Febrile in Fiji

I am a little behind in my posts but I think I have dengue fever...(my worst nightmare, getting sick in a foreign country and thinking of the million things that could go wrong.)

I have had fevers before but never the "bone breaking fever" that is classic for dengue fever. It started after my last shift. I sensed I was not feeling well at the end of the night. I was starting to get lightheaded and my bones and muscles were starting to ache. I had been feeling this way for the last couple of days but I just thought maybe I'm confabulating symptoms but then...

I started having the most intense chills of my life while my body was burning up. I threw myself on the bed as I got home, who knew I wouldn't get up again for another >24 hours. My body ached so bad. Moving exacerbated the pain and made me nauseous. So I lied there like a useless sack of potatoes, hoping to break the fever. I was so ill I did not even move to take some antipyretics or analgesics. I slept from 2am when I got home on a Tuesday night till Thursday at 8am. Wednesday was my day off, a day lost in my febrile time warp. I have NEVER called in sick but I could not physically move. I have been in car accidents, febrile with strep throat etc and still never called in to work.  I intermittently woke up to inform people I'm not dead but I did not feel better.  Then slept more from Thursday to 9pm.

This was easily the worst I have ever felt from any illness. I thought maybe I should go to the hospital, but I am the worst patient ever. I figured there is a housekeeper that comes daily to these apartments so if she found my dying corpse they would bring an ambulance and it would be fine. I would not have to move. It was THAT bad. If I am not dead or dying (or at work or doing work things) you would not catch me in the hospital for the life of me. The alternative was to go to the hospital and get lab work as well as IV fluids. They would probably stick me in the step down unit (unairconditioned- baseline 80 F). I feel ill just walking in there on a regular day, not to mention actually being a patient. I have no idea how the people deal with the heat. On a side note, I walked home during the day one day, and nearly had a heat stroke. I was so close to my apartment at that point that it seemed silly to catch a taxi for the last 1/4 mile. It was early morning so the sun was not at full blaze and it's only a little over a mile. I am such a pansy compared to the indigenous people here.

 I did not have any of the warning signs for hemorrhagic dengue minus a minor episode of epistaxis (hallelujah!). I'm suppose to work today so feeling slightly better. I think my fever finally broke, but for those that read my dengue fever blog, now I enter the critical phase of dengue after the fever breaks.

My sentiments exactly

In other news, before my deathly experience with at least clinical dengue, I had the most creepy and spooky experience ever towards the end of my shift. This is a very regular experience for the other residents but for me VERY SPOOKY. So I deal with death and dying on a daily basis, no surprise there. However, usually when an ambulance responds to a house call and the person is very obviously deceased, they never come to hospital. That is beyond repair. However here in Fiji, they stop by the hospital for a quick death exam before going off probably to the morgue.

The death exams I usually do are in the hospital in a well lit patient room after the family has decided to withdrawal care from a patient that probably has very poor functional outcome. In those circumstances, when the patient has passed I do a quick death exam (examine for pupillary reflex, corneal reflex, gag reflex, pain reflex, heart beat, lung sounds, cap refill, any signs of life etc) then if none exists you call the time of death.

This was not that experience. The patient was driven to the hospital in a old pick up truck with a back covering. Very similar to the one below. They parked in an unlit back alley of the hospital in the middle of the night. Family members had wrapped his mummified corpse in the back of their truck after they discovered him and called the police to ensure no foul play was done. They called me out to this back alley.

Shady, murder truck

Nurse: Ok crawl into that truck bed to examine the body.
Me:  My thoughts: What?! Are you for real? You want me to crawl into that dark/dim, really sketchy looking truck bed with a known dead body, with basically no one else in sight and unwrap it to examine the body?!! I have no idea what's in there or if these people will drive off while I'm in this covered truck bed and murder me.

I was being professional so I said: "Ok" Reluctantly

By the way there are no authorities, it's the nurse and me with 2 other large men who claim they are family members. I felt like this is how scary movies start. 

I do my death exam with a very obvious rigor mortis body and then pronounce him. I had the nurse hold my light (on my phone) so I could see what I was doing. Of course she had no idea what I meant by shining the light in his eye and then moving it away (to check for pupil reflex). I was trying to make this as swift as possible. Wonderful. I had to de-glove and then commence with the exam with one hand.

Very crime scene investigator style. Not on my list to ever do again. Ever. I haven't died or been murdered yet.  That's a win for today. Hopefully I'll have some more interesting cases at work today to report.