Early Signs of Trouble
As our plane approached Johannesburg after a 17-hour flight, I struggled to put my boots back on. I was inexplicably short of breath and every breath I took felt strange, almost damp and fatiguing. I hadn’t been sick when I boarded the plane, and have no history of asthma. I am usually raring to go upon arrival, shaking off redeye sleepiness – fueled by adrenalin for a new place. I started to pull my bags, which were weighted down with photography equipment for our safari and I quickly got out of breath. By the time I was going down the jet bridge I was so out of breath that a flight attendant, hearing me struggle, offered me a wheelchair. I declined it, fearing it might be difficult to clear customs in a foreign country while appearing sick. I gave my bags to my husband and we got through the entry process. Later we took a 2-hour flight to Cape Town where we were starting our adventure.
I’d had iron deficient anemia before which produces shortness of breath, so I purchased iron and aspirin, in case it was something else. I decided I would give it some time as these symptoms usually went away on their own. I was not yet ready to seek healthcare in a foreign land or interrupt our planned activities, and wasn’t sure it was even necessary. We spent the week exploring Cape Town sights like the waterfront area and the Boulder Beach penguins and went on our shark diving activities in Simons Town.
Hiking at Cape Point
One of the days we went hiking on a cliffside trail in Cape Point. My breathing still had not returned to normal after several days and was especially bad when climbing hills, stairs or carrying heavy items. Even walking with things in my coat pocket made me tired. I agonized over the final hill on the trail before the Cape of Good Hope sign, knowing I should not be hiking, but there was no way back to our ride other than this. I had to stop every two steps on the hill to catch my breath, sitting down several times to do so. I may not call myself an athlete, but a simple hike up a hill doesn’t usually exhaust me.
At one point a very thin woman was walking by me, irritated that I was by the side of the trail. She glared down at me muttering something in another language – Portuguese, I believe. I speak French and a little Spanish so I can sometimes understand some of that language. I was horrified as I heard the word for “fat” and saw the look on her face. Not only was the walk exhausting me to the point of being afraid, now I was being judged by strangers who knew nothing about me. It was like ending up in one of Dante’s lesser known circles of hell, 3.5 perhaps, the one where you are assessed as being less fit than you actually are. I glared back into her face defiantly. Still, I had nothing to say. I wasn’t sure what was happening to me, but I knew it wasn’t normal. I slowly made my way down to the Cape of Good Hope sign, taking the usual pictures.
We returned to downtown Cape Town, preparing to drive to Mossel Bay for more shark diving. As we rounded the corner to our hotel I spotted it again – a hospital that shined so brightly it was as if it were lit from above. I had seen it our first night in Cape Town and it’s mere presence had given me hope and comfort. It looked modern and new, like something you might see in any major U.S. city. I wouldn’t even know where to begin to look for healthcare in South Africa, so its proximity to our hotel seemed fated. Still, I felt uncertain about whether I needed it. I’d never had any major medical problems and I found it hard to believe this was anything more than what I’d had before, but maddeningly, it wasn’t going away. I decided not to push the issue, as we still had several more days of shark diving planned and paid for and I didn’t want to disrupt that. I knew we had some days in wine country planned for afterward, I would reassess things then. On our way out of town I felt a twinge of regret, knowing we were leaving the hospital behind.
I’ve written another entry about Mossel Bay shark diving. The thing that stands out for this entry was the long walk up a hill to the dive shop from the boat dock. While normally it wouldn’t be any big deal, on these few days it was absolutely excruciating. I even stayed in one day to avoid it – that day, of course, was the day my husband saw the first shark. Thankfully she came back for me the next day. We made our dives, then headed to Franschhoek – the French South African wine country, and stayed overnight.
As I exited the hotel the next day I knew my time was up. Not only had things not gotten better, somehow they had actually gotten worse. Where before I had difficulty breathing on hills and stairs, now I had difficulty breathing on flat ground. I made it to our rental car and it took several minutes to catch my breath. I told my husband we had to go to the ER. There was no more putting it off. I was strangely relieved that it was finally bad enough to seek help as I had been in real distress for a week to the point where strangers on the street stared at me. We called our travel insurance hotline and they confirmed that the hospital we saw in Cape Town was a great choice, so we headed back into the city.
