And yes it is necessary to admit walking in the forest the heart is a lock
it has inviolable chambers like the woods, fallen trees that block
access to the river snowdrops surprising its edges moss crystalline with frost
What I thought I wanted what I have tried to be was the slender instrument that opened
a key: presence moving deeper into the forest that releases the birds from the trees and sends them ascends them to sky by definition open
but now there is nothing left to be solved like a riddle
this time the lock must be broken what’s left has to be seized
because God only loves the strong thief I mean the man who breaks his heart for God ~Jennifer Grotz, “Locked” from Window Left Open
All my life I wanted to be an effective key, unlocking life’s mysteries and opening up the world to those who are hopeless, stifled and trapped. Doctor training gave me a few locksmith tools. I found my patients taught me far more about their pain and suffering than my professors did.
Yet profound mysteries remain: some illnesses are rare or unique enough to defy diagnosis, some just don’t respond to available tools, while illnesses as well understood and treatable as depression or COVID infection still kill and incapacitate with abandon. The keys I may have accumulated don’t fit every lock. They don’t necessarily open the doors to freedom from fear or worry.
At times I feel aimless, wondering what tools I still have and if I remember how to use them. Simple knowledge is only one key, while brute force – breaking and entering – may be necessary to break the hardest lock of all – access to the troubled heart and soul.
God wants in, to pick up our broken pieces and put us back together. He doesn’t need a key to enter what He Himself has built from scratch. He owns the place.
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When I was sick with a head cold, my head full of pressure, my father would soak a washcloth in hot water, then ball it up, ring it out. He would open it above my head, then place it against my face like a second skin, the light around me disappearing entirely except through the spaces between the stitching. I would inhale the steam in that darkness, hearing his voice on the other side, otherwise almost devoid of any other bodily sense but the warmth and depth of his voice, as if I had already died and was on the other side of life waiting for the sickness to lift, but I wasn’t. I was still on this earth, the washcloth going cold on my face, my body still sick, and my father still there when I opened my eyes, as he always was, there to give me warmth before going cold again. ~William Fargason “Elegy with Steam”
A common clinic conversation this time of year:
I’ve been really miserable with a cold for three days, and as my COVID test is negative, I need that 5 day Z-pack antibiotic to get better faster.
It really can be miserable suffering from cold symptoms. Ninety eight percent of the time these symptoms are due to a viral infection and since your rapid RSV and influenza nasal swab tests are also negative today, your illness should resolve over the next few days without you needing a prescription medication.
But I can’t breathe and I can’t sleep.
You can use salt water rinses and a few days of decongestant nose spray to ease the congestion.
But my face feels like there is a blown up balloon inside.
Try applying a warm towel to your face – the heat will help improve circulation in your sinuses and ease your discomfort.When it cools off, warm it up again – basically rinse and repeat.
And I’m feverish and having sweats at night.
Your temp today is 99.2 so not a concern. You can use ibuprofen or acetominophen to help the feverish feeling.
But my snot is green.
That’s not unusual with viral upper respiratory infections and not necessarily an indicator of a bacterial infection.
And my teeth are starting to hurt and my ears are popping.
Let me know if that is not resolving over the next few days.
But I’m starting to cough.
Your lungs are clear today so it is likely from post nasal drainage irritating your upper airway. Best way to help that is to breathe steam to keep your bronchial tubes moist, push fluids and prop up with an extra pillow.
But sometimes I cough to the point of gagging. Isn’t whooping cough going around?
Your illness doesn’t fit the typical timeline for pertussis. You can consider using an over the counter cough suppressant if needed.
But I always end up needing antibiotics. This is just like my regular sinus infection thing I get every year.
There’s plenty of evidence antibiotics can do more harm than good, eliminating healthy bacteria in your gut. They really aren’t indicated at this point in your illness and could have nasty side effects.
But I always get better faster with antibiotics. Doctors always give me antibiotics.
Studies show that two weeks later there is no significant difference in symptoms between those treated with antibiotics and those who did self-care without them.
But I have a really hard week coming up and my whole family is sick and I won’t be able to rest.
