Tuesday, April 22, 2014

Day 12: Build Your Own Pharmacy!

Day 12: April 15, 2014

Blog day 12
Despite the best efforts of concierge medical care in Mbeya, Tanzania, I was unfortunately up all night that night after the IV fluids.  I went back and forth to the restroom, and about midnight I decided that the bugs flying around me on the couch (which sat next to an open window) were just too much.  If I got sick, I thought, they all knew where to find me.  Thus, I took some Motrin/Tylenol and fell asleep in a much more comfortable and bug-free (relatively) setting.

The fever was better throughout the night, as I needed fewer doses of antipyretic, but the diarrhea became RELENTLESS.  About 12:30 AM, I woke up and was in the restroom.  I went back and forth multiple times, getting either to the sink, to my bed, or even lying down in bed just for a second before the rumble returned.  I am not sure what it was.  It was as if every time I stood up, fluid shifted, something moved, and my stomach said "Hey bud, not done yet!"  It was EXTREMELY frustrating.  Thus, the cipro was restarted in the middle of the night, and I was determined to make this a long course. In any case, I was so tired, but couldn't lie down.  At one point, I sat on that damned toilet for what must have been at least an hour, back and forth, faucet on, faucet off.  I sat up, I put my head on my knee, I tried to lean back.  I was doing all I could to keep my legs from going from kinda numb to not working when I tried to stand back up again.  Finally I stood up, washed up, and gingerly walked back to bed.  I sat down.  I realized if I just sat, then I felt fine.  So, ala airplane flight or long road trip in a crowded van, I stacked my three pillows in my lap and put my head down.  It was comfortable, thank God, and I stayed that way for probably 20 minutes or so.  Then somehow in my sleep-deprived state I started to nod off and lied down at a time when I probably didn't much care or wasn't aware enough of what my stomach was saying.  Gladly, I fell asleep and the next time I woke up it was 7:30.  Friends, it was a bad night.  So reflexive was my stomach acting that I laid out a towel to sleep on because I was afraid of...an incident occurring.  Fortunately we didn't end up down that route.

My pharmacy...by the way, ORS tastes NASTY.  Even in a dehydrated state I refused to take more than my first sip.

When I finally rolled out of bed at 8:15 (post multiple snoozes), the diarrhea remained.  I took fluids, a bit of food here and there, and was in and out of the restroom through the morning.  I knew I HAD to get to clinic...I hadn't seen my family in days, and I was determined to call home.  At the very least I needed to be there in case I needed fluids again, as I was not going to have Jason and Liane have their evening interrupted again just because i couldn't drink. As the morning progressed, my stomach was still rumbling.  I went to the restroom, and nothing.  Sitting was one thing, but walking was another, so I started walking around the house in loops to see how long I could walk and if that might upset my stomach.  About 5 minutes of walking later, rumble again, but nothing.  Finally after three episodes of false alarms where my stomach actually JUST rumbled and didn't tumble, I decided it was now or never. 

About 11:30 or so, I made my way.  I told Amelia as I left that if I couldn't make it to Mbeya Hotel down the road I would turn around and come back.  And no, I couldn't get a ride, as her siblings were in town with their car and everyone else I knew was in clinic. I walked gingerly but attempted to take a somewhat more than leisurely pace, and I made my way down the road, Rosary clutched in my hand praying that I'd make it, to be frank, without messing myself in the middle of Mbeya.  As I passed the roundabout, I felt great and pretty sure I would make it.  Passed the Cathedral I was home free.  Still, crossing the threshold of the clinic was like walking into a church and claiming asylum.  I was somewhere where toilets abounded, multiple doctors were around, and I could get IV fluids if I needed them.  The security blanket was back on, and it was mighty comforting.

That said, once I got to the clinic, I was pretty useless.  I checked and caught up on emails all day, did a little work, paid some bills (which were due that day, ALSO motivation to get to clinic), etc.  I was still incredibly tired, and felt I was in no condition to try to make myself feel valuable by seeing two or three patients in the afternoon.  (Also the whole "Don't give immunosuppressed kiddos relentless diarrhea" thing...I think that falls under "First do no harm").  I sat pretty much all afternoon waiting for time to pass with my head on my chin.

Jason stopped by and mentioned earlier in the day that if I needed fluids the nurses could help me out.  About 2:30, I was feeling okay, but really wanted to be sure I didn't call anyone over for fluids in the evening or at night.  I told Jason I would take them up on the offer.  He told me he'd have them get everything ready, but that the clinic didn't have any bolus fluids at the time.  No worries, as he said they were available just across the street at Kissa Pharmacy.  Eager to get my fluids, I volunteered to walk over and get them.

