Published: April 19th 2008April 6th 2008
Ohmygod, I've got malaria
. . . was the first thought that crossed my mind Friday morning, as I sat beneath a tree watching a mistnet, feeling the gradual oncomings of the flu. I'm not too much of a hypochondriac, but I've been told time and again that "if you're not taking antimalarials (which no long-term researcher does, mind you), assume you're coming down with malaria when you begin to feel like you have the flu." A bit of an extreme precaution, I suppose, but better safe than sorry - if left untreated until too late, malaria will cause flu-like symptoms every few months for the rest of one's life. Plain and simple, that would be a pain in the ass. (It would also suck to die from malaria, which is another possibility . . .)
I actually woke up Friday morning feeling fine, with nothing more than a slight grumble in my stomach - something I’m quite used to after a greasy dinner the previous night (if Mpala is any indication, everything is cooked in liters of grease in Africa). Within the hour, however, my slight grumble turned into a fairly pressing need to make a mad dash to
Not lookin' so good . . .
How a 103F fever makes me feel . . .
the nearest toilet - also not that unusual since a lot of grease in the diet often necessitates such urgencies.
Confident that I had vanquished the grease-demons residing in my gut, I went about my morning routine and met with Wilson and Godfrey before setting up mistnets to catch Greater Blue-eared Glossy Starlings for the Brain Hormone Project (Phase 2). Since we were netting at the research center that morning, I had the luxury of sitting in a chair, as opposed to on a rock, while watching the mistnet.
I can’t recall exactly when, but it was sometime shortly after making myself comfortable in that chair that I began to realize I wasn’t feeling quite right. I initially convinced myself it was just a mental issue - I was tired and it was a somewhat chilly morning, and perhaps feeling a bit “off” was simply the justification for wanting nothing more than to crawl back into a warm bed. Or did I want to crawl back into a warm bed because I did not feel well? Hmmm . . . a genuine chicken-or-egg debate. Until I could pinpoint specific symptoms of being ill, I told myself to buck
Stool Sample Cup
You've got to be kidding me . . .
up and stop being such a sissy, certain that the weaker part of me was trying to use “not feeling well” as an excuse to escape from a morning’s work and instead enjoy the lazy warmth of my bed for a few extra hours.
But I did begin to notice symptoms - symptoms that I would generally attribute to the flu: hypersensitive skin, aches, and general malaise. I sat and waited, continuing to watch the net, hoping these little red flags would fade, hoping it was a tired, cold morning that was making me feel this way. But was it really that cold? “Cold” is relative in Africa - the morning was at least 60F, chilly to locals but plenty warm for me to be comfortable. So why was I shivering?
As the symptoms persisted and began to worsen, I decided I’d had enough and closed my nets before retiring to my banda, where I hoped to recover, by virtue of the solace offered by my bed, from whatever malady was affecting me. Sleep was restless, however, and there was no warmth to be found beneath the sheets. For two hours I shivered, drifting in and out of
The VIP Room
My first of two rooms at The Cottage - this one was the most expensive in the entire hospital (thanks for telling me!)
sleep, occasionally glancing at the clock to discover only minutes had passed since my last short bout of unconsciousness. While looking at the clock one of these times, I noticed the indoor temperature read 75F - yet I was still shaking uncontrollably, even though I was curled in a ball beneath my usually-warm blankets. There was no question - I was sick.
At home, in the US, I would have thought, Well, damn, there’s no helping it . . . here comes the flu
. It’s a different story in Kenya, however, where malaria is found virtually throughout the country, prevalent at sea-level and petering out only at higher elevations (such as the mile-high Mpala Research Center). For those of us who opt not to take antimalarial medication (primarily because of the health implications of prolonged usage, such as liver damage), the general rule, as I said before, is to consider flu-like symptoms as the potential onset of malaria. For this reason, I decided it was time to find somebody to whom I could report my condition and request the favor of a ride into Nanyuki for a hospital visit.
Crawling out of bed, I discovered I did not
It doesn't make me squeamish, I just don't like
foreign objects like this becoming a part of my body, even temporarily.
want to walk - my energy gone, I felt very weak and somewhat lightheaded. I stumbled to the library, where I found Jake and explained to him the series of events that led to how I currently felt. Jake then helped me find a ride while I tried to muster the mental wherewithal to figure out what I should take with me in case I ended up bedridden for a number of days. I snagged some warm clothes (but not an extra change . . . oops), my point-and-shoot digital camera, my phone and charger, and a book (Band of Brothers, by Stephen E. Ambrose) before heading to the administration building to catch my ride. Here, I ended up waiting for approximately 45 minutes - inexcusable, according to Jake, who reamed out various askaris
and administrative personnel for the long wait, citing the fact that had I (or anyone, for that matter) been bitten by a cobra, they would be dead already. Apparently I had to wait for the Mpala school bus to be rescued from getting stuck in the river while being washed before a driver was available (though a vehicle was ready and waiting). Granted I wasn’t dying,
A much more affordable room, just as comfortable, though no TV (not that big of a deal - only three channels and I haven't missed it in the two-plus months I've been at Mpala)
but we also didn’t really know I wasn’t
dying (doubtful, though I felt like it), so why I took the backburner to a school bus is beyond me.
