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Food for thought

From the January ACP Hospitalist, copyright © 2012 by the American College of Physicians

By James S. Newman, MD, FACP

It was Thanksgiving 2011, a time to be thankful for a job, a healthy family, and a topic to write about in my column. I sat down at the dining table, my loving family assembled around me—smiles on their faces, hands clasped in silent joy, all ready to say a Thanksgiving prayer. OK, in reality it was screaming, raucous laughter and texting psychodrama, with overfeeding on the horizon. Just the way I like it.

I looked at the turkey, the cranberry sauce, the pie. I salivated like the veritable dog in Pavlov's lab. As we dove in, I thought about how the cranberry sauce would keep any little E. coli pili from sticking to my bladder wall, though the sugar in the pumpkin pie might push me over the hyperglycemic edge. But the turkey, that was the charm. My body was ready for that gobbler-induced L-tryptophan load which would send me into sweet slumber as overgrown men pounded each other on the gridiron on T.V.

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Photo courtesy of James S. Newman.

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I woke up on the couch, my “turkey sweatpants” tight around my waist. I was hungry again. There was a game on television but it wasn't football; it looked more like space cricket. I stumbled to the dining table, which was still surprisingly laid out with food.

I reached for a blueberry muffin, but as my hand grabbed for it, it transformed into a newborn baby, covered in a purpuric rash. Her hearing and vision were impaired, and I could almost feel the murmur coming from her tachycardic little heart. I assumed her mother had been infected with rubella in utero. I shook my head, and the baby was gone; it was back to being a muffin again. I decided to pass on that treat.

I thought maybe I'd have a piece of apple pie instead, yummy with a load of grated nutmeg. But it transformed into a nutmeg liver, volume overloaded with passive congestion. Unappetizing at best, but at least it wasn't sago spleen. Even when my vision cleared and it was a pie again, I had to pass. Maybe a bon-bon, I thought, but no—it became a chocolate cyst, blood-filled and poised on an ovary. I'd rather eat blood pudding, and I don't even like blood pudding. It was starting to seem like I should skip dessert.

Perhaps my body was telling me not to eat unhealthy food; better stick to fruits and vegetables. The watermelon looked so delicious, but as I sliced into it I realized I was cutting into a stomach with the striated vascular bands of GAVE syndrome. Gastric antral vascular ectasia was not on my diet list. How about those nice cherries? Ugh. They flashed before my eyes as cherry angiomas. Maybe, I thought, a slathering of my mother's lovely currant jelly on a piece of bread would be better—but to my surprise, I heard a cough and saw a glob of jelly-colored sputum from a patient coughing up large globs of Klebsiella. Yum. How about a strawberry? Thanks, Dr. Kawasaki, for ruining my snack.

I needed a drink, but a glass of port became a port wine stain. Coffee turned into café au lait spots. I resisted the inclination to check for axillary freckling.

Maybe something exotic like caviar? Sadly, it became the dilated infra-lingual veins of caviar tongue. Perhaps I should just have plain bread, maybe with a little butter? As I looked at the toast, though, I saw the fibrinous exudate of bread and butter pericarditis. Something simple like rice? Not to be; it was the distinctly unappetizing rice water stool of cholera.

Desperate, I thought of making a pancake with some nice maple syrup. But, of course, I smelled maple syrup urine, and the pancakes themselves caused pancake syndrome—anaphylaxis from ingesting mite-contaminated flour.

I woke up with a start. I just wasn't that hungry anymore. The television was back to playing football. The kids were tearing around the house and my dogs were flatulent. In other words, business as usual. I made a decision right then. Next year we would eat out.

But wait, maybe MSG would give us Chinese restaurant syndrome. Or I'd eat a steak and get steakhouse syndrome with an impacted bolus, which would progress to a cafe coronary. I hoped my kids knew the Heimlich maneuver. Japanese might be safer, but what about the risk of wasabi-induced sushi syncope?

It was just too much. I stared at a drumstick. Would it turn into a neutrophil's nuclear appendage? What to do? I took a deep breath, and crammed the unheated hunk of gobbler down my throat without a problem.

Sometimes you just have to go cold turkey.

Dr. Newman is a hospitalist at the Mayo Clinic in Rochester, Minn. and editorial advisor to ACP Hospitalist.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated