Summer (Volume 28, Number 2)

The Tale of a Snake-charming Rheumatologist

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By Raman Joshi, MD, FRCPC

Sammy was a snake who lived a long, long time ago — the turn of this millenium. He wasn’t one of those venomous snakes that could kill you, or that could squeeze you to a miserable death. He was a garter snake, and as far as garter snakes went, he was a good garter snake. But recently, Sammy was a sick snake. First, he started getting red rashes all over, then his eyes turned red and hurt, and he could barely keep them open. Then his back started to hurt.

This is a problem if you’re a snake, because you’re basically all back. Soon, it was hard for Sammy to slither around and catch mice, shrews and bugs to eat. He could barely sleep, because he kept waking up through the night with his aching back, which was basically his whole body. And, in the morning, when the mice and shrews were easiest to catch, Sammy was stiffest and sorest, and couldn’t catch them!

Starving and lonely, Sammy started feeling sorry for himself. Once before, when he had felt this sad, he had coiled himself up into a circle and slept, and woke up feeling better the next day. But now he couldn’t do that, and he was straight as a pole!

Not even the thought of visiting Swweet Sssinthia made him feel better. Seven days before his troubles started, he had visited her for a playdate and a sleepover. She might be able to make him feel better, but the thought of slithering across town to visit her was just too much to contemplate.

Sammy, the snake.

Sammy found a big box and slid into it, thinking that at least it would keep him warm and dry for the night. However, this was no ordinary box. In the box was a flat-screen television. The next morning, Sammy rolled and rattled around his new box. Bruised and battered, he peered through a hole in the box to discover that he was in the office of a group of rheumatologists — the kindest and wisest of all doctors! They had purchased the big screen TV to watch videos and learn how to better inject all manners of weird and obscure joints (in their spare time). Sammy pulled back from the edge of the box not a moment too soon, for an instant later, an X-Acto knife sliced its way down the edge of the box, and Sammy rolled out into the middle of the room.“What’s that stick?” asked one of the secretaries as she stepped toward Sammy.

“AAAH!! A snake!” another yelled, jumping atop a chair. Sammy, stiff as a pole, just lay there, flicking his tongue out occasionally.

Soon, all six of the secretaries were standing on the chairs in the waiting room, screaming.

“Hey, let’s cut him up and fry him for lunch!” one of the secretaries finally said. After all, it was lunch time for the humans.

“I don’t want to eat snake!” said another, the others nodded along with her.

“What’s going on here?” asked one of the rheumatologists, entering the room, hearing the commotion. She saw the secretaries all standing on chairs, and followed their gaze to the centre of the room, where her eyes lighted upon Sammy.

“A snake!” How did he get here?”

“He was in the box that the new TV came in!”

“He’s hurt!” said the rheumatologist, gingerly taking a step towards him. She bent down and picked him up by the back of the head, as she had seen a snakecharmer do once when she was a kid.

“He’s stiff as a pole!” she said.

By this time, the other rheumatologists in the office had gathered around.

“It’s a garter snake.”

“I’ve never seen such a thin snake.”

“He must be starving.”

“What are we going to do with him?”

They all looked at each other and realized that, being rheumatologists, they lacked the financial resources to take him to even an ordinary veterinarian, let alone a snake specialist. But, being amongst the wisest of physicians, and with some considerable experience dealing with back pain amongst them, they knew they would figure out what to do

“We better get him something to eat first. What do snakes eat anyway?”

“They’re carnivores — rats, grasshoppers, shrews” said one.

“We don’t have any of those here.”

“Hey, maybe we can find something from the drug lunch yesterday,” said one of the rheumatologists, running to the fridge in the back room.

Sammy could smell the chicken even before the man came back. This rheumatologist, Sammy thought to himself, was different from the others. Not only was he the only male rheumatologist there, and ruggedly handsome in a human kind of way, but he had a certain cunning that only he, as a snake, could sense.

“This is chicken from yesterday’s lunch,” the man said. “I warmed it up and cut it into little pieces for him.” Sammy’s soul stirred as he wolfed down the chicken. From that day on, even though the doctors were all vegetarians, they made sure they brought something non-vegetarian to lunch, which they later shared with Sammy. They decided to keep him in the back room in a little box, so that patients wouldn’t see him and get scared. Using techniques and therapies they and other rheumatologists like them had used for millennia, they slowly helped Sammy regain some of his strength and energy — yet Sammy remained stiff as a pole, and was beginning to think that this might represent his future life…forever.

However, this was the dawn of a new millennium. And the rheumatologist who had fed him chicken the first day had an idea. For in this golden new millennium, new molecules had been discovered. Marvellous molecules that could help humans with problems much like Sammy’s. If these molecules could help humans, perhaps they could do the same thing for Sammy. So he obtained some of these molecules, carefully put Sammy on a scale, and calculated how much of the medicine he should give Sammy. With aseptic technique, he divided the dose a human normally takes in a month into a two-year supply for Sammy, and gave him the first injection (Phase 1 study, first-in-snake trial, N of 1).

Within a few weeks, Sammy was feeling much better, and was able to move like he had when he was a young snake. Everyone was so happy! Even the secretary who wanted to fry him for lunch!

And so, over the winter months, Sammy continued to get more and more agile and faster. When the winter snow gave way to the warmer, longer days of springtime, and his X-rays had returned normal, the rheumatologists decided it was time to set Sammy free. With equal measure of joy and sorrow in their hearts, they watched as Sammy slipped across the parking lot through the grass, to the school next door. Ordinarily, a snake appearing at school would be a source of fear and tears for the little children. But this is a happy story, and Sammy’s presence made the children laugh and play. Sammy lived in the playground until a ripe old age.

As for the rheumatologists, Sammy not only made them happy when he was there, but long after he left. Shortly after Sammy left, the rheumatologists decided to make a new sign for their practice. One of them wanted to put a drawing of a knee degenerated from years of heavy work. Another wanted to show a picture of a spine fused like bamboo. Others wanted to put up a picture of a syringe. The best idea, the one they all liked and would all remember, was the idea from the male rheumatologist. Tired of telling people what had happened with Sammy, he decided to make it visible.

At a glance, everyone would know that Sammy with his fused spine had been helped back to full health. Coincidentally, the symbol also turned out to be an ancient symbol of the medical arts.

The rheumatologists’ new symbol became so popular that many pharmaceutical companies started to approach them. One eventually bought the rights to the drawings from the rheumatologists. The rheumatologists took this money and kept it in their medical professional corporations, where it continued to grow and allowed them all to retire quite comfortably at an age earlier than even the cardiologists, and to send their children to really good schools. Perhaps this is not unsurprising, since if you look at the symbol they had created, it also looks a bit like another symbol. . . $

Ultimately, even though many of the rheumatologists’ patients did not suffer as much as Sammy; and although many patients did not do as well as Sammy, many patients did do well with their treatments. And this knowledge, beyond any other and beyond the money they had made, gave the kind rheumatologists great joy and satisfaction, few others had the privilege to experience.

Raman Joshi, MD, FRCPC
Rheumatologist,
Brampton, Ontario