During the hour-long, bumpy, dusty, goat-, sheep-, and cattle-dodging drive, I stared out the open window, trying to maintain a sense of calm and rational thought (though I was succumbing to a mild delirium). The bone-chilling cold was replaced by a vicious heat throughout my body, and I welcomed the whipping wind against my face, which I’m sure had a blank and ashen stare to those viewing from the outside.
I remember thinking, in between my dazedness, how long it was taking to get there, until we finally bumped through Nanyuki’s absurdly potholed streets to the hospital. After inquiring with the nearest staff we could find, we discovered we had arrived just in time for the doctor to go to lunch. Another 45 minute wait. In the meantime, the nurses took my vitals and wrote down my basic information. Removing the glass thermometer from my armpit, the nurse informed me that I had a 39.5C fever, and I tried testing my brain, to see if it was completely fried or
Much, much better, thanks to good care and plenty of medication.
not, by converting that to Fahrenheit. Unable to think (or see, for that matter) completely straight, I managed to figure out that 40C was 104F, so I was probably within a degree of that (I later worked it out to be 103.1F). It made sense why I was struggling to do some simple arithmetic - my brain actually was
frying (my normal temp is usually low- to mid-97F). The nurse brought a giant pink M&M and told me it was to make the fever go away, and I devoured it. I felt stupid, I felt slow, I felt horrible - and I wanted all that to “go away” as soon as possible. Finally, they informed me that I would need to provide a stool sample. Oh, great, I have to poop into a cup
, I lamented inwardly. There’s a first for everything, I guess. Let’s just hope it’s a big cup.
Well . . . to my shocked dismay, they produced a small plastic container not much larger than a film canister. I was floored. It was inadequate for a urine sample, much less a stool sample. I spent the next agonizing 45 minutes waiting for the doctor in
A view of the hospital from near the small stream that borders one side of the compound.
a feverish stupor on the only chair near reception - the world, and time, proceeding in slow motion - wondering how was I going to poop into that film canister. It just didn’t seem possible.
When he finally appeared, Doctor Butt (interesting name for an Indian - well, for anybody, really) invited me into the nearest examination room, and I shuffled in and plopped down on a chair to describe my symptoms and answer an onslaught of questions. I honestly can't recall much of it, though I do remember his verdict: I’d be staying the night.
I’m not one to be squeamish or scared of needles and the like, but as I watched Doctor Butt prepare the cannula and slide it into the vein above my left wrist, I felt myself growing hotter and becoming more lightheaded, feeling like I was on the brink of passing out. Taking one look at me, the doctor ordered a wheelchair to take me up the side ramp, not confident that I could walk myself up the stairs to my room. Then he left. Must be a busy man
, I thought.
My room was plush. I managed to have just enough
A Quiet Place . . .
A "Quiet Place" open to anybody to come pray, think, have peace of mind, do whatever one wants to do, as long as its done quietly.
awareness about me to be astonished and impressed, as I staggered from the wheelchair to the bed, to see an en suite bathroom and a TV, in addition to a couch, a lounge chair, and couple beautiful paintings. The room was white, but not stale, and I had a decent view of lush greenery and trees from my second-story window. I’ve slept in worse (much worse) hotel rooms. This was not bad, by any standards, for a hospital in the middle of Africa. I started to relax.
Then the IV came, and I grew nervous again as I watched the nurse, clearly somewhat of a newbie, fumble with the one-liter dextrose bag while connecting the tube that would run into the cannula in my arm. When it was finally hooked up, I watched in horror as a couple large bubbles began flowing towards my vein, venturing the guess they probably should not be entering my bloodstream.
“Hey, is that okay?” I pointed to the bubbles.
“Oh, fine, fine,” she replied and removed a little cap on the cannula. I could feel the hiccup in the flow of fluid, as the air escaped, before it continued again. I didn’t like the feeling at all, because it felt like the bubbles were entering my vein via the catheter. “Call us when it’s almost gone!” she said pleasantly before disappearing out the door.
