SALISBURY CATHEDRAL BOYS AND GIRLS CHOIR
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By Eileen Goldfinger, Food Editor @Blogfinger
Cooking the lobsters:
2 lobsters , approx 1 1/2 pounds each, steamed for 15 minutes and then cooled in an ice bath and set aside.
1 1/2 cups cooked lobster meat cut in 1/2″ pieces
3 scallions, minced
1/3 cup celery, minced
1/2 cup + 2 Tbs. mayonnaise
4 drops Tabasco (hot sauce)
1/2 tsp. freshly grated black pepper
1 Tbs. fresh lemon juice
pinch of salt
5 ounces mixed baby greens
2 small bell peppers, thinly sliced
2 radishes, thinly sliced
2 inches of a seedless cucumber, thinly sliced
2 Campari tomatoes, quartered
1 avocado, peeled and quartered
6 endive leaves
1/2 small lemon, juiced
1/4 cup extra virgin olive oil
salt and pepper to taste
Lobster salad preparation:
Mix lobster, celery and scallion together in a bowl.
In another bowl mix mayonnaise, lemon juice, Tabasco, salt and pepper.
Combine the mayonnaise mixture with the lobster mixture.
Green salad preparation:
Mix baby greens, peppers, radishes and cucumbers together in a bowl.
Squeeze lemon juice on greens and add oil, salt and pepper and stir.
Place half of the greens mixture around the perimeter of two dinner plates.
Divide the lobster salad in half and place in the center of each plate.
Place the endive leaves on the outside of each plate (3 leaves per plate) and place
a piece of tomato on each leaf and place a quarter of the avocado on opposite sides of each plate.
Serve with an artisan bread and enjoy.
EVA CASSIDY from Porgy and Bess
ALLAN SHERMAN with a letter home from the boy in camp.
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BOB DYLAN from his album Shadows in the Night. Dylan sang this song for David Letterman on the night before his final show.
The Columbus (OH) Dispatch (5/19, Crane) reports that research published in JAMA Internal Medicine suggests that “many” patients “who go to emergency departments each year with chest pain can safely head home and follow up with cardiologists or family” physicians.
Forbes (5/18) contributor Robert Glatter, MD, writes, “Data was evaluated from emergency departments at three community teaching hospitals.” Altogether, “11,230 patients met the criteria to be included in the study.
HealthDay (5/19, Preidt) reports that just “four people in the study group – working out to just 0.06 percent of patients – developed a life-threatening heart rhythm, suffered a heart attack or cardiac or respiratory arrest, or died.”
Overall, the researchers “found a low short-term risk of life-threatening heart problems among patients with chest pain who have normal cardiac blood tests, vital signs and electrocardiograms.”
Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC
People often go to emergency departments when they have chest pains or similarly worrisome discomfort in the neck, back, or left arm. That is because the public has been well schooled in the idea that “time is muscle” and that a heart attack (i.e. a myocardial infarction—-MI) can cause death. They know that early arrival in an ED during an MI can minimize heart muscle damage and save lives.
Much of the time, patients showing up in an ED with chest pain are not actually having a heart attack. The challenge is to make a correct diagnosis, and a certain diagnosis is often elusive. The pain may be cardiac without any damage to the muscle (the definition of a myocardial infarction includes heart muscle damage.) So cardiac pains without an actual MI may still require admission to the hospital.
The ED stay is often hours long as the staff strives to avoid diagnostic errors. If the diagnosis turns out to be clearly non-cardiac, such as a cracked rib, then the patient may be sent home. But, at the other extreme, if the diagnosis is definitely a heart attack, then the patient needs to stay and be treated urgently . And there are many situations where uncertainty or ancillary factors mandate admission even if there is no obvious heart attack.
But what is to be done with a person who has had chest pain of uncertain origin, and the screening tests are negative? Maybe they do have a heart problem, or anxiety, or reflux. In other words, the electrocardiogram shows no acute changes, the cardiac blood tests are negative, and the heart rhythm and vital signs remain normal.
The usual routine is to either admit the patient or keep them in a holding area for observation. This is to make sure that a dangerous complication doesn’t occur. It is that fear that typically keeps the patient in the hospital.
Even if the doctor feels comfortable enough to send the patient home, he may be pressured by guidelines that demand admission; and then there is the fear of malpractice suits (i.e. “defensive medicine.”)
This research trial gives permission in such situations to safely discharge the patient and have them follow up the next day with a cardiologist or primary doctor–perhaps to have a stress test. It allows the ED doctor to use his best judgement in a situation where there is always a small measure of uncertainty, and that is why the patient is told to see his doctor the next day.
Having official backing for medical facilities to use this approach will be better for patients and will save a ton of money for the system. No one wants to be admitted to a hospital. Changing the guidelines will provide support for doctors to use their judgment in such situations. And that, the art of medicine, is what doctors do every day.
But I don’t know if doctors will want to take a chance, even if the risk is small. After all, doctors need to sleep nights too.