Then suddenly, while I was in the midst of drawing up medications for another patient, an old man appeared at my side. He said he was her father. He looked nearly as tired as me. But with a sweet smile, he asked me if she was medically cleared, and if so, could he take her home? Unanticipated, a huge sigh whooshed out of me. I told him that yes, she had been cleared. Another sad little smile and he said, “If she is clear, then I can take her off your hands.” This small stocky man with the unruly grey Einstein-esque hair and disheveled appearance–sweater pulled taut over a slight paunch–was my knight in shining armor. And after a full day of caring for this patient with no relief or remission of symptoms, arguing with her about her diagnosis (or lack thereof) and just generally sweating over her care, she meekly followed her father out the door. That easy? For me, it was. That was one day for me. One hard day and then I get to wash my hands of it. But guess who doesn’t get to do that? Her kind mother who called earlier in the day to inquire about her status and her sweet father who came to escort her home and ultimately ended the circular game of discharging someone against his/her will, sick or not. Mother and father will never wash their hands of their daughter’s illness and neither will this woman herself, who is clearly sick in a way that the medications in our Pyxis simply cannot treat. I left very sad, and frustrated. Our system isn’t very good at dealing with the mentally ill. In fact, I would even go so far as to say that the system failed this patient, despite our well-intentioned efforts, and that makes it fundamentally flawed. Clearly, I don’t know the whole story. I only saw a small piece of the puzzle. But, I know something different should have occurred to stop the cycle of her using the ER like a revolving door. Should she have received a psych consult even though every complaint she had was physical in nature? The clues of prior visits point to yes, although clearly this is not a means to a permanent end since prior psych consults have not yielded answers or an end to the behavior. And should she have been assessed for an addiction? Perhaps. It is hard to say without knowing more of the story than her singular ER visit.

What I do know is that the very next day, while putting a chart away at the charge nurse’s desk, a little piece of me shriveled up inside when I heard her voice behind me saying, “Oh, Rachel…I’m back. This time I am really sick!” There she was, brought in by EMS…AGAIN…on a stretcher. She told me that she was still feeling terrible, and that “they” had called her back because they had seen something on her CT scan when re-reading it. I have to admit, I held my breath and crossed my fingers that our team wouldn’t be assigned to her care. And it wasn’t. But the Communications nurse later told me that the look on my face was priceless when the patient called out my name, she said she cracked up, and only for that reason was the patient not assigned to our team again Only in blog-land can I admit how grateful I was. After another 12 hours of her in the ER, with so many other patients, I may have quit my job on the spot. Obviously, I need to learn to better outlets to control my frustrations, because not every patient is pleasant or kind. I am working on learning not to let my crazy patients make me crazy as well because then i really can’t help them!

And now, a recipe for peace. Tea and these cookies, combined with a little yoga on the side help me stay externally peaceful in the ER.

simple lemony cookies

Ingredients (I doubled this recipe and kept one log in the freezer for later use at a future tea party date!) From: VodKitchen

• 9 Tbsp. butter
• 1/2 cup fine sugar
• 1 large egg
• Barely less than 1 cup all-purpose flour
• 1/4 cup quick cooking oatmeal
• 1/4 tsp. baking powder
• 1/2 tsp. salt
• 2 lemons for zest

Preparation

1. Put your softened butter into a food processor with the rest of the ingredients (save the lemon zest) and process until smooth.
2. Finely grate your lemon zest. Stir the zest into the cookie dough and mix together well. Spoon on to a piece of plastic wrap and roll into a sausage shape with a roughly 2 1/2-inch diameter. Chill the dough in the freezer for 30 minutes.
3. Preheat the oven to 375°. Get your chilled dough out and cut it into 1/4-inch thick slices. Place these on two cookie sheets, making sure you leave a good bit of space between the slices because they’ll spread while cooking. Place the cookie sheets in the middle of your preheated oven and bake for about 10 minutes, until the edges of the cookies are golden brown. Let them cool down slightly before transferring to a wire rack to let cool completely.

Also great made with orange zest instead of lemon, and served with tea, coffee, or hot cocoa!

