Carmen sent me a Tad Bag picture. Can you beat this?

A 31-year-old woman was brought in by police on a psychiatric hold. In such cases, the police officer writes out a document that says why he or she feels the patient is being forced to undergo psychiatric evaluation.

This is what the police officer wrote on this lady’s hold:

“Subject called 911 and reported that her cat was acting strange and that she had tried to kill it by twisting its neck. Upon police arrival to the subject’s home, there was blood on the sink, floor, tables and all over the cat. The subject told me that the cat was acting strange and not obeying her so she tried to kill it by choking it. When the cat stopped moving, she thought she killed it. Subject said she started to give the cat CPR. When subject started to blow air into the cat’s mouth, the cat came alive and bit her on the hand and lip. Subject was not talking in a coherent manner and she said she had been hearing voices lately.”

The “subject” had cat bites and scratches on her face and fingers. She was given first aid and sent to emergency psychiatry.

Here are two stories where someone really needed to call 911 immediately.

Get Cleaned Up for the Paramedics

A 71-year-old woman went up to take her evening bath as she did every day. Three and a half hours later when she had not reappeared, the family went looking for her and found her in the tub unconscious and unresponsive with the water flowing over the top of the tub. She was incontinent of stool and urine. The family pulled her out of the tub. They  cleaned, dried and dressed her then called 911.

Your Mother Is Not Breathing

An 86-year-old man was noted by his wife to be not breathing at 1:45 in the morning. The wife called their daughter, who was at work. The daughter tried to get the wife to call 911, which she refused to do. The daughter then called her own husband at home. She asked him to call the patient’s wife to try and convince her to call 911. He placed the call but had no more success in convincing the wife to call for help. In the meantime, the daughter left work and headed to the patient’s house. When she arrived there, the patient was still not breathing so she called 911. The patient was brought to our emergency department where he was found to be dead.

I used the new greenish-yellow straps placed horizontally with vertical black stripes. Not bad.

Front View

Rear View

This basic recipe is all over the Internet. Spices vary. Some have raisins and/or nuts. Adding the icing and turning them into whoopie pies was my idea.

Yield:

32 small sandwich cookies

Ingredients:

1 cup butter, softened

1 cup sugar

2 eggs, beaten

1 cup grated asparagus

1 tablespoon vanilla

2 cups unbleached flour

1 teaspoon baking soda

1 teaspoon ground cinnamon

1 teaspoon ground ginger

1 teaspoon salt

1 cup rolled oats

¼ cup butter, softened

4 ounces cream cheese, softened

1 teaspoon vanilla extract

2 cups powdered sugar, sifted

 Instructions:

Heat oven to 375 degrees.

Rinse fresh asparagus.  Cut off any tough ends.  Hold the stalk of the asparagus at a 45-degree angle on an old-fashioned flat grater.  Grate, turning the stalk. It will look like a pencil getting sharpened. Set aside.

Mix flour, baking soda, cinnamon, ginger and salt. Set aside.

In mixing bowl, cream 1 cup butter and sugar.

Stir in eggs, grated asparagus and 1 tablespoon vanilla.

Stir in flour mixture.

Stir in oats.

Scoop into 1 tablespoon balls and drop on parchment paper-lined cookie sheet.

Bake for 10-12 minutes, until light brown. Do not over-bake.

Cool on a rack. Handle them gently as they are very soft.

In a large bowl, beat together ¼ cup butter, cream cheese and 1 teaspoon vanilla with an electric mixer.

With the mixer on low speed, add the powdered sugar a cup at a time. Beat until smooth and creamy.

Spread frosting on the bottom of one cookie. Press the bottom of a second cookie against the frosting.

 Notes:

Consider adding to the cookies:
ground cloves
ground nutmeg
raisins
nuts

Recently, a new kind of strap started showing up on our trauma patients. They are greenish-yellow and are stiffer than previous straps I have seen. Of course, I grabbed some, ran them through the washing machine and sewed up a couple of bags to see how they worked. Not bad!

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.

Yield:

36

Source:

http://www.tasteandtellblog.com/cookies-and-cream-pudding-cookies/

 Ingredients:

¾ cup butter, at room temperature

½ cup brown sugar

½ cup granulated sugar

2 eggs

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

 Instructions:

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.

Notes:

They don’t brown very much so if you leave them in until they are brown, they will be over cooked.

Why use Cookies and Cream pudding? I have bulk vanilla pudding which would probably be as good since the Cookies and Cream pudding seems to be vanilla pudding with some Oreo chunks in it.

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.

Ofelia asked me for a bag. She asked for one with a “ruffle.” I think she may have had in mind a flower but it got me to thinking and I came up with this ruffly bag. Good idea, Ofelia!