Jun 14, 2013

6.8.13


The day that Nikki almost died but didn’t


I find evidence of the miraculous everywhere and usually it’s nonsensical.  Perhaps it does make sense to a greater or simpler mind than mine.  Perhaps there’s an overarching plan that I’m too small to see.  Perhaps there’s a reason or perhaps there’s nothing but I know the meant to be when I see it and I’ve seen it enough not to question it anymore.  Without one small link in a chain of occurrences the outcome would have been so much different, but it wasn’t; that link was there and everything fell into place exactly so.  Sometimes it ends in tragedy, sometimes in triumph – today she could have died but didn’t.

            We’d taken the students to Montezuma, a remote town on the tip of the Nicoya peninsula. From there we hiked to a beautiful deep jungle waterfall and set intentions with silence, solemnity and a healing mantra that we all chanted together; circled and hand-holding.  When it was over we dispersed and climbed up the falls to document it with a photo.  On her path up the water Nikki brushed by a tree laden with ants and received many bites on her upper thigh.  Since they were only ants and this is the jungle where everything eats you she thought nothing of it, posing for photos and taking photos as the group walked down to the bigger set of falls below.  After she’d finished taking my photo and I swam back to her rock I found her seated and alarmed.  She had flushed skin and told me her lips felt numb. 

            I ran down to tell Russ what had happened and that we needed to leave.  By the time we’d gotten back to where she sat her face and neck were red with hives, her lips and eyes were swelling and it was clear that this situation was more serious than we thought.

            Moments later Jake showed up with Benadryl and a random couple.  We gave her the pills as the strange man knelt and said, “I’m a doctor.”  He was Dr. Kiav Nemati. Having just graduated from UCLA medical school he’d surprised his girlfriend Miss Emily Groves, who was a nurse, with this trip to Costa Rica.  They’d been debating whether to go to the waterfall or the beach that morning and at about the same time that we had joined hands and started chanting, the waterfall had won.  They’d been there only fifteen minutes when he’d overheard my cries to Russ and found us kneeling around Nikki.  He proceeded calmly to ask a series of questions both comforting and terrifying.  What was her name?  What had stung her?  Did she have any allergies, any history of hospitalization or medical issues?  Did she feel any numbness, any tingling or dizziness?  Was she having trouble breathing?  As the questions and answers continued with affirmations the gravity of the situation became clear.  We needed epinephrine he said, which none of us had.  She needed urgent care he said and at that moment Nikki stood up saying, “I have to go,” and she and I just started going, leaving them behind to figure out details.
 

Whatever plan they came up with, ours was very simple – get out of the jungle, find a clinic.  As we crashed and climbed up the narrow slippery path that had taken much longer to get down, I talked to Nikki trying to be as soothing and calm as I possibly could.  While reminding her to breath and giving her breath cues, while telling her every bit of comforting information I could find in my brain about anti-histamines and ants, I worried about the heat, our pace, her heart-rate and the strenuousness of our climb.  I prayed for Russ to hurry, hurry, catch up!  Because I knew and I’d just said to Nikki that when we got to the road we’d stop a car, any car, the very first car and we’d get in it and go to a doctor.  Luckily just as I was worrying about doing that alone I heard a call.  Emily was behind us and they were coming with us and were we ok?  “We’re ok,” I yelled back, “but we’re just going.”

            I found out later that Kiav had taken Russ aside as we started up the trail.  If her symptoms got worse her throat may close and if that happened before we found a hospital she’d need a tracheotomy.  It was as he was describing to Russ how to perform one that Emily suggested, “Maybe we should just go with them.”  It had only taken moments for Russ to grab his bag and tell his son he was leaving but we’d gone so fast he had to run all the way and still caught up to us only at the very top of the trail.

            He and I on either side of Nikki supported her as we got to the road and at that very moment a taxi arrived.   While she and I had been flying up the trail he had been arranging with the hotel to have a car pick us up at the trailhead and it’s arrival could not have been more perfect.  As we were getting in the taxi Russ turned to me and said, “the healing chant didn’t work.”

            “Yes it did!” I countered without hesitation.  “We have a doctor and nurse with us; we’re in a taxi, it worked.”

As we all drove into Montezuma, it seemed that Nikki’s condition had stabilized.  Her symptoms hadn’t worsened and her face almost seemed less red in spots.  We were about to drop Kiav and Emily in town and go on to the nearby clinic without them when Emily said, “maybe we should stay, do you want us to stay with you?”  Russ immediately said yes and they stayed in the taxi.  Not even two minutes later Nikki started moaning and panting, her hands started swelling up, she was having trouble breathing and her feet were tingling.  I held her hand and tried to help keep her calm, speaking low and steadily while Kiav tried to measure her pulse and everyone rallied the taxi driver to go faster, por favor!

It was only a few miles away on the windy dirt road but as every second became worse for Nikki the drive seemed like an eternity.  “Just a few more minutes,” I kept repeating to her, praying that it was true.

            We got to the private doctor just as Nikki was starting to lose it.  He wasn’t there.  We rushed on crying ‘clnico!’ and barely concealing our communal terror. 

