Surviving the Extremes: A Doctor's Journey to the Limits of Human Endurance (7 page)

Schistosomiasis is called “snail fever” because it is a worm disease carried by snails that lie in muddy river bottoms. There they breed the parasite, releasing over a thousand a day into the water. The worms go in search of soft, thin skin they can bore into, such as the webs between the toes of little boys wading in rivers. Like most parasites, they make their way toward the liver. All food absorbed by the intestines is processed by the liver, which is the most nutrient-rich place in the body and therefore the most desirable neighborhood for a parasite. Male and female worms meet in blood vessels near the liver, forming a union that can last ten years and produce several hundred eggs per day. The offspring enter the liver, then, flowing into the bowels, they cause diarrhea, which expels them from the body and, if the toilet is the river, back to the snail. Successful parasites merely weaken their hosts, keeping them sick for years; killing the host would ruin the parasite’s lifestyle.

I treated the boy for dysentery. I couldn’t have treated him for schisto even if I’d been sure he had it. I didn’t have the medicines, which in any case are dangerous to dispense outside a hospital; and even if he were cured, he’d undoubtedly go right back to the same river and be reinfected.

As the family was leaving, the little boy—who until then had not shown much vitality—asked if he could have a tennis ball. The word
had gotten out. We gave him two. Holding one in each hand, he stepped easily into the canoe, satisfied with his visit. Maybe he wasn’t so sick after all.

Another canoe arrived one evening with an emergency trauma. An elderly appearing woman (though it was hard for me to judge age from the faces of these jungle-worn people) had been knocked in the head while attempting to tackle a pig she intended to prepare for dinner. She had been stunned and dizzy at first, and now had a headache. I did a complete neurological exam and then wanted to check her eyes. As I lifted my ophthalmoscope out of the tackle box, I found a cockroach running around inside. I unscrewed the handle of the scope, then used the bottom end to crush the roach. Neither my patient nor my audience of crew members thought anything of this; it was all quite natural to them. I imagined what the reaction would have been had this happened at home. My patient passed her exam easily. This was unsurprising, since she had canoed over by herself. I told her there wasn’t anything wrong with her. “I know,” she replied. “I just came for something for my headache.”

Antonio often watched me work. Once, after I had treated a routine problem, he came to me with a round, spiny fruit called an achiote. He broke it in half; the inside was filled with small, bright-red seeds. At first I thought he was offering me a snack, but then he pressed his thumb into the middle of one of the halves, squashing all the seeds, creating a cup with a red paste inside. He put some on his fingers and painted my face, drawing an upside-down T on my forehead, a line under each eye, and a line across my chin. The dye went on as easily as if he were using a grease pencil. “This makes you a witch doctor,” he said. The Indians watching him laughed. Antonio laughed as well, but I could sense his seriousness; his laugh, I suspected, was to show the younger generation that he understood he was hopelessly old-fashioned. I told him I was proud to wear the markings.

Antonio said that witch doctors used face paint for its psychological effect on their patients and that this was a big part of their medicines’ efficacy. I told him it was a big part of ours too. Our doctors don’t wear face paint, but they do wear white coats, to keep that same separation between themselves and the people they treat, and they
often use a big medical word when a simple one would do, to give an impenetrable, mystical quality to the knowledge they possess. Maintaining that aura of authority is essential, so that a sick person can believe his doctor has the power to make him better. Much as I would have liked wearing my witch doctor paint every time I saw a patient in the jungle, it would have looked silly in a camp full of scientists, amid natives who wore clothes that looked like leftovers from a Kmart closeout sale. Though they had practical value, these garments were exotic artifacts produced in mysterious ways by a culture that obviously controlled powers far greater than those controlled by the local medicine man. Their proliferation eroded respect for traditional customs and polluted the jungle.

In spite of our Western costumes and our comfortable camp, however, we never forgot we were in the jungle. The daily rains and steam-bath humidity turned our
campground
into a slippery, muddy ooze. It was impossible to stay either clean or dry; one by one we succumbed to the allure of the Indians’ bath boat.

