Silent killer who left no telltale signs of his late-night visit

Dr SP KalantriIt was a quiet morning in Sevagram, a village 20 km from where Gopal (name changed), a small farmer, lived. As dawn broke, his life took a violent turn. He woke up with severe abdominal pain, vomiting and extreme weakness. There were no warning signs — no heavy meals, no alcohol, none of the usual causes of indigestion. For a man who lived simply and worked with his hands, his condition was baffling.

With no nearby medical facilities to turn to, Gopal called a close friend who picked him up on a motorbike. When they arrived at our hospital, the village was just waking up. In the emergency department, the young doctor moved swiftly. “It looks like acute appendicitis,” he said, arranging for Gopal to be admitted to the surgery ward. There, the surgery resident and a senior resident doctor — eyes gleaming with anticipation — prepped the new laparoscope, a recent prized asset in our rural hospital.

While getting Gopal ready for surgery, the anaestheist noticed Gopal’s drooping eyelids and unusual sleepiness for his age. He called me in for a second opinion. When I arrived, Gopal’s eyes were barely open, and he struggled to swallow. His symptoms didn’t match appendicitis. Instead, they pointed to a venomous snake bite, likely from a krait, one of rural India’s most dangerous snakes.

“Where did you sleep last night?” I asked. “On the floor,” Gopal replied weakly. “Did you see a snake bite you?” I probed. He shook his head, but his father added: “We see snakes all the time, especially now during the rains. A jet-black snake with yellow stripes was in our backyard last night.”

The pieces fell into place. This was indeed the silent work of a krait — a nocturnal snake that often slips into homes in search of rats, biting sleeping victims with its thin, needle-like fangs. The bite causes no pain, no swelling, and leaves no telltale signs. Most people are unaware they’ve even been bitten. But the venom is deadly, paralyzing muscles, including those needed for breathing.

By the time Gopal was settled into an ICU bed — his first experience with a bed, having slept on floors his entire life — his breathing had grown shallower. Though his heart was stable, he could barely count to ten before gasping for air. His eyelids stayed heavy, and he could barely swallow. The diagnosis was clear: krait venom had blocked the signals between his nerves and muscles. Without quick treatment, his diaphragm would stop working, and he wouldn’t be able to breathe.

The ICU nurses — despite exhaustion and sleepless nights —worked tirelessly to save his life. Our 26-bed ICU often handles cases that city ICUs rarely see: snake bites and pesticide poisoning. We had to act quickly and the residents, trained to handle such cases, immediately took charge. We gave him two key medicines — neostigmine and atropine — and inserted a tube into his windpipe to connect him to a ventilator, which helped him breathe. We also gave him anti-snake venom, an expensive but life-saving treatment. In villages, Rs 7,000 for ten vials is a huge cost, but it was Gopal’s only chance. Over the next 24 hours, Gopal’s condition slowly improved. His heavy eyelids began to lift. Though he couldn’t speak because of the tube in his throat, his eyes showed he was smiling. His body was fighting off the venom successfully.

A day later, Gopal was breathing on his own. We took him off the ventilator. A week later, he was ready to leave the hospital. This time, he walked down the stairs smiling, fully recovered. His friend, who had brought him on the bike, handed him the keys. Gopal, now stronger, drove himself home.

Krait bites are stealthy and deadly, often mistaken for other conditions like appendicitis or stroke. Yet, with awareness and quick action, lives can be saved. For Gopal, the bite was a wake-up call — a reminder that next time, he might not be so lucky.

It’s time he bought a bed.

(Dr Kalantri is a professor of medicine at Mahatma Gandhi Institute of Medical Sciences in Sevagram, Maharashtra)