Trip to the Emergency Room

Fair warning: this might be a little graphic and gross for the weak of stomach.   Be warned!
Fair warning update 2017: this was also written by a much younger version of me.  Please forgive her glaring… youth.

So, as I was saying a temporary goodbye to Kong – my Angkor Wat motorcycle driver –  I was also eating “mien” (like ‘mean’) or longan  – a relative of the lychee.   They are a delightful fruit with a thin peel.   Once peeled, they have the consistency of a grape (smooth and slick), are slightly smaller than a golf ball, have a flavor much like cantaloupe and pineapple, and a big seed in the middle – about twice the size of a corn nut.   I had one of these glorious globes in my mouth as I walked away.   As I shouted back “Okay, bye!”   I took a deep breath in to follow up  with, “See you at 5:30!” and instead inhaled the un-chewed fruit straight into my throat.   Ahhhh!

Longan’s aren’t huge, but they aren’t small either. photo Emran Kassim

Two minutes later, as I wandered up the street to check out Singing Trees, I could no longer swallow.   I am one of those people with an ‘esophagus  thing.’  If I eat too quickly, food becomes lodged on its way to my stomach.   From here, I either sit drooling over a sink or toilet until it passes – unable to get anything past the painful blockage, or I throw up.   Not stinky-from-the-stomach puking, but my body just clears out whatever was stuck.   Throwing up is always much nicer and quicker than waiting for the lump to work its way south, but I never get a choice.   Starchy foods like rice and bread and dense foods like meat are the biggest culprits.   This has been a source of embarrassment at several “just-met-you” dinners for me, as my dining companions worry and hover over my drooling, spitting self as I assure them “I’m really fine.   This happens all the time.   I don’t know why it happens.   No I’ve never been to a doctor.   My parents just told me to eat more slowly.   Really.   I’m fine.   It will pass.   Please, go eat.   I’ll be fine.   I’ll be out in a minute.   No, really.   It’s fine!”

Never have a I swallowed something so large and so… whole.   So… unchewed.   The tightness in my chest was worse than any other time as I trudged through the streets back toward my guest house spitting everywhere.   Kong had been so nice to me, and I was sure the blockage would pass soon.  So I went to meet him… and his girlfriend Heather for dinner.   We were going to the market to get ingredients and then go back to their place to make dinner.   The market was fantastic, minus me fleeing to the street every few minutes to spit.   And then few times that my mouth was so full of saliva that I couldn’t respond to questions without looking like something out of a horror flick.

Cambodian markets don’t really stink, which is awesome.   Usually the smell of flesh and fish at the markets penetrates all corners – even the dry goods and clothing – but it wasn’t like that at this market.   We rolled up our pant legs to cross through the section of vendors selling flopping fish, and I got to see a woman with a seasoned hand rapidly turning a pile of skinned frogs into frog legs for sale.

Frog legs – not at the market, but this is what they looked like there.        photo wikimedia

We bought vegetables from their favorite vendor.   At the pork stand, there was also a black block of a clay-like substance for sale.   I asked my companions what it was (between mouthfuls of saliva), and they told me it was blood mixed with a gelatinous substance which is then cut into squares and used as soup stock.   Heather said she likes it.   Oh.   Umm… yum.

After our rice purchase, we loaded up in Kong’s tuk  tuk  for the trip back to their apartment.   They have a lovely furnished place that is so 70’s with dark wood paneling covering one half of the main room and burnt orange paint covering the other.   Heather showered while Kong worked on chopping things for dinner.   I helped out, between spitting out mouthfuls of saliva, trying to be  a good conversationalist and not let the tightening in my chest distract me.   Then it was Kong’s turn to shower, and I chatted with Heather about her past and her Cambodian existence.   She’s done lots of teaching around the world, and loves it here!   I’m invited for drinks later with their friends – a goodbye celebration as I learn Heather and Kong are moving to Phnom  Penh in a few days..

As the evening moves on, my need to spit turns into a need to throw up as I inevitably swallow some of my saliva.   My esophagus fills up, and when it’s full, I then wretch over a toilet until it comes back up in a froth.   Ew.   I tried to eat some rice and veggies, which made me puke almost immediately.   Then, at Kong’s urging, I try to take a big drink of water in the hopes that that will force it down.   When I have my esophagus problem, this is always the first remedy people suggest, but I know that anything else going in just makes things worse.   I’m desperate this time, so I take two big swallows of water.   Big mistake as I bolt for the toilet and spend a few minutes escorting it back out of my throat.   Yuck.

Finally, Kong finishes his water, and I stealthily nab the bottle creating for myself a place to spit without having to run to the bathroom every 90 seconds.   Now I am much better company, and I can only hope they don’t notice that I am now collecting a bottle of saliva.   Again, yuck.   We head out on the town to meet up with their friends.   It has now been almost five hours.   Usual clearance time is from 3 minutes to an hour.   The longest I’ve gone was 90 minutes because of some stupid rice in college.   Now I’m getting worried.   I decided to skip the social scene which would require  me to sit in a bar and spit in a bottle unable to partake in the celebrating.   Nothing will go in my body.   I go to an internet cafe and start looking up ‘can’t swallow’ and ‘ask-a-nurse’ phone numbers in the U.S.   I call my boyfriend, Pat, who calls the hotline for me.   In my distress I forget to tell him that you have to trick the nurses because of stupid US laws.   They won’t (can’t) help you if they’re not licensed in your area.   So he tells the Montana nurse that he’s calling from California, and she says, “Sorry.   No dice.”   Oh no!