This could be your body’s way of saying that you need to take the time you need to recover – is there someone who can help pick up the load your carry?
But I just waited an hour to see you.
I really am sorry about the wait; we’re seeing a lot of sick people with so much viral illness going around and needing to test to rule out COVID and influenza.
But I paid a $20 co-pay today for this visit.
We’re very appreciative of you paying so promptly on the day of service.
But I can go down the street to the urgent care clinic or do one of those telehealth doctor visits and for $210 they will write me an antibiotic prescription without making me feel guilty for asking.
I wouldn’t recommend taking unnecessary medication that can lead to bacterial resistance, side effects and allergic reactions. I truly believe you can be spared the expense, inconvenience and potential risk of taking something you don’t really need.
So that’s it? Salt water rinses, warm towels on my face and just wait it out? That’s all you can offer?
Let me know if your symptoms are unresolved or worsening over the next few days.
So you spent all that time in school just to tell people they don’t need medicine?
I believe I can help most people heal themselves with self-care at home. I try to educate my patients about when they do need medicine and then facilitate appropriate treatment. Also, I want to thank you for wearing your mask today to reduce the chance of transmitting your virus to those around you.
I’m going to go find a real doctor who will actually listen to me and give me what I need.
It certainly is a choice you can make. A real doctor vows to first do no harm while always listening to what you think, what your physical examination shows, then takes into account what evidence-based clinical data says is the best and safest course of action. I realize you want something other than what I’m offering you today. If you are feeling worse over the next few days or develop new symptoms, please let me know so we can reevaluate how best to treat you.
I’ll bet you’ll tell me next you want me to get one of those COVID vaccines too, won’t you?
Actually, I prefer you be feeling a bit better before you receive both the COVID and influenza vaccines. That would offer extra immunity protection for you through the next few months. Shall we schedule you for a time for your vaccination updates next week?Remember, I’m still here if you need to review your options again…
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when my father had been dead a week I woke with his voice in my ear I sat up in bed and held my breath and stared at the pale closed door
white apples and the taste of stone
if he called again I would put on my coat and galoshes ~Donald Hall “White Apples”
She skimmed the yellow water like a moth, Trailing her feet across the shallow stream; She saw the berries, paused and sampled them Where a slight spider cleaned his narrow tooth. Light in the air, she fluttered up the path, So delicate to shun the leaves and damp, Like some young wife, holding a slender lamp To find her stray child, or the moon, or both. Even before she reached the empty house, She beat her wings ever so lightly, rose, Followed a bee where apples blew like snow; And then, forgetting what she wanted there, Too full of blossom and green light to care, She hurried to the ground, and slipped below. ~James Wright “My Grandmother’s Ghost from Above the River: The Complete Poems
I saw my grandma’s ghost once.
She was my only grandparent I actually knew and who actually knew me — the others were lost before I was born or too young to realize what I had lost.
She had lived a hard life: losing her mother when she was 12, taking over the household duties for her father and younger brother while leaving school forever. She married too young to an abusive alcoholic, lost her first child to lymphoma at age 8 before treatment was possible and took her three remaining children to safety away from their father for a year to live above a seedy restaurant where she cooked seven days a week to make ends meet.
But there was grace too. The marriage somehow got patched together after Grandpa found God and sobriety – after his sudden death sitting in church, Grandma’s faith never wavered. Her garden soil yielded beautiful flowers she planted and nurtured and picked to sell, her children and grandchildren welcomed her many open armed visits and hugs.
She was busy planning her first overseas trip of a lifetime at age 72 when we noticed her eyes looked yellow. Only two weeks later she was bed-bound in unrelenting pain due to pancreatic cancer, gazing heaven-ward instead of Europe-bound. Her dreams had been dashed so quickly, she barely realized her itinerary and destination had changed.
I was 16 at the time, too absorbed in my own teenage cares and concerns to really notice how quickly she was fading and failing like a wilted flower. Instead I was picking fights with my stressed parents, worrying over taking my driver’s license driving test, distracted by all the typical social pressures of high school life.
