Friday, November 21, 2014

When Travel Attacks...Part 1

Surviving Ten Days Solo in a Thai Hospital

It's been a year now since I got sick while rock climbing at Tonsai beach near Krabi in southern Thailand where I spent ten days in the hospital as well as many weeks afterward recuperating. I wrote a very detailed blog post about it at the time, but for some reason decided to hold on publishing it. I'm glad I did. A lot of things have happened to me in the subsequent year including the death of my amazing Father and a lot more time on the road living nomadically. Having the extra time to reflect on this event and others, has given me a slightly different perspective and I want to share this now.
Beach & cliffs at Tonsai in Southern Thailand
I knew at the time, my situation was pretty precarious, but I think it was probably much more severe than even I suspected. At the risk of sounding melodramatic, I feel I am very lucky to be here now. There is great irony in this for me as well. As a long-time adventurer and adrenaline junkie, I always thought that if something was going to kill me, it would be some sort of sudden, violent accident. A fall perhaps, or a plane crash. Running out of oxygen on a dive or being bitten by a venomous animal maybe, but certainly not illness. I eat well and have exercised virtually everyday of my adult life. I seldom get sick and aside from a very serious battle with Scarlet Fever as a child, have never been really seriously sick my whole life.

On the other hand, I think I've already used up all of my allotted nine lives in other ways. For example, I survived a head-on crash at highway speeds with a loaded semi-truck, a helicopter crash, two near plane crashes and some long scary falls climbing among other things. I really thought that if my number was up, I would check out in some similar fashion. Nowhere in my mind did I imagine passing away quietly in some foreign hospital wracked with pain and fever, swollen and covered in lesions and blisters; trying to catch my breath just laying there inert. But that is what almost happened and I count my blessings everyday that I'm still here and thankful for all the people who made it possible. Here then is a short account of what happened as I remember it.

Rock Climbing at Tonsai Beach Near Krabi in Thailand


 A couple of months in to what I had planned to be a year long round-the-world (RTW) trip, I was in southern Thailand living out a long held dream to rock climb the amazing surreal cliffs and rock formations on the coast there. Tonsai is not far from the famous James Bond Island, probably first seen by most westerners in the Roger Moore episode "The Man With the Golden Gun." The rock here is very steep and often rockets right out of the sand on these fantastically beautiful beaches. In fact, most of the climbing is on overhanging rock, but this is the kind of landscape I like most given my ability to do lot's of pull-ups combined with a generally inelegant technique.

Steep starts to steep climbing right on the beach - me fighting gravity before fighting the microbes 
I felt fit and healthy despite a small annoying cough and some minor chest congestion I'd been experiencing for more than a week after leaving Kanchanaburi farther north in Thailand. That location was the scene of the famous Death Railway immortalized in David Lean's masterpiece film "The Bridge on the River Kwai." It's where 90,000 Asian forced laborers and more than 12,000 Allied POWs died during its construction in World War Two. In fact, my visit there culminated in one of the singular most powerful and inexplicable episodes I've ever personally experienced. But that of course, was all discussed in a post I wrote at the time. You can find it in the Archives here.

Climbing in the big cave right beside the best bar in town
Tonsai sits just over a small forested knoll from Railay East and West beaches, which are generally more posh and also where you're likely to encounter a slightly more affluent type of traveler. Tonsai is where the more hardcore and transient voyagers congregate to climb, base jump and seek adventure. As both a lifelong climber/traveler and design professional, I am as comfortable living a dirt-bag existence in a jungle hut or wilderness tent, as I am in a 5-star hotel.  Things are much more spartan in Tonsai, but the atmosphere is energetic and jovial as people from all over the globe come to play on the cliffs and paddle in the warm green sea. The only way to access Tonsai and Railay beaches is by long-tail boat, and usually from Ao Nang. There is no airport and no roads in or out. Electricity seldom runs anywhere during the day, WiFi is hard to come by and getting a cell signal (for me at least) seemingly impossible. I thought it was all perfect though.

Getting Sick


It was the evening of the Loi Krathong festival and I was watching them float candlelit paper balloons off the beach in Railay. They formed this ethereal parade of softly flickering lights slowly drifting out to sea in the near total darkness. To my mind, they looked like little souls journeying off in a vast expanse in order to be reunited with loved ones and the cosmos. It's difficult to describe just how beautiful it was to sit there and watch this from a breakwater on the beach that warm autumn evening.

