The patient’s CC: bug in ear.

Physical exam: Pt in mild distress, holding one ear.  Otoscope exam shows the back end of a bug.

I started by filling the ear with 1% lidocaine, to drown the bug so they quit moving (which is apparently painful and freaky in an attached-to-your-brainstem weirdness kind of way).

Then it happened, something that hasn’t happened in years of doing this: the bug came out to keep from drowning!  There’s a little bug running on the bed, which met its maker quickly.  Re-exam showed the inside of the ear none the worse for wear, and the relief of everyone was terrific.

First time I’ve been charged by a bug, though.