Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance (11 page)

The boy on the roof had been quietly weaving thatch the whole time we were drinking
chicha.
Now that we had finished, Antonio called him down. To my surprise, I discovered that he was my patient, Hermanigildo. No bandage, no splint, and apparently no problem. I asked the sister how long ago they had stopped following my instructions. She said just yesterday, but patients will always say that no matter how long it’s actually been. She had given me precisely the same answer I get all the time from noncompliant patients in New York. The surgery had been two weeks earlier. I wouldn’t have been surprised
if the bandage and splint had come off the next day. When I asked the boy about the bandage and the splint and the antibiotics I had given him, he looked at me blankly.

They had ignored all the advice I had given them. They knew better than I that my instructions, which were what I would have given a patient back home, did not apply here. The Indians believe in seeking cures, from witch doctors or otherwise, but societal pressure prevents them from doting on a wound. The exigencies of the jungle simply do not allow it. That kind of luxury can only exist in societies with much thicker protective barriers. In a small group, in which survival is a full-time job for each member, those unable to pull their own weight cannot be carried for very long without endangering the whole group. Individuals adapting to their environment must also, therefore, adapt to the rules of the group that provides their protection. The harsher the environment, the more stern and unyielding its rules; the group must do what is best for the survival of the species, even at the cost of the individual. The principle of preserving genes, which motivates altruism, also works in reverse to motivate baser instincts. To maintain the gene pool at large, it is sometimes necessary to detach a small portion when it drains a disproportionate amount of resources. In practical terms, an Indian boy has to learn to take care of his injuries himself because the tribe can’t afford to do it for him for very long.

There wasn’t enough light in the hut for me to examine Hermanigildo’s wrist, so we moved out onto the porch, though the light there wasn’t much better; an aluminum pot in the corner held a smoldering fire that was filling the porch with blue smoke. I put on my headlight. Judging by the amount of dirt ground into the palm, the bandage had been off for quite a while, but the wound had healed well. The boy held his hand in a normal posture, not like a wounded paw, and he lifted his wrist readily. Children heal quickly; yet I felt something else was at work here. The need to survive generates a positive force within the body—actual physical changes that intervene to alter the course of a disease or to speed up healing. It’s well known that positive thinking promotes health. People heal faster, live longer. Whatever influences the mind to generate that force—a placebo, religion, will, word of honor, desperate circumstances—the effect is the
same: the ability to recover from injury is improved. It is a crucial adaptation to any extreme environment.

The sutures were ready to come out. Unlike the ant heads that Antonio had put in his finger earlier that day, these would not fall out by themselves. I took out my forceps and scissors to begin work. Then I had an inspiration. I took out the achiote paste left over from this morning when Antonio had insisted I spread some around my ankles. Before removing the sutures, I carefully painted my face with the same red lines Antonio had designed for me. In this setting, at this time, it seemed to fit, though no one reacted outwardly.

The sutures were removed and the wrist was working; it was still a little weak, but there is no Indian word for “rehabilitation therapy,” and anyway, the jungle would provide all the motivation and exercise Hermanigildo needed. I had repaired his broken parts, but I had not made them heal; that he had done himself. I thought there was nothing left to do, but I was wrong. The boy was waiting for the rest of his treatment.

Amazon Indians live in a natural pharmacy, and each tribe has found remedies for the diseases they all face. From tribe to tribe, however, the same botanical specimen may be used to treat very different conditions, and conversely, different plants may be used to cure the same disease. The reason lies not in the plant’s chemistry but in the aura it creates for the patient. Even if the plant has no physiological properties, the belief that it does can give it real power. When that belief is reinforced by ritual, the treatment will be even more effective.

Antonio had gone outside while I was finishing up. He returned a few minutes later with a branch from which sap was seeping from the cut end and he dabbed it on the wound. Then he crushed some of the leaves in his hand, sprinkled the powder onto the sticky sap, and rubbed it in. The boy had been waiting for that step; he left contentedly. His sister told me that Hermanigildo had been receiving this treatment from none other than Antonio, who had been making twice weekly visits.