For the next half-hour, I dozed lightly, waking up in a jolt every few minutes to watch the bag gradually deflate and sag. I pressed the call button when there was just a little bit left. A minute or two later, two nurses came in and switched the bag for a one-liter bottle, and set the drip going again. This one took slightly longer than the first, and again I alternated between sleep and apprehensive observation of the draining fluid, not sure what would happen if the nurses didn’t get to it before it had all disappeared into my body and the fluid was replaced with air.
The third and final one-liter bottle was, I believe, a concoction of antibiotics and saline solution, and took about eight hours to slow-drip. During this time, I slept fitfully, waking because of my fever and frequent visits from various nurses to check on me and my vitals. It appeared my temperature was slowly declining: 38.5C, which was still a fever, but better. I had tea. I slept. I woke up. I went to the bathroom in increasing frequency to relieve myself of the two-plus liters of sugar water recently pumped into my body, dragging the IV stand with me, careful not to let the blood backflow into the tube (though it inevitably happened, making the four or so inches of tube leading into my arm turn a bright red before slowly becoming clear again).
One of the most frequent questions from the nurses was whether or not I had produced a stool sample for them, yet. What a question! I kept saying no, that I wasn’t “ready.” In all honesty, I was avoiding it like the plague, silently hoping that, by ignoring it, that little film canister might disappear. It didn’t. Finally, at about 1530, a nurse told me they needed it by 1600 if the lab was going to get to it today. It took some careful work, but I managed to get the job done surprisingly well. I’ll leave it at that.
For the next six hours, until the final IV drip was complete, I dozed, stared blankly at the ceiling, watched TV, and did what I could not to feel miserable, including being as upbeat as possible for the several nurses who came and went throughout the afternoon and evening for check-ups. I ordered beef stew, mashed potatoes, and beans for dinner, only to realize I had absolutely no appetite by the time it arrived, and felt embarrassed when they came to take it away, only about a quarter eaten. I also discovered, from a nice nurse named Ester (who coincidentally worked at Mpala eleven years ago), that I had been placed into the most expensive room in the hospital without being told I had a choice. That explained the sweet digs. It was a treat to be able to watch three channels of TV (though, only one of which was worth watching), so I wasn’t about to complain too much, but decided I would move into a room the following day for half the price.
Ester was a riot. She was a smiling, amiable nurse (I suppose they all were, for the most part), and particularly bubbly. When I told her I was American, she excitedly responded that she was leaving for Baltimore, Maryland, at the end of the month. She was excited to visit the States, and possibly look for a job there. She was also looking forward to teaching Americans that “all Africans do not run around barefoot and naked in the bush with machetes and war with one another.” I didn’t bother telling her she probably wouldn’t find too many people who would be startled to hear such news.
I was relieved to finally be able to push the call button when the third liter of fluid snaked its way into me, and have the nurse pull out the IV. Now I could go to the bathroom without dragging the damn IV behind me. I could also finally sleep decently, though I had to be careful not to bump or agitate the cannula still in my left arm.
At first light the next morning, I woke up feeling infinitely better. I felt alive again. I had energy - at least, enough to hold up my book concentrate enough to read. I also had enough of an appetite to bolt down the scrambled eggs, toast, and sausage I ordered that morning. My smile and attempts to be upbeat for the nurses was no longer a façade - I felt genuinely better. Not fully recovered, but well on my way. My fever had broken, and my symptoms were gradually abating: my skin became less sensitive, my headache slowly diminished, and other body aches were only the result of sitting awkwardly. That general malaise - that generally shitty feeling - was disappearing. I was elated.
Despite already having managed to coax a stool sample from me, the nurses were almost uncomfortably interested in my bowel movements. At least once every two visits, I was asked how my diarrhea was - did I have any? How watery/what texture? How many times? I wasn’t sure what they wanted to hear, but not wanting to lie, I played it as safely as I could by admitting I still had a bit of "the runs." I feared that the wrong answer would find me hooked up to the IV again to keep me hydrated, and I loathe how constricted and helpless I feel with that thing attached to me.
Finally, sometime after 0900, Doctor Butt arrived with some results to share with me. The blood tests proved negative for malaria - good news. I did, however, have a bad bacterial infection. What hell does that mean?
I wondered. How did I get it? What was it? How bad is “bad?”
I listened to what Doctor Butt had to tell me. I was a bit disappointed not to learn anything more about this mysterious “bad bacterial infection,” other than it meant I had to stay another night in the hospital. As long as I didn’t have to deal with any more IV’s, I was fine with another day of rest at “The Cottage,” which was like an upscale youth hostel with room service. I was actually enjoying it, now.
Doctor Butt was apparently interested in the consistency of my stool, as well. I told him what I told the nurses, trying to make it clear that I had the runs while remaining vague on the details.
