BLACKWATER FEVER

David Swanson looked out the window of his 7th floor New York apartment. The yellow morning horizon of just a few minutes ago was rapidly turning into a sunny day and the outside temperature reading was already 66 F. Not bad for October in New York City. This will be a good day. But he was soon to be proven wrong. Going to the desk in his small study, he smelled a peculiar but familiar odor coming from his body. It was there every time, after the attacks of drenching sweats and shaking chills. He attempted a few simple exercises and felt the usual soreness in the muscles of his shoulders, abdomen, and thighs. It had happened again .Another malaria attack and I don’t remember a thing.

He tried to think back to last evening when he had taken his latest medication. Usually he remembered the aura preceding his attack. He had gone out. What happened? Usually when he got the ringing in his ears, along with the throbbing temporal headaches, he had at least two-hours to get back to his apartment before the sweats and shaking chills began. The proof would be in the bathroom. He lifted the toilet seat lid, emptied his bladder, and there it was. His urine was dark red. His army doctor in Iraq described it as port wine. In dim light it looked almost black.

“Lieutenant Swanson, you have the type of malaria caused by a strain of the plasmodium parasite of the falciparum variety.”

“That means nothing to me, Major.” Swanson sat up in his frame bed at the field hospital. He was built like a cage fighter but with a college refinement–all the more deadly with the expertise of Special Forces training.

“The parasite lives and grows inside the red blood cells–your red blood cells. When it gets too big for where it lives, the red cell bursts releasing hemoglobin, the substance making red blood cells red. Then your kidneys get rid of it. You pee out the hemoglobin. It’s dark red because there’s no oxygen attached to it anymore.”

Major Robert Gordon held a chart showing the lifecycle of the plasmodium falciparum organism. “This little sucker started out in the salivary gland of a mosquito.”

“A friggin mosquito bit me and spit that thing into my body? For almost a year I’ve been dodging bullets, landmines, and RPG’s, and I get downed by a microscopic creature that lived in the spit of a bug?” Swanson steadied himself by hanging onto the bed rail.

“Lieutenant, you may feel a little dizzy because the net result of the whole process is that you tend to lose almost a whole unit of blood when your red cells burst. We have several medications we’re now using here in the Middle East which should prevent future attacks. However, it is possible this type of falciparum can remain dormant waiting for your system to get run down at which time its life cycle could start up again. Unless you take the medication when you have a cold or feel ill you could get another attack.”

“What happens to me now? I’m part of a special operations unit here in Baghdad. We’re ready to launch an important mission against a concentrated Al-Qaeda group and I have to get out of here.” Swanson fell back onto his pillow from the dizziness.

“We have a standard protocol for treating malaria and a few other serious infectious diseases in this place. You’re to be transferred to Ramstein Air Force Base and recuperate in Landstuhl Army General Hospital...” Major Gordon held up his hand to stop Swanson from interrupting. “…for at least two weeks Lieutenant. And there can be no discussion on this.”

Swanson remembered that first attack vividly. There were no blackouts in his memory at that time. He also remembered everything at the end of his two-weeks in the Landstuhl Army hospital when he had his second attack.

“Lieutenant Swanson, your strain of falciparum is not responding to the chloroquine or the primaquine antimilarials. We have to get your disease under control or it could kill you. But there’s good news.” The infectious disease Army specialist smiled. “You’re being shipped home to the states…to Walter Reed Army General Hospital.”