Dengue Is Not My Bitch

Having been bar reviewing, on and off, since the late Jurassic, I rarely get hangovers. But the one in Singapore was a corker. The aching legs that had kicked in as I progressed to my sixth bar of the evening hurt worse than even the day after we climbed Mount Kinabalu. And I had an absolutely splitting headache that neither water nor even paracetamol could dent.

All of which was most odd since, feeling a little under the weather, I hadn’t consumed huge quantities of booze and had paced myself solemnly with water. It was, further, inconvenient, as that day I was due to collect Zac from the airport – after a school hols sojourn encompassing Australia, New Zealand, Germany, Belgium, the Netherlands and the UK – and meet friends in Chinatown.

Still, as a lapsed Catholic I believe in suffering through anything that’s self-inflicted and quite a lot of stuff that’s not. And, even if I didn’t, I could hardly abandon my spawn at the airport, or fail to meet up with friends we hadn’t seen in six years and who were even checked into our hotel.

“Do you feel cold?” I asked at the airport, pulling my cardigan around me, as Singapore’s besotted fondness for A/C struck home quite bitterly.

“Not really,” said my spawn, who, despite having failed to manage his sleep on his flight back from the UK, seemed much livelier and healthier than I.

Odd, I thought. And, curiouser and more curiouser, the chills continued to bite even in the steamy surroundings of sunny Singapore.

“I’ve either got the world’s worst hangover or I’ve got dengue.”

“Sorry about this,” I said feebly to our friends, as my action-packed schedule for our sojourn in Singapore – the new National Gallery! Haw Par Villa! One of the best bars in the world! – shrank down to a shivering hobble through Chinatown to Maxwell Food Court for Hainanese chicken rice at Tian Tian. “I’ve either got the world’s worst hangover or I’ve got dengue.”

Dengue, AKA breakbone fever, is an occupational hazard of living in the tropics. Around 100 million people go down with it every year, with symptoms ranging from a mild flu to internal bleeding and death by way of something highly painful and extremely debilitating.

Knowing me, however, they assume I have a hangover. And, to be frank, having heard gory tales of precisely what dengue does to you from sundry Old Asia Hands, I don’t feel quite ill enough to be diagnosing myself.

My bones ache, sure. I probably have a temperature, though I don’t have a thermometer to check. I have the mother of all headaches. But I don’t have the searing pain behind the eyes and, although my appetite is off, I have yet to start puking my guts up. Further, chills smack more of flu than dengue.

In fact, with my cardigan firmly wrapped around me, I even manage to go for two sedate local beers, before curling into the foetal position around 8pm and shivering myself to sleep.

The flight passes in a miasma of sweats and chills, interspersed with copious quantities of water.

There are few things less relaxing than transiting through an Asian airport – indeed, any airport – with non-specific flu-that-might-be-dengue-oh-for-god’s-sake-woman-man-up-and-stop-being-such-a-hypochondriac. Mercifully, Zac happily carries my tote bag, whose several kilos seems rather beyond me, and is happy for me to sit down and rest every few hundred metres.

At this stage, I’m still thinking it’s a bad flu, but am wondering whether I might be diagnosed with something more sinister at an airport, and refused admission to one country or other. And I fear that if Indonesia bounces me back as being too sick to come in, Singapore certainly won’t have me either, leading to a potentially nightmarish – and financially crippling – unscheduled return to the UK.

I decide not to sit down, and hope not to shiver, or sweat excessively, when in line at immigration. The flight passes in a miasma of sweats and chills, interspersed with copious quantities of water – the first line treatment for dengue, like that for flu, is basically drink water and take paracetamol (not aspirin or Nurofen, if you’re reading this for medical advice, which you shouldn’t as I AM NOT A DOCTOR). The mysterious leg ache won’t go away, and AirAsia’s minimalist legroom policy doesn’t help for not only is it a bucketshop airline, it’s a bucketshop airline with a target audience significantly shorter than me.

