nose leech

Long but impressive.

Forwarded-by: "Joseph \"Jofish\" Kaye" <wbsvfu@zvg.rqh>
Forwarded-by: Michael Hawley <zvxr@zrqvn.zvg.rqh>
Forwarded-by: Seth Alves <nyirf@Uhatel.PBZ>
Forwarded-by: ari@obfgvp.pbz (Nev Dull)
Forwarded-by: "Geoffrey S. Knauth" <txanhgu@ooa.pbz>
Forwarded by: Tom Schuneman <rys@jnirznex.pbz>

A True Story from the Himalayas

Anxious and distracted, I gripped the table leg where I sat in a
tea stall pigeonholed in Kathmandu's noisy and crowded central
bazaar. I tried to concentrate.  A boy wearing rags patched on
rags stepped from behind the counter and, balancing a trayload
of tumblers of milk tea, set a glass at an adjacent table.
Then, he looked at me. It was there. Something was crawling out
of my nose.

The boy froze as if electrically shocked.  Dropping the tray, he
ran from the teashop, fleeing as from the curse of the Hindu
demoness Kali, Shiva's wrathful manifestation, whose gaze alone
can mortify armies.

So, it was real, after all.  Reflexively, I leaped up and over
the spilled and broken glasses, and found the boy half-crouched
and trembling against the wall of a nearby building, burying his
head into his folded arms.

"What did you see? What did you see?" I asked him intently in
Nepali, wanting to grab him and shake out an answer, or
sympathy, perhaps.  I felt as frightened as he.  Shielding his
eyes from mine, he ran from my voice, head down, arms pumping,
through the alley and across the next street.

My thoughts raced, trying to piece together the chain of events.
 I prayed that the ordeal that began eighteen days earlier in
the American Peace Corps office in Kathmandu might at last be
nearing an end.

Recently graduated from college, I was a Peace Corps volunteer
posted in Nepal, monsoon season, 1975.  As I relaxed on the
couch in the office lounge, reading my mail, a drop of blood
splashed onto an aerogram from home. I looked up, unable to see
where it came from. More drips appeared, from my nose, bloodying
my fingers.  Not again, I thought -- not an early symptom of yet
another exotic Asian disorder.

I had recently returned from a trek to Mt. Everest base camp.
In my mind I reviewed the trip -- the 18,000 foot altitude, the
thin, crystalline air, the simple meals of well-cooked,
bullet-resistant buckwheat pancakes, and the cold, refreshing
mountain spring water. At lower elevations, to drink untreated
water, even if clear, would risk infection with hepatitis,
typhoid fever, giardia, amoebae, and other parasites.  But I
disliked the taste of iodine pills, and a vigorous thirst could
overcome my caution if the water looked as if it originated in a
mountain spring.  I had come to accept that, in Nepal, disease
was an occupational hazard, and doctors, if available, often
prescribed a shotgun treatment of broad-spectrum drugs.  Risky
place, this corner of Asia, I pondered while standing in the
hallway, staring blankly at an outdated notice on the bulletin
board.

Barney, the office doctor, stepped into the hallway.  I said
hello, but did not mention the brief nose bleed, afraid it might
arouse too many questions. Barney was a pediatrician. Nepal, and
tropical medicine, were new assignments for him. Each case he
saw seemed to set off an imaginary beeper, allowing him to
escape, scratching his head, to a medical text in his study.
Generally, he would select an overweight volume, heft it onto
the examining table, then read and re-read passages aloud to his
patients, becoming more indecisive with each rendition.  The
volunteers referred to him by the nickname of "Ke Garne" ("What
To Do?") Barney.

Anyway, my nose had stopped bleeding.  But when I bicycled
through the bazaar to my apartment, it began leaking blood
again, continuously, for 20 minutes.  The next afternoon, I went
to a tree farm to request seedlings for the village where I
taught school. There, my nose dribbled again. Not knowing what
to do, I held a handkerchief to my face like a shy,
about-to-be-married Hindu woman hiding the terror and shame that
she pictured awaiting her.  The following day, still bleeding, I
saw Ke Garne Barney.  He examined my nose with his nasoscope,
and speculated that my nasal membranes might be weak, perhaps
aggravated by the dryness and cold of high altitude.  He gave me
a bottle of neo-synephrine, a thumbs up, a good handshake, and a
return appointment.

