Serendipity Saved My Life

cerebral malaria pesonal story
They just don't see a lot of malaria in the Midwest...
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The year was 1984 and I had spent the last few months in steamy Africa with a university-sponsored teaching project.  By the time my teammates and I returned to our small-town Iowa campus, I had teeth-chattering chills and intense fever.

Two days later, when I was spiraling downward, the campus doctor figured it wasn't just the flu. A trip to the local hospital revealed my white blood count at almost zero! A major emergency, they said, and sent me speeding to the “big guns” at the big teaching hospital, one hour away.

The state-of-the-art hospital admitted me for further testing and when I told them I'd been in Africa, I was promptly quarantined in the Contagious Diseases Unit. 

The next day they determined that I had a really nasty case of malaria. Malaria is a mosquito borne parasitic infection that, yes indeed, I had brought back with me from Africa. The parasites are clever little guys who enter the bloodstream through mosquito saliva and take a trip to the liver, setting up base camp there while they mature and reproduce.  Symptoms like fever, fatigue and nausea usually begin ten to fifteen days after being bitten… and I'd been bitten a lot in Africa.

I had two strains of malaria critters taking over my liver, hence the lack of soldiering white blood cells that had succumbed while defending me; my body wasn't doing very well at holding off a full-scale invasion. Little did I know, but this was just the start of a life-changing experience that would tilt my world....

After a two week stay in the hospital, I was back on campus. My buddy, Tom, had been assigned to bring meals to me in my dorm room, since I still felt horrible. But after a few days, he told me he was done with that, and I had to go to the cafeteria starting that day, if I wanted to eat. I couldn't blame him for not wanting to baby-sit me, and I didn’t feel quite as bad as I had before going to the hospital. So, I crawled out of bed and headed across campus.

I was a bit unsteady, but took it slowly and started down the cafeteria food line. Suddenly, a strong spasm tweaked my neck. My head jerked and I started feeling woozy and disoriented. Then it happened again. I started to panic, thinking, I can't let anyone notice me looking weird.

I tried to control myself, feeling like a hurt animal, just wanting to hide away in misery where no one could see. Somehow, I carried my tray to a table and sat down. Other students were talking around me as I tried to focus on eating.

I couldn't.

I put some salad onto a fork, watching it approach my mouth in slow motion. Then everything went black.

I opened my eyes slowly, feeling like a troop of gorillas had run over me in a hurry to get somewhere. I was laying in bed... a hospital bed. Again?

When I woke up next, several doctors were clumped around me.

One of them asked me how many fingers he was holding up. I tried to look at him but someone had propped my broken glasses, askew, onto my nose and I couldn't see. He adjusted my glasses saying, “You crushed them a bit when you hit the ground.”

“You're holding up three fingers.” I answered.

“Do you know what your name is?” he asked.

“Well, sure,” I answered. “What happened to me?”

“You had a grand mal seizure, and then slipped into a coma. To be honest, we almost lost you.” He paused, emphasizing the gravity of the situation. 

“When we treated you for liver malaria, we didn't know that you also had cerebral malaria, which is deadly, because it attacks the brain. We'd never seen that here. And the incubation cycle is longer, so it didn't show up in blood tests when we first saw you. 

He continued, “When you were brought in again, we literally had no idea what caused the seizure and why you were in a coma. Your brain was swelling from encephalitis and you were this close to dying.” He held up his hand, the tips of his thumb and first finger only a fraction from each other.

“You're a very lucky young man.”

I looked at him in disbelief. A seizure and a coma? I didn't remember any of that.

The last thing I remembered was trying to eat salad in the dining hall and feeling weird.

“Apparently, you collapsed on the floor of your dining hall,” he explained. “Then you went into what is called an “active coma” - that's when your eyes are open and you're active, but you're not conscious, not aware of anything. Someone called an ambulance and got you back up here.”

I was overwhelmed. “That means... if my buddy hadn't made me go to the dining hall that day, I would've had the seizure in my room. No one would have even known...”

I closed my eyes, shuddering, and thought, serendipity....

The doctor continued, “While you were in the ambulance they gave you enough sedatives to down a moose, but apparently with no effect.  When you got here we immediately started test after test to figure out what was happening; MRI, CT scan, even a spinal tap... You were flailing around so much they couldn't keep your head still to do the CT scan, so the techs used a medical version of duct tape to hold your head in place on the machine.” 

Seriously? I thought. Hospitals use duct tape on patients?

So, there I'd been, in the emergency room, in a coma, brain swelling and deprived of oxygen. The falciparum malaria parasite was killing me and no one at the best hospital in the state even knew it was there! 

After a week of treatment and rest, I felt better. I was still having headaches but the fever was down and the malaria was slowly dying off. 

One afternoon, my doctor came by with second doctor, a kindly looking, older fellow. My doctor said, “This is the gentleman who really saved your life. If he hadn't stopped by that night.... well, I'll let him tell you the story.”

My doctor left us and the second doctor looked at me brightly and said, “I'm so happy to see you awake and looking better. When I first set eyes on you in the ER, I thought you were a goner!”

