Sunday, November 30, 2014

When Travel Attacks - Part 2

Ten Days Solo in a Thai Hospital - Part 2

If you read the first half of this article, you already know about how and where I got sick, as well as my rapidly worsening condition after three nights stay in hospital at Ao Nang in southern Thailand. You can read the first part of the story HERE.

Long-Tail boat on the beach in Kamala, Thailand

During that third night in the Ao Nang hospital, World Nomads and my family went to work remotely on my behalf, so that when I awoke, they had arranged for an ambulance to take me to world class Bangkok Hospital in Phuket, about 3 hours drive from Ao Nang. The ambulance picked me up in the early afternoon and we made a run for it. There were two ambulance attendants/paramedics on board as well as the driver. They both spoke fluent English and were not only very professional, but also very personable and friendly.

As soon as the ambulance left the curb, the attendants began asking questions and gleaning information on my conditions, symptoms and general health. Then they began taking readings on blood pressure, pulse, respiration and other things. They also had copies of my health charts from the Ao Nang doctors. We made a pretty fast exit from Ao Nang and Krabi without resorting to the kind of NASCAR driving tactics that ambulances are not only capable of, but legally authorized to conduct. The driver kept the siren off much to my relief, and I'm sure, everyone else on the road. We ended up on the highway and faster progress in pretty quick order though.

Once all the tests and questions had completed, we were left with nothing to do but chat amiably about everything under the sun. However, the topic of conversation inevitably ended up coming back to speculation around what, precisely, was wrong with me. They had all kinds of ideas and theories about what it could be and bandied them back and forth in a kind of paramedic ping-pong match. I acted as line judge and would periodically answer more pointed queries about specific symptoms and such. By the time we reached the hospital emergency admitting area, the albeit very weak, consensus was that I probably had Dengue Fever. Aside from similar symptoms, apparently one of the biggest factors weighing on this was an overall large number of cases this particular season. Apparently as it turned out, they were wrong. However, this wasn't the last time medical professionals would wrongly speculate on cause, based purely on a combination of some (but not all) symptoms along with larger than normal local outbreaks.

The first admitting physician was one more such speculator. He focused heavily on the swelling, blisters and lesions on my feet and hands before telling me I probably had a case of Foot, Hand and Mouth disease. Never mind that there were no symptoms in my mouth or head and that adults only very rarely contract this disease mind you. While painful and kind of hideous to look at, these were hardly the worst of my problems and not at all what was, in most likelihood, quickly killing me. He was careful to remind me that it was only an educated guess and that they'd need to conduct a battery of tests first. More importantly, their top Epidemiologist would be there in the morning to take charge of the case and render a proper verdict.

I met her next morning as promised along with a couple of other specialists put on the case. She was much younger than the others, but she was clearly in charge of proceedings. We talked, they probed and finally ordered more tests to go along with the ones we'd already done. She immediately dismissed all speculation around Dengue and Hoof, Foot, Hand or Paw diseases too. She didn't speculate at all, but I could see her gears working on possibilities here. I think she might even have been enjoying the challenge a little. I don't mean that she didn't care, because she plainly did, but given her skills and training, I could tell she liked solving this type of puzzle. After we were done, I settled back and took stock of the situation as best I could.

I had a large private room with en-suite bathroom and remote TV with tons of channels in all languages. I didn't complain at all, but part of me wondered how much of this was due to an informal quarantine and how much was the result of a westerner with really good insurance. Probably I decided, it was a little of both. Shortly after they left the room, I got a phone call from Mike Johnson making sure I was okay and relaying news from home. It was so great hearing a friendly voice in those circumstances that I can't even tell you. Mike was a fabulous mix of friendly chat and down to business "let's get you well and out of there" brass tacks. It was perfect and I think having him as intermediary helped keep my family from jumping on a plane and coming over right away since we've all known him from the time we were kids. If I'd asked, I think he would have taken a leave and flown up from his job in Malaysia too. Fortunately, that wasn't necessary and besides, he was able to do a lot remotely with his local knowledge and contacts.
The view from my hospital room

My family was also working hard on the other end along with World Nomads to ensure my well being and care. With a 14 hour time difference, this could sometimes be pretty challenging. Just knowing they were all behind me was a huge comfort. I have to say that even with all that, and the top level of medical care I was receiving at Bangkok Hospital, there are times laying in that bed when you feel very alone and vulnerable. The doctors all speak fluent English, but very few others do, and my Thai vocabulary was limited to just a few formal greetings and pleasantries.

Even to my untrained eye, the quality of care at Bangkok was way above what I had received earlier. For example, the contraption (official medical term - not) they put in my arm that hooked me up to all the various intravenous medications and solutions was miles better than the rig in my hand at Ao Nang. That one was fairly painful, always seemed like it was coming loose and constantly appeared to have my blood leaking back up the tube. I'm a total medical no-nothing, but it didn't seem to me like that should have been happening. Also the IV stand there was set up in such a way that made trips to the bathroom somewhat akin to attempting a summit assault on Everest. No way am I ever going to use a bedpan - ever - unless I'm comatose, and even then probably not...