So, I am starting orientation. I still don’t know quite what to expect. I am stressed, excited and apprehensive. I have only been there a few weeks and haven’t been taking my own patients yet. But apparently, that may change tomorrow, since the hospital just activated its disaster protocol for Hurricane Irene. All nurses on deck, either for the acute phase (storm) or recovery (after the storm). That includes lil ol’ me. I am going in tomorrow afternoon, and depending on the storm’s course, they told me not to expect to leave until MONDAY! Talk about a dramatic entry to the world of nursing. Don’t tell my mother, but I am pretty darn excited.

Wish me, and all souls that find themselves in Irene’s wrathful path, good luck!

rubies of the early summer

And with my lovely sis’ we ventured on even more cook-a-thons (she, holding my hand all the way through, as I rolled my eyes at the outrageous pickiness of the classic macaron recipe, and simultaneously steeled my nerves for my fear of failing) BUT WE SUCCEEDED! Recipe to come shortly, but I simply cannot do it justice today. A sneak preview:

double trouble

And with the increasing CSA bounty, I have had my hands FULL. And therefore, if for no other reason, the blog must come back, because all the awesome green (and other color) creations that I am making need to be recorded so I don’t forget them for next summer! Easy suppers (ie: taco salads, black bean veggie burgers, vegetable & tofu stir fries), crunchy lunches (read: massive salads) and delicious and different breakfasts…like the one I made today!

midsummer CSA love

Huevos Rancheros

“East Coast Style” inspired by Deb at Smitten Kitchen (who is my kitchen guru despite all the other cooking blogs I have found and delighted in…her taste is superb and her writing style is still my fave.)

Combination: Salsa Fresca con Salsa Verde Crudo (tomatillo salsa)

Makes about 2 cups.

2 large fresh ripe tomatoes, finely chopped (set aside)

10 tomatillos, husked and well washed, quartered
1/2 large white onion, peeled and coarsely chopped
3 garlic cloves, peeled and crushed

1 jalapeño pepper, stemmed, seeded and chopped
1/4 cup chopped cilantro leaves
Fresh lime juice or 1 teaspoon red-wine vinegar
Salt and freshly ground pepper, pinch of allspice

1. Puree all ingredients together (reserve the ripe tomatoes) until smooth, then combine with the tomatoes that were set aside, taste and adjust seasoning as necessary.
2. Let the flavors marry for 15 minutes or so before serving, but serve within a couple of hours.

Can I complain for one hot second? I’ll take a rain check on a verbal/written reply and take the silence as a ‘yes.’ I am fed up with winter. It rained for my sister’s entire outdoor graduation. Sideways rain, and I don’t think you can get more insulting than that. It rained for my graduation too, but I was happy as a clam to be inside a Track & Field stadium (addendum: I would not have found myself quite so content had it been a sunny-side-up day). I am angry at the weather. Angry to be on the East Coast, although, given the recent (and not-so-recent) rash of natural disasters and other not-so-natural disastrous events, I suppose I should feel at least a modicum of gratitude to be right where I am.  But I am not grateful for my location so much as the produce that it produces. Today, it a little market near my train stop I found all three of the above-pictured vegetables. I hadn’t a clue what to do with them, but daydreamed all the way home on the train, and by the time I arrived, I had the scaffolding of a couple of ideas in my head. I rushed home. I dirtied a lot of a pots and pans. I sweated in my kitchen for the first time in many moons. I requested fancy cocktails from my fiance for our guests. He provided them. (they were delicious) I had a mini-meltdown over 2 poorly poached eggs. Then I got the hang of it.

I took one singular picture…it doesn’t do the final dish justice…but if you want to try any/all of the mishmash medley of vegetarian sensations that I created, the lackadaisical recipes are as follows:

Creamy Polenta

6 cups of water with a dash of salt to speed the boiling process

2 cups dry polenta

½ cup cream

2 tbsp butter

¼ cup grated romano/pecorino/other fancy cheese

Salt & Pepper to taste

Bring the water to a rollicking boil before mixing in the 2 dry cupfuls of polenta. Lower heat and let bubble and brew at a simmer for 10-15 minutes. Stir in cream and butter, stir well and bring to a simmer again. Lastly, mix in cheese and season with salt and pepper to taste before serving. Best served hot. Makes 6 servings or more…

Mizuna Greens

A Japanese green, these tender young’uns have been descried as “piquant, mild peppery flavor…slightly spicy, but less so than arugula.” I tossed them lightly with sesame vinaigrette, toasted sesame seeds and finely grated pecorino.

