Ailing in Taiwan: unexpected sightseeing stops (pharmacy, hospital)

{Glossary}
Ayi = my aunt (my mother’s sister)
Yifu = my uncle (Ayi’s husband)
If you haven’t read my previous travel entries, you can catch up starting here.

What journey doesn’t include an unforeseen wrench in the plans? This time it was a bug bite that wouldn’t go away. It led me to two pharmacies, a near panic attack, a hospital visit, and a wheelchair — and a quite ample stash of waterproof bandages in several sizes.

Before we went to Taiwan, I talked to my friend Kevin, who said, “The first time I went to Taiwan I got a mosquito bite that was so bad I had to go to the ER because my whole head started swelling.” He saw my aghast expression, and said with a reassuring smile, “Don’t worry, that won’t happen to you!” I was not reassured. I’m not usually an accident magnet, but when it comes to bug bites, well, they find me.

Pharmacy #1

Something bit me on our second afternoon in Taiwan, three times: on my right ankle just behind the bone, on my outer right forearm near the elbow, and on the middle of my belly between my breasts and navel. All three bites formed the requisite itchy red welt, I did my best not to scratch, and so far so good — so I thought. By evening of the third day, I had noticed that my right ankle felt a little peculiar. I took off my shoes when we got back to Ayi’s apartment, and saw that the bite had become a blister “about the size of a small pearl button” (I wrote in my journal), and my foot was beginning to swell. I put Benadryl cream on it, and went to bed. The next morning we were booked to go to Hualien, a four-hour ride away, without Ayi or Yifu. Our train left at 6:05 AM and if we missed it we would forfeit a hotel stay, two guided tours, and our visit to Taroko National Park.

I awoke at 4:30 with a foot that was (I wrote) “now so swollen that it always feels stiff and hot, and it’s not as easy to walk on.” Not knowing what else to do, Ayi and Yifu took us to a 24-hour pharmacy, where the white-haired man behind the counter looked at my ankle and concluded that I should go to a doctor. “Only look at how this foot is swelling,” he said in Mandarin, “it’s completely different from the other one.” Apparently my Mandarin encompasses a good deal of general medical vocabulary; during the several conversations on this trip that ensued from my weird bug bite, the only phrase that had me completely stymied was “waterproof bandages.” I couldn’t respond to anyone’s remarks, but I understood them nearly entirely.

“We can’t go to a doctor,” Ayi told the pharmacist, “they need to go to Hualien today.”

“Hualien!” he said. “But she shouldn’t be running around on this foot.”

“They’re visiting from abroad,” she said. “And the tickets are already booked — they have to catch a train.” They went back and forth for a bit, he disapproving, Ayi adamant.

“Well, don’t walk too much then,” he finally said grudgingly. “And don’t go in the water — no swimming, no wading, nothing like that.” He shuffled out from behind the counter and disappeared briefly into the shop’s narrow aisles, returning almost immediately with a roll of surgical tape, a tube of antibiotic ointment, and some squares of that stuff that’s like gauze but doesn’t stick. This he handed to me.

“And I’ll give you some medicine,” he added, gesturing at a contraption behind the counter. It looked like a circular slab of flecked grey stone, punctuated with deep wells around the edges, set atop something kind of like the base of a water cooler. I wish I had a photo because I can’t find anything like it online. I suppose the round bit might have been plastic and not stone, but both Erik and I thought it was a stone mixing surface and he was going to compound something on it. Instead, the pharmacist turned to the shelves behind him and took down several big white plastic pill bottles, and began unscrewing the tops and shaking the contents into the wells. When he was done, he depressed a little metal lever on the side of the thing, and the circular slab began to rotate. From an opening on the side of the base, he tore off a long strip of what looked like translucent plastic. It turned out to be glassine. Contained inside the strip were each day’s dosage of pills, sealed and separated into packets, with perforations in between so I could tear off each dose as I needed it. I don’t know if these machines are commonplace in pharmacies or in other countries, but I have never seen anything like it before, and it fascinated me. The pharmacist gave me enough pills to get me through the Hualien trip (four doses a day for the next two days) and each time I tore off a packet I marveled afresh at the convenience.