Her funeral was unbearable as I had never really said goodbye – only one brief hospital visit when she was hardly recognizable in her anguish and jaundice. I didn’t even get to hold her hand.
Soon after she had been lowered into the ground next to her husband and young daughter, she came back to me in a dream.
I was asleep when my bedroom door opened into the dark, wakening me as the bright hallway light pushed its way via a shimmering beam to my bed. Grandma Kittie stood in my bedroom doorway, backlit by the light surrounding her silhouette. She silently stood there, just looking at me.
Startled, I sat up in my bed and said to her, “Grandma, why are you here? You died and we buried you!”
She nodded and smiled. And then she said to me:
“I want you to know I’m okay and always will be. You will be too.”
She gave a little wave, turned and left, closing the door behind her. I woke suddenly with a gasp in my darkened bedroom and knew I had just been visited.
She hadn’t come to say goodbye or to tell me she loved me — that I knew already.
She had come to shine with her light blossoming around her, mending my broken heart by planting it with peace.
Grandma Kittie and Grandpa Leslie in their courting days
You’re in a better place I’ve heard a thousand times And at least a thousand times I’ve rejoiced for you
But the reason why I’m broken The reason why I cry Is how long must I wait to be with you
I close my eyes and I see your face If home’s where my heart is then I’m out of place Lord, won’t you give me strength To make it through somehow I’ve never been more homesick than now
Help me Lord cause I don’t understand your ways The reason why I wonder if I’ll ever know But, even if you showed me The hurt would be the same Cause I’m still here so far away from home
In Christ, there are no goodbyes And in Christ, there is no end
So I’ll hold onto Jesus With all that I have To see you again To see you again
And I close my eyes and I see your face If home’s where my heart is then I’m out of place Lord, won’t you give me strength To make it through somehow
Won’t you give me strength To make it through somehow Won’t you give me strength To make it through somehow I’ve never been more homesick than now ~Millard Bart Marshall
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Here is a story to break your heart. Are you willing? This winter the loons came to our harbor and died, one by one, of nothing we could see. A friend told me of one on the shore that lifted its head and opened the elegant beak and cried out in the long, sweet savoring of its life which, if you have heard it, you know is a sacred thing., and for which, if you have not heard it, you had better hurry to where they still sing. And, believe me, tell no one just where that is. The next morning this loon, speckled and iridescent and with a plan to fly home to some hidden lake, was dead on the shore. I tell you this to break your heart, by which I mean only that it break open and never close again to the rest of the world. ~Mary Oliver “Lead” from New and Selected Poems
Why shouldn’t we go through heartbreaks?
…if through a broken heart God can bring His purposes to pass in the world, then thank Him for breaking your heart. ~Oswald Chambers from “Ye are not your own” from My Utmost for the Highest
These last two years have seen an epidemic of heart-break.
Due to hospital visitor restrictions, thousands of loved ones have died of COVID without family by their side, deprived of the solace of hearing familiar voices and being touched by familiar hands. A weary and over-worked health care team can only do so much in their efforts to comfort and console when so many patients are losing their battle with the virus at the same time. Although nurses and doctors have always been witnesses to the cries of the dying and the weeping of the grief-stricken, that is usually together at the bedside.
An iPad screen isn’t the same for those saying good-bye forever.
For all the advances of our modern society – through technology and communication and the development of medical miracles – people still die and others still grieve and weep over their loss. We’re not used to dying happening with such frequency to those who have no business dying in the first place. We assume death rates exceeding birth rates happens only in third world countries beset with drought or plague.
Not any more.
So my heart is tender – for those lost, for those left behind, for those trying their best to save lives when they are weary and ill themselves, for the irony of hundreds of thousands of unnecessary deaths when the preventive measures available to us all are so clear-cut.
If anything, a breaking heart is an open invitation for the solace of a God who himself had no business dying in the first place, but did. He cried out in a long, sweet savoring of his life and ours, saving us in the process.
