On a blazing Tuesday afternoon in late June, painter Charles Lennox was working on a house nestled in the woods above Frederick when his putty knife tumbled into a shrub. As he reached in to retrieve it, he felt something crunch down hard onto his hand.
He jerked his arm away and a jolt of fear shot through him when he saw what was attached: Crotalus horridus horridus, the highly toxic timber rattlesnake, dangling by a single fang from the flesh of his forefinger.
"Oh, my lord," he thought.
Lennox flung the 39-inch snake into the air. A co-worker dialed 911. Recalling something he had seen in movies, Lennox frantically pressed his lips to the puncture and sucked. But by the time paramedics arrived, the venom was already taking effect.
"I started to get the shakes. Every muscle I had felt like it was jittering. My eyes started to blink," the 38-year-old said. "Within minutes, my hand swelled up to my wrist." In the ambulance, paramedics sawed off his wedding band. "By the time I got to the hospital emergency room, my fingers were like kielbasa sausages - I couldn't spread them apart."
As emergency room doctors huddled over Lennox, the pager of Dr. Barry Gold sounded in Pikesville.
Gold is a 54-year-old practitioner in internal medicine with an unusual sideline: He is one of a handful of physicians in the United States who specialize in snake venom. This is his busy season, the time when man and beast are most likely to meet.
For nearly two decades Gold has been the one to whom doctors in Maryland and beyond have turned to when confronted by severe snakebites. He estimates he has worked on more than 250 over the years - including some by the world's deadliest snakes and on victims as far away as South America and Siberia.
"There's no cookbook formula, no protocol like there is for heart attacks," Gold likes to say. "Every bite is different."
And every one, he says, has the potential to take an unexpected turn-which proved true in the case of the Frederick painter.
Dangerous but unlikely
The widespread fear most people feel toward snakes is disproportionate to the danger they pose. Of the twenty-seven species of indigenous snakes in Maryland, just two are venomous: the timber rattler, which dens mostly in Western Maryland; and the northern copperhead, found throughout much of the state. Copperhead bites are no picnic, but the venom is rarely life-threatening. Rattlesnakes are different. Left untreated, a victim could die.
It's hard to know how many people are bitten by venomous snakes. Attacks often go unreported. Based on a 1990 study he did with Dr. Robert Barish of the University of Maryland School of Medicine, Gold estimates about a dozen venomous snake bites occur in the state each year, compared with 7,000 to 8,000 nationwide.
Accidental bites like the one in Frederick are rare. "A lot of people bitten by snakes actually deserve it," Barish says. They poke wild snakes with sticks, or take in venomous exotics as pets. One unpublished study of snakebite victims is particularly revealing. Nearly all were white men. Many had tattoos. Many rode motorcycles. And a significant number were drunk. "Do you get the picture?" Barish says.
In last week's New England Journal of Medicine, Gold and Barish highlight another surprise surrounding snakebites: Much of what we think we know about treating them is just plain wrong. Remedies such as ice or a tourniquet can lead to complications such as amputation, they say.
Perhaps the most famous treatment - so-called "cutting and sucking," first proposed by the Indian physician Sushruta in 600 B.C. and long a Boy Scout mantra - has never been rigorously studied, they say. The best first aid? Keeping the wound below the heart and having a set of car keys handy.
But snakes rarely kill. Less than a half-dozen Americans die from one each year. Three Marylanders in the past century have succumbed to a snakebite.
The most recent case occurred in 1992, when a 25-year-old amateur herpetologist in Emmitsburg went into cardiac arrest after he was bitten in the toe by his pet Indian king cobra. In 1958 a 3-year-old girl in central Maryland died after being bitten twice while playing in a corncrib. Her killer was suspected to be a copperhead.
But by far the most bizarre death occurred in 1955 at Billie's Night Club, a former Fells Point cabaret. The victim: a Baltimore stripper named Princess Naja.
Naja - in real life, Frieda Hoxter - was a blonde who worked The Block and other nightclubs in town. To make her name, she began incorporating snakes into her act.
One night, while gyrating with the cobra coiled over her shoulders, something went wrong. Audience members saw Naja smack the snake. Moments later they noticed her lips and ears swell. She danced for eight more minutes, finishing her act, before stumbling offstage. It would be her last performance.
"Princess Naja, 25-year-old German-born entertainer who rose to night-club stardom with a snake dance, died paralyzed in an iron lung last night," The Sun reported. Clubs along The Block, the paper noted, "halted the blare of Bands" to mourn her death.
