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...from “I’ve Got To Write a Book!”
by Ira Wiggins





The Panama Adventure

Our life in Panama had several aspects:

1. The medical practice.

2. Social life in&around the Canal Zone.

3. Snorkeling.

4. Frequent trips into the countryside to mingle with the country folk and the primitive, indigenous indians.

We lived in the spacious quarters formerly occupied by naval officers when Coco Solo was a U. S. naval base. I was assigned to work in the outpatient clinic of Coco Solo Hospital. Our patients there were:
a. Employees of the Panama Canal Co. and their families. This included both U.S. and Panamanian citizens. Many of the latter spoke little or no English.
b. U.S. Army personel referred to us from the army clinics on the military posts.
c. Passengers and crew of ships transiting the canal.
d. Emergency cases regardless of status.
With some notable exceptions I found the types of cases to be treated were essentially exactly what I had been treating in my practice in Jonesville, Mich. I still saw lots of colds, flu, psychoneurosis, hypertension, minor and major injuries, family problems, foreign bodies under the skin and in various body orifices, etc. Malaria occurred but was rare. I never saw a case of yellow fever. There was, however, a vast increase in the number and variety of venereal diseases and intestinal parasites to be seen. Some of my experiences in the practice of medicine in Panama are worth the telling.

*****

In the second week of my work in the Canal Zone a Panamanian farmer (he worked for P.C.C.) entered my office stating he thought he had a worm under the skin of his arm. Where I came from that smelled a mental problem. I examined the area and found only a very ordinary looking tiny pimple with a slight swelling beneath it. I gave him some ointment and a reassuring pat on the back.

The next day a grinning lab worker presented me with a small specimen bottle in the fluid of which lay what appeared to be a small maggot.

“The emergency room doctor took this from the arm of a patient of yours last night, doctor. He thought I should show it to you.”

I had been totally ignorant of the existence of the worm known as a “gusano” in the tropics. It results when a certain type of fly lays an egg on a person’s skin. Poor hygiene is usually a contributing factor. Fortunately the patient had realized that I was an uninformed “gringo” and had the good sense to return to the emergency room that evening when a Panamanian doctor was on duty. Subsequent to that I had occasion to see several similar cases and, of course, used the appropriate treatment. I always made it a point to show such cases to recently arrived American doctors so they might be spared the chagrin which I had experienced.

*****

I am almost too embarrassed to relate the case of the elderly lady with vaginal discharge on whom I did a vaginal smear test. The result was “gram-positive diplococci present” and I informed her she needed to be treated for gonorrhea. It had been so long since I had seen a case of gonorrhea in my practice in Jonesville, Mich. that I had forgotten the positive diagnosis is made from intracellular gram-negative diplococci. I had been used to a negative report reading “no gram-negative diplococci present.” She went to another doctor in the clinic who wisely informed her that the test showed nothing needing treatment and reassured her that she did not have gonorrhea.

The chief of the out-patient department had a little discussion with me about that case. My apologies were profuse and sincere. I am sure he reviewed my case records for a time thereafter and I can’t say that I blame him. It wasn’t long before I became all too familiar with positive reports for venereal diseases. Syphilis had become a great rarity in my practice in Jonesville. Here even the secondary state was not uncommon. I learned to differentiate between lymphogranuloma venereum and granuloma inguinale, chancre and chancroid. Condylomata accuminata (venereal warts) were common.

*****

I learned to recognize with reasonable certainty, the occasional case of dermal leishmaniasis - “tropical sore”. It is transmitted by the bite of a certain type of tiny sand fly and causes a chronic skin ulcer which doesn’t heal for many months. The permanent scar is often quite large and, despite years of research, consistently effective treatment had not yet been devised.

*****

It was about 10:00 p.m. and I was on duty in the emergency room. The buxom black Panamanian lady settled her ample proportions in the chair beside my desk.

“Yes, ma’am. And what may I do for you?”

Her accent was 100% Jamaican. Many Canal Zone workers were of Jamaican ancestry.
“Doktah, my pye she too tweet, tweet, tweet.”

“I beg your pardon.”

“Doktah, my pee she too tweet, tweet, tweet,” she emphasized.

“I’m afraid I don’t understand.”

This time she stared fixedly into my eyes and slowly and firmly, as to a small child, she repeated, “Doktah, - my - pee - she - too - tweet.”

It sounded to me as though she were telling me that her pee was too sweet.

“Do you mean that your pee is too sweet?

With a sigh of great relief, “Yaaaaaaaaasssssssss, doktah.”

The nurse was listening with an amused smile on her face.

