Angry Patients and Arrabbiata Sauce

Sometimes, patients can express anger quite simply.

In medicine, you get quite used to dealing with angry patients. Sometimes patients are angry because they’re frustrated with care they received in the past. Other times, patients think that by yelling, they can bully the physician or nurse into doing what they’d prefer (whether or not it’s providing them with prescription drugs or lying to their insurance companies)…though you can probably imagine that as person like me yells back. šŸ˜‰

And then, you have the patients who are just plain sassy.

I was recently on a consult month, which means that we’re asked by primary medicine and surgery teams to see their patients as “experts” in a certain organ system. For this consult, we were asked to see a patient who was currently intubated.

Patients are at different levels of “awakeness” when they’re intubated. Some patients are completely sedated, others are able to follow simple commands, while still others are awake enough that they can write responses to your questions.

As part of our assessment of an intubated patient, we need to determine how “awake” they are. If we already know the patient isn’t at the writing stage, we’ll normally ask patients questions and see if they can respond appropriately.

Fellow: Sir, squeeze my hand if you can hear me right now.

*patient squeezes hand*

Fellow: Sir, squeeze my hand if you are in a hospital right now.

*patient squeezes hand*

Fellow: Sir, squeeze my hand if the sky is orange.

The patient did not squeeze his hand. Instead, he glared (or as well as you can glare with an endotracheal tube in your moth) and slowly raised his hand towards our fellow.

Only his middle finger was pointing towards the sky.

Simple Gestures Arrabbiata Sauce

because everyone knows how to show displeasure

Ingredients

  • 1 lb hot Italian sausage (removed from casing if that’s the only way you can find it)
  • 1 lb lean ground turkey
  • 1 tbsp olive oil
  • 1 really large onion or two medium onions, diced
  • 3 tbsp minced garlic (feel free to add more if you’d like)
  • 2 large cans diced tomatoes
  • 1 small can whole tomatoes
  • 1/4 c sugar
  • 1 c red wine
  • 2 tsp red pepper flakes (again, feel fee to add more to kick up the spice)
  • 1 tbsp dried oregano
  • 1 tbsp dried basil
  • Salt
  • Pepper

How-to

  1. In a large saute pan, brown sausage and turkey. Drain the fat and put into a really large crock pot (if it’s the largest size you can find, that’s the way to go. I know it might seem crazy to have a crock pot that big, but you can cook an ENTIRE CHICKEN, enough chili for a party, or enough of this sauce to last you for a few family dinners. Or, in my case, enough to have friends over for one meal.).
  2. In the same saucepan, add in the olive oil over medium heat. Add in the onions until they start to sweat. Add in the garlic and saute until they become translucent. Add these to the crock pot.
  3. Pour in the 2 large cans of tomatoes. Add in the smaller can of whole tomatoes after breaking up by squeezing with your hands (get out that anger!).
  4. Stir in sugar, wine, red pepper flakes, oregano, and basil.
  5. Cook on low for 6 hours or until your entire house smells of delicious tomato sauce.
  6. Salt and pepper to taste. Serve over a good large pasta with ridges (see the rigatoni, above!). Top with some freshly grated parmesan and my family’s favorite- cottage cheese (yes, I know it sounds weird, but that’s how we do it in my house. It’s the only way I’ll eat cottage cheese).

P.S. This sauce freezes beautifully!

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Psychiatrists Part 2 and Meatballs

It’s a rule in med school that residents and attendings are not allowed to ask out a medical student while they are overseeing them. Some people ignore that rule.

Now, this event occurred days after my last awkward encounter. This time, I was working in the Psych ER. This was a six hour shift in a room that was maybe 15 by 15 feet with at least 8 people occupying that space at any one time (and sometimes, more).

I was assigned to work with the resident that night, and the first thing I noticed is that there was something…wrong…with his face. Specifically, it looked like he had been attacked by a herd of clawed animals.

Which turned out to be the case.

Resident: My girlfriend just dumped me. She’s a vet. We had 8 cats that she left with me. I was holding one while I was crying and he didn’t want to be held.

Now, I like to think I’m a nice person, so I expressed my condolences. However, that was a mistake.

Resident: So, are you single?

(At this point, I’m wondering why on earth I’m getting asked this twice in one week.)

Me: Yes.

Resident: You seem like you’d be fun to date. We should get margaritas tomorrow. When are you free?

Now, this guy really wasn’t my type. Plus there was the issue of the 8 cats. Thankfully, I had an excuse up my sleeve!

Me: It’s actually med school policy that we can only have professional relationships with those that oversee us while we work with them.

Resident: Oh come on, no one follows that anyway. Go on a date with me!

I said no. He would not get the hint. He followed me up to the cafeteria when I attempted to escape to get a soda. He followed me around that tiny room. He kept asking. I kept saying no.

Finally, after about an hour of this ridiculousness, the social workers and nurses took pity on me and sequestered me into a corner with at least 2 of them standing guard at any one time.

