A few days ago, a nurse friend from my ER days posted this meme on her Facebook page and asked for other “gross” stories/memories.
Immediately upon reading her request, I had the picture—and putrid smell—come to mind of—since 1998 I still remember her name—Bertha.
Although she probably had other housing available to her, Bertha lived under a bridge with a few homeless “friends” in a small Arizona town. Alcohol was part of their daily routine. One night, while deeply intoxicated, she fell into the group’s campfire and severely burned her foot. After calling an ambulance (it’s interesting that in almost any group of homeless folks, there’s almost always one who has a cell phone), she arrived at our ER with a 3-inch diameter, fairly-deep 2nd degree burn on the dorsum of her left foot. She reeked with a nose-searing mixed perfume of campfire smoke and body odor (sweat, alcohol, grime, and tinges of urine).
Our paramedic cleaned the ashes and debris from her wound—and the rest of her foot—with soap and water as much as he could—it was the only part of her body clean at that time. I suggested that she needed to be hospitalized for a day or two to be treated with IV antibiotics and be seen by the surgeon—she refused, so we slathered her burn with Silvadene, taped on a heavy gauze dressing and gave her strict instructions to follow-up at her free clinic the next day.
Exactly a week later on a Sunday evening she again arrived at our ER via ambulance complaining of pain in her burned foot. I glanced at her foot as her gurney rolled through the door, and, even at a distance it was clear that she still was wearing the original gauze dressing we’d placed the week before. One of our brave paramedics met his companions as they unloaded her onto a bed—he whipped out his bandage scissors, quickly cut through the dressing and threw it aside. Then, as I watched, he quickly turned and headed for the sink.
His unusual activity piqued my interest, so I immediately went to the bedside. The burn on her foot was not initially visible, because the whole top of her foot was covered with hundreds and hundreds of squirmy white maggots, which spilled out onto the table and floor on every side accompanied by the putrid stench of rotting flesh. The paramedic slammed his hand over his mouth and turned again to the sink—but to his credit, he didn’t lose his cookies.
Cleaning up the rolling, squirming maggots and clearing the stench from the room were the most difficult parts. After several days of “natural maggot debridement”, by now her burn was actually quite clean, and, surprisingly, looking healthy with early healing. I commended the maggots for saving the patient’s foot.
This time Bertha consented to hospitalization, but her reputation had preceded her (it’s funny how quickly news and unusual stories get around in small hospitals)—the medical floor nurses refused to take her unless I certified her to be maggot-free.
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Her story and condition reminded me of one I heard from a somewhat elderly neighbor, Les when I was a youth. It seems that in the early 1900s when he was a young adult, Les had been chopping wood with an ax—holding the chunk he was chopping with his left hand. The wood slipped as he swung his ax, he missed the piece and chopped the back of his left hand, lacerating the skin and transecting all the extensor tendons.
His family took him to town to Dr M, the old country doctor who painstakingly sewed together all the extensor tendons and the skin (I always identified with the “ol’ country doctor”, trying to do all he could with not a lot of conveniences).
A few days later the 4-inch laceration across the back of his Les’s hand was getting angry red and pus was bubbling out from the corners. Upon returning to Dr M, the experienced old gentleman just shook his head. This was the pre-antibiotic era and folks sometimes died from infected wounds like this. Les said that Dr M laid him down and stretched out his infected left hand. Then he opened the wound back up and removed all the sutures. After that from some unknown storage area in his office, Dr M retrieved a container of “sterilized maggots” (after hearing that story, I always wondered about the procedure for “sterilizing” maggots), and with a pair of thumb forceps, he gently removed “about 25 of them” and individually placed them inside Les’s infected hand wound. Then the doctor sutured the wound edges closed again, put on a clean dressing and sent him home with instructions to return in a week.
A week later, Les went back, Dr M again cut and removed the sutures and removed the—now fatter—maggots. The inside of the wound was now clean and healthy appearing. Then, for the 3rd time, Dr M resutured Les’s hand laceration. Les then came back again for removing the sutures—for the final time—two weeks later, leaving Les with a functional left hand. When I saw the hand 50 years after that incident, Les had a barely-visible straight threadlike scar across the back of his perfectly-functional left hand.
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The wonders of maggot-ism! I had an older patient once who told me that as a kid he’d had a ruptured eardrum with constant pus draining from it, perpetual crustiness on the outside of his ear and pus on his pillow. Finally (again pre-antibiotics), they took him to the old family doctor who retrieved some maggots (apparently, in those days, doctors just had maggots lying [actually squirming] around in a container somewhere in their offices—maybe they got them from their medical supply reps?). My patient said the old doctor just put a bunch of them (maybe 10 or more?) in his ear canal with tweezers and put a piece of tape over the ear opening. He was instructed to remove the tape in about a week and as the maggots finished their work, they’d crawl to the outside and drop off. Apparently, they all came out—he never had problems with the ear infection after that, and when I examined him dozens of years later, he had no maggots—nor flies—in the ear canal, and the eardrum was healed.
While it all sounds gross, maggots only eat dead tissue and pus and other wound debris, so, after they’re done, all that’s left is healthy tissue—at least in this series of three maggot-related stories. Maybe, in this era of antibiotic resistance, we should more generally revisit the value of maggot therapy.