Monday, September 15, 2008

The death of rats...

With apologies to Terry Pratchett

Picture from here.


I'm tired.

A casualty to handle, a week end on-call, and personal emotional turmoil.

But all that's besides the point of this post.


I walked into a medical ward yesterday... sat down near the house officer (an old friend) and started a random chat. I can't explain the difference I felt... was the air somehow heavier in this ward? Was there somehow less light than the one I worked in, or was it just the generally overcast day?

These musings at the back of my mind were cut short by wails and screams of agony. Over and over again... now high pitched, now low... different voices... different levels of torture ripping through souls. At times a confused babbling.... at times just incoherent moans. Over and over again...

I listen for a full minute, mouth agape... "what is that?" I ask, horrified. My friend looks glum. "Them? They're the lepto patients..."


The farmers call it mee una (rat fever). The spiral like bacteria lives in the kidneys of rats... and when they pee, get passed into drains and canals and paddy fields. Unwary farmers go sloshing around... and get infected through the cuts and scrapes on their feet. The fever sets in and chills shake the bodies of these young, strong, healthy males. Blinding headaches. Uncontrollable vomiting. Delirium. And the complications are killers : inflammation of the heart and brain, liver failure, kidney failure, relentless bleeding tendencies.

It is "Lepto season" again in Sri Lanka. There is an epidemic going on... but I don't have the statistics or the numbers yet. Many many are transferred to Colombo... from all over the country and they die like flies... young men, reduced to moaning shells of their former selves. Women die too... young and old... some who have only stepped into the paddy field to help a friend during the sowing.

There is hardly enough space in the dialysis unit for patients with chronic kidney disease. The unit is full of lepto cases, their blood being fed into machines in a desperate attempt to clean out the toxins that are poisoning them. The wards overflow with the infection... the systematic removal of bodies is only matched by the relentless inflow of even more patients.

Antibiotics can cure... if given early. As soon as there is even a faint suspicion of the presence of Leptospira. Before the complications set in. I believe there's an island wide awareness programme going on. Cut off as I am from newspapers, TV and other mass media that is available to the normal population, I haven't a clue as to what they're saying. But please listen, and take care.


It was close to 9 pm as I walked to the flat, the full moon radiant overhead. I bump into another friend, moodily making her way to the canteen.

"Heavy weekend eh?"

"You have NO idea. Three early morning arrests today"
(cardiac arrests... not good, obviously)

"How many survived?"


"Damn! Poor you... hope the rest of your day was better..."

She looks at me... tiredness, and something else I can't define seeming to ooze out of her very being.

"I got a call from the dialysis unit at about 10, a patient had arrested during dialysis. While giving CPR, I got a call from the ward... another arrest."

I didn't have much to say after that. Obviously her weekend was a helluva lot more shitty than mine. I only had one question.

"All lepto?"

"Yup, all lepto."


Jack Point said...


I'm not going complain how bad my days are in the office- ever! I never realised guys sitting in offices pushing paper had it so easy.

Also my respect for medicos is up about 10 fold...

pissu perera said...

not sure how much this will help, but i hope it does the same to you as it does to me. when i'm feeling blue i load this and try to forget everything else. it usually works.

good luck :)

TheWhacksteR said...

Hey Angel simply love your blog! keep it up and im adding you to my blogroll. cheers!

realskullzero said...

Whooow...chilling..yeah there are hundreds who have perished, must have been a damn heavy weekend..

uhu said...

Hey Angel... I think I took more time thinking of how to leave a comment for this post than you took to write it.. it all seemed to soppy or flirty.. so I give up *Hugs*

noorie said...


I enjoy reading your blog.. So was added it to my blogroll :).

You don't mind yeah?


DeeCee said...

Agreed with Whacky. Good stuff. Rats have always been such good carriers of illness huh...from the medival black plague to now. fascinating. Poor people tho. :( Who are truly blessed to help these people..or have i already said that in a previous post? hm :)

DeeCee said...

ps- loving the Terry Pratchett reference.

gutterflower said...

Oww. Thats the mother of all bad days. I feel very small and petty now, whining about my issues.

Hope things get better.

On a different note altogether, its good to see you blogging frequently. :)

Bawa said...

this comment is on your post.. the penis factor..

male doctors have it just as bad.. i heard this story from a senior at med skul.. after a prostrate examination the rather elderly patient had yelled " menna muu mage puke agillak gahuwa"


uhu said...

So Angel.. do you think its lepto.. or could it be a hemorrhagic fever

Angel said...

JP : right now, I'm dreaming of a nice office type job, with fixed working hours, a nice air conditioned workspace and lotsa healthy people around me... :)

PP : Thanks a bunch.... cool song and video, definitely a mood lifter! :)

Wrackster : Thanks! Honoured to be blogrolled!

Realskullzero : up till August, 110 dead and over 3000 infected. Compared to about 2700 for the whole of 2007. It was a totally sucky weekend.

Noorie : thanks! I am honoured!

DeeCee : Terry P was always a favourite and this seemed quite apt. Agree about the poor people :( sometimes life sucks really bad.

Gutterflower : thanks... it's great to have you blogging again too...

Bawa : lol, the poor guy must have been most embarrassed!

uhu : well, we're treating the fevers as lepto, and the diagnosis is based on clinical features (what the patient complains of and what we find when examining) and also by lab tests. Of course, other common causes of fever such as malaria and viruses including dengue are also kept in mind. With lepto, there's the high fever and redness of eyes and later, jaundice.... so that's what we watch out for.

If by any chance there's also a viral haemorrhagic fever such as lassa fever, ebola or bolivian haemorrhagic fever, we're truly sunk!

And thanks for the hugs....!

samanalee said...

With every work-related post you put up, my respect for you doctors goes up several notches. And every single time, any comment I may think of leaving sounds simply silly or meaningless, so I usually don't. But I thought you ought to know anyway.

Pahan P. said...

It is really something to be a doctor!

P.S. your blog is very interesting. thanks for showing the world what life is like at you job!
Even remaining anonymous, there are ways you can reach out (I guess that was just thinking aloud)

Pahan P.

Anonymous said...

I am reading this article second time today, you have to be more careful with content leakers. If I will fount it again I will send you a link

Angel said...

Annon. : thanks for commenting, but I'm not sure what you mean... did you see this article printed or posted online somewhere else? If so, please let me know... thanks!