Dark Banquet (20 page)

By the 1930s the need for
Hirudo
husbandry dropped off considerably—and it pretty much stayed that way until the mid-1970s. In New York City and Boston, pharmacists sold leeches through the 1920s, mostly to treat black eyes. But generally their use as a therapeutic tool became limited to a very few rare conditions and most leech breeders were forced to find new jobs.

“Then in the 1970s,” Rudy said, “a few surgeons started using leeches after reconstructive surgery—especially in cases where they were doing reattachments. Some of these guys picked up the technique after serving in Vietnam and now they wanted a source for leeches back home.”

Rudy explained how his business partner, Marie Bonazinga, had met up with Jacques des Barax, the president of Ricarimpex, at an international conference on medicinal leeches in the early 1980s. Not long after, Leeches USA was formed and surgeons in the United States and Canada would have easy access to an ancient but valuable surgical assistant—one that required little if any training and could be delivered by overnight express, courier, or even helicopter. Currently, Ricarimpex sells around seventy thousand leeches a year.
^*83

Rudy recounted a number of cases—some of them rather high profile—in which leeches from his company played an important role in surgical reattachments. One such case involved a young female musician who was pushed off a New York City subway platform and had one of her hands severed by a passing train. The woman's hand was successfully reattached, and although she could no longer pursue a career as an instrumentalist she went on to become a successful occupational therapist.

Another was the case of John Wayne Bobbitt, who gained an unwanted degree of fame when his wife, Lorena, briefly took the penal code into her own hands. Driving off with a tip from her husband, Mrs. Bobbitt eventually tossed the evidence out of her car window. Remarkably, the misplaced member was recovered by a sharp-eyed policeman and Rudy's company was called upon to supply the leeches necessary for what was to become a combination reattachment/enlargement surgery.

In addition to their importance in reattaching structures like fingers and ears, a hundred or more leeches might be used over the course of several weeks in cases where the scalp has been accidentally torn from a person's skull. Typically, though rarely, this occurs when the victim's hair is pulled into a piece of heavy machinery.

Leeches are also commonly employed in breast reconstruction, although in 1993, a leech went missing after such a surgery. Concerned physicians eventually determined that the wayward creature had entered the sutured wound. The wandering worm was later recovered from inside the patient's breast.

Leech therapy is also used in transfer operations, when skin or muscle is grafted from one place on the body to another. Two Slovenian surgeons, who reported their results in the
British Journal of Plastic Surgery
in 1960, undertook the first of these leech-assisted transfers. Some thirteen years later, the procedure would save my father's leg.

In July 1973 my father was involved in a terrible boating accident while we were on vacation in upstate New York. The propeller of our ski boat motor tore apart his knee, leaving a horrible wound and little for surgeons to use to reconstruct the joint.

To replace the missing flesh surrounding his knee, a multistep procedure started when a flap of tissue from my dad's abdomen was partially removed, then stitched into a tubelike structure. After a week or so, one end of the tube was detached from his body and reattached near his wrist (the other end of the tube was still attached about eight inches to the side of Dad's belly button). Once the circulation was reestablished, the belly end of the tube was removed and reattached to the area just below his elbow—so that it now resembled a handle spanning his forearm.

In this type of surgery—where a flap of skin is “walked” to a new destination—leeches are commonly used if circulation in the transferred skin begins to fail (i.e., if the color of the transferred skin changes from pink to purple).

“Check it out, Billy,” I remember my dad saying. “They're turning me into a set of luggage!”

I could tell that my mother was absolutely mortified at this weird-looking handle of flesh—although she hid it well from my dad.

“I think it looks kind of neat,” I told her later, as we left the hospital.

“You would,” she said, shaking her head.

After my dad's “handle” stabilized, one end was detached from his abdomen and sutured onto his thigh, just above the damaged knee. An excruciatingly uncomfortable two weeks later (he had to remain with his left arm attached to his upper thigh by an eight-inch tube of flesh), the arm end of the handle was transferred to the area just below the knee.

My father never complained once during this whole painful and grueling process—one that ended a full three years after his accident with a surgery that basically fused his knee joint together. Within a month of returning home, Dad was chomping at the bit, and several months later he was back at work, driving an oil truck again.
^*84

Besides their ability to draw off accumulating blood at surgical reattachment or transfer sites, researchers are currently exploring the possibility that leech “saliva” contains a virtual cornucopia of pharmacologically active compounds, including antihistamines and antibiotics.

“
Hirudo
and some of its relatives may offer alternative treatments for ailments ranging from osteoarthritis to the circulatory problems associated with diabetes,” said Rudy Rosenberg.

The latter was a condition that Rosenberg had faced in the early 1980s after he received a call from his sister in San Diego.

“She said that one of my mother's legs was completely discolored and that doctors wanted to amputate it immediately. She was eighty-two years old at the time.”