Caramelized Rutabega

1 large rutabaga (cut into ½-inch cubes)
¼ cup butter
2 tbsp. brown sugar
1/8 tsp. pumpkin pie spice
Freshly ground pepper

Cut the ‘bega into small cubes. Boil in salted water until tender-crisp (about 10 minutes). Drain well. Melt butter in pot, add the rutabega, sprinkle brown sugar and mix gently until caramel appears, just a few short minutes. Add pumpkin pie spice and pepper.

Crispy Pan-friend Spring Onions

4-6 young spring onions

3 tbsp butter

salt, pepper, lemon

With a mandolin, slice the onions into rounds. Melt butter in a skillet and turn up the heat. Add onions and flash-fry for 1 minute on each side. Season the onions with salt, pepper and lemon. Drain any excess butter (can be used with the polenta for an additional seasoning flavor).

Poached Eggs

Tips:

1. Do NOT boil the water. Do not let it simmer. Get the water “excited” with bubbles just barely appearing at the bottom. It is poachable now.
2. Pour in a splash of vinegar
3. Prep your eggs in ramekins, do not crack directly into the whirlpool you create.
4. Make a whirlpool in the water with a spatula in your dominant hand, hold the ramekin containing the egg in the other hand, and gently dump it in the center of the whirlpool at the same moment that you remove the spatula
5. Do not touch your egg as it swirls and gels. Close your eyes if you have to! Do not touch the egg. Trust it.
6. Let it cook for at least 90 seconds before nudging it gently with the spatula to make sure it is not sticking to the bottom of the pan. If it is ready, gently scoop it out with a slotted spoon and put in a warm bath of water to await serving time.

I discussed egg poaching in a previous entry and recommended Smitten Kitchen for an excellent tutorial. I still  stand by this method, despite my initial failed attempts. Check it out for detailed instructions and pictures.

Happy happy spring!

]]> http://healingspoonful.wordpress.com/2011/05/21/spring-has-finally-sprung-today-in-my-kitchen/feed/ 0 rachelsspoonful spring onions purple rutabaga mizuna IMG_2728 http://healingspoonful.wordpress.com/2011/05/04/healing-for-the-belly-morning-glory-muffins/ http://healingspoonful.wordpress.com/2011/05/04/healing-for-the-belly-morning-glory-muffins/#comments Thu, 05 May 2011 00:48:14 +0000 rachelsspoonful http://healingspoonful.wordpress.com/?p=536 ]]>

Sorry for the lame-O photO today...rushing around this morning and had to use my phone camera for the snapshot.

Mmmm, I made the most delicious and nutritious muffins yesterday. Truly! The word muffin is not usually synonymous with nutritious (even if it poses as nutritive) but this is actually factually a yummy-tasting specimen.  It doesn’t even taste like cardboard, as my mother suspiciously asked me today, point-blank, as I gushed about them. Rightly so, she is suspicious of replacing butter and other deliciously decadent fats with healthier alternatives like applesauce, and for the most part, she is right. Nothing stands up to butter and fat in the taste category. But if you are looking for something that won’t necessarily compete, but simply serve as a humble and healthy alternative, then this is it. And it won’t even make you muffin-top over those nice new pants you just purchased. Unless you eat 20 of them. Bah ha ha.

Morning Glory Muffins

Ingredients

• 1 cup all-purpose flour
• 1 cup whole wheat flour
• 1/2 cup white sugar
• 1 tablespoon ground cinnamon
• 2 teaspoons baking powder
• 1/2 teaspoon baking soda
• 1/2 teaspoon salt
• 2 cups grated carrots (about 3 medium-sized)
• 1 apple – peeled, cored, and chopped
• 1/2 cup shredded coconut (raw or sweetened, to taste)
• 1 egg
• 2 egg whites
• 3/4 cup applesauce
• 1/8 cup vegetable oil
• 1 tablespoon vanilla extract
• 2 tablespoons chopped walnuts
• 2 tablespoons toasted wheat germ (if you have it. I didn’t, and didn’t miss it.)

Directions

1. Preheat oven to 375 degrees F (190 degrees C). Lightly oil 18 muffin cups, or coat with nonstick cooking spray.
2. For ease and speed: food process your carrots, apple, walnuts and coconut all together, and set aside.
3. In a medium bowl, whisk together eggs, egg whites, apple sauce, oil and vanilla.
4. In a large bowl, combine flours, sugar, cinnamon, baking powder, baking soda and salt. Stir in carrots, apples, coconut and walnuts mixture. Stir in wet ingredient mixture until just moistened. Spoon the batter into the prepared muffin cups, filling them about 3/4 full.
5. Bake at 375 degrees F (190 degrees C) for 15 to 20 minutes, or until the tops are golden and spring back when lightly pressed. (I had to bake them much longer, roughly 25-30 min – test the centers!)

Amount Per Serving  Calories: 194 | Total Fat: 4.2g | Cholesterol: 12mg

However, I can’t pull on that protective mask if I don’t have a moment of fair warning.

I tried out my first 12-hour night shift the other day. I was paired with a wonderful preceptor, one who has many years of experience under her belt, and has oriented a plethora of new grad and recent-hires. She was very kind, no-funny-business, and utterly confident in my abilities. I did my best to live up to her expectations. I ignored my typical self-doubt and plowed ahead. The night sped by, hours melting away as I focused on remembering my patients, honing my skills, and keeping the facts straight. I assessed, I gave meds, I started IVs, I charted. Our partner on the team took “lunch,” so we took her patients. All along, my preceptor helped me organize my tasks, but took a background role to my work. Soon I realized that I was functioning more autonomously than I ever had before. Granted, I wasn’t flying completely solo, but I hadn’t crashed and burned either. I glanced at our chart rack and realized that I was caring for 12 patients. Twelve! I knew a little bit about each one, and what they needed from me. I felt pretty darn good.

Of course, my very next patient threw me a total curve-ball. A slimy, puss-laden softball. My preceptor told me to go assess a new patient that we had just picked up. There was a scant note from triage about a foot infection, and that he had left AMA (against medical advice) from another local hospital that very same day. She told me to get a history and help the patient remove his clothing and socks. I went in. I blanched at the smell. I stoically held my breath and put on my gloves. Our patient had already urinated in the bed and soiled his clothing. He was incontinent, but not because he was old, just because he didn’t care. I struggled to help pull his double-layer of sweat pants off; he didn’t help me. Suddenly, the fabric came free and I stumbled back a step, sweats in hand, along with one sock. What I saw made me gasp. No time to pull on the straight face. I’ll spare you the gory details, but the gist of it was a VERY fresh, and VERY infected total metatarsal amputation. I soon found out that the infection was osteomyelitis and the prior hospital had tried its full arsenal of antibiotics to treat it, with no success. Gingerly, I pulled off the second sock. My gift was a big toe amputation, in a stage of healing that looked much better off than the other foot, but certainly not pretty. The patient was not friendly, refused care, and stunk. I am embarrassed to say that I avoided his room whenever possible that night. He wasn’t a fun patient to treat, but he is one I will most certainly remember. It reminded me that I am still quite new, I am not an old hat in this business, and I can still feel shocked and grossed out. In fact, maybe I always will. It’s a spectrum, and my gross-out quotient has already improved dramatically. Maybe one day an infected TMA won’t even make me blink. Maybe, but somehow I doubt it.