IV rig in my hand at Ao Nang - you can see my blood coming back up the tube






Every two hours the nurses came in to check the usual blood pressure, heart rate etc., etc. 24 hours a day. That means at night too, so wakey, wakey, rise and shine for 10 minutes and then back to sleep little rosebud. The nurses cracked me up on occasion too. They were unfailingly professional, polite and good-natured, but sometimes the language barrier made for some interesting terminology. For example, instead of asking if I'd had a pee or a bowel movement, what I would get was "you go poo-poo's yet today Mr. Cody?" Like something someone would say to a toddler. Funny.

It turned out that all the antibiotics and other meds I was prescribed at the first hospital did keep me alive, but also made obtaining a proper diagnosis much harder for the Epidemiologist. She had to do quite a bit of forensic sleuthing to figure out what happened and when along with what exactly was going on now. Her best guess was that it all started with some form of airborne respiratory Legionella (Legionnaire's) disease that opened me up to a massive systemic infection involving several other very serious pathogens. I probably got the Legionella bacterium from a dirty air conditioner somewhere along the way, but hard to prove from where exactly. All in all, some pretty serious business apparently. The tests did not show any kind of parasites or anything either, which was a big relief. Yup, things do grow well in a tropical climate it seems.

Attack of the Killer Bean-Counters

Once the Epidemiologist had the diagnosis and knew what pathogens she was up against, she was able to prescribe a course of treatments that ultimately worked; stopping and then pulling me back from the flaming tailspin I'd been riding toward the hard pack below. I had long way to go and it was still several more days in hospital before I was anywhere near discharge. After that, I still needed some time holed up in a hotel before I was fit enough to go anywhere. All in all, I would need many months rehabilitation to gain most of my health back. Before then though, on the morning of my third day in the second hospital, I got a visit from the bean-counters.

He showed up dressed in a suit, which should have tipped me off right away. The doctors might have worn suits and ties under their medical coats, but I hadn't seen much in the way of suits anywhere in Thailand up to that point, outside the banking and consulate areas in Bangkok. Anyway, he was pleasant enough, but definitely had an agenda. All medical facilities around the world now seem to be driven as much by financial concerns as health and this was no exception. He came into my room, introduced himself and then raised the clipboard to his chest like he was referring to some type of official edict from on high. He apologized first and seemed genuinely pained to be on this distasteful little errand, but he had a job to do.

"I'm sorry" he said, but we haven't received payment yet from your insurance company and we need "X" Thousands of Baht from you now in order to continue treatment. I had only just started the new course of treatment, so I was still really, really sick. I felt like nine miles of bad road and I cracked an eyelid. "I thought they gave you a promise and guarantee to pay" I replied. "Yes they did" he says, "but we haven't actually received funds yet." As ill as I am, even I can't believe we're having this conversation right at my bedside with tubes, monitors and hospital gack surrounding us. "It's the middle of the night back in the States, they provided a guarantee of payment, and it's only been two nights since I was admitted" I'm thinking sort of aloud both to myself and Monsieur Accounts Receivable. "Yes, yes" he says, "but we haven't yet received the actual funds yet" so we need the money from you now. You'll be reimbursed later" comes the (not so) soothing reply.

I came in wearing a grubby pair of shorts and a dirty t-shirt with a small day-pack of essentials only. I can't even recharge the minutes on my Thai cell phone SIM card so I can make calls home or for pizza (kidding). I'm waaaaayyy short of enough cash in my wallet to cover that bill and as pleasant and spacious as my hospital room was, it somehow did not come with an ATM installed alongside the bed. Obviously an oversight on the part of the planning department. They should have consulted the finance department. Besides, the amount would be way past my daily limit anyway. I point out these annoying realities as well as the insurance company's size and reputation as my rebuttal. We go back and forth a couple of times, but ultimately he agrees to wait and leaves my room somewhat mollified. I picture this whole exchange in my head like a cartoon and it totally cracks me up.

World Nomads did make good of course and payment was received in full during my stay as well as at its conclusion. I can't thank them enough for all they have done for me, both for this as well as another, later episode on this RTW trip. Bean-counters rule the world though.

Just before discharge from the hospital
It took a few more days for me to improve sufficiently to be discharged from the hospital, but not to actually go anywhere. Normally, this is the part where the doctor tells you to go home and keep getting better. Since I can't exactly go home, my options are a little more limited. I'd been told under no circumstances to attempt travel outside the area until the doctors clear me. Aside from still feeling like a warmed up crap sandwich, my feet were too blistered and swollen to walk very far at all. Once more, Mike came through and set me up with a room in a hotel owned by a friend of his in Patong Beach. I hadn't been to Patong yet, so really knew nothing about it, except there was a mall with a Starbucks about a block away. By now of course, coffee fiend that I am, was dying for a cup of coffee. It had only been about 10 days, but good grief for me felt like an eternity. The food and care in Bangkok Hospital is excellent, but I really needed coffee and fresh air.

