Positive muffin sign

In medical school, our cafeteria was terrible, but the patients had it much worse than us. Patient food was miserable, bland nastiness. However, there was one tidbit of salvation: the breakfast muffin. Every breakfast was powdered eggs and something resembling sausage, terrible coffee, and what I assume was oatmeal. But the joy of every morning was the blueberry muffin that came with breakfast. It was moist with a little crunch to the crust. The blueberries were rich in flavor.

And I slowly came to realize that one could determine the acuity of illness of any given patient based on the muffin. If it was entirely consumed, the patient was improving. If it was half eaten, then the patient might be stable, or may be declining. If the muffin was not eaten at all, then the patient was definitely declining. Even the dysphagic patients went to town on the muffins, knowing that it was pretty much the only thing worth aspirating.

The muffin was such a reliable estimation of patient wellbeing that I would actually ask patients about why they hadn't eaten their muffin. And in my mind, as we rounded on patients, I would tally up the muffins, and chuckle. My attending would say, "I think he's doing better!" but the patient didn't eat the muffin!

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