Rich Dreben, M.D., is a board-certified psychiatrist who has treated patients in multiple outpatient settings, the psychiatric emergency room, and jail psychiatry clinics. Dr. Dreben currently practices psychiatry in California.
Murdoc Knight, M.D., is a board-certified emergency physician attending, working at multiple hospitals in Massachusetts. He holds degrees in biomedical engineering and medicine from the University of California.
Marty A. Sindhian, M.D., is a board-certified adult psychiatrist who specializes in psychosomatic medicine and forensic psychiatry. He works and teaches in a hospital in California, while also having a small private practice.
Not Just for Rice Anymore
In Korean culture, some believe that one should never place chopsticks directly into a receptacle, like a bowl, in order to prop up the chopsticks. Such an act signifies death. No wonder North and South Korea always seem so stressed out.
This individual had no problem sticking his chopsticks anywhere. In fact, he may have been directly taunting death by risking an intestinal tear or infection by putting these in his receptacle.
While the chopsticks in this image are metal, chopsticks are typically made of bamboo or plastic, and, at times, bone, ivory, or wood. An August 2007 article on the China Daily Web site reported that the secretary general of the China Cuisine Association (CCA) said that China produced and disposed of more than 45 billion pairs of wooden chopsticks annually. The secretary general estimated that this practice cost the Chinese environment approximately 25 million trees. We're not sure what percentage of chopsticks is used for the purpose demonstrated in this X-ray, but hopefully those chopsticks are not reused afterward. That would certainly give new meaning to the word, Pu Pu platter.
Someone Switched This Patient's Usual Cup of Coffee with ...
We've seen plenty of bottles stuck up patients' rears, but not nearly as many cups, even though they both hold liquids. This is not surprising given the shape of each. Images like the one in the accompanying X-ray naturally make people wonder if a cup can even get all the way up there. Doesn't the object seem much bigger than the pathway?
Basic biomechanics provide the answers here. Most skin and mucosa have certain viscoelastic properties, meaning that with enough pressure and time, one can fit surprisingly large objects through a relatively small, yet viscoelastic, space. Now you know how babies are born!
Obviously, this property is finite. There is still a limit as to how large an object can ultimately fit without causing a tear or damage. We're not sure what the record is, but we'll continue to keep track of people who try to set it.
Which Fork Does Etiquette Suggest You Use Here?
For utensils to be useful for handling food, they must be long and easy to grip. This feature also makes them great for other activities, too. Often, picking the right utensil for a specific use can be a difficult task. For purposes such as this, a knife is obviously too sharp and may cause damage, while a spoon could potentially be too dull and thereby not as stimulating. Goldilocks would have probably made the same choice, assuming she did not have any mental issues after having to run for her life from three talking bears.
We think a slightly safer choice would have been a spork, although sporks are often hard to come by as they are typically used only by children, who are far too smart to do this.
The more important consideration would be the composition of the silverware. Although worse for the environment, we would hope that people choose plastic, disposable utensils for obvious reasons. Unfortunately, this patient and most others choose stainless steel, probably for the durability and easy handling. Or perhaps they finally found a reason to break out the fine china.
Ultimately, you could summarize this case by saying that when this patient reached for a fork, he took it on the road less traveled, and that made all the difference.
Pain in the Glass
The comedian Janeane Garofalo once quipped, "I guess I just prefer to see the dark side of things. The glass is always half empty. And cracked. And I just cut my lip on it. And chipped a tooth." Sadly, the accidental ingestion of small pieces of glass is no laughing matter.
One patient, while eating a shrimp and rigatoni dinner at his favorite restaurant, suddenly felt severe pain in his throat, followed later by chest pain. After he completed his meal--yes, after--the patient went to the ER, where the physician discovered glass in the patient's bowels and a perforation of the patient's esophagus. These injuries ultimately healed.
The patient asked the restaurant to reimburse him his $200 co-pay for the hospitalization, to which the restaurant agreed. We were surprised by this, considering that when we see physician procedures cause perforations, patients typically ask for far more than their co-pay. In this case, he might have at least also asked for a gift certificate for a free meal ... at another restaurant.
