As a semi-retired GP Dr Adrian Barns hadn’t quite found the spur to give up his practice in the rural Lake District. He now mainly worked as the on-call doctor when the main surgery was closed.
Dr Barns had been looking at retirement with wary eyes for some time but as he knew most of his patients personally he couldn’t quite bring himself to leave the practice altogether. It wasn’t the case that he’d have nothing to do if he stopped working because there was always plenty to do on the family farm. His wife Carol mainly ran Grizedale Farm but he helped out whenever he could. By way of holding onto their former hippy days, Grizedale was a purely organic farm with no trace of artificial pesticides, fertilisers or plant growth regulators. Adrian had had to reconcile his professional preference for synthetic medicine and the evidence of its effectiveness with his passion for the natural organic ethos that underpinned all the work on the farm. At times he felt a little hypocritical as he prescribed medicines to his patients in surgery while at home he and his wife campaigned against the use of man-made materials.
Bella Marcel, one of his patients who shared his passion for organics and conservation, was unwell and he was making a home visit tonight. Outside the cloud cover was hiding the moon and starts and without any streetlights at 4am in this part of the country it was like driving blindfolded. Adrian had lived in the area off his life he knew the roads like the back of his hand but habit and respect for the countryside made him drive slower than perhaps he needed to as he made his way over to the village of Satterthwaite.
Bella had come down with a mystery infection following a trip to South America and Adrian couldn’t help but feel a little uneasy about symptoms she had described. Dr Barns was gifted with a sixth sense. He had an intuitive understanding of patients’ symptoms from the moment he met them without even having to ask them any questions. He was quite accurate and on more than one occasion he had diagnosed an illnesses or condition that the patient hadn’t even been aware they had. But with Bella, the GP was unsure whether the unease he was feeling was due to his talent or because of the rumours circulating in the media South America. Bella had returned home a couple of weeks before the outbreak hit the news but very little was known about it yet as the authorities were trying to keep a lid on it. All he knew was that there was area in eastern Peru where there had been of some kind of nasty outbreak of gastrointestinal intestinal infections, not far from where Bella had been travelling and it was likely she may have picked it up.
Dr Barns had known young Bella all her life. He had treated her mother before she passed away a few years ago. When Bella was younger she used to work on the farm helping out at weekends in the nursery. She was a hard worker and he predicted she would go far in life. She was currently reading fashion at university with the aim of being a designer and she appeared to have some talent. Last Thursday when he had first visited her she had shown him sketches of the organic baby clothes collection she was working on. At the time she had looked tired and complained of low energy. She also reported symptoms of vomiting, loss of appetite, feeling cold and had cramps in her stomach. Stroking his grandfatherly beard in a thoughtful manner Dr Barns had considered her symptoms and wondered about a possible gastroenteritis but he had observed the recent suntan and Bella told him about her traveling.
“Yes, my boyfriend and I were travelling around Peru about a month ago” Bella’s face had lit up slightly as she relived memories of the holiday. She continued in a queasy voice: “We spent two amazing weeks trekking around Puerto Maldonado, it was fantastic Adrian; you would have loved it”. Dr Barns let most of his patients refer to him by his first name. It was a close community out here and there was no point in distancing oneself with professional titles. He asked her about the food she had eaten over there and if she had had any water that wasn’t pre-bottled; as his sixth sense had hinted at the cause of her illness.
“Well, on one expedition we did run out of water” she had admitted with a guilty glance. “We found a freshwater river but we used water purifying tablets and only drank a tiny amount. Oh god, do you think I picked something up there?” she had asked nervously.
“It’s likely you may have picked up some kind of parasite”. An image of a tapeworm had flashed into his mind. “Tapeworms can be quite common in under-developed countries such as South America. But most of the time they’re relatively harmless so you’ve nothing to worry about”, he had tried to reassure her with a sympathetic smile as he saw the look of disgust cross her face. It had been too early for any evidence to show up in a stool sample but he had taken some bloods away to be analysed. He had also prescribed some praziquantel and suggested she came into the surgery if she felt no better after a few days. Unfortunately she had not been able to come to the surgery because her symptoms had indeed got worse.
As he arrived at Bella’s house he saw the downstairs lights were on illuminating the dark path up to the front door. He knocked on the door and let himself in, as Bella had requested on the phone. He found her lying sprawled on the sofa wrapped in a red and white checked duvet. It looked like she had been trying to work earlier; there were sketches of baby-grows and matching hats spread out on the floor around her in disorganised piles alongside a cold cup of tea and a slice of toast with one bite taken out of it.
“I’ve been trying to work and get this thing finished” she gestured towards the dining table where a length of soft cuddly-looking brown material lay in the jaws of a sewing machine. “But I’m not feeling any better. I’ve still been throwing up and I’ve not eaten for a while now” Bella complained weakly with a grimace. “I can’t hold anything down and I’m still getting those pains in my stomach as well” she added rubbing her stomach very gently. Dr Barns peered over the top of his round spectacles and observed that her stomach was noticeably larger and slightly distended, which was unusual for a tapeworm infection. Typically a person suffered malnutrition as the worm feed on the food that the host consumed.
“Let’s take a look. Lift you’re t-shirt up please” Dr Barns asked and gently pressed her abdomen feeling for any signs of infection or inflammation. He was about to ask how long her stomach had been swollen for when he felt something move under the skin. It felt like a slight tap, not too dissimilar to a baby kicking.
“Did you feel that?” Dr Barns asked in surprise.
“Yes, I’ve felt this fluttering feeling for a few days but I thought it was just indigestion. Should I be worried? Do you think it’s linked to those cases in the news? I hear it’s quite serious over there now”.
