DAY FIVE OF ILLNESS.
After a night of constant fluid ingestion (and expulsion, for that matter), we returned to the hospital for a blood test. I got poked at 8:30am, then we sat around with anime cartoons blaring at us on TV until the results arrived at 10:30.
The Emergency doc from yesterday interprets the results for us. My platelets are about the same, around 74K. Dengue fever is rampant in this area, so in the absence of certainty, we have to assume I have dengue and treat it accordingly. The doctor explains that I am entering the “critical phase” of the disease (days five through seven), during which my fever should break, the platelet level should bottom out and then start rising, while my fever may rise temporarily before subsiding altogether.
During this process, any sudden bleeding or change in blood pressure must be caught quickly. Supervision and monitoring are key during this period, and he says that the opportunity to go back to the hotel at night is no longer available- I need to be admitted to the Men’s Ward, which, he says, has about 11 beds and the necessary staff to come by frequently and change IV bags and administer blood tests.
I wanted to avoid staying at this hospital, and Karen and I tried to scheme a way out of it. We thought of flying to a private hospital in Kuching or Kota Kimbalu. The problem is that if I have dengue fever, my capillaries may be fragile and the pressure changes of flying are out of the question. Take a bus? The bus ride here was very rough on me, and I can’t reasonably spend any part of the “critical phase” unsupervised on a bumpy bus anyway. They have me by the IV tube.
We exit the Emergency entrance, cross the driveway, and enter the large concrete building across the way. Any optimism I had about the condition of this building fades. I begin to feel that I am being marched to my prison cell after receiving my sentence for a particularly heinous crime.
The front, um, “lobby” is dark and dingy. We begin climbing steps (no lift?) in a poorly-lit staircase. One flight up, we head down a hallway. As I march past smaller enclaves of people, every head turns, every eye follows the new inmate. Finally, we enter the Men’s Ward, a high-ceilinged room with roughly 11 beds in. They are all occupied, so we keep walking into the OTHER room on the Men’s Ward, the one with 25 beds. Every bed along the wall is occupied; there are a few temporary beds in the middle, and I am led to one (just like prison overcrowding!). Home Sweet Home.
My eyes scan the room. No central air. Just a bank of windows- all of them open with no screens- and ceiling fans spinning.
All the doctors and nurses wear surgical masks; none of the patients do. You can guess who we’re going to side with here. We ask for masks, are given a whole box, and are never without one on our faces.
The reason I’m here is for close supervision. The irony is not lost on us when it takes, literally, hours for them to start me on an IV drip. When they find that it is very slow, they realize that they used the wrong size needle (pediatric size). I don’t have many obvious veins popping out of my arms, so I’m glad when they relatively painlessly get the correct needle situated in my right hand.
I am supposed to receive 117 ml/hr, and after an hour we can see that I haven’t received nearly that much. Karen officially makes her transition to Dr. Karen. She will now monitor my IV and adjust the drip rate as needed. I’m finally getting 117 ml/hr thanks to her.
She also helps me drag my IV bag with me to the grim bathroom, a trip I make often because I am keeping myself so well hydrated. It always stinks in the bathrooms, the toilets work intermittently, and the walls are dirty. The bathroom can also be used as a shower, so the floors are always wet… sometimes the floor is completely covered in a puddle. Hmm, let’s see, take a bunch of sick, elderly, balance-challenged patients and have them walk through water to use the can. Brilliant.
The nurses-in-training travel in flocks. The simplest operation (i.e. sticking a thermometer under your arm) requires at least two of them. More complex operations will garner you a gaggle.
I didn’t find much to smile about in my situation or that of the other patients. But the nurses could always find something to giggle about. Asking me to pee in a cup for a urine test ended in giggles. Any language difficulties were worthy of a giggle. And then there was the time they gave me an EKG. They drag a cord across my face- giggle. They drop part of the expensive unit on the floor- giggle.
At dinner time, the ward is jam-packed with family members visiting patients. Being in the middle of the room, my bed is jostled by people trying to squeeze by. One older man has dozens of visitors- his daughter strikes up a conversation with us. By the end, she is asking if there’s anything I need her to buy me: fruit? beverages? We are touched by her generosity.