“He wanted the sap, and he wanted me to put it on,” Antonio said. “Your pills are good too, but sap heals faster.”

I nodded my approval, though I felt the effect was due not so
much to the ingredients as to the act of applying them. Treatments may vary, but the need to inspire confidence—whether the technique begins with a white coat or red face paint—is universal. Antonio understood this as well as I. He said, “I can cure my people because they believe in me.”

Our work on the porch had attracted a crowd of children who were watching us from below, one of them steadily bouncing a tennis ball off his head. Like the cartoon stickers distributed by the nurses in my office, the tennis ball had gone a long way toward breaking down the fear all children have of doctors. This group seemed to be waiting for me to play ball with them. Then something more interesting caught their attention. They heard yelping, and ran off.

Having suddenly lost my audience, I went to see what the commotion was about. Antonio followed me. The children had gathered at the edge of the clearing, around a dog lying in the brush. The yelping had stopped. Tremors were passing through its body and combining to form waves of convulsions. It was bleeding from its nose. Then it vomited bright blood and stopped moving. The children quickly lost interest. Only Antonio and I remained at the spot. I asked him what had happened. He shook his head and replied that some of the children were careless. They had gone out hunting with their blowguns that morning, having tipped their darts with a dart-frog poison and curare. For every animal, the Indians know the specific mixture of poisons that kills fastest and best. The quantity placed on each dart has to be carefully measured: enough to bring the animal down quickly but not so much that it spoils the taste or makes the meat dangerous to eat. The part of the animal around the dart is cut out before eating because it holds too much poison.

Out hunting monkeys, the boys were unable to hit any, so they settled for a toucan. The bird was shot with a dart made for a much larger animal, hence its whole body was poisoned. The boys knew the toucan was inedible and threw it into the brush. But not far enough away from the hungry dog, which had tried to eat it. Parts of the mauled bird were lying around the dead dog. It was a gruesome scene, but an amazing display of the power a natural poison could have. That poison had been extracted from a living plant and a living frog, in
which it had caused no harm, yet a small dose had been enough to kill a bird instantly and, after diffusing throughout its body, remained strong enough to kill within minutes the dog that tasted it. Antonio saw that I was intrigued.

“I’ll show you how it is made,” he said.

He led me to the edge of the village clearing, but before we started our tour around it, he removed from his pouch a few seeds from the fruit we had eaten for lunch, dug a shallow hole, and casually dropped them in. I looked around us and realized that what had first appeared to be a random collection of plants and trees was actually a peripheral garden, supplying not just food but medicines, fabrics, and building materials for the families within. They had modified their personal space in the jungle. In a small way, they were adapting the environment to them rather than the other way around.

The garden served as the village pharmacy, a renewable storehouse of medical supplies; and Antonio, though not a shaman, was a repository of knowledge about medical and magical cures for the body and the spirit. As we walked, he pointed out plants used to relieve pain, heal infections, and get rid of parasites. The bark of one tree on which he rested his hand was useful as a treatment for rheumatism; its leaves offered a cure for diarrhea. Antonio explained that red saps were good as disinfectants, while white ones treated upset stomachs. (It struck me how the colors matched those of iodine and milk of magnesia.) I learned that the root of the gumbolimbo tree relieved “women’s pain,” which I took to mean menstrual cramps, while its bark treated “men’s and women’s pain”—urinary infections. There was a leaf used to overcome electric eel shock and another for stingray barbs. Antonio uprooted the bulb of a small tree and declared that when fed to a dog it improved the animal’s ability to hunt. He smiled when he pointed to one delicate plant with long slender leaves. “If you make this into a tea and serve it to someone you love, that person will fall in love with you.”

We walked a little way into the forest so that Antonio could show me an ampiwaska vine. Wrapped around a tree was a green woody vine with red berries, pink flowers, and leaves that looked like those of a philodendron. How odd it was to see unassuming houseplants
thriving in the jungle, but in fact this is where many of them come from. They’re suitable to bring indoors only because they’ve had thousands of years to get used to high heat and low light. The conditions here are similar to those in a house, so the transition doesn’t require any sudden adaptation, something no species is good at.

