The Common Ailment of Cockroach-in-Ear

I'm not easily grossed out.

This (along with a desire to help people!) is why I'm in medical school. The first patient I ever examined was a 60-year-old man at a free clinic on the west side of Chicago. Moments after meeting the patient, my attending physician told me to perform a rectal examination. Seriously. I was 22, a first-year medical student, and totally out of my element. I don't know who was more nervous during the examination -- me or the patient. My discomfort, however, did not turn into disgust. Even though my finger was in his you-know-what, I wasn't grossed out. I think this means I have a fairly robust internal gross-out meter. This is highly fortunate trait, because throughout my career I will encounter all forms of gore, bodily fluids, and skin abnormalities. I won't be able to reply with a heteronormative "ew!" if a patient shows me an infected wound, complains of bloody stools, or vomits on my Cole Haans.

That said, I have to level with you: I'm totally grossed out by bugs.

I mean, if a little ant scurries across my desk, I don't hyperventilate. I can tolerate flies. Ladybugs are almost cute. But all other creepy, crawly, flying, scurrying small things are absolutely disgusting. (As an aside, I also hate small mammals: rats, mice, squirrels, and even rabbits are gross to me.)

Given what does and does not gross me out, you can probably imagine my response to the following clinical vignette.

"A 19-year-old patient presents to the ER with a primary complaint of ear pain. She denies traumatic injury. She denies previous history of ear pain. She describes the pain as sudden onset, felt upon waking this morning. She ranks the pain as an 8/10. You tells you she lives in low-income housing. You perform an otoscopic exam. [You look in her ear with a flashlight and magnifier.] You notice something shiny and brown. Upon further inspection, you realize she has a cockroach in her ear. You remove the cockroach with forceps. The pain subsides."

Gross! I am very grossed out! And to make it worse, my professors then show enlarged Power Point slides of a cockroach-in-ear. Trust me, It is absolutely disgusting. I haven't personally Googled pictures of this unfortunate ailment, but I'm confident there are lots of pictures of cockroach-in-ear because five of my professors on five separate occasions have shown my class pictures of this terrifying malady. Even more upsetting is the fact that each of these five professors have given personal anecdotes about the time he or she actually saw a cockroach in a patient's ear. One of my professors, Dr. Marshall, told a particularly memorable story. As an ER physician, Dr. Marshall had performed hundreds of ear examinations on patients with ear pain. He was accustomed to seeing redness and wax buildup, but absolutely unprepared for the cockroach. Upon seeing the beast magnified and lit up with his otoscope, he was so shocked that he jumped back, tripped on a chair, and ended up on the floor. Understandably, his patient was hysterical.

With these kinds of stories, I think my professors are trying to prepare us for worst case scenarios. They are trying to de-program our innate biological responses to grossness. I understand the rationale, but I think it's humanly impossible to react calmly to cockroach-in-ear. I posit that a negative visceral reaction to cockroach-in-ear is hardwired into the human genome. Or at the very least, a negative visceral reaction to cockroach-in-ear is hardwired into my genome.

Fortunately, cockroach-in-ear is not very common. If your home is free of cockroaches, your ears will be free of cockroaches too. Unfortunately, if you do have cockroaches in your home (and I'm so sorry if you do!), one may find its way into your ear canal. But never fear! An ER physician -- someone whose internal gross-out meter is calibrated at a higher setting than mine -- will remove the cockroach with forceps. Pain will subside, but... feelings of disgust may persist.