As night falls, Karen and I are torn. We realize that I need more monitoring than Dr. Karen can provide (i.e. blood pressure readings), yet we are observing unhealthy practices around me. Concerned about lax standards in a roomful of sick people, we announce that we were going back to the hotel for the night. One doctor comes by to try and talk us out of it; she relents and says we can leave, as long as we sign a form that it was at our own risk. Minutes later, she returns to say that the head doctor can’t let us go and will stop by to talk to us soon. It isn’t soon, but eventually he shows up and gives us a big speech about how I need supervision. We hit him with our observations: my blood was taken at noon and we’re still waiting for results at 10pm, nurses are not checking on my IV drip, the woman teaching the student nurses is not wearing a mask and is coughing on people. “This is a government hospital,” he says with resignation.
We ask if we could pay to move to a better room. Miraculously, mention is made of a “first class” room, a private room with air conditioning. That’s where I want to go. The doctor unspools another speech about how I need to stay in the big room, where the staff is moving around me all night, noticing anything that is going wrong. Karen has stern words with him over the quality of observation I am receiving from the staff. Finally, an agreement is reached. The doctor will take blood for a test early tomorrow morning, so it gets into the lab early, before the daily backlog. If the blood test is trending positively, I can move into the first class room. Tonight I will sleep in the big room.
I hunker down, as if digging into a bunker to wait out an aerial bombardment. Karen tells me she doesn’t want to leave me overnight. “I don’t trust these people to take care of you,” she says, tears welling up in her eyes. It is touching, and I couldn’t ask for a better advocate than her in our conversations (arguments) with the staff. But there’s nowhere for her to be comfortable, and there’s no point in her getting sick, too.
The best a loyal family member can do is try to sleep nearby in a lawn chair. One woman spreads out a cardboard box and spends the night underneath her sick husband’s bed.
The U.S. is waking up at this time of day/night, so we decide Karen will go back to the hotel and call our health insurance company’s nurse helpline for advice. We say farewell.
Despite all the talk of careful observation, I know that my health is 100% my responsibility this night. I tighten my mask and settle into bed- of course my feet stick off the end because it’s too short.
Geckos on the ceiling of a hospital ward? Doesn’t seem like a good thing, until you watch one eat a bug that otherwise might have come down and bitten you. Go, gecko, go!
The night passes interminably. I feel every minute. I listen to podcasts for a while, then they give me a headache. Every twenty or thirty minutes I need to pee, so I clamp off my IV bag and carry it to the dreary bathroom, do some acrobatic one-handed urination, and then return to bed. One time, I also extract a roll and some jam from my food bag before unclamping the bag; the IV drip doesn’t start back up, probably because the “inlet” in my hand had time to heal up slightly and close the hole. It’s pretty quiet… none of those attentive staff members pass by… I try to clear the blockage myself, as I’ve seen the nurses do… and finally someone passes by. I tell her my drip has stopped, and she walks away. She returns after a while and gets it started again. I’ve lost maybe half an hour of hydration. I think they took my blood pressure once- that’s the sum total of staff attention overnight.
DAY SIX OF ILLNESS.
They kept up their end of the bargain on the blood test- they drew blood nice and early, like 5:30am.
Karen returns around 7:00am, and I can finally rest a little bit easier. I survived the night, my advocate is back, and we have some test results to look forward to. My temperature is down to 98.6- whew!
They probably never have the chance to clear out this ward and give it a deep clean, so Super Backpack Vacuum Man comes through spot-vacuuming, followed by someone mopping.
Of course hours go by with no news. At 10:00, the doctors come by on their rounds. We ask about switching to a first class room, and once again get the “you need closer monitoring” argument. “But my indicators are all headed in the right direction,” I plead. “Actually, your platelets are down to 60K,” counters the doctor. We realize that my morning test results came back and no one told us about it. We let them have it. Dr. Karen asserts that we are not getting the information we need from them. And at this point in the “critical phase” my platelets are supposed to bottom out and then start climbing. And she learned from her call to the U.S. nurse that a truly dangerous platelet level is 15K, so I am nowhere near that.
They agree to transfer us to a first class room.
The first class room is heaven. It is a private room with a bed, a chair with cushions, two tables, a closet and an air-conditioning unit. The bathroom is shared with the room next door. In the U.S. this would be the most basic room on offer- and patients would complain because it doesn’t have a TV.
The choir of angelic voices is interrupted only by the woman next door, hacking up a lung. Her coughing and sputtering is almost continuous, and our shared bathroom is often in use. I decide to pee in a bedpan to reduce our need for the bathroom.
Meals are delivered on plastic trays, and Dr. Karen picks through them, removing, for example, the many bones in the fish they served.