biggest smile of the day

No…I didn’t take a picture of a patient. But, I did take a picture of what, or whom rather, a patient left behind. Upon our 7am arrival, there was a patient sleeping off her intoxication. Not a rare occurrence in the ED, despite what one may assume is the purpose of the ER (emergencies). My preceptor sent me in to this room to see if I could elicit any information from the patient. Since most of my encounters with drunk people in the ED have been less than pleasant (think: belligerence, lechery, obstinate and loud) I was expecting more of the same, and braced myself. But when I walked in, I saw a middle-aged lady, with hands folded primly above the covers. 1st clue that things would go differently. I asked her about how she arrived here, and if she knew where she was. I was right in assuming that she was oriented times 3. And then she took me for a trip down storybook lane, telling me all about how she had no idea why EMS picked her up, she only drank 3 beers, she was in her own home, alone, not disrupting anyone. To top it all off, someone had stolen her pants and shoes. She was bottomless. Scratching my head in some confusion, I left the room, promising to seek out some clothing for her. I reported back to my preceptor about what I thought was our mistake. My preceptor laughed at me and then very gently pointed out the 28 prior encounters in our EMR that this very same lady had been in for intoxication. I had been hoodwinked. Sober patients are night&day different from their drunk counterparts. After finding this patient a set of bottoms and sending her on her merry way, I noticed the stuffed animal left behind. I guess she didn’t need it anymore. Another nurse set the Dr. Seuss character up in bed, as you see above and closed the curtain. When the 11am shift came on, this same nurse told one of her coworkers, “There’s an emergent case in room 4. Can you go assess, stat?” The nurse agreed and quickly went over to room 4…to find our little friend, all tucked in, with a flat-line for O2 saturation…

Ah, the joys of the ER.

Is this lady really refusing to remove her diarrhea-saturated panties and jeans because she has money in the pockets?  Upon closer examination, the pockets are actually safety-pinned closed at least 10 times on each side. Maam, do you honestly think I am going to steal your diarrhea-saturated money? Really?

Is that man-struck-down-by-car in the trauma room really arguing with approximately 10 residents and nurses and 3 attendings about the need to lie still while he is being examined because, as he (rightly, as it turns out) states, “I am a physician and I know exactly where I am injured!” He then proceeds to sit up on the bed, ignoring all protest, and removes the C-collar himself. Really?

While I wasn’t present for this, the story is far too good to go unshared. Young drunk lady comes into the ER asking every nurse/resident/doctor that she encounters, “Wanna see my kitty?” Despite stern admonishing, by a nurse that she needs to lie still and keep her gown on, she repeatedly keeps pulling it up while squealing, “Wooooo!” Finally an exasperated nurse says, “Put away your cookies! No one wants to see them.” Too true. But still, really?

Is the nursing student soon-to-be-nurse really still puzzling over the diagnosis of our lovely opera singer? Ah, drunk, yes, that took about 20 seconds too long. Really.

I’ve been meaning to post this recipe for quite a while, but kept it on the back burner–so to speak–(pahaha, so punny) since this whole Emergency Room saga began. I figured now is a great time to put it up, though, since it’s been wiggling its way into my food brain lately. Nothing like coming home from a 12-14 hour shift to the tangy and mouthwatering scent of barbecue sauce wafting out into the stairwell, and knowing that it’s coming from my own apartment. The best part about this recipe is that the prep time is next to nothing and it’s great for leftover lunches, too.

Texan Picante Chicken Sandwichitos

Cleverly named by: My fiance

- 1 medium onions or 1/2 large onions, thinly sliced

- 3 boneless skinless chicken breasts

- 1 cup ketchup

- 2 tablespoons cider vinegar

- 2 tablespoons molasses

- 1 tablespoon yellow mustard

1. Cut the onion in half and slice. Line the bottom of the crock pot with the onions.
2. Trim the chicken breasts and place on top of the bed of onions.
3. Mix all of the sauce ingredients together and pour on top of the chicken covering completely. (I made the sauce the night before so that it’s even easier to prep in the morning.)
4. Cook for 6 hours on low setting. While cooking, the sauce will thicken and darken and the onions will soften or perhaps dissolve completely depending on how thinly you’ve sliced them.
5. When the chicken is falling apart tender, take two forks and shred the chicken.
6. Serve on top of split buns. I like mine toasted and with a few spinach sprigs so they hold up better to the weight of the shredded chicken.