Of the horrible sights of surgery, neither mangled limbs nor charred bodies could create a
more lasting impression than the presence of maggots in sores. I vividly recall the elderly
man who attended the emergency room with his penile sore. The first stopper of this encounter
was the pungent, sickly smell of the chronic ulcer. His elderly wife was with him but like him
she had adapted to the repugnant smell. But when the patient undressed for examination, the
amazement on her face told me she had not seen the sore for some time.
He had refused to seek medical attention. He rightly thought that medical care would be
further amputation of his penis. Already he had the stub of a penis, the glans already gone,
eaten by a penile cancer. For the uninitiated doctor what could be worse was that maggots
infested the ulcer. While examining the ulcer the maggots began wriggling like so many
frenzied ants over a disturbed mound.
The neglect nudged an accusatory sentiment into my consciousness. But reason prevailed. Who
was to blame? Not the patient and certainly not the wife. Occasions like this make me doubt
the benevolence of any god. But I swear by the religion of surgery that its good surgeons are
also its priests. Surgery is a religion for surgeons who serve but do not seek the ultimate
cause of disease.
I ordered a galipot, forceps and antiseptic. I pored antiseptic on the sore and painstakingly
dug every single maggot out of the nooks and crannies of that ulcer, drowning the maggots in
antiseptic. I collected half a galipot of maggots. The cancerous ulcer had no necrotic tissue.
The maggots had done a marvelous job of debridement. But this was of little consolation.
With the ulcer clean I performed a biopsy of the ulcer. The diagnosis was cancer and the
patient went on to have a penile amputation. Unfortunately follow-up care of this patient,
like so many others in the Third World, was incomplete. Could he ever accept his emasculation?
What psychological pain must he have suffered? Why was his follow-up incomplete? Ask the
politicians. No, all of us are accountable for this shortcoming. I hope you remember this come
next election. See to it that your leaders improve your health care.
Another instance was that of an elderly lady who was admitted to hospital with a large chronic
stasis ulcer on the side of her leg. On the morning ward round the nurse brought to my
attention the fact that the lady’s ulcer was infested with maggots: “I know you are little
disturbed by ulcers with `little people’ in them. Here’s one for you.” Maybe this is so
because my Mayan ancestors routinely used maggots in the treatment of wounds. Later that
morning I debrided this lady’s ulcer.
A few weeks later her ulcer was grafted with her skin. She was discharged with a healed ulcer.
She was given advice and training for the prevention of recurrence of a stasis ulcer.
I remind you that in the olden days when surgery was not scientific but based on the wisdom of
our ancestors, maggots were deliberately left in wounds to facilitate healing with the natural
debridement of maggots. My experience attests to this practice; all infested ulcers have clean
beds.
Maggots of flies devour necrotic tissue of ulcers and other fungi (saprophytes) demolish the
dead tissue of corpses. On a lower level, organisms such as termites and bacteria assist in
the decay of organic matter. All take part in the grand cycle of matter. Christians are
reminded of this cycle on Ash Wednesday when they have ashes placed over their foreheads with
the words “From dust to dust …”.
As a child I imagined interred bodies being devoured by maggots. Now I know that saprophytic
bacteria are in the lowest node in the network for the decay of organic matter. Multi-cellular
organisms die and are decomposed by unicellular organisms. Unicellular organisms don’t appear
ever to die natural deaths. A bacterium proliferates by fission. One bacterium becomes two.
The continuum in the propagation of man is less direct. It’s only the genetic material, DNA
(deoxyribonucleic acid), of human cells that appears to be in perpetual existence. This is how
the cycle of life is maintained on an organic level. This life that remains after I am gone is
my afterlife. I have every hope that it will continue for eons to come.
Now, as for the individual, his distinct personality and existence, there is truth in what
Bernard Shaw said: “Don’t try to live forever. You won’t succeed.” Certainly when you die your
personality is lost forever. The most your person can be after death is a memory. As an aside
then, make the most of the living. Build memorials to the living. Shower the living with
gifts. Add in any way to the happiness of the living.
There was an insight in a conversation with a criminal. The security forces had shot him.
While nursing his wounds I said to him: “Why? You may have harmed innocent people. You will
most likely be killed by the police.” “Doc, some must die so that others live.” That’s the law
of the jungle and a truth of life. Those he kills die premature unnatural deaths. If a human
is killed or dies before he has progeny then his DNA leaves the cycle of living matter to
enter the wider cycle of inorganic matter. All living forms die within the cycle of inorganic
matter. The debris within this cycle of matter is recycled. The breadth of this cycle,
however, is finite and there must be a limit to the extant human biomass. This biomass has to
be regenerated from recycled debris. How else could 6, 9, 10 billion souls be made.
So be not distressed. The bottom line is that on the lowest level, the physical level, beyond
the cycle of life, in the cycle of inorganic matter your atoms do not disappear. They are
recycled in new living or nonliving components of mother earth.
Now you should be happy with yourself, with what you are. You do not fear disease or death
because you live in your progeny and after them you continue to exist within mother earth.
This is how I perceive the cycle of nature with maggots in a wound a spindle on that wheel.
SurgicalInSite 