Friday, September 22, 2006

A Bad Trip

Chiang Mai, Thailand

After I finished vomiting, I returned to sweating. The air conditioner was off and the temperature in the hotel room was stifling, but I was buried under the covers trying unsuccessfully to stop shivering. My head hurt, the room spun, and, if I fell asleep for a few moments, I woke up and had trouble remembering where I was. My body was broken.

So were my dreams. Imagine that someone smashes a television screen into tiny shards, each one still playing its fragment of the picture. My dreams were those shards, incoherent swatches of writhing color. I could close my eyes and, still awake, see my dreams projected onto the back of my eyelids.

My medicine was poisoning me.

* * * * * * * * * *

Malaria is the definition of nasty. The Plasmodium parasites live in the stomachs and salivary glands of infected, female Anophelese mosquitoes. If an infected mozzie bites you, the parasites move to your liver, buy furniture and have kids. Once the colony has sufficient numbers, the parasites enter the bloodstream and burrow into your red blood cells, where they continue to reproduce until the infected red blood cells explode, spilling yet more parasites into your circulatory system. The toxins released by the rupturing of the red blood cells are what causes the fever, chills and other symptoms of the disease. With proper medical care, you will not die, but there will be a one- to three-week period when you might wish you would.

Two of the principal anti-malarial medications on the market are mefloquine (often referred to by its brand name Lariam) and atovaquone (called Malarone). The pills are not perfect. They're expensive. They're hard to find outside the First World (where they are least needed). They can have powerful side effects, including, according to the warning label, "intense nightmares, depression and fear."

Worst of all, the anti-malaria pills don't prevent malaria. The various medications suppress the number of parasites in the liver or blood, but the only way to prevent the disease is to not be bitten by an infected mosquito. There is no vaccine.

* * * * * * * * * *

At 3 p.m. last Tuesday, I was fine. At 6 p.m., I took my first dose of Lariam, in preparation for a planned trip into Laos. By 9 p.m., I was suffering from debilitating Lariam side effects, as happens to a small percentage of travellers.

Travellers who are sensitive to Lariam sometimes experience a truncated version of the disease itself. Think of Lariam side effects as the 30-second trailer to malaria's Peter Jackson-length epic.

I couldn't sleep at night, and I didn't have the strength to get out of bed during the day. I had no appetite, which was just as well, since anything I injested quickly flew out one end or the other. The psychotropic effects of the drug were powerful: I went from happy and optimistic about the next phase of my travels to being so depressed and lonely that I wanted to get on the next plane back to Los Angeles.

The first and second days were torture, the third and fourth much better, although a new set of symptoms seemed to establish themselves. Sore throat. Cough. More obviously a cold of some sort.

The fifth day took a return for the worse, and I decided that, for the first time since I was born, I was going to have to check into a hospital.

* * * * * * * * * *

Chiang Mai Ram Hospital is a private hospital which treats both "medical tourists" and local Thais who can afford private health care. The hospital rooms for the medical tourists -- which include a lot of Japanese patients -- are like four-star hotel suites, with a couch, kitchen, mini-bar (no booze) and satellite TV. The Thai floors are less sparkly and more utilitarian.

The doctor's diagnosis was that the Larium side effects held me down, while a throat infection decided to slap me around for grins. The doctor ordered two nights of observation.

The hospital had a rhythm. Cute nurse in impossibly tight uniform took my vital signs at 6 a.m. First meds at 7 a.m. Breakfast at 7:30. A nurse would then come in about once every hour to give me more pills or change my IV or tell me to drink my chalky electrolyte-replacement beverage. Lunch at noon, and, in a nod to the fact that hospitals house senior citizens, dinner arrived at 4:30 p.m. Regular visits from the nurses continued until about 10 p.m., at which point I was left alone until a 2 a.m. vital signs check. The actual doctor would show up once a day about 11 a.m.

Total bill for three days in the hospital: $550. Less per night than a fancy resort. My guess is that the exact same treatment in the United States would have cost ten times as much.

I'm feeling much better now. And I'm throwing out the Lariam and switching to Malarone.


Anonymous Tom said...

Enough of your problems Paul, is Nicholas Cage okay??! (Seriously, I'm glad to read you're feeling better. Take care.)

Caged-in in Bangkok
By Herald wire services
Friday, September 22, 2006

NICOLAS CAGE felt that Thailand’s military coup made filming his new gangster movie, “Bangkok Dangerous” really, well, Dangerous. When news of the Tuesday night coup reached the set, Cage was sent back to his hotel, according to the Chinese Web site, But crew members were ordered to remain on the set to keep an eye on prop guns until Cage persuaded the producer to send everyone home.

3:14 AM  
Anonymous Anonymous said...

Blech. Glad you survived.

12:42 PM  
Anonymous Nagi said...

Love that shards-of-television description, even as I worry for your health and sanity. I also admire your willingness to crack on in these circumstances; just try to keep out of any Deer Hunter situations that might in a moment of impairment seem like they'd be bloggable.

9:05 PM  
Anonymous barney haole said...

i preferred the "infected mozzie buying furniture" bit, but nagi and i have always thrown rocks into different cracks.

keep your head up and your food down.

3:05 AM  
Anonymous Anonymous said...

There are world-class affordable healthcare options in Mexico:
provides all is needed to go to Mexico for a great medical trip.

12:26 AM  

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