At Denpasar, we pass immigration quickly, which is a relief since collapsing in an immigration line would not be a good look, and I slump in a corner while Zac sorts his bag out. I deliver a not-bad-in-the-circumstances performance at haggling with Denpasar Airport’s toxic taxi touts and my aching legs, my jetlagged spawn and I finally return home.

That is, I concur, rather dengue-esque, and also a feature that Old Asia Hands on their second or even third bout of dengue recall with a certain gory relish.

Some people, I admit, might have gone to the doctor at this stage. But guidance with flu is to sit it out for the first three to five days unless something hideous happens, my temperature is only 38.5° (101.3°) against an expected 40° (104°) for dengue, which, even with my reptilian normal body temperature of 36.4° (97.5°), makes me figure I’m just not that sick. Further, Facebook tells me there’s a flu bug going around our neighbourhood.

Then my eyes start aching. When I move them, it starts to feel as though someone’s running sandpaper between the back of my eyeballs and my brain. That is, I concur, checking the NHS list of dengue symptoms for probably the twentieth time, rather dengue-esque, and also a feature that Old Asia Hands on their second or even third bout of dengue recall with a certain gory relish, rather as if reminiscing over grim toilets or that time they got captured by bandits.

I decide to see how I do after the day in bed I should have had the day before were I not scheduled to escort Zac from Singapore to Bali, order takeaway, and proceed to projectile vomit pizza all over the bathroom like an out-take from the Exorcist.

But for the puking, the next day passes remarkably well. My temperature drops. The aches seem to recede. I binge, contentedly, on longform.org.

In fact, I’m even ready to contemplate doing activities with Zac for the remainder of his school hols – we have ex-Bali friends over from England and plans for diving etc – and, even if I don’t feel like getting out of bed, it feels like the flu bug has gone.

On the morning of day four, the roof falls in. My joints ache so much I can’t get into a position to sleep and come quite close to crying with pain and frustration. My temperature rockets back up. The pain behind my eyes progresses to cheese-grater levels and I can’t seem to get around it by moving my head not my eyes as I could on day two. I start vomiting water, which worries me, both since dehydration is a real risk and since I’d like to keep my paracetamol down.

On Twitter, where I’m whining, as is my wont, Mr Travelfish (an Old Asia Hand who’s had dengue twice to date) wonders, not for the first time, whether I would like the number of a doctor who does house calls, including blood tests for dengue.

I think about the economics of this for a while. Then I think about the alternatives, of actually getting up and sitting in a taxi – because there’s no way I can ride a bike or even sit on a motorbike taxi – and waiting in a doctor’s surgery or a hospital, and call Dr Ari.

He arrives. I describe my symptoms. He nods. Apparently, it sounds like dengue. He gives me some tablets that stop the puking, although don’t bring my appetite back, and takes two vials of blood. One is to establish whether I have dengue. The second is to establish whether my platelets have been so ravaged by it that I need to go into hospital.

I send an only marginally compliant Zac off to the cashpoint for money, and then off a second time for more money. For I have, in contravention of my own best advice, allowed our insurance to lapse. Sod it, I think. I’m probably being melodramatic. Or a hypochondriac. I almost certainly don’t have dengue, and if I do, it’s obviously a mild version.

He’s definite. I can’t go in the morning. I need to go to hospital tonight.

Time passes. Zac games. I order him takeaway and drink some Vitamin C. Early in the evening, Doctor Ari rings me back. My platelets are well below the 100,000 mark (a normal range is 150,000-440,000, and mine are 81,000) and I need to go into hospital. He’s found me a bed at Kasih Ibu.

“Do I really need to go tonight?” I ask.

“Yes,” he says. “We don’t know what level they will be at tomorrow. If they were above 100,000, you could stay at home, but they’re not.”

