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When body begins to self-destruct, all you can do is wait


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The body detonates a nuclear bomb to eliminate a threat where a simple shotgun would do

Tuesday January 14 2020

Collins* was a jovial 29-year-old accountant who loved to travel. He worked hard all week and on the weekends, he would jump into his car and drive off to nowhere. He had explored almost every corner of this country and discovered exquisite, little places that brought so much joy to his soul. His new year’s resolution for 2017 was to expand his explorations beyond the borders of Kenya.

However, this resolution hit a snag when Collins woke up one morning feeling unwell. He tried to shrug it off, but by afternoon he had to give in and visit the emergency department. His head and joints were throbbing with pain. He was beginning to run a fever.

After running some preliminary tests, Collins was shocked when the doctor told him he would admit him. He was thought to have meningitis. He had never slept in a hospital bed all his life, so he considered himself a healthy young man. Things went south pretty quickly and Collins found himself in the high dependency unit fighting for his life.

It took another 36 hours for a diagnosis of meningo-encephalitis to be established and by this time Collins was in the intensive care unit for assisted ventilation.

This is a condition where the infection of the brain and its covering membranes, the meninges, leads to inflammation, brain oedema and excessive accumulation of cerebro-spinal fluid. Things were not looking good. He was not responding to antibiotics and the infection was determined to be viral not bacterial. The neurologist initiated antiviral medication alongside all other supportive medication he was receiving.

CARDIAC ARREST

Despite this, his brain was still swollen and he was fully dependent on machines to keep him going. It was a desperate moment and everything possible was being done to keep Collins alive. Last ditch attempts included the use of rarely used medications such as interferon. It took 10 days for Collins to turn around. He was finally on solid ground and he appeared to be on the path to recovery.

However, on the 14th day, things quickly changed again and his blood pressure plummeted. Machines were beeping crazily around him as he suffered a cardiac arrest. He was successfully resuscitated and efforts intensified to support him. Then his kidneys started to malfunction and his liver started failing while doctors cracked their heads trying to figure out what was causing him to go down again.

By the 16th day, the diagnosis hit hard. Collins’s skin started peeling off in huge patches. This extended to the mucous membranes lining his mouth, causing sores. The outer covering of his eyes was also under attack. Within two days, Collins looked like he had suffered massive burns. He was still on a ventilator, but was now nursed on a plastic bedsheet. He had a team of 13 specialists attending to him and the prognosis appeared extremely grim.

He was on daily dialysis due to the acute kidney failure; the dermatologists had his body smeared with Dermazine cream to protect him as he had no skin; he was on fourth generation antibiotics to keep away bacterial infections and balancing his daily fluids to keep him adequately hydrated without fluid overload was akin to rocket science. His urine turned bloody and the nasogastric tube would drain bloody secretions from his stomach. Thankfully, his airways held and he did not suffer lung collapse.

His room was heated to keep him warm and prevent hypothermia and his blankets were draped over a metallic crib to prevent them from touching the raw flesh. Despite being fully sedated, he required pain medication to keep him comfortable and he fully depended on intravenous feeding to meet his nutritional requirements.

FIGHTING CHANCE

Collins was battling Toxic Epidermal Necrolysis (TEN), an extremely severe form of hypersensitivity reaction carrying a mortality rate of up to 70 per cent. Simply put, this is an allergy-like condition where the body’s immune system overreacts to a specific trigger, leading to massive destruction of normal body tissue in an effort to get rid of the offending trigger. Essentially, the body detonates a nuclear bomb to eliminate a threat where a simple shotgun would do.

The commonest trigger of TEN is thought to be medication. Unfortunately, there is no indicator of who will suffer TEN and to which medication one will react. Rarely, some patients may get a similar reaction following infection or when battling cancer.

With the cocktail of drugs, Collins had been on for the meningo-encephalitis, it was difficult to pinpoint the culprit. All those no longer required were discontinued so as to give him a fighting chance. Unfortunately, there was not much that could be done to cure the TEN. It was supportive care and watchful waiting, willing his body to overcome this.

Collins’s survival was miraculous. It took three more weeks in the intensive care unit before he began to stabilise. He was eventually weaned off the ventilator and transferred back to the high dependency unit before eventually moving into an ordinary ward. It was a long journey in and out of the hospital for him to recover a semblance of his former self.

As the condition causes multiple organ failure, each one of these organs needed to heal and resume normal function before he could leave the hospital. The initial meningo-encephalitis had also left him with some deficits. He struggled with patchy memory, learning to walk again and to perform mundane tasks such as feeding himself or buttoning his shirt, but he fiercely fought to regain his independence.

2017 was an extremely long year for Collins, but today he is grateful to be able to get back to work and to sit behind the wheel of his beloved BMW and just drive along deserted highways taking in the scenery with a fresh pair of bespectacled eyes. He has had multiple eye surgeries to restore his vision this far. He bears obvious scars on his skin from the damage it underwent and still suffers skin sensitivity when exposed to sunshine, but he is grateful to be alive.

Dr Bosire is an obstetrician/gynaecologist