...from “I’ve Got To Write a Book!”
by Ira Wiggins
Panama (part 2)
I had never seen a vampire bat bite in my medical career and had the commonly held but erroneous notion that it would consist of a set of double puncture marks located over a large vein, probably in the neck, representing the sites where two hollow teeth had punctured the skin in order to suck blood. Panama has some vampire bats in the remote areas, so I did see a few of the actual bites, always in “campesinos” (farmers) or in military personnel on bivouac who had slept in the jungle.
The bat itself is quite small, only about three to four inches long, is nocturnal and reddish-brown in color. It has extremely sharp, razor-like front teeth with which it can remove a tiny divot from the surface of the skin, so deftly that the sleeping person usually does not awaken. This divot is most often taken from a highly vascular area of skin (nose, ears, fingertips or toe-tips) so that a slow, steady trickle of blood develops. The bat then settles down to lap the blood up as it surfaces, drinking until it is distended with its meal. Blood is the only food that its digestive tract will accept. Experiments have shown that if denied access to blood for a period of longer than 72 hours the bat will die, regardless of subsequent easy access to blood, forced feeding or even blood transfusions. Thus the creatures must feed frequently, usually every night, and they pose a hazard to cattle (their normal food source) in which anemia and weakness are produced, making the cattle subject to secondary infections and illnesses. The vampire is also a carrier of the deadly rabies virus.
Combined with a history of sleeping in a bat-infested area and awakening with a bloody scab on a susceptible area, the typical appearance of the tiny, clean, saucer-shaped wound makes the diagnosis relatively certain. Even when protected by a mosquito net the sleeping soldier may be subject to the bite or an area of skin which presses against the netting. Treatment consists of protection against infection, tetanus and rabies.
Eradication of the vampire bat is of concern to the U.S. military as well as to the government of Panama. To date the best means they have found is as follows: Several vampire bats are captured by placing “mist nets” in the area at night. These bats are handled carefully to avoid injuring them and are painted with a solution of anticoagulant (ingestion causes blood to lose its ability to clot). The bats are then released to return to their lair in a hollow tree or cave. In the usual process of social grooming the bats lick each other and themselves, thus ingesting the medication which causes death by internal bleeding. In this way most of the bats may be eventually eliminated.
*****
The following is an exact transcript of an emergency home-call report made out by a co-worker of mine:
Consultation Report
Date: 9/25/62 Doctor left: l0:30 p.m.
Pt’s wife called ambulance and doctor because her husband had locked himself in a closet.
On arrival pt’s wife didn’t allow me to get in the house because she didn’t know me and because I wasn’t driving an official car.
I left without seeing husband; when driving away husband came out on the porch and waived good-bye to me. He seemed in good health.
Signed: Dr. ________
*****
I had just come on duty in the emergency room of the hospital and for the remainder of my shift would be responsible for the patients in the hospital (55 beds at that time, as I recall) as well as the patients who came to the emergency room for care.
“It’s the fourth cardiac arrest he has had in six hours!” the breathless nurse said to me as she called me to see a cardiac patient in the intensive care unit. It was 24 hours after he had incurred a small myocardial infarct (“heart attack”) and he was still attached to the cardiac monitor machine which blinks and beeps most alarmingly when the heart fails to beat for three or four seconds. A ward attendant was applying external cardiac massage by vigorously applying intermittent pressure to the lower sternum with the heel of his hands. The patient was wide-eyed with fright and apprehension; he was breathing as normally as could be expected under the circumstances and could talk. The monitor showed no cardiac activity.
“Should we shock him?” asked the nurse.
I had little experience with cardiac monitors but considerable with patients. It seemed to me that a man with cardiac arrest should be unconscious. Asking the attendant to cease his efforts (the patient was greatly relieved) I felt for and found a normal pulse. A slight adjustment of the monitor resulted in “normal cardiac activity”.
“Thank heavens it’s beating again!” someone exclaimed.
Outside the patient’s room I had difficulty convincing the attendants that the fault had been in the machine, not in the patient. At the rate they were going the man would have been written up in a medical journal as having survived the greatest number ever of cardiac arrests. A different monitor was brought in and the patient had no more “cardiac arrests” that night. The staff had several formal lectures in the next few days on proper procedures. I believe the gist was “treat the patient, not the machine.”
*****
“Doktah, I wants you tuh remove suthin fum down heah,” indicating the genital area - stated the Jamaican lady as she seated herself in my office.
