Hidradenitis Suppurativa is a chronic skin disorder that causes inflammation and infection of the subject’s sweat glands. This creates painful lesions in the armpits as well as around the genitals and anus. It is a particularly nasty disease that leaves its victims in constant pain, not to mention the social implications – patients often become limited in interpersonal relationships, unable to participate in normal activity due to pain and self consciousness.
I became a doctor to help others. While my colleagues obsess over statistics and regulations, I take my Hippocratic oath seriously. Other doctors are paid by big pharmaceutical to push some drugs and ignore others, but I truly care about the people whose lives are in my hands.
“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”
Three years ago I spent a summer in Guam researching skin diseases in indigenous populations. The Chamorro people come from a very unique culture – one that combined many different ethnicities. These different people converged into one geographically based culture, which was then built around two castes: one of wealth and power and one of servitude.
My research compared skin diseases in the descendants of the different castes to see how the spread of disease could have been affected by ancestral prestige, ethnicity, and wealth. The health of a people over decades can be affected by hundreds of variables, but I used medical history, as well as cultural history, to focus on the correlation of social structures and disease. The skin diseases I focused on are all non-contagious, so I attempted to measured how wealth and access to resources affected people over centuries of social division.
While working closely with these families, I began to notice a trend. Certain groups fared much better than others, despite social and economic standing. By reviewing and comparing hundreds of individual’s family medical history, I was able to connect improved skin health through generations with one specific medical event: an Integium infection.
There is a parasitic flatworm unique to the island from the Eutetrarhynchidae superfamily. Unlike most tapeworms from the Cestoda class, this flatworm does not remain in the intestines, nor travels to the heart, but instead can be found in the glands of the Integumentary System. Hence the name, Integium. While living in a human’s sweat gland, Integium releases an enzyme that increases the epidermis’ ability to fight infection, often calming inflammations.
Inflammations such as those caused by Hidradenitis Suppurativa.
While a tapeworm infection doesn’t sound particularly pleasant, the side effects are fairly mild, especially when compared to the benefits. The most common being discomfort and a sensation of movement under the skin.
As fall came I brought my findings, along with numerous Integium, back to the United States. Filled with excitement for my groundbreaking discovery and the potential it held, I knew I was fated to do great things. I was approaching the zenith of my career, fulfilling my destiny as a doctor.
“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”
Trying to get the FDA to approve the use of worms for medicinal purposes proved much more difficult than I had expected. No one took my findings seriously. When I shared my discovery with the medical world, I was laughed out of the industry. Desperate, I turned to private pharmaceutical companies despite my moral distaste of them, but none would sponsor me. They told me that it would be an “unsound investment” to spend the time and resources studying Integium further, even if it could mean extracting the enzyme and bottling it up for hundreds of dollars a pop. Without financial or political assistance, I was unable to perform further experiments in a controlled research environment.
Frustrated with my discovery’s reception and convinced that I could show the world the benefits of the Integium worm, I decided to take testing into my own hands by surgically embedding an Integium into a patient with Hidradenitis Suppurativa. The procedure, though technically successful, was also technically illegal and my medical license was immediately revoked.
Losing my license to practice medicine completely ruined me. None of the nearby hospitals nor private practices would even look at my resume, whether I applied as a medical assistant or even a non-medical staff position such as a receptionist. My savings slowly dwindled as I tried to clear my name. The shame and humiliation that followed turned me into a person I no longer recognized.
My younger brother, Nate, worried endlessly about my mental health and well-being. As all I had left in this world for family, he alone bared the burden of supporting my withering self. He begged me to go to therapy, to turn away from the community that exiled me and work towards becoming the strong independent person I once was. But I couldn’t let go of the life I loved. I turned to the internet in a desperate attempt to prove myself. Scavenging like a vulture, I plunged head first into social forums searching for patients who needed my help.
That’s how I found Harold.
Harold had the worst case of Hidradenitis Suppurativa I had ever seen. Patients with the disease rarely find the infection on their necks, let alone their faces, yet the lesions Harold experienced were large, puss filled welts that extended all over his body. A sea of infected boils covered his epidermis from head to toe. Blisters the size of quarters surrounded Harold’s mouth, nose, and eyes. Viscous green fluid leaked from them constantly, leaving glistening trails on his skin. When the sores grew too big, stretching the thin layer of skin beyond breaking point, they would burst painfully, expelling a rancid sticky substance. The persistent grease limited the amount of oxygen that could reach his pores, which suffocated and clogged, causing groups of swollen pimples to surrounded the infections with their own angry inflammation.
