reprint of 2008 meningococcal meningitis episode

Looking through old emails I cam across this, and thought I would share it…. something that happened in 2008 but is fresh in memory….. it’s an email  I sent to friends at the time….

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don’t know how to start this email, even remotely. this morning I sent
out a rosy picture of how things were going, and “disregard previous email”
seems the best way….. many of you have read the manuscript I tried to
write about the experience here in Nepal last summer. Be advised, rough as
it may have been each episode was revised, edited, proofread etc before it
was told. I now have a new episode, happened just today, and this is the
rough cut.

want the short version? we took care of 45 y.o. woman who died of
meningitis.

medical version? it was meningococcal meningitis. took her six hours to
die, she’d been dicking around with typhoid treatment in her village six
days before arriving on our doorstep.

detective version? I get five points for correctly identifying the rash on
her legs arms and torso without being told. not bad for a person who had
never seen this in person before, other than attending a communicable
diseases workshop in the State of Maine Public health department maybe four
years ago. ( thanks, Ellen B!)

and of course, the most exciting version. Now a digression. remember the
Three Stooges? there was a scene in a Three stooges short where Curly Larry
and Moe are in Trench Warfare, and somehow they have ingested laughing gas before coming under German artillery fire. after each shell they say

“thats a German shell!” ( peals of laughter)

“they ‘re trying to kill us !” ( snorts of delight)

“we’re all going to die!” (thigh-slapping).

do you remember it? well, that was me for a bit this afternoon.

The day started innocently enough, four patients in “Medical Critical Ward” and I was wandering around checking on the ten or so students.quick trip to Burn Unit to make sure the three over there were doing as they were supposed. Around noon Dr Sunil comes clattering in hauling a stretcher where the patient is stretched out, a resident doctor using the ambu-bag and  Sunil’s  usual entourage of medical residents along side.

“She’s been having seizures and the only way to stop them was to load her up on valium – we need to intubate”

Oh goody, a chance to use the ventilator…..

So, with the usual hoo-rah, we got the patient intubated. At one point Sunil and I were both assessing the patient and came to identical conclusion as to the settings and adjustments needed. we reached for the same dial at the same time, a small satisfaction.

After about two hours, things were getting calmed down as the patient’s vital signs stabilized. At that time I decided to do a more thorough evaluation, and I lifted up the sheets to look at her legs.

That’s when we both saw The Rash. I know my mouth dropped; Sunil gave me a flash of recognition. A knowing look that froze me…..

“You don’t suppose this ….. Is ….????”

“Yes, Joe I Was wondering that myself….”

left unsaid out loud  – – meningococcal meningitis. a heck of a poor way to die.

Oh Noooooooo…….

We looked around. all the people in the rooom with us, with this, all the nurses….. let’s not expose everyone in the whole place, shall we?

I told Sunil we had a person in the isolation room with active Hepatits B.

“this is far more dangerous than plain old hep B” says Dr. Sunil in a businesslike voice with a deadpan expression.

So we realized the communicability of what we had, we had to move our jaundiced full blown liver failure guy with Hep B out of that room so we could move this lady in.

Not til after I washed my hands for ten full minutes.

Not til after my feelings of nausea had passed.

Not til after a little scene with Sunil, one of my favorite doctors on this planet, him asking

“why are you worried? didn’t you get this shot???”

“no, my doctor at the travel clinica said it wasn’t necessary and he wouldn’t give it to me”

ever been at the epicenter of a small outbreak? of anything? I have, again. (giggling) someday I will tell about the previous times, not now though.

“no problem its treatable with pennicillin”

“of which I am allergic.” ( peals of laughter)

“thank God I wash my hands.” (thigh slapping punchline)

at which point I go wash them again, using the half-bar of peach-scented soap.

O the insanity of it all. for those non medical readers, the nursing school also qualifies s a college campus, meaning that we now have to address the issue of immunizing our eighty or so nineteen year olds. BTW the shot only protects against two of the three strains, probably not the one we aree dealing with.

I knew life on the communicable diseases ward would be entertaining. and it is. In terms of dealing with making the assessments and performing the tasks, I did great… if it is any consolation.

love to all,

Joe