This document provides a recipe for sourdough rye bread that yields 2 loaves. It requires making a sourdough starter, which takes 5 days to develop and involves mixing rye flour and water over several feedings with 24 hours between each. The starter is then used in the dough along with rye flour, whole wheat or white flour, salt, and cracked rye or rye flour. Instructions are provided for both developing the starter and making the dough.
3. BUFFALO BILL’S .......... 5
e.e. cummings
DIAGNOSIS: MADNESS .......... 11
dr. lisa sanders, m.d.
POUR UNTOMBEAU D’ANATOLE .......... 21
stéphame mallarmé
IT’S NOT OKTO ACTTHIS WAY .......... 35
kama brown
SPOKEN & WRITTEN .......... 53
ferdinand de saussure
A HISTORY .......... 61
leah lauber
YIELD: 2 LOAVES .......... 71
mark bittman
A CONVERSATION .......... 79
david foster wallace
TABLE OF CONTENTS
13. 13
Onset
A CRY FOR HELP
ATERRIBLE FALL
“Get me out of here!” the middle-aged man shouted to his sister from his
hospital bed.“They’re coming to get me.” His eyes darted from side to side
as if searching for someone who was after him. His arms and legs shook.
She had never seen him like this. He looked terrified.
Three months earlier, the patient, a 55-year-old man who suffered from
depression and alcoholism, was admited to the same hospital after falling
down the stairs in his home. He wasn’t found for two, possibly three days.
Because of his injuries and this delay, when he was discovered, he was close
to death. His kidneys had stopped working, and his body chemistry was
completely out of whack. On the way to the hospital, his heart stopped,
and he had to be shocked back to life.
The patient remained in Waterbury Hospital in Connecticut for five weeks
(where I was one of his doctors), three of them in intensive care. Even after
these weeks of care, the toll of his injury was terrible: his kidneys were still
not working, so he required hemodialysis three times a week; his arms and
legs were so weak that he could not even lift them. He was unable to swal-
low and had to be fed through a tube. When his sister visited him there,
she barely recognized him. His slender body was bloated. He had tubes
everywhere. He could do little more than whisper. Still, she saw that he
was slowly improving. He had to started to smile and make jokes despite
his many disabilities. After five weeks in the hospital, he was transferred to
a short-term rehab facility.
A SLOW RECOVERY
14. 14
After two weeks in rehab, something changed. He started talking to people
no one else could see. He feared they wanted to harm him. When the
hallucinations persisted for a second day, he was sent to the emergency
room at Waterbury.
The patient told the E.R. psychiatrist that he was seeing people he knew
couldn’t be there. Despite the hallucinations, he was calm and clear. He
told the doctor that he thought the visions began after he recently started
taking a new sleeping pill.That made sense to the doctor. Delirium is an un-
usual but known side effect of that drug. He put the patient on a different
sleep medication and returned him to rehab.
DELIRIUM
SEEINGTHINGS
Two days later he was back. He was still seeing people who weren’t there,
but now he was also frantic and confused. He knew his name but little
more. All he was certain of was that he was in danger. Because of his
confusion, Dr. Brian Linde, the intern on call, couldn’t rely on the patient
to tell his own story. Instead the doctor had to depend on the patient’s
records to make sense of the situation in front of him: the hospital notes
provided an outline of the patient’s earlier admissions. The rehab-center
records showed some details of his recovery from the serious injury. It also
included a long list of the medications he was taking and reported that he
had been confused for the past four days. On examination, the patient had
a fever. His heart was racing, and his blood pressure was high. His arms and
legs were weak and swollen. His legs were shaking, and his muscles were
hyperreactive.
BLOOD COUNT: Anemic but unchanged from previous tests
Abnormal because of the kidney failure, but
unchanged from previous tests
Abnormal, with white blood cells and
bacteria suggestive of an infection
Unremarkable
Unremarkable
TEST RESULTS
BLOOD CHEMISTRY:
URINETEST:
HEAD CT:
CHEST X-RAY:
15. 15
INFECTION & CONFUSION
WORSE & WORSE
Dr. Donna Windish, the attending physician, first heard about the patient
during rounds the next morning. She stood with her team outside the
patient’s room as Linde described a man recovering from a severe injury
who had suddenly begun seeing things.The cause wasn’t clear, Linde told
Windish. It wasn’t from the sleeping pill, because eliminating it didn’t help.
