A Guest From Hell

As I introduced myself, the guest suggested we not shake hands because he didn’t want to give me lice. He had lice.

I settled myself to listen. He explained that when he stayed in a hotel he always asked Housekeeping for the temperature at which they laundered bedding. To save money, they often kept it under 150 degrees, too low to kill the eggs. He was susceptible to lice, an affliction that mystified doctors. Treatment only worked for a short time, but this was a cross he had to bear. At home he laundered bedding and clothes daily. Although he fumigated his house once a month, this barely kept the infestation at bay. He concluded by handing me a sheaf of printouts from internet medical sites discussing lice and their treatment.

This was delusions of parasitosis: rare but not terribly rare. I’ve encountered half a dozen over thirty years. Confronted with a delusion, no one, doctors included, can resist the urge to point out the facts, a useless tactic. As anyone familiar with the debate over vaccination knows, faced with a deeply held belief, facts are worthless.

“Can you show me a louse?” I asked.

“I pick them off so fast they’re hard to find. But let’s look.”

I pulled out my flashlight, and together we peered at his pubic area.

“There’s a nit (egg),” he said after a long search.

“That’s a flake of skin.”

We turned up other bits of debris. Finally, I straightened up. “A louse infestation isn’t subtle, and I don’t find one.”

Having heard this from every doctor, he was not offended. “I need a prescription. Over-the-counter remedies don’t work.”

I wrote the prescription and held it out.

“Give it to the hotel,” he said. “They’ll pick it up and pay for it.”

“I’m not sure they will,” I said.

“They’ll do it. I’ve already told them I plan to sue.”

Doctors hate hearing that word. “That costs a lot of money,” I said. “And I doubt you’ll win.”

“Right on both counts,” he responded pleasantly. “It costs five or ten thousand dollars to hire the lawyer and file the suit, and usually the hotels won’t settle. But I can’t let them get away with filthy bedding.”

Insect Bites

A caller was suffering an itchy rash, present for a week. Three companions were also affected. That sounded good. When more than one person has a medical problem, it’s the same problem and not serious.

In the room, all four gathered to show me their skin which revealed the scattered, small pink pustules left by ectoparasites. I use that term to be accurate because not every bug that bites is an “insect.” Spiders, ticks, mites, scorpions, and centipedes aren’t.

Bedbugs (an insect) have become fashionable, but these travelers had been moving frequently from place to place. Where hygiene is reasonable, lice (an insect) limit themselves to hairy areas; I didn’t see any. My diagnosis was scabies, a mite (not an insect) that burrows under the skin. Scabies is hard to catch from clothes or bedding; mostly it requires rubbing against someone else with scabies, and it looked like these young people did a lot of that.