I gave the neo-synephrine a full trial, for three days, though
from the first application my nose only seemed to bleed more.
Each day, it bled in painless, erratic spells. It dripped in the
evenings, but not while I slept or, unaccountably, until ten in
the morning. I remained in Kathmandu, reluctant to return to the
village where I was posted. Even without nose problems, to most
villagers I was a strange enough apparition.  I knew what they'd
do with me: direct me to the shaman, who would likely deduce
from a diagnostic trance that I had been infected by the hex of
a witch with reversed feet, requiring that I shave my head and
sacrifice a water buffalo to Narayan, an incarnation of Vishnu.
Fine, but on my Peace Corps allowance I couldn't afford a water
buffalo.

"Well, I might have to cauterize your nose," Barney suggested on
the fourth day.  "I can't think of what else to do."  The
neo-synephrine hadn't worked, and he could see no irritant.

"I'd like to wait," I told him, adding that I had heard that
noses didn't smell as effectively after cauterizing.

"Well, yeah, I've heard the same thing," he shrugged in
agreement.

Eight days of chronic bleeding.  Rumors surfaced that Barney had
misdiagnosed some patients, the positive side of which was that
they got medically evacuated to Bangkok, a great place for
overcoming homesickness. I needed another opinion, but during
the monsoon Barney was the only Western-trained doctor in town.
Perhaps Warren, a scholar friend who lived downstairs, would
have an idea.  Warren's guru was a Buddhist priest of the Newar
ethnic group, and the man practiced traditional Asian medicine.

On our Chinese one-speed bicycles, Warren and I threaded through
the bazaar to the pharmacy and clinic of Dr. Mana Bajra
Bajracharya. Descended from a 700-year lineage of Royal
Physicians, "Mana" practiced Ayurvedic medicine, an empirical
science described in the Vedas.  It works by treating
fundamental imbalances, rather than symptoms, by realigning the
body's complementary elements of nerve, mucous and bile.  Mana
had earned a thick volume of testimonial letters from around the
world -- thirty-two years' worth -- extolling his cures for
diabetes, hepatitis, arthritis, multiple sclerosis, sexual
dysfunction, and cancer.

Sitting in the waiting room, Warren assured me that Mana would
have a safe and ready treatment.  Aging but animated, the doctor
appeared in the vine-framed doorway.  He summoned me into his
examining room. Dr. Mana performed a thorough Ayurvedic exam,
which included reading my pulse and turning my eyelids inside
out, presumably to search for clues in the sound and pattern of
blood vessels.  Mana's diagnosis was similar to Barney's, but he
was puzzled by the duration of the bleeding.  He prescribed
aloe, an herbal astringent. That didn't work, either.

Fourteen days.  The total loss of blood was not serious, but I
began to question whether I would ever be normal again, as
victims of chronic hiccoughs must feel, longing for rest.  I
wondered if I should have my nose cauterized, after all, or be
evacuated to Bangkok or Atlanta's Center for Disease Control.
Perhaps the village shaman should be sent for. I couldn't
concentrate, saw fewer friends, stammered slightly, and
experienced jarring flashbacks of college psychology case
studies of deviants, and of cautions from the U.S. Government
shrink who screened me in the U.S.  Long periods of isolation
from that which was familiar, they all said, could induce
hallucinations, or worse.

On the eighteenth day after the first nose bleed, I bicycled
down a cluttered, medieval side street of the central market.
Thankfully, my nose hadn't dripped in several hours.  But from
the corner of my eye I thought I saw something emerge from my
right nostril.  I reached for my nose, which felt normal.  I
continued pedaling, presuming it to be a piece of coagulated
blood.

There it is again.  Then gone.  Yes, something is in there, and
it's working its way out.  A panic flushed over me.  My nose
grew large in my field of view, and the world beyond my face
diminished.

I needed to have this sighting confirmed by someone, by an
earthling not yet infected.  But if this thing was part of a
generalized, insidious infection, I feared, people might not
tell me the truth. I pulled over to a teashop, ordered a glass
of tea, and waited. Again I saw a blurred form, but felt
nothing.  That's when the boy in the teashop saw it, too, and at
terrifyingly close range.