After it was over, I began the walk back to my hut further back in the jungle where most accommodations are in Tonsai. Navigating down the path in the dark was a little challenging, but by now I knew it well enough to ignore my flashlight. Just after the darkness enveloped me, I felt suddenly and terribly sick. No nausea or anything that would indicate a food borne illness, but whatever it was hit me like a truck. Every joint and muscle in my body began to ache and I felt a fever building. My head ached. The chest congestion was flaring up and my throat hurt. I was stunned and alarmed by how fast it was all happening. It really only took about a hundred feet of walking to feel a significant difference. No boats left Tonsai in the dark and no medical facilities were available there either, so regardless, my only choice at that moment was to go back to my room and await the dawn.

Sunrise did not come quickly or easily as it turned out. It was a terrible, painful night and by morning my joints and muscles burned, my fever left me alternately sweating (even more) profusely or shivering with numbing cold. I grew dizzy and delirious. By morning I was having a hard time staying upright or remaining conscious. I passed out briefly several times and at some point I noticed these weird little lesions here and there on my arms and legs. They looked like something between a bug bite and a boil. I'd never seen anything quite like them and began to wonder whether I had been bitten by something. Some of the symptoms seemed a little like Dengue (Break-Bone) Fever to me, but really I had no idea. I was only mildly nauseous and my stomach was one of the few body parts seemingly unaffected, so I was pretty certain by now it was not food poisoning.

Self-Evac from Tonsai to Ao Nang


At dawn I knew I had to seek medical attention right away, but also knew I was too weak to carry my backpack and climbing gear out with me. With some difficulty, I put together a small day-pack with a few essentials including my passport, phone and small laptop, leaving all else behind in my room. Then I walked down the dirt road parallel to the beach and into the small cafe place where I ate breakfast most mornings. I was hoping to run into the three climbers that I had most recently been hanging with in hopes they could assist me. One of them, Chris, was a doctor from Finland, so his help would have been especially welcome at that point. Maybe they weren't up yet, but for whatever reason, they weren't there.

The owner of the cafe/coffee place took one look at me and his eyes widened in obvious surprise. "You look sick" he said immediately using his limited English. My command of the Thai language was pitifully poor, so English remained the Lingua Franca for our exchanges. He felt my forehead and drew his hand back like he'd been burned. "You really sick man" he said with wide eyes. "You should go hospital" was his follow up and I totally agreed. He hadn't seen my climbing buddies yet this morning and I couldn't delay seeking medical attention any longer.

"Restaurant Row" in downtown Tonsai - really great food actually!
He agreed to keep my main backpack and climbing gear at his little shop until I returned and asked one of his employees to take me down to the beach in one of their little three-wheel motorcycle gizmos. Sort of a cross between a Tuk-Tuk and a wagon more or less. I could sit on the small platform on the back to be ferried down to the beach like a load of groceries. It meant I didn't have to make the walk there with unsteady legs and foggy brain.

At the time he agreed to watch my pack, I'm sure both of us thought I'd probably be back next day. I had no idea that I'd be spending the next 10 days in hospital. In fact, no idea that I wouldn't be able to return at all. I'm not sure what that bit of foresight would have done to the equation at the time could it have been known.

We arrived at the beach just in time for the next long-tail boat to leave for Ao Nang (Krabi). This was phenomenally great timing since the wait times can be up to hours depending on how fast they can fill the boats. You have to wade out into the water and then climb over the sides to get on the boat. Normally it's trivial, but I was really having a tough time of it. You have to love the irony, in that the previous day, I was climbing on overhanging rock down the beach. Fortunately a group of departing Dutch tourists noticed my distress and came to my aid. They got me on board and gave me water to drink. Sometimes the kindness of strangers, however seemingly simple can make all the difference. Lifesaving even. In the short time since dawn that day, I was the grateful beneficiary of two amazing acts of kindness like that. I wish I knew their names so I could thank them personally. The shop owner's name was Chai.

Long-Tail boats on the beach at Tonsai
On the other side in Ao Nang, my kindly Dutch benefactors helped me up to the road and into a cab for a short ride to the medical clinic. The cab driver wanted an exorbitant sum to drive about 5 blocks and I wasn't in a position to argue (or walk). This was one of the only times I ever had someone in Thailand blatantly try to take advantage or rip me off in any way. In all my other dealings with the Thai people, they were unfailingly honest and generous to a fault. At any rate, he did get me to the clinic and I managed to stumble inside without falling over.

The First Hospital Stay in Ao Nang


By this time, my difficulties breathing had grown steadily worse and I was panting rapidly, trying to oxygenate my lungs sufficiently. It felt like I was suffocating. At the reception desk, I attempted to convey my situation, but only got a few sentences out before I collapsed at the foot of the counter. The next several hours were a foggy haze of imagery, sounds and sensations as I went back and forth between conscious and unconscious states. At some point I realized I was in an emergency room hospital bed with an oxygen mask and IV tubes sticking into my arms; feeding me saline and antibiotics intravenously as it turned out.

