I'm back! 9/9/12

I last wrote on a Tuesday, and that was well over a week ago.  Sorry loyal readers!  I have a lot more to say when I can talk about other's illnesses instead of my own!

 

I should have tried to write something, because my memory of the last week is not stellar; it all seems a blur.  I'll attempt to recount some of the events… 

 

Last week Monday was a long, hard day in clinic, due to a cold and a whole ton of very sick patients.  Tuesday I rounded on a few, ran home for a short break (and because I was going to be sick again), and got a phone call saying, my patients were being taken care of, stay home and get well.  (I reread my last entry to know that all was true, from here on out I'm a bit fuzzy on the details…) 

 

I felt much better by Wednesday and was able to round (although on very few patients since I hadn't admitted any the day before.  I was able to rest for two hours between rounds and clinic, and then another two hours between morning and afternoon clinics.  The patient load was much lighter!  I was about to see the last patient, and we would be finished by about 5:15, instead of the typical 6 pm.  I then had that horrible sense I was going to be sick again.  I went to the back of the clinic room, where there was a sink, and was able to get rid of that panicked feeling of impending emesis.  The relief must not have yet cleared my face because Lisa walked in at about the same time, and sent me home.  She offered to see the last patient who had already patiently waited all day.  My interpreter walked me home (and wouldn't accept no for an answer) and then let me know that I have to be honest with him, because we are a team now! 

 

Impending emesis became actualized, and was present after anything I put in my mouth.  I drank Gatorade, water and  SRO (also known as ORS or oral rehydration salts) a horrible salty liter of fluid that has balanced salt and sugar to that of the body to be optimally reabsorbed and to replenish lost electrolytes.  I ate an apple here, a piece of toast there, some ramen at times.  It all came back.  Although terribly thirsty I had to limit myself to one or two sips at a time to try to trick my system into keeping it down.  Sometimes it worked, sometimes it didn't.  So the pattern continued for the rest of the week.  In general, most of the time I felt relatively well, but would feel miserable and exhausted for a short period of time after each episode of emesis.  I took cough medicine, Tums and Zofran, to no avail.

 

I was feeling a little weak but hadn't had any emesis overnight, so on Sunday morning I went up to the hospital.  I had traded call days to have an extra day of rest, and so although I really had no patients at this point, I could see Lisa's, admit some of my own, and then be ready to go on Monday!  I got up to the entrance about the same time Dr. KL arrived and he asked me, what at the time I thought was an unfair question.  He asked me if I had thrown up in the last 24 hours.  The answer to that was yes, but let's look at the last 12 hours, that was great!  Perhaps my sites were too short, or he recognized something that I didn't.  When my answer was yes, he sent me home, again. 

 

I was pretty tired by the time I got home again, and the hospital is not far!  When he finished with rounds he came by again, and finding a blank lab order form on my kitchen table, recommended I get some labs drawn.  I got some SRO for the road, and walked back up toward the hospital.  Labs were drawn without a glitch, and called to Dr. KL at some point later.  Creatinine 0.9 [0.6-1.2], sodium 149 [135-145], potassium 5.2 [3.5-5].  (My potassium hadn't been > 3.5 for most of the past year, but for other reasons!)  So, the labs looked reasonable.  My creatinine is usually 0.6, so it had bumped a little, but in general, everything was relatively close to normal and could be explained by being a little dehydrated.

 

Lisa came over at one point, enjoying her first day off since arrival, and asked if I wanted her to bring a book over and read here for a while, just to be here.  I'm not sure why I said yes, and I don't know that I normally would have, but she was here.  I don't remember any deep conversations but just kept resting knowing she was nearby. 

 

The biggest change about Sunday was pain.  Throughout the whole week prior, I had never had any pain.  No headaches, no belly pain, no hunger pain, nothing.  Sunday, my belly felt like it was going to explode.  I couldn't identify it as anything specific, but as it was suprapubic my differential included my uterus or my bladder.  My bladder was empty and I hadn't been making urine again, so it wasn't that it was too distended or anything.  And, thankfully I can't ever recall having my uterus itself cause me any pain or discomfort.  I have a brilliant friend who once admitted that she was having an "uter-ache."  I understood the pain she was describing, and thought, what an insightful and clever term!  Regardless, there was a constant pain, exacerbated by movement, and unable to be relieved.

 

By Sunday afternoon, my bedroom was transformed into a hospital room.  An IV was started on the first try, after much searching and praying!  I can be a hard stick when dehydrated!  (I even remember once getting stuck in the jugular, but that was years ago!)  It took two liters before I was able to urinate again, and before I could appreciate that I again had visitors. 

 

I had been prayed for at church, which for the folks on the compound is on Sunday nights.  Up until that time many people didn't know I was sick - the doctor's are uusally so busy, you don't expect to see them on a daily basis!   I remember some faces, but mostly I remember that all the ladies were wearing blue! 

 

Laughter really is good medicine, and finding that Lisa had left her book (The No. 1 Ladies' Detective Agency) earlier in the day, it was commandeered and read out loud to me.   People stayed with me for a couple hours at a time, and one brought a cot, and camped in my room for the night.  When I was able to safely ambulate to the bathroom on my own and carry my fluids with me, I was allowed some time alone. 

 

The IV fluids overnight allowed me to urinate twice, which for the liters going in admittedly isn't much, but it was more than the few days prior!   I had had so much vomiting I got dehydrated, and then after 4 and a half liters of fluids (I'm sure it would have been 6 or 7, but my IV infiltrated, and the back of my hand became very puffy and swollen, so I was off the hook, and line!  Hehe.  Get it?  :)  ), instead of doing something productive like continuing to make urine, mostly it was just all horrible amounts of diarrhea.  After two days of Cipro and after a couple Imodium, I felt so much better, and hoped to return to work on Wednesday! 