At the Hospital in Cape Town
The private hospital was located on the upper floors of a building in downtown and when we parked I had my husband find the entrance before I followed him – I knew I couldn’t afford any extra steps at all. As we walked into the ER I was gasping for air loudly and they took me immediately. Upon conducting several tests, they told me I needed a CT scan. After having this done they confirmed I had a saddle, bilateral pulmonary embolism – a deadly blood clot had lodged itself in the artery which connected my two lungs. It had the potential to cut off all breathing at any point. This type of blood clot is usually fatal, found post-mortem in autopsies, and I was told the doctors were surprised I was still able to be sitting up talking to them.
There was the matter of money to be settled, and we were told as international private patients we had to put down a 100,000 rand deposit for treatment, the equivalent of about $7,300 USD. While we didn’t have that money, thankfully our credit card company did, so we paid up and were told insurance would reimburse us later, and they did. This was the first time I have ever been admitted to a hospital overnight since the day I was born, and though I heard my diagnosis and had suspected the possibility, I was in such shock that I felt numb and nothing seemed real for days. At some point they administered shots of blood thinner to my stomach and wheeled me to the intensive cardiac care unit. I was so relieved that I didn’t have to take one more step or struggle to breathe anymore. I could finally rest and receive help.
By this time it was nighttime and my husband prepared to return to the first hotel we had been staying at, since it was so close. It was frightening – being in a hospital for the first time, in a foreign country. The doctors and staff were professional, competent and nice but it was unnerving to be in a strange place, hooked up to monitors, unable to leave with your spouse. I envied him as he returned to normal hotel life, even though I didn’t want to leave as I knew I desperately needed their help.
I spent 5 days in the hospital, so worried about our amassing bill that I questioned my doctor repeatedly about when I would be able to leave. I’m sure I seemed ungrateful, if not a little insane, but I knew how much this stay would cost in the states and I was worried it would be similar here. We had visions of being required to settle an astronomical bill before being allowed to leave the country. It ended up being slightly above the deposit and all would eventually be reimbursed, I worried for nothing. By about the third day I was feeling better, the fourth day we were talking about me leaving and the fifth day I was discharged with no more gasping for air. I was even cleared to continue our trip, so we were happy to finally head to Kruger National Park.
A New Respect for Doctors
I’ve never had much need of doctors outside the usual ailments – a flu here, a rash there. My visits to them were so infrequent I didn’t even have a primary care physician. But there is something to be said about them – they are such amazing professionals when you really need them and your life depends on it. They walk you through the direst of circumstances like they are just taking you on a guided hike, pointing out things to watch out for. It’s not until you look back that you realize what you just came through and how utterly dependent you just were – especially when you don’t really like to be utterly dependent on anyone. Still, they came through for you – this stranger from the other side of the world who studied for years to be able to help people, happened across your path and saved your life. It is both humbling and awe inspiring. You realize how incredibly good they are at what they do.
For me this moment was in the Cape Town airport, getting ready to fly to Johannesburg and continue on. As I waited for my husband to return the rental car and meet me, I had a moment of real panic when I was temporarily short of breath and realized my doctor would be hours away on the other side of the country, that I might have to find a new, unproven one or be on my own in a rural area. The feelings of distress I’d had the week prior came flooding back. I sat for a while, gathering my strength and calming my breathing – something I am unaccustomed to as I am usually fairly brave. After awhile I was able to board the plane and move on with no repeat of these feelings. Still, the gratitude that remains for the excellent help I received is profound.
When I returned to the states I was told how good the health care is in South Africa and how lucky I was to be there as well as to survive such an event in general. While the average person might not know what a pulmonary embolism is, doctors sure do and they are amazed to hear my story. I am amazed to think I was hiking along oceanside cliffs and diving with great whites with my own terrifying monster in my chest. (link is to someone else’s operation showing removal of a massive pulmonary embolism – not for the faint of heart) Since I am generally healthy and it was considered “provoked” by a common medication, they tell me I will probably live a very long life and I take them at their word, doing all I can to ensure that’s true. This year as part of a healthy lifestyle I am undertaking a new set of athletic challenges involving travel. I will write about them in a future entry.