Dengue Fever

Wednesday, April 30, 2008

My arrival in Krabi had three primary objectives. Number one, find a place to stay. Number two, get to the hospital. Number three, meet up with Kristoffer and get my snorkel. I had just arrived off the boat from Phi Phi feeling quite horrible; Fever, headache, dizziness, aching muscles, and no energy or appetite to speak of. I managed to get a free ride into the city to check out a hotel (Bai Fern) which I wound up staying at for 500 baht per night, a definite splurge, but there was no way I was going to be this sick without air conditioning and a hot shower. As soon as I checked in and checked my medical kit for a quick self-diagnosis, I caught a couple motorbikes to the hospital. What a zoo! Everything is numbered, non-sequentially, so when I arrive I get directed to go to “number one”. And pointed vaguely around the hall. Well, ten minutes of trudging sickly around later and I find number one. I talk to the nurse in broken English, fill in some details, and she sends me to number 29. God help me! 15 minutes and a flight of stairs later and I somehow found 29. Another nurse and I saw a westerner – a Spanish girl – who was also in the hospital after her eyes had puffed up huge. She looked fine now, I guess she’d already done the hospital circuits. I answered some questions, had my temperature taken, and discovered it was just over 40 C (104-105 F). No wonder I felt horrible. The Spanish girl sat with me and we talked about getting sick in Thailand and then I was in to see the doctor.

About one minute later, I was back out. You have a sore throat? No. Open wide and say Ahh. Ahh. Dirty looking stainless steel stick on my tongue, flashlight down my throat, “Tonsillitis”. “Tonsillitis?!” I respond. I’m thinking I may have to get them removed, I’m thinking who the hell gets tonsillitis in Thailand, and I ask how I would’ve gotten it. Dirty air, most likely. Well, Phi Phi did stink, and I DID use a public snorkel. Still, shouldn’t I get a blood test? Blood tests are the only way to confirm two of the most dreaded tropical illnesses, malaria and dengue fever. No no, you have tonsillitis. Well, just to make sure? If you don’t better in three days, you come back. You won’t die from malaria in three days. Oh, great! I think it was the shock of this statement that derailed me from demanding a blood test, though retelling the story you’d think it would have the opposite effect. So, I went to number 97, which thankfully, the Spanish girl was familiar with, and got my prescription filled while we talked about the unlikeliness that I had tonsillitis. Some antibiotics and pain killers in my pocket, I left the hospital. How I was supposed to take those antibiotics with food when I couldn’t even think about putting a spoon in my mouth without gagging was beyond me. I soon found out I didn’t need the food that badly after all.

So I spent the next couple days not getting better in my hotel, trying to drink water, occasionally stomach food, and stay cool and out of pain. I had free wireless with which I became fairly convinced that not only did I not have tonsillitis but I also didn’t have malaria. Unfortunately, I had every symptom for dengue fever that there was and I was quite certain that was what I had contracted. Dengue is spread by mosquitos, which are plentiful here and much more stealthy than their Saskatchewan cousins. It is also known as breakbone fever for the muscle and joint pain it causes, comes with extremely high fever, headache, lack of appetite, and, in later stages, a rash, and lasts a solid 10 days. Still, I hoped that somehow I had the first case of tonsillitis without a sore throat, and I staggered dizzily to a nearby restaurant called Joy Corner. I almost threw up waiting for the food, and it was a battle against every urge in my body to swallow the grilled cheese and ham. I managed to convey my illness to the restaurant people and got a card and menu and they agreed very graciously to deliver me meals to my room. This was very very kind and I can’t tell you how much I appreciated that I wouldn’t have to trek down here and sit in the heat trying not to pass out waiting for food.

Back home I laid in bed, my head to sore to read and laid and slept and rested. In the morning I ordered some soup and fruit and yogurt from the restaurant and they brought it over true to their word, along with plates and cutlery. Kristoffer came over that night and brought me some more water, a chocolate bar, and of course my snorkel set. He sat and we chatted a bit though I fear I was horrible company, and he left me to drift off to sleep. I don’t know if I can convey how little energy I had. I would lay shivering because I couldn’t bring myself to sit up and find the remote to shut off the A/C. I would be thirsty, but the water bottle was way over there. I obviously forced myself – eventually – to just do what needed to be done, but it wasn’t always easy. So it was that I couldn’t be bothered to order food the next morning. I didn’t want to find the phone, or the card, or pick and order food that I didn’t really want anyway and then have to choke it down. So I laid in bed that morning and took my pill with no food, but soon enough the woman from the restaurant came over to see if I wanted any food today and if I was doing okay. So I got another fruit salad. The hotel owner also came over and asked if I was doing okay and wanted a ride to the hospital again. These gestures were small but very appreciated.