I whine a bit, but he’s definite. I can’t go in the morning. I need to go to hospital tonight. The problem with dengue, you see, is that if platelets drop below a certain level, generally 20,000, it can kill you pretty quickly if you’re not in a hospital with access to platelet monitoring, blood transfusions etc. (Some stay at home and monitor their own platelets until they reach a level they determine requires hospitalisation. These people are made of sterner stuff than I.)

I post a message in my rare blood type Facebook group mentioning that I’m going to hospital with low platelets and asking people to keep an eye out for a call from the docs. (Bali uses beer fridges to store its blood, and blood groups that are only a bit rare in Europe can be very rare in Asia, so rare blood group donations are requested as and when needed rather than kept in stock.)

I am most annoyed. Bastard mosquitoes. How the devil could I have been so blasé about mosquitoes? And, further, why did I ignore my own advice and let our travel insurance lapse?

There is one issue, of course. What on god’s earth am I to do with Zac?

The strange thing is, at this juncture, I’m not feeling all that bad. I’m quite capable, for example, of packing my little holdall for the hospital and carrying it to the taxi, although I can’t be fagged to change out of my nightie as I’m only going to be wearing it anyway. The leg aches are less awful, the headache is a bit less drilly, I’ve managed to train my head to move in place of my eyes, and the drugs mean I’m not puking: I haven’t eaten, but, hell, I think, I can do with losing the weight.

There is one issue, of course. What on god’s earth am I to do with Zac? At 15 and nudging six feet he can fend for himself given adequate funds for a day or even several, being perfectly capable of ordering takeaways, ordering taxis and, for that matter, going to the shops and cooking for himself, but it’s not going to be very nice for him.

His most regular sleepover buddies, further, are off the island, as is the Bag Lady, to whom I already owe about a gadzillion babysitting tokens after I asked her to put him on a flight which then refused to take him then switched my phone off while on a sleeper train in China (long story).

We discuss and conclude that he’ll stay at home this evening, and the ex-Bali friends will come over the next day to supervise. In the taxi, the mother of a schoolfriend with whom Zac stays over – with whom I have yet to have a proper face-to-face conversation – calls, heroically volunteering to have him for as long as it takes. She has four kids, she says, and staff, and will pick him up tomorrow. Whew. She is a saint.

The staff present me with a distressingly large though in theory perfectly reasonable cost estimate for a projected five(!)-night stay.

The hospital might be expecting me, but that doesn’t mean it has a bed ready. My vital signs, all encouragingly robust, are taken in the casualty area, and I’m hooked up to a drip. I am already regretting my lack of unread books, if not yet feeling self-pitying about visitors.

The staff present me with a distressingly large though in theory perfectly reasonable cost estimate for a projected five(!)-night stay (23 million IDR, or over $1700 US). I sign a bunch of paperwork, order dinner despite the fact I have no appetite, and put down a deposit for my treatment.

It’s my first time in an Indonesian hospital, although Zac had day surgery to remove the plate in his arm at Sanglah. Though not as sheeny-shiny as the more foreigner-focused places, which can run you $3000 for a five-night stay and drugs (not necessarily the right drugs, either), it seems on a level with a small private hospital in the UK. That’s to say: better than the NHS, lightyears behind the Hong Kong extravaganza where Zac’s arm cost $20,000 to fix and several centuries ahead of the facilities in Tsagaanuur, Mongolia.

All the rooms are private, which provokes a rash of financial panic, but Doctor Masyeni, who’l be looking after me, is a tropical medicine specialist who does a lot of dengue (there’s a lot of it about on Bali). Further, this is where the Bag Lady got treated, as well as sundry other Bali bods, so probably a good place to be. And, further, I’m in no condition to go touting my arse around town looking for quotes.

“Two and a half years?!” she says. “And you haven’t had dengue yet?”