Convalescing at Patong Beach

As promised, the hotel owner was a wonderful and welcoming host as well as ex-pat German, so naturally everything was Bavarian themed and most of the guests spoke German as well. The Thai staff were fabulous too and very helpful there as I convalesced. My room was on the ground floor right behind the bar/restaurant so access was easy and it remained surprisingly quiet despite the noisy bedlam a few feet away on an insanely crowded side-street. I thought it would be a good place to hole up and get better. It was for awhile anyway, at least until I was well enough to go out and explore a little. Very shortly after arriving there, my feet underwent the next stage in their not so pleasant evolution. All the skin began sheeting off my feet including the very thick callouses I had built up over the months walking many miles each day in sandals. This left them raw, tender and bleeding in many places. Now I worried about another infection.

Patong Beach madness

Fortunately, I managed to get two pairs of clean socks, some antiseptic and bandages, so I could begin making short forays out into the world. Almost providentially, American Thanksgiving happened just as I was holing up there. I had a lot to be thankful for and felt very grateful to still be alive. I thought if I could find some restaurant catering to expat Americans somewhere in town, I might venture out and partake. Alas, I couldn't find anything, so took a wonderful Thai meal in a nice restaurant next door in the mall. I saw a movie in the theater there and had the place mostly to myself. It was a very nice venue and a delight to sit there watching a movie in English in the cool darkness. I was also reminded me that Thailand is indeed a monarchy and King Bhumibol is much loved by the Thai people. They play a short film before every movie there that portrays the King growing up and becoming benefactor to his country and it's people. Everyone in the theater stands in respect while it plays much like Americans do during the National Anthem before football or baseball games.

Where could this be....??

Once I was able to venture out and explore the town a little bit, I discovered that the beach was only about two blocks away. The whole place was just tourist madness and I hadn't experienced anything like it up until then during my time in Thailand. I'm uncomfortable in crowds and normally take pains to stay off the beaten track, but here, I was sort of stuck. Much as I loved everywhere else I'd been in this beautiful country, I seriously disliked Patong with it's noisy tourist crowded everything, cheesy bars and most especially, all the old white guys chasing young Thai women/girls around. It was the first time I'd really experienced that sort of thing since I'd been there - and I loathed it. I needed to get out and heal somewhere quieter.

A Sobering Reminder of the 2004 Tsunami

Tsunami Memorial in Kamala

With a little research, I found Kamala, a short drive up the coast, yet still close enough to the hospital. I got a room in a wonderful post-modern hotel about half a mile from a gorgeous and much less crowded, but far from empty beach. The whole place was perfect for what I needed to heal. There was a fabulous lap pool with expansive view up on the roof as well as a small gym down the hall. I could stay cool and quiet in my room, or walk down to the beach now that my feet were healing - or at least as I grew accustomed to the discomfort. One day I discovered, quite by accident, the memorial to the victims of the 2004 tsunami that devastated the coastline here and killed more than 227,000 people in all affected areas.

Long-Tail Boat on the beach in Kamala
It was a sobering reminder how fragile life can be and how quickly it can be taken away from us. It made me doubly grateful to be alive in that marvelous place and time. Suddenly my own trial didn't seem quite so monumental and spending 10 days in hospital minor by comparison. I promised myself not to ever forget that fact.

An Amazing Act of Kindness and a Happy Ending

Before I left Thailand and while I was convalescing at the hotel, I managed to get an email through to Elke, the ex-pat owner of the climbing shop next door to the cafe where I left my pack and climbing gear. Long story short, she contacted Chai, the cafe owner holding my belongings and he returned everything to me exactly as I had left it nearly two weeks earlier. Incredible, as he had no reason by then to believe I was ever coming back, or even alive for that matter. He only asked for payment to cover transport (which I arranged of course) and two days later a guy in a car showed up at my hotel and placed the backpack in my room. I gave him a tip and some more money to pass back. I also donated all my climbing gear to Elke. It wasn't nearly as much as I would have liked to give them, but they also have my undying gratitude. One day I will return and thank them in person.

Finally I got the okay hall pass from the doctors to travel again. Just in time too, since I had tickets already for the next leg of my journey to Bali, Indonesia. Before I left however, I found a couple of pendants being sold on the beach that caught my eye. One of them was a turtle, which is one of my two personal animal totems. It's simple, but I haven't seen one exactly like it since. It reminds me everyday of what I went through and how lucky I was to be alive. I flew out on December fifth, the same day as the King's birthday. I felt a little like it was my birthday too.