The disease made Harold a complete social pariah.
I approached him several times on message boards and via email explaining my treatment, its side effects, and its promising results. I expected him to be ecstatic, jumping at the chance of a cure, a chance to be normal. Instead, Harold looked my name up online and discovered the controversy surrounding my research. He refused my offering of help without even reading my pleas.
“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
Using some creative googling, Nate was able to find Harold’s address for me. I figured if I could get his attention long enough to explain the wrongness with which I was cast out of the medical society, he’d understand. He’d trust me.
Instead, Harold referred to me as a stalker and filed a restraining order.
“I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
After our mother was killed in a car accident, I had raised Nate as if he were my own. For years I protected him from the blows of our alcoholic father and when he finally walked out, I fought to keep us together, saving my little brother from a life in an orphanage or worse. I supported him, working two jobs while sacrificing nights and weekends to earn my degree. When Nate went to college, I took out loans for both of us, allowing him to earn his BA while I earned my MD. Nate saw me struggle for him, for us, and my reward was Nate’s complete loyalty. Nate knew me. He trusted me. So when I explained what we needed to do to save my career, my life, and Harold’s, he agreed to help.
And so late one night, Nate and I found ourselves standing in the dew-soaked grass of Harold’s lawn.
Nate picked up a rock from beside the plastic siding of the house and used it to smash through the lower window of the back door. He reached inside, careful not to cut himself on the exposed shards of glass, and with a quiet click unlocked the door.
‘I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”
Harold’s home stunk of disinfectant and sick, as if we walked into a hospital instead of a residence. Treading lightly I lead the way upstairs, searching the open doorways for my patient’s bedroom. I stopped short as I saw it: the shadow of a sleeping figure. His chest rose and fell with his deep even breathing.
Nate watched from the doorway as I approach him, my delicate footsteps silent on the carpet. Lacking an anesthesiologist, I was forced to concoct my own formula to knock Harold out. As I approached I readied the large needle and dug it deep into his neck, dispensing the cocktail of sleeping agent and anesthetic.
“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”
Nate turned on the bedroom light and came up behind me. I heard him inhale sharply at the sight of Harold’s face. The angry red blisters boiled up from his skin, forming bubbles that shook with each deep inhale.
“You grab his shoulders, I’ll get his feet.” I instructed Nate, who grimaced at the idea of touching the patient. I picked up Harold’s legs while Nate reached under his shoulders and pulled the unconscious man up, turning his face away, his mouth twisted in disgust. As we lifted the body, one of the larger blisters by Harold’s nose burst, the green phlegmy substance spraying upwards and splashing against Nate’s lips.
“Oh sick!” Nate said, instinctively dropping Harold. The body hit the floor with a muted bang. Nate sputtered and whinced, wiping his face furiously. “It’s all over me!” He cried in anguish.
“Nate! Grow up!” I scolded, though I knew I was the one who had been negligent by not bringing masks. I delicately placed Harold’s feet on the ground and ripped the sheet from the bed. The dark fabric was stiff and stained, completely crusted with dried fluid. I threw it over Harold’s body to give my squeamish brother a barrier.
Once again, I lifted Harold’s feet, the sour scent of the sheet filling my nostrils. I felt bile rise in my throat and I forced myself to swallow it back down. My eyes watered as my delicate scent receptors were bombarded with the putrid smell of infection. Nate picked up his half of the body, tightening his mouth in an attempt to stop his gagging.
“I will prevent disease whenever I can, for prevention is preferable to cure.”
Once Harold was safely in my basement – which I had spent the entirety of my prematurely withdrawn retirement fund to refinish into a makeshift operating room – we stripped him to his underwear and placed him on the hospital bed. Cysts leaked and oozed from every inch of his body.
Harold’s eyes were wide opened. I shuddered, the effect of his dead stare making my skin prickle with goosebumps. Leaning forward, my face only inches from his, I searched his eyes for consciousness. He blinked and I shoot back with surprise. I prepared another needle with the sleeper agent and injected him again, forcing the needle to drive deep into his neck muscle. I again injected the thick substance into his system. His eyes slowly drifted shut, but not completely – a small sliver of eye was still visible between his eyelashes. I shined my pen light into his irises, searching his pupils for a response. Satisfied that he was dead to the world, I begun the procedure.