The almost panic attack

“It’s reassuring to have the pharmacist’s opinion,” I wrote later that morning, “and to have some medicines, but alarming to know he thinks I should see a doctor.” As Yifu drove us to the train station, I mulled over all the worst-case scenarios and worked myself into a state of anxiety I tried very hard to hide from everyone else. I thought of fever and infection and mosquito-borne diseases. I imagined my entire leg swelling up and going numb. I thought of being delirious or comatose and not being able to communicate with anyone. But I knew that if I seemed worried, Ayi wouldn’t let us go off by ourselves, and then I’d be ruining everyone else’s trip too. So after we arrived at Hsinchu station, I made myself smile and wave to Ayi and Yifu as we crossed the ticket barrier onto the platform. Then we boarded the train and my panic exploded into my chest, drawing me into an unnamed, familiar sensation of constriction and terror. I wanted to burst into tears, collapse, vomit, or rush back to Ayi and Yifu. I feared I was experiencing the “shortness of breath” described on websites as a symptom of dangerous bug bites, and then I envisioned myself with oxygen deprivation and heart failure. Mere minutes after the train departed, I rushed into the restroom and nearly puked into the tiny corner sink.

Somehow, the cold, silver, private spaciousness of that train restroom was very reassuring. I think I’d feared — on top of everything else — that I was going to disgrace myself in public, so it helped immeasurably just to get away from everyone and lock myself into a space where I could freak out as much as I needed. I took deep breaths of that air-conditioned, antiseptic air as my hysteria slowly retreated to an arm’s distance. After a while, I returned to my seat, ate a bun, took my first four pills, and wrote in my journal, “Panic is still there under the surface, but I’m not feeling like hyperventilating anymore.”

The peach jellybean and pharmacy #2

Taking the pills calmed me, because I expected them to do something, and eating calmed me too; I think my instincts take I’m eating to mean I’ll survive today. The last vestiges of the near-panic attack vanished when an attendant came around selling biandang: box lunches (the Japanese call them bento). Each hearty hot meal cost about $2 US, and kept us going for hours.

But though I was feeling much better, my foot wasn’t. The bug bite blister was now grotesque; it bulged like a peach-flavored jellybean inserted just under the top layer of skin. I wrote in my journal: “My foot is really quite swollen now. It’s getting harder to move my toes and ankle. When I touch my calf it also feels tight and full, which would alarm me except that the left one feels very similar… something about this place, or our activities since arrival, has just swelled everything. All the same, it’s hard not to worry. What will I do if the swelling doesn’t stop?”

Once we arrived at the hotel in Hualien, I washed my hands thoroughly and then attended to the blister with ointment and bandages. Devin suggested ice, Erik fetched it from the clerk, and Sarah lent me her bandana to wrap around the bag of ice. Later that night, the blister popped. The drainage helped ease the discomfort of walking, but the swelling remained.

The next day I tried to stay seated as much as possible, but it wasn’t easy on a national park tour. We arrived back in Hsinchu just before 11 PM. Upon hearing that my foot was no better, Yifu whisked me into their neighborhood pharmacy just before closing. This pharmacist was a woman, and she repeated the previous pharmacist’s advice: go to a doctor. “A dermatologist,” she said.

Hospital

The next morning, Ayi brought us all to Mackay Memorial Hospital in Hsinchu. Sarah and Devin went out to explore the streets, but Erik and I waited with Ayi. The hospital didn’t open for business until 8, but there were plenty of people milling about the waiting area. We took a number (11) and stood around until the reception windows opened. When our number appeared on the light-up board above one of the windows, Ayi explained my situation to the clerk. After a brief discussion, the clerk handed us a folder and told us the dermatologist would see us at 9. We headed up to the second floor and settled ourselves for the next hour.

The dermatology department was clean, cheerful, and completely empty. As it turned out, our waiting time went quickly. In the folder we found several forms to fill out, which of course I needed Ayi’s help to do. I was particularly interested in two sections. Under risky behaviors, she read off: “Do you drink alcohol?” I said no, and she continued: “Do you smoke?” Again I said no. I could see that there was one more question in that section, and anticipated that it would be about unprotected sex. But no, it was: “Do you chew betel nut?” Ah.

