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These stories are true, but the names may be As a consequence of their environment and diet, most, if not all, of the Vietnamese, Montagnard, VC and NVA patients we worked on had intestinal parasites. These ranged from pinworms to large roundworms to tapeworms. These parasites, doing what they do best, lived off the intestinal and bowel contents. Since their diets were marginal to start with, most of the patients we saw were very skinny. Part of this was also due to their uninvited guests. This was nice for surgical teams because the fatty layer was so thin. It made for a quicker entry and exit from opening a belly when we'd have to open one up for a look-see. When we got a patient in the ER with a suspected belly wound, the typical procedure would be to get an X-ray of the belly from a couple of angles. If it looked like the peritoneum (the lining of the abdominal cavity) had been penetrated, we'd prepare for a laparotomy (surgical opening of the abdominal cavity). In combat surgery, it's very important to be able to see what you're doing, so the incision would typically be much larger than you'd see in a civilian setting, often 8-12 inches. At that time, x-rays didn't provide nearly as much information as todays' CAT scans and MRIs, so we did a lot of unnecessary laps (short for laparotomy). In fact, I remember doing 5 one night and in none of the cases was the peritoneum actually penetrated. The doc in the ER was a new guy (sometimes called FNGs..no explanation from me) and was being cautious. After the chief of surgery reamed him out quite nicely for causing us so much unnecessary surgery and so much recovery time for the patients, he did better in diagnosing his cases. ANYWAY...back to the background for this story. Whenever we had to open up a belly, the first thing we'd do was look for any source of bleeding and take care of that. Once control of bleeding was established our next job was to see if the intestine had any holes. This was done by "running the bowel", which involved running your hands along the entire THIRTY foot length of the intestinal tract, feeling and looking for any holes. While doing this, you could obviously feel what was inside. A nice, clean GI bowel would have just normal contents, which would squish out of the way of your probing fingers when you applied a little pressure. The typical "native" bowel felt as if it contained hundreds of flexible pencil leads...roundworms! The first time I felt them and asked what they were, it made me a little squeamish, but I got over it. As I mentioned in another story, body hair is considered a potential source of contamination in surgery, so one part of preparing ("prepping") the patient was shaving the op site and surrounding areas. After shaving, the tech doing the prep would perform a 2-minute scrub of the op site. This involved using Betadine scrub and surgical sponges and vigorously washing and scrubbing the area. After scrubbing, the area would be wiped clean, using a sterile technique, and an application of Betadine (not the scrub, the disinfectant) would be applied, then removed, again using good sterile technique. All of this was done to minimize the probability of bacteria on the skin contaminating and infecting the wound. The bane of all surgical personnel is the rogue fly, sitting quietly on the wall until the scrub was finished, then flying into the brightly lit surgical site and landing. This was considered a gross contamination and required rescrubbing. I'd just finished scrubbing an NVA belly. He'd been shot in a firefight a couple of days earlier and just captured. He took the hit about an inch from his belly button at the 2 o'clock position. The round had lost most of its' energy and there was no exit wound. It was just a nice little round hole in his belly. In the bright light of the overhead surgical lamps, the op area was clean and ready to drape. We draped off the area with sterile drapes, clamped towels around the edges and the team prepared to operate. Just at that moment, as the surgeon prepared to make his initial incision, out of the bullethole popped a shiny dark form. It slithered out about an inch or two, laying out on the patients' belly. A large roundworm had just made his Hollywood debut! The surgeon cursed and the scrub tech grabbed a pair of "fingers" (you probably call them "tweezers") and grabbed the worm, tossing it in the waste bucket. After some discussion, we decided to wash down the area with alcohol, which would disinfect it sufficiently for the case to continue. When the worm reared its' ugly "head" (actually I don't think they have a head), it told us much about what we'd find inside. If there was one worm running around in this guys' belly, there would be more...many more! When we opened him up, it smelled like a gut-shot deer. It was BAD! Everybody had the circulating nurse put a little oil of wintergreen on his mask to cover up the smell. The belly was terribly inflamed and full of worms and pus! We spent about an hour rounding up all the worms, rinsing and suctioning out as much yuck as we could, then we ran the bowel, finding several holes. The surgeon decided to cut out the damaged section, then performed an end-to-end anastamosis (stuck it together). We rinsed the bowel thoroughly with an antibiotic solution, put in some drains, sewed him up and sent him off to post-op. I often felt sorry for the post-op team. We'd send them patients who were mostly-dead (please see "The Princess Bride" for an explanation) and expect them to pull the patients through long enough to get them stable enough to evac to Japan. As long as they didn't die on the table, we'd done our job. Too bad if they died on somebody else! Such is the horrible calculus of war. One post-op nurses' hair went completely white in about six months of working there. The stress was horrendous. One of the post-op nurses took an intentional overdose on Tylenol and just about died. It wasn't until I was working as a pharmacist in the Idaho Poison Control Center, several years later, that I appreciated how deadly Tylenol can be in overdose. The really bad thing about it is that the damage doesn't really appear for several days after the overdose, at which point it's usually too late to do anything about it. I had other adventures involving worms, but none as dramatic as this. We had repeat performances of this scenario many times and it became fairly routine to find worms in a shot-up belly. One interesting thing about worms is that they're opportunistic parasites. They can only survive in a living host. Within minutes of a patient expiring, the worms would start to make their way out...hoping to find a new host. This was a very creepy sight. Unless the patient had been gut-shot, the only way for the worms to exit was through the anus or mouth. The image of a dead patient, lying dull-eyed on the OR table with worms crawling out through his anus, mouth and nose is not one soon forgotten. Comments: E-mail me Thanks for visiting ...SP5 Steven Streeper
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