Every afternoon the Indians took a canoe out to the center of the lake, soaped themselves up, and, to our astonishment, dove into the water to rinse off. We had caught, and released, more than enough crocodiles to know what was in the water with them. Moreover we had been catching and eating piranha and weren’t anxious to give them an opportunity to get even. Yet the natives swam about unconcerned. They live here, we reasoned; they must know what they’re doing. And anyway, we were so hot, dirty, and uncomfortable that suicide in the lake was starting to look like an option. Their explanations made sense—or perhaps we were ready to believe anything. They told us that the crocodiles, dangerous as they are, spend the day in the shallow grasses along the shore, only venturing to the center of the lake at night. As for the piranha, they are meat-eaters with razor-sharp teeth that intermesh to close like a bear trap. They’re small but travel in groups of thousands. Piranha sense blood, and when they’re hungry it drives them into a frenzy. They can strip a mammal to a skeleton in minutes. (So far, their words were not too reassuring.) However,
they added, during the rainy season the lake expanded, and fruit trees that were on land during the dry season were now standing in water, dropping their fruits into the lake where the fish can reach them. Piranhas much prefer fruit to flesh, so as long as they remained finicky eaters, there was nothing to worry about.

Several of us hitched a ride on the next bath boat, preparing to dive in before we came to our senses. First the Indians pounded the lake bottom around the canoe with long poles. This was to chase away any stingrays that might be lurking in the mud, we learned. A stingray has a tail longer than its body, and at the end of it sits a rigid stinger lined with barbs and coated with venom. The tail acts as a muscular whip, propelling the harpoonlike stinger deep into whatever disturbs it—such as, for example, the foot of a doctor desperate for a bath. The injected toxin causes severe pain and significant tissue damage. It can even be lethal, though rarely. I had heard that holding a lit cigarette near the wound was very effective in relieving symptoms because the venom is heat sensitive, but no one on the boat smoked and, all things considered, I thought it wiser simply not to step on the bottom.

The natives didn’t seem concerned about still another inhabitant of these waters—the electric eel. I was determined to swim, so I decided a visitor could ignore it too. The eel can grow to 9 feet in length and is mostly made of muscle. Every animal’s muscles produce some electricity when they fire, but the eel native to the Amazon basin has modified its muscles to produce a lot more. Plus, they’re hooked in series so the voltage is additive. When it’s annoyed, the eel can produce a 500-volt electric field around itself. The Indians say they feel a tingle when one of them swims close by. You don’t have to touch it to be electrocuted—you just have to violate its personal space.

We were all ready for a carefree swim. Just as we were about to dive in, Bill said, “Okay, no skinny dipping.”
Who asked him?
I thought. Although our canoe was coed, I seriously doubted that anyone would have minded, or even noticed, considering how many other things there were in this lake to occupy our minds.

I hit the water and it felt great. Amazon water is very soft because the soil through which it runs is mineral-poor. The swim was so refreshing, I couldn’t help but relax. I didn’t want to get out of the
water—until something suddenly grabbed my leg. I recoiled, ready to fight for my life. My first thought was
Can I reach the boat before the crocodile pulls me under?
My second thought was
These Indians are real jokers,
as I saw one surface in front of me, laughing.

I got back on the boat anyway. Bill was there already. He said he didn’t know how any of us would get our underwear dry. “If you hadn’t said, ‘No skinny dipping,’ ” I pointed out, “we wouldn’t have the problem.”

“It’s not because I’m a prude,” he replied. “It’s because there’s candiru in this lake.”

Just the thought provoked a sharp pain in my groin. The candiru is a kind of catfish, about the size and shape of a toothpick. Attracted to salt, such as that contained in the urine within a human bladder, it is small enough to swim through a male or female’s genital opening and get lodged in the urethral tube. The fish’s stiff pectoral fins angle backward; there is no way to pull it out. It has to be removed surgically. So a little modesty can be good preventive medicine.

These medical facts I was already familiar with, but Berullio volunteered some additional information. He swore that the fish’s attraction to salt was so strong that he had once seen one swim up the urine stream and enter the penis of a man peeing in the water. I dismissed the story as an example of an Amazonian Indian having fun with a credulous American doctor. Yet competition for survival within this lake was desperately fierce. Only highly developed adaptations kept players in the game. The anopheles mosquito, black caiman, schisto worm, stingray, and electric eel have each found its own unique way to succeed. So has the candiru, whether or not it can swim up a urine stream.