            We raced through whatever small town we were in to the clinic and Kiav and Emily ran inside, Russ spoke with the driver and I helped hold Nikki up as we walked down the short yet infinite path to the clinic.  I was flooded with relief. We were here!  We’d made it!  In the nick of time we’d made it!  It was all going to be ok!  I was saying this to Nikki in low soothing tones as we entered the clinic.  As I scanned the room and took in the situation I realized how silly my faith in our destination had been.  Kiav and Emily were at the front desk, animated, gesturing, asking for epinephrine, for help, for a doctor, Nikki was leaning on me heavily and shuffling, her hands curling into her chest, her limbs stiffening, her tongue swelling.

            I looked at the staff of the clinic with pleading eyes.  No one was doing a thing.  No one was moving or responding or even showing signs they’d seen us.  The woman behind the counter did not even lift her head off her hand.

            What followed was blurred by terror.  Nikki slumped to a horizontal position, laying on the chairs in the waiting room.  Kiav and Emily were telling everyone, anyone, trying to make anyone listen; that we needed epinephrine.  They were doctors and we needed epinephrine right now!  Russ was rushing back into the clinic looking for a doctor, chased and threatened by the security guard.  Nikki started hyperventilating and swearing and crying.  I held her hand and stayed with her as she looked straight at me and told me not to leave.  She was crying and said, “I don’t want to die.”

            “Don’t worry,” Kiav said, “I’m not going to let you die.”

H was yelling “Epinephrine, ahora! Por dios!  Por favor! Epinephrine, I need epinephrine RIGHT NOW!”  Nikki’s limbs were seizing up and no one was helping us.  Kiav and Emily were holding Nikki’s head back, pulling her neck, opening her airway. 

            Out of nowhere a new person, a nurse came walking into the waiting room.  Somehow Emily conveyed to her that she Emily was also a nurse and we needed epinephrine.  Thank god for whatever unspoken bond exists between nurses because she left, albeit slowly and strolled back with a shot which she knelt and administered on the waiting room floor.

            There was no reaction; just Nikki still yelling and swearing, the flurry of yelling around us and a staggering amount of inactivity from the staff.  At some point someone brought out a wheelchair and somehow we got her in it.  I had no real idea what was happening.  I only knew  we were wheeling her back in the clinic finally and I was not letting go of her hand.  We got her in a hospital bed and finally a lot of things happened very fast. 

The woman from the front desk came in with the security guard and threatened to call the police if we didn’t get out of there.  ‘Fine!’  Everyone said.  ‘Call the police!’  Kiav cut her shirt off and with the silent tican nurse, hooked her to oxygen and machines that measured her vitals.  The clinic staff tried to make me leave the room and Nikki started screaming, “No! no!’ in a tone they quickly stopped arguing with.  I just stood and held her hand through the chaos watching Kiav as he worked and knelt over her and I remembered what he said,

“Don’t worry.  I’m not going to let you die.” 

It was true.  He did not.  Slowly her face returned to normal and I heard the relief in his voice as he said her vitals were stabilizing also. 

            It was around this time that the police did come and usher us all from the room.

            It was ok now, she was stable, it was over.

            As soon as she could move they pretty much kicked us out of the clinic, no payment or paperwork necessary in their eagerness to get rid of these insubordinate gringos.  We stopped at the pharmacia and it wasn’t long before we were back in our cool dark hotel room where Emily and Kiav were McGyvering an IV drip by the light of our headlamps using a hanger and an old broken lamp.

            As Nikki’s system was flooded with healing fluids and soothing drugs we sat around, amplified, recounting the exciting events of the last hour, the details we remembered, the way we’d felt, the things that had worried us, our amazement at the clinic employees inactivity. 

            For whatever reason, if there even was one, that this event occurred it couldn’t have unfolded in a more perfect or miraculous way.  If the nurse who helped us hadn’t been at the clinic, if we’d had to wait two minutes longer for the taxi, if we hadn’t left the waterfall as quickly as we did, if Emily and Kiav had gotten out of the car in Montezuma, if they hadn’t come with us, if they had gone to the beach… the chain reaction that saved Nikki’s life would have been broken.

            I don’t think it’s for us to know why – it’s simply to be grateful.  We learned a lot about our need for more complete first aid kits and deeper knowledge of wilderness medical response.  We learned about preparedness and protocol.  But most of all we were reminded of what we all already knew. 

That life is precious and every moment with those you love is to be treasured.  This whole thing is a delicately balanced miracle and if one thing is removed or added to the balance it can all end quickly.

            We forget these things.  Powerful things happen and cause us to see so clearly, but then time passes and we forget.  It’s how we keep going.  It’s how we can love again after heartbreak, live after loss and glory after pain.  We forget the intensity of our experience and move forward. Then, as today, a moment, when the fragility of life is exposed, reminds us to be thankful that we’re still here to recognize. and try to remember. and continue to experience this amazing, gut-wrentching and beautiful balancing act we call life.



             I have a new and healthy respect for those in the medical community.  I have no doubt that this afternoon would have ended very differently without Kiav and Emily and they will always be as angels to all of us.

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