My room has a telly, which is nice, but they haven’t fronted for the better cable movie channels, which is less good. I have my very own bathroom, into which to drag my IV stand, and one of those beds that goes up and down electronically, which would be rather fun in a childish way were I not so pathologically enfeebled.

Doctor Masyeni appears and examines me. We discuss how long I’ve been in Bali. “Two and a half years?!” she says. “And you haven’t had dengue yet?”

“Well, actually, I think I may have done,” I say, explaining the mysterious flu bug in Bangkok which had sickened both me and Zac and which dengue researchers we met on a beach in the Philippines identified as likely a mild bout of dengue.

Dengue is worse the second time, apparently. You can get it up to four times as there are four strains. And, for anyone who’s ever been told that dengue mosquitoes bite just during the day, they bite at night as well.

We discuss whether mine is a Singapore dengue or a Bali dengue and conclude, regretfully, that it’s likely a Bali dengue. I resolve to be more sensible about mosquitoes.

I suspect that only a person who is on the mend could actually hold down even a soupcon of green slime.

I settle into the tedious routine of mid-range hospitals everywhere: crack of dawn breakfast, 6am blood tests, twice-daily vital signs, 9am cup of tea, noon lunch, afternoon tea, etcetera. I Skype with my parents, Skype chat with Zac, WhatsApp with the Bag Lady and the Bag Lady’s sister, who promises me papaya leaf juice.

Papaya leaf juice is, among the Bali expat community, generally held to be a fantastic dengue cure-all when it comes to getting one’s platelets back to a level where folk will let you out of hospital, although Dr Masyeni winces and says there’s been no research when I mention it.

Even when mixed with guava juice and lime juice, the taste is quite spectacularly vile – bitter, with backnotes of slimy compost. On the other hand, my platelets need a hand. Following a course that’s fairly typical of the disease, they drop and drop until they’re at 26,000, close to the level at which a transfusion is typically given, and levels are being tested every 12 hours, not every 24.

An unsightly rash pops up across parts of my body. They’re petechiae, the nurse explains, or bleeding into the skin, which causes me (and my folks in the UK) to self-diagnose with dengue haemorrhagic fever, when what I’ve actually got is dengue fever with haemorrhagic features.

I start on the juice, glugging great mouthfuls of it with my nose held, in between forcing down hospital food, and, that evening, my platelets start to rise. Should I have dengue again, I’ll take it again, even if, rather churlishly, I suspect that only a person who is on the mend could actually hold down even a soupcon of green slime, and that the relationship between chugging a bottle of green slime and rising platelets is therefore correlative rather than causative.

Around teatime, around $1200 poorer and with platelets still resolutely below 100,000, I make my way downstairs, call a taxi and head home.

By the morning of day 4, I am super-keen to leave, what with the bill rising and all that. My platelets have increased a second time, although only to a smidgin over 50,000, and I’d like to be excused rather than hanging around waiting for them to get to 100,000.

I explain to Doctor Masyeni that I have no insurance and am covering this out of my own pocket, and can I please, pretty please, go home now. She says she’ll check my blood again at 12, and if it’s still rising I can leave, though I’ll need to keep an eye on my levels.

And so, around teatime, around $1200 poorer, with platelets still resolutely below 100,000 but mercifully relieved of my IV, I make my way downstairs, call a taxi and head home.

Dengue recovery can mean two to three months of utter enfeeblement and general wussiness, occasionally accompanied by throwback aches and pains, and can lead to post-viral fatigue syndrome.

Given that much (although not all) of my income requires me to be on my feet and moving, and all of my income depends on me being able to think straight and type, I’m hoping it’s not going to be that long. The school fees don’t pay themselves, you know and, if you don’t have insurance, the hospital bills don’t either.

Oh, btw, if you’re looking for travel insurance, World Nomads will cover you no matter how long you’ve been out of your home country, though you’ll likely need a residential address (check the Ts & Cs).

Thanks to John Tann for his Mosquito image on Flickr’s Creative Commons.