When Bad Things Happen to Good People on Vacation
Out of Africa (and Fast!)
by: Michael Modzelewski
It was a splendid safari. Along with the English guide Robert Carr-Hartley, my then-wife and I led a group of Americans through the game parks of Kenya for three weeks, seeing wildlife up close and in great numbers. The only disappointment was that we didn’t get to view the wildebeest migration in the Serengeti. There had been so much rain that year, 1991, that the wildebeest stayed south with plenty of grass to eat. So much rain… standing water, puddles in all of the camps… mosquitoes everywhere.
At the end of the safari we put everyone on the plane for home, but R. and I stayed an additional day, with appointments to interview leading African environmentalists, who lived in Nairobi. That morning I awoke with a splitting headache and a feeling of overall malaise. The house doctor at the Norfolk Hotel in downtown Nairobi was puzzled by my symptoms. He thought it was the flu, but then sent us downtown for a blood test, saying that when he received the results he would come to our room.
I told R. to go ahead and photograph the environmentalists – the interviews I could do later over the phone. She left reluctantly, sensing trouble.
I then tried to catch up on my journal, but couldn’t concentrate. My mind was overpowered by intense, physical pain. I was on fire. I stripped off my clothes and lay down on the bed. Sweat rose out of every pore, pooled together, then fell off my body like rain. The sheets were soon soaked. Then when the fever broke, there were chills so severe that I shook the bed.
Then and there I knew I had malaria – nature’s torture wrack. I had taken the daily preventive medicine, but to no avail. There was now a super-strain of mosquito-borne parasite immune to chloroquine. In a fit of black humor, I laughed. To be out in the African bush surrounded by large carnivores and man-eaters, only to be done in by a minuscule mosquito bite.
A knock on the door. The hotel physician, Dr. Shah, from India, stepped into the room wide-eyed and talking rapid-fire. “You have malaria and it is the worst kind – cerebral. It doesn’t stay in your liver but goes after your brain. It’s called ‘kill or cure.’ You have a 50-50 chance of living or dying. It’s now a race against time…” He took my temperature: 103. Then a dose of Fansidar. “This will lower the temperature and buy you some time. When is your flight home?”
“In a few hours.”
He said, “Good. You belong in a hospital right now, but I must tell you, the hospital here in Nairobi is not like those in America. It is somewhat primitive and I cannot guarantee you that every needle will be sterilized. AIDS is epidemic here now. With malaria you have a 50-50 chance. With AIDS – none. You are very fit and strong. Get on the flight and if you don’t make it all the way home, you’ll at least reach London where there’s a very fine hospital.”
R. returned from the photo shoots to find her worst fears confirmed. Dr. Shah gave her instructions on how to keep her husband alive: ice-cold towels during the fevers, blankets during the chills and water, water all the while to keep the patient hydrated. He then added: “The airline won’t let you out of Africa if they know you have malaria. It’s not contagious – but they don’t want a death on their hands. Be careful.”
The malaria parasite is a wicked creature. It attacks, withdraws, then attacks again. In a lull between battles, we left for the airport.
It was a 10-hour flight from Nairobi to London, 18 hours total to San Francisco. Our plan was to check my condition in London, then decide whether I could make it all the way home. We were optimistic until we boarded the plane. The flight was delayed. After an hour it was determined to be engine trouble. “A part is being flown up from Johannesburg,” the pilot announced. We sat on the runway for a total of three hours; then the flight was canceled. We were bused back into Nairobi and put up at a hotel. We would be called when the plane was ready. In the race against time, I was already falling way behind.
A few hours later we were back at the airport to try again. There was one small hitch. I couldn’t sit up. Under siege once again from the malaria parasite, I felt as though all the destroyed red cells had turned my blood to sludge; the only way to get oxygen to my brain was to be horizontal. Sitting up I could feel my brain begin to suffocate. I had no choice but to stretch out on the cold, filthy floor, watching a wide array of sandals, shoes and military boots step by me as I struggled to keep my brain breathing.
R. reported that the flight was only half-full, so I could get three seats to stretch out across – if I could get past the customs officials. From my prone, pale and sweat-soaked appearance, clearly there was something wrong with me. On the spot R. hatched a plan. I’d fake an ankle injury with my wife explaining that the severe strain was why I looked so pained – but then in my delirium, I kept forgetting which ankle it was, alternately limping on both. As she talked fast, I slowly hobbled by them…. then collapsed across three seats, steeling myself for the long flight – that then grew longer. This flight was inexplicably delayed an hour and a half, and the air conditioning was not operating. In the stifling hot cabin, another wave of fever hit. And then something I have never seen before or since. The interior of the British Airways 747 was sprayed to kill all bugs trying to immigrate to England. If only they knew what was incubating in row 24, I thought as a man with a spray can walked by. Fever-maddened, and recalling Kafka’s “Metamorphosis,” I upgraded the insect, picturing myself turning into a giant mosquito that terrorized the plane.