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By the road to the contagious hospital under the surge of the blue mottled clouds driven from the northeast — a cold wind. Beyond, the waste of broad, muddy fields brown with dried weeds, standing and fallen
patches of standing water the scattering of tall trees
All along the road the reddish purplish, forked, upstanding, twiggy stuff of bushes and small trees with dead, brown leaves under them leafless vines —
Lifeless in appearance, sluggish dazed spring approaches —
They enter the new world naked, cold, uncertain of all save that they enter. All about them the cold, familiar wind —
Now the grass, tomorrow the stiff curl of wildcarrot leaf
One by one objects are defined — It quickens: clarity, outline of leaf
But now the stark dignity of entrance — Still, the profound change has come upon them: rooted they grip down and begin to awaken ~William Carlos Williams “Spring and All”
I ask your doctor of infectious disease if she’s read Williams he cured sick babies I tell her and begin describing spring and all she’s looking at the wall now the floor now your chart now the door never heard of him she says but I can’t stop explaining how important this is I need to know your doctor believes in the tenacity of nature to endure I’m past his heart attack his strokes and now as if etching the tombstone myself I find I can’t remember the date he died or even the year of what now are we the pure products and what does that even mean pure isn’t it obvious we are each our own culture alive with the virus that’s waiting to unmake us ~Brian Russell, “The Year of What Now”
It is the third January of a pandemic of a virus far more tenacious than we have proven to be, it continues to unmake us, able to mutate spike proteins seemingly overnight while too many of us stubbornly remain unchanged by this, clinging to our “faith over fear” and “my body, my choice” and “lions, not sheep” and “never comply” — because self-determination must trump compassion for the unfortunate fate of vulnerable millions.
We defend the freedom to choose to be vectors of a contagion that may not sicken us yet fills clinics, hospitals and morgues.
William Carlos Williams, the early 20th century physician, would be astonished at the clinical tools we have now to fight this scourge. William Carlos Williams, last centuries’ imagist poet, would recognize our deadly erosion of cooperation when faced with a worthy viral opponent.
So what happens now?
Starting with this third pandemic winter, with our souls in another deep freeze, covered in snow and ice and bitter wind chill, a tenuous hope of restoration could awaken – tender buds swelling, bulbs breaking through soil, being called forth from long burial in a dark and cold and heartless earth.
Like a mother who holds the mystery of her quickening belly, knowing we nurture other lives with our own body, we too can be hopeful and marveling at who we are created to be.
She, and we, know soon and very soon there will be spring.
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Under the harvest moon, When the soft silver Drips shimmering over the garden nights, Death, the gray mocker, Comes and whispers to you As a beautiful friend Who remembers.
Under the summer roses When the flagrant crimson Lurks in the dusk Of the wild red leaves, Love, with little hands, Comes and touches you With a thousand memories, And asks you Beautiful, unanswerable questions. ~Carl Sandburg, “Under the Harvest Moon”
As we enter the season of all that is lush and lovely which starts to wither and decay before our eyes, we know the flowers and trees aren’t alone. Death, whispering within its gray night’s cloak, has been stealing the young and old since time began, but never as boldly as during a pandemic. Millions of family members are left with nothing but bittersweet memories of their loved ones now buried deep.
The harvest moon – not nearly bright enough, as a poor reflection of the sun – mocks us who covet light during a rampage of contagious illness and death.
As we endure the searing beauty of yet another dying season, let us treasure those we protect through our care and concern. Let us cherish the memories of those we’ve lost. There can be only one answer to the unanswerable questions: Love itself died to become Salvation, an ever-sufficient Light that leads us home.
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You are alive. It needn’t have been so. It wasn’t so once, and will not be forever. But it is so now.
And what is it like: to be alive in this one place of all places anywhere where life is? Live a day of it and see. Take any day and LIVE IT. Nobody claims that it will be entirely painless, but no matter.
It is your birthday and there are many presents to open. The world is to be opened. It is the first day because it has never been before and the last day because it will never be again.
