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Out There
The Worm and I (continued)

AFTER A THREE-DAY course of albendazole, I waited for the worm's dramatic exit. And waited. But instead of leaving my body, the worm went AWOL. A week later, I was playing soccer when my ankle started to feel weird. I took off my shoe at halftime, and there it was, squiggling angrily, as if I'd awakened it. The albendazole nauseated me and made my urine smell like sulfur, but I suffered through another round of it. And again, the worm vanished, but resurfaced when I finished the pills.

It appeared I had an indestructible parasite, which didn't bother me too much as long as it stayed in my ankle. My wife, however, was dying inside. "I can't stand it," she confessed. "I've never found anything in my life so disgusting. Please, get rid of it. I'm begging you."

A Brazilian friend told me he knew exactly what to do. "Don't bother with doctors," he said. "This is a very common problem in Brazil. Just get a needle and some thread and sew a circle around the worm. Pretty soon he will have nowhere to go, and he'll pop out of the skin all by himself!"

Ultimately, I went to see Dr. Kevin Cahill, a famous tropical-medicine specialist and president of the Center for International Health and Cooperation, in New York City. In 1959, Cahill, now 68, worked in the slums of Calcutta with Mother Teresa, and he later became known for his relief work in war zones like Somalia, Sudan, and Nicaragua. Today he treats seemingly all the foreign correspondents and diplomats in Manhattan. His office on Fifth Avenue is decorated with poison-tipped arrows and an antelope-skin quiver from a pygmy tribe in Central Africa, plus 16 of the 30 books he's written on relief operations and tropical medicine. When Cahill himself appeared, he looked like a ship's surgeon in Her Majesty's Navy— small, cherubic cheeks, caterpillar eyebrows, and a dollop of white hair combed à la Horatio Hornblower.

"So you've got a worm," he said cheerily. "Let's see." I pulled up my pant leg.

"Ha!" Cahill said. "There it is." He cradled my foot in his hands and squinted. "Where'd you get it?"

"Panama," I said.

"Of course, Panama. Good place to get one. You can put your shoe back on." The doctor seemed less than impressed. I felt disappointed.

"Do you see this a lot?" I asked.

"Just saw an entire wedding party infected with creeping eruption last week. Twelve people. The ceremony was on a beach in India." He patted his butt. "They were sitting in the sand, where the worm larvae like to hide."

"Is it dangerous?"

"There's a condition called WORM PSYCHOSIS," the doctor said. "People think they're literally OVERFLOWING WITH THEM."

"Creeping eruption itself is not. But there's always the chance that what you have is not creeping eruption but a condition called visceral larva migrans, caused by a similar worm. In that case, the parasite wanders through the body, looking for a home. It doesn't find it in the bowels, it doesn't find it under the skin. It wanders and wanders"—I thought I saw him smile, relishing the details—"until it reaches, very often, the back of the eyeball."

I smiled wanly, feeling much less brave.

"A few times a year, I get a call from some surgeon who just removed a patient's eye, and instead of finding what he expected to find—cancer, say—there's a worm."

"I see."

"I can offer you a remedy," he said. "A stronger parasiticide called thiabendazole. The tablets will make you sick, but they'll do the job. Or you can see if the worm goes away on its own."

I chose the medicine and began taking it that night, though I was on my way to a wedding in San Francisco. There would be partying and merriment all weekend, but I would lie in my hotel room, blurry-eyed and dizzy, writhing in agony as the chemicals coursed through my body and burned into my intestines, which felt as if they were dissolving in flames.

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