COLUMBIA — The woman didn't know what bit her — a spider, a snake. Something. The pain became excruciating. She was rushed to a hospital emergency room where the examining doctor was just as puzzled.
But he knew who to call.
"Puss caterpillar," said Jill Michels, managing director of the Palmetto Poison Center, who identified the toxic reaction.
The moth larvae, also known as a woolly slug, has a venomous nip like a bee sting that just doesn't go away.
Michels runs a seven-person, seven-day-per-week, 24-hour-per-day clearinghouse that's literally a lifesaver for veteran doctors, as well as panicked everyday callers who need to know what to do — and now. The center performs a vital public service without charging for it.
Snake bites this year continue to occur at a near-record pace, just as they have for the past three years. By mid-June, the center staff had handled its 70th snake bite call of the year and were taking calls on bites every day, Michels said.
There have been at least nine reported bites in Charleston County alone. This could be the third straight year that the center handles more than 200 snake bite calls.
Bites from snakes and other insects are a small fraction of the calls the center does take. The worst are the "mistaken container" cases when someone gulps from a drink can or bottle that a pesticide or another chemical has been dumped into.
Then there are the designer street drugs that keep evolving, including the new synthetic cannabinoid made of blood thinners called "fake weed" or "spice." It's killed more than 100 people in the country, according to CNN.
Sometimes the people who have been poisoned just itch. Other times, they are comatose.
The operation, housed at the University of South Carolina, isn't an answering service. The person who picks up your call is an experienced nurse or pharmacist and likely to be a certified toxicologist, or poisoning expert. Other experts are a tap away on the phone dial.
They are the practiced, calm voices when the pain or swelling becomes intense, when the doctor needs to know how to treat, not only the symptoms, but the unexpected complications.
"It might make you feel jittery or anxious," nurse Nancy Kennedy reassured a caller recently over a phone so heavily used the numbers have worn off the dial. Kennedy, a 20-year veteran with the center, has taken more than 55,000 calls.
The Palmetto center is a vital resource for doctors, particularly in the less urban parts of the state. But Medical University of South Carolina emergency room doctors will use it, even though the level of skill at MUSC is strong enough that Nicholas Connors, its toxicology director, is one of the experts the center will tap.
"The number of drugs and side effects is always changing. It's unreasonable to expect any emergency room doctor or pediatrician to keep track of it all," Connors said. In an emergency, the doctor is treating the patient and doesn't have the minutes to spare to review the most recent data.
"The center does," Connors said. "I think we'd have a significant loss in our knowledge base if we lost them."
You'd think an invaluable resource like this would be a well-funded, full staffed, championed resource. It's not.
The center operates from a cubbyhole of desks in a small room at USC's School of Pharmacy that looks like a dormitory study hall. The seven staffers rotate all the shifts.
Its $1.2 million budget is pieced together with grants or budget provisions from federal, state, university and other sources. The amount varies year to year and some years Michels has to scramble and cut staff to stay open, she said.
"I'm proud of our staff and what we do. But I know how much better we could be," she said.
This time of year is one of the times they get busy. Snakes have come out, along with any number of other venomous animals or plants. And humans have come out, too. A paddler was bit on the Edisto River in May when he picked up a baby rattlesnake.
Because of patient confidentiality, center staff can't say whether they took a call about a specific incident. But Michels nods when told the details of the rattler encounter. Most snake bites happen when a person messes with the animal. A few of the calls the center gets are about people who have been bitten in the foot, she said, but most are bites in the hand.
A lot of venomous snakes inhabit the Lowcountry and South Carolina: copperheads, cottonmouths, rattlers including the canebrake, pygmy and Eastern diamondback. The deadly Eastern coral snake also is here but is rare.
The center has to be able to identify the symptoms and know the locations of the nearest anti-venom doses. A wide variety of exotic venomous snakes turn up for sale at reptile shows. Michels has gone to shows to help keep track.
Center staff has handled calls that range from Tamiflu overdose side effects during the severe flu outbreak last winter, to children swallowing the latest craze toy that turns out to have a toxic coating. They bolster their online records with internet searches and thick, well-thumbed catalogs they have put together and keep current on their own.
Connors and other toxicologists consult with the center regularly, sometimes in conference calls.
"If we don't know what it is, we don't know what it is," Michels said. But "when it comes to toxicology, we don't get stumped."
The poison center can be reached toll free at 1-800-222-1222.