My Night in the ICU: an Unusual St. Patrick's Day Celebration

I should warn you now--don't read this if eating is anywhere in your recent past, present, or near future...

When I woke up feeling quite normal yesterday, I had no idea what my evening would have in store. I spent about 7 hours in epidemiology lecture during the day, reviewing concepts of exposure and outcome, common-source epidemics, and attack rates (to name a few). As soon as class was over I was feeling dizzy and nauseous, so I opted for a quick nap. Sleeping was restless, though, as I felt like I was having trouble breathing. So when I saw friends later on, I told them I was feeling "weird"--the only way I could describe that combination of symptoms--and I informed them that I would probably just be resting in my room for the rest of the night.

Around 6:30, I developed some pretty severe diarrhea that persisted for a long time, intermittently; at 7:30 I began vomiting (and did so another 6 times over the course of two hours. None of my symptoms were abating, which struck me as odd (based on past experience), so I informed a friend who insisted I should be taken to the hospital--in this context, the combination of diarrhea and vomiting can be very much an emergency. But there are 15 doctors in our class, so all of them offered differing opinions about what should be done with me, and it took another half hour before the collectively-decided course of action was a trip to the hospital (just in case any complications developed).

After a very uncomfortable ride in the school's van, we arrived at the Enam Medical College and Hospital in Savar (about 20 minutes away from campus). The consulting doctor who met me at the door asked for my history and decided that I should be admitted for treatment of severe dehydration and gastroenteritis. By this time I was feeling extremely weak--I was very thirsty but I was also terrified to drink anything because I knew any input would prompt another vomiting response. So I was admitted, and my paperwork was completed with the help of the--literally--van-load of people who came with me: the TA for our current course, who is in charge of such little emergencies when they arise; the campus manager, who speaks no English at all; one of the school's drivers, who I had never seen before that night; and three other students: Basir and Arif, both medical doctors (the latter from Bangladesh helped immensely in communication with the medical staff), and Vanesse, fellow anthropologist and resident best-friend (who served as my voice during most of the proceedings).

After the paperwork was completed, I was transferred upstairs to the ICU--it was cleaner and quieter and more private. By this point it was 10:10 pm. I'm not sure that such a case was typical of the ICU, but I am also fairly certain they don't get a lot of Americans coming into this hospital, so I was getting at least a little special treatment (and I was grateful for it at the time). So they put a butterfly catheter in my left wrist and started me on a saline drip, followed by a Cipro drip (antibiotic), followed by a glucose/saline drip. I haven't had an IV since I was 10, so it was kind of a strange experience. They also administered an anti-emetic so that I could drink things safely, and a sedative so I would sleep through the night. I had my ups and downs the whole night, but my friends (the three students) stayed the entire time with me, and were never out of sight. Vanesse was able to sleep in the bed next to me (or she was able to try to sleep--I was the only one with the sleeping pill and it made a big difference), and the guys were taking turns in another bed nearby. I don't think any of them slept more than an hour in total, but I was so thankful for their presence--what otherwise would have been a very scary experience for me was much less terrifying because of their being there.

In the middle of the night when I woke up, Arif asked me if I had ever been hospitalized before. I told him no, apart from a minor scheduled surgery when I was a child. So he told me to remember the date--as it was the first time I should recall the date and celebrate next year. March 17th--St. Patrick's Day. Not many people know about St. Patrick's Day here, so after a brief explanation of the idea behind it, Arif proposed a 'Happy St. Patrick's Day' Toast among our circle of sleepy internationals, and I must say, it brightened my mood considerably.

I also spent a good deal of time wondering where I got my bacteria (they didn't do any kind of culture, but I heard some doctors saying it was likely Salmonella or Shigella). My two meals yesterday were also served to 32 other people each time, and no one else got sick (leading me to believe it was not, in fact, a single-exposure common-vehicle outbreak...officially brainwashed by Epi now...though just in case it was, I calculated the attack rate as 0.0303.)

The staff monitored my vitals on and off all night. At one point my BP was down to 90/60, which is quite low for me, and just before discharge this morning I had a temperature of 101. But in the end I was deemed fit to leave, and they gave me a big box of drugs to take with me. Pretty much they're going to continue to kill any bacteria that might be living with me, and they're going to ensure that I can't lose fluids by any means.

I arrived back on campus this morning feeling thoroughly disgusting, and I still haven't had enough strength to stand up long enough for a shower (which is driving me NUTS), but I'm in higher spirits, and I have been sleeping on and off for the last 6 hours. Everyone says I need to try to eat something now, so I guess I will attempt to comply with the orders of ALL my resident doctors. And I have 1.5 liters of Oral Rehydration Solution (developed locally 30 years ago by two of the school's instructors!) that I'm supposed to be drinking. So maybe I will do some of that before part 4 of my day-long nap. My goal is to be strong enough to shower within the next two hours, so I have a little way to go...

Ok. That is my tale. If I look at it as a learning experience though, I can understand why treatment of diarrheal disease is such a priority in this country. Such problems are ubiquitous among all age groups, and there's an entire hospital in Dhaka dedicated to the treatment (and research) of diarrheal disease. But seeing how quickly I went from feeling alright to feeling dreadful, it's easy to understand how such problems cause so many fatalities in Bangladesh every year. Diarrheal diseases are the leading cause of death among infants and children--that's why the development and now widespread use of ORS was considered such an incredible public health feat--it saved millions and millions of lives, and it continues to do so. So even though I'm feeling a bit like I've been hit like a truck, I also, in a way, feel closer to this country that I'm now calling home. Which is a good thing, I think.