Dumbfounded, I stood in the alley beside the teashop, watching
the boy run off.  I paid the startled shopkeeper for my tea, and
the spilled tea, and biked back to my apartment.  In the bedroom
mirror there was only a nose, a normal one.  I drew up a chair
and positioned myself squarely in front of the mirror, hands
cupped on my knees, resolving to watch my nose until I saw it,
the thing.  For a quarter hour, self-conscious but purposeful, I
focused, a hunter stalking himself.

Then, as if trying to catch me unaware, a long, brown, eel-like
creature slid out, silently, offering no physical sensation at
all. Guardedly, it scanned the air and retracted, leaving no
trace.  The probing tentacle of a monster.  Kali.  An
hallucination, a mirage. I momentarily felt non-human, an alien
sent to earth on reconnaissance to test the spiritual or
intestinal fortitude of those who dared look at me.  I would not
last long in this incarnation.  I would be captured for
dissection by the world's scientific community. "War-ren," I
called haltingly.  Warren ran up the stairs, perceiving from my
voice a turning point.  We met in the bathroom, where his
initial skepticism turned to dread.

"Eee . . . Yaah!" Warren exclaimed in unique, guttural sounds,
appropriate for what we were beholding.  He held his hands up,
preparing to fend off the worm-like organism should it escape
from me and head in his direction.

Experimenting, I found that, somehow, handfuls of water splashed
up my nose drew out the animal a finger's length, weaving and
searching.  I tried to grab it, but was unable to touch it
before it withdrew. Warren tried, his face distorted in
trepidation and disgust, betraying his stoic military school
training.

We couldn't even touch it.  Our index fingers and thumbs were
poised closely at my right nostril, but the slippery form
retreated before either of us could pinch closed on it. Sensing
any threat, the thing disappeared. We were horrified -- Warren
more than I;  my hormones of self-preservation had overtaken the
hormones of fear.  So this was why I had found it strangely
easier to inhale than to exhale through that nostril: the thing
had formed a kind of a valve in there.

It was Sunday.  Barney's day off.  The American medical clinic
was closed except for emergencies, which were discouraged.

"Let's go see Mana again, now," Warren proposed.  He was
confident that Dr. Mana, though he missed the diagnosis, would
at least recognize the thing itself.

We bicycled through a bazaar teeming with busy, unconcerned
mortals. Like a Tibetan chanting his mantra, Warren rhythmically
intoned "I don't believe it, I don't believe it," synchronizing
the don'ts to each pedal stroke.  I repeated the familiar
Buddhist mantra, Om Mane Padme Hum, but it came out sounding
more like "Oh Mommy Take Me Home."

Mana motioned us into his study, an extension of his examining
room. Demonic, cryptic charts peered from the tops of cabinets
overflowing with unbound ancient texts.  Glass cases lining one
wall were filled with odd-sized, murky bottles of tonics with
Sanskrit names.  I thought I saw my name on one of the bottles.
Mana said a few words in his tribal language to the gnomish
compounder, who was wearing a smock caked with herbal and
mineral -- and what looked like animal -- residue.  He then
turned to serve tea, assuming we had come to discuss a
publishing project Warren had been helping him with. Warren
stated that this meeting was of much greater urgency, then
explained my situation.  The thing was hiding. Perhaps it would
burrow into my brain, or lay eggs.  Ungraciously, Warren let out
a spacious laugh.

"None of this is possible!" Mana interjected with customary
confidence. "Thirty-two years I am a physician in Nepal, and I
have never seen a worm in a patient's nose!"

I hadn't, either.  "Watch this," I rejoined, equally
confidently, though my voice was breaking.  I asked Dr. Mana to
call for some water, and we stepped into his courtyard, a square
of buildings that housed his herb stores, compounding
laboratory, and apartments of his extended family. His
grandnephews and nieces ran about in carefree play until the
compounder arrived with a glass.  I squatted down. Mana and
Warren followed. The children stopped playing.  I poured water
into my hand and tossed it toward my nose.  The thing came out
on cue.  Startling us, Mana jumped up, hands and fingers
writhing, eyesrolling, face contorted.

"Aaahhh!" he cried, as if in anguish himself.  "It's a leech!"
A leech. A lurking, tenacious bloodsucker, evoking the quivering
agony of Humphrey Bogart wading through a carnivorous,
parasite-infested, uncharted African river -- an animal that had
found its refuge, a human host, where it could develop, mature,
lay eggs, and finally emerge as an evolved, aggressive, and no
doubt hungry, life form.