Get the Hint Pesto Meatballs

just leave me alone so I can eat these! shown with my tomato sauce

Ingredients

  • 1 lb ground sirloin
  • 1 lb ground veal
  • 1 large onion, diced in large chunks
  • 2 eggs
  • 3/4 c breadcrumbs
  • 1/4 c parmesan, grated
  • 1/8 c skim milk
  • 4 tbsp garlic
  • 1/8 c pesto
  • 1/4 tsp pepper

How-to

  1. Preheat oven to 350 degrees Fahrenheit.
  2. In a blender or food processor, process the onion until smooth.
  3. In a large bowl, mix together onion slurry, eggs, breadcrumbs, parmesan, milk, garlic, pesto, and pepper.
  4. Break up the meat in large chunks and add to the other ingredients. Use your hands to combine.
  5. Coat a baking sheet or roasting pan in aluminum foil (for easier cleanup, but you can skip this step if you’d like).
  6. Use a cookie scoop to form round balls and evenly space meatballs in your baking sheet or dish.
  7. Bake for 30-40 minutes or until meatballs are no longer pink in the center (or use a meat thermometer to the ground meat setting).
  8. Serve with your favorite sauce on pasta or layer with sauce and mozzarella between two pieces of bread for a delicious sub. You could also coat these in your favorite sauce for an appetizer!

Sore Throats and Spicy Pizzas

Medicine has a learning curve. Some people just take longer to catch on.

My very first rotation of my third year of medical school was family medicine. At this point, we’re probably the smartest that we will ever be in regards to biochemical processes that cause any disease to happen or any medication to work, because we have just taken Step 1….or, in other words, the worst exam anyone ever has to take in his or her life. Step 1 is easily 100 times worse than the MCAT, which is the exam you have to take to apply to medical school.

However, though we are the smartest book-wise at this moment, we have never seen a real patient before in our lives (I’m not counting any of the standardized patients who teach us how to do physical exams)…and have not, in many cases, performed a variety of medical procedures.

Which is what led to the incident in question.

As I said, I was on my family medicine rotation at a small town and was there with one of my classmates. Now, this classmate (who will be featured in a later post) could be described as quite eager but also quite awkward. And that might be the biggest understatement of this particular post.

Anyway, my classmate on this particular day came running into the clinic room to excitedly announce that his patient had a sore throat and needed a strep test. And, since this clinic was quite busy (all 4 physicians there had 2 patients booked every 15 minutes…they had 2 coworkers out on medical leave and thus were having to pick up all of their patients), and since I had performed multiple strep tests at this point, they sent me in with my classmate to provide instructions.

Now, many of us have had a strep test before. but for those of you that haven’t, what essentially happens is that one needs to swab the back of one’s throat with an elongated q-tip and stick it in a liquid that shows quickly if a patient does or does not have strep throat.

I walked into the exam room as my classmate was approaching the patient…but not with the correct swab.

I saw the patient’s eyes begin bugging out, so I quickly stepped over, grabbed the correct swab, and said, “I think that we can use a smaller swab than that, don’t you?”

What kind of swab had he grabbed, you ask? A huge swab (think of a giant cotton ball at the end of a long q-tip) that is only supposed to be used when doing a pelvic exam to clean off the cervix.

That woman had no idea how close she came to a REALLY unpleasant experience.

Kill the Sickness Spicy BBQ Chicken Pizza

the spice will kill whatever ails you

Ingredients

  • Pizza dough for 1 pizza (I normally use the Cuisinart recipe since that’s what I have, but any uncooked pizza dough from the store will do)- make sure you leave this on the counter for 20-30 minutes to come to room temperature.
  • 1 c spicy pulled chicken (or see note below)
  • Olive oil spray
  • 2 tbsp light ranch dressing
  • 2 tbsp barbeque sauce
  • 1 c 2% shredded cheddar cheese
  • 1/2 bell pepper, diced
  • 1 tsp garlic salt
  • 1 tbsp parsley

How-to

  1. Preheat oven to 425 degrees Fahrenheit.
  2. Spray pizza pan with olive oil. Take pizza dough and spread out on pan. If the dough doesn’t appear to be stretching, let it rest for a few minutes, then try again.
  3. Spread ranch dressing and barbeque sauce onto the pizza dough. Top with cheddar cheese, then the pulled chicken and bell pepper. Sprinkle with garlic salt.
  4. Bake for 14-18 minutes or until crust is crispy. Remove from oven and sprinkle with parsley. Cut into slices and serve. If desired, top with a bit of cole slaw.

Note: If you don’t have any spicy pulled chicken on hand, make a quick version- mix together 1/8 c sriracha and 1/8 c barbeque sauce and stir in 1 c shredded chicken. Cover and place in the fridge for at least 30 minutes so the flavors can get into the chicken.

Crying and Chicken and Dumplings

It can be hard to switch back to eating meat after being a vegetarian.

As I stated in an earlier post, I was a vegetarian for about six years. After I finally started eating meat again (the infamous ham incident in my family), I still couldn’t do anything to prepare it.