Well, I had to ask it: “How do you know that your pee is too sweet?”

“Wy, doktah, I tasted it.”

She had not been to the clinic recently but had no record of diabetes on her chart. A bit non-plussed, I managed to say, “Well, we certainly should test a specimen of your urine. Take this bottle to the service (I had learned to use the local term for ‘toilet’) and bring some back for me.”

Sure enough, it tested four-plus for sugar. Later blood testing confirmed that she was, indeed, a diabetic. I could hardly believe that in 1967 diabetes had been diagnosed by the “taste test” as used to be done a few hundred years ago when the doctor was expected, as a part of the examination, to taste the urine of the patient. The alternative was to pour the urine on the ground near an ant-hill and see if the ants were attracted to it.

On a subsequent visit I could not resist trying to find out how she had come to taste her urine.
“Mrs. ________, you were very fortunate to have found your urine to be too sweet. How did you happen to taste it?”

“Wellll, doktah, y’see I has a weak bladdah. Wen I coughs oh sneezes I lose mah pee lessen I puts mah fingah down theah and presses. Also I cooks at de cafeteriah in______ an I taste de food ah lot. Well, wan day I puts mah fingah down to stop de pee, den I forgets an I tasted it.”

Of course the story was too good to keep. Medical ethics not withstanding there was a lot of good-natured jocularity about “Dr. Wiggins’ sweet-pea patient”. One of the last to hear the full story was my wife and then only after the patient no longer worked at the cafeteria for we had occasionally eaten there.

*****

Before I had learned that the local term for toilet was “service” derived from the Spanish word “servicio” - a Panamanian mother brought her teen-age son in with the complaint that “when he was in the service he saw some blood.”

I thought it not unusual that someone in the military service might see some blood.

Groping for further explanation, I asked, “And how long ago was that?”

“Just yesterday, doctor.”

After ascertaining that the blood had been in the stool and finding that he hadn’t been “in the service” yet today, the meaning of the term gradually dawned on me and, after the appropriate examination, I proceeded to treat his anal fissure. It was several months before I became really comfortable using the term “service” instead of “toilet” with Panamanian patients.

*****

Sexual morals and mores were somewhat different in Panama than those to which I was accustomed. It was not acceptable for a man to appear in public bare-chested. If company arrived the typical Panamanian man, if shirtless, would immediately hurry off to put on a shirt. Once in Choco indian territory as we approached I saw the man hurry to put on his shirt (his only other clothing was a G-string) while the wife and grown daughter unabashedly continued their chores completely bare-chested, as was their custom.

As I was returning shirtless in my car from the beach one day a guardia stopped me, pointed and sternly reminded me, “La camisal La camisal” (“The shirt!”). A friend of mine was not so fortunate. He was given a ticket for the same offense, appeared before a judge and was fined $10.00. The ticket he kept as a momento. It simply said, “sin camisa.” (“without shirt.”)

On the other hand it is a common sight, and an apparently acceptable act, to see a man (never a woman) urinating at the roadside. I have never heard of guardia action against this.

Also, prostitution is legal in Panama but quite discreet and never advertised as such. Street-walkers are apparently not allowed and the “houses”, though well-known by everyone, are unobtrusive. One unique feature there is the B.Y.O.B.(bring your own babe - a Gringo term, not theirs) motel. My information is solidly second-hand, obtained from a friend who, out of curiosity (with his wife, I hasten to add) utilized the services of such an establishment. Word of mouth is the only advertisement; the building is about 100 yards off the highway and mostly hidden by trees. Rental is by the hour. Weekends, I am told, there is often a waiting line of cars. The car drives up to the automatic door; it opens; then drive in and the door closes behind them. They then enter the clean, orderly room. In one wall of the room is a lazy-susan type of turn-table, one half of which opens into the room and the other half of which is looked after by an attendant. If drinks are desired, such are noted on the paper provided which is then placed on the turn-table, to be rotated 180 degrees for the attention of the attendant. Drinks, the bill and the payment thereof are all provided by the same means. No words are exchanged. No one sees the customer and the customer sees no one throughout the entire procedure. Amazing! I had never heard of such a thing.

I was amazed also by the amount of venereal diseases of all kinds, which, fortunately, were usually relatively easy to cure with modern antibiotics. I usually asked such patients, “Did you pay for it?” Judging from the answers I concluded that VD was much more apt to be contracted from “a friend I met on the street” than from a professional, who could ill afford to have her business diminished by such bad news.