Eventually, I regained some semblance of clear thinking again and then talked with the doctor on duty. He couldn't say much until test results came back, but he seemed a little perplexed by the potpourri of symptoms I was exhibiting. I'd get this reaction a lot in the coming days it seems. He told me I'd be staying there over night and then added a bunch of oral medications to the intravenous ones I was already receiving. I guess I was getting the full meal deal and that was fine by me. Later in the day they moved me up to a private room and I made first contact with my travel insurance company back in the States - World Nomads.

This was the first time I had ever purchased travel insurance and I thank my lucky stars everyday that I did for this trip, and that I chose World Nomads. They went to work immediately behind the scenes arranging payments and assuring the clinic that I was not some kind of indigent bum ready to skip town without paying the bill. This relaxed everyone and I think ensured that I received the best care they could offer.

It was so nice to lay in a comfortable bed in an air-conditioned room under the care of medical professionals. Although I was still in a lot of pain and distress, at least I felt like I wasn't going to die or be tossed into the street. They put a more permanent injection port into my hand for all the IV meds and antibiotics they were administering, at which point, I was tethered to a big metal stand via the gravity-fed tubes, bags and syringes that poured various stuff into my system. Later on, this made getting up and going anywhere like the bathroom, a small challenge in strength and logistics.

My hand with IV rig inserted
As it turned out, my condition was much more serious and perplexing than anyone thought at first. It was apparent that I was fighting a very complex and massive systemic infection that mimicked symptoms from several diseases. It soon became obvious I wasn't going to be discharged the next day as I had initially hoped. In fact, I would spend three nights in that first clinic before being moved by ambulance to world class Bangkok hospital in Phuket.

While bedridden, I managed to contact my family back home using the dwindling minutes remaining on my phone's Thai SIM card. They went into overdrive looking for ways to help and managed to contact long-time family and childhood friend Mike Johnson, who came through as a true champ over the next days and weeks. Mike was married to a Thai gal and had been living in Thailand for many years. He knew the system and had lot's of contacts that proved immensely helpful for me. Unfortunately, Mike was in Malaysia at the time working and unable to be there personally, but he still worked magic from afar.

I knew my worried family would hop on the next flight out if they truly knew the severity of my condition, and although I would have loved to have them there, several factors weighed against this for me, so I purposely downplayed things and worked to talk them out of it. First, I still didn't think I'd be in the hospital all that long and figured by the time they got here, I'd probably be out. It's a very long and expensive flight, or more correctly flights, from where they live. Second, my Dad was not only in the early to middle stages of Dementia, but had also just been diagnosed with what turned out to be cancerous tumors in his liver and pancreas. My Sister and her Husband had just opened a new business after quitting their jobs and the holiday shopping season was critical to their business' survival. Lastly, none of them had had ever traveled abroad and although I would dearly have loved to see them do so (still do), this was not the time or place to get their feet wet. Just knowing they were there supporting me and working behind the scenes provided an incredible boost in my spirit, determination and morale. I am lucky to have the best and closest family anyone on this little blue dot could ever ask for.

Things Turn Worse...


My feet beginning to swell & blisters from nowhere...
While I seemed to make good progress the first couple of days, by the start of my third night in hospital, I knew I was in deep trouble and the doctors there were in over their heads. Quite rapidly, I not only began feeling worse, but new and alarming symptoms popped up like prairie dogs in the sun. My legs began to swell up like balloons and hideous blisters and lesions covered my feet and hands before showing up everywhere else. Thankfully they never really made an appearance on my face, but everywhere else was fair game. I still have many of the scars they ultimately left behind.  All the other stuff came back too and I started getting pretty concerned I might be losing this battle. After all, I'm in the hospital being pumped full of everything they could think of to help me, but whatever it was took a small shuffle back and then stepped back into the ring like a freight train to finish the job.

This is where my little cadre of family, Mike Johnson and World Nomads came to the rescue. That night they arranged for an ambulance to take me 3 hours by road to Bangkok Hospital in Phuket where some of the top doctors and epidemiologists for a zillion miles around could help me out. With hindsight, this probably came not a moment too soon. The third night in the Ao Nang hospital was a tough and very uncomfortable one. Normally I'm an extremely optimistic person, but little bits of doubt began to creep into my thoughts that maybe modern medicine and my usually more than capable immune system had found something we couldn't beat here. The doctors weren't even able to identify what it was that was rapidly killing me, so how could we even fight it effectively?

Next - Bangkok Hospital and a long recovery...