Lima, Peru

Latitude 12.06426°S Longitude 77.03307°W

Friday, December 20, 2002

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We stopped in Lima for a few days to attend to some matters. We were warned that the inner city areas were very dangerous so we stayed in the much safer nearby suburb of Miraflores, the trendy emerging social center of Lima.

I needed to see a doctor about a lump on the back of my head that just would not go away. And we also wanted to find a professional photo lab to start processing the growing mountain of exposed slide film I had shot since Mexico.

An appointment was obtained easily enough with a German doctor in Miraflores, but on arrival, despite our insistence that the doctor we see be fluent in English, and an assurance that he was quite so, we discovered he could not, in fact, assemble more than three English words together coherrently. The examination thus proceded very slowly, mainly a struggle for comprehension by both sides as to what the issue was.

The issue was a lump that I had noticed appeared on my head almost two months ago, perhaps in Costa Rica. At first I had thought it was a harmless bump, but I had been gradually losing faith in that theory after the bump refused to heal, and further, had started to cause very sharp pain on occasions. I started to wonder if I had been bitten by a tick or other bug. By the time we reached Panama, I was ready to see a doctor about it.

The episode at the health clinic in Panama City was another comedy of errors. Again, despite requesting a doctor who spoke English, we received a very cogenial lady doctor who spoke no English at all. But the bump was self evident, so, nonplussed at our failure to communicate, she jabbed me with two shots of local anesthetic and proceded to cut it open. After the wound was drained I felt an immediate relief to the pain, which was probably good (I thought). She also took a sample of the stuff that came out in order to grow a culture and perform analysis. She finished up by prescribing a course of antibiotics and asking me to return in a few days time when the analysis was back from the lab. I asked her whether she thought it was a bite but she vigorously denied that possibility. I left the clinic reasonably happy that the issue was resolved, and felt even more confident a few days later when I returned to the clinic and heard from the doctor that the analysis had returned clean.

We left Panama a few days later, and it was only then, while on the plane, that I happened to look more closely at the result of the analysis the lab had performed. It was all in Spanish so I didn't understand it all, but I got the gist of it. Just then, I noticed at the top of the form the name of the patient the analysis was for. And, sure enough, I knew enough Spanish to know it wasn't my name! The doctor had mistakenly pulled out some other patient's analysis instead of mine. While it was comforting to know that this other patient was fine - at least for him - I could only wonder, hopelessly, what my analysis was. Well, there was nothing much I could do at that point, and besides, the pain had abated.

Well, as the weeks rolled by, the lump did not go away completely. In fact, soon it seemed that it was back as large as before. And a little worryingly, I had started getting the same occasional sharp pains again. By the time we reached Lima, I was ready for round 2 with the Medical Establishment.

And so it came to be that after almost an hour of battling language barriers, the German doctor in Lima had concluded the lump was an "ateroma". Completely harmless and common, mind you, but it should be removed nevertheless. I had never heard of an "ateroma" before - the term could have been German, Spanish, Latin or Ancient Greek for all I knew. All my attempts to get an English translation were futile. He opined that the doctor in Panama had merely cut it open to drain it, rather than completely remove it as properly required. He said that I'd need one more surgical procedure like the one I had in Panama, however this time, the surgeon would know to completely remove the "ateroma". I again raised the possibility of a bite of some sort and again had this suggestion vigorously and absolutely refuted. Admittedly, what could an obviously uneducated, non-medical profession plebe such as myself possibly know about such matters? A few moments later he had made an appointment for me at the Clinica Anglo Americana (the best in Lima), to have the matter finally resolved.

At the proscribed time Keiko and I arrived at the clinic and waited for the doctor. I asked the nurse whether the doctor spoke English (the German doctor had assured me that he spoke "good English", but as you can imagine, by now, I was starting to feel very vitriolic about such assurances and especially the people who asserted them). Sure enough, the nurse, in a disconcerting flash of honestly, admitted the doctor who was going to perform the operation in fact spoke barely a few words of English. By this point I had decided that enough was enough, so I requested to be referred to a doctor - any doctor in the Anglo American clinic - that spoke Anglo American English! I was surprised a second time when my request was actually fulfilled. Before too long I was speaking to Dr. E. Paul Lucchesi V., immediately identifyable as a very capable and professional emergency room doctor who listened to my story from beginning to end. Upon inspection of the lump, he finally resolved the mystery of what an "ateroma" was - apparently it was simply a subcutaneous cyst or abscess. He also confirmed that it was common, generally benign and could be removed by a simple enough procedure. He asked me to wait a few moments while he prepared for the procedure, and I exhaled a large sigh of relief that we were finally getting somewhere.

Presently I was laying face down in the operating room and the doctor started the procedure. First some hair was clipped away, the area washed with disinfectant and shots of local anasthetic administered. After a few moments I lost all feeling in that area and he went to work with a scalpel to open, drain and remove the cyst. None of it was painful but I did not care to imagine what my opened head looked like. Suddenly, the doctor stopped his work. I heard his assistant gasp and make a kind of gagging sound of revulsion as she backed away from the table. Uh-oh, I thought, Something Bad just happened.

"Have you been in any jungles?!", he suddenly blurted in a shocked voice.

"Umm, yes. One or two..." I mumbled faintly.

More silence. Now some other doctors had started to come in from outside and stood around the table peering at me. The suspense was killing me, but I was getting a very bad sinking feeling in my stomach. A feeling of terrible conviction.

Finally, the doctor intoned in a flat voice "It seems you have picked up something from the jungle".

I knew it, I thought. I had suspected something along the lines of a tick bite all along.

"It appears that you were bitten by some kind of insect that laid eggs inside your head. The eggs burrowed into your scalp and have hatched into some kind of larva which I have just exposed. Be still, I will now attempt to remove it".

At the sound of the doctor's words I started to feel ill. It was a scene straight out of Alien, a worst nightmare come true. What the hell was in my head? I broke out in a cold sweat imagining hundreds of wriggling white worms oozing out of my flesh. But soon enough I was able to confront the reality, which was only slightly less repulsive. The doctor cleaned the wound, sutured with three stitches, and instructed me to sit up.

There, on a stainless steel dish, was the invader. It was about three quarters of an inch long and a quarter of an inch thick. It had a translucent covering wet with my blood and something could be seen indistinctly wriggling inside. It seemed quite developed - the larva of some kind of flying insect? Whatever; it would never hatch now. The doctor referred to the condition as "myiasis" - click here and here to see more revolting details. He dropped the trophy into a vial of alcohol for posterity and presented it to me with a big grin. Keiko almost puked when she saw it. The thought of something hatching from an egg and growing into something that size inside my head was one of the grossest things I've ever had to imagine. Most likely I got it in Costa Rica, either in the jungle of Monteverde or else on the hiddeously filthy Tica bus that took us on the overnight journey from San Jose to Panama City. I prayed that this matter was now absolutely resolved.

Photos: (click on images to see full size)

The grown insect larva that was surgically removed from Nick's head

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