Rudy recounted how he instructed his sister to hold off on approving the surgery until he got there. Then he talked to his mom about an idea he had.

“I asked her if I could try to restore the circulation to her leg by using leeches. She agreed and off I went.”

Rudy plopped twelve leeches into a jar filled with distilled water, sealed it tight, and headed to the airport, having booked the first flight to San Diego.

“When I got out there I could see that her leg was in bad shape. It was nearly black, and when I tried to apply the first leech, it refused to bite.”

By now I was leaning forward, literally perched at the end of my chair.

“I abraded the skin a bit, and about fifteen minutes later the second leech finally took hold. Within ten minutes her toes started to turn pink.”

“That's incredible,” I said.

“Yes, that's what I thought too. I wound up treating her for three days.”

“And…?”

Rudy grinned, glancing up at the framed photo of a smiling woman seated on a chair. She could have passed for Albert Einstein's mom. “And she lived to be ninety-seven—with
both
of her legs.”
^*85

Kitanda usicho kilala hujui kunguni wake.
(You cannot know the bugs of a bed that you have not lain on.)

—Swahili proverb

There may be bugs on some of you mugs

But there ain't no bugs on me.

—Wendell Woods Hall, “Ain't Gonna Rain No Mo”

With, ho! Such bugs and goblins in my life.

—Hamlet,
act V, scene 2

7.

SLEEPING WITH THE ENEMY

L
ouis Sorkin reached across a table stacked high with cardboard specimen boxes and glass vials of every size. There was also enough Tupperware to throw a party for the entire Upper West Side of Manhattan. He shared the combination office/lab space with another entomologist, although collaboration would have been a challenge since the men worked on opposite sides of an island of insect-related paraphernalia that had risen from the fifth floor of the American Museum of Natural History to claim the middle two-thirds of the room.

“Did you want to have a look at my bed bug colony?” Lou inquired, a few minutes after I'd arrived. He could have been asking if I wanted to see his kid's latest school photo.

“Definitely,” I replied, leaning in from my seat as he snagged what looked to be a fist-sized canning jar before handing me the metal-covered container.

The first thing I noticed was that the bottom of the jar was padded with a generous wrapping of duct tape. Another band of tape prevented anyone from unscrewing the metal lid. In the center of the lid, a circle the size of a quarter had been removed and covered with a layer of fine mesh. I would later learn that this was a section of plankton net that had been secured to the ceiling of the colony by a generous schmear of silicon glue.

An air hole,
I guessed. To my horror, I would later discover that I was only half right.

Inside the jar, there was a gray cardboard baffle, folded like an accordion. I tilted the container slightly and took a closer look—the cardboard was flecked with tiny black spots but there was no movement.
Nobody home.

“I can't see anything.” I said, even though, for a second there, I thought I might have seen
something
—a shift in the darkness between one of the cardboard folds.

“Cup the jar in your palms,” Lou instructed, holding his hands as if in prayer.

I complied, although now it was impossible for me to see the interior of the container. About fifteen seconds later the entomologist nodded in my direction. “That ought to do it.”

I shifted the canning jar to my left hand, bringing it closer to my face so that I could peer—

“Holy shit!” I screamed, and for a second, the jar shifted precariously in my hand. I secured my grip, then held the container at arm's length.

The entire inner surface of the jar was seething with movement—tiny flat ovals—some the size of apple pits, others more like sesame seeds, and all of them frantically pressing themselves against the glass. More and more of the creatures appeared. Within seconds there seemed to be
hundreds
of them pouring out of that single piece of folded cardboard.

I sensed Lou coming up behind me.

“Look closer,” he said.

I squinted. There
was
something else. Amid the shifting pits and seeds were minuscule dots—barely visible and noticeable only because they were showing quite a bit more determination than your common household dust speck. In fact, if anything, their movements were even more frantic than the “giants” that clambered around them.

I found myself checking the silicon seal on the jar, having quickly come to the realization that a thin wall of glass and glue was the only thing keeping the bed bugs from the object of their frenzy—
me.

“I'll let you feed them later, if you like,” Lou said, almost as an aside.

“That would be great,” I said, having absolutely no idea what I'd just agreed to do.

