FEATURE
THE Good, THE Bad AND THE Ugly
Brian Ferguson, DO
T
he emergency room is a special place, with the oddest things one can imagine happening to humans. Some
of these encounters bring a smile to my face and warm my heart. There are those that make me squeamish,
and others sad. As I consider recent happenings, I am feeling uncommonly thankful for such a curious and
strange job.
THE UGLY:
A woman frantically storms into the ER. “Something is crawling in my ear!” The nurse
precipitously beckons me from my charting to come immediately to bedside. The patient
was conveniently driving by the hospital, when she felt a bug fly through the open window
into her ear. She saw the “H” exit and sped up the ramp and into the ER while she tried
sticking anything she could find into her ear to extract the parasite.
She is pacing quickly around the room, intermittently yelling in anguish. I reassure her
that we will thoroughly evaluate this ear. As I piece together the disposable attachment
with the otoscope, I try to calm her down with genuine statements to the effect of: “We
see similar situations in the ED all the time…. Don’t worry you’re in the right place…
Frequently, with the ear being so sensitive, there is often a very convincing false sensation
of foreign body…”. I look in her ear and, in shock, I hurriedly leave the room. “OK I will
be right back,” I promise, and rush out to find the nurse.
I tell the nurse that she will not believe what is in this ear, and we need to get copious
irrigation and a spray valve. I walk back to the patient’s room about 60 seconds later. She
implores me to tell what I saw. I say, “We are going to address this immediately and elab-
orating more will only worsen the situation.” I tell her that there is definitely something in
this ear and we will get it out immediately, but first I have to explain the awful feeling of
having cold calorics done. Her response: “Do anything!”
She tilts her head, affected ear down, as I flush the ear with NS under syringe pressure
irrigation – and out come 10 maggots, 2-3 millimeters in size, along with the broken body
of some undecipherable bug thorax (which presumably contained a popped egg sac). After
the irrigation, she begins vomiting violently. Even so, she profusely expresses her gratitude,
before and after retching.
(continued on page 16)
OCTOBER 2017
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