Maggots!

*Warning: graphic medical story about to commence.*

So while I'm here enjoying-myself-slash-studying at the shore, others in my class have actually started their fourth year of medical school by doing actual work. My friend David, for instance, just finished a month of neurology and yesterday began a month of urology, his chosen field. One of his first patients was an older, homeless, alcoholic man that urology was asked to consult on.

From what they can tell, the guy isn't a very good historian, and now he's doped up on meds to keep him sedated, but apparently he was out on his boat (I guess he lives on a boat on the Ohio?) and mentioned that he was having trouble seeing. A friend convinced him he needed to see a doctor, so he docked his boat and started walking to the hospital. At some point, he collapsed or fell or something, so EMS was called and that's how he actually ended up in the ER, as a trauma patient.

Well, I don't know what exactly happened when, but at some point they took off his clothes, and noticed that the flesh of his crotch was nasty looking, black, necrotic, etc. An old infection, perhaps? But then -- and don't say I didn't warn you or that you didn't read the title of this post -- MAGGOTS come crawling out! And on further inspection, they were coming out of his perineum as well. And his umbilicus.

And THEN, ENT comes to examine the guy, and they discover maggots in his ears, and coming out of his EYES.

Oh. My. God.

On his head CT, you can apparently see the tracks the maggots have made burrowing around his head. They think the maggots have eaten through some of his extraocular muscles, which is why he can't move his eye properly and is having vision problems.

Ophthamology did an exam on him and videotaped it, and David got to see it. He said it looks fairly -- well, not like a normal eye exam, but nothing that impressive -- and then all of a sudden, maggots come crawling out!

Trauma apparently had the idea to give the guy a bath and try to wash the maggots away. Great idea, except they all (the maggots) freaked out at the touch of water and burrowed back into the patient, not coming back out until the bath water was gone.

The smell is apparently horrendous. I can imagine -- I once saw maggots on a person, but it was a dead person (an old guy who had died alone at home of natural causes in the summertime in Philadelphia, without air conditioning, and he had started to decompose by the time he was discovered and brought in for autopsy; I saw him in the autopsy suite, and it was the most horrifying thing I've ever seen in my life -- maggots crawling out of his nose and everything, and the smell was absolutely nauseating). This guy is -- at least for now -- STILL ALIVE. An entomologist of some sort has been called in to give his opinion. I mean, this guy is essentially rotting from the inside out! Urology doesn't really know what, if anything, they're going to do -- the maggots in his privates are probably less of a concern than the ones in his head, at this point.

And today, David sends me this text message: "That guy with the maggots...they are turning into flies."

I told him he needs to get a copy of all the xrays, CTs, videos, everything on this guy. Take a picture for his own records. De-identify it all, and save it. Because no one is ever going to believe this story, and he's going to need the pictures to prove it.

I am so jealous.

Hey, I start urologic gynecology next Monday; think I'll get to see anything similar?

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OK, so side note: I don't really know what is going on with this guy from a medical standpoint, but I would love to know. How do you grow maggots in you without your body putting up some sort of defense (his white count is reportedly normal)? AIDS? Some other weird sort of immunodeficiency? How long has he been infested? Someone had better write up a case report, because that shit needs to be published!