When I was very young, I would trace my finger over the long scar that curved along the front of my mother’s neck and ask her what happened. She would tell me her thyroid gland had been overworking so she had to have it removed before I was born. That’s all she had to say about that and I never thought to ask more. Somehow I knew, just as my knowing my father would not talk about his experience as a Marine in WWII, my mother was hiding more than her big scar under high collars or a pearl necklace.
Hers was a deeper scar I couldn’t see or touch.
However, my older sister – about five at the time – remembers my mother’s illness. Mom was a little over thirty when her hands began to tremble, her pulse raced and she was irritable with trouble sleeping. My parents were hoping for a second child, but unable to get pregnant. Once her doctor diagnosed thyrotoxicosis , Mom had the option to try a new medication that had been recently developed – propylthiouracil – meant to suppress the function of overactive thyroid glands.
It didn’t work for her and she felt worse. It caused more side effects and my mother’s symptoms grew so severe, she was unable to leave her bedroom due to severe anxiety and paranoia made worse by insomnia. My paternal grandmother came to help since my father needed to continue to work to support the family but there was little that could be done other than sedation to ease my mother’s symptoms. My sister recalls not seeing Mom for days, unnerved by the wailing she heard from the bedroom. From her description, I now wonder if Mom was experiencing the beginning of thyroid “storm” (extremely high thyroid levels) which is potentially life-threatening with severe physical and emotional side effects.
After Mom was hospitalized and her entire thyroid was removed, she was placed on thyroid hormone supplements to take daily for the rest of her life. It took months for her to recover and feel somewhat normal again. Her eventual hormonal stability resolved her infertility as well as most of her other symptoms. She remained chronically anxious and had heart palpitations and insomnia the rest of her life, like a residual stain on her sense of well-being, although she lived another 55 years. The trauma of how her illness affected my dad and sister was never fully resolved. They all suffered. I can understand why those months remained as hidden as my mom’s surgical scar.
I was born about two years later – the second baby they never expected could happen. My brother was born 20 months after me.
From my family’s suffering came the solace of new life.
So I nearly wasn’t.
I’m reminded on each birthday: I needn’t have been here yet by the grace of God I am. I need to BE ALIVE and LIVE THIS DAY because it will never be again.
This is a truth for us all to cling to.
Each day is a gift to be opened and savored. Each day a first day, a last day, a great day – a birthday of amazing grace.
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Nothing seems to please a fly so much as to be taken for a currant; and if it can be baked in a cake and palmed off on the unwary, it dies happy. ~Mark Twain
Today I will wrap up 45 years of uninterrupted training and doctoring. Most of that time, I have worried I’m like a fly hiding among the black currants hoping to eventually become part of the currant cake.
Maybe no one has noticed. These days we call it the “impostor” syndrome. Mark Twain knew all about currant cake and how easy it was for a fly to blend into its batter.
Even while bearing three children and going through a few surgeries myself, I’ve not been away from patients for more than twenty consecutive days at any one time. This is primarily out of my concern that, even after a few weeks, I would forget all that I’ve ever known. In fact, half of what I learned in medical school and residency over forty years ago has evolved, thanks to new discoveries and clarifying research. I worried if I were to actually to step away from doctoring for an extended time, then return to see patients again, I would be masquerading as a physician rather than be the real thing. A mere fly among the currants palmed off on the unwary.
If being truly honest, those who spend their professional lives providing medical care to others always share this concern: if a patient only knew how much we don’t know and will never know, despite everything we DO know, there would really be no trust left for us at all.
Of course, some say, didn’t the COVID pandemic prove our ignorance? Physicians started at Ground Zero with a novel virus with unclear transmissibility and immense potential to wreak havoc on the human body … or cause no symptoms whatsoever. We had no collected data to base prevention or treatment decisions: would masks just protect others or would they only protect ourselves, or maybe they protect both? Could a common inexpensive anti-inflammatory/antimalarial drug be beneficial or would a parasitic wormer medication be somehow effective to fight the devastation of the virus?
Effective treatments are still being sought all these months later; others have been debated, studied and discarded as worthless.
Or would this pandemic finally resolve thanks to effective yet controversial public health mandates while rapidly distributing highly effective vaccines developed from many prior years of carefully performed research?