I applied a thick white cream to his face, arms, and legs. The cream – a mix of steroids and irritants – was designed to purposely make his condition worse, inflaming his current sores and forcing them to burst. This opening of the blisters would help the wounds breath and allow the enzymes secreted by the Integium to mix with the body’s own fluids in an oxygen rich environment instead of a rotten dome of infection. As long as he didn’t pick at the forming scabs, the disappearing boils would leave only small scars in their place.
I lifted his right arm, letting it drape over his head as if he were a model posing at the beach. Taking a scalpel from the metal table beside me, I made a small incision in his armpit, careful to avoid the many pulsing blisters. I cut deep, searching for a lymph node.
Thick red blood mixed with greenish-yellow pus as it flowed from the wound, the liquid turning into a brown stream that ebbed around blisters towards the paper covering of the bed like a snake weaving through a garden. Widening the wound in Harold’s armpit with a pair of toothed prongs revealed a set of glands so inflamed they pressed against the skin with what I could only imagine was an incredibly painful pressure. The delicate membranes were blotched with a heavy purple I had never seen before. I made a slight opening in the largest of the glands.
With great delicacy, I withdrew one of the Integium from a tank at the wall and held it before me with a set of thin plastic tongs. It slithered and wriggled, more like an almost microscopic soggy noodle than a living creature. I placed the worm on a metal plate and, using a set of surgical tweezers, placed it into my incision.
“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”
Satisfied with my work, I began the process of stitching up the cut. I smiled to myself knowing that the scars I left on Harold’s body would be nothing compared to the blisters he’s had to bare all his life.
An inhuman scream suddenly disrupted my intense focus. A painful force to my side knocked me to the ground. I looked up to see Harold sitting upright, screaming as he looked desperately from me to Nate.
Snapping out of his shock, Nate rushed towards him. Harold, who should have still been sedated, grabbed the bloodied scalpel from the table beside him with surprising quickness and plunged it into Nate’s neck. A geyser of blood exploded, spraying against the white wall behind us.
“Nate!” I cried, jumping up to his aid. Kneeling beside my brother, I applied pressure to the wound. Harold, still holding the scalpel, watched me with horror.
“You!” He cried, recognizing my face. “What did you do?” I ignored him, keeping my attention focused on Nate who was losing far too much blood. Harold stood and walked to the sink, examining himself in the small mirror. “What did you do to me?” He roared.
Hot tears streamed from my eyes, burning my cheeks as I felt the life flow from the one person who still loved me.
“What did you put inside of me?” Harold screamed, patting desperately at his fresh stitches. He pressed down into weak, torn flesh, feeling around, completely disregarding the sores that covered him. The tips of his fingers entered one of the blisters, pushing deep inside of it and releasing puss and blood that oozed out like toothpaste from a tube.
“I can feel it! I can feel it inside me!” He screamed, his breath jagged, spittle flying from his lips. He directed the scalpel towards his flesh, and pushed, cutting into the fresh stitches.
“Don’t!” I screamed, my voice choked with sobs. I pressed down on Nate’s neck, my efforts to keep his blood from flowing proving futile.
Harold dropped the scalpel into the sink and screamed defiantly as he dug his bare fingers deep into his armpit. His breathing became sputtered as he pushed deeper and deeper. Blood and puss flowed freely from the enlarged wound, running down his side. A blister burst and I cringed as I saw the fluid enter the wound I had created, my small incision ripped into a gaping hole eating the very contamination I so meticulously avoided. He cried in pain, baring his teeth as his fingertips scraped at his insides, blood now cascading to the floor in violent geysers.
Panting, his face covered in sweat, tears, puss, and grease, he looked down as he slowly pulled his fingers out. The thin white body of the Integium stretched from his armpit, twisting and elongating with the force. Finally, the end slid from the wound without resistance and the creature fell.
“No!” I yelled. My words of warning garbled by my sobs as I tried to explain that the cream would burn his skin without the healing effects of the Integium. That he would become worse. That I had fixed him. That he was unraveling all the good I had done.
Harold glared at me as he picked up the metal tray by the bed, my tools falling to the floor with echoing clangs, and brought it down on my head.
“If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.”
I woke up draped over Nate’s corpse, my body engulfed by pain. I tried to move but my limbs no longer responded. My brother and I laid on the floor, our blood pooling beneath us. My gentle sobs broke the silence as I watched bits of green puss swirling in the red, pieces of Harold now a part of us. He’ll never know that he could’ve been cured. That he could’ve been normal. Instead he’ll be a monster forever.
“May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”