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Outside Magazine November 2004

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Out There
The Worm and I
Having a parasite hitch a ride under your skin is bad enough. Evicting the little bugger is even worse.

By Ben Ryder Howe


	Photo Illustration by Mark Hooper

LAST WINTER, I came home from a trip to Panama hosting a worm. The parasite, which invaded my left ankle while I was reporting a story, had been living in me for about two weeks, and had suddenly become quite active. It was white and tiny—about a half-millimeter long—and it left a meandering, pus-filled track that looked like a piece of angel-hair pasta trapped under my skin. I discovered the creature while in the shower and showed it to my wife.

"What do you think?" I asked, still in my towel, proudly holding out my ankle.

"It's revolting," she said. "What are you going to do about it?"

"I don't know. Maybe nothing."

"How do you know it won't lay eggs in you, or migrate to another part of your body, like your brain?" she asked.

Decent questions. I went off to find answers, relying on that old, trustworthy medical source, the Web. I quickly found a site devoted to exotic skin maladies and diagnosed myself with "creeping eruption" caused by Ancylostoma braziliense, a hookworm that normally lives in dogs and cats but sometimes invades humans. The site featured photos of A. braziliense, blowups that revealed the creature to be a sort of Hollywood alien, eyeless and toothy, with a menacing black vortex of a mouth.

Was it gross? You bet. Was it dangerous? It seemed not. Humans are accidental, dead-end hosts for A. braziliense, noted eMedicine.com. The worm isn't equipped to suck blood or lay eggs inside the intestines of humans—they can only do that in dogs and cats—so I probably wouldn't suffer much harm.

I put off going to the doctor. Meanwhile, the worm wandered with great energy, sometimes covering three inches a day. But this was not the George W. Bush of parasites. Instead of pursuing a path relentlessly, it flip-flopped and crossed over its own tracks as if it were blind, which, of course, it was. It often ended up exactly where it started, and never once did it roam into the ample spaces beyond my greater ankle.

Before long, I had a raging skin infection. My ankle blew up to the size of a softball and leaked prolific amounts of worm juice, a syrupy yellow pus that was as slippery as slug slime. At first I tried to conceal the mess, but as I quickly learned, parasites don't necessarily make you a pariah. They can also make you popular. People wanted to see the worm, and a few wanted to touch it. After someone in my office snapped a digital photo and e-mailed it around, news of the worm's existence spread far and wide. Soon, old friends I hadn't heard from in years were writing to ask if I had given it a name. (Never got around to it.) My four-year-old nephew gave a report about the parasite to his preschool class, in which he bragged, "My uncle has a worm in his ankle!"

The cachet was so sweet, I began to grow fond of my worm. Many people I know who work in the tropics—whether they're missionaries, scientists, or gold miners—like to tell horror stories about the afflictions they've endured: scorpion stings, trench foot, dengue fever, vampire-bat attacks. As soon as I could, I told everyone I knew about my little hitchhiker, and the response was unanimous: None of them had ever had a worm under their skin. They were jealous.

The only people who failed to appreciate the worm were my wife, who thought I was crazy not to get rid of it, and her mother, who was convinced that it was contagious and rushed to our apartment the day after she heard about it and scrubbed the floors with bleach. To reassure her, I paid a visit to my physician, Dr. Blanche Leung, who gave me a prescription for albendazole, a medicine that, she said, would screw up the worm's metabolism and kill it.

"Then what?" I asked glumly.

"Probably it'll just decompose and get flushed out of your body," Leung replied. But there was also a chance for one last act of gross-out theatrics—the worm might bolt for the exit, so to speak, in which case I should prepare for the sci-fi scenario of a live worm wriggling out of my mouth or one of my nostrils. I could only hope it would happen at a crowded dinner table, under a bright light.

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BEN RYDER HOWE, a senior editor at The Paris Review, wrote about Panama's Darién Gap in September 2004.

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