Tests indicated that the patient had a urinary-tract infection. Could that be
the cause of the patient’s delirium? Although disorientation linked to an
infection is more common in the elderly, Linde said he thought that this
patient’s weakened state might make him more susceptible. If they treated
the infection, the confusion should clear.
The next day the patient’s sister arrived and was greeted with his para-
noid entreaty for help. She was bewildered; he had been improving. She
demanded to know what was going on with her brother. But no one knew.
Windish was also worried. Patients usually improve rapidly when urinary
infections are treated with antibiotics. But he was no better than he was
the day before.Windish told her team that she didn’t think this confusion
was caused by his infection. She had another idea. He was on two antide-
pressants at the time of his admission.These medications help allay depres-
sion by increasing the amount of serotonin, a neurotransmitter, in the brain.
But too much serotonin can confuse the mind and hurt the body.
TOO MUCH OF A GOODTHING
High serotonin levels can lead to something called serotonin syndrome.
This rare, potentially life-threatening disorder is characterized by increased
body temperature, increased heart rate and blood pressure and muscle
hyperreactivity.Windish had never seen a case of it. She and the team read
up on it, and while the diagnosis seemed to fit, there was no definitive test.
She stopped the antidepressants and asked the neurologist on duty to
double check the diagnosis. He agreed, and they put the patient on a drug
that blocks serotonin.The response was remarkable and immediate.Within
24 hours the patient was alert and talking. His hallucinations were gone, his
heart rate and blood pressure normal, and tremors resolving.
16. 16
UNRAVELINGTHE MYSTERY
KEEPINGTHE RECORD STRAIGHT
How had this patient developed serotonin syndrome? When he was sent
to the Waterbury emergency room, he was taking two antidepressants.
He was on one for years, but no one, including the patient, knew when he
started the other. A phone call to the rehabilitation center resolved the
mystery.The patient was seen by a psychiatrist there two days before his
E.R. visit and was given a second antidepressant and the sleeping pill.The
patient was also taking a heartburn medication that raised his serotonin
level. After one dose of the new antidepressant, he began to have hallu-
cinations and his blood pressure and heart rate went up. No one in the
rehab center connected these symptoms to the new antidepressant. And
when he went to the E.R., no one knew that he had been given a new
serotonin-increasing medication.
Effectively conveying medical information is essential. Yet, as patient care
is shared with more providers and institutions, this basic necessity has be-
come more difficult to manage. The electronic medical record was sup-
posed to help.Waterbury Hospital uses electronic records, but the rehab
facility does not. And even if it did, electronic sharing between institutions
is rare.This patient is recovering. He’s walking - although with a cane.The
hospital psychiatrist didn’t think he was depressed, so he’s not taking any
antidepressants, and he feels just fine.
17. 17
A SELECTION OF READERS’ RESPONSES
More than 200 readers commented on this case after it was posted onThe
Times’s Wellblog on Feb. 7.
The first person to come up with the correct diagnosis was Thea Grendahl
Christou of Chicago, a writer and musician married to a physician. Here
are some other responses:
Mara - Somerville, Mass.
Neurosyphillis associated with latent stage syphilis
02.07.13 @ 13:24
T.W. - California
He has been in hospitals for too long. Patients, especially old ones, lose
contact with reality, get very confused and have hallucinations. I have seen
it happen to an older friend of mine.
02.07.13 @ 11:21
Elizabeth -Virginia
Sinus infection that spread to his brain
02.07.13 @ 11:21
Naomi Utgoff - Silver Spring, Md.
Bipolar disorder. He was self-medicating with alcohol all those years.
02.07.13 @ 10:35
Jonathan - Massachusetts
I wonder if withdrawal from the sleep medication could present with
psychosis/confusion, hypertension, tachycardia and clonus?
02.07.13 @ 3:43
42. 42
What an ag
You were so beautiful
in the picture I have
of you; Dad said you
were twenty-one.
You were forced to
choose between your
dreams or me.
43. 43
ge to be free.
I don’t blame you
for running away
and leaving me.
45. 45
Even though you’re not
here and you never were
I feel your genes in me. I
hear the ocean call me in
my sleep, as it called you.
I smell the scent of the
wild the same way you
did. I understand why I
couldn’t come with you;
I have a daughter now too.
46. 46
I think I will leave soon,
too. I can’t stop thinking
about the life I will be
heading towards.
54. 54
Language and writing
are two different
systems of signs;
the only purpose of the
latter is to represent the
former.
Linguistics is not
concerned with the
connection between
the written and spoken
word -
its sole object is the
latter: the spoken word.