“This being a teaching hospital, some of us old timers like to swing by the emergency room just to see what's going on... I wasn't even on duty that night.” He smiled sheepishly. “But after a lifetime of ER duty, it's a bit of a habit. We try to save as many lives as we can, but sometimes we fail. Either we don't know what to do or what we do just isn't enough. And sometimes, we actually do the wrong thing.  There's a lot of heartache in the ER...”

He gazed into the distance, then shook it off, continuing,

“When I saw you lying there in a coma, I asked the ER's Chief Medical Director, “Hey, what happened to the kid with the sheet up to his chin?” (read: almost dead). He handed me your file, frantic, explaining that they'd tried everything and you were running out of time. You'd been in a coma for fifteen hours by that point, and your EEG was approaching flat-line.”

“I saw that you had been treated for liver malaria a few weeks ago. Putting that together with the fact that you'd just been admitted in an active coma, I took a gamble that you had cerebral malaria and you needed immediate treatment with quinine.”

“We don't keep quinine here at the hospital... there's not much call for tropical disease remedies out here in the Iowa cornfields.” he said. “I told them not to wait until they identified the falciparum parasite in your blood. They were desperate by that point, so they took my advice and had the quinine flown in ASAP. It was really close, but we got it to you in time.”

Then he looked at me and said, “I owe you my sincere thanks.”

I asked him how he could owe me, when he had just saved my life.

“There's a back story,” he answered, “one that's been with me for a long time. You see, I was in the Navy during WWII, the Senior Medical Officer in charge of everyone on board a troop ship in the South Pacific.

One afternoon, a seaman went wild and hit his commanding officer, which earned him a night in the brig.  They called me in to have a look at the fellow, and he looked pretty much like he was on a drunken rant, all wide-eyed, kicking and yelling like crazy. I agreed that the best thing was to let him sleep it off in the brig. By the time they went down to get him the next day... well, he had died in the night. We discovered that he had not been drunk. He had cerebral malaria and had been in an active coma, just like you were.” 

“Whoa,” I said. “I guess I'm lucky I wasn't on a military ship when this happened.”

He looked at me, and I swear I saw a glistening of tears in his eyes. “The young fellow had done nothing wrong, but I'd never seen symptoms like that. We just jumped to conclusions. Cerebral malaria has a ninety-seven per cent death rate...mostly because no one recognizes it.”

“That poor boy didn't have a chance because we left him in the brig for over twenty-four hours. And I've never been able to forgive myself.”

“When I saw you there, in a coma, it all came back to me. This time I knew what to do – and by helping to save your life, I feel like I've finally repaid a debt. I can't bring back that boy's life, but at least I helped to save another one. Now you understand why I thank you for this opportunity.”

What could I say to that? 

I took a deep breath, and exhaled. “Then I guess this is ending better, because I'm alive to thank you, Sir.”

Two acts of serendipity saved my life and I became one of the three per cent who survive the deadly disease known as cerebral malaria.

My friends came to pick me up when the hospital released me some weeks later. They had a great time teasing me about the wild things I'd done during my seizure. Apparently, when I started jerking around at the cafeteria table, I threw my fork in one direction and knocked my salad bowl in another... they jokingly referred to that as my “Seizure Salad.” 

But it got worse. When they carried me back to the local hospital, I was in the active coma.  Of course, they had no idea that I was in a coma, because my eyes were open and I was yelling and moving around.  Just like the WWII guy had been.  They told me that when the EMT's released me from the ambulance gurney, I jumped up and ripped off my clothes, hollering about being on fire and burning up (from the fever). I then took off running through the hospital parking lot in my tighty whities! It took three orderlies to catch me... a large female EMT actually sat on me while the other two strapped me back down on the gurney. 

How embarrassing. Fortunately, this happened in 1984, if it had happened today, I'm sure a video of that little scene would have gone viral! 

I was alive, but it wasn't easy. I didn't have the cognitive brain damage that the doctors had feared, but the infection caused neuronal damage, affecting my autonomic nervous system. I couldn't drive for a year because they thought I might have another seizure and I was always tired, with recurring headaches. I also faced a $30,000 hospital bill, which was catastrophic in itself, for a twenty-four-year old student with no income. Fortunately, the hospital took pity on me, and after two years of paying ten dollars a month, they wrote off the remaining debt.

Now, after thirty-five years, I've never really “recovered” physically. I'm still chronically fatigued, regularly needing more sleep than a newborn baby. The neuronal damage causes a variety of headaches and body pains, almost daily. I also suffered hearing loss, a side effect from the cocktail of anti-malarial drugs that I was given so long ago.  Over the years, it has been a challenge explaining to employers or prospective employers why I sometimes have difficulties with (what are considered) normal work day hours.

But in some ways, I'm better than I used to be. After going through a nearly fatal event over which I had no control, I found that the element of fear was greatly mitigated in my life. When I noticed that, I gave a lot of thought to what people worry about or are fearful of... death, pain, loss of control, suffering, failure... the “worst” had almost happened to me, and it wasn't so bad. I discovered a new sense of calm and acceptance of whatever life can throw my way... and that makes life worth living.

 

 

 

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