80 and Creechies

In the middle of rounds yesterday we reached the bed of a middle-aged person with newly-diagnosed HIV and complications of the illness.  One of the nurses presented me with the person's initial "CD4" count, which is an important lab indicator of the strength of  the immune system with HIV.  The value was 80, which is quite low and much below where HIV medications would usually be started.  As we wrote the orders to start new medications for the HIV, one of the nurses on rounds commented that this was the highest CD4 value we had seen all day.  We all continued on rounds in a fairly somber mood after reflecting on the truth of the statement.

Things changed two patients later when we saw a person in their 40s recovering from typhoid.  This person had developed a row of very tiny blisters across the cheek and the side of the face.  Maria and I were in the process of formulating a list of what this strange new lesion could be when I looked over and saw two nurses quietly looking at each other.  This is a universal sign in mission medicine that the nurses know something important that you do not know.  Upon asking, we were told that these were the tracks of a "creechie" (no one knew how to spell it.  I guess it is not a word which needs to be written often).  The creature leaves such tiny blisters on the skin when walking across it.  There is  no pain or irritation, and the blisters can be treated or prevented by wiping the skin with a little alcohol.  We took the advice of our nursing consultants and ordered the appropriate treatment.

Of course, you can't just hear about this bug without seeing one, so the busy rounds ground to a halt while everyone searched the walls of the ward building until we found one.  It looks like a little winged ant (we tried to take pictures but they just turned out as little "bug blobs").   We were happy to see what this amazing creature looked like and the patients in the ward were all smiling at the sight of a bunch of their doctors and nurses searching the walls of the ward for a bug.

I now feel a bit more self-confident knowing what to do if a creechie ever walks across my arm.   And,  just for the record,  the little creature was not harmed and was allowed to continue on his way and do whatever creechies do during the day.