A Fishy Story
It's the same old story. A patient once explained that he spent a relaxing day fishing in the ocean. He brought his knife along to cut some bait and clean fish. He than continued the story by saying, "I was fishing, and I must have fallen asleep and rolled around on the ground where the knife was. Next thing I knew, I had this knife in me." Yet another falling asleep fishing and rolling onto a knife story. If you've heard one, you've heard them all.
What not everyone has heard of is how dangerous fish can truly be because of all sorts of special bacteria that come with fish. The bacteria can even spread to and infect the brain, which may be the true reason fish is known as brain food.
In fact, seafood comes with so many health risks that if we were to review them all it might make you the opposite of a pescatarian, a person who avoids eating most animals but will eat fish.
So someone might conclude from the above that if you want to win the fight against a health problem, perhaps you should have lots of cases that scare people. Maybe after this book we will actually see fewer cases of inserted or ingested foreign bodies ... though knowing human nature, quite possibly not.
Just Beat It
This patient's reasons were obvious. Beaters work by really being able to get into and penetrate whatever they are mixing. The multiple prongs maximize what the beater can grab. With all this penetrating and grabbing, getting this beater off--oops, we mean, out--was challenging. We had to get the patient to use his sensations to direct our movements to get the beater out, as offbeat as that sounds.
Using beaters properly is particularly important when cooking a soufflé. A soufflé is composed of stiffly beaten egg whites that are folded into a sweet or savory base. You may have heard the classic lore that by opening or closing the door of the oven the soufflé may fall. This demise actually happens due to a quick change in temperature from opening and closing the door to the oven. Any grease or dirt on the cooking utensils can prevent the egg whites from rising and also lead to collapse. Therefore, upon removal, the beater in this X-ray should not be used to make a soufflé.
Some Sneezes May Require More Than a "Bless You"
We have peppered this vignette with all sorts of facts. Wikipedia states that black peppercorns were found stuffed in the nostrils of the Pharaoh Ramesses II, ruler of Egypt, who died more than 3,000 years ago. More recently, a pepper shaker, presumably full of ground peppercorns, was found stuffed in the rectum of this individual. This patient's medical records do not comment on whether his act was a modern interpretation of the ancient mummification ritual or whether he had heard that in ancient India, where black pepper is thought to have originated, it was used to treat conditions such as constipation, diarrhea, indigestion, cough, and nasal congestion. Using pepper to decrease nasal congestion seems as intelligent as eating spicy Indian food to decrease diarrhea.
So for those who may be tempted to follow this example, let us consider that if black pepper makes people sneeze when it's inhaled, just imagine the effect down below.
The Pepsi Challenge
This type of bottle is made of hygroscopic material, which has the ability to absorb water, like the colon. Approximately 97 out of 100 physicians recommend allowing the colon to function on its own, without the aid of a bottle. The three others replied, "No comment."
Patients who suffer from the problem of having a bottle stuck up their rear are often not honest about what happened. Here are some examples:
PATIENT A: Doc, I was vacuuming in the nude, and I fell. It was a million-to-one shot, Doc, a million-to-one.
PATIENT B: My hands were full.
PATIENT C: I swore this would never happen again. This time I made sure to put a string in the bottle and closed the cap. When I pulled the string, there was nothing on the other end.
Note the angle at which this bottle is inserted, near the prostate. An article published in The New England Journal of Medicine in 1985 indicated that major colas might affect sperm motility. Perhaps this patient was trying to figure this out for himself.
So Would It Taste Salty?
Doctors often recommend that patients reduce their daily sodium intake. One patient clearly did not heed those warnings.
Table salt is traditionally made of the compound sodium chloride. One of the most common forms of high blood pressure can be affected by salt intake. This patient had more than high blood pressure to worry about, though, which probably raised his blood pressure even more.
Salt can have some benefits. In America, salt contains iodine. If you do not have iodine, your brain sends hormonal messages to the thyroid that may cause it to grow larger and develop a goiter in an attempt to make more thyroid hormone. The thyroid gland can grow so large that it can wrap around the throat and extend down into the chest. If it could extend down a little further perhaps it could push out the salt.
If your doctor tell...
--This text refers to an out of print or unavailable edition of this title.