Amebiasis, Appendicitis and Ascariasis

Another GI bug.  I was just thinking that we must be getting used to the bugs here because it had been a while since any of us had diarrhea or vomiting.  But there was Tim, vomiting and diarrhea-ing the night before we were supposed to leave for our in-country retreat.  And to get there we would have to ride a bus for four hours.  Oh, the joys of living overseas.

At the time it crossed my mind to act as Tim’s doctor for a moment, so I got my stethoscope, listened to and palpated his belly, checked his pulse, which also gave me a rough idea about his blood pressure.  Everything was fine, no evidence of appendicitis.  I actually thought that!  I asked Tim if he wanted to stay at home rather than go on the retreat, but he thought he would be fine.  After all, a GI bug usually lasts 12 to 24 hours and then passes, leaving enough time for him to actually enjoy the retreat: the friends, the worship, the talks, the food.

But a couple of days later, he still wasn’t better.  The explosion of fluids coming out had slowed, but Tim was still not feeling well.  When people asked me how he was doing, I typically said that he was improving but still feeling crummy due to dehydration because he was refusing to eat or drink anything out of fear of nausea and bloating. 

Then the earthquake hit.  Tim was sitting outside the hotel room so that Jack could fall asleep.  I could see the room from the flat area outside where I was standing, and Tim was swaying next to the hotel door looking rather poor. 

That night the outpouring of fluids started again, so I had our “on-call doctor,” who is our hospital director, look at him.  It seemed he probably had a mild ileus and was certainly dehydrated, but again he had no worrisome signs, medically speaking.

The next day we decided we needed to get him some IV fluids because he was continuing to become more dehydrated, and we knew we needed to return to Tansen soon but didn’t want Tim to be so unwell on the ride back.  The hospital director, interim medical-superintendent and I went on a hunt for IV fluids and an IV giving set at the pharmacies to no avail.  So we took him to a local clinic, well-established in Kathmandu but new in Pokhara.

He received over 4 liters of fluid and had an x-ray done, which of course had many air-fluid levels, a worrisome sign usually but common to see in severe acute gastroenteritis, which we all thought Tim had.  One of our surgeons came along and examined Tim’s belly and agreed with our assessment, suggesting more fluids and staying overnight in the clinic for observation.  As one friend said, it was “BYOS,” or Bring Your Own Surgeon!

Unfortunately Tim called me soon after to say that he was sitting in a wheelchair outside and had been told he would be sleeping in the field out of fear of further earthquakes.   Well, that hardly seemed appropriate for healing!  So I asked them to quickly finish up his IV fluids and stole him away back to our hotel room.

The next morning we left on the bus to head back to Tansen, for which our entire team was grateful.  On arrival, there were more fluids coming uncontrollably.  Our surgeon friend suggested that, if Tim couldn’t walk home he should probably be admitted.  I was trying to figure out what to do with Jack, how to get all our stuff back up to our place (a five-minute walk on flat ground but purely uphill and up steep stairs here), and how to take care of Tim.  Thankfully we have an amazing community of both foreigners and Nepalis, and this is when they really started to help us out.  Their help only continued in tremendous ways over the next week.  Another surgeon neighbor offered to check Tim out that night and continued to follow him very closely from that point on.

That night, Tim’s right hip and back started hurting severely, which we initially blamed on the incredibly uncomfortable hospital beds.  But the next morning his abdominal pain had worsened and was showing signs of peritonitis, a worrisome medical sign.  We had found the ameba in his stool, but according to a very experienced and excellent Nepali physician here, these symptoms would rarely—if ever—result from ameba.  By ultrasound Tim had a collection of fluid in his right lower abdomen, small but still significant in the face of his clinical exam. 

A nasogastric tube was placed—through his nose into his stomach—in attempt to relieve the pressure of his abdomen.  But a couple hours later Tim was still bloated and in pain, so he was taken for surgery.

Tim and Dhana Maya Didi, a fantastic nurse, just before Tim went in for surgery.

The culprit!

We discussed appendicitis, but we also discussed other more scary possibilities, such as very inflamed bowel or toxic megacolon and even the potential need for a colostomy: a poop bag through the abdomen.  Not good things. 

