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Urology Pearls

‘The Prime Sneezer’ and other tales

Shahar Madjar, Journal columnist

I nicknamed him Scrotum. His scrotum was so massive that I could imagine him carrying it around in a wheelbarrow. The size of a basketball, I would say, perhaps bigger. It reminded me of a picture I had seen in a urology textbook of a man with elephantiasis. If elephantiasis were his diagnosis, I thought, the plot of his story would include four protagonists–a parasitic worm, a mosquito, and at least two people–and it would go something like this: The parasitic worm lived in the lymphatic system of one person. It looked, under the microscope, like a tiny thread. It had an exotic name, as if it were an Italian movie star–Wuchereria bancrofti (say it aloud several times and you too will become imprisoned in its charm). It took a mosquito for the parasite to spread from one person to another. The mosquito bit one person for a blood meal, and acquired the parasite. Then, it “injected” the parasite to another person’s bloodstream. The parasite then found its way into the lymphatic channels and blocked them. The flow of lymphatic fluid from the scrotum slowed down, giving rise to a swelling of his scrotum. The scrotum became so heavy that it pulled the skin around his penis, burying the penis in its folds as if it were the head of a shy turtle.

A fantastic story, wouldn’t you agree? But not as fantastic as that of Ms. Lemon. “About a week ago,” she said to me, “after I took a walk in the woods, I found a tick attached to my arm. I took it off, but then this happened,” she pointed to a red rash, about an inch in diameter, along her forearm, “and it’s getting bigger by the day.” Ms. Lemon’s story sounded like Lyme disease, and if that were her diagnosis, her story would include five protagonists–a deer, a white-footed-mouse, a tick, bacteria exotically called Borrelia burgdorferi, and Ms. Lemon. The tick would live on a deer but would “jump” for a bloody lunch on a white-footed mouse from which it would acquire the Borrelia bacteria. For dinner, the tick would prefer human blood, for variety is the spice of life, and therefore it would bite Ms. Lemon and inject her with the Borrelia he acquired from the mouse.

The second episode would be marked by a power struggle between the Borrelia and Ms. Lemon’s immune system. The conflict would be fierce. The bacteria would first take a hold in the Lemon’s skin, giving rise to the typical rash. Later, it would enter the bloodstream and spread into the joints, heart, and nervous system. Left untreated, Lyme disease would cause high fever, neck stiffness, and agonizing headaches and joint pains. It could bring about paralysis of the face, and memory loss. Will the doctor correctly make the diagnosis? Will the antibiotic treatment work its magic? Or will Ms. Lemon fall victim to the devastating effects of Lyme disease? Can you see how this can play out as a Netflix series?

A fantastic story, wouldn’t you agree? But not as fantastic as another story that, these days, might hit closer to home. The protagonists here are a bat, the coronavirus, the entire human population, and a person I would call ‘The Prime Sneezer.’ Here is the story: A bat is hanging upside down in a cave. Within it, a deadly virus resides. The virus finds its way, perhaps through a different animal, into one person, ‘The Prime Sneezer,’ who feels a tickle in his nose and, without prior notice, explosively sneezes. The tiny droplets formed by this first sneeze contain the virus. Other people in the immediate vicinity of ‘The Prime Sneezer’ inhale the virus. And they spread it in a similar way, unknowingly, innocently, through droplets, as they speak, sneeze, cough, and laugh. The virus is highly infectious. It is also deadly. From one to two, to four, to eight, to 16, to 32, to 64 … at the work place, at the local pub, in schools, in houses of worship, on the ground, aboard international flights, and after landing … to millions of people around the world the virus is spread. It is a pandemic. Scientists are scrambling for a cure, for a vaccine. Epidemiologists and governments are eager to flatten the curve. Millions die. Economies fall. The social fabric of society is tested. And the virus is relentless.

These stories are true, yet so fantastic. Mother Nature is playing tricks on us. It paints a picture of infinite dots that desperately move through time and space. It pulls invisible strings. It creates beauty and turns beauty into shambles. It gives life and sentences to death. How can one understand the stories Mother Nature tells us? How can one find the peace to accept it all?

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