Thursday, June 30, 2011

Bug Season

I work in an area where there’s lot of hunting and fishing, so I’ve become familiar with the “seasons of the kill.” Right now it’s between seasons in the field, but within the ER Bug Season is in full swing. Bug Season is that time of year when bugs wander into people’s ears and people wander into my domain wanting the bug out. It’s something that’s unique to early summer, and all I can figure is that the bugs, attracted to the porch light on a summer’s evening, suddenly realize they’re gravitating towards the Bug Zapper of Arachnid Doom and think better of it, ducking into the nearest dark spot they can find, knowing full well that if they think twice about it they’ll finish that run to the afterlife. (See Marty Robbins, “El Paso.”)

Those whose ears have been used as insect refuge usually drift in about two in the morning. I’ve never had a bug in my ear (other than the metaphorical one), but it seems to be one of the most excrutiating things imaginable. The skin of the ear canal is paper thing and loaded with nerve endings, so the motion of the bug causes severe pain. In addition, the wafer of skin cells lies directely on top of bone, and bone conducts sound better than air. So every little flicker of the bugs legs or wings is not only felt, but heard as a loud, interminable grating noise. So when you consider that the bug is susally still alive, feet and feelers looking for traction and wings beating against the eardrum…you can get a sense of why getting the bug out constitutes an emergency that even I, with my low tolerance for anything less than an actual acute illness or injury, would recognize as worthy of an ER visit I the wee small hours of the morning.

There are a couple of ways to do this. One is to try to wash the bug out. This usually never works, as most people have already tried it at home and if the bug was dead, it came out. They’re in the ED because the bug, having tenaciously fought the deluge, is still thriving, damper but cleaner. So you have to kill the bug, and the best way is to drown it with some kind of oil of a solution of viscous lidocaine, a thick local anesthetic gel that you squirt into the ear canal and let it sit for ten minutes or so. Then you try to irrigate out the ear again, but this time using an IV catheter and a syringe in order to get a high-pressure blast of water in there. With any luck, the bug pops out. You hope it does, because the expectation from the patient is that you will then dig in the ear for the bug. You try to talk them out of this because a) it’s painful, b) it never works, and c) you’re just going to send them to an ENT guy the next day who actually has micro bug-out-of-orifice stuff in the office. The patient will want the bug out now, so you make a couple of half-hearted blind stabs (we don’t have the kind of ear instrument or scopes that allow you to look in the ear canal as you’re working, nor tools fine enough for the work), which results in more pain and quite likely a little bit of oozing of blood form the ear as you scrape the inside of the canal. You apologize profusely, show the patient whatever you’ve gotten out of the ear (a feeler, a leg, a bit of wing, a strangely shaped piece of wax) to demonstrate some progress, tell them that all bleeding stops eventually, and refer them to the ENT guy on the morning. Which is, of course, what you wanted to do in the first place.

Sometimes bugs beat the odds, and are just slowed enough by the attempted drowning to be flushed out, but still able to make a valiant attempt to get away once they’re back in the light of day. They pop out of the ear canal into a basin of water, often in tatters, their little feet struggling to bring them up for one last breath. It kind of makes you feel for the bug, as you witness their last gasp of buggy life. I was watching this Mutual of Omaha Wild Kingdom struggle for survival and remarked, in what I thought was a fairly deep moment for someone who had eaten nothing but six Hostess Twinkies, three Cokes, and a piece of Hampton Inn Free Breakfast Sausage in the past 36 hours, that the poor creature was “drowning in the waters of his own despair.” So for some reason now all the post-ear bugs in the ED are called “Howard Junior,” and I’m wondering if it’s time to start saying Kaddish for them. But given the way I long to have things named after me, I hope it sticks no matter what the bug’s personal faith tradition might be.

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