At the pharmacy, I was in awe.  I walked in, I told them what I wanted (2 liters normal saline), and they handed it to me.  I was for some reason amazed that I could just do this.  Granted, it was normal saline, but my understanding is that I could walk in and just buy morphine, ketamine, etc and nobody would bat an eye.  No prescription, no degree, just BUY YOUR OWN MEDICINE.  Also, I was rather suprised at how inexpensive the fluids were.  Two liters of NS for $3 US.  Now, in the US, at an emergency room, getting that done would cost an incredible amount.  I was getting by on the cheap.

$3 worth of IV fluids in Tanzania...in the US, you'd get about that drop of water on the ground below for that amount. 

I made my way back and in no time I was lying in the treatment room with an IV running.  It took about an hour for the fluids to finish, but in the interim multiple staff members came by to say hello and offer their "Pole-sana's" (very sorry).  I passed the time with some crossword puzzles, and then ran upstairs once all was finished to call home. 

 One poke...nurses are AMAZING...but not available after hours.
 My arm is cold!
 I never did well having to sit still for an hour.
This is the equivalent of my baby mobile...although it didn't much keep me entertained. 

That was probably the best medicine. Calling home was great.  I hadn't seen the family since Friday, and it was now Tuesday.  I think what made me feel better was knowing that they could see that I was okay.  Before, Daddy was a picture on the internet of a sorry looking dude having to get IV fluids in his living room.  When I was able to see them, I knew they felt better, and so I felt better to.  Plus, getting to see those beautiful and silly smiling faces would make any guy feel lucky and motivated to get better.

At about 5, Jason and Liane offered me a ride home, which I graciously accepted.  About the time I was being dropped off, I started to notice a nasty burning sensation in my chest and especially in my throat.  I was burping a lot, and it tasted sour.  Then I realized that it had been since Sunday night that I had eaten really more than just a bite of food here and there.  Essentially I hadn't eaten since Sunday night.  Further, I had taken my second dose of cipro that afternoon, and I didn't eat anything or really drink much water with it either.  I decided that I had pill esophagitis'd myself.  I needed to eat something to make it go away, and just to eat again.  By now my appetite had returned nicely.

Of course, I walked to Mbeya Hotel.  I looked thru the menu past all the Chinese and Indian dishes, trying to order something bland.  Finally I settled on some minestrone soup and "Macaroni Cheese".  These sounded bland enough for me.  I then realized that I was about to eat for the first time in 2 days and hadn't taken Zofran.  So, I got up, told the waiter I was going the restroom, and ran home quickly to pop a zofran.  I was back in about 12 minutes or so...which I knew based on Mbeya Hotel standards put me in no danger of missing my food. I sat down as if nothing had gone on, and waited impatiently for food.

Finally, the food was ready, and so was my appetite, but was my stomach?  The minestrone looked fine, and so did the other dish.  But it was NOT macaroni & cheese.  As it turns out, it was macaroni cooked with bell peppers and onions, placed on a plate, COVERED with a ton of mozarella, and baked until brown.  It was really a macaroni pasta bake.  It looked greasy, but it was by far less spicy than the surprisingly kick-filled minestrone. 

 Dinner is served...minestrone soup (the M is for MUSHROOM) and the famous "Macaroni Cheese"
 Dinner was ready...but was I?
Showing remarkable restraint, I ate about twice of what is already gone here, and that's IT.

I started.  I ate some of the soup, and some of the bread with it.  I ate a few of the macaroni noodles, trying to stay away from too much of the cheese.  I ate for about five minutes, slowly, then made myself stop and wait.  After a five minute time out, during which I pretended to pick at my food so they wouldn't think I was done, I ate some more.  Soon, I had finished the soup (minus the TONS of canned mushrooms in it) and about 25% of the macaroni....which was the line I had drawn for myself.  No matter how much I wanted to eat, that was all I was allowing myself until I knew it was staying down.  I asked the waiter to put the rest in a box, and while waiting for it picked a bit more at the food (cheating my limit just a bit).  Soon I had my leftovers and paid, then walked home, esophagitis in control, it seemed. 

At home, it was time for a couple more trips to the restroom, but then it was SHOWER time.  It was my first since Sunday night, and it felt AMAZING.  I made it as hot as I could stand, as I felt like I was covered in my own grossness and then whatever bug was making me so sick. After a good, long time, as long as the water heater would allow (as the hot became warm became lukewarm), I got out of the shower. 

As I got dressed, I realized the esophagitis was back again.  Even worse, it was time for another cipro.  I sat down at the table and decided I was gonna bury this cipro sucker.  I took a good bite of my leftover macaroni, then took the pill, swallowed a few big swallows of water, and then downed three or four big bites of the dish, cheese covered and all.  I felt confident that the cheese sandwich/burial approach would work.  However, in the immediate interim, my stomach and throat just hurt.  They were actually bothering me more than the stomach issues, and I decided that the following day was gonna have to include some tums.  I lied down in bed trying to stay somewhat upright, and I fell asleep, having improved one issue but brought on another almost as bad.

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