“CUT THESE JIGGERS OUT OF ME!”
I could hear this patient screaming from the hallway. At least it was a break from the monotony of chest pain, abdominal pain, and dizziness workups. I walked into the room and saw a woman scratching and digging at her skin as if her very existence depended on getting whatever it was out from underneath it. I stepped out, put on some gloves, took a deep breath, and stepped back inside.
“How are you today?” I asked, mentally slapping myself for asking such an open-ended question to someone who was clearly going to need to be directed if I was ever to escape this room.
“You have to cut these jiggers out of me!” she shouted. “Look, look at these things – they’re all over me!!”
I saw some scabs which all seemed to be self-induced. She could tell I was going to need convincing so she pulled out her phone. “Here, look at these YouTube videos. I have jiggers. I’ve seen them crawling out. They’re all over me. You have to operate on me now!”
Jiggers are parasitic insects found in most tropical and sub-tropical climates. They are native to Central and South America, and have also been found in sub-Saharan Africa. Not so much in rural Georgia.
Broadening the differential diagnosis just a tad bit, I asked her if there was any chance she was using drugs.
“My neighbor sometimes puts meth in his coffee and then shares it with me. But I don’t use it. So if you test me it might be there. But I don’t use drugs! Now where’s the operating room? I don’t care if you put me to sleep, just cut them OUT!”
I printed out her discharge instructions, sighed, and picked up the next chart: “Chief complaint: chest pain, abdominal pain, dizziness, and penile discharge”. Hopefully there will be more jigger outbreaks.
