#5 The Blow-by-Blow

Disclaimer: This was actually written in real-time and has not been edited.

December 22

9PM: Lyol blows chunks in bed. Danae heroically scoops him up and rushes in to the bathroom. He throws up three times before arriving at the shower. Once at the shower, he stops tossing his cookies.

Much less heroically, I’m trying to fold up the sheets in a way that don’t allow leekage of the liquidy emesis, but all the while forgetting that every precious second allows more barf to seep through onto the mattress cover. Oh, and we’ve placed 90% of our clothes on our bed to motivate us to put them away before going to bed (didn’t work, we were practically asleep with all sartorial appendages still adherent to the bed). I throw the clothes around to get the sheet off without placing the clothes on the soaked mattress pad or on the unbelievably dusty floor.

Lyol fusses, but falls back asleep. I set to putting away all the clothes. Danae, ever the heroine, cleans up the vomit. Very foul-smelling chunks of still-recognizable watermelon and seeds mostly.

I think... He’s had a little diarrhea today. Come to think of it, it did smell extra special today. I figured it was just my sensitivity since we changed to cloth diapers today. And he feels warm (which intellectually, I know means nothing). Well, diarrhea in the states I don’t care about. Why should I care about it here? Oh right. Malaria, typhoid, parasites, etc. Hmm...

Our Arm & Hammer based cleaning spray is still marinating the mattress pad... and it still smells of vomit. The mattress pad goes in the laundry.

We place Nanny’s large green pad (the one assigned the task of keeping furniture smelling nice) over the offending spot and place Lyol on top of that.

11:30PM: I feel the need to shower.

And so I shower.

6AM: We wake up. Danae and I realize that we feel a little queasy. I eat a little rice and stew. Danae stays back with Lyol. I grab a water bottle and head for the hospital.

At the hospital, I continue to ponder... can it just be a benign reason he’s sick? If this were the states, I’d say virus and remain well-hydrated. Oh yeah, we’re in Africa still. It would be beyond strange for us to all have malaria at once, and we’re all feeling queasy. Must be some intestinal thing, not just a side effect.

2PM: I make it home for lunch. My stomach has been gurgling. I go to the bathroom. That’s interesting. I could have sworn I was pooping, but it sure sounded like peeing.

3PM: Lyol blows chunks again. This time it’s banana. Doesn’t smell as bad. Daddy gets to be the hero this go-round. He’s still going through cloth diapers like he’s shooting skeet.

5PM: I lay down the ultrasound probe. I turn and tell the husband that his wife has a liver that reaches down to her pelvis. It’s probably cancer. My stomach turns. That’s odd. I’ve delivered much worse news, this week even, and never been queasy from it.

6PM: I’m in the hospital, in my office. I’m talking to Mr le sous-Prefet about the new HIV diagnosis his family member has. My stomach rumbles loudly for about 30 seconds. It sounds like sloshing water.

I wrap up the meeting as quickly and as tactfully as I can and head home.

7PM: Ok, two emergency trips to the bathroom in the last hour, but I’m feeling pretty good now.

Danae and Lyol are sleeping on the couch. Our anesthesiologist (who didn’t have any actual formal training) stops by to ask for a computer lesson. We practice turning it on and off, logging on and off, opening/closing programs, saving files and he goes home.

7:20PM: Whoa. What was that? A chill? I’m in Africa. Danae’s in short sleeves. Lyol’s in a diaper. I’m wearing a sweatshirt. I’m always the last one to get cold. Not cool.

7:30PM: Hmm.. This has progressed from simple queasiness to full-blown nausea. I could steal my wife’s Zofran, but it’s not nice to take medicine from your pregnant wife. I learned that on the internet somewhere.

7:40PM: Why do my joints feel stiff? Time to grab my Tropical Infectious Disease textbook. Wow, that’s a lot of words dedicated to my symptoms. Let’s try Tintinalli. Hmm... typhoid fever? Danae and Lyol and I are all afebrile. Malaria? Again, unlikely we all got it at once. Simple food poisoning? Probably, but hey, we’re in Africa. Hey, that’s vertigo I just felt. Stop that.