“Certainly, Mrs._______. What is it you would like removed?” Visualizing a mole, wart or other undesirable skin lesion.
“Well, it’s a dollah.” stated sheepishly and almost inaudibly.
“I beg your pardon?” Too often, when I find myself saying that, surprises follow.
“Is: got ah dollah in my gina and can’t get it out, doktah.”
I tried to appear unflustered but couldn’t help asking, “Is it a silver dollar or a dollar bill?’’
“A bill, doktah.”
“All right, Mrs._______, just step behind the curtain and remove your panties while I go outside to get the nurse.”
I could hardly contain myself. “Mary, for heaven’s sake try to keep a straight face but the patient in my room says she has a dollar bill in her vagina and we have to remove it.”
“You’ve got to be kidding.”
“Nope. Let’s go.”
As the nurse was getting the patient on the examining table my curiosity was raging. “Now did the bill get in your vagina, Mrs._______?”
“Well, doktah, I got this dollah, see? An I jes knew if mah husbin foun it he’d take it away fum me. I din know where to hade it so I hade it in there.”
I didn’t know how much longer I could keep a sober, professional manner. Turning to the nurse I said, “I expect if my wife hid something there that is about the first place I’d find it.’
With that the three of us exploded with laughter. We had had an excuse to laugh heartily without the patient feeling that we were laughing at her.
One glance sufficed to show that there was nothing abnormal in the vagina, not even a penny. I made the examination meticulous and unnecessarily long to convince the patient that I had overlooked nothing. Even had the nurse look carefully over my shoulder while I manipulated the speculum to expose all areas.
“There is absolutely nothing here, Mrs._______.”
“Sure nuff, doktah?”
“Yes, ma’am, I’m quite sure.”
“Well, I’ll be! Now way could it of gone?”
She left, shaking her head in apparent bewilderment.
“Now, that’s one for the books!” exclaimed the nurse. This was one of the many occasions on which I affirmed, “I’ve got to write a book!”
When the patient and nurse had left I found myself unoccupied, so leafed through the chart to peruse her previous medical history. I should have done it sooner. The light dawned. This particular lady had had several minor mental problems in the past.
Her next visit to me was some six months later, at which time she had a simple cold. After giving her a prescription I couldn’t resist the temptation to ask, “By the way, Mrs._______, did you ever find that dollar bill you lost?”
Without a moment’s hesitation, she came back with, “Wy yes, doktah, it was undah heah all de tam!” With that she vigorously indicated the area under her very ample right chest. I did not pursue the matter further.
*****
The concerned mother brought her four month old infant to the clinic. It had seemed fussy and she had found a white “growth” on the roof of its mouth. Sure enough, on the center of the hand palate was a two centimeter diameter, firm, non-tender well-demarcated, raised, bone-white area with a narrow purplish border. A differential diagnosis was a solid blank. It certainly was not thrush, which I had occasion to see frequently. I called the pediatrician and the surgeon in to look at it and they were as puzzled as I was but thought it was warranted to send the patient to see a pediatrician at the larger Gorgas hospital at the other end of the Panama Canal. En route there the mother noticed the baby happily chewing on something and extracted a large, round flake of coconut from its mouth. The “tumor” was gone. The flake had apparently stuck to the roof of the mouth by suction, the resultant irritation causing the purplish border.
The practice of medicine may be many things. But it is never dull!
*****
Some of the patients had a misconception about “Pay-roll deduction”. As the man was leaving he said to me, “Please mark ‘emergency’ on this prescription (so he could get it on pay-roll deduction). I been paying each time and losing money.” Guess he figured if he couldn’t see the money leave his hand it was free.
*****
I knew no Spanish whatsoever prior to going to Panama but, once there, I enjoyed learning the language. Doctors and nurses were allowed to attend a class in Spanish (held at the hospital) for one hour a day five days a week.
This was during working hours and was considered on-the-job training. It was a pleasant class; our teacher was a pretty, young married lady from Cuba with a delightful sense of humor and endless patience. One day in class it was my turn to make a statement in Spanish. I was near the end of a sentence, planning to make it a longer sentence, then changed my mind and decided to end the sentence, intending to say the equivalent of “period” in English, I said “periodo”. She turned a bit red, shortly controlled her laughing with considerable effort, then managed to stammer, “Oh, no, no, doktor. No, no. Usted quiere decir ‘punto’. Una mujer tiene ‘periodo’.” This translates to “No, no. You should say ‘punto’. A woman has a ‘periodo!’”
