September 18, 2019
September 18, 2019
A Taste Of My Own Medicine: What Happens When The Medic Gets Sick……
Dr Helen Gertig, medic for TDA Trans-Himalaya 2019, describes an episode of illness and some surprising lessons.
After one month on the Trans-Himalaya Cycling Tour, I was feeing pretty smug. Despite three weeks spent at high altitude, multiple questionable street food forays, and a morning spent cycling along the world’s most treacherous road, I was sitting pretty healthy. However, in a country notorious for its gastroenteritis, where a runny tummy is so prolific it has its own loving nickname – “Delhi Belly” – it was only a matter of time. And so it was that I found myself halfway through an evening consultation with a rider, starting to experience worsening waves of nausea. A gulp of air as I reached for my stethoscope, a shift in the seat. The urge to vomit was becoming irresistible……
How could I play this? A quick silent vomit in the ditch behind whilst the patients back was turned, quietly waiting for me to listen to their chest? But what about the inevitable spray? And its pretty hard to be sick in silence….. Confess, and let the patient be party to the whole sorry spectacle? But you wouldn’t really want antibiotics from a doctor who was clearly in the process of succumbing to their own raging infection. Flashbacks to medical school – why was this scenario never covered in those endless medical ethics lectures? With the idea to maintain some scrap of dignity, I gently excused myself and walked in the calmest manner I could summon to the nearest bathroom. Sweet relief in the form of a noisy expulsion of gastric contents back up the way. A heavy decontamination later (think water, soap and multiple bottles of alcohol gel) and I returned to finish the consultation, muttering something about a coughing fit. No, my finest moment it was not.
So began my twenty four hours as a patient – every doctor’s worst nightmare. Luckily, the wonderful TDA family was on hand to help, and in between raging vomits I learnt some useful and affirming lessons:
Every Indian hotel, hostel and guesthouse comes with a sturdy, large bucket in the room. Previously I had used these for washing clothes only, but it turns out they are most excellent for containment of your gastric disasters when the bathroom feels just a heave too far. I’m now back to washing my clothes in them, albeit with a surreptitious antiseptic rinse first.
2. If you didn’t know it already, TDA tour leaders are pretty awesome
“I can do injections if you think you need one for the nausea, just not IV lines” declared our leader Emily in a businesslike manner as she washed out the aforementioned bucket. I gabbled something about orally dispersible medications (medications that dissolve in the mouth, meaning the patient doesn’t have to try to swallow tablets when vomiting. They are a brilliant form of drug delivery that sometimes avoids the need for an invasive injection when a patient cannot swallow), and we eyed each other warily. Emily, a thousand thanks. I owe you a drink, or five.
3. Yes, I concede, ORS is pretty horrible
As an expedition medic, oral rehydration salts (ORS) are my favourite bit of medical kit. Whether you have vomiting, diarrhoea, or have just had a long, hot sweaty day on the bike, you loose a lot of salt. Your body is highly sensitive to very small changes in its salt concentration, and even a relatively mild loss can leave you feeling pretty rough. Oral rehydration salts can be found in pharmacies all over the world, and are basically small premixed sachets of salt and sugar to dissolve in a set concentration of water, to rehydrate the patient and restore their salt balance. They are magic things and can make you feel better really quickly. Anyone who has been on expedition with me knows that I push ORS like mad, and can bore anyone unlucky enough to innocently enquire with hours of witterings on osmolalities, optimal intestinal absorption and hypo- vs hypernatraemia. However, like any medicine worth its salt (apologies, irresistible…), oral rehydration salts are not very palatable. And thus it was that my room-mate watched me with a humorous glint in her eye as I tried to swallow down the disgusting taste of my own medicine.
This 3,300km ride will take cyclists from Kashmir to Kathmandu. Along the way they will pedal over passes as high as 5,000m, spin past remote forts...
4. India has its own illness comfort food, and its pretty great
In the UK, when someone is nauseous, the consensus seems to be that they must be fed dry toast and flat coke. Nothing so pedestrian in India. Once I had stopped feeling quite so sorry for myself (and had cleaned out my nose), I was ready to join my colleagues around the dinner table once again. They warily watched me perusing the menu, before swiftly taking matters into their own hands. “She’ll have the kedgeree, thanks” – from my colleague Nirmika. “You will love it, its the ultimate Indian comfort food when you’re ill” Move over dry toast – this soothing blend of rice, lentils, stock and a touch of ghee is exactly what the doctor would order again!
5. Mother’s wisdom is not cross-cultural
On the phone with my mum (because you are never too old to call your mum when ill……), she wasted no time in prescribing- “Yoghurt, the more the better – replace all the good bacteria you know?” I mentioned this to Baba and Rama, my Indian colleagues, who were horrified – “My mother said you must NEVER eat yoghurt when you have a bad stomach!“. Whose mother was right? Let us not look to science here, but simply respect the universally agreed law that your own mother is always, always right……
6. It takes a village to treat a recalcitrant doctor
As news of my vomitus downfall spread through the group, I thought I would feel humiliated. Rather, it was an affirming experience. Enquiries from all, encouraging words and grinning thumbs up on my return to the breakfast buffet. Detailed fluid balance updates were asked for and given. Multiple bags were carried, medicines fetched and extra jobs done. It was lovely reciprocation of the caregiver relationship, and a real privilege to be propped up by our entire TDA Trans-Himalaya community.
Thanks team – I promise to buy a nicer flavour of ORS on our next rest day!