Despite the apocalyptic predictions that I would feel abandoned here, nurses pop in occasionally to take my blood pressure and temperature and change my IV bag. They never get the drip anywhere near the specified rate, so Dr. Karen always makes her adjustments after they leave.
I continue to drink ungodly amounts of water, fruit juice and 100 Plus. I’m not going to let them throw another “but your _____ parameters are low” comment at me. Victory through hydration!
At 6:00pm, a doctor draws blood for a test. Miraculously, he is back in 45 minutes with the results. My platelet level is now… 91K! We nearly raise the roof with a cheer. But there always seems to be some bad news lying in wait: the doctor reports that my hemocrit numbers are showing that my blood is a little too thick.
The solution? A faster flow of IV fluids. Isn’t that ironic (since I’d be getting even less if we weren’t secretly goosing the juice)? They later decide to stick with 117 ml/hr. How does that address the issue?
With a decent chair available, I can finally vacate the bed and let Dr. Karen take a much-deserved nap. Even when she got back to the hotel for a night, she spent some of her time on the phone and gathering supplies and clothes, so she hasn’t had a good night’s sleep in a while. When bedtime does roll around, she cobbles together the chair cushions and various blankets to create her own bed, of sorts.
DAY SEVEN OF ILLNESS.
Bright and early, at 5:30am, they take my blood for a test. By 7:45am, we have the results (I’m liking this submit-the-test-early-for-early-results scheme). The news is not good: my platelets have fallen to 80K, and my hemocrit is still abnormal. I’m dehydrated. The problem is that last night… I slept. Delicious, blissful sleep. I regret nothing. Today I will return to “Victory through hydration” and lick this. But boy did I need that sleep.
Another doctor stops by to tell us that my dengue antigen test came back negative. He thinks that I most likely have a viral fever, not dengue fever. However, they are not able to run the conclusive dengue test, since they do not have the necessary test kit. I should be able to leave the hospital tomorrow.
Mimi, the front desk manager from our hotel, stops by with a fruit basket and kind words.
Yet another new doctor arrives, introducing himself as a specialist. He says that my parameters are headed in the right direction but that I remain in the “critical phase”. “We would like you to stay one more night, so we can make sure nothing changes,” he says with pleading eyes. “I was told that you want to leave early.”
“I don’t want to leave early. I want to maintain a standard of care,” I tell him. We had already decided to stay (a much easier decision to make in the first class room), so it was no problem to oblige.
4:00pm test results put my platelets at 94K, with hemocrit improving. By 8pm, platelets are 102K. Victory through hydration! The fluids keep flowing, in drip and drink form, and we even listen to the some music and an episode of This American Life. There’s a light at the end of the tunnel.
DAY EIGHT OF ILLNESS.
As Departure Day dawns, my early-morning blood test shows platelets at 104K and hemocrit looking good.
No more need for an IV drip, ready to be discharged. So of course we sit around for hours more. I’d have no problem packing up and marching toward the front door, but I’ve still got that leash stuck in my right hand.
We finally get a nurse to remove it (ahhh), and Karen leaves to settle up the payment for the first class room. I pack up and stand by the door. Then by the window. Then I sit. This is taking a long time. It turns out the hospital only takes cash… and doesn’t have an ATM. Unbeknownst to me, Karen is taking a taxi into town, extracting a wad of cash from a machine, and returning to make the payment. The total cost comes to RM 620 (US $195).
Released from my sentence, we gather our bags and walk through the crowded ward toward freedom. We have had plenty of time to wonder about the people crammed into these beds, in this dingy, stuffy room. Do they accept these conditions because their own homes are worse? That’s probably the case for some, but it can’t be for everyone. I guess if you grow up seeing this as the standard of care, you get used to it. But that doesn’t make it a good place to recover from illness. We did not see evidence of patients demanding better- ask for a mask, people, and if the nurse is coughing on you, tell her to knock it off!
The doctors and nurses (excluding the coughing one) here are doing their best. Karen read that Malaysian doctors are required to serve a couple years in a government hospital before they can accept more lucrative postings. That probably explains why so many of my doctors were very young. They all seem to genuinely care about their patients, but they simply don’t have the resources to achieve what we would consider an acceptable level of care.
Blinking in the bright sun, we load our bags into a taxi. As we start down the hill, I catch one last glimpse of the buildings of the Duchess of Kent hospital. And then it is gone… from my life, at least.