Finally we took off, R. kept me in both cold towels and warm blankets. About halfway into the flight, wracked horrendously by pain, I knew I was in trouble. In the semi-darkness, I reached out and grabbed the creased pant leg of a male flight attendant as he walked down the aisle.
“I have malaria. Do you know if there’s a doctor aboard?”
“No, there isn’t. I just checked the passenger list for someone else. But there is a flight attendant who used to be a nurse… I’ll go get her.”
After taking my temperature, she gave me a pill that she guaranteed would lower the raging red line. When the stewardess returned, she pulled the thermometer out of my mouth and held it up to the light. Her eyes widened. She shook it and looked again.
“I can’t believe it. The temp is even higher – 105!” She stepped back for a moment, glanced at R., then knelt down next to me. In a clipped English accent she whispered: “There are five hours until we land in London. You’re going to have to fight for your life. I don’t want to scare you but no one can help you now… Fight it. It will get very bad, but fight it. I’ll check on you often. I’m going to tell the pilot to radio ahead to Heathrow.”
Crying, R. held my hand. I squeezed back, wincing from yet another attack. Again fever raged as the parasites ravaged my bloodstream. The veins at my temples were distended. The back of my neck felt axed. Then – chills so severe the tremors curled my feet and chattered my teeth.
To save my life, I reached for images… trying to visualize some sort of shield against the pain. I recalled an old invasion movie and made it my own. My brain was the castle and I had to keep the door closed to the invading army – but I was outnumbered and the barbarians were now slamming against my firm resolve with a battering ram. I felt the parasites right there against my brain and knew for certain that if the door opened a crack, I’d be finished.
In the darkened cabin and with the unchanging hum of the jet engines, time seemed suspended. Five hours an eternity to endure.
I floated in and out of consciousness, and at 35,000 feet I had “visitors.” Gerhard Kiesel, and adventurer who died trying to set a sailing speed record from California to Hawaii, a close friend who had 30,000 miles of blue water sailing under his belt was suddenly there. I saw him in my mind’s eye: a living vision who inspected my “castle door” nodding his head. Then my father was next to me. I heard his living voice loud and clear in my ear: “Michael, you have the strength to make it. Take my strength too.” I did – attaining confidence and peace.
I was jolted awake by the landing gear hitting terra firma. I opened my eyes and looked at R..
“I’m alive… right?”
“Yes!” she said, laughing and crying at the same time. “But now we have to rush to the hospital.”
Flashing lights in the night, speeding past stately palaces, hotels, rows of Victorian houses on rain-soaked streets… up a flight of stairs, taking one-at-a-time forever, then collapsing into a bed, surrounded by expert care. I let go, giving myself completely over to the Hospital for Tropical Diseases.
Malaria-carrying mosquitoes have killed more humans than all the wars combined. Approximately 2 million people die annually, world-wide, from malaria and malaria-related causes. Prior to the 17th Century, malaria ran rampant in the fever-ridden cities of Europe, claiming many lives each year. Alexander the Great died of it. The collapse of the Greek and Roman empires is partly attributed to it. Yet, despite Hippocrates’ familiarity with malaria in the 5th Century BC, for much of the modern era the cause of the disease was a mystery. The Italians in the 18th Century referred to the cause of the fever as mal aria, bad air. The African explorer Richard Burton thought it had something to do with sleeping in the moonlight. It wasn’t until 1897 that an English doctor discovered that malaria was caused by mosquitoes. A cure had long preceded the cause. In 1663, a Jesuit priest in the pharmaceutical forest of Amazonia learned form the Indians that an extract from the bark of the cinchona tree defeated fever. The Jesuit shipped quinine to England in time to save the life of Charles III, but not Oliver Cromwell, who did not trust the medicine of Catholics.
Around the clock, this traveler (and former alter boy) swallowed mega-doses of quinine as if it were Holy Communion.
Turned out I was lucky, very lucky. I landed at the best place in the world to treat malaria. The Hospital for Tropical Diseases has been in service for more than a century, acquiring its expertise when mad dogs and Englishmen stayed out too long in the tropical sun, struggling to expand the British Empire. If they didn’t altogether expire in “The White Man’s Graveyard,” as Africa was then called, many pith-helmeted colonialists recovered in these same hallowed halls.