Villagers had told me that leeches are inauspicious even by
themselves, but by manifesting one in my nose I had been
transfigured into an evil spirit of semi-human form.  Even the
children recognized it.  Panic propelled them from the
courtyard, running as if from a ravenous, multi-armed deity that
subsists on small children.  Women leaned from the courtyard's
upper story windows and promptly latched the shutters, then
climbed to the flat rooftops and called their neighbors to
clamber over, across the roof -- not at ground level -- to see
this from a safe distance.  I felt a chill, and shivered
uncontrollably.

Mana ordered tweezers, salt, and more water, figuring that the
salt, a good leech repellent, might cause it to release. We
squatted again. I splashed salt water into my nose.  His
tweezers could not touch the leech.  He tried several times
again.  The salt water only caused it to retreat further inside.

"I don't know what to do," he confessed, frustrated that the
case had seemed to defy his entire Ayurvedic medical tradition,
and do so in front of his family.  "I give up. Maybe your
Western doctor has some kind of suction machine." Genial in
defeat, Mana desired only that it be removed any way possible.

I called Barney at home from the phone in Mana's waiting room.
Excitedly, I described the events, though perhaps not in the
order they occurred. Yes, a leech stuck its head out of my nose
when I splashed water up it, but it always disappeared before I
could touch it. I asked Barney what he thought.  There was no
response.

"Are you there?" I asked into the telephone.  It was not
uncommon for phone calls in Kathmandu to be disconnected.

"Yeah, yeah, I'm here."  Barney didn't like surprises.

"Well, what do you think?"

"This is difficult.  I don't know what to say, exactly, except
that I... I'd like to make an appointment for you to see the
Embassy psychiatrist."

Ke Garne.  I covered the receiver with my hand.  Barney had
decided that I was a drug- or culture-shocked deep end case --
another not uncommon feature of Kathmandu.  I needed someone to
corroborate my story, a respectable witness. Mana was busy
calming his extended family, who were peeking over the rooftops,
worried about contagion; Barney would probably figure Mana as a
quack, anyway.  Warren, a long-haired, unemployed U.S. Air Force
Academy dropout, might not qualify, but he occasionally did
construction work under contract to a branch of the United
Nations.

"I have a U.N. contractor here, his name is Mr. Warren Smithson,
and I'm going to put him on," I said resolutely to Barney.

Warren was low on patience with any kind of authoritarian
figure, which for him included American-trained professionals.
He tried to turn the case around on Barney, asking if maybe he
was nuts, reminding him that this was reality, that I had better
get some respect, and that he had better know what to do about
this, and do it soon.  I reached for the receiver, fearing
Barney might have us both carted off to the psych unit.

"Okay, okay," Barney relented.  "So, what do you want me to do
about it?" What To Do.  "I want you to take it out," I tried to
say calmly, though my tone was of exasperation and pleading.

"How?"

Barney knew of no precedent for a nose leech.  Maybe his
liability insurance wouldn't cover an untested leech removal
procedure.  I relayed Mana's suggestion about suction apparatus.

"I'll think about it on my way down to open up the clinic,"
Barney offered. "But I can't promise anything... I think the
nurse should come, too, for this one," I could hear him add in
an aside to himself.

Wearing the reluctant expressions of first year anatomy students
just introduced to their cadaver, Barney and the nurse greeted
me with simple nods in the driveway of the American medical
compound. Barney mumbled about not having been taught anything
about this in medical school, of vacation time, and of his
chances for getting transferred to a post in Europe or the
tropics.  He kept glancing at his beeper hopefully.

The nurse and I helped him set up the naso-gastric suction pump,
but the motor wouldn't operate: a burned fuse, with no
replacement. Barney asked the two of us, for lack of specialists
to confer with, if the pump would logically be the proper tool,
and how he might use it if it did work. We had no idea.

I sat on the examining table.  Barney inserted the nasoscope but
saw nothing, hoping out loud that maybe the leech had fallen out
while I was bicycling to the clinic.  He flicked his head as if
shaking off a dream, then brushed his hair back slowly and
tightly with both hands, momentarily smoothing the set lines of
his face.  He fished out a pair of hemostats, resigned to having
a go at grabbing it, just as Warren, Mana and I had tried.

I palmed water into my nose.  I could tell that the leech
appeared when Barney's body jerked.  He hesitated, then bit his
lower lip and approached, cautiously, as toward a dormant beast.
 Wait.  Silently emerge.  Clamp. Vanish. Wait.  Emerge.  Clamp.
Missed again.