55. 55
But the written word
is so closely bound up
with the spoken, whose
image it is, that it is
inceasingly arrogating
the main role to itself/
Ultimately the point is
reached
where more importance
is attached to
representation of the
spoken sign
than to this sign itself.
63. 63
1988
1987
1986hello, world
sister born
The hospital asked my parents why they
waited so long to get there. Dad was making
himself a sandwich.
I don’t remember this at all, and I’m okay
with that.
That’s enough children, my parents decided.
We don’t want them out-numbering us.
move to new jersey
november
september
july
1990move to florida
july
I don’t remember the move, but I do
remember playing Barbies with my sister
at our first house. It had a terrazzo floor.
64. 64
1992
1991
start kindergarten
start pre-k
I would be with the same kids through
high school.
My parents were told it was a
non-demoninational school, but
got suspicious when my sister and I
started bringing home dreidels and
declaring we were Jewish. We’re not.
august
august
1998x-press team
I was accepted to be a reporter for a
kids’ section of The St. Petersburg
Times, my local newspaper.
july
65. 65
1998
1999
first concert
women’s world cup
*N SYNC, because it couldn’t get any
more teenage girly than that.
With help from my X-Press Team editor, I
obtained credentials and was the youngest
reporter in the press tent after the final game.
november
july
2001first day of high school
august
2002driver’s license
Good thing I didn’t have to parallel park.
november
66. 66
2005high school graduation
may
2005start florida state
Once a Seminole, always a Seminole.
august
2007transfer to usf
My best friend used to crash at my dorm,
and I would read her A Clockwork Orange as a
bedtime story.
august
2007twenty-first birthday
Learned to never drink (multiple) Irish Car
Bombs on an empty stomach again.
november
67. 67
2008first apartment
My landlord’s mother lived below, and I’m
pretty sure she spied on us. We partied any-
way, and my landlord awkwardly asked to
buy weed from me.
july
2009college graduation
Entirely unsure what I wanted to do with my
life. Lots of reflection (via partying) ensued.
may
2011start ringling
august
2013last day of class
I’m going to sleep until August.
april
72. SourdRyeTotal Time
5 days the first time;
overnight subsequently
Yield
2 loaves
Sourdough Starter:
Dough:
For the
For the
2 2
/3
cups rye flour
Pinch instant yeast
Sourdough starter
2 cups rye flour
2 cups whole-wheat or white flour
1 tablespoon kosher salt
1 1
/2
cups cracked rye or rye flour
73. ough
73
Starter:
To make the
In a tall, narrow, nonmetal contain-
er, mix 2
/3
cup rye flour with 1
/2
cup
water, along with the tiniest pinch of
instant yeast - less than 1
/16
teaspoon.
and let sit for about 24 hours, then
add the same amount of both flour
and water (no more yeast).
twice more, at 24-hour intervals; 24
hours after the fourth addition, you
have your starter.
(From now on, keep it in the refrigerator; you
don’t need to proceed with the recipe for a day or
two if you don’t want to. Before making the dough,
take a ladleful - 1
/2
to 3
/4
cup - of the starter and
put it in a container; stir in 1
/2
cup rye flour and a
scant 1
/2
cup water, mix well, cover and refriger-
ate. This starter will keep for a couple of weeks. If
you don’t use it during that time and wish to keep
it alive, add 1
/2
cup each flour and water every
week or so and stir; you can discard a portion of it
if it becomes too voluminous.)
Cover
Repeat
74. 74
Dou
To make the
the starter in a big bowl with the
rye flour and the whole-wheat or
white flour.
then cover with plastic wrap and
let sit overnight, up to 12 hours.
The next morning, the dough
should be bubbly and lovely. Add
the salt, the cracked rye and 1 cup
water - it will be more of a thick
batter than a dough and should be
pretty much pourable.
it into two 8-by-4-inch nonstick loaf
pans. The batter should come to
within an inch of the top, no higher.
Combine
Mix well
Pour & scrape
75. 75
gh:(an improvised dome is better than
plastic wrap; the dough will stick to
whatever it touches) and let rest until
it reaches the rim of the pans, about 2
to 3 hours, usually.
the oven to 325 and bake until a
skewer comes out almost clean; the
internal temperature will measure
between 190 and 200. This will take
about 11
/2
hours or a little longer.
loaves from the pans and cool on a
rack. Wrap in plastic and let sit for a
day before slicing, if you can manage
that; the texture is definitely better
the next day.
