As The Sparks Fly Upward

On Saturdays, we have a half-day clinic in the AM, and I am the lone licensed provider, so I see all of the patients. This allows my colleague, CPT Hall, to get a day off, and in turn allows me to take Sunday off. Not a bad deal.

We had a very strange bunch of patients come in today; it was like bizarro world. Usually we see a roughly equal amount of stuffy noses, gastrointestinal illnesses, and back/ankle pain. Today, I had few of the routine folks and a whole lot of the “fun” (or at least “interesting”) cases.

One was a young marine, with a northeastern accent. His first words to me when I walked into the room and asked him what brought him in today: “I learned that what happens in Vegas doesn’t always stay in Vegas.” And indeed, for this unfortunate young man, it did not stay in Vegas. Turns out he had spent time in a casino bar and “picked up” a girl there, and had unprotected relations with her. For the purposes of knowing what kind of things this stupid kid might have exposed himself to, I needed some more info on his sexual partner.

Me: Was this girl a prostitute?

Marine: No, she was just a girl in the bar.

Me: Did she work in the bar?

Marine: I think so, yes, sort of.

Me: Sort of?

Marine: Well, she didn’t get paid by the bar. She got paid by the customers in the bar when she did things for them. But she only “hung out” with me because she liked me.

Me: Did you pay her to “hang out” with you?

Marine: Well, yeah, but she wouldn’t have taken the money from me if she didn’t like me. So she was just a girl in a bar who sometimes got paid to “hang out” with people she liked anyway. She wasn’t a prostitute.

Me: Interesting distinction.

Lance Corporal Horny-No-More had developed a painful discharge, and needed to be cultured (the dreaded “rod”) and we threw in a syphilis test and an HIV (called a “high five” by every soldier I’ve met) for good measure. I spent a good 5 minutes telling this marine how absolutely, mind-numbingly stupid he had been. I gave him a spiel which has become almost second nature to me: channeling my inner “House, MD,” I berated his lack of any forethought, and described in painful detail the many diseases which might just become perpetual gifts for him (HIV, herpes, genital warts, syphilis), as well as the disgusting disease which he currently had (gonorrhea, possibly chlamydia as well). His ruddy complexion became more and more pale as I spoke, and in the end I seriously thought he might cry. He got his two grams of azithromycin (cephalosporin allergy), and hit the road, visibly shaken. (Good.)

A second patient had a unique problem: he had some pain in his right ear, which had become worse over the past month. Also, he said it sounded like everything was muffled, “like people are talking to me through a tunnel.” Pretty good description, that; the guy should be a writer. My medic told me that she looked in his ear and saw something that looked like (as I heard it) a “konk.”

Me: A what?

Medic: A “konk”

Me: What is a “konk”?

Medic: One of those shells that you can blow into and make noise.

Me (light-bulb over my head): Oh, a conch! [pronounced "konk"]

Medic: Yup.

I figured that this Army SPC had some cerumen (ear wax) which just happened to have taken on an unusual shape, so I looked in his ear. “You seem to have some sort of shell in there.”

Unbelievingly, the SPC asked me “What kind of shell?”

“It appears to be a tiny conch” I offered.

“What is a konk?” asked SPC Conch-ear.

“I’ll show you.”

A set of tweezers, a flashlight and a couple of minutes later, and the offending foreign body had been removed. And I do mean “body.” This soldier, who had admittedly slept on the beach, had not been able to bathe regularly, and who was now on his second deployment—this guy had (I kid you not) a tiny hermit crab in his ear.

And it was alive.

Now I have never been big into photography. Too many hassles and too much telling your friends to pose for my liking. But on this day, I cursed myself for not having brought my camera into the clinic. I talked with the patient, and he denied having ever felt something crawl up there, nor having come into any known contact with a hermit crab. But he had, indeed, “lived hard” over the past few years, sleeping in trenches, foxholes, and OPBs (Other People’s Beds) on a not-infrequent basis. Presumably, he picked up his little saprophytic buddy sometime during those travels, and it had lived in his auditory canal, living off of cerumen, and basking in the humidity and warmth there. Not a bad gig. If our Siamese cat Mimba could possibly live in someone’s ear, she probably would.

When all was said and done, I put this patient on some antibiotics for a concurrent outer ear infection, and asked him to come back on Monday. You can bet that I’ll have my camera with me, and will get a picture of that crab up in a blog post STAT.

After the patient had gone home, I thought of the one burning clinical question which I should have asked him before he hit the road, to wit:

Me: When you had that shell up there right inside your ear, did you “hear the ocean” on that side?

Inquiring minds want to know.