Dr Barns didn’t reply straight away. He had always been fascinated by parasites and this was a very curious case. Her symptoms now appeared very similar to pregnancy but she had said she had not had any unprotected sex and her periods were still regular. Whatever it was she was becoming increasingly unwell and his feelings of unease grew.
“I’m not entirely sure what is wrong, if I’m honest, Bella. But I think a more thorough investigation in hospital may be beneficial. I’ll make a referral and they will be in touch with you in a day or so. In the mean time I’ll prescribe more praziquantel” The GP advised as he filled out the prescription. “I’ll ask John at the pharmacy to drop it round to you in the morning. He owes me a favour” he added with a friendly wink to try and cheer her up.
Bella managed a weak smile in appreciation.
The following day as Adrian ate a bowl of steaming porridge another report about the mystery outbreak in Peru came on the radio advising that large parts of the country were now under quarantine. Accounts were still sketchy and still no one outside the country had any real facts. It was all just speculation and rumour to which Adrian did not pay any attention.
The telephone rang and Adrian finished loading the dishwasher before answering it and was surprised just a little concerned that it was Bella. She apologised for phoning him at home and asked if he could go round. He had given her his home number and had said to call if she felt worse. It was supposed to be his day off and he had intended to go through the latest invoices with Carol but Bella sounded much worse and he decided to see to pay her a quick visit first, the invoices would wait an hour or so. Bella had sounded as if she was in some pain on the phone and she had been slurring her words. She didn’t think she needed an ambulance but she wasn’t feeling well at all. So Adrian switched on the dishwasher and drove over to Satterthwaite again.
When he arrived at Bella’s house he rang the bell but there was no answer. He looked through the window into the living room and saw her lying face down on the floor. She was not moving and appeared to be unconscious. Dr Barns tried the front door and fortunately it was unlocked so he let himself in. A stale musty odour seemed to hang in the air and clung to Adrian as he hurried into the lounge. Bella’s limbs jerked with tiny spasmodic movements as if she had slipped into some kind of seizure. She didn’t respond to his voice so he put his jacket under her head to help make her comfy and pulled out his phone to call an ambulance. In the background he could hear a news report on the television about the mysterious outbreak again. A reporter was now saying the quarantine had been ordered by the UN and World Health Organisation. Increasing numbers of people were dying and neighbouring countries were now closing their boarders to try and contain the epidemic as more cases were reported outside Peru. The reporter had a distinctly anxious tone to his voice, as if he were reporting from a war zone and coming under direct fire. People in some towns and districts, he reported, had started to panic and riot. Adrian wondered how a common illness could case so much mayhem and also wondered what else the reporter knew but wasn’t able to broadcast. The reporter started to describe the features of the infection but Dr Barns didn’t catch anymore as he noticed Bella’s lips were turning blue and his attention returned to her at once.
She was no longer breathing!
At first he thought she had swallowed her tongue but as he hooked his finger inside her mouth to clear the airway he found it wasn’t her tongue that was lodged in her oesophagus; there was something else stuck there. As his finger touched the object, it withdrew further down her throat like the antennae of a snail when it is touched. Bella was now totally pale and glistening with a thin sheen of sweat. There also appeared to be movement beneath her faded Rainforest Alliance t-shirt. As Dr Barns carefully lifted her t-shirt and grimaced at what he saw. Her pale stomach was moving, the flesh rippling as if it were a sack full of snakes. Whatever was in there wasn’t just kicking, it was… writhing? Mesmerised by the horrific spectacle he barely felt his sixth sense urging him to move away from his patient. Overwhelmed by a mixture of both professional curiosity and morbid fascination he stared over the top of his glasses at the scene before him, trying to consider a sensible diagnosis that would explain what he was seeing. But before he could reach a hypothesis Bella’s body abruptly transformed into a living nightmare. Her ears, nose, mouth, eye sockets belched forth squirming horrors as long tentacles suddenly burst from every orifice in Bella’s body. Pinkish muscular tubes slick with blood and other bodily fluids stretched out from the young woman. Dr Barns recoiled from the sight as Bella’s body began shaking violently. Her arms and legs thrashed wildly for a moment before the soggy crack of her abdomen splitting open. The two halves ripped apart by a nest of lashing tentacles. Dr Barns leapt backwards from the ruined body in revulsion, colliding with the wall behind him. He felt bile rising at the back of his throat. But he was unable to tear his eyes away from the angry knot of protrusions twisting in the air. He had seen many sights in his career but nothing as stomach churning as this. The clutch of tentacles seemed to be aware his presence in the room and began groping towards him, blindly reaching out in his direction. Whatever was inside Bella, it dragged her body towards him. Dr Barns scrambled to the side only now realising his danger, but he wasn’t quick enough. A long probing member had snaked around his ankle and was working its way up the inside of his trouser leg. He felt it wrapping itself around his calf in sickening peristaltic movements. Its grip was tight and unrelenting and he felt the squeeze of suckers and the pinching of tiny hooks press against his bare skin. He kicked his leg frantically but the thing continued in its ascent. Dr Barns searched for a way out as more tentacles reached for him. Bella’s body was between him and the door. He was pressed against the wall. He tried to side step to the right but the weight of the thing tipped his balance and he fell awkwardly to the floor. He could do nothing as the monstrous tendrils reached his waist. More exploratory tentacles were probing his body, caressing his flesh with slithering interest. The GP screamed long and loud as his sixth sense hinted at what was to come. Moments before the clutch of worm-like tentacles found what they were looking for Dr Barns mercifully lost consciousness as the sickly members forcibly penetrated his body through all natural opening they found. Driven by the natural twin instincts of survival and reproduction, the very unnatural parasite ejaculated a batch of tiny eggs inside the unfortunate doctor before slipping away in search of more food.