The inner surface of the ampiwaska bark, Antonio explained, is scraped off and mixed with water, then filtered through banana leaves. The resulting amber liquid is boiled down to a paste. This is the prime ingredient for curare—a useful but dangerous drug I was quite familiar with as a muscle relaxant during surgery; given in too high a dose it causes death by paralyzing the respiratory muscles.

Antonio showed me several other plants that he uses in his recipe for dart poison. Each had a specific purpose: one made the poison enter the bloodstream faster; another made it stick better to the tip of the dart; a third appeased the spirit of the dead animal. As far as I knew, none of those plants had been laboratory analyzed, but I did recognize one ingredient from my surgical practice—a leafy plant rich in coumarin, the chemical used to make Coumadin, a medicine that prevents blood clots. Antonio adds it to the curare because once an animal is hit, it ensures that its bleeding doesn’t stop.

Antonio varied his recipe depending on which animal he was after, employing the leaves, sap, or bark of anywhere from three to fifteen plants. What he considered most essential, however, was an ingredient that doesn’t even come from a plant: frog poison. The children collect the frogs as needed by grabbing them with big leaves to protect their hands. They are easy to catch because they’re not in the habit
of
hiding and don’t have much fear of predators. Antonio said he’d been using a frog that he still had in the hut. I reminded him that he had told me he usually hunted with a rifle. “Yes,” he admitted, “but lately I’ve been unable to get any ammunition.”

A rifle is an intruder in this ecosystem—made of materials that do not grow locally and based upon technology beyond the comprehension of the people who live here. Like any invading force, it is capable of radically disrupting the environment, but it needs a supply line for ammunition and replacement parts, and so far the jungle terrain has limited its spread. The blowgun, on the other hand, is a natural outgrowth
of the jungle. Given man’s clever mind but weak physical abilities, combined with his need to obtain food using the materials around him, its creation was inevitable. It represents a renewable resource: the expertise to make it gets passed down through succeeding generations of humans, and the materials from which it is made are replenished by succeeding generations of plants. The blowgun is a weapon in harmony with nature. But rifles are easier to use and more powerful, and in a clash of cultures the deadlier weapon always wins out. It is just a matter of time until the older tool for food-gathering is replaced by the new.

Leaving his biological warfare section, Antonio wanted to show me another department of his pharmacy, though the plants involved were scattered here and there among the others, and some were quite a distance from the clearing. He led me to a thin interlacing vine that rose up around a tree trunk in neat, regular coils. “Ayahuasca,” he said. This vine is well known to Amazon Indians, field botanists, and lab scientists alike because of the alkaloids it contains.

Alkaloids are chemicals that plants have developed as weapons of survival. Plants cannot run from predators, but they can practice chemical warfare. The alkaloids in ayahuasca are powerful nerve poisons with startling side effects. A preparation from its bark is capable of producing intense visions in multiple colors. Its alkaloids prevent the breakdown of neurotransmitters—those substances that temporarily float across the gap between two nerve cells to allow an incoming electrical pulse to “spark” across and continue on its way. They are supposed to break down immediately after the spark and re-form only for the next pulse. That way, one nerve stimulation leads to one signal transmitted. Should the neurotransmitters remain in place, however, they will continue to stimulate downstream nerves and so create a flood of sensations. One major neurotransmitter, serotonin, a naturally occurring substance in human brains, gives a feeling of well-being. Too low a level causes depression; too much leads to euphoria. Ayahuasca doesn’t make serotonin, but its alkaloids prevent serotonin from breaking down after it has been used—recycling it, keeping it in the loop, and allowing it to transmit far more signals than are actually arriving at the nerve. Under the influence of ayahuasca, the effects of
natural outside stimulation—a sunrise, a birdcall, or a waterfall—are multiplied, distorted, and intensified into hallucinations. When artificial stimulations are intentionally added—ritual music, dances, and frightening masks—the effects can be overwhelming.