The Blog Week: The Snake Story

Disclaimer: If you don’t like snakes, you won’t like this story.  If you like snakes, you might not after this story. So now you are warned, you can proceed or not.

There are 4 varieties of snakes here in Nepal. There are non-poisonous ones we like that chase away the mice and rats, the hemotoxic ones that make you bleed, the neurotoxic ones that make it so you can’t move, and the ones that make you bleed and unable to move.  Now, for those wondering what kind of people these are who live with toxic snakes,   let me reassure you that generally a snake bite, usually meant for a rodent, will not inject enough venom to cause any of these complications to a human, and, this is really how we sleep at night, none of the neurotoxic snakes live at the high elevation of Tansen, where our home is.

Though we rarely see snakes and are not all that concerned about them, snake bites do happen, particularly to those who live at lower elevations.  Not that long ago a patient came into the hospital with a snake bite wound on the face.  He had been sleeping on the floor and was woken by a particularly unfortunate bite from a particularly nasty snake, called the krait. Kraits are known for this. Perhaps they are looking for a warm place to stay on a cold night. Or perhaps they are just that evil that they like to bite people while they are down.

This gentleman was rushed to a regional medical center, which was likely no more than a cement room with a cabinet full of medicines. They typical course following a krait bite if there was a significant amount of venom is injected is that the victim becomes weaker and weaker over a course of about six hours, until they are too weak to breath. By the time this man arrived at the medical center he was already quite weak, and having difficulty breathing. He was given the full remaining stock of anti-snake venom at the medical center, however this was only enough for the first dose, and a second dose would be required in the next hours, so he was shipped up to our hospital. Before leaving, his family was given a bag-mask, and shown how to use it. A bag mask is a contraption that allows someone else to breath for you, but much cleaner than mouth to mouth. This was a good thing, because en-route, he stopped breathing.

IMG_1970On arrival, he was quickly intubated, and placed on a ventilator. At this point, most of the excitement stopped. He was given his second dose of anti-snake venom, but at this point much of the poison has already been taken up into the nerves, and would stay there until this man’s own body could process it out, which we anticipated would take several days.  At this point, if the patient is able to remain ventilated, people generally survive.

Despite his inability to purposefully move his limbs and breath, he was able to interact with us. The poison does not put you into a coma, it just kind of paralyzes you. He was always very gracious to do his best to squeeze our hands or try to lift his arms and legs off the bed.  Day by day his strength gradually grew until he was strong enough to be taken off of the ventilator. On the day of discharge, 5 days after his arrival, his only complaint was some pain on the side of his face where he was bit.

It was not only the patient and his family that was touched by his healing, I was too.  It is this kind of dramatic recovery and gracious patients that makes working at a place like Tansen Hospital such a privilege.  I get to see exotic diseases like snake bites, and it is a place where medicine really is a tool for saving lives.