*****
The lady in my office spoke only Spanish. Her baby girl was a darling and I was quite taken by her. As they were leaving I wanted to say to her, “What a sweet baby you have.” I had studied German in college and the German word for sweet is “susz”. At this point I unfortunately mixed the two languages as I smiled at the mother and said, “Que sucia su nina!”, which means, “What a dirty baby you have!” She smiled as she left the office, realizing, I hope, that the Gringo doctor had not meant what he said.
*****
One of the nurses aides was an older, pleasant, Jamaican lady who spoke Spanish fluently. Initially Joanna was my interpreter, then, as I gained fluency, she aided me in the language when necessary. I would often mimic the phrases she used in speaking with patients. One situation where I had trouble was in instructing the patient that he or she could get down from the examining table. The correct, formal phrase (and one I was just starting to learn to use) is, “Usted puede abajar” (“You may get down”). I noticed that she had a habit of saving to the patient, “Ya, va!” (pronounced “Yeah, bah!”) at which point the patient would invariably sit up and jump down from the table. However, when I subsequently used the phrase in the case of a dignified matron, she laughed and (after the patient had left) gently reprimanded me.
“A doctor would never use that phrase, Dr. Wiggins.”
“But why not, Joanna? It works fine for you. What does it mean?”
“I don’t know how to say it in English. But a doctor wouldn’t say it to a patient.”
I later learned that it is the Spanish equivalent of “Okay. Git!”
I dropped it from my repertoire.
*****
Social life in and around the Canal Zone was as active and as varied as one wished to make it. There were cocktail parties, square-dancing, photograph clubs, riding clubs, flying clubs, fresh and salt-water sports of all kinds, fishing, tennis, year-around golf, bridge clubs and a variety of other activities. The Panama Canal Co. liked to keep its employees and their families contented.
Cocktail parties were fun but we didn’t want to make them our main activity. Throughout our stay we were involved with square-dancing on a regular basis and played bridge regularly with friends. The ping-pong table in our apartment was also a good source of entertainment. We spent hours in the jungle looking for, and finding, antique bottles of all kinds. The jungle also provided us with ample opportunity to satisfy our thirst for knowledge of nature, trees, plants, birds, insects and reptiles.
*****
These outdoor excursions occasionally provided a ‘’small adventure” to enliven the day. Once, in the vicinity of Nombre de Dios, we had walked a long distance down a jungle path, then along a sandy beach. We were enjoying the solitude, observing nature and looking for antique bottles but had become a bit fatigued. We felt that we knew the area well enough that we could take a short-cut back to the village air-strip where our small home was. We ran into thick brush and a bit of swampy ground where the going was difficult but felt that the distance saved would be worth the effort. In one area we found ourselves stepping from tree root to tree root of mangrove trees to avoid several inches of water and muck below. It finally dawned on us that we should have long since come to the path we had intended to intersect. We had broken our rule of never going into the jungle without a compass and it was too near noon for the sun to be of any use. We could not bring ourselves to wait for two hours while we decided definitely which way the sun was traveling. At times we could very faintly hear the surf on the beach.
“Betty, let’s head for the sound of the surf regardless of what we have to go through and we will end up on the beach and will at least know where we are.”
“Guess you’re right. How stupid of us; no one even knows where we are. We’ve got to get out of here. C’mon the surf is that direction.”
“Oh, it sounded to me like it was over there.” I pointed in the opposite direction.
We listened carefully. At times the sound seemed to come from one direction and at other times from the exact opposite direction. That’s not possible. How can it be? Panic was starting to rear its ugly head. We knew we could survive a night in the jungle but it would be most uncomfortable, especially with no food or water.
We agreed to head for one of the surf-like sounds and started out. Our adrenaline had helped to erase part of the fatigue. (Never, but neeeeeeveeerr go out in the jungle without a compass!) We came to coarse grass taller than our heads which we had to part with our hands (the grass, not our heads) as we stepped very high to avoid being tripped. Our faces were flushed and we were perspiring profusely. The throbbing in my chest seemed to shake my entire body; I checked my pulse and found it was 160, so we rested. Betty said that if I had a heart attack she certainly couldn’t get me out. But the sound of the surf was coming closer. What a joy to reach the beach. We found ourselves not far from where we had left the shore and doggedly started the long trek back to the village. This was a remote area and we had not seen a soul on the beach or on the path.
We flew over the area and lo! the mystery of the two surfs was solved. We had been in the center of a peninsula-like projection of land and there had been surf on both sides of us. We were then able to laugh at our foolishness.
*****