Located in a Gothic brick building on St. Pancras Way, the hospital has wooden floors, slightly slanted; old, iron-clad radiators rumbling and hissing heat; window glass rippled from the long march of time. Not one beep or byte from computerized hardware; instead, a plenitude of TLC from a most knowledgeable staff.
It is also a teaching hospital. The morning of the second day, with the tree bark extract having delivered me from death’s door, but with my temperature still sky-high and spleen and liver fully swollen, my physician stopped by and in his best bedside manner, asked if I would be willing to serve Medicine and Mankind – by allowing a few of his students to “pop in for a visit tomorrow to examine your spleen.”
“Sure Doc, what do I have to do?”
“Nothing. Just be yourself. They see malarial spleens in textbooks, but one like yours doesn’t come along very often.”
The next morning I awoke to find my spleen – an organ I had never given a single thought to – now the subject of a lengthy discourse by the good doctor to a group of med students all gathered around the bed, fresh-faced in white frocks. Amid the medical jargon, the gist of the message was that the spleen, along with the liver, are the body’s two main filters, straining out harmful substances from entering the bloodstream. From it’s distended, football-like shape, it was clear that my spleen was clogged – by a multitude of ravished red blood cells.
The students formed a single file line under the doctor’s (and my own) watchful gaze, they each stepped up and with both hands, studiously followed the spleen’s ovoid outline.
The next afternoon, I got out of bed for the first time. I stood up slowly, then shuffled to the bathroom feeble and spent. I felt battle-weary, robbed of a vital essence. I cringed under the spray of the shower; shaved with a trembling hand; struggled into a clean robe and went down the hallway to the communal dining room, where I sat at a long table running the length of the room.
The hospital was a regular United Nations, with seven different nationalities seated for supper, speaking in varied languages about equally diverse afflictions. I sat across from two young, rugby-player-big Englishmen, their faces wrapped in bandages – muscular mummies.
“Hey mate, what you got?”
“Malaria – cerebral,” I said, tapping my head.
“Oohhhhh, the bad one….”
“What brings you here?”
“Sand fleas. Can you bloody believe it? We were in Panama on a reptile-collecting expedition for museums, when along a riverbank this cloud of fleas drops down, biting us. Thought nuthin’ of it. Then a couple weeks later we started scratchin’ our faces off. Turns out the fleas lay their eggs in your blood when they bite, then later the larva hatch and want out….”
“Skin is thinnest around the eyes,” the other man said, pulling a bandage back to reveal the exposed white of a facial bone.
“Cheeky bastards!” the other said, both men erupting in muffled laughter at the pun.
I looked down at the spaghetti and pushed it away. The next morning I told the doctor about dining with the “Sand Flea Boys.” He nodded his head saying, “If you’re from North America or the temperate zone, you basically live in quarantine. In comparison, the tropics harbor some monstrous diseases and with no built-up resistance, you’re constantly under attack from one or the other. Our case files are full of horror stories. This hospital has seen it all.”
The around-the-clock doses of quinine steadily chipped away at my high temperature, but they did so with a strange side-effect, an eerie repercussion. My ears buzzed constantly. More than an intermittent ringing, it was as if all the dying mosquito parasites themselves were protesting en mass in my ears. As my temperature dropped, the quinine doses were decreased and my hearing cleared.
I was then shocked to hear my own voice. It was garbled, sloppy, out of control. The words all had chipped edges or were slurred in their entirety. When R. arrived later that afternoon, I asked if I had sounded like this all along.
“Yes,” she said, looking crest fallen. “The doctor told me, but said he didn’t want to worry you. The malaria did get into your brain, to the part that affects speech.” She started crying.
I lay there stunned. Words formed perfectly in my brain but then fell apart on my tongue, lost somewhere in the translation.
“Is id puhmahnant?”
She cried more, then shook her head. “The doctor doesn’t know. He said everyone is affected differently. He said that part of your brain was suffocated from lack of oxygen during the last attacks – probably on the plane here to London.”
We held hands and cried together, but then I refused to get discouraged. “I con beet dis ting!” I said, sounding like a punch-drunk fighter.
The next day, during lunch, I had one of the nurses, on her library card, check out “The Collected Works of William Shakespeare,” and for hours each day I struggled to wrap my tongue around those marvelous sonnets and soliloquies. But no matter how hard I tried, how long I read, my speech remained slurred. The doctor suggested I see a speech therapist when I got home – that I might need to learn how to speak all over again. “But consider yourself fortunate. You’re alive. You got here in the nick of time. If you had arrived an hour later – well, you might have been totally impaired…. or dead.”