Several days earlier, I'd contacted Lou because I was interested in learning what was behind the recent and dramatic resurgence in bed bugs, the epicenter of which appeared to be New York City.
^*86
It seemed that every week the local papers were featuring stories about people attacked in their sleep by the tiny blood feeders, but the weird thing was that these attacks weren't taking place in rundown apartments or “no-tell motels.” The rich and famous were being bled as they exercised in posh fitness centers and as they slept in ritzy Riverside Drive co-ops. And not only were they getting bitten up and grossed out (sometimes enduring hundreds of bites) but these folks were also starting to squawk about it, as only New Yorkers can squawk. Guests at upscale hotels, both at home (the Helmsley Park Lane, overlooking Central Park) and abroad (the five-star Mandarin Oriental in Hyde Park, England) were filing huge lawsuits, not just because they'd suffered bed bug bites but also because of the cimicid souvenirs they'd brought home with them.
^*87
By January 2007 things seemed to have reached a fever pitch. There were splashy front-page stories in places like the
Village Voice
(“Bed Bugs & Beyond”) and major articles in the
New Yorker
(“Night Visitors”) and the
New York Times
(“Everything You Always Wanted to Know About Bed Bugs…”). Web sites (often offering conflicting information) and bed bug–related blogs sprang up on the Internet, some of them logging thousands of hits each month. Even politicians were getting into the act, scrambling to enact legislation to prevent the sale of secondhand mattresses. In typical fashion, the media gravitated toward a few experts who could combine bed bug–related expertise with a good sound bite (and occasionally, what my aunts would have considered to be some damned strange behavior). In that regard, American Museum of Natural History entomologist Lou Sorkin and classical music programmer–turned–exterminator/therapist Andy Linares had quickly become bed bug superstars.

What was causing the uproar? Why had bed bugs come back with such a vengeance, and where had they been for the past fifty years or so? How were they spreading so rapidly and what could be done about them? And just what were bed bugs anyway? That seemed like a decent question to start off with.

Back in Lou's office I continued to stare at the creatures that were now trying desperately to eat me. “Are there different species of bed bugs in here?” I asked, having noted that the insects seemed to come in several handy sizes.

“No, they're all the same species, but you're looking at six different developmental stages.”

I would soon learn that the smallest members of Lou's colony were the “first instars”—newly hatched bed bug nymphs, eager for their first blood meal, and nearly invisible until they had gorged themselves.

For members of the phylum Arthropoda (which includes insects, spiders, scorpions, crabs, lobsters, and shrimp), growth presents a different set of challenges than those encountered by vertebrates like mammals. Mainly, this is because the arthropods' hardened skeleton is located on the
outside
of its body. Additionally, rather than having adjoining bones articulate at specialized surfaces, their joints are actually composed of thin, highly flexible, sections of exoskeleton.

This jointed structure produces movement in its owner much like its vertebrate counterpart (with pairs of muscles working in opposition to each other)—except that in arthropods the muscles are found
within
the skeleton rather than outside of it.
^*88
Since exoskeletons don't grow once they've hardened, in order for the juvenile arthropod to attain a larger body size, the entire skeleton has to be shed periodically. Ecdysis (Greek for “escape” or “slipping out of”) reoccurs at the end of specific developmental stages called instars, eventually culminating at adulthood.
^*89
In some arthropods (like moths and flies), the early instars (caterpillars and maggots, respectively) don't resemble the adult stage at all. These strange-looking eating machines are referred to as larvae (or the larval stage). In other arthropods (like bed bugs and many other types of insects), the instars are called nymphs, and each successive nymphal stage more closely resembles the adult form.

The colony of
Cimex lectularius
I was holding in Lou Sorkin's office contained all five nymph instars plus the adult, or reproductive, stage. Each of these developmental stages was successively larger and dependent on obtaining a blood meal that would swell a body to the point that it would burst through a suddenly ill-fitting exoskeleton. Enzymatic secretions and an increase in blood pressure also helped to split the bed bugs' outer cuticle, which is composed of a tough waterproof polysaccharide called chitin. Littering the crevices where they hide (like outgrown clothes from Gymboree), I would come to learn that the sloughed-off skeletal casts were one of the telltale signs of a bed bug infestation.
^*90

Arthropods that have recently undergone ecdysis avoid predation by hiding out until their soft-shelled armor solidifies.
^*91

One final note about this soft-shelled phase: it's been hypothesized that structural collapse of the arthropod body is a potential hazard for those squishy-limbed individuals who have recently emerged from a round of ecdysis. This rationale was then used to explain why the largest aquatic arthropods (like lobsters and king crabs) are
far
heavier than their terrestrial counterparts (crabs, insects, spiders, and centipedes).
^†92
Since water is more viscous than air (i.e., it's thicker), objects in water are supported to a greater degree than they are on land (where gravity is much more of an issue). According to this rationale, heavyweight arthropods going through their soft-shelled phase can support themselves only if they live in water. Another way to look at it is that size in terrestrial arthropods is limited (i.e., constrained) by two physical parameters: gravity and viscosity. Beyond an interesting explanation for arthropod size differences, to me the
real
take home message here is our tendency to believe that in evolution
anything
is possible. In reality, though, constraints like those placed on arthropod body size by gravity and viscosity serve to illustrate that in nature some forms (like car-sized bed bugs) just aren't possible.
^*93