Cover
Preheat
Remove
84. 84
Boy were you on today. Boy did
you ever make that guy look sick.
When he hit that one down the line
and you got it and fell down and hit
that drop-volley Pemulis said the
guy looked like he was going to be
sick all over the net, he said.
Boo, I kicked a kid’s ass is all.
End of story. I don’t think
it’s good to rehash it when
I’ve kicked somebody’s ass.
It’s like a dignity thing. I
think we should just let it
sort of lie in state, quietly.
Speaking of which.
88. 88
It’s late, Mario. It’s sleepy-time. Close
your eyes and think fuzzy thoughts.
Always worked for me, Boo.
That’s what the Moms
always say, too.
You think I think fuzzy
thoughts all the time. You let
me room with you because
you feel sorry for me.
Booboo I’m not even going to dignify
that. I’ll regard it as a warning sign.You
always get petulant when you don’t get
enough sleep.And here we are seeing
petulance already on the western
horizon, right here.
90. 90
...
...
When I asked if you were
asleep I was going to ask if
you felt like you believed in
God, today, out there, when
you were so on, making that
guy look sick.
92. 92
Really don’t think midnight in a
totally dark room with me so tired
my hair hurts and drills in six short
hours is the time and place to get
into this, Mario.
You ask me this once a week.
...
You never say, is why.
93. 93
So tonight to shush you how about
if I say I have administrative bones
to pick with God, Boo. I’ll say God
seems to have a kind of laid-back
management style I’m not crazy
about. I’m pretty much anti-death.
God looks by all accounts to be
pro-death. I’m not seeing how we
can get together on this issue, he
and I, Boo.
94. 94
...
I do too. I just did.
I just didn’t happen to say what
you wanted to hear, is all.
You’re talking about since Himself passed away.
See? You never say.
...
95. 95
There’s a difference.
I don’t get how you couldn’t
feel like you believed, today,
out there. It was so right
there. You moved like you
totally believed.
...
96. 96
...
How do you feel inside, now?
Mario, you and I are mysterious
to each other.We countenance
each other from either side of
unbridgeable differences on this
issue. Let’s lie very quietly and
ponder this.
99. 99
I’m going to propose that I
tell you a joke, Boo, on the
condition that afterward you
shush and let me sleep.
100. 100
Is it a good one?
I give.
Mario, what do you
get when you cross
an insomniac, an
unwilling agnostic,
and a dyslexic?
You get somebody who
stays up all night torturing
himself mentally over the
question of whether or not
there’s a dog.
That’s a good one!
104. 104
How come Moms never cried when
Himself passed away? I cried, and
you, even C.T. cried. I personally
saw him cry.
You listened to Tosca over and over
and cried and cried and said you
were sad. We all were.
...
105. 105
Hey Hal, did the Moms seem like
she got happier after Himself
passed away, to you?
...
106. 106
...
It seems like she got happier. She even
seems taller. She stopped travelling
everywhere all the time for this and that
thing. The corporate-grammar thing. The
library-protest thing.
Now she never goes anywhere,
Boo. Now she’s got the
Headmaster’s House and her
office and the tunnel in between,
and never leaves the grounds.
She’s a worse workaholic than
she ever was.And more obses-
sive-compulsive.When’s the last
time you saw a dust-mite in
that house?
107. 107
Now she’s just a
agoraphobic workaholic and
obsessive-compulsive.That
strikes you as happification?
Hey Hal?
108. 108
Her eyes are better. They don’t
seem as sunk in. They look better.
She laughs at C.T. way more than
she laughed at Himself. She laughs
from lower down inside. She laughs
more. Her jokes she tells are better
ones than yours, even, now, a lot of
the time.
110. 110
She did get sad, Booboo. She
just got sad in her way instead of
yours and mine. She got sad, I’m
pretty sure.
You remember how the staff
lowered the flag to half-mast out
front by the portcullis here after
it happened? Do you remember
that? And it goes half-mast every
year at Convocation? Remember
the flag, Boo?
Hal?
112. 112
Don’t cry, Booboo. Remember
the flag only halfway up the pole?
Booboo, there are two ways to
lower a flag at half-mast.Are you
listening? Because no shit I really
have to sleep here in a second. So
listen - one way to lower the flag
to half-mast is just to lower the
flag.There’s another way though.
You can also raise the pole.You
can also just raise the pole.You
can raise the pole to like twice its
original height.You get me?You
understand what I mean, Mario?