7:50PM: So it strikes me that I’ve asked for this. I always wanted to be a ‘real’ missionary. ‘Real’ missionaries get malaria. Maybe that’s what I’ve got. This isn’t as much fun as I expected becoming a ‘real’ missionary to be. This is no fun at all.

8PM: Shaking chills. A rigor. I always imagined it being a relief to have a cold sensation in Africa. Nope.

8:10PM: I’ve been checking my temperature. It’s gone from 96 to 97 to 98.4 to 98.7 to 99.2 to 99.3 to 99.4. Somebody give me a lighter. I want to at least have a fever if I’m going to feel this bad.

8:20PM: I swear I just got hit by a truck. One of those overloaded African trucks carrying cargo easily three times as tall as the cab of the truck. Yeah, one of those suckers must of just hit me. I should probably go to bed. It wouldn’t be the first time I’ve gone to bed this early in Africa. I’m exhausted. My back hurts. My stomach hurts. I have a headache. I can barely keep my eyes open. I’m afraid if I lay down I’m gonna ralph.

8:30PM: Lyol hurls. In his sleep. He wakes up for a couple seconds afterwards, but he’s just too tired. I clean it up. These bananas smell worse than the last ones. I throw the couch cushions outside and make a mental note to apologize to the Appels for getting vomit on their bed and couch. Actually, I suppose I shouldn’t apologize until tomorrow. We’ll probably be getting vomit on something else too. Might as well be efficient and stream-lined in our vomit-stained apology.

8:40PM: Oh yeah. I’m sure of it now. I’ll be vomiting with Lyol shortly. I don’t know if I see the hospital patients being rounded on tomorrow.

8:50PM: 99.6. Come on fever. Big money. No whammies.

So what should we get tested for tomorrow. Malaria? Typhoid? Stool ova and parasites? Urine? Any number of other things? Is there a test for dengue? Or yellow fever?

I’m really thirsty. I want to drink. But I think that will just add fuel to the fire and might be the difference between making it to the bathroom in time or not.

Why does my neck hurt? Is this meningitis? I have been diagnosing that quite a lot and doing lumbar punctures without face masks or shoes. Could I have given it to Lyol and Danae? I’d actually feel pretty bad about that. Oh hey, ebola! I hadn’t thought of that. Not much sense in testing for it though. Not much to do.

I’ve been diagnosing patients clinically with tetanus and rabies in the hospital.

Tularemia? I saw a rabbit the other day.

Plague? Sure, why not?

Diphtheria? Uh, probably not. I’m vaccinated.

Spotted fever? As good a guess as any. If I could just get that fever.

Anthrax? I did see some weird things on people’s necks that looked kinda like super-early anthrax lesions. I diagnosed them with tuberculosis and Burkitt’s Lymphoma. They seem to be getting better with treatment. So probably didn’t catch anthrax.

Leptospirosis? I just like how that one sounds.

Shigella/Salmonella/Campylobacter? Those all sound like great options. I’ll put them up high on my differential.

Polio? Unlikely.

9PM: Note to self. Please please please. Do NOT belch again. That was dangerous and highly unpleasant.

I have had no encouraging signs whatsoever that make me think I’m not going to vomit before this is all over.

What should I be starting in the morning? Azithromycin? Cipro? Flagyl? Quinine? Mebendazole? Praziquantel? All of the above?

Man, I just can’t keep my eyes open except out of feel of vomiting.

Come on Netteburg! You have an iron stomach! Man up!!!

9:10PM: Ok, can’t stay up. Going to sleep. $20 says I vomit by sunrise...

11PM: Another urgent trip to the toilet.

1AM, December 24, Christmas Eve: Another urgent trip to the toilet. My money’s now on giardia.

2AM: Another trip to the toilet. This time the nausea is pretty severe. I pick up a pressure-cooker pot and take it with me. I’m choosing between which end to stick in the toilet and which end to risk. More severe diarrhea. We’re out of the good toilet paper. Now we’re using the toilet paper which doubles as a file for camel hooves. Awesome.

