Creepy-Crawlies

Kandahar, Afghanistan

Warning: If you are eating or about to eat, wave off on this post.

This morning as I arrived at the ICU I was greeted with the unsavory revelation that our Afghani two year old had worms.  Not too startling, except for the fact that it came out of his chest tube.  I know this to be true because in our digital age one can see the evidence in a photo, which a nurse gleefully provided.  Gross.  It was in in a toomie - a large syringe that some had used to suck it right up.

The two year old had come to us from some local forward operating base with known effusions, i.e. fluid, in his chest cavity between the lung and chest wall.  It was nearly coffee colored.  We figured it was most likely tuberculosis, although we had a few other theories.  Round worms didn't make our top ten list.

Prior to rounds, one of our infectious disease colleagues brought over his collection of worms that had come from various orifices of patients over the past few months.  I had seen one photo of a young child who was intubated - i.e. had a breathing tube down her trachea - and in whom a large white round worm was found crawling out her right nostril.  That sucker was included in this morning's show-and-tell.  I hadn't eaten breakfast up to that point, fortunately.

We have other interesting specimens crawling around here in Kandahar.  Apparently it is locust season as now I see them all over the place.  This place conjures up the Old Testament in more ways than one.  I had to escort a juicy locust out of the ICU a few days ago.  He wasn't so bad after all, probably fairly clean, which is more than you can say about the fly tape that hangs from the ceilings everywhere around here.  Filled with black flies.  They are above hospital beds, in front of the OR doors, and most disgustingly, in the Stand Easy where we eat food when on call.  Gross.

My friend Joe revealed to me that he was really tired today because he had call last night.  Lots of cases? I asked.  Not really, he said.  In the tent where the on-call guys sleep the amorous (or just plain loud) rats that were bouncing on the tent ceiling kept him awake all night.  Gross.