creator and the happy recipient.

The paramedics brought in a twenty-two-year-old man who was found hanging by his ankle under a freeway overpass.

The story he told me was so bizarre, amazing, funny and sad that it ranks near the top of all the stories I have come across in the emergency department.

He told me he wanted to “dance,” hanging upside down. When I asked for clarification, he said he was doing “hardcore acrobatics” and repeated, “I just wanted to dance.”

To do that, he went, alone and at night, to a large freeway overpass. There, he climbed up onto a ledge and tied one end of a rope to a “big-ass pipe” that formed part of the overpass structure. He then tied the other end of the rope around his left ankle. Having secured both ends of the rope, he let himself down over the ledge so he was hanging, upside down, against the concrete wall that formed the vertical support of the freeway overpass. He then spent forty-five minutes doing his “dance.”

What he didn’t count on, he said, was that by the time his dance was done, he was too tired to pull himself back up onto the ledge. He hung there for six hours, flailing in his vain attempt to right himself.

It was not clear who found him hanging there, but the paramedics, who were eventually called, cut him down and brought him in, exhausted, dehydrated and complaining of severe thirst and pain in his leg.

My emergency department evaluation was aimed mostly at the health of his leg. He had rope burns around his ankle. His foot was swollen but the blood flow and sensation were normal. His entire leg was tender and almost all of his skin was red and covered with scratches from where he had scraped against the concrete wall.

I gave him pain medicine and intravenous fluids. I took x-rays and ran some blood tests that showed he was dehydrated but, more importantly, he had developed a condition called rhabdomyolysis. The stress on his leg caused widespread breakdown of the muscles. That caused proteins to leak from the damaged muscle cells into his blood stream. A high concentration of these proteins is toxic to the kidneys so he was admitted to the hospital for care to prevent that complication. See my favorite medical reference, Wikipedia, for more information about rhabdo: http://en.wikipedia.org/wiki/Rhabdomyolysis

I posted another case of rhabdomyolysis. Please see Too Many Pushups.

Last week I told you about looking for a good wheat germ cookie recipe. The closer the cookies got to being like normal cookies with some wheat germ thrown in, the better they were. Here is an example of that. I used Heath Bar chunks and they were wonderful. They go pretty flat so leave a good amount of room between them. They need to be browned but don’t over cook them!

Recipe By:

Martha Stewart

Yield:

48

 Ingredients:

3 cups rolled oats

1 cup plus 2 tablespoons all-purpose flour

1 teaspoon baking soda

1 teaspoon baking powder

½ cup wheat germ

1 cup packed light brown sugar

1 cup granulated sugar

½ pound unsalted butter, at room temperature

2 large eggs, at room temperature

1 teaspoon pure vanilla extract

12 ounces good-quality chocolate, chopped into chunks, OR

1½ cups golden raisins, OR

10 ounces toffee pieces

Directions:

1. Heat oven to 350 degrees.

2. Line baking sheets with parchment paper.

3. Combine  rolled oats, flour, baking soda, baking powder, and wheat germ in a large bowl. Set aside.

4. Combine  brown sugar, granulated sugar, and butter in an electric mixer fitted with the paddle attachment. Beat until creamy and fluffy, about 5 minutes.

5. Scrape sides of  bowl with a rubber spatula. Add eggs and vanilla. Mix to combine.

6. Add  dry mixture to the butter mixture. On low speed, mix just to combine, 10 to 15 seconds. Remove  bowl from mixer stand. Stir in your choice of chocolate chunks, golden raisins, or toffee pieces.

7. Use an ice cream scoop to form dough into 2 tablespoon balls. Place the balls of dough about 4 inches apart on prepared baking sheets. Bake until golden and just set, about 12 minutes. Remove from oven. Let cool on sheets 4 to 5 minutes before transferring to a cooling rack.

Free Ultrasound

A lady in her twenties came in with a gallbladder attack. I treated her pain and ran some blood tests to make sure she didn’t need to be admitted to the hospital. I then told her she needed to get the report of her gallbladder ultrasound, which had been done at another hospital. The surgeons would need this before they would schedule her to have her gallbladder removed.

She said she didn’t want to have to contact the other hospital to get the results of her previous ultrasound. She just wanted to have it done again. When I told her that would be a waste of money, she said. “I don’t have to pay.”

When I pointed out that it still costs someone money, she rolled her eyes and said, “F—!” as she walked out the door.

Needed a Ride Home

A 69-year-old man was out in public and wanted a ride home but had no money. He haled a cab but the cabby refused to take his watch as payment for the ride. He then fell on the ground, feigning to be ill so an ambulance was called. The medics transported him to the emergency department where he had no medical complaint.

He was found to be dirty, disheveled and smelly. The social worker was consulted to try to get him a ride home.

Obama Cab Voucher

A woman in her sixties was ready to be discharged. She said she had no way of getting home and asked for a voucher to pay for a cab ride. When the nurse told her the hospital did not offer cab vouchers, the patient grew upset and said, “That’s not true! Obama passed a law that you have to give cab vouchers!”