D e s e r t E x p o s u r e
December
2008
The Snake and I
When a snakebite transforms a doctor into a patient, he learns a lessonthat has nothing to do with venom.
By Michael Sergeant, MD
It was just a few rocks I was after. That's all. I wanted to make a beautiful arrangement for my wife, Diane, who was returning in the morning from taking care of her mom in the hospital in Atlanta.
 |
The author's snakebitten
foot, a few days after twin bites. |
I had the roses — delicately beautiful, magenta, magic. I had the lovely vase from Portugal. What I needed was a few desert rocks to complete the picture in my head and the feeling in my heart. It didn't quite work out that way.
The magic was different: I got to dance with the power of nature.
I was singly focused as I walked out the front door on a Tucson desert night with a dishpan (of all things) to gather those few rocks from the front garden. My vision was tunneled towards the creative endeavor.
I think the snake (or maybe snakes), for its part, would actually have been quite satisfied to be left alone. I expect it was not the least bit pleased to have the still of the evening disturbed by some human guy tromping around picking up the rocks near which it lay. It is even possible there was an even more egregious infraction: snake coitus interruptus. Whatever the case, indicting said snake or snakes for the subsequent events would be inappropriate.
So there I was, contentedly in my own front yard, dressed in my desert best (shorts, T-shirt and flip flops), in the pale and not very illuminating glow of the front porch light, gathering a few rocks I thought would lend beauty to my arrangement. Beneath the nearby garden wall, the ground was in shadow. I was oblivious. The night was quiet.
I was bending over to pick up the last couple of rocks when my peaceful world exploded in pain. My left foot had been crushed, it seemed, by an acid-coated sledge hammer wielded by no less than John Henry himself. Shock first. Then a knowing. And then, only after the truth had already permeated my consciousness, the slight and ever-so-ominous rattle. What I would not know until the next day is that I had actually, in that life-changing split second, been bitten twice.
The brief moments following the shock resulted in only a little disruption of the quiet desert night as a few choice words erupted from me — not so much a yell, more a series of almost disbelieving profane whispers. My mind, once convinced of the reality of being snake bit, switched almost immediately to a kind of analytic stillness. As I hobbled into the house I was telling myself that 20 to 30 percent of rattler bites are not envenomated, and though the ongoing pain was telling me otherwise, I was briefly hopeful that would be the case for me. By the time I reached the bathroom, the fact that this was not my fortune was evidenced by my foot having already ballooned to half again its normal size.
In the bathroom I found the top of my foot bloody. I had a syringe right there and actually attempted to aspirate some of the venom from the wounds. This was not one of my more brilliant moments, but the illusion that this would be effective fortunately lasted only a few seconds — ending with my recognition of the foolishness of this endeavor and an understanding of my need for immediate medical care. I needed anti-venom and I needed it as quickly as possible.
Back to clear thinking. I considered calling 911 for an ambulance and medics but reasoned that by the time they got to me, got me loaded and then again took off, much more time would be eaten up (and much more tissue with it) than if I just took off for a hospital. Further, and again perhaps foolishly, I didn't want to incur even more expense as I already knew this whole adventure would indeed be expensive.
So, with increasing discomfort (euphemism for pain) I got out to the garage, grabbed a tourniquet from my crash bag I keep in the car and opened the garage door. There was a brief moment of internal debate as I considered the tourniquet: Current evidence recommends against the use of a tourniquet in snakebite, as the amount of local damage is increased and there is a risk of bad things happening when the tourniquet is removed and a bunch of toxin is released quickly into the general circulation. Despite this, I decided to apply one very lightly, hoping to diminish systemic effects of the venom while I was driving myself to the hospital.
Once in the car, I realized I was unsure which hospital to head for, as I was pretty much right between at least two. Because of this I did then call 911 while driving to ask if there was a regional snakebite specialty place to head for. There wasn't. Assuring that whatever hospital I did arrive at had anti-venom sufficiently stocked also seemed of import. I did find that the 911 dispatcher was not pleased that I didn't want to wait for an ambulance. Of course, when I said jokingly that I knew I was fine because I knew it was October of 1947, her angst became significantly amplified and I had to repeatedly convince her that I was indeed joking and that I was OK to be driving. That said, it was a very surreal journey as I drove to the large private hospital, avoiding the regional trauma center on an urban Saturday night.
Upon arrival in front of the ER, the venom effects were getting markedly stronger. I was unable to bear weight at all on my left foot and was feeling progressively more ill. I left the car in front of the ER and I had to hop inside. Once I had announced the nature of my problem, I was quickly wheeled back to the triage area, two IVs were started and blood was drawn. Knowing I was now in the medical realm, I relaxed a bit — at least for a little while.
From there things seemed to move in a strange kind of slow motion. After the initial registration, lab draws, IVs and all that, I was moved into a treatment area. I was seen first by the ER nurse, then by an intern and a resident who really knew nothing about snakebite, so I treated my own anxieties by talking to them about the pathophysiology involved. The attending physician then showed up and the anti-venom could finally be ordered.
Herein lay the next problem: Anti-venom takes about an hour just to reconstitute. Tack onto that the time required to transcribe the order, send it to pharmacy and for pharmacy to get to work on it — there was an eternity yet to wait. By that time I had removed the tourniquet and had slipped briefly into a bit of denial, imagining that I might somehow get a few vials of anti-venom and then dance on home as if nothing had happened.
A brief digression regarding that dangerous Egyptian river, Denial: Its currents are powerful indeed, with all kinds of eddies and undertows. One should keep in mind here that I myself have treated quite a few rattlesnake bites and have seen how dangerous they can be. While none of my patients with this injury has died, they have universally required at least a couple days in the ICU and been quite sick. Thus my brief fantasy that I might just get a hit of anti-venom and slip on home was silly indeed. Not to mention that the anti-venom itself, though far safer than what we used some years ago (then we had a horse serum), still has a bit of inherent risk.
Well, my time floating on denial was short. I had managed to make two calls to my closest support, family in California: one to my daughter Caitlin and one to my sister Judy. (My wife was on the east coast where it was the middle of the night; she could get to me no sooner than the flight she already had and I felt she needed to sleep.) The one to Judy was answered by my brother-in-law Phil, who apparently did not understand what I was trying to communicate (he did, after all, have a cold) and didn't even tell Judy that I was hospitalized. Thus my thought at the time that my whole family would know what had happened was faulty. On a second try, or maybe it was a return call from her, I did talk to Caitlin briefly, which was very comforting.