the sickness

by carlocmd

it started out a few mornings ago, when i woke up to very bad lower back muscle pains.  every uncontrolled muscle twitch followed with a rolling wave of spasm that left me breathless.

i ascribed it to fatigue after our long countryside trip, where i drove continuously over twisty and bumpy terrain.  there and back again, six hours per journey.

as the day progressed, i managed to bring down the pain with mild analgesics to manageable levels.

we had a family reunion to attend that night.  you must realize that i loathe large gatherings of people.  each rub, each interaction takes a bite out of me.  and i find the continuous social interaction draining.  before each gathering, i find that i need shore up as much energy as i could to last the night.

we ate as much of the food as the hosts gave.  it was a lot more than i was accustomed to.  but willing to endure this social obligation, it turned out i ate more that i was capable of.  on the drive home, i began to deteriorate.

it was a rapid decline.  it started out as a throbbing headache.  then the nausea made its appearance with each wobble of the car.  it took a tremendous amount of will to overcome these symptoms to safely drive the 20 kilometers home.  besides, with my wife beside me, and my four boys sleeping soundly, i absolutely had to make it home.

the fever burned as i lay in bed.  the nausea bordered into vomiting, and i had a bowl ready beside the bed.

‘one of those stomach viruses,’ i thought, ‘or the flu.’

when i thought i figured out what it might be, then i had an idea how to treat it.  most viral illnesses are self-limiting, meaning they need to run their course.  you get worse before you get better.  all the medicine you need is supportive – lots of fluids, bed rest, and adequate nutrition.

problem was, because of the dinner buffet, i was over-nourished.  two hours after the meal, i could still feel the food shifting in my stomach.  ‘ileus,’ i thought.  or an intestinal dysmotility, a condition where the body shuts down less vital functions (like digestion) to maintain essential perfusion to the heart and brain.

i could not lie down flat because the food would just regurgitate up.  but i could not completely lie down with the head up because a prolonged position produces recurrent muscle spasms throughout my spine.

so i would shift every few moments from a reverse-Trendelenberg to a right-side down position (a position i know that uses gravity to help bring food down from the stomach to the small intestines – it’s a feature of our anatomy).  it was a very restless, sleepless night.

then the palpitations started.  it began as a slight discomfort in the chest.  but when i began to count, i realized my heart was beating faster than normal, interspersed with some irregularity in the rhythm.

it has been so long that i had a tachycardia (a fast heart rate).  my baseline heartrate is 50 per minute, considerably lower than other people’s normal rate of 60 to 100.  but i’ve never had irregularities in the rhythm before.  ‘an atrial flutter or fibrillation?’ i worried.  checked my blood pressure at 100/70, which was usual and a little reassuring.

the headache continued to pound.  my heart continued to flutter.  i couldn’t sleep because i was so restless, when i realized that i hadn’t urinated for some time.  so i propped myself up to go to the bathroom.  my urine was concentrated and contained sediments.  ‘uh-oh,’ i said, ‘looks like acute tubular necrosis.’  another survival mechanism of the body kicking in.  in sepsis, you need all the fluids you have to maintain homeostasis.  so the body sacrifices the kidneys to keep you alive.

i needed to get fluids inside me, to save my kidneys, but my stomach felt so full.

so i got a bottle of a sports drink (because it had some electrolytes that i needed) and drank as much as i could.  i felt like throwing up.  but after a wait, i continued to sip a little more.  then a little more.

then, when i thought things couldn’t get worse, it did.

the watery diarrhea started.  it wasn’t foul-smelling, like an infectious diarrhea would.  it was just liquid.  and it went on and on.

i started praying then.  keep we well enough until tomorrow.  give me the time and strength to heal.

but as prayers sometimes go, this one remained unanswered during that long night.

i started to drift into delirium.  it was an effort to discern what was real.  there were flashing blue lights throughout the room, worsened by squeezing my eyes shut.  the bedroom lights took a yellowish tinge.  the air felt cool but heavy and oppressive.

thrashing and turning, tormented by small but persistent and recurrent muscle pains, a feeling of drowning when assuming the supine position, a pinprick pressure in between the ribs when assuming the right-side down position, a steadily throbbing headache, an uncomfortable flutter in the chest — i wept.

‘find your center,’ a voice whispered in my heart, ‘you healing begins there.’

images of family came to mind.  my loving wife.  the warmth of my sons’ love.  my burning desire to be with all of them.

i looked inward and found a bright white light in the middle of my abdomen.  it was surrounded by a grayish dirty film.  it took some focused will to wipe away these contaminants.  and the effort of maintaining this activity exhausted me, and i finally fell into a dreamless sleep.

i woke up to the same body pains in the morning, feeling much weaker than the day before.  i saw my wife start about her day, cleaning the house.  it was her routine every time a new year approaches.  i wanted to call out to her, but all i could manage was a plea for water and paracetamol.

‘you need to get up,’ she said.  ‘you should not be babying your sickness.’

i wasn’t babying it, i wanted to say.  it was pounding me into the ground.  but after an effort, i stood up, wobbly in the legs, gasping.  i fell back in the bed, exhausted, and fell into another dreamless sleep.  the day passed by, alternating with painful wakefulness, thirst, diarrhea, and fever.  the boys would pass by the room, chattering in their cheerful voices, then fade away as the fever took me.

i learned that by going back to that white light in the center and continuing to wipe off the gray haze, it helped focus my attention to heal.  each wipe exhausted me, but by giving me a goal, something repetitive and meaningful to do, it gave me reason to get better.

then you feel it.  a shift in the wind.  a turn for the better.  like you had finally crested the hill, and it was smooth downhill going the rest of the way.

the night of the next day finally found me sitting up, taking a sip of soup.  the morning brought with it hunger… and life.

it would probably seem unusual to you why a doctor would just not check in the hospital when these things began to happen.  i questioned my sanity too.

but i did not want my family worrying.  and as long as i can understand the things that are happening, i can do small things to alter the outcome for the better.  besides, you know how doctors make the worst patients.

but i realized in this ordeal, that there is only so much medicine can do to help a patient.  if i had gone to the hospital sooner, getting intravenous hydration and various medicines, i might have gotten better quicker.

was i reckless?  i probably was.  but i know of my limits, and had readied a plan to bring me to the hospital if things did not improve by the third day.

but…

sometimes, we see patients, despite our best efforts, continue to slide down to death.  and it frustrates us.  it haunts us during the morbidity and mortality conference.  it burns the conscience on whether we had done right or done enough.

when in fact, when the patient has lost hope, and the will to live, despite your best care with the best medicines, the battle is already lost.

i enjoyed the day today, playing with my sons outside, in the grass, under the sun, thankful to be alive.  we laughed about the world.  we laughed about our jokes.  we raced their remote control cars in the corridors.  we made mom smile with our funny dances.  we even fed each other during dinner.

as i write this, i had just come from my sons’ room.  after sharing their highs and lows, praying with them, promising to stay until they all fall asleep, i sit here writing… thankful.

thank you for this day, Lord.  thank you for this lesson.  may it not be forgotten when things begin to get busy as the new year starts.

p.s. listen to ‘brave’ by josh groban.

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