Monday started off normally, and by normally I mean all the irregulars that constitute daily living in Thailand. Began by teaching four fifteen-year-old girls how to write the SAT essay (more the humorous as I detested everything to do with the SATs). In the afternoon: 101 presentation skits. -- I had high expectations, but also knew I should be practical – students here are not one to volunteer, to raise their hand, talk loudly in class, act. But my students did not let me down! The classroom was filled with talk show hosts, fairy godmothers, hotel managers, movie stars. We traveled from Japan to Korea to France to the local night bar in Chaing Mai complete with a crowd of boys in my class wearing light up glasses, stumbling around stage acting drunk exchanging phone numbers.
Then back to tutor one more student and it was here where things started getting interesting. A note: if anyone was in any doubt, it is hot in Chiang Mai. For school I wear a nice short sleeve shirt, skirt and sandals, on the weekends I switch to shorts. At night all I can bear is light capris and a tank top. However on Monday when I went to tutor I was freezing in long capris, a shirt and a sweater! I barely made it back to my room afterwards to find that my temperature had rocketed up to 103.4! I skyped mom, took advil and went to bed…or attempted to go to bed, which entailed tossing and turning, feeling miserable and waking up at some point in the middle of the night.
One thing our family is known for is enduring through sickness – that means if you can still go to school you go to school – otherwise you might miss something. Of course if you have a fever you are exempt because the school won’t take you, but otherwise there is an expectation that you will drag yourself to school. I have long since internalized this mentality and unsure whether CMU had a fever policy and without anyone to cover for me, I dutifully dragged myself to class.
Tuesday night was fever filled and I ended up waking up at 3 am, chatting with mom and getting interviewed by someone from my elementary school who was over at our house at the time.
Wednesday: Denali was wonderful and brought over a rice porridge with vinegar, ginger and chives for breakfast. By this point I had eaten little more than fruit since Monday and was still highly feverish. I dragged myself to Thai lessons and then to tutoring and then back home where I curled up attempting to sleep and watch a movie. By 6 pm I admitted defeat and decided it was time to make a hospital visit and get checked out. I was pretty sure I was plagued with a bad case of the flu. My symptoms: high sustained fever, sore throat, headache, light stomach ache, mild dizziness, achy joints, general sore muscles. The problem was that all of these symptoms could be flu, but they can just as likely be signs of one of those nice tropical diseases, like malaria, or dengue fever.
Denali came over and picked me up and we headed over to the well-oiled machine that is Ram Hospital where you get directed from station to station to station. I was weighed, fever checked (back up to 103), blood pressure taken, symptoms explained, blood given. After hearing my symptoms the doctor was convinced I had Dengue (I was not). While I waited for the blood test, I was severely chastised by a nurse for taking Advil to reduce my fever. “You can not take Advil if you have dengue” she kept telling me, of course I didn’t know I had dengue, and still didn’t think I had dengue so what was I supposed to do? (I later learned the Advil lowers platelets and stopped taking it immediately.) Instructed to return in an hour we headed out to get ice cream.
Back at the hospital I was ushered into a doctor’s room in the emergency area (the main offices were closed by this point). I sat down thinking ok nothing to be worried about I just have the flu – Denali says dengue isn’t that common -- and the doctor wastes no time in telling me: you have dengue fever. WHAT?!I have dengue?! How?! NOOOO! I look at the sheet of paper, it reads: “positive for dengue, negative for normal.” The doctor then proceeds to tell me that he thinks I should stay in the hospital for the next two days hooked up to an IV! At this point I sort of panic and my eyes grow really big and shocked. Almost immediately he amends his previous statement and says, “or you could stay at home drink lots of water and electrolytes and take Tylenol to bring your fever down.” I go with option B.
Dengue fever or “breakbone fever” (a fever so painful that it feels as if your bones are breaking) is prevalent in cities all over the world, mostly in Africa, South America, and South Asia. Interestingly the word dengue is Kiswahili in origin, from the word ka-dinga pepo – meaning a disease caused by an evil spirit. (I feel like this is a small consolation prize for me of sorts.)
Like malaria, dengue is contracted by mosquito bites, but unlike malaria, dengue mosquitoes live in cities and primarily bite during the day. Across the globe 50-100 million cases occur each year. In Thailand the peak epidemic time is the start of the rainy season – June to July. Unfortunately there is very little that can be done for dengue. The issue is making sure one stays hydrated and keeps platelet and white blood cell counts high. For these reasons many people are hospitalized so they be assured of getting enough fluids into their system. For me this meant daily blood checks and mantras of “raising platelets, lowering fever, raising platelets, lowering fever,” in between continuing to teach my classes at CMU and going to bed at 8 pm.
I have since become well acquainted with the first floor of Ram and the nurses have become well acquainted with me to the point that they know my name and greet me when I walk resigned to the internal medicine station. They also are well aware now that I detest needles. I have had a whole collection of doctors, my favorite by far being a lovely young woman who has great English and answered all of the odd questions about dengue that I could think up. The other doctors were less inspiring. I wait fifteen minutes get led into their office, get read my platelet and white blood cell count from a sheet that I also have a copy of, am told to get another blood test and leave…I’m not sure why this is a necessary step. Indeed with the last doctor I saw I had to actually convince him to give me more electrolyte packets.
The completion of dengue is marked in many cases with a fully body itchy rash. A send off party if you will for the disease. Some people are lucky enough not to ever get the rash…I am not one of those people. Currently as I sit typing, my legs and arms are covered in hundreds of red spots. Yesterday was when the rash first appeared, my limbs changed chameleon like from normal, to splotchy, to rashy, to purple and pale and then back to relatively normal. Today they are determinedly angry red and very itchy. In addition I have edema – the swelling of the hands and feet, another lovely symptom of this disease!
The good news: The disease has almost (hopefully) run its course, I am now resistant to this form of dengue (there are four types in all), I can say that I had dengue – I should get some small amount of credit for that!