Thumbelina Does Guate
September 1, 2001
By Bernadette Bernon
"So, what happened to your thumb?"
I've been hearing this question nonstop lately from other cruisers, and curious locals, as they notice the conspicuous, gauze-swaddled digit on my left hand.
"Skin infection," I'd say to the cruisers. "No biggie. I'm on an antibiotic." Mercifully, this usually would end the discussion.
"Very WEIRD skin infection," I'd say to the locals, which usually aroused their interest. Guatemalans, it turns out, know all about weird tropical skin problems. Everyone has an opinion, and I was learning from them what could be wrong with my finger.
Nothing heals quickly down here. An insignificant scrape—subjected to a wet, salty life on a boat, combined with the sweat and heat of a jungle environment and all the airborne viruses that thrive there—can turn nasty fast. That's what happened to me. Back in May, while Douglas and I were exploring the isolated islands of Belize, I scratched my thumb near my fingernail, such an insignificant event that I don't remember it. Then, a day or so later, while I was securing the dinghy, I abraded the cut when I pulled a few feet of the dinghy painter across it. Woof! That hurt! The next day, the cut was infected.
I began soaking my thumb in hot water every few hours, cleaned it religiously with betadyne, and kept antibiotic ointment on it, all to no avail. By the next day the thumb began to throb, and the day after that, a red streak was crawling down my thumb and heading toward my wrist; the infection was aggressive and serious. Douglas and I dug out our medical supplies, and I immediately started a five-day course of antibiotics. This seemed to arrest the movement of the infection, but by the end of the five days, the thumb was still red and painful. Three days after I finished the antibiotics, the throbbing returned.
I pulled out another bottle of augmentin and began a second five-day course. At the end of that round, the thumb looked marginally better, but still pretty grizzly, so I continued the soaking routine. A couple of days later, I noticed a strange mound forming in the center of the wound, which was now open, raw and showing no sign of drying out. Most unattractive. I started a third round of antibiotics.
In order to protect my thumb from the elements and from brushing against anything, which was incredibly painful, I made a small donut out of a length of gauze; I positioned it over the mound, wrapped the whole thing in more gauze, and taped it to my thumb. Thus shielded, I went more or less about my business. It became second nature for me to hold my left hand up in the air if we were speeding around in the dinghy, so as not to get it wet. And I was becoming quite dexterous in accomplishing my boat tasks one-handed. It was around this point that the thumb became a conversation piece.
Eventually, I had to stop showing it to other cruisers who were curious to see it, because doing so only elicited such screechy remarks as "Gross!" or "That's so weird!"—which I already knew. By the time we got Ithaka into the Río, and anchored in front of Ak'Tenamit, Mr. Sensitive was calling me Thumbellina, and I was pretty frustrated with the whole affair. My thumb and I went to see Katy Mitchell, the American doctor who runs the Ak'Tenamit clinic. At first, she thought I had a wart that had gotten infected; she put me on a different antibiotic, keflex, and began burning my mound off by applying an acidic substance to it every day. This made my thumb angry, and it reacted to the abuse by contorting into strange shapes and turning blood red, then purple. Douglas said I was growing a prune. But he exaggerates. It was more like a large raisin, and after three days of treatment, my hand in a not-quite-Michael Jackson dishwashing glove, the mound was still there and looked even worse. Katy decided to lance the thumb, relieve the pressure and allow the infection to drain. But when she did, nothing came out.
"This is really weird," she said. She stitched me up, gave me another course of keflex, and instructed me to continue the four-times-a-day hot-water soak.
Meanwhile, as I worked at the school, the local people I met asked me about the thumb, and a few insisted on seeing it. This is when I began to learn more than I ever wanted to know about Central American tropical skin infections. When I unraveled my gauze donut and showed it to one old Guatemalan man, he nodded his head, and then confided, "Doctor Katy, she very smart. But she only know gringo medicine. This no gringo problem."
"But it's a problema grande for this gringo," I said. "What is it?"
He shrugged. "It looks like a fungus. My son had a big one growing out of his toe. It took two months to kill it."
Ithaka tied to the dock at Tortugal Marina in the Río.
Another day, a Q'eqchi Indian woman told me about her sister, who'd had a mound on her leg that turned out to be a condo for some kind of tape worm. Katy had to make an incision near the ankle, get the worm to wrap itself around a pencil, then turn the stick a little every day to wind the worm out of the woman's body. It took many days. (This story made me feel light-headed.)
An American woman who was living in Guatemala told me that her husband had had a lump on his head the year before. Frightened that it might be a cancerous tumor, they flew home to Boston, and went to a doctor at Mass General, who felt it and ordered an MRI, which offered no clues. The doctor suggested they "keep an eye on it for a few months." When the couple returned to Guatemala, an old Garifuna Indian woman, their cleaning lady, overheard them talking about the lump, and asked if she could see it.
"Ahhh," she said. "Señor, I try something?"
"Go for it," he said.
She lit a cigarette, took a deep drag, parted the man's hair, and repeatedly blew smoke directly onto the lump. Within a few seconds, an enormous worm came out!
I thought I'd faint upon hearing that one. Stunned, I looked at the raisin growing out the side of my finger, and declared to Douglas that we were getting on a bus the next day and heading into Guatemala City to find a specialist in tropical skin infections. It had been two and a half months since that first scratch, and I'd had it. The mound and whatever the hell might be living inside it had to go.
The colorfully painted chicken buses are cheap, plentiful, and the best means of transportation all over Guatemala.
I got the name of a top doctor from the American "worm-head" couple, and when we arrived in Guatemala City, (nicknamed Guate, and pronounced Gwa-tay by the locals), we headed straight to his office at the Centro Medico building. Doctor Pedro Cordeiro Greenberg had an impressive suite of offices in a modern building next door to the main hospital, which I found comforting. I started to relax, and as I waited my turn I noticed from some pamphlets that said not only did this office specialize in plastic surgery, Doctor Cordeiro was chief of dermatology at the hospital. Another good sign.
