To The Bitter End and Back Again

The day of Thursday began by ending like any other night. The power went out at midnight and as the day officially began I rolled over in bed and decided to go to sleep. I thought about getting up and drinking another liter of water but decided against it. It didn’t take too long into the day before things started going wrong. Once the lights went out, the two mosquitoes that hide under the bed in daylight came out and started harassing me. I pulled the blanket over my head and went to sleep. At 2am I woke up and felt awful. I was shivering cold under two blankets and I was beginning to sweat. I figured that there was nothing to be done until morning so I didn’t get up, instead I went back to sleep. This repeated a few times through the night until it reached around 8am. Thinking that I was a little dehydrated and that could be the source of the problem, I decided to re-hydrate and if that didn’t work, I would go to see a doctor. Feeling dizzy, weak, and out of breath, I got the one liter water bottle on the other side of the room and then returned to my bed where I drank it slowly with some vitamins. Feeling no better, I repeated the same process again lurching across the room and back. After the second liter sized bottle of water was gone and nothing had changed, I knew that something was very wrong. My first thoughts were that I had dengue fever, even though there are no mosquito born diseases in the Kathmandu Valley.

Grabbing my laptop bag I hoisted it over my shoulder with most of the effort I had available. I left my room and headed for the front desk. The same as leaving any other day, I gave the reception desk my laptop bag and key. This time I showed them an international number and told them that I needed to dial it. It was my insurance carrier. On the phone, they said that seeing a doctor did not need any pre-certification. That was only needed for being admitted to a hospital. I rested my head on the front desk of the hotel and the man asked if I was tired. I responded that I was sick and something was wrong. I asked him if Patan Hospital was close, already knowing that the answer was yes. Also, knowing that there were no taxis near the hotel entrance I asked if he could have one of the hotel staff walk with me to the hospital. He looked confused at first from the strange request but then got someone to walk with me. As we headed out of the hotel and down the streets, I was having trouble keeping up with my escort. He was walking at the ordinary Nepali pace, which was normally painfully slow for me. As we rounded the corner I expected the hospital to be right there, instead it was further down the road a distance that seemed like eternity. I thought about needing to stop at the ATM but decided not to because of my exhaustion. We walked to the check-in for the emergency ward and I filled out my admission sheet. As the woman processed it, I rested my heard on the counter, barely able to hold myself up. She gave the sheet to me and pointed into the emergency ward.

With my blank pink medical chart in hand, I walked into a busy emergency ward full of beds and patients. Uncertain where to go, I walked past the waiting area into the treatment area. There was no definite line separating the two. I saw one western looking doctor and I locked eyes with him as I struggled to stay standing. A shorter local doctor passed in front of me and I made eye contact with her, looking for anyone to help me. She told me that I needed to put my chart in the bin on the wall and a doctor would come help me. I did just that and since the bench for waiting was full, I leaned on the wall, a little too afraid to sit on the unclean ground. The western looking doctor came and took the chart, then led me to an inclined bed around the corner where I sat down. He started to take my blood pressure as part of a routine check. As the blood pressure cuff tightened around my arm, it started to fall asleep, tingling everywhere below the cuff. I told him that my arm was going numb and that this was not normal for me. A nurse came by and took my temperature and another doctor took my blood oxygen levels, all as he redid the blood pressure measurement to make sure he had the right number. After a few other quick tests, the western doctor told me that I had a fever of 104 and my blood pressure was 80 over 60. I repeated back to him “80 over 60” and said that it was not good. Something he knew already. I told him that my arm was still numb and that it wasn’t coming back to life even after he removed the cuff. Answering some questions, I gave the two answers usually ruling out stomach problems, no vomiting and no diarrhea. Helping me up, he said that depending on how the further diagnosis went I may want to transfer to a western hospital or I may need to fly to Bangkok. My eyes widened when he said Bangkok and I realized that I may be in more trouble than I was used to. He continued to help me as we walked over to one of the emergency ward beds. Each bed was only a few feet from the next with no separator in the crowded one-room emergency ward. Lying down on the bed, I looked up at the whitewashed concrete ceiling above me. It had a visible layer of dust from where one of the many fans in the room blew air over it.

I asked the western doctor where he was from and he said he was from Britain. He asked if I had a friend that I could call. My left arm completely immobile on the bed, I used my right arm to point to my left pocket and I asked him if he would take the phone out of my pocket. He did so and then placed the phone in my right hand. Lifting my head off of the bed, I looked at the phone and pushed the button for the address book. When I tried to make the call, the phone fell out of my hand and onto my chest. I put my head back on the bed and looked up at the ceiling again. Now my right hand was starting to malfunction and I felt a little more scared. I asked the doctor if he would dial the first number in the address book, labeled “Albert”. Albert was a semi-retired American architect I had met through Rotary and he was my best friend in Kathmandu. The doctor told Albert where I was and then gave me the phone. My fingers becoming useless, I cupped it in my hand and held it to my ear. I told Albert that I didn’t know what was going on, but something was very wrong with me. The doctor talked to Albert for a short while and then hung up the phone. He told me that Albert was coming and would be there in about 30 minutes, it might as well have been forever to me at that point. I asked the doctor why my arm wasn’t coming back to life since the blood pressure test. He responded that he wasn’t a doctor yet, just a medical student. I responded by saying that I didn’t care. I saw the look of surprise on his face at the response he didn’t expect to get.
My phone rang again and I managed to answer it and cup it to my ear, only dropping it once along the way. It was Seema, a friend and local Nepali woman my age that Albert had introduced me to a while ago. I told her the same thing I told Albert and she said that she would visit after she got off work. At this point it was still 10am in the morning so I told her that I would call and keep her updated of any changes. I had the western medical student put the phone back in my pocket as he asked if I had money to pay for the emergency ward services. I pointed to my other pocket and told him my Nepali money was in there. I told him that it was probably not enough but I had some American money and that Albert could pay for anything when he arrived. I told him that I would have no trouble affording the cost of the medical services. He told me that the hospital would only take the Nepali money and he left with the small amount of cash I had.

