The Beauty of Medical Maggots

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“If I could train maggots to resect brain tumors, I would.” Dr Mark Simard, neurosurgeon, Maryland School of Medicine.

St Paul’s Hospital was an eye opener. I arrived in 1985, a wide-eyed intern who tumbled down the rabbit hole into St Paul’s parallel universe, an astonishing new world replete with an exotic cast of characters, their colorful lifestyles and their bizarre medical problems. This hospital services the residents of the West and East End of Vancouver and it was (and is today) an epicenter for cutting edge care for the extraordinary and mysterious new disease called HTLV-111 or AIDS (now called HIV). Daily, its Emergency Department serviced the gay and transgendered community and downtown apartment dwellers. It was also the go to location for the working girls of Davie Street, , the addicted, the jumpers and the homeless. Together, they created a vast cornucopia of fascinating medical problems.

My most vivid memory of St Paul’s featured the gentleman in cubicle #5. Tiny rice grains,I presumed from a dinner tray , surrounded his curtained cubicle, then I noticed them moving gingerly, with purpose. I pulled the curtain back to encounter a fellow of undetermined age, lying on the bed. He suspiciously scrutinized me, eyes flecked with fear. It was then I noticed the same black-headed rice grains swimming around his trouser leg, tiny sailors marooned from their ship. Maggots.

He shared with me the story of his solitary existence deep in the woods under the canopy of Stanley Park. He left, only to forage in the dumpsters or panhandle for a few coins. A hospital visit was a trying and dangerous visit beyond the wall, but necessary, because he had lacerated his leg on a dumpster. The wound festered and refused to heal. Weeks later, a maggot or two appeared in the wound and then it became a handful every morning. He scraped them off each day but somehow they returned.

I removed his solid sock to find a significant wound on his lower leg swirling with a frenzy of fat, industrious maggots. Scooping the local residents off the wound, I was impressed to find a pristine ulcer bed. The maggots had kept this gentleman’s wound as fresh and clean as a surgeon’s knife. Fascinated by the sight, I went from revulsion to awe at the maggot’s diligent expertise.

Why, I thought, don’t we use maggots to clean wounds,? Then I discovered that we do, but not so much in Canada, due to importing restrictions. Specially reared USA maggots that only devour necrotic tissue are raised to debride wounds. In patients with non-healing wounds or burns where other methods are too painful or have not been successful, maggot therapy can be offered.

The man in cubicle #5? His underlying medical problems and his wound were successfully treated in hospital. I discharged him a week later and he returned to Stanley Park, the only place he was willing to go.

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Glamored on to a Bicycle

 

Road biking is a popular sport but few are more enamored than my husband. As I write he is off with his buddies, peddles furiously wind milling for hours on end. He will arrive home exhausted; shrouded in a cadaverous hue, only to inform me that he has had the best time ever. A man with a passion is a dangerous thing, dangerous because he feels compelled to share it with those he loves. In my case, that means I have been glamoured on to a bicycle.

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Handling a lightweight road bicycle can be tricky. High speeds, thin wheels pumped up to impossible pressures, shoes locked into the pedals, twitchy low rise handlebars, front wheels that love to turn sideways with the slightest imbalance, back wheels that are prone to skid out on corners, these features of a road bike all require mastery and that skill comes from practice. It is a simple fact that the more you ride the more proficient you become, the less you ride the more time you spend falling off. As I seldom ride, I know what it is like to hit the ground.

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When a human body protected by onion thin lycra is launched from a moving bicycle, there is a predictable soft tissue outcome. In the lingo of cyclists the resulting damage is referred to as a scuff, or even more endearingly as road rash. Whatever it is called, hitting the pavement is not a benign experience and a few crashes are enough to provide the memory bank with instant recall of the sights and sounds of sharp elbows, knees, hips and shoulders grinding along the highway. Nor is one likely to forget the subsequent date with a stiff brush where raw flesh is scrubbed clean to prevent the asphalt impregnated road tattoo. Once that remarkable experience is over it is a small matter of 2 weeks of stiff muscles and oozing sticky wounds.

 

I have not fallen off the bike this year and that is a milestone. Nevertheless,there are days when I wish my husband’s passion was more pedestrian, one that didn’t involve road tattoo- perhaps fly fishing or golf.

Ressurecting My Father

image 2 copyIn the prairie where dinosaurs have laid their bones, so too are the bones of my childhood. And yet, I admit, I have more knowledge about the past of the dinosaur than I do about my own. So much of my memory of childhood is missing. Sixty years ago my father died in the grasslands, and I have left him there without a voice, absent from my life. But now I am restless. These last few years the whispers of both the ghosts of his past life and my long dead childhood have beckoned me to return to this place and resurrect them, to bear witness to their stories, and let them finally rest. The stories await my arrival, stored in the mind and the heart of my Aunt Rosemary, my father’s only living sibling. Rosemary is the one I need to visit because she is the portal to the past, the keeper of our collective history and our secrets, the ones I long to hear.

image 4 copyMy father died at 26, before his life had started. His death was sudden and tragic, an event that brought devastation. I was 2 years old when my mother barely 24, was a widow and my father was buried. As I grew up my mother and my extended family never discussed my father. For them years later, his passing remained a wound so fresh and raw they were consumed, undone by the whisper of his name. So I learned to never ask. It is only in my seventh decade that I realize the silence has been costly because within it, I have lost a part of myself.

I am half my father, but he is a stranger to me. Who was this man? My aunt knows the answers I seek and during a recent visit she spends 2 days reliving the life she shared with my father. His younger sibling by 4 years, my aunt is the person who knew him the best and she is animated reliving their one-room school adventures. Horses were a big part of their life and on weekends they rode 11 miles in blizzards and sunshine to the Artland train station where the rest of the planet started and their known world came to an end. She sparkles as she shares the tricks they played on others and on themselves and describes my father as very funny, a clever comic. She is solemn when she talks about his health, how his frequent sickness in childhood preceded his fading as a man. Rosemary brags that my dad was tall, handsome, an eligible youth but when he married he blossomed in his role as husband and father. She recounts her brother’s nightly trips with me in tow, across the farm yard to his parents and his brother’s family, so proud was he to have a daughter.

image copySlowly, over 2 days, one story connects to the next and a skeleton forms of my father’s life. The stories allow me a glimpse of my father but it is the rawness and depth of his sister’s emotion in the telling; hushed grief, tears, happiness, exuberant joy, laughter and love that put flesh on the bone of a man previously invisible to me. Through her my father is given a voice and he appears to me animated, alive, a ghost no longer but a man that I would have loved to know. In sharing her memories Rosemary gives me the greatest gift one person can give to another. In the autumn of my life and the winter of hers she gives me back my father. To know that I was well loved, wanted and welcome gives me a certain peace and in turn, the opportunity to reclaim a missing part of my childhood and a chance to put both of our ghosts to rest.