It was my freshman year of college and we had to go back a few days early. Now, the dining halls wouldn’t be open again until Monday morning, so we were on our own for food. My parents had gotten me a crock pot for Christmas, and before they left they thought they’d be nice and get me some groceries so I wouldn’t starve for two days. Those groceries included a whole chicken.

Back in my pre-vegetarian days, I had loved a crock-pot chicken roasted whole, so it made sense that my parents decided to buy this (also, chicken was on sale).

I set up my crock pot in the residence hall floor kitchen and then got out the chicken. Which is when I discovered the problem…

The chicken was too big for the crock pot.

Remember how I just said that I could again eat meat, but was unable to prepare it?

Yeah….so I had to cut up the whole chicken to fit it in the crock pot. Please understand that never before in my life had I cut up any sort of meat….which doesn’t totally explain what happened next, but I use it to justify it.

I started crying while cutting up the chicken. Let’s be honest- I was practically bawling. And I kept apologizing to the chicken in my upset state.

“Oh chicken, I’m so sorry. You’re so slimy and gross. And now I’m cutting off your wings. Wahhhhhhhhhhhhhh.”

You can imagine how shocked the guy I was dating at the time was when he walked into the room, expecting to see me competently making a roast chicken, and instead I was wailing and talking to a dead bird.

I really couldn’t blame the guy for bursting out laughing.

P.S. I can now butcher a chicken without crying, thank goodness.

Don’t Cry Over Me Chicken and Dumplings

does not induce tears to prepare

Ingredients

  • 2 tbsp olive oil
  • 1 large onion, diced
  • 4 cloves garlic, minced
  • 1/2 c dry sherry
  • 5 1/2 c low-sodium chicken broth
  • 1 small can reduced fat, low sodium cream of mushroom soup
  • 3 lbs chicken breasts or thighs, cooked and shredded or uncooked
  • 1/4 c water
  • 2 tbsp cornstarch
  • 1 tbsp poultry seasoning
  • 2 c Bisquick
  • 2/3 c fat free milk
  • 2 tbsp dried parsley
  • 4 tbsp chopped chives
  • 1/2 c fat free milk (optional)
  • Salt
  • Pepper

How-to

  1. In a large pot, saute onion and garlic in olive oil until onions are just translucent.
  2. Add in sherry, chicken broth, and cream of mushroom soup.
  3. If using raw chicken, add and simmer for 25-30 minutes until cooked.
  4. Removed chicken and cool, then shred. Add back into pot. Mixture should still be simmering.
  5. Mix together water and cornstarch, then add to pot and stir.Ā  Add in poultry seasoning.
  6. In a separate bowl, mix together Bisquick, milk, parsley, chives, and pepper. Spoon onto top of mixture. Simmer for 20 minutes, stirring occasionally (the dumplings will break up a bit but that’s okay). Place lid on and simmer covered for an additional 10 minutes.Ā  If mixture is becoming too thick before the dumplings are done, add up to 1/2 c milk (I normally have to do this).
  7. Salt and pepper to taste, then enjoy!

Again, this makes a lot of food, but it reheats quite well if you stir in 1-2 tbsp fat free milk halfway during the microwave process.

Missing Boobs and Salmon

There are some things it might be awkward to forget.

When I worked at Macy’s, I was on the price change team. I worked with a number of older retired ladies who were a bit crazy (and that’s putting it mildly).

My favorite was a Jewish woman in her 80s. She easily was the loudest, craziest, sassiest, most opinionated, and shortest of the bunch.

She also was the most forgetful.

One morning, we were working in the women’s bathing suit section marking items on sale and making displays (there’s actually an art to arranging bathing suits, if you could believe that). All of a sudden, my favorite woman let out a horrible yell, followed by the last thing I expected her to say…

“AHHHH! Oh my lord, did I forget my boob today?”

She then clutched her rather ample chest and sighed, “Oh, thank goodness, I DID remember it today.”

Turns out my favorite old lady was a 35 year breast cancer survivor who didn’t want a surgical impact and instead stuffed her bra every morning…but lately had been forgetting.

From that morning on, she would walk in proudly, puff up her chest, and go, “See, I remembered my boob today!”

Unforgettably Easy Salmon

I’m serious- it’s that easy and turns out perfectly every time

Ingredients

  • 1 lb salmon filet, skin on or skinless
  • Olive oil
  • Salt
  • Pepper
  • Parsley
  • Garlic powder
  • Powdered ginger

How-to

  1. Preheat oven to 200 degrees (seriously).
  2. Rub the bottom side (or skin side if you’re using that) with olive oil and sprinkle with salt and pepper.
  3. Place the salmon onĀ  a baking sheet. Rub the top with olive oil, then sprinkle on salt, pepper, parsley, garlic, and ginger.
  4. Bake for 40-60 minutes. Do NOT open the oven door for the first 40 minutes. Depending on thickness (my filet was 1.5 inches), place back into the oven for 10 minutes at a time (you can turn the oven temp up to 250 for the last 20 minutes if necessary to compensate for opening the oven door.