The Doctor and Dysentery: A Personal Account with Potential Literary Applications

In H. G. Wells' War of the Worlds, the conquering Martians in their saucer-topped tripods are not defeated by arms but microbes—the common cold. A similar episode occurs in T. H. White's The Once and Future King, where Merlin battles a black wizard in a shape-shifting contest. When the black wizard becomes an elephant, Merlin quickly changes into a virus, and the opposing wizard dies before suspecting Merlin's strategy.

While studying immunology in medical school, I was amazed by a singular fact. I had always thought that we developed antibodies in response to new pathogens, that our white cells analyzed the threat and subsequently designed a protein to defeat it. Not so. The DNA of our lymphocytes is much like a closed library collection. Either we already have the code for a pathogen or we don't. Thus immunity, for the most part, can only be acquired through cross-breeding. Between Cortez' arrival in Mexico in 1519 and the year 1650, it's estimated that ten of eleven-million natives died, millions from smallpox and measles—not discounting mistreatment, slavery, and starvation. The Mexican race didn't begin to bounce back until there was sufficient European blood to confer immunity to imported diseases.

Put another way, even if Columbus had given vaccinations for measles upon his arrival in the West Indies, it would have done the natives little good. Their DNA did not contain a blueprint for a pathogen their ancestors had not encountered, so no true immune response could be mounted. Over half the indigenous population of the Caribbean Islands thus died from measles. Apparently their Asian forebears, having crossed the Bering Straight some 10,000 years before Columbus, had never been exposed to rubella. (I should add, for mothers fearful of vaccinations, that measles can still be fatal for those of European stock. It is not a mild disease, and MMR boosters are now recommended at age 15.)

Now on to the personal.

I have lived in central Mexico for over a year now, and never in all my life have I been so sick so much. Even now I am recovering from my fifth bout of amoebic dysentery. Strangely, my wife and visiting children have all been immune. Most norteamericanos here have few problems as well, after an initial six-month adjustment to new colonic flora. Which makes me ask Job's question, "Why me?" (To which God famously replied (in so many words) "Why not you?")

I think the answer simple. My maternal grandmother immigrated from Norway, my maternal grandfather from Sweden, and my paternal grandfather comes from Nordic stock in Normandy, while my maternal grandmother was a Boston Blueblood descended from William Bradford. In the land of ice and snow, there ain't no amoebas. I take more after my mother's side in appearance than my siblings, thus I suspect I lack the genetic library reference for developing immunity, much less cooperation, with pushy protozoans.

Don't get me wrong. I'm careful, I disinfect tap water with iodine and our reservoir has silver colloid for protection, I carry antibacterial gel to frequently clean my hands, don't eat off the street, bash knuckles instead of shaking hands while saying "No amoebas!" Yet repeatedly, the protozoans invade my bowels, pump me up with gas until I look eight months pregnant, forbid me to eat, make me vomit in the morning (including several post-coital episodes, after which I tried to assure my beloved it had nothing to do with her charms or lack thereof!). Sometimes I think I've filled more stool sample cups here than cups of coffee (amoebas won't let me drink coffee anyway; I always lose my taste for it when infected). To make light of my plight, I have instructed my Mexican friends to address me by a new honorific: "Don Colon de los Amoebas."

My worst case was in November and December of 2003. In late October I had just returned from a marvelous fishing trip in Northern California, healthy and refreshed. Within a week or two I began to resemble Homer Simpson, though I kept telling people, "I'm not fat, it's just gas!" (It is possible to lose weight while looking fatter.)

The worst of it is the gas pains. The night before Thanksgiving 2003, I rolled back and forth on my bed, holding my belly, wishing for a machete so I could carve myself open and hang my colon out on the laundry line. It was the worst pain of my life. I longed for a total colectomy like a starving man longs for bread. I've seen patients with bowel obstruction in less pain, and though I have a reputation among family and friends of a very high pain tolerance, the agony of one's hollow viscera being pumped up to Macy's Parade balloon proportions is no picnic.

In typical gallows humor I began to joke with my wife about colostomy bags. I wanted an Elvis bag with white leather fringes and rhinestones. I wanted a black bag for New York, a tie-dyed one for LA, a hand-tooled leather bag for Wyoming. The humor helped sustain me, but in truth I would rather have been dead if it hadn't been for my wife and children, who still needed me (or so they told me).

Adding insult to injury, I visited a specialist in a big city near our small town of San Miguel, who, after a history and brief physical, diagnosed me with "Irritable Bowel Syndrome," a diagnosis I received once before in the states, which I now believe was mainly a complication of narcotic maintenance for chronic pain after my failed back surgery (worsened by two decades of lithium for my manic-depression). There is, by the way, no treatment extant for IBS in men. I had already tried strange Mexican fiber mixes and charcoal capsules with no relief. I was eating dried dandelions, for God's sake! Yet I insisted on bringing in stool samples to the overconfident doctor, and lo and behold! The lab discovered I was afflicted with not one, but two, two breath mints (I mean amoebas) at the same time: the common entamoeba histolytica and the less common endolomax lana.

I had already taken the one-pill cure and the three-day cure for amebiasis prior to the visit, but my Mexican doctor, after receiving the results, informed me that only the old ten-day cure with metronidazole was truly effective. The treatment was as bad as the disease. I vomited, my stools changed to water, I felt feverish, and I prayed these further symptoms meant the horde of amoebas was dying off. Indeed, "Death to amoebas!" became my new mantra. After taking the cure, it took me weeks to return to normal, and I had a lingering problem: I was afraid of food.