That day passed, day three arrived, and true to the doctor’s word, I wasn’t dead but neither was I feeling better, despite religiously following the medical schedule. I spent the morning gathering the energy to drag myself to the hospital. I was a bit afraid to ride on the back of motorbikes as dizzy as I was feeling but once we got going and the air was blowing across my face I was okay. More waiting at the hospital and finally I got a doctor that was really helpful, though sitting and waiting this time was a lot longer (it was a busy day to be sick) and I wasn’t sure I’d last in the chair much longer when I finally got to see her. I got my blood test, she checked my ears and did some other tests at my request but concluded that I probably had dengue fever. She arranged for a nurse to wheelchair me to the place where I had to get a blood test, which I would’ve refused except that the thought of stumbling and trying to find that number in my present condition was more than I could handle. And then the wheelchair wound up being a gurney and I was highly embarrassed to crawl onto it but I got my blood test done and then wheeled back to where I could wait for my results for about two hours. I laid there, eventually a victim of the open-air design when the rain really started coming down and a friendly man came and wheeled me elsewhere.

Sure enough, dengue fever. My platelet count was 140,000 and the minimum for staying out of hospital was 100,000, but she suspected my numbers would be dropping as this was only my third day (they did indeed dip to below 60,000). In fact, she was quite insistent that I stay in hospital and even tried to find me a private room. I decided that maybe it wouldn’t be so bad. It would be a good experience for someone who is usually healthy, I’d meet some locals, maybe have a few pretty nurses, and on top of that, this way I would – or so I thought – get to keep being monitored by this doctor whom I quite liked. So I got another bike back to the hotel, gathered my bags, and went back to the hospital, where I would spend the next six days withering. My first day I was able to eat and drink and be fairly sociable. The guy beside me had dengue fever as well and he looked a mess. I had heard the worst was to come and looking at him was more than a little demoralizing. He had a little jug to save himself some trips to the toilet and when his family visited, they talked – or tried to - more with me than him because he was so out of it. Or they tried to. Only his brother spoke English, and that includes all the other patients, visitors, and nurses.

The bed and pillow were anything but comfortable, the rooms had nothing but fans to keep things somewhat cool, and there were all manner of phlegm being produced all around me. Seriously. One guy at the end, whose wife was quite nice and would offer me anything she thought I might want including jasper-scented washcloths, would make noise that probably exceeded health and safety regulations for hearing protection before letting out a nice quiet “pttoie”. I swear he probably woke up the entire hospital on more than one occasion. Except for the guy across from me. He could sleep through anything, provided, of course, that everybody was awake but him. I felt bad at first because I came in and he was on oxygen and his poor wife and daughter stood by his side the whole time. Especially the daughter got me, probably nine years old or so, sometimes I’d look over and she’d be holding his hand. I tried to smile encouragingly or reassuringly at her and received only dirty looks back. Still, as soon as he was off the oxygen, he’d be wide awake all night and talking – no, yelling, really, but not angrily, just talking as loud as possible – even when there was nobody to listen. Except of course for the entire ward, who was trying to sleep. He didn’t need to sleep because he’d get his in the day, and after several days of this I really considered standing beside his bed and screaming (calmly) random gibberish at the top of my lungs. Hey, I was sick and irritable, and lacking sleep, food, and any company whatsoever. Sue me.

Aside from the brother, who visited only occasionally and was quite nice, I met only three other people who spoke any English. Two were doctors (they would spend about 2-3 minutes per day with me) and one was a random visitor that passed through whom I never saw again. My only other company, now that the pain killers were starting to work, was my books. I finally finished The River at the Centre of the Earth, a story about the Yangtze and more specifically a journey back in time in China, and while in the hospital I was gratified to lose a day and a half reading Raymond E. Feist’s Magician. The escape into that world of fantasy mid-way through my hospital stay is, I dare say, all that kept me sane. And while I’m mentioning it, might I add that this is probably the best fantasy book I’ve read by anyone other than Tolkien.

Enough can’t be said for how important ‘comfortable’ food is to the healing process. Dengue fever takes away any and all appetite, so it’s doubly important that you really WANT to eat whatever it is you are trying to force down your gullet. Well, I enjoy Thai food, but it’s nothing to eat when you’re sick. And even if it were, the hospital adaptation of it most certainly is not. Even the smell, that sickly salty bland smell, made me gag when people on either side of me would try to eat it. I tried, once. I vowed I would go find my own food, dizzy and IV in hand before I would try it again. The mornings were a rice-based gruel. Seriously. After a few days not eating that, they tried a cold egg and soggy bread with yogurt and juice. I ate half the yogurt, that was all I could take. And when one of the nurses was particularly worried about my lack of intake, she asked what I wanted. Oh, how to tell her? My grandma’s chicken noodle soup. Greens. Roast pork. Of course, they had none of those things, but she did offer ‘spaghetti’. Yes, I thought. Good old plain spaghetti with meat sauce. No weird sweet and salty taste, they can’t mess it up. I nodded that I’d have that, but never did see it or any food that evening. I asked again the next day and the nurse was so embarrassed that she went and got me some from a restaurant. It was pineapple and sour something and nothing like I wanted, but I choked down what I could of it to be polite.