"Damn," Barney swore forcefully, as awed as the nurse and I by
the lightning reactions of the primitive animal.  Slowly, he
backed away, as if trying to determine whether time was
critical, or if he should stop right there and phone someone for
advice, or maybe step out for a cigarette.

Sweating, his hand unsteady, he advanced again and tried
clamping -- randomly -- below my nostril.  After several
minutes, he nabbed the end of the leech, the head, on its way
out for air.  He cinched down the hemostats' miniature grippers,
and there the two of us paused, locked together in suspended
animation.  Then, with one palm on my forehead, he began to
pull, slowly increasing the pressure.  My focus narrowed as,
cross-eyed, I watched the leech stretch outward. For the first
time I could now feel the thing -- pulling vaguely from the
interior of my head, indeed as if from the back of my head. It
wouldn't let go.

"Let me know if it hurts -- otherwise, I'm . . . I'm just going
to keep pulling until something happens," Barney stuttered,
sounding unsure what that something might be, or whether he was
doing the right thing at all. He now needed two hands on the
hemostats.  I braced one foot and a hand against the side wall
of the examining room, while my other hand gripped the back of
the cushioned table to keep from being pulled forward. The leech
was stretched out nearly a foot;  again we hesitated in this
position, braced.  I could see Barney soberly trying to reckon
that under prolonged, static tension the leech might loosen and
release, though his face was twisted in anticipation of a
horrible accident.

My neck strained against the pull.  I heard myself mouthing
Warren's mantra.  I don't believe it.  I realized that I might
never again experience this, nor again see such an expression on
a doctor's face. I had been told to expect the unusual in this
country, but this was more like some altered, metaphysical
dream.  I don't believe it.

Something snapped.  Barney hit the wall directly behind him,
while I fell over backward across the examining table.  I
couldn't see where the leech went, if in fact it came out, or if
it had taken part of me with it.  I wasn't sure Barney knew,
either, until, with deliberation, he held up the trophy -- a
fidgeting, clean, unattached leech, tightly seized in the
clamps.  Unstretched, it measured four inches long, as thick as
a pencil, with a nickel-sized sucker on the host end. Barney's
mouth hung open, grinning at the same time.  As far as he could
tell, he had done the right thing.

My nose dripped not a drop of blood.  The leech, the hex, was
gone. I said thanks and shook hands with Barney -- still
speechless -- and stepped from the clinic to again join the
world of benign, unencumbered humans.  I slowed as I passed a
neighborhood shrine.  A gathering of devout Hindus were
chanting, entranced, conducting a propitiatory ritual. I
wondered if they had seen visions as gripping as my real one.

Two days later I went to see Mana.  He caught sight of me before
I crossed the threshold of his clinic.

"I know how we could have gotten it out!" he declared bouyantly
from his waiting room.  "If we had held a glass of water to your
nose, and kept it there, it would have dropped off into the
water on its own. Yak herders attract them from the nostrils of
their yaks that way. Your leech had completed a stage of its
life cycle -- it was done living in the host, which is usually
livestock, and was waiting for a stream to drop into and float
down, to reproduce and continue its cycle!  Ha! You must have
picked up the leech by drinking water from a stream the way a
cow does!"  He laughed loudly, unreservedly. I could feel the
people sitting in the waiting room gawking at me with open,
uneasy concern.

Then I remembered the mountain spring water.  I had
intentionally drunk on hands and knees, face in the stream,
thinking it more sanitary. Of course.  Villagers drink spring
water from cupped hands, I now realized, to look for and avoid
leeches.  I returned to the American clinic to tell Barney.  He
was preparing a small shipping box for the creature, which was
now safely restrained in a stoppered test tube.  He was
intrigued by Mana's explanation of the leech's life cycle, and
said he would inquire about the removal technique in a cover
letter to the Smithsonian Institution, where he was sending the
specimen.

I expressed some apprehension. "But if our leech is lost in
shipment, no one will believe the story."

"I don't think they'll believe it in any event," Barney
responded as he carefully lettered a small label.  I could see
him grinning to himself, as if listening to his name being
announced at a tropical medicine conference somewhere in Europe
or the Caribbean.  The label he prepared read simply, "Nose
Leech. Nepal."  I was grateful that my name, and I, were not
attached to it.