 

The funny thing about making urine, is that then you have to go to the bathroom, and sometimes that just takes time.  Not until after getting all those fluids and drinking liters of oral rehydration did I really realize how little urine I had been making.  

 

I really thought that in the face of illness, I would be strong and handle things well, but all that went out the door after the first week.  As I mentioned before, I never had hunger pain, even though I ate almost nothing.  I never really had any pain until Sunday, and that was when I had abdominal pain like nothing I'd ever felt.  It literally hurt to move.  By that point I wasn't peeing, again, so at least that was a blessing not to have to move (before I got the IV)!  Then, after all the IVF, instead of urine, as I said before, it was all diarrhea.  Which also was associated with some belly pain, but better than the day before.  After about 12 such rendezvous with the baÑo for the aforementioned, I was quite discouraged.  I cried. 

 

I don't cry.  I thought I hadn't cried for probably 10 years since my grandmother died!  (After thinking about this more closely, I cried on the flight on the way back from Kenya.  (I think Katy was sleeping.)  I was frustrated that the one thing I had hoped to accomplish while in Kenya, I had failed to do, and I felt like I had wasted an incredible opportunity.  Don't get me wrong, it was a great introduction to medicine in Africa, it was great for providing me with concrete examples of why I was still interested in the International Fellowship, and it gave me a better perspective and helped revive myself in multiple ways.) 

 

Anyway, I was so frustrated.  When I was asked why, the obvious things that came to mind were: I came here to work and learn medicine in Africa, not stay in my bed and be a patient; I am a very private person and African mission society is a very loving, connected, community endeavor; and possibly the tip of the ice berg, was that I was spending so much time in the bathroom, and it was much hotter than my room as there was no fan.  I searched for a plug-in, in case I did need to just camp out in the bathroom for a while, and I couldn't find one.  I think that was the culminating, push over the proverbial hump, tears welling up and cascading out, straw that broke the camel's back.

 

 So...strong...not so much.  A complete dependence on God?  That would have been nice, but that hasn't been part of our interaction up until this point.  I have really struggled with having a "relationship," trusting and loving Him, and being loved by Him. 

 

 Lisa went on a walk at one point, and came back and said, you need to ask God what this was all about; there is something God is trying to teach you through this...  I think my lesson was that I do need to have complete dependence on God.  That I really do have to let go of thinking I am doing the right things for myself and let Him take care of me.  It was against everything I have ever done to have people walking in and spending time with me (when I'm well, fine, but when I am leaking nastiness from every orifice...eck.)  Until I was strong enough to walk to the bathroom myself, someone was with me 'round the clock!  I knew I had gotten into trouble by doing my own thing, and not that I wasn't going to participate in my own care, I vowed to do what I was told for 48 hours.  I drank what I was told, ate what I was told, and I got better.  If these guys are giving me SRO, what better gifts would a loving Father give me?!?  (I still can't categorize SRO appropriately.  On one hand the taste would put it in the stone, snake, scorpion category, whereas the obvious benefits I got from it put it in the bread, fish, egg category!  It was made with love, kool-aid, and sugar in an attempt to mask the salt, and that helped tremendously!)

 

The time has passed and I have felt better daily. 

 

When I was strong enough to hold a book, I would read.  I finished Evidence Not Seen,  Surgeon on Safari, No 1 Ladies' Detective Agency and Sword and Scalpel (and I am not a fast reader!)  Evidence I've mentioned before, Surgeon on Safari was about an orthopedic surgeon who took his 9 kids to Kenya for a year long, short term mission trip, Sword and the Scalpel was about Bob Foster in Zambia and Angola, and the Detective Agency was set in Botswana.  Each book was about Africa or Missions, and I saw over and over in the missionary books, how often these folks were in prayer, how deep their faith was in God, especially when they were in circumstances beyond their abilities, and how they could see God through suffering. 

 

Wednesday I felt so well I started to unpack my trunks!  (I know, how many layers of insight can I read into that one!)  On Thursday I was told I still couldn't work, but that I could walk around the compound, with an emphasis on the fact that it was in the direction opposite the hospital. I walked, but I was quite dizzy again and back for another liter of SRO.  On Friday, I got added instruction, that not only was I not going to go back to work till Monday, and not only was I supposed to walk around the compound, but talk to his wife!  They live on the far end of the compound, and although I had made two full circuits the day before, I had never stopped in to say, Hi!. 

 

So, Friday I stopped in, and hours later emerged.  I had one of the most enjoyable conversations I've ever had and read a children's book called, Monkey Crosses the Equator.  The monkey is at the equator, but doesn't feel any different when he swings from a tree in the Northern Hemisphere to the Southern Hemisphere.  The moral of the story is that you may not see a difference right away, but, "the further you go, the more you will know where you are, and where you are going, and the more you will feel it."  I also got a book of a few bible studies that I am excited to work through.

 

This weekend I've been trying to eat more, walking more, resting and getting my strength up.  Tomorrow, I am excited to go back to work, and be on call!  It is kinda like having a first day again, but without the stress or anxiety of the unknown! 

 

Thanks for your concern and prayers.  It was a very long, hard road for a while there, but I am so thankful for the love and support of my neighbors - strangers who have become family.  Despite the love and all the lessons learned, I am so ready to be a functioning member of this community again!