Have you ever been afraid of food? Food is the ultimate human comfort, from the breast to the hospital tray in the ICU. Yet for more than two months, food literally scared me. I didn't know what would happen if I ate. I didn't know if my pain was hunger or just pain, or if food would cause more or less pain—most often it was the former. Some days I couldn't eat at all. Other days I could handle a little yogurt, maybe some soup and rice. I tried to maintain my protein levels with fish and dairy products. And during the cure (or should I say "temporary stay"), I couldn't drink alcohol, so I couldn't even flee to what Sinatra called "numbsville." And, indignity upon indignity, during the illness and cure, the cure being as painful as the illness, I smoked pot for purely medicinal reasons. How humiliating to have to take a drug for pain that had formerly been used only for pleasure! If someone tells you, "You must take this recreational drug," it takes all the fun out of it.

Call me long-winded, call me confessional, call me a gas bag, a plague dog, a dyspeptic doctor indulging in dithyrambic whining, and I will plead guilty. The question is, can I redeem this story in any literary way?

First, imagine how many dyspeptic authors may have suffered from some type of indigestion. C. S. Lewis, no dyspeptic author, once observed than many may mistake spirituality for the gift of a good digestion. Perhaps Mencken had gastroesophageal reflux. Poe and Coleridge were certainly constipated from narcotics. In his Tale of a Tub, the often dyspeptic Swift portrayed Pentecostals as farting their prophecies.

Even the Bible contains gastroenterologic metaphors. In the Revelation of John, Christ says to the Church of Laodicea, "I will spew you out of my mouth." St. Peter wrote of apostates, "The dog returns to its own vomit." There is even straight medical advice for indigestion, as St. Paul admonished Timothy to "take a little wine with your water for your stomach's sake."

In the Raj, or British Colonial India, the problem of dysentery was so severe among the English that their loos were large wooden affairs which earned the sobriquet "Thunder Boxes." Aldous Huxley's "Point and Counterpoint," set largely in India, may have had its satire increased by Huxley's own digestive problems there. The Wasp of Twickenham, Alexander Pope, suffered digestive problems (along with near crippling kyphoscoliosis), both no doubt contributing to the acid of his pen.

Yet most significant among writers, especially poets, is not acid stomach or dysentery, but black bile, the old humor blamed for melancholy (see Robert Burton's Anatomy of Melancholy) for which physicians, from time immemorial, have prescribed strong purgatives. Browse through any anthology of poetry, and you will find, guaranteed, a plethora of poems containing morbid introspection and a general dearth of joy. Most amateurs, even most poets of reputation, are more likely to spew poetry while suffering than celebrate life's joys when feeling better. Blame it on black bile or christen it "therapeutic logorrhea," it is nevertheless true.

Thus from a temperamental aspect (probably with physiological roots), one might posit two types of literature: the dyspeptic and the melancholy. H. L. Mencken, Ambrose Bierce, Jonathan Swift and Alexander Pope qualify as dyspeptic writers given to satire. Poe, Tennyson, Hawthorne and Hardy are melancholy writers, as are most of the Romantics and Victorians. Then there are writers who can be both dyspeptic and melancholy, like Robert Frost.

So how much of an author's Weltanschauung can be attributed to dyspepsia? And how much to melancholy, or a depressive nature? These questions would properly require a investigation beyond my short speculative attempt to redeem a confessional column into something literary. I do think such a study would yield fascinating details. As Jesus said, "Out of the heart the mouth speaks." I might add, "Out of the gut the writer spews." Imagine footnotes added to famous works where we discover, for example, that Doestoyevsky wrote his famous chapter, "The Grand Inquisitor," while suffering from an ulcer, or that "The Merry Wives of Windsor" would have been funnier if Will hadn't been so constipated.

To return to the personal, while under the dyspeptic spell of amebiasis, I had little positive to say about anything and wrote virtually nothing new, though I could edit and revise. In my protracted illness creativity departed from me. As a bona fide third-generation manic-depressive, I have also never been able to write in my deepest depressions, with the exception of a few minor poems. I have been able to write in a melancholy vein, like most self-respecting poets, during milder depressions.

It would be foolish of me, however, not to remind the reader that there are more cheerful writers whom I suspect had good digestions, C. S. Lewis being already mentioned, to whom we might add such luminaries as Ogden Nash, Dorothy Parker, Erma Bombeck, e. e. cummings and Walt Whitman.

The whole question boils down to nature and nurture (a phrase first coined by Shakespeare, I believe in reference to Caliban). As a physician and psychiatrist, I am convinced that nature is much more important than nurture, given an adequate environment (or what Winnicott called "a good-enough mother"). I was likely born with a weak colon, and when in the throes of its dysfunction, I become acerbic and negative. In retrospect I remember having such severe gas pains in elementary school that I would sometimes drop and roll on neighbor's lawns while walking to school. Here in Mexico my Nordic genes lack the ability to code for immunity to subtropical parasites.

As an afterthought, I should say that in the course of writing this column, I had my wife tested and discovered that she is an asymptomatic carrier of amebiasis, as no doubt the majority of the population is here, and I have no doubt our son will test positive as well.

Et tu, Brute? Or better, Eres tu, Jose?