During the past 16 months, your next door neighbor, or the loudest tweet on Twitter proclaimed more expertise than the average medical professional and definitely had a stronger opinion. At least we doctors knew how much we didn’t know and how much was simply guess work based on experience, good intentions and hopeful prayer. Gradually, while lives were lost, including too many of our own, real data began to trickle in so decisions could be made with some evidence backing them. But even that data continues to evolve, day by day, as authentic medical evidence always does.
That doesn’t stop all the “quack” flies out there from climbing into the batter pretending to be currants. With so much rapidly changing medical information at everyone’s fingertips, who needs a trained physician when there are so many other resources – sketchy and opportunistic though they may be – for seeking health care advice?
Even so, I am convinced most patients really do care that doctors share the best information they have available at any point in time. None of us who are doctoring wants to be the “fly” in the batter of health care.
As I meet with my last patient today, I know over forty years of clinical experience has given me an eye and an ear for the subtle signs and symptoms that no googled website or internet doc-in-the-box can discern. The avoidance of eye contact, the tremble of the lip as they speak, the barely palpable rash, the hardly discernible extra heart sound, the fullness over an ovary, the slight squeak in a lung base. These are things I am privileged to see and hear and about which I make decisions together with my patients. What I’ve done over four decades has been no masquerade; out of my natural caution, I am not appearing to be someone I am not. This is what I was trained to do and have done for thousands of days and many more thousands of patients during my professional life, while passing a comprehensive certification examination every few years to prove my continued study and changing fund of knowledge.
The hidden fly in the currant bush of health care may be disguised enough that an unwary patient might gobble it down to their ultimate detriment. I know I’ve not been that doctor. I’ve been the real thing all these years for my patients, even if I’ve seemed a bit on the tart side at times, yet offering up just enough tang to be exactly what was needed in the moment and in the long term.
And someday, hopefully not too soon, I will die happy having done this with my life.
My ID photo from my first year of medical school 197645 years later…
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You can’t say you haven’t been warned: there are creepy crawlies in this post
Things I will never like: 1. Drying off with a cold, damp towel. 2. The feeling of seaweed wrapping around my legs. 3. Anything that was popular in the 70’s. 4. Licorice, yam, or raisins. 5. That high-pitched screech that babies make. 6. Writhing maggots. ~Bill Watterson from It’s A Magical World: A Calvin and Hobbes Collection
A fly maggot photo from a recent Atlantic article on maggot therapy found here
A few weeks ago, I had a bit of home-made potato corn chowder left over that I added to our compost bin in our barnyard. It isn’t often that much animal protein makes its way into the bin so when I checked on the compost a few days later, I was amazed to see it teeming with fly maggots in the midst of their Thanksgiving feast. Ordinarily pictures and videos of maggots would not find their way to this blog. People might be looking at this blog while eating their breakfast or lunch and writhing maggots are not something you are expecting to see. My apologies in advance and now is the time to delete delete delete.
Therefore: a trigger warning. Don’t scroll down further if you would rather avoid seeing (and hearing) creepy crawly things.
My first medical exposure to maggots came while examining the leg and foot wounds of the homeless folks I helped care for when training in an inner city emergency room. Peeling off old ragged stockings and socks would often reveal more than dirty feet – in fact, the maggots may have been somewhat beneficial in those cases yet we were quick to dispose of them.
Maggots are, in fact, fascinating creatures with potential therapeutic value, notwithstanding their gross-out factor. This week in a brief Atlantic article found here, there is a summary of a recent study in France comparing typical surgical debridement of venous ulcers of the skin with maggot therapy. Maggots were faster in cleaning the wounds but didn’t enhance eventual healing any more than traditional surgical care. There wasn’t a difference in the discomfort level as long as the patient didn’t know which therapy was being used. For those who had been randomly assigned to maggot therapy in one study, an astounding 89% said they would opt for the insects over surgeons if faced with needing wound care in the future.
I’m not sure what that says about surgeons, but it is a great compliment to maggot larvae!