Also, you’ll notice there are some sections on the form with a great many checkboxes. One of those was occupation. Along with the usual suspects like doctor, teacher, and government worker, Ayi also read off “farmer” and “fisherman.”

There was space on the form for my height, weight, and blood pressure, but I couldn’t remember that last one. Then we noticed that along one wall there was a combination scale and measuring stick, and a blood pressure station. I did yogic breathing during the blood pressure part and it came out fine (I’ve had “white coat hypertension” in the past).

After a while, the doctors and nurses began to come in, and we watched them open doors and turn on the waiting-area TV (public health cartoons, and a disgusting photo of a betel-nut chewer’s mouth sores).

Before long they called us in, and feeling a bit like a parade, the three of us trooped into the little exam room. The dermatologist was a young woman, probably not too much older than me, and unlike the two pharmacists she did not seem the least bit horrified or surprised by the look of my blister. This itself was hugely reassuring. “I think it’s probably a mosquito bite that got infected. You have no fever, and the ankle’s not hot,” she observed. “Just stay off the ankle as much as you can, and don’t get it wet, not even during showers.” (That’s when I encountered the phrase for  “waterproof bandages.”) I said I had been icing it and she nodded, “That will help.” She prescribed a few more days’ antibiotics and anti-inflammatories, and then sent us into the next room where a sweet-faced young nurse drained the blister with a syringe and then bandaged it up. She was extremely nice, and seemed amused to see the three of us all together (“I’m her aunt,” Ayi explained, “and he’s her husband. They’re visiting from abroad.”).

We went downstairs to the reception windows again, where we paid for the visit and for the medications. Then we went to a different set of windows — the pharmacy — and picked up the prescriptions, which were already waiting (the information had been sent electronically). There was also a tiny drugstore in the lobby, where Erik and I found waterproof bandages. The whole visit had taken us less than 2 hours, from check-in to exit, and cost less than $20 US, including the pills and ointment (but excluding the bandages, which cost about as much as they do at home). If I’d never watched Sicko, I would have been shocked, but as it was, I could only sigh and wish healthcare reform at home could happen faster. (Non-US readers: such a visit here would have run about $200 without insurance, I guess, and the medication another $75 or so… maybe much more, without insurance. And my options would have been the emergency room, if we’d gone to the hospital, or my private-practice dermatologist if she could fit me in for a same-day appointment. If she’d prescribed anything, I would have had to take it to a drugstore to be filled, and I’d have to wait at least 20 minutes for them to do that.)

The wheelchair

After that visit, I stopped worrying about my bug bite. The blister filled again and the swelling continued, but short of taking to bed for the rest of my trip, I knew there was very little we could do to make it better. The only thing we could do was limit my walking as much as possible… which, of course, was not very possible. Mostly I limped along after the others, and if they saw something they wanted to explore, I tried to sit. But when we went to the National Palace Museum in Taipei, they had wheelchairs to lend… and Ayi got one for me.

It was right embarrassing, having everyone in the museum looking at me and wondering why this apparently healthy young woman needed a wheelchair. But it really was a relief on my ankle — you can see in the photo just how much it’s swollen — and Erik was astoundingly on-point about maneuvering me around the crowds and intuiting which exhibits I wanted to get closer to. And the tour guide always motioned everyone else to let us through. As a result, I think I had a more enjoyable experience of the museum than anyone else in our group: I was off my feet for an hour and a half, and I got to see everything close-up without having to push people!

The day after the wheelchair, we flew to Hong Kong, where our friend Joanna met us — but while last year she didn’t have a car, this year she did. So I managed to stay off my feet much more than I’d dared hope. A couple of days into our HK stay, my antibiotics ran out, and as if on cue, the swelling went down that same day. By the third day, I was still eager to go when everyone else was tired, and on the fourth day Erik and I walked, my pedometer informed me, 9 miles.

By the time we came home to the States, the blister was becoming a scab. Just this past Saturday night it fell off somewhere in San Francisco, I wish I knew where. All that’s left now is a patch of new skin on my ankle, about the size of a nickel.

All’s well that ends well!