*****

The couple came into my office with the complaint that “his sex functioning isn’t as good as it used to be.” From his chart I could see that he was 16 years of age. She appeared considerably older, but I assumed from the nature of the complaint that they were married. Never assume! I was wrong. After a bit of delicate (and not so delicate) questioning I found that she was the boy’s mother - he was single - and had become concerned about his health because he had told her that lately he had not been able to perform as well sexually as he used to. Ah, the worries a mother has! It was one of the many occasions I had to remind myself, “Equinimitas, doctor, equinimitas!”

*****

It was not unusual for the member of a crew of a foreign ship to be unable to speak a word of English and to come to the clinic armed with a medical phrase book - German-English, Spanish-English or whatever. We would then point to the appropriate phrase(s) to inform the doctor of his symptoms. I had finished treating one such Japanese patient when a fiendish idea struck me. My sign language I asked if I might have the booklet; I was sure there were plenty more aboard ship. He readily agreed.

After office hours I took the booklet home and laboriously copied on a slip of paper the “chicken-track” characters which translated into English as “I have symptoms of gonorrhea.”

One of our good friends in the Canal Zone was away. Arnold, the modest, good-humored but very proper Japanese wife of our square-dance caller, Sid, who had been in military service in Japan. Partly because of her modesty, some of us liked to tease her and to watch her blush, but we truly admired her. Her command of the English language was excellent and she had assured us that she could read Japanese characters “perfectly well.” I decided to put her to the test and have some fun at the same time.

Our “after-party” following the next square-dance was at the home of Sid and Kay. I had revealed my plan to no one. In the later part of the evening, as we were sitting and talking, I said to Kay, “By the way, I had an interesting experience today. A Japanese physician was in my office with a patient from a Japanese ship. He spoke excellent English and we chatted for a bit after I had finished treating the patient. He was very friendly - even gave me a note so that if I am ever in Japan I can show it to any Japanese doctor and he said I would be immediately accepted as a fellow doctor and shown every courtesy. Wasn’t that nice of him?”

“Oh, yes. How very thoughtful. He must have liked you.”

“He appeared to. Here is the note he wrote. Perhaps you can read it for me.” Whereupon I solemnly handed it to her.

As I watched her face I had no doubt about her ability to read Japanese.

At three seconds her jaw dropped. Her face froze in horror.

At five seconds an intense flush spread rapidly across her face. Her mouth opened. She did not breathe. Finally she gasped, “That’s awful!”

“Kay, what’s the matter? What does it say?”

“That’s awful! That’s awful! What a terrible man to do such a thing!”

“Do what? What does it say?” I was merciless.

“Oh, I can’t tell you. It’s terrible! And he doesn’t write Japanese very well either. How could he do such a thing?”

At that I broke down laughing and confessed the crude practical joke to her. She was confused and duly flustered but accepted my apologies. When I complained to her, “Kay, you said I didn’t write Japanese very well.”
“Oh, but for an American you wrote it very well.”

At a square dance later, in retaliation, she pinned a paper to the back of my shirt: “Watch me. I can dance the part of a girl better than anyone.”

*****

Seamen on U.S. registered ships had a clause in the contract whereby, if removed from the ship by a doctor’s orders the shipping line had to pay their transportation back to the U.S. and continue to pay them their regular base wage until the ship returned to its port in the U.S. This applied even if the man’s illness lasted only a week but the ship did not return for three months. Meanwhile the man could be collecting wages from another job if re so desired. At times this could produce a tendency to gross exaggeration of symptoms or even outright malingering. The shipping companies understandably frowned on our ordering a man removed from his ship. But if a man had abdominal pain and there was any chance of early appendicitis it was hardly sensible to send him to sea on a ship without a doctor.

Sometimes, due to conditions aboard ship, a man would go to great lengths to be medically ordered from the ship. On one occasion a seaman came to ms with a swollen wrist.

“A beam fell on it, doc. I guess it’s broken.”

“Could be. We’ll get an x-ray.”

The x-ray was okay. The most I could give him credit for was a bruised wrist.

He was stunned. “Are you sure, doc? I thought sure it was broken.”

I showed him the x-ray.

After a few moments of silence he took a deep breath and confessed: “Look I gotta get off that ship. I hate it!”

“I’m sorry, but I can’t give you a medical certificate for that.”
We talked a bit and he told me how he had wrapped a sweater around his wrist before striking it with an iron bar in an attempt to break it. The most I could offer him was my sympathy.

“Well, can you tell me how I can break my wrist?”

“I’m sorry, buddy, they didn’t teach us that in medical school.”

“Well, stick around. I’ll be back, you can be sure of that, doc.”

I heard no more from him. He may have returned on a different shift.

*****



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