Here is a formal cross-referenced evidence-based summary from UptoDate.com about wound treatment with biologic methods:
Biologic — An additional method of wound debridement uses the larvae of the Australian sheep blow fly (Lucilia [Phaenicia] cuprina) or green bottle fly (Lucilia [Phaenicia] sericata, Medical Maggots) [42,43]. Maggot therapy can be used as a bridge between debridement procedures, or for debridement of chronic wounds when surgical debridement is not available or cannot be performed [44]. Maggot therapy may also reduce the duration of antibiotic therapy in some patients [16].
Maggot therapy has been used in the treatment of pressure ulcers [45,46], chronic venous ulceration [47-50], diabetic ulcers [42,51], and other acute and chronic wounds [52]. The larvae secrete proteolytic enzymes that liquefy necrotic tissue, which is subsequently ingested while leaving healthy tissue intact. Basic and clinical research suggests that maggot therapy has additional benefits, including antimicrobial action and stimulation of wound healing [43,47,53,54]. However, randomized trials have not found consistent reductions in the time to wound healing compared with standard wound therapy (eg, debridement, hydrogel, moist dressings) [55,56]. Maggot therapy appears to be at least equivalent to hydrogel in terms of cost [56,57].
Dressing changes include the application of a perimeter dressing and a cover dressing of mesh (chiffon) that helps direct the larvae into the wound and limits their migration (movie 1). Larvae are generally changed every 48 to 72 hours. One study that evaluated maggot therapy in chronic venous wounds found no advantage to continuing maggot therapy beyond one week [48]. Patients were randomly assigned to maggot therapy (n = 58) or conventional treatment (n = 61). The difference in the slough percentage was significantly increased in the maggot therapy group compared with the control groups at day 8 (67 versus 55 percent), but not at 15 or 30 days.
The larvae can also be applied within a prefabricated “biobag”, commercially available outside the United States, that facilitates application and dressing change [58-61]. Randomized trials comparing “free range” with “biobag”-contained larvae in the debridement of wounds have not been performed.
A main disadvantage of maggot therapy relates to negative perceptions aboutits use by patients and staff. One concern among patients is the possibility that the larvae can escape the dressing, although this rarely occurs. Although one study identified that approximately 50 percent of patients indicated they would prefer conventional wound therapy over maggot therapy, 89 percent of the patients randomly assigned to maggot therapy said they would undergo larval treatment again [62]. Perceived pain or discomfort with the dressings associated with maggot therapy may limit its use in approximately 20 percent of patients.
The STARZ show Outlander (a show and series of books by scientist Diana Gabaldon I thoroughly enjoy) used real maggots in the fifth season of the show when in 18th century America, wife (and surgeon) Claire successfully treats her husband Jamie’s snakebite wound with the larvae. Actress Caitriona Balfe describes her co-starring maggots in this brief video:
image from Starz – Outlander Season 5 Episode 9image from Starz – Outlander Season 5 Episode 9
So there are still things to learn about medical therapies we used in the past which have been sidelined or forgotten in our push for modern treatment modalities. The days of leeches and maggots may not be over after all.
And now for video, complete with little maggotty sound effects — scroll down
Maggots in our compost bin – enjoying corn and potato chowder leftovers
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The talkative guest has gone, and we sit in the yard saying nothing. The slender moon comes over the peak of the barn.
The air is damp, and dense with the scent of honeysuckle. . . . The last clever story has been told and answered with laughter.
With my sleeping self I met my obligations, but now I am aware of the silence, and your affection, and the delicate sadness of dusk. ~Jane Kenyon, “The Visit” from Collected Poems
As we slowly adapt to evenings spent with family and friends again, taking off our masks to actually witness the emotion on a familiar, now unveiled, face:
There are smiles and laughter again. We are trying to remember how to be ourselves outside the fearfulness that contagion wrought. More important: there are tears again. And wistfulness. And regret. And longing.
This delicate sadness happened – even to those of us who were never directly touched by sickness. We will never be the same, never so light of heart again, remembering what this past year has cost.
It is a slow transition to dusk. We sit together now and watch it come.
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