So when I heard the news that our surgeons had found a ruptured appendix, I was grateful!  And so were they!  A ruptured appendix is not to be messed with, but it sure is a better option than the other ones discussed!  The appendix was very deep in his pelvis, explaining his presentation.  He also had a small bowel obstruction due to the intestines getting caught up in the inflammation of the appendix.
But all of his intestines--minus the appendix--were left inside his belly.

One of the hardest things about having Tim in the hospital here was that someone had to be with him at all times.  There are no call buttons, and the nurse-to-patient ratios are much higher, especially at night.  There are no bins to go to the bathroom in bed.  There are no buttons to push to release pain medicine automatically.  And in all but one room in the hospital, there are no beds for the family member or friend to sleep.  Fluorescent lights are kept on all night.  There are no automatic vital machines, so a nurse comes by to wake up the patient and check them.  People talk loudly all night.

Paras, physiotherapist, and Dhana Maya Didi.

Surgery, anesthesia and nurses rounding on Tim the first day after surgery.

Tim’s first two nights after surgery were in the surgical critical unit, which is a room of four patient beds.  (Most rooms have 6 to 15 beds or more in one room.)  A friend brought her couch mattress and sleeping bag to put on the floor for me.  Another friend brought a little mattress to add to Tim’s bed so that he would be more comfortable.  After I put Jack to sleep, I went back to the hospital, and our didi slept at our place to keep an eye on Jack while I slept in the hospital.  On other nights, some of Tim’s friends stayed with him in the hospital so I could stay at home with Jack and recuperate a bit in my own bed. When I needed to run home to feed Jack or put him to sleep during the day, someone else was almost always available to stay with Tim in the hospital.  People brought juice and fruit gifts for Tim.  There was a nearly non-stop flow of visitors, sharing their sorrows and giving encouragement and prayers.  We were surrounded with support during a challenging time.

Sweet card from the daughter of one of Tim's surgeons.

Through all of this, I couldn’t help but notice that I was not feeling hopeless, abandoned, defeated.  I was overwhelmed at times by being pulled in both directions—to the hospital for my ill husband, to home for my young child—but not as overwhelmed as I usually get when everything seems to be going wrong.  I can only attribute this to the lessons God has recently taught me (see previous blog) and His strength and love sustaining me.  And I was grateful to the people who did not abandon our hospital to help with earthquake victims.  Yes, they obviously need help, but only so many people can fit into an operating room or into a helicopter.  Other hospitals must go on to care for people with non-earthquake illnesses because, unfortunately, the appendicitises, COPDs, and pregnancies do not push the pause button after earthquakes.

Tim's various bags of bodily fluids.

All tubes out!

Tim is still healing.  He has lost a lot of weight, so our did and I are making lots of good food for him to eat, but I’m eating more of it than he is!  His intestines are starting to function better, although he still gets bloated; he has no nausea, thankfully.  His wound is healing well everywhere except in one spot that keeps leaking, likely due to a small fascial dehiscence; however, there are no signs of infection, so we are waiting for it to heal on its own.  Jack was having a hard time going to sleep while Tim was in the hospital, likely because Tim was never home and I was only home to put him to sleep, so he was understandably more clingy.  But since Tim’s return home, Jack has been sleeping much better.  I am working a little bit before we fly back to the US.  This is hard because Tim cannot pick Jack up, which affects everything: playing with him, making sure he’s safe, feeding him, putting him down for naps.  We can only get an extra didi for a little bit, so my hours will be much less.  But the hospital has been very gracious in giving me time off.  

Operating room behind, waiting room to left, critical room to right, cross above.  Great summary.

Using papa's walker.

At the same time as all of this, Jack has had severe diarrhea thanks to ascariasis.  I am treating him, but cleaning up poop for two family members is not exactly fun.  I don't usually mind flushing our toilet with buckets, but right now a regularly flushing toilet would be so nice!

Overall this all seems a bit surreal to us still: earthquakes and weird, severe illnesses.  But we also feel cared for by God and our community. 

We do ask that you continue to pray over the building we live in.  I had a vision that indicated that there is a spiritual battle occurring here, and another friend had the same sense during prayer.  Three believers in this building have become ill with strange diseases ever since a 24-hour puja, or worship, occurred very close by that kept us all awake.  We have prayed as a group over the building, and I would ask that you also join us in this prayer.  We know the Lord has sent His army to battle, and we ask that He strengthen them and end this particular battle soon.