The British medical student returned and put my money back in my pocket. He said that the money wasn’t enough but he had paid my emergency room bill for now, the USD equivalent was $35. Another local doctor came by and joined the medical student. I noticed that his coat said “Resident” on it. He had helped do some earlier tests on me and he began to take my blood pressure on my right arm as I lied on the emergency ward bed. Again, my arm started to tingle and it didn’t stop when he removed the cuff and repeated the same numbers, 80 over 60. He then left to go get another machine. While he was gone my right arm continued to tingle. Suddenly, both of my hands froze solid and rigid in an awkward position that a person would never make intentionally. They started to hurt in this position as they were fixed solidly and awkwardly out of my control. My right arm still barely awake, I lifted up my right hand and asked the British medical student why my hands were doing this. He responded that he didn’t know. I put my hand back down and within a few seconds my right arm was gone. I couldn’t move either arm and the tingling feeling was starting to move across my chest. The resident doctor returned with what I assumed to be an EKG, and he also brought a nurse with him.

As the tingling across my chest was getting worse and worse, I started to roll my head back and forth on the bed. I was the only part of my upper body I could still move. I said, but in actuality probably yelled, “This is bad. I’ve never felt like this before… …This is really bad. I’ve never felt this bad before”

The resident doctor replied, “Please calm down. Things will be much better in 5 to 10 minutes. Please calm down Sir.”

“OK. I’ll calm down.” I replied while relaxing everything in my body I could. My hands stayed firmly locked in their awkward position despite my will. The British medical student asked the resident doctor why my hands were acting that way. The resident doctor responded that I was probably going into shock. He then lifted up my shirt and started placing multiple sensors on my chest. He slid down my socks and placed a clamp on each ankle. He put his hand slightly above my wrist, expecting me to lift my wrist into his hand so he could put the clamp on it. I looked him in the eyes and told him that I could move my arms. With that, he picked up my wrist and put the clamp on it, and then the next one. As he looked at the machine all I could think of was the end of my life. At the same time the tingling numbness in my chest was getting worse. For the first time ever I saw the possible end in the near future and I definitely wanted to live. I didn’t want to live for myself though. I could only think about my father and mother, grandmother, and sisters and brothers and how sad they would be if I never came back from Nepal. Mostly I thought about how devastated my mother would be if I died in a Kathmandu emergency ward. I looked up at the ceiling and prayed, ‘God please don’t let this ceiling be the last thing I ever see… …and if it’s not too much to ask, I’d like to keep my hands too.’ I stared at the ceiling some more until I was brought back to reality by the doctor removing the sensors from my chest and the nurse inserting an IV into my arm. Even though I couldn’t move my arm, apparently I could still barely feel pain through it. I looked up at the IV bottle as a constant stream passed through the drip system. I’d never seen and IV move so fast. I imagined that if it moved any faster, a whirlpool would form in the bottle. In less than a few minutes the bottle was done and it was replaced by a second, and a few minutes later a third. As the drip went on, life slowly returned to my chest and then spread down to my arms and my hands. The resident doctor was right. In 5 to 10 minutes things were much better.

About 15 minutes later Albert arrived. He asked how I was doing and I told him that I was doing much better compared to about a half hour ago. My Nepali-only speaking escort from the hotel stepped forward and waved in a way to ask his leave of us. I nodded, not even realizing that he had stayed there the whole time. I told Albert the story and then lifted my hand into the air, touching each finger to my thumb. I reiterated that I was much better. Using his phone, we called Seema to let her know that things were much better and that I would be alright. I talked to Albert and made sure that he paid both the Hospital and the British medical student, especially the British medical student. I didn’t want his kindness to be punished by negligence. Thinking that this may be just a case of dehydration, Albert and I started to plan where we would have dinner together. I lied on the bed for several hours waiting for all of the tests and the x-ray to come back. When they did, the doctors said that they wanted to admit me because I showed signs of an infection that they couldn’t determine the origin of. Postponing dinner, Albert and I agreed that I should be admitted. The only room available was half of a double room in the private ward of the hospital. A situation that turned out for the best in the end, but that’s another set of stories to be told.

The stories not told also include A LOT of help from Albert and Seema. I am especially thankful for all of their help throughout everything. That is one nice thing about hanging around the Rotary circle. You meet a lot of genuinely great people who are willing to help you when you need it the most.

Just for anyone who is concerned about my health. After 5 days of in-patient service I was released from the hospital today with my last 4 cipro pills in-hand. I am feeling much better. The final diagnosis had to be made after I had recovered. Many tests were done with each one coming back negative. Two days before I was discharged I had a malaria test because the doctors still weren’t sure what I was suffering from. According to them, it was apparently one heck of a case of dysentery. Although I must admit that its strange that I had no vomiting, little diarrhea, and all negative stool samples. I don’t think I’ll ever be certain, but things are much better now and I am thankful for that. I’m also glad that I decided to go see a doctor so quickly. From the first signs of symptoms, it was less than 8 hours until I was going into shock.