Source:

hersheys.com

Yield:

About 40 cookies

Ingredients:

1 cup butter, softened
2 cups packed brown sugar
2 eggs
2 teaspoons vanilla extract
1 ¾ cups all-purpose flour
1 teaspoon baking soda
1 teaspoon ground cinnamon
½ teaspoon salt
3 cups oats
1 1/3 cups (8 oz. pkg.) HEATH BITS ‘O BRICKLE Toffee Bits
1 cup MOUNDS Sweetened Coconut Flakes (optional)

Directions:

1. Heat oven to 375°F.

2. Lightly grease cookie sheet or line with parchment paper.

3. Combine flour, baking soda, cinnamon and salt. Set aside.

4. Beat butter, brown sugar, eggs and vanilla until well blended.

5. Stir in oats, toffee bits and coconut, if desired.

6. Drop 2-tablespoon balls of dough about 2 inches apart onto prepared sheet.

7. Bake 8 to 10 minutes or until edges are lightly browned.

8. Cool 1 minute. Remove to wire rack.

Sue, a nurse in our ED, asked me for a black bag with an orange flower. I told her, “No way,” as there are no more black straps coming in. Well, I got some black together and made if for her. Turned out pretty nice, don’t you think?

Not G-Rated
My patient was a 39-year-old man who presented in police custody. He wouldn’t talk to me but the police said he they had been called to the home of a twenty-year-old woman who said someone tried to rape her. The woman was drinking at her home with the man. She told police he put his hands around her throat to force her to engage in oral sex but she fought back and bit him. When police arrived at her place, they found her roughed up and upset. A testicle was sitting on her living room floor.

She told them who the body part belonged to and where he lived. Medics, who had been called to the scene, put the testicle in a plastic bag, placed it on ice and brought it to the emergency department in case it could be reimplanted.

When police got to the man’s house, they found him lying on the couch in pain. They brought him into our emergency department for care before he went into custody.

The man’s injury was very interesting in that none of the scrotum was missing. She had pinched the testicle so strongly that it literally popped through the skin, leaving a linear laceration on the front of the scrotum through which the testicle had been pushed out.

We numbed up his scrotum, irrigated the wound and stitched him up. He went off to jail with fifty percent fewer testicles than he had when he got up in the morning.

The woman was also brought in for evaluation. As the word circulated through the emergency department that a woman had bitten off a man’s testicle in order to keep from getting raped, the staff was impressed. Our immediate response was to be moved with compassion for her and pride that she had stood up for herself. She was kind of a hero.

Everyone there was on her side and wanted to be with her emotionally. However, she was just the nastiest person to interact with. She was drunk, dirty and smelly. She was so foul in body and personality that it was impossible, after interacting with her, to continue to have any fond feelings towards her at all.

Her evaluation showed she suffered bruises and scratches but was in no need of medical treatment. The police took her home.

We later found out the woman was a prostitute and the man was on parole after serving seven years on a prior conviction for forced oral copulation.

Here is a redacted copy of the article in the local paper about this event:

Man loses testicle, held in assault.
By XX, Paper Staff Writer
A 20 year-old Sunnyvale woman told police she reacted in self-defense when she bit off the testicle of the man who sexually assaulted her.

A  Municipal court judge on Tuesday ruled XXX, 39, must now stand trial on one count of forcible oral copulation.

The woman, who was drinking at her home with XXX on September 29, told police they may have kissed, but when XXX put his hands around her throat to coerce her to engage in oral sex, she fought back and bit him.

“She thought she was going to die,” said The Department of Safety Detective.

She suffered major bruises around her neck and on her shoulders, scratches and minor bruises on her back and arms, and abrasions on her knee, police reported.

After the woman called police, officers found XXX at his home and rushed him to The Medical Center.

XXX was paroled from prison in February after serving seven years on a conviction for forced oral copulation, according to state Department of Corrections. He remains in jail in lieu of $250,000 bail.

These are a bit tricky and it takes some work to keep the caramel inside the dough. I don’t know what difference the Nutella makes as they didn’t taste too much like hazelnut to me.

Recipe By:

My sister-in-law sent this to me. She got it at http://barbarabakes.com

Ingredients:

2 ½ cups flour all-purpose flour
½ cup unsweetened cocoa
1 teaspoon baking soda
½ teaspoon salt
1 cup sugar
¾ cup firmly packed brown sugar
1 cup unsalted butter, softened
½ cup Nutella
2 eggs
2 teaspoons vanilla
36 caramels, unwrapped and frozen
1/3 cup granulated sugar for rolling, optional

Directions:

1. In medium bowl, sift together flour, cocoa and baking soda.

2. In large mixing bowl, beat sugar, brown sugar and butter until light and fluffy.

3. Beat in Nutella, eggs and vanilla until well combined.

4. Add dry ingredients and mix just until combined.

5. Cover bowl with plastic wrap and chill for 1 hour  or more so the dough is easier to handle.

6. Heat oven to 375º.

7. Shape a tablespoon of dough into a ball. Press a caramel into the center of each ball and reshape into a ball. Roll in granulated sugar and place on parchment-lined cookie sheets, then place the cookie sheet in the freezer for 15 minutes before baking.

8. Bake 10 to 12 minutes or until set and slightly cracked.

9. Remove from oven and cool on the baking sheet for 5 minutes before transferring to a wire rack to cool completely.

 Notes:

Don’t over bake.