3AM: It’s coming hourly. I’m laying in bed deliberating how last-second I should wait. My back is absolutely killing me. I think it’s because I’ve been sleeping semi-upright. I dare to lay on my side. The nausea’s worse. I hear Lyol pass a load of diarrhea. I think it psychologically stimulates my intestines. Now I need to go. I hand a diaper to Danae and head to the bathroom. Back in bed, it smells pretty horrific. Danae says the diaper leaked a little.

5AM: Sweet. We’re now spacing it out to every two hours. Oh wait. Oh no. I just lost my lunch (since I didn’t eat dinner) in the toilet. I would think with all the diarrhea there wouldn’t be anything left, but sure enough, there’s quite a bit. And it’s coming out quite violently. I wash up, trying to get the vomit out of my nose. I collapse into bed. Hmm...

7AM: Danae takes one for the team and decides to go round by herself. Lyol keeps bringing me books and climbing up into the bed and playing quietly while Daddy sleeps.

9AM: Danae’s done with surgery and maternity. After I suck it up and steal my pregnant wife’s Zofran I feel a little better and agree to accompany her on medicine and pediatric rounds. We stop at the lab do get a malaria test done on Lyol and me and to drop off my stool. Danae notes all the petechiae on my face.

10AM: My head is pounding. I’m dizzy. I’ve been drinking quite a bit while rounding, but I feel pretty terrible.

Noon: Danae leaves me for surgery. I finish up pediatrics and start some ultrasounds and ER visits.

1PM: The lab visits. Lyol and I both have malaria. What the deuce? I’ve lived in Africa before. I’ve visited several times before. I’ve traveled many times to endemic zones in South and Central America. I’ve been to Southeast Asia. How have I been in Tchad for less than two weeks, during dry season no less, and have malaria? Oh well, at least I’ve officially attained missionary status.

2PM: I take my pills. Lyol cries and vomits when he tastes the quinine. I try to explain to my 22-month-old son that his options are either take the medicine or get an IV. He just doesn’t get it.

3PM: Come on. Daddy needs a new pair of shoes. Yes! 101. Officially febrile. Finally.

4PM: I nap.

5PM: Danae wakes me up to play with Lyol. Mostly I sit on the couch and he brings me books.

5:30PM: I ride on the back of a motorcycle to Gary and Wendy’s (missionary couple down the road). Wendy serves a delicious meal of banana bread, cinnamon rolls and plum pudding. It smells delicious, so I imagine that it is and I go lay down on the mattress in the middle of the room and fall asleep. I awaken intermittently to Christmas carols and Christmas stories. I actually love the good Christmas company, but I contribute zero to it.

8PM: We’re back at home after another motorcycle ride. I take my first pee of the day. I feel like I just ran a hundred miles. My joints hurt, my muscles hurt, my back hurts, my head throbs, my stomach churns. I don’t think I’ll be awake at 10PM for my next quinine dose. I take it and go to bed.

5AM: Hooray! Made it to 5AM with only two emergent trips to the bathroom!

6AM: Lyol’s up and wants to eat and play. How come he has malaria too and is bouncing all over the place? Well, at least I’m feeling better. Just a lingering headache.

7AM: Wow, I’m really dizzy. This is borderline trippy.

8AM: Well, I guess my stomach isn’t completely cured. Still quite nauseated, but able to eat a piece of bread and keep it down.

9AM: Lyol barfs. I don’t think we’re making church today. I think most of the patients will need to fend for themselves until tomorrow.

9PM: Wow, what a Christmas. I was too dizzy/nauseated/fatigued to leave the house until an hour ago when I had to go see an urgent patient. Constipation. To their credit, he was really constipated. I thought he had splenomegaly just like all the other malaria patients, but when I ultrasounded it, his spleen was peristalsing alot like intestine. Man, they’re right. Quinine really does affect your ears.

A Merry Christmas to all and to all a good... Oh hang on. Gotta go. Be right back.

Update:

It’s now December 28. I can say I’m on the downslope. Currently, I’m only suffering from quinine and no longer from malaria. This stuff is the most bitter medicine in the world. It also makes you very dizzy and nauseated. I have barely eaten in the last week, but fear not. I packed on enough reserves in France that I’m doing just fine.

As always, we can be reached at danae.netteburg@gmail.com

You might be in Tchad if...
You think you’re pooping, but it sounds like you’re peeing.