The Baltimore City Council passed Ordinance 1372, making it illegal to own "any poisonous reptile or any reptile in excess of five feet in length." The law remains on the books today.
Personal experience
Perhaps the most visible sign of Gold's snake experience is on the man himself, tattooed to a pasty patch of skin near his left elbow.
"See this," he says, folding back his arm to reveal two faint dimples. The scars were put there by a timber rattler when he was a teen-age Boy Scout on a camping trip to Western Maryland. An evening firewood run is when the snake struck. "It felt like somebody stuck me with a hot poker," he recalls. Gold had to be flown to Baltimore.
After that encounter, he studied everything he could on venomous snakes. Later, while attending medical school at the University of Maryland, he spent a summer treating snakebites and other injuries at a hospital in Arizona, home to many of the 20 venomous species indigenous to the United States.
Today his success stories number in the hundreds. Coiled atop a bookshelf in his office are souvenirs from some of them: A freeze-dried western diamondback rattlesnake and a stuffed monocled cobra whose last living act was biting a 27-year-old Northern Virginia man.
"I can't get the cleaning lady to clean the top shelf," says Gold, who teaches snakebite medicine at the University of Maryland and Johns Hopkins medical schools. He has also been a consultant to the Maryland Poison Center, the Baltimore and Cleveland zoos, and National Geographic Television among others.
"He's the person we call if I'm unconscious. He's literally got my life in his hands," says Jim Harrison, director of the Kentucky Reptile Zoo, a Lexington-based nonprofit facility that houses 1,200 venomous snakes for use in scientific research and antivenin manufacturing.
A few years ago, Gold helped him through a rare bite by a king cobra, a snake that produces enough venom to kill an elephant.
Fighting the venom
Within an hour after painter Charles Lennox arrived at Frederick Memorial Hospital, Gold was on the phone with Lennox's physicians, advising them on what antivenin to administer. They agreed on CroFab, a new antivenin. It was less likely to trigger an allergic reaction but had only been used on one or two timber bites.
By evening, the painter was feeling even worse. His left arm had swollen to the armpit. His skin had colored a menacing purple. "By eight o'clock, I felt like I had to throw up every other second," he says.
More worrisome to physicians were blood tests showing his platelet count was dropping fast. Healthy people have platelet counts above 150,000. Three hours after Lennox arrived in the emergency room, his were down to 28,000.
Platelets are blood components key to the clotting process. Timber rattlesnake venom, a complex and somewhat mysterious stew of proteins, "just chews them up," says Gold. If the count dropped too low, doctors worried Lennox might start to bleed spontaneously-a potentially deadly complication if it occurred in the brain.
Gold once treated a man at St. Agnes HealthCare who had waited nearly 24 hours after a timber bite before going to the hospital. By then, Gold says, "he was bleeding from every orifice." It oozed from his nose and mouth and into his urine. Blood-filled blisters dotted his arm. "I thought he was going to die," Gold recalls. Miraculously, the man pulled through.
During the next few days, doctors watched nervously as Lennox's platelet count plunged and soared like a roller coaster. "It got scary," admits Dr. Michael Rudman, who led the team of Frederick physicians and says he was on the phone with Gold once or twice a day.
Gold, meanwhile, called the scientist who invented CroFab and the doctor who conducted clinical trials on it for advice. One told him: "It sounds to me like you've got a problem."
A few days later, Gold's phone rang around 2 in the morning: The painter's platelet count had plummeted to 500 - almost undetectable. "He could start to bleed at any time," thought Gold. Worried, Gold woke up Barish to talk about their options.
After briefly discussing whether to switch to an older antivenin, they decided to hold off. The hospital was advised to monitor his urine and gums for blood and keep filling him with antivenin.
In all, doctors pumped 46 vials of CroFab into Lennox, nearly wiping out most of the state's supply of the $750-a-dose drug. Doctors also gave him a platelet transfusion. One or both eventually did the trick. Ten days after entering the hospital, Lennox was finally allowed to go home.
Two weeks ago, the Frederick painter went back to work for the first time. When he walked in the office, his boss asked: Would he mind going back to the house where he had been bitten and finish the job? "I had chills," Lennox recalls. "But from what I hear, my chances are better getting hit by lightning."
The house looks great. The timber rattler that bit him fared less well. It now chills in a garbage bag inside a freezer at the painting company where he works. Lennox intends to get it stuffed.