The Case of the Screaming Man

As everyone knows, the human body has orifices. Occasionally, these become occluded, or occupied, by things that aren’t supposed to be there. Every doctor knows this, as does almost everyone else. Who hasn’t heard, as a child, the cautionary phrase “Don’t stick beans up your nose”?
Human nature being what it is, almost every clinician must deal with foreign objects–flora, fauna–that have been put into places where they don’t belong. Sometimes, though, “beans” can materialize without a patient’s permission.

Here is one such case–a personal favorite of mine–that I’ve mentally entitled “The Screaming Man.”

I was back in the furthermost part of the clinic, arguing with an insurance company representative about the need for a patient’s CT scan, when one of our receptionists ran up.

“Dr. Lyons! There’s a man screaming in the waiting room!”

“Is he bleeding?”

“No, he’s banging his head with his hands and screaming! I think he might be crazy!”

I ran to the front. There in our packed waiting room was in fact a seemingly crazy man, screaming, dancing around and batting at his left ear with both hands. The other patients were cringing away from him, their eyes wide. He was burly, dressed in a City laborer’s jumpsuit soiled with leaves and debris. With every leap, his heavy work boots left red mud clods on the floor.

“Jesus Christ, help me! Get it out! Get it OUT! It’s MOVING!”

Okay, now I had a clue. I grabbed the man by his suit front, assured him that we would help and pulled him into an exam room, calling for the ear, nose and throat tray and some mineral oil.

When I looked through the otoscope into his left ear, I nearly screamed myself: Staring back at me were the multiple, horrifyingly-enlarged eyes of a common spider. Probably equally terrified, it was clinging with all eight legs to the inside of this man’s ear canal.
Now the cause of my patient’s frenzy was clear. Once an arthropod (as the medical literature likes to call spiders and insects) makes its way into the human ear, every one of its tiny movements sounds as loud as a jet airplane to its unfortunate host. Add to this the creepy knowledge that your ear has been “invaded” by a creature that would make you recoil if you encountered it in the bathroom sink, and you have the perfect recipe for temporary insanity.

My patient, calming down a bit, explained that he had been clearing brush with one of his coworkers close behind and had felt a tickling sensation on top of his left ear. Suspecting a joke perpetrated by his coworker, he had swiped at the ear, only to feel the sensation of many wriggling feet running for cover, right into the nearest dark hole.

Now that I’d had a chance to assess the situation, I realized that only one of my two patients could survive. I chose to save the larger. A syringe of mineral oil, gently instilled, quickly euthanized the spider, and I washed the tiny carcass out of the man’s ear with saline.

One part of me rejoiced at the relief in my human patient’s face, now that he’d been freed from the tormenting interior flamenco dance. Another part of me wondered wryly if we should be playing “Taps” for the intrepid arachnid explorer.

The man insisted that I spread its draggled corpse with forceps so that he could make sure that none of the legs remained within his ear. Together, we counted all eight. Then he paused and reflected.
“Doc, you don’t think it had time to lay eggs in there, do you?”
I hid my smile. “No, certainly not.”

My patient began to recover his composure–and his swagger. He asked me to place the tiny body in a sterile urine container so he could show his friends the proof of his ordeal. By the time he left our clinic, amid the smiles and congratulations of the staff, I felt certain that, had the spider been just a bit larger, he would have had it stuffed and mounted.
The clinic staff and I went on to enjoy a long and congenial relationship with this patient–whose nickname forever after, of course, was “Spider Man.”

Paula Lyons, MD

Story editor: Diane Guernsey

First Published in Pulse-voices from the heart of medicine
26 February 2010