It looked like she sucked a black worm out of his body, but I think it represented the evil and darkness he'd seen, done or felt. Like killing that boy by shooting into the closet, thinking he was a soldier, then having his superior shoot the boy in the head. He'd carried that with him for years and never even told his wife. When she saw that witch doctor suck a black worm looking thing out of him (the evil/darkness - "the snake"), it understandably made her feel sick.
"I became insane, with long intervals of horrible sanity." ~ Edgar Allan Poe
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