Survival in the Amazon requires everything from wearing underwear to learning how to handle poisonous snakes. Coming back from the camp latrine one evening, I was about to step over a bent branch hanging low over the trail when suddenly it moved. I caught my balance, stopped in my tracks, and felt my heart palpitate. My headlight illuminated a deadly black coral snake. It was coiled around some leaves, holding its
head out and straight up in the middle of the trail about a foot off the ground. It had a tiny ugly white head and a body of alternating bands of black, orange, and yellow that stood out against the green leaves before disappearing in the dark underbrush. The sharply contrasting colors, lit up by my headlight, made the snake hideously attractive—almost transfixing—while it rhythmically bobbed its head up and down and flicked its tongue. I had caught its attention, and it had definitely caught mine. But there was no need for us to scare each other. I stepped back a few paces, made a very careful semicircle, and then hurried down the trail to camp.

The snake was still there when I returned a few minutes later with Antonio and several others. Antonio poked at it with a long branch, got it to wriggle onto the bushy end of it, and carried it back to camp, laying it on a log next to the dining table for everyone to look at. Then he killed it. With one whack from his machete he separated the head from the body. I jumped at the unexpected violence and looked questioningly at Antonio.

“No way to tell if it was poisonous, and too close to camp,” he explained.

Pushing the back of the snake’s head against the log with one hand, he poked at the mouth with the end of a banana. Though the head was completely detached, it bit down viciously into the fruit. The survival instinct lived longer than the snake had.

Antonio was not one to let a good snake go to waste. He turned the body over, slit the belly open, and scraped out some highly un-appetizing ingredients, which he collected.

“Much easier to skin a snake when it’s fresh,” he said.

I wondered how anyone could eat that goop, and Antonio caught my look of revulsion.

“Not for eating,” he said. “For bait.”

I was reassured, but then he added, “Too small to cook.”

Just the head was left on the log now, still clamped onto its prey. With some difficulty, Antonio extracted the banana and showed us the bite marks. There were two rows of dots that nearly formed an oval, and at one end, just outside the oval, were two large holes—the teeth and fang marks of a poisonous snake. I would have liked to examine
the head further, but Antonio said it was still dangerous and threw it into the jungle. I thought he meant it could still bite, but he said, “Snake heads can cast bad spells.” He didn’t seem to be joking.

After dinner, sitting around our campfire, Sebastian told me the terrifying story of an encounter Antonio had had with a snake many years earlier while working for some geologists from an oil company. His job was to guide and protect the vulnerable strangers who, like us, had no chance of surviving on their own. They were carrying out the kind of work that was destroying his homeland, but Antonio saw no conflict. He had learned from his ancestors that the environment always recovered, and had seen this for himself his entire life. He didn’t realize that this time he was opening the door to a civilization with far more destructive force than anything he could imagine.

One cool night in that tiny jungle-encircled oil camp, Antonio was asleep on the floor of his tent, wearing loose clothes and lying on his back between two blankets. He was awakened by some wriggling around his ankle followed by the unmistakable sensation of a snake slithering up his leg inside his pants. He felt its full weight as it coiled up to rest on his stomach. Reflexively, Antonio pulled the blanket off, but the snake was under his T-shirt. Snakes are cold-blooded, meaning that their body temperature depends on their surroundings, and on cool nights pit vipers have been known to enter tents in search of warmth. A pit beneath each eye acts as a long-range infrared heat sensor, easily able to detect the warmth coming out of a tent. With its ability to distinguish temperature variations as small as 1°F between its right and left pit, the snake can target any heat source and home in on its warmest part; in this case, Antonio’s stomach, just below his heart. The snake had only been seeking a comfortable place to rest and had no intention of biting him. But snakes, though deaf, are exquisitely sensitive to motion or vibration. Antonio knew that if he changed position or called out, the snake would interpret it as an attack. If it were going to strike, it would lift its head up, as if cocking its upper body, before plunging its fangs forward and down faster than the eye can see.