"And When I Am Ill, Only He Can Heal Me"

Four years into nursing, I've observed that it is customary to place a patient with dengue fever in the non-acute cubicle -- somewhere far and hidden, only to be seen when changing IV drips and recording intake and output.

Today is Asrul's day 5 of dengue fever. This will also be the 3rd night he spends in the ward. The first 2 nights were spent in the emergency observation unit because his platelet level was average, not critical enough to actually be admitted. This is something new I've learnt about UKMMC's hospital policy. They don't admit patients with a platelet count of above 50, unless there were other complications.

When he first arrived at the emergency department on Thursday, his temperature was a whooping 38.8 degrees. His platelet count was 71 (normal count is at least 150), thus deemed stable and admitted for observation. Within the next 2 days, his fever swung up and down like a see-saw, always staying between 37.4 - 38.8.

The doctors took blood samples every 6 hours, waking him up at 4 a.m. to jab him. He doesn't have a high pain threshold but then again, I guess I don't blame him since they poke him in the same arm, at the same vein, every 6 hours. The vein would've probably just started recovering before it was all poked through again. Plus, the medical staff at the emergency department had a tough time inserting his IV cannula, resulting in 1 jab on his left hand, and about 3 jabs on his right. They were only successful upon the 4th jab.

This morning his platelet level dove right down to 50, and he got admitted to the medical ward for aggressive treatment. In a way, I'm thankful he got admitted to the medical ward because he is now under Dr. Shahrul Azmin, an excellent doctor I got to know during my clinical posting this semester. He's very concerned about patient education, friendly and gentle towards patients, and involves the family in the course of treatment. I'm just glad to know that he is in good hands.

After 4 years as a student nurse, it is only today that I've discovered there is no cure for dengue. Yes, I've noticed that dengue patients won't have anything more than IV drips and paracetamol but I didn't know it was because there's no cure for dengue. I always thought it was because they were stable and didn't need meds. Like I said, they are placed right at the very back, unless they started to bleed profusely, which almost never happened.

Platelets are blood cells needed for coagulation. If you accidentally cut yourself and the bleeding stopped after a few minutes, it's because the platelets rushed to the site of injury and clogged up the cut, causing the bleeding to stop and the formation of a tiny crust or keruping.

Dengue is dangerous because it lowers the production of platelets, which, if severe enough, could cause spontaneous bleeding, thus the name Dengue Hemorrhagic Fever. Not only does it lower platelet count, it lowers general white blood cell count (the blood cells needed to fight disease), and raises hematocrit levels which means the blood is more concentrated, leading to low blood pressure (postural hypotension) and dehydration.

A combination of bleeding (internal bleeding as well), dehydration, and low pressure for the blood to reach vital organs, can cause death. For more info on dengue, click here.

I know the death rate for dengue is very low and most patients recover within a week but knowing what I know, and the fact that Asrul is the type who's always falling ill, I am worried sick about him.

Nurses tend to forsake dengue patients (unless they're bleeding to death in the ICU) because they take for granted that they are stable and most will recover, and I don't blame them for that but just in case, I have taken it upon myself to be his private nurse whenever I'm not sleeping.

He is on 6 pints of normal saline over 24 hours, so I change his drips every 4 hours, change his IV tubing once a day, change the IV plaster if it's soiled with blood, write the date and time on each IV drip, force him to drink 4 bottles a day, including orange juice, 100 plus, and mineral water, buy him lunch or dinner (whichever his mom didn't bring him, he won't eat hospital food) and make sure he finishes his meals (he's constantly lethargic and doesn't have an appetite) make sure he showers and doesn't have a temperature, teach him how to record his urine output on a piece of paper, inform the nurse how much fluids he's taken, make his bed, clean his room, and lastly, keep him company.

He's not much into talking, he seems depressed and it hurts me to see him that way. I study while he sleeps because I have exams till Wednesday. I come in after exams and stay till 8 p.m. because I don't want the nurses to think we're doing anything obscene since he's in the isolation room at the very end of the ward, so it would be inappropriate for me to linger at night.

Ezzura came by today and she brought UNO cards. He brightened up for the next hour or so while we played because I secretly let him win because I know how much he loves to win at games. We used to play PlayStation 2 at his house and he would gloat like mad whenever he won.

"I so hebat!!"

Today, I also learnt how important it is to visit loved ones when they're ill, however minor the illness may be. He would constantly ask me for the time and when 5 or 6 o'clock loomed (visiting hours end at 7 p.m.) and yet there were no signs of his parents or friends, he would then be visibly depressed all over again.

Sedih sangat tengok dia tertunggu-tunggu kawan dia datang, tahu tak?

After he had his night shower and I said let's play another round of UNO before I leave, he played with no enthusiasm at all and did not even smile when he won. I then tucked him in, made sure his drips were okay and promised him I'll be over first thing tomorrow morning.

We both have exams at 2 p.m. tomorrow. He's taking his exams in the ward, all the while feeling constantly tired and not wanting to eat. I'm buying him breakfast tomorrow and then we'll do some last minute studying together. After the exam, I'll go straight back to the ward and stay with him till 8 p.m., as always.

“Be steadfast, may God purify you.” (Saheeh Al-Bukhari)