“Yes, you see,” he replied, “the diarrhea is good at this point, because it will flush your system of the bacteria. That is one of the purposes of the IV.” Oh! So they
want me to have diarrhea! Why didn’t they just say so?
I decided to elaborate on the specifics.
“Hmmm. Well, see, we don’t want you to become dehydrated, or else we’ll have to put you on a drip again.” Shit!
I then managed to provide an explanation as true to fact as I could without giving him reason to stick a tube back in my arm. He was satisfied. No IV. Phew.
After Doctor Butt left, telling me he’d see me again in 24 hours unless my condition deteriorated, I was given soap and a towel for a shower. Then, after doing battle with the knobs that appeared to have no control over water temperature, which was excruciatingly hot, I was moved to another shower down the hall while a male nurse transferred my belongings to another (cheaper) room.
This room, too, was great. The only difference between this and the “VIP Suite” was the lack of a couch, TV, and en suite bathroom. Various paintings of Kenyan birds (including a Superb Starling, how fitting) replaced the bigger scenic paintings. Again, the room was bright (as a corner room, even more light spilled through the windows than in the first), yet didn’t have that stale aura I feel is usually associated with the white walls of hospitals. An easy place to spend a day of rest.
I spent almost the entire day reading, devouring “Band of Brothers” (quite interesting to compare and contrast it with my last book, Catch-22). When not reading, I dozed, stared at the ceiling in contemplation, occasionally assessed how I felt, and entertained nurses. I continued to feel better throughout the day, my symptoms all but vanishing. The nurses brought me food, tea, and medication, including a fatty syringe full of antibiotics injected through the cannula. My only complaint was a confused G.I., angry that, with this tremendous input of antibiotics, I was killing all the good bacteria along with the bad. Otherwise, I was almost glad I had come to the hospital - it was pleasantly relaxing.
A slightly unexpected visit from Kayna was a treat. She had said yesterday that she might stop by (hopefully to pick me up), but I figured she never made it into town, or had heard I was to stay another night. Much to my delight, she did make it into town, with cookies and finger-bananas nonetheless. I was most appreciative.
Because I had my cell phone, I was able to take calls from and talk to Shan and, later, my parents. It was great to have the attention and care, and definitely helped my recovery. Dad made me nervous, though, in his perplexity at a systemic bacterial infection and his assessment that they could be very dangerous. I just hoped that my feeling better every minute was a good indication that mine was not very serious.
The one and only thing I truly regretted not grabbing, though I considered it, before leaving for the hospital . . . was my binoculars. Feeling well enough to wander around, I strolled the hospital's perimeter, admiring the grounds. They were quite green and lush, with a small streamlet and associated riparian area bordering one side. Large trees dotted the compound, which was also strewn with a somewhat haphazard garden of trees and flowering shrubs. I saw and heard birds I couldn’t recognize without my bins, and was sorry I didn’t have them with me.
I cruised through the rest of the day, happily eating my meals and conversing with the nurses in between reading and relaxing, continually feeling like I was improving. After another decent night’s sleep, I decided the Nanyuki Cottage Hospital had done its job, and was glad to hear that Doctor Butt was going to release me. Jake arrived shortly after 0900, and we spent about an hour shooting the breeze while waiting for Doctor Butt to show up with his final instructions. Turns out that, because I had started the antibiotics before providing them with my stool sample, it was too difficult to make a culture to determine what, exactly, the bacteria was that had wreaked havoc throughout my body. As it was, the doctor was confident that I was on my way to a full recovery and told me to continue to get some rest and finish up my cycle of antibiotics. He didn’t seem to have any concern about my prognosis, so I decided not to, either.
Ester returned to exchange e-mails (she was more than excited to have an American pen-pal) and say goodbye. Then she explained to Jake her visit to the United States, saying again how she was looking forward to educating random strangers that “Africans do not live nakedly in cages and eat raw meat and kill each other” (her idea of what the Western world thinks of Africa grew continually more convoluted and absurd each time she brought it up). Jake was at first quite taken aback, but ended up laughing at the comment, and reassured her nobody thought that. I found her misconception of American misconceptions pretty amusing, too. We had a good laugh about it.
I was given my final antibiotic injection, had the cannula removed, said my thank yous and goodbyes, gathered my things, picked up my medication (5 days’ worth of Cipro, some anti-vomiting pills, stomach cramp pills, and antidehydration salts), and we left.
We made it to Mpala just before lunch. I spent the rest of my day relaxing, reading, catching up on e-mails. I met briefly with Wilson and Godfrey and told them I’d be recuperating for the next day or two. I’ll be back at it in no time.