Doctor Cordeiro turned out to be a handsome, fashionably dressed man of about 40, who spoke perfectly beautiful English, and who examined my finger and hand with such tenderness that I actually felt myself blush. He diagnosed the hideous raisin not as a worm or another such tropical weirdness, but as some form of a cellular granuloma, and said he'd have to remove it, but to be on the safe side he wanted to biopsy it first in order to rule out skin cancer. He said this would be highly unlikely, from what I'd told him about what had happened so far. But he said he'd seen two skin cancers in fair-skinned people that had revealed themselves at the nail bed; although this was unusual, he just wanted to be on the safe side before doing anything invasive to it. He had one of his associates, Dr. Jose Tabush, do the biopsy, which entailed freezing down my finger with ice, slowly injecting it with Novocain, and then cutting off the top of the raisin. Who ever thinks cruising is gin-and-tonic glamorous has never contemplated a family of worms taking up residence in their thumb.
Dr. Tabush, a handsome, cultured young man of great skill, entertained me during the biopsy with stories about some of the bizarre skin problems he sees down here. I told him about the worm and the cigarette smoke, and he told me another way the Indians get worms out from under the skin is by putting a slab of red meat over the lump. "The worms are drawn out to the meat by their lust for the blood." (Sweet Jesus.) "This is why I practice down here and not in the States," he said. "It's not for the plastic surgery, which is fun and lucrative, but you just don't see tropical stuff anywhere else. I love it here." Dr. Tabush also entertained me with stories about the plastic surgery business in Central America, and how lots of Norte-Americanos come down to spa/clinics in Costa Rica and Guatemala for bargain face lifts.
"Many plastic surgeons from Central America have been trained in the U.S., and some have offices in Florida. They advertise in the U.S., and see potential patients for a week a month up there. Then, the rest of the time, they live down here or Costa Rica and run their own private facilities where they perform all the procedures and operate beautiful spas for the Americans to recuperate. Plastic surgery is not covered under your American health insurance, so the surgery, flights, luxury spa, and everything is cheaper than having the procedure done up in the States. It's a big business, especially in Costa Rica."
As Dr. Tabush talked about the penchant for plastic surgery among the upper classes in Central America ("It's very popular with Latin women. They all feel they must have their breasts big and firm"), and all about Gloria Estefan's recent eye job, Dr. Cordeiro poked his head in the door to check how everything was going. "Ah, Dr. Tabush," he said, "I envy you. You are the one who has the privilege to hold her hand, while I must toil out here in the trenches."
Latin men. So smooth, I thought, as I tried to imagine such a conversation occurring in a doctor's office in the United States. Before I left the office that day, each doctor had given me his cell-phone number, home number, and hospital paging number, just in case I had any questions or concerns. "Call one of us personally over the weekend," said Dr. Tabush, "and we will try to have the results of the biopsy early for you."
There's only one pathologist in all of Guatemala, so it takes a few days to get a biopsy result. Douglas and I spent the time idling around the cobble-stoned streets of old Antigua, the magnificent colonial city just 45 minutes from Guate. I called Dr. Tabush on Saturday morning, he'd just gotten the results, and he confirmed that the mound was not malignant. "This kind of thing can occur from a trauma," he said. "The cells of the blood vessels around the injury begin to grow out of control, the granuloma develops, it bleeds easily and excessively, and it won't heal. You must have it removed to be rid of it. We see it in children sometimes, usually on their ears."
A side street of charming Antigua
I was elated. My mound's days were numbered. We returned from Antigua to Dr. Cordeiro's office on Monday. He iced, then anethstisized my thumb, tied a tourniquet around the base of it, cut away part of my fingernail, then proceeded to burn out that little bastard of a mound with liquid nitrogen. He couldn't use any electrical devices to do this, as would be normal practice, because I have a pacemaker. He worked slowly and carefully. To keep my mind off the procedure, we chatted all about the difficult political situation in Guatemala; about the civil war just ended; about how his family, which had been very rich, and had lost their flower farms and much of their fortune over the course of the 30-year conflict; and about our mutual passion for the world's best chocolate. "My secret fantasy," he whispered, "is to cover my wife all over in the finest melted Swiss chocolate. So far, sadly, she will not co-operate."
Before I left Dr. Cordeiro's office, newly bandaged up and happily sans mound, he opened the bottom drawer of his mahogany desk, took out a beautiful foiled box, opened it as though it contained the royal jewels, and offered me a mouthwateringly rich, imported chocolate truffle from his secret stash. We each ate one in ecstatic silence.
Douglas and I will set out from Guate by chicken bus tomorrow, carrying our backpacks, along with special soaking powders and Teflon bandages from Dr. Cordeiro and Dr. Tabush. We'll pile into the rickety bus with, probably 123 Guatemalan Indians, all headed up to the mountain villages, and toward the cooler breezes of Lake Atitlan.
The experience of my thumb has lasted three months, an ordeal to be sure. But, provided this last remedy works out, I have to admit I've gotten a lot out of it. I've gotten to know warm-hearted Indians who tried to help me with their gruesome worm stories and advice. I've met a couple of suave and excellent doctors who exposed me to the views of the elite class here in Guatemala, a complicated country that until we came to Guate, I'd only known from the point of view of it's most impoverished people. Now, I'm happy to kiss Thumbelina good-bye, and although I'm already having pangs about leaving Ithaka alone at her dock in the Río while we go larking, I'm excited to be setting out with Douglas to explore the interior of a country that so far is one of the most culturally rich of our entire journey.