Again, inspiration from Montreal. When we were poking around in shops there, we were looking at various bags. One inspired me this week to come up with this one.

Recipe Adapted from:

Home-Tested Cookie Recipes

Ingredients:

3 ½ cups flour, 15.75 ounces
½ teaspoon salt
1 teaspoon baking powder
1 ½ teaspoon soda
½ cup butter, at room temperature
½ cup shortening
1 cup sugar
1 cup brown sugar
2 large eggs
1 tablespoon vanilla
½ teaspoon coconut flavoring
½ cup caramel topping
1 cup macadamia nuts, chopped
1 cup chocolate chips
1 cup shredded coconut

 Directions:

1. Heat oven to 300 degrees.

2. Combine flour, salt, baking powder and soda. Set aside.

3. Cream butter, shortening and sugars until creamy.

4. Beat in eggs, vanilla, coconut flavoring and ice cream topping until fluffy.

5. With mixer on low, gradually stir flour mixture into butter mixture until just combined.

6. Stir in nuts, chocolate chips and coconut.

7. Drop in 2 tablespoon balls on parchment-lined baking sheets.

8. Bake 16 to 20 minutes or until just golden brown.

Notes:

The caramel sauce and cooking them at low temperature give these tasty guys a very nice texture and chew. The idea of adding coconut flavoring came from my Aunt Mabel June. Makes about 60 cookies.

I went to see a 31-year-old man who was complaining of headaches and a bump on his scalp just above the forehead. The bump on his scalp was unusual. It was red and tender. It looked and felt kind of like an abscess though it is unusual for someone to develop an abscess on that part of the scalp.

A good way to find out if a bump in the skin is an abscess is to poke a needle into it and aspirate with a syringe to see if any pus comes out. I recommended this to the patient and he agreed.

I got a needle and syringe then wiped the bump with an alcohol swab. I poked the needle into the skin over the bump and pulled back on the plunger. I then slowly advanced the needle, watching for pus. I knew if the needle hit the skull and no pus came back in the syringe it was not an abscess.

But, the needle never hit the skull. Just as I realized this, the syringe started to fill up with liquid. It was not the yucky, thick pus I was expecting from an abscess, but clear, colorless liquid. Cerebral spinal fluid. The fluid that bathes and supports the brain inside the skull. I had poked a needle through his skull!

Shaken, I told the patient what happened. I then ordered x-rays, which clearly showed there was no skull under the lump.

I made arrangements for the patient to be watched in the hospital since I had potentially contaminated his cerebral spinal fluid. This put him at risk of an infection around the brain.

As it turned out, he got no infection and was later diagnosed as having an eosinophilic granuloma or Langerhans cell histiocytosis. This rare condition caused the replacement of normal skull tissue with a tumor that caused the bump on his head.

http://en.wikipedia.org/wiki/Langerhans_cell_histiocytosis

Uncle Boyd and Aunt Betty

Uncle Leonard

Bruce and Sandy

Chip and Debbie

Christy. Where is Keoki?

I pick up the chart of a man in his early forties. “Rectal pain” is the chief complaint.

When I enter the room, the patient is standing in the corner, dressed in a hospital gown and looking rather glum. I introduce myself and ask how I can help him. He mumbles enough of a non-specific answer for me to understand he has something stuck in his rectum that he can’t get out.

I invite him to bend over the exam table as I turn to get some gloves.

Turning back to him, gloves on hands, I pull the gown away from his backside. Sticking out of his anus is the end of a broomstick about a foot long. This surprises me somewhat. I touch it and the patient moans in pain.

“How long has this been in there?” I ask.

“Mmmmm. Four days,” is the reply.

I explain to the patient that we clearly need to give him pain medicine and also something to help him relax before trying to get the stick out. I then excuse myself and pass orders on to the nurse to get this started.

Once the patient is medicated, I return to the room and, again, don gloves. This time, the patient is comfortable enough that he only moans as I pull the stick out. Interesting. The other end of the stick is wrapped in twine. I’m trying to figure this out when the patient looks up at the stick and groggily asks, “Where’s the rest of it?”

An x-ray reveals the outline of a large, penis-shaped dildo stuck in the patient’s rectum. Now, I think I understand what happened. The patient wanted to get the dildo farther into his rectum, so he put it on the end of a broomstick. However, the broomstick was smaller than the inside of the hollow dildo so he wrapped the stick with twine until it fit snuggly inside the dildo and would not come off.

What he failed to consider was what would happen when the dildo was all the way up inside his rectum. Once his anus closed down over the dildo onto the broomstick, it was stuck and couldn’t be pulled back out again.

The poor guy, too embarrassed to seek help, had been sitting – or not sitting – around the house for four days, in miserable discomfort, with that thing stuck in there.

I will blog more in the future on rectal foreign bodies as it is a recurrent and interesting subject in the emergency department. Sometimes, we are able to get them out in the ED. Other times, as in this case, we are unable to do so. In those situations, we call the surgeons. With the patient asleep, and with access to tools they have in the operating room, the surgeons are often able to pull the object out. But, not always. Sometimes, as in this case, the surgeon actually has to cut the abdomen open for removal.

Please don’t ask me why people do this. I never ask. You will just have to use your imagination or go online for more specific information.