Killer Shrimp Ceviche
It's October, and I'm a second-year medical student. My best friend Carly and I have just finished a backpacking trip through South America. We fly out tomorrow from Lima, Peru, and we have just one thing left to do: eat shrimp ceviche, the classic South American dish of raw seafood marinated in lime or lemon juice, oil and spices.
We wander along the busy streets until we find the restaurant our hostel's desk clerk recommended. It's a small, dingy joint that doesn't look up to the current health code, but I don't give that another thought once a giant bowl of amazing shrimp ceviche is placed in front of me.
It's incredibly delicious, and we quickly demolish it.
"I'm so full!" I lean back and sigh.
"I know! I could throw up right now!" Carly says jokingly.
Minutes later, she's not joking.
"No, I really might throw up," she says, looking confused.
I'm confused, too. The timeline doesn't make sense: Food poisoning wouldn't kick in this fast. But I don't have a clue what else it could be.
Back at the hostel, Carly says offhandedly, "You know, it feels like my throat is swelling." She absentmindedly scratches her chest, where a few angry welts have appeared.
This sets my head reeling. This is not food poisoning, I think. This is an allergic reaction--a potentially deadly medical emergency! Allergic reaction...how to treat an allergic reaction?
I rummage through my bag, find some Benadryl and hand Carly a tablet.
"It's Benadryl. You are not having anaphylaxis on me in Peru," I tell her firmly.
She shrugs and pops the pill.
I make her take two more, just to be thorough. I'm trying not to freak her out, but I'm absolutely terrified. I learned about this in class, but I've never seen it in real life. My mind is racing: What are the other symptoms, again?
"Can you breathe?" I ask, scanning her for signs of distress.
"Yeah...obviously," she answers a bit snarkily, clearly unaware that anything much could be wrong.
"No, I mean, is it hard to breathe?" I persist.
She looks alarmed.
I don't even know if 911 is the right number to call in Peru, I realize. It probably isn't.
"Just stay here, keep your phone close, and call me if you can't breathe," I say.
Her eyes pop.
"What is happening?!" she yells after me as I run downstairs to find out where the nearest hospital is.
The desk clerk speaks some English, but not much. After some extensive explaining ("No, no, there was nothing wrong with the food; she's just allergic to it"), I get a hospital address and call a cab.
Carly and I gather our passports and our few remaining Peruvian soles, wait an eternity for the cab, then wait another eternity as the driver takes us to the hospital.
With every passing minute, my apprehension grows. Carly's face and neck are ballooning out, and her skin is covered in hives. She isn't wheezing yet, but her voice sounds muffled. I peer anxiously through the windshield for any sight of the hospital.
Finally we stop in front of a small white building that gives no hint of its purpose. I run inside. Carly trails behind, now completely unable to speak.
The clinic layout is simple: just one open room. To the left, there's a waiting area devoid of magazines or toys. White plastic lawn chairs line its whitewashed concrete walls, whose small windows overlook the street outside. A few people sit quietly waiting. To the right is the treatment area, divided by white curtains into a half-dozen individual "rooms."
This is an urgent-care center at least, I realize. They probably have the capacity to treat anaphylaxis. Despite its drabness, this space is the most beautiful sight I've ever seen.
Two nurses in plain blue scrubs greet us calmly.
In my broken Spanish, I begin: "Um....Necesitamos un doctor....Mi amiga esta enferma...." ("We need a doctor....My friend is sick.")
The nurses look at me with expressions that say, "Um, yeah, we can see that."
Carly, who now resembles a juicy, ripe tomato, is viciously scratching every accessible inch of skin.
Before I'm done speaking, the nurses whisk her into an exam room and stick two needles into her deltoids. I hope that at least one of them holds epinephrine.
A man in scrubs--a physician, I presume--appears. He surveys the situation, murmurs approvingly to the nurses, then walks out.
I try to ask what's in the syringes, but my Spanish is so horrible that no one can guess what I'm asking. Carly speaks Spanish fluently, but her ripe-tomato face, coupled with her intense fear of needles, makes her taciturn.
After thirty minutes, she's definitely improving, and I exhale for the first time in what feels like ages.
The doctor walks in, shines a light into Carly's throat, plants a stethoscope on her chest, murmurs something to the nurse, and leaves. The nurse pushes the remaining medication through the syringes, then briskly removes them.
Carly looks like a different person. Her hands rest quietly at her sides instead of attempting to remove her skin. Her face is still puffy, but its color is almost back to normal.
We wait there for another couple hours, listening to the waiting room backdrop of screaming children, coughs and sneezes. I look around the clinic and notice that, spare though the room is, every item there has a purpose: Nothing is wasted. Although no one speaks English or attempts to explain what's going on, and the amenities are basic at best, I couldn't care less. Clearly, these medical professionals are getting the job done, and Carly continues to improve.
Finally the doctor deems Carly to be healed. He hands her a piece of white paper on which he's scribbled instructions to purchase two medications at the pharmacy and to avoid beer, oranges and fish. I read it and look quizzically at him as he ushers us out.
"Why no beer and oranges?"
"It makes...." He places his hands by his neck and slowly moves them outward, puffing his cheeks.
Carly and I look at each other and shrug, then head to the front desk to pay. My heart starts pounding all over again. How much is this going to cost?
Much to my surprise, the whole experience costs only fifty-five soles, the equivalent of twenty bucks.
We eat our last meal in South America at Applebee's, taking special care to avoid beer, oranges and fish, and marveling at the crazy events of the day, now that the terror and shock have worn off.
"Hey, thanks for not letting me die in Peru," Carly says casually, through a mouthful of burger.
"No problem," I shrug.
Then, thinking back on how truly terrifying the whole experience was, I add, "Thanks for helping me rule out emergency medicine as a career choice."
About the author:
Kirstin Hirni recently graduated from an internal medicine/pediatrics residency at the University of Missouri–Kansas City and has begun a new job as a hospitalist at Menorah Hospital in Kansas City, KS. "My passions include medicine, bioethics, travel, the complexities of human interaction, Royals baseball and ice cream. I've kept a journal since the third grade, chronicling volumes of mostly insignificant events over the course of my life; at the encouragement of my bioethics mentor, Dr. Brian Carter, I have started sharing a few of the more interesting encounters."