Pat calls the Mad River (Arcata) Hospital who say I would need to cross the thousands of miles to the California coast and come in to be  evaluated.   What they will tell him is that I either need a muscle relaxer to help the spasms do their job, or (god forbid) an endoscopy to push it down or pluck it out.   Oh, please no tubes in throat.   In my frustration at the cards being stacked against me, I am short with Pat who I wanted to be my salvation (sorry sweetie) and rush to end the pricey call.   Having no other options, I head back to my guesthouse to wait it out.   My bus leaves at 7:30 a.m. to take me to the Thai border.   At least, if it’s not gone, I can go on to Bangkok to get some medical care.   My guidebook says cryptically, “If you fall ill in Cambodia, run – don’t walk – to Thailand.   Cambodian medical care is atrocious.”   Oh no!

I watch National Geographic specials for a few hours, spitting into my bottle every 90 seconds, and puking  up the accidentally swallowed saliva every 20 minutes.   The squeezing in my chest is awful, and my hopes at getting any sleep are dashed  as I instantly start to drool all over the pillow.   I resign to reading my newest purchase, “First They Killed My Father” – a book about a family by a woman who was five when the Khmer Rouge took over.   When the chest pain gets so strong I can’t concentrate, I stare at the wall as I spit into my bottle and think about the next step.   I would die for a drink of water.   It’s been seven hours now since I’ve had anything.   My pee was dark, dark yellow last time I went – a product of hiking up and down temples in the tropical heat all day while only drinking a liter and a half of water.   I slowly realized that if I’m still in this condition in the a.m., getting on a bus would be a stupid choice.   I will be hot, continuously more dehydrated, and starving.   I realize that I could end up passing out and would then be at the mercy of my rescuers.   I shudder at the thought of the death-trap of a clinic described by my guidebook.   Crap.

I’m getting desperate.   I start to brainstorm ways to get a muscle relaxer into my body.   I remember a third-grade teacher my mom used to work with said when she was in Ireland, they used to snort shots of vodka to get drunk really fast.   Would that help?   I realize that I can breathe and therefore  could smoke something.   There’s a reason that ‘medical marajuana’ exists.   It’s supposedly really illegal here, and I weigh the possibility of  Cambodian prison with the possibility  of being able to eat and drink again.   In the end, I don’t take the streets in search of weed.   Then I remember someone once told me that anorexics  put alcohol up their bums to avoid ingesting the calories associated with it.   I consider this and then realize that I might also be able to put a pill there and accomplish the same thing.   Then I decide I would rather risk illegal pot smoking than experimentally shove some questionable pharmaceutical up my rear.   Damn .

Now it’s midnight.   My chest pains are increasingly worse as I become more and more dehydrated.   I flip open my guidebook and read about medical care in Siem  Reap.   It names a hospital that’s ‘affiliated’ with ‘the hospital’ in Bangkok.   This is like saying a college is affiliated  with a university in Boston.   Um… there are dozens.   Which one?   I decide I don’t care.   ‘Bangkok’ is enough for me as I weigh the possibility of  passing-out-from-dehydration-and-choking-to-death-on-my-own-puke with sub-standard medical care.   I am going to the hospital.   I dress and try to rouse one of the staff sleeping next to the front desk to help me.   He murmurs sleepily from his hammock, “No speaking English.”   I look up hospital  in the dictionary and try out the foreign words.   No dice.   Then I say “tuk  tuk.”   Still nothing.   Then I say, “Can you help me get a tuk  tuk to the hospital?”   Again I get, “No speaking English.”   Shit.

I’m starting to get a little panicked, which is saying something.   Usually I am the epitome of calm, even when bad things are happening.   But I do NOT like this.   At all.   Finally I decide to hit the streets and hope there’s someone there.   The image of the girly bar I will have to walk past with all its leering staff lingering outside passes through my head and I shudder.   About a block past my guesthouse, I hear a motorcycle  coming.   Make that a tuk  tuk.   I peer into the headlights trying to discern whether it is occupied.   I think not, and I raise my hand to flag him down.   He wants five bucks for a two dollar ride, but I am too desperate and anxious to keep this opportunity, so I agree.   I spit in my bottle the whole  way to the hospital  and am greeted  by corridors empty of patients except for me.

I explain to the man at the nurse’s station and ask for internet so I can show them a picture of what I swallowed since they are having trouble understanding.   I quickly email Pat so the only person out there who knows of my fruit choking incident will also know where I am.   They want an xray.   I tell them they won’t see anything, except maybe the seed, since fruit is organic matter.   I ask for a muscle relaxer.   They say they will give it to me, “but first x-ray.”   I suspect this might be a money maker for the hospital and nervously wonder if my insurance company is going to live up to the reputation of  insurance companies and I will have problems with my claims.   I am the type of person who would not carry auto insurance if it wasn’t legally required.   This time I am glad that I followed advice, albeit reluctantly, about getting travel insurance.

