Wednesday, January 21, 2004

Lost Weekend

The last time I worked before my accident was on a Friday in late September.

When I returned to work this week, I found that, for two days, whenever I went to scrawl the date on prescriptions and notes, my hand wanted to write "9" instead of "1" .

There must be a separate little rat brain that runs my medical life that switched off on 9/27 and only rebooted today. Or that went to sleep and woke disoriented.

So, let's see, shall I do some MEDBLOGGING ? Why not !

I looked in an ear today. I love looking in ears. I look in everyone's ears, practically, unless their presenting complaint is so un-otologic that peering in their ear would seem insane and cause them to flee the exam room in fear for their safety.

The eardrum -- the tympanic membrane -- is beautiful. Pearly gray, shiny, round, a little bone called the malleus visible in the middle. It sits right there at the end of the ear canal, as plain as day. Drum and hammer. A nifty little thing. I never get tired of looking at it.

Today a patient came in with an earache. Guy about my age. Fairly healthy. Not a terrible earache. But enough to come to the doctor.

I looked in his ear. 2/3 of the way in, and blocking my view of the eardrum, was a bright white glistening discrete clump of STUFF, beautifully speckled with tiny discrete brown spots. Like this:

It reminded me of nesselrode pie: white frosting and tiny brown flecks of chocolate.

Nesselrode pie !

When I was small, my Aunt Sofie and Uncle Peter took me to New York City. It was wonderful and exciting. New York ! My Aunt, for her broad experience of the Big(ger than Boston) City, seemed glamorous and sophisticated, and my uncle a brilliant and dapper man of the world. Part of their usual New York itinerary was to eat a confection known as Nesselrode Pie at a famous cake shop. This was a grown up confection: I believe I was allowed to look, and perhaps taste, but probably was given a more mundane sweet.

Which made it seem all the more glamorous.

I've never encountered Nesselrode Pie anywhere else.

Until today. When I discovered and named a new otologic sign: the Nesselrode Pie sign.

(Of course I had no idea what I was seeing. I guess a signifier does need a signified. I thought it might be fungus. I talked to the ENT doc. I did NOT mention nesselrode pie. I've got enough of an oddball reputation as it is. He wasn't sure either. We settled on some eardrops and a follow up consultation.)

There is a venerable medical tradition of naming medical phenomena after food. Miliary TB is a diffuse tuberculous infection that, on xray, appears as tiny white dots stippling the dark lung fields. Dots like "millet" seeds. Strawberry tongue in scarlet fever. Currant jelly sputum in Klebsiella pneumonia, and currant jelly stool with intestinal intususseption. Rice water stool in cholera. Peau d'orange (orange peel) changes of skin overlying breast tumors. The classic "spaghetti-and-meatballs" description of the microscopic appearance of malesezzia furfur, a skin fungus. "Fish flesh" tumors. Sausage fingers. Cauliflower ear.

And there is a related tradition of sizing lumps and bumps and nodules with food analogues: pea, walnut, plum, lemon, orange, grapefruit, cantaloupe, watermelon.

In naming our pathologies, we acknowledge that the body is food.

As we eat, so shall we be eaten.

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