I realize my last several blog posts have read like a promo for Prozac so it seemed the time to mention something a little lighter. Sometimes the patients do fine and sometimes the story is actually kind of cool, in a typically boyish, gross sort of way.
Last week, one of the ICU nurses came to pound on our door one evening to tell me there was a boy with airway obstruction. That’s a big deal so I hustled up to the ICU immediately. The on-call resident was there and there was a ten year-old boy in one of the beds. Each time he inhaled, there was a noise from his throat called inspiratory stridor. He was actually comfortable and in no distress and had been experiencing this symptom for about six days. Apparently he had developed a slightly bloody cough a few days prior to the stridor.
Other than the stridor, we could find nothing else significant on exam and his x-ray’s were fine. As the resident and I scratched our heads, the father informed us that there were worms in the river water he had been drinking and that a worm was causing this. Poor uneducated soul, we thought. We figuratively patted him on the head and explained that it was likely an infection of his upper airway and started him on antibiotics and some steroids.
He did fine through the night but still had the same symptoms the next day. The father again informed us that the worms in the river water were causing this. Our head anesthetist was there and, after looking at the boy, informed me that she had seen leaches causing this. After nine months here, my ego is a shadow of what it used to be so we accepted the distinct probability of our ineptitude and took the boy to the OR for a look. As we were getting ready to put him to sleep, I polled the audience regarding what we were going to do if there actually was a leach in there. My ego further deflated as everyone in the room matter-of-factly explained to me the process as if it were the same as buttering toast. Apparently, if you just yank it out, it will bleed like stink so you just grab the thing with some forceps and wait. Eventually it will get mad at the thing grabbing it and it’ll let go of the tissue and attack the forceps. Then you just pull it out.
We put him to sleep and looked in with the laryngoscope (an instrument used to expose the vocal cords to place breathing tubes). At first, I didn’t see anything but then I noticed a bit of brown beneath the vocal cords that looked kind of like liver. Then an inch-and-a-half tail of a leach came slithering through the cords toward me. As I ‘ooohed’ and ‘aaaahed’ like a kid at a fireworks show, the resident grabbed the tail with some forceps and, about twenty seconds later, triumphantly displayed his catch. Totally cool. I ran to get Becca’s dad and he shot a bunch of pictures (his are way better than mine).
The moral of the story? If you’re going to drink river water, run it through a strainer first. The best news? The kid did fine. I always like a happy ending.leach 1leach 2

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