A week after entering the hospital I was released. R. and I rode in the roomy back seat of a London cab to the airport. I was 22 pounds lighter and very, very weak.
At home in California, R. fielded all the phone calls, covering up my impairment – saying I was OK, resting. I was panic-stricken. Words were literally my life – written mostly, but I also earned a good part of my income lecturing across the country, and how was I going to pitch intelligent story ideas to magazine editors when I sounded like Joe Palooka?
To feel useful, I helped R. with the housework, even agreeing to move two large houseplants outside for watering. But afterward I collapsed on the bed, exhausted. Now I cried. Before the malaria, I was an Iron Man. I ran 100-mile ultra-marathons; I lifted tons of weights daily in the gym. Now I couldn’t even tote two houseplants 20 feet…..
At that time, this vegetarian suddenly developed an insatiable craving for meat, and the redder the better. I was astounded. What previously was repulsive was now all I wanted to eat. But not just any carcass of cow. I had to have prime filet mignons – not cooked, but merely warmed up on each side. The beef had to be sitting in a pool of blood and grease or it wasn’t appetizing. After devouring the raw meat, I then lifted the plate, tilted it, and gulped down the blood. As sick as it sounds, I somehow sensed it was making me healthy.
This went on for a week. I looked forward to the raw repasts and drinking blood with all the relish of Count Dracula.
At night, I began having childhood regression dreams of putting together Tinker Toys, excitedly inserting spindles into the wheel knobs – which proved to be my subconscious mirroring what was actually taking place in my brain.
On morning I awoke speaking clearly. The words were fully formed!
I then saw a doctor who set me straight, both about the vampiristic tendencies and the Tinker Toy dreams: “Right now, in your bone marrow, your body is working overtime to rebuild all the red blood cells the malaria destroyed. And the ingredients to make red blood cells are iron, salt, B vitamins, certain fats – all found in your raw filet mignons. I saw a lot of malaria cases as a medic in Vietnam. Did they drill a hole in your head?”
A lot of times with Plasmodium falciparun – to counteract the swelling of the brain – a hole is drilled into the cranium to relieve the pressure.”
“How I wish!” I then told him the case history, the entire story.
“You’re very fortunate. Cerebral malaria is a real killer. It can suffocate the brain in short order, setting up massive strokes. The way I see it, you survived because you were in great shape physically from marathon running, and that also prepared you psychologically – being used to carrying pain through time, as you do in a marathon. So many people die because when that intense pain hits, they panic and that opens the ‘floodgates’ to the brain. As far as your ability to speak coming back – the brain is actually able to figure out what’s wrong and then among all the unused neurons, reroute circuitry to reconnect that ability. Your “Tinker Toy” dream reflects that… Your brain may have lost a battle but it ultimately won the war.”
Then, as suddenly as the vampirish craving started, it vanished. I went back to vegetarian fare, and watering the plants was a piece of cake. With new red blood cells being manufactured every day, my strength began to build. I no longer needed to sleep after the slightest exertion. I began eyeing my running shoes.
The first run was pitiful. I could barely finish a mile at a snail’s pace. Breath came in gasps; leg muscles cramped from lack of oxygen. But I stayed with it – each day pushing further and faster against my limitations. Out on the trails I soon felt progress like a palpable companion. I marveled at the human body and its recuperative powers. Exercise and stress it on a regular basis and the body only gets stronger. Do the same to a machine and it weakens and breaks down.
Two months after returning home, I ran the Point Reyes Trail Marathon, a rugged seaside course with 5,000 feet of steep uphills. I set a personal record, not merely finishing but running it faster than three previous times, times when I had my “original” blood intact.
One year after malaria had stripped away all of my strength, I completed the Angeles Crest 100 Mile Endurance Run in the San Gabriel Mountains. Running with my youngest brother, in less than 24 hours we climbed 20,000 feet and blitzed downhill for 20,000 more, finishing 17th out of 300 starters.
As for Africa, I write about it incessantly; awake in the middle of the night, snap on the light to continue reading about the Dark Continent. Nocturnal dreams are filled with the splendors of the Serengeti Plain, where one day I saw 27 lions.
In “Journey Without Maps,” Graham Green wrote: “I thought for some reason even then of Africa… a shape, as strangeness, a wanting to know. The unconscious mind is often sentimental; I have written ‘a shape,’ and the shape, of course, is roughly that of the human heart.”
Despite the hellish ordeal with malaria, Africa’s hold on this traveler has not weakened. I would return in a heartbeat.