As day bled into day, and my estimated time of departure was always “a few more days”, I developed something exciting: a rash. That may smirk of sarcasm, but I was indeed excited. When you have been laying around the last week and nothing has changed at all – still a 40 degree fever, still on IV, still dizzy when you get up and dead tired/in need of a nap by the time you get back from the washroom – any change is a good thing. I thought of it as the dead virus from the internal battles floating to the surface. This excitement didn’t last long however, before the redness added a new irritant. Pain. Now my entire body felt and looked like it had been completely sunburned. Worse than ever, not only because it literally covered every square inch of leg, knee, body, underarm, neck, and scalp, but it felt like the needles and pins you feel when your leg, for example, falls asleep. Anytime something touched it even faintly.

By the end, it was a combination of food, IV, and heat that drove me mad. Hauling the IV with me to the washroom or anywhere made me feel tied down. Trying to sleep with it (I generally sleep on my arm) was not a successful venture. The food, as I detailed, was not encouraging consumption or giving me the energy I needed to fight this virus. And the heat, well, all there was to combat IT were a couple fans. The man beside me had one mounted over his bed, which he always wanted off. There was another fan opposite which I couldn’t feel but was always on. And there was a fan on the far wall that rotated. When it briefly pointed in my direction, the air took 3.5 seconds to reach me. Which, with my rash, was accompanied by a bit of pain in my scalp as my hair was tussled ever so slightly. The morning that was to be my last in hospital, or so I thought, my fever was down to a normal 37. I was told 24 hours of no fever and I could finally go home. But by midday it was at least that hot in the hospital anyway. I lay there sweating as other patients had their guests fanning them – these are locals, remember – and trying to keep cool all the while getting more and more irritated. It was no surprise when my fever spiked back up as they took a reading that afternoon, but it meant another day of this. I prayed for rain, I really did. I cursed that they had nothing better to keep the patients cool. I lay with a wet towel on my head and did everything I could think of but kept sweating and feeling worse and worse.

The food that night was not edible. It simply was not. It appeared to be the sandwich I’d not been able to eat from lunch, the same one as the day before, and the mayo didn’t look healthy anymore. There was leftover spaghetti. Anything I’d remotely tried to put down, it was on my plate. And a Coke, for some reason. At least I’d got them to take my IV out. Breakfast the next morning, after a mercifully quiet night (night-talker had gone home the previous day) more gruel. And while I’m on the subject, watching people you think are on their deathbed get better and go home while you’re still in the hospital is, at best, discouraging. Staying beside someone with the same virus as you who leaves two days earlier, likewise. New patients who stare, literally pass their day staring at you, also discouraging. So when the doctor came to see me that morning and clucked his tongue that my fever had resurged briefly last afternoon, I told him I was leaving. No, you stay until no fever for 24 hours. NO, I’m leaving. Today. How can I not have a fever when it’s so hot in here?! I’m going back to the hotel, to air conditioning, and to normal food.

“Well, it’s safer for you to stay here” at which point I told him that I would lose it, literally lose it, if I had to stay another hot and sweaty afternoon in this ridiculous bed. I’m not asking permission, I’m telling you, I’m leaving. If you have any advice, I’m happy to hear it, but my fever’s pretty much gone and I’m not on any medicine or IV anyway. By now, something in the desperation of my voice had attracted all the patients in the ward and all stared at me wondering what was going on. But I had won. The doctor said I could go if I signed a release (which I never did see). So it was that I paid my bill – 8600 baht – and was back in my hotel that very afternoon, basking in the air conditioning. I did strike out from the hotel to get pizza, which was almost a doomed trip in the heat of the day, but man that pizza was great. A couple days laying around the hotel and doing nothing but resting and recuperating, and I still had no energy, but also no fever. I had to get my butt into gear, so I booked a flight to Bangkok. After all, my visa was expiring, and the only border I was near was Myanmar, and they were expecting a cyclone near where I would have to cross in the next few days. A cyclone which, it would turn out, killed over 300 people. Can you imagine just getting better from dengue fever only to die or be injured and hospitalized? So, still feeling sub-par, I jetted off to Bangkok, leaving untouched Ko Tao and Ko Samui, two islands I’d really wanted to visit, in favour of making tracks. Thailand, it appeared, would require a subsequent visit sometime in the future.

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