There are many ways to get into trouble visiting foreign ports of call. I seem to find them. For instance millions of people go to Vietnam a year and do not come down with killer bacterial brain infections (see ‘My Madness’ in the side panel). I am unlucky I fear. I tried to come out of the womb backwards and have been doing the same (metaphorically speaking) ever since.
Here is the tale. It is a story about fear actually, but I’ll get to that. On a Thursday back in March we drove to Sally. A small costal city in Senegal where there was a company that flew mini-helicopters that we were thinking of using to drop sterile male tsetse flies over wide areas (you know—to make it hard for a female tsetse to find a good man).
On the way back we stopped at a game reserve that had a rather posh outdoor restaurant. I’d eaten there during my last trip, and they served a zabu cattle steak that is the best this side of Kilimanjaro. You eat above a large watering hole in which cape buffalo rested and crocodiles float in the turbid water. You could throw a big bread roll down into the water and the crocs would slide their noses beside it and wait until large fish were nibbling at the bread and then in a sudden snap and blinding thrash they would grab bread and fish and then, splashing wildly, choke them down.
Anyway, when we got there, everyone ordered the fish. And actually since it was lunch and I wasn’t sure I wanted something as heavy as beef and, besides, maybe they knew something about the beef I didn’t. I’d been hypervigilant about only eating cooked food and such, but decided that the in-country people must know what they are about, and since none of them got the beef, neither would I. I ordered the fish.
You will no doubt remember the Simpson Episode in which Homer orders Fugu, the famous Japanese blowfish
After eating he is told he as 24 hours to live.
The episode follows how Homer would spend his last hours if it did kill him. It didn’t. Happy ending.
Yes we had been fed blowfish. My colleague, an animal disease epidemiologist went down first. He started feeling really tired and fatigued. Another colleague and I were leaving for Dakar that afternoon and I could not tell extreme sleep deprivation and jet-lag from blowfish toxin onset so nothing seemed surprising or out of the ordinary. We drove two hours to Dakar and checked into the hotel. I ate dinner with my associate in the hotel and then went back to my room. Explosive diarrhea followed. I knew instantly the fish was bad, but I thought it was bacterial and took some healthy-bacteria pills (which work better than anything for flooding your system with good bugs that outcompete the bad) and went to bed. That night I woke up with my brain shocking me with bursts of electric zapping. Hard to explain, but not pleasant. Later again that night my stomach emptied into my esophagus causing extreme acid burning all the way to my nose. Bad bacteria I thought.
The next day my host said that we had been poisoned by the fish itself. Not bacteria. We’d eaten puffer fish well known for their deadliness when not prepared properly. Ours had not been. Crap. We had been dosed with a Tetrodotoxin. Here’s the Wiki entry on it I read back at the Research facility in Dakar:
Tetrodotoxin is a potent neurotoxin with no known antidote. Tetrodotoxin is 100 times more poisonous than potassium cyanide. Fish poisoning by consumption of members of the order Tetraodontiformes is extremely serious.
Then there was a slight miscommunication, which is mostly worth talking about because of what I did next.
My host started talking about how he thought this fish species was not as poisonous as other puffers, so we probably had seen the worse of it already. Then he started talking about Ciguatera poisoning from fish and I thought he was still talking about Tetrodotoxin posoning this is what he was talking (there are challenges with language of course). So he went out to look at some things I googeled Ciguatera. This what it said.
Neurologic symptoms tend to occur later (up to 72 h) and may persist for months. These are predominantly paresthesias, but a myriad of other sometimes bizarre neurologic symptoms may also be observed
Now I was scared. Not hallucinations! No! Not fair. I’ve don’t that already. I though I might not make it home if things tanked. I was very angry and depressed. I could hear everyone saying things, “He escaped death many times, but it was pufferfish that finally got him. It was inevitable really.”
I made up my mind about some things: 1) There was no cure; nothing could be done but supportive treatment anyway so I was not going to get hospitalized in Senegal. I’d have no family or anything in the way of support. So as long as I was conscious, no matter how much pain I was in, I was going to make it at least to Paris. Tough it out to Europe. Booyah. Recognizing that I might be incoherent when I arrived I wrote this on my leg hoping they’d see it when they put on my hospital gown (again I was very tired, toxified, and jet-lagged):
Of course, you know me. I misspelled ‘poisoning’ so the doctors would have said, “Wait . . . Wait look at this! It says he may have Ciguatera, we should check it out . . . No wait . . . never mind, it says ‘poising.’
Shades of this Farside:
Anyway, my host cleared it up when we got back that, no, we had pufferfish toxin not the dinoflagilate poisoning (I did not show him what I’d written on my leg). But still the next 36 hours would tell the tale as the symptoms will either get better or not in that time period. My stomach hurt, but it was a dull pain, and I had occasional face and tongue twitching.
So given that the hospital’s only treatment was with activated charcoal, we stopped on the way to the airport at the local pharmacy to get some charcoal pills (My two colleagues were both already taking them (thanks for not mentioning that earlier guys). I downed the briquettes gel-caps and prepared to either get better or get worse. Crap. This was not the way I wanted to go. I wanted to go peacefully in my sleep at age 106, not pufferfish toxin. I was really mad. The pills did seem to help. I wrote my wife and said I had a stomach ache caused by fish poisoning and all was fine. I added a sentimental note just in case this was it, but didn’t really say I wasn’t sure I’d make there. No sense causing any extra worry.
Anyway, the next 36 hours were spent in much contemplation about life. I thought about my family. How arbitrary things are and how you can be as careful as you can and still things get you. I was so worried about getting food poisoning and had been hyper-vigilant the whole trip. Now, ‘food poisoning’ that seemed so . . . pffit. Big deal. That’s at least curable. Well the time ticked on as I made my way to Paris without anything but stomach pain and twitches, but no advancing progression. I got on the plane and waited, with each hour bring hope that I might make it. Then, viola, 36 hours passed and I was still here. I’d made it.
I laugh now. But being in Homer Simpson’s place was not fun. So please next time you eat fish in certain places in the world ask the species. If they say Tetraodon lineatus, have the beef.