Of course the xray  shows nothing.   This is my first hospital admittance.   Ever.   In my entire life.   My mom has taken me to the emergency room before for flu and whatnot when it was outside of doctor’s hours, but never have I been a hospital patient.   And now I have to go choke on fruit in Cambodia.   How exasperating.   So, finally they stick one of those awful IV things into my hand, draw some blood, and put some antispasmodic medicine into my bloodstream.   Finally!   Actual treatment.   Now just work on my dehydration issue and you’ll be my new hero!   I get a little nervous as the doctor and the nurse converse in front of me with confusion on their faces.   I get the impression they are trying to make a team decision about what to do and don’t really know.   I don’t like it, so I say, “What’s going on?”   I get a barely intelligible reply and the doctor ushers the nurse out to hash out their guessing game in private.   Oh no!

Finally the nurse returns and he hooks up my saline drip.   Relief!   Over the next half hour, my dizziness starts to subside (placebo?), and they tell me I am going to be  admitted to a ward.   I become an official invalid as they insist on rolling me and my I.V. on a gurney upstairs to my first ever hospital room.   I spy a computer in the hall and ask to again use the internet to send an update to Pat.   I feel like I’m in a movie as I wheel my drip with me down a hallway.   I hunt and peck out an email with my I.V.-free hand.   I get new nurses and a new doctor to whom I have to explain the story all over again.   The new doctor wanted to give me a muscle simulator.   Isn’t that like drinking a beer and then having a cup of coffee?   I am desperate to drink, eat, swallow, and be pain-free again, so I agree.   They are going to monitor me for a few hours.   If I’m not better, I go to Bangkok for an endoscopy.   Yuck.

The nurses want me to try and  drink some water, so I go through the uncomfortable demonstration of just exactly  how it doesn’t work.   They freak out as turn exorcist and puke back up the water and extra saliva that’s gone down recently.   Convinced, they leave me to read my book.   Finally, it’s 3 a.m. and I am exhausted.   I raise my bed to sitting and actually manage to sleep for 20 minutes at a time until my throat fills up, my chest tightens, and I need to puke.   At 7 a.m. my new doctor decides I should have another x-ray – the kind where you drink something that appears on the x-ray and identifies the blockage.   I try and  explain that I can’t get more than two tablespoons in before immediately puking  but he wasn’t to try anyway.   ($$$$$$??)   Oh well.   The not-so-gentle morning nurse helps me get my top off again for the xray.   They take three shots, lining me up, having me swallow at the last minute and then wretch until they move the equipment so I can puke.   Yuck.   Of course they don’t come out because I couldn’t drink enough fluid.   Crap.

Now we are making plans to fly me to Bangkok where they have endoscopy equipment.   I will miss the first departure, so they try and  get me a seat on the afternoon flight.   Once my second saline drip runs out, they unhook me and I get my affairs in order.   The plan is to go to the airline office, purchase  my ticket (insurance better pay!), go to my guesthouse, retrieve  my luggage, then go to the airport.   My personal plan, since I am in one of the wondrous spells of no chest pain, is to swallow NOTHING until I get to Bangkok.   Then, on arrival, before going to the hospital, I will try some water to test the blockage and possibly invite a whole new bout of puking  and chest pain.   I get my affairs in order and am escorted to the cashier’s where I sign my credit card slip for $373.33 in medical care.

My escort has disappeared, so I sit down to wait and re-read my insurance policy.   To my dismay, the coverage section seems to say that it will only cover doctor recommended medical care (I’m safe here, I think) and flights where the ensuing hospital stay is seven days or more.   Shit.   I am only going to need a few hours.   As I wait for my escort, I lament having to give up the pain-free spell I am in to test the blockage, and head for the water tank.

I fill my glass with cold water, enjoy a few more seconds of being pain free, and take a tentative sip.   Nothing.   Then another sip.   Still nothing.   I get brave and take a big swallow.   NOTHING!   What timing!   I am cured!   No pricey airline flight!   I can eat!   I can drink!   I take a few more tentative swallows until the glass is gone.   I fill it and finish it two more times.   Drinking never felt so good!   YES!   My escort is still missing, so I ask reception if they can arrange a tuk-tuk.   Turns out that’s part of my $400 visit, so I am delivered back to town for free.   Thank you!

Yay!   I am free!   Afraid to stomach solids, I order up a fruit shake for breakfast.   It is heaven to feel food in my stomach again.   Then, I make phone calls to Pat and my mother, and one to my bestie Mags for good measure. I feel silly, but I am joyous as I make my way to my guesthouse to drop off my things.   Since I’ve missed the only buses out of here, the only thing to do today is blog, read, eat, and relax. I decide an ice cream is in order for the ‘sick girl’ and get myself to the  air conditioned  shopping center for a banana split.   Mmmm!!!   Today has ended up being a great day.   Now I just hope my insurance comes through!

Update 2017: It did.  Submitting the paperwork was super easy, and they paid the whole thing!