Leaving a Balinese hospital against medical advice is just the beginning
Even in the moment, it made me laugh to be on this side of things
At least once per week (if not once per shift), I have a conversation with a patient about leaving Against Medical Advice (AMA). “If you leave, you could get more sick, you could have a complication, you could even die… blah blah blah…” Well, now it was my turn to be in the hot seat. Literally, it seems. My temperature was 102 °F. My blood pressure was 90/40, and I had just been diagnosed with pneumonia. They wanted to admit me to the hospital for additional observation and IV antibiotics because my blood pressure was too low and I technically met sepsis criteria. This is not what I had planned for our final day in Bali. And yet, here I was, still fevering and hypotensive even after a liter of fluids, asking to be disconnected from my IV antibiotics so I could leave the emergency department.
This had all started at least a week earlier, and it all makes sense in retrospect. We were pushing our bodies to the absolute limits on this trip, wanting to squeeze as much as possible out of each day. We both contracted some sort of viral illness - cough, congestion, chills, fatigue. I also had a GI bug and terrible abdominal cramping for two days. We had been at a little Airbnb tucked into a forested valley in Ubud, and despite feeling sick, we continued with our plans to take the ferry to Gili Trawangan to get scuba certified.
We were feeling pretty run down. Carrying our equipment to and from the boat and staying focused during the theory lessons was the most we could muster. Our hotel/hostel hybrid was not the most restful either. Our room was located directly above the bar’s kitchen, so we heard dishes clanging until 2am each night before early morning roll call. We pushed through though, and we had an incredible time! We are now scuba certified and so grateful we did it.
Immediately after this adventure, we moved to a little villa in Pererenan, where we had initially thought, “Ah, yes, we will rest when we are there.” Well... that didn’t happen. We met a new friend, Steve, when we were scuba diving, we joined a gym filled with awesome people, and we just couldn’t help ourselves. Multiple back-to-back workouts over multiple days. Met another friend who had just started a business and went out to dinner. Stayed up late to enjoy everything the Pererenan and Canggu areas had to offer. Woke up early to the godforsaken roosters and honking scooters. Rest, we did not.
Toward the end of the trip, I was starting to feel poorly again. I was convinced it was circumstantial–too much exercise and booze, not enough sleep. So I did what anyone would do and got on WhatsApp to order an IV infusion to our villa so that we could bounce back and go out to dinner with another pair of new friends. And it worked! Briefly, at least. The massive infusion of B vitamins, Balinese hospitality, and fluids gave me the energy I needed for the night and a little bit of the next day. Looking back at this roller coaster of a trip, I am not sure I would have done it differently. Consequences be damned.
I guess it comes as no surprise that my cough worsened, my energy dipped, and on the final night of our blitzkrieg of a Bali trip, I had a fever with terrible rigors. Foggy and shaking in bed, it was all I could do to try to diagnose myself. Dengue? Leptospirosis? Pneumonia? I had been crushing Paracetamol and NSAIDs around the clock, convincing myself that I was fine and just needed some rest. But there was no rest in sight. We had a hell of a travel day ahead of us and there would be even fewer services and less healthcare infrastructure where we were headed next. So this was my only chance to get any sort of medical attention. I knew that there was nothing I could do if it was Dengue or Leptospirosis, but if it was a bacterial pneumonia I needed antibiotics, and I needed them now or things would only get worse.
At 7:30am I left Emily at the Airbnb to pack and clean while I got myself to the nearest emergency department with decent reviews on Google Maps. I had to be back by 12:00pm because the motorbike lady was coming to pick up the little orange Honda Scoopy we had rented. I met her only briefly when she delivered the bike. She was a no-nonsense woman and she had my credit card number. Missing the drop-off time was not an option. We also had to check out of our villa by noon and leave for the airport for our marathon travel day.
I signed the AMA paperwork and hurried out to my motorbike
It was 9:36am when I left the hospital AMA. I know this because that was the time my bill was delivered to my WhatsApp (still amazing to me). Still fevering and lightheaded, I stopped at the hospital pharmacy to pick up my antibiotics and hurried out to my motorbike around 10:00am. It was about a 30-minute drive, so I walked out to the parking lot knowing I'd have an hour and a half to shower, finish packing, and leave for the airport.
Yeah, well, Bali had other plans for me.
I put the antibiotics in the seat storage and the key in the ignition. I turned the key. Nothing. Not the “ding ding ding” of the bike’s display powering on. Not a single attempt by the engine to turn over. Not a sound. “No way,” I said out loud. Took the key out. Put it back in. Still nothing. I looked around the motorbike parking area for anyone who might be able to help me. Nope. “How the hell am I going to solve this problem?”
Enter: Made (pronounced “Mah-Day”, the traditional name given to the second-born son in Balinese culture).
He and another man were clearly the hospital security and parking attendants, having a smoke outside of the parking box at the entrance to the lot. I walked up to him and tried to explain my predicament. His English was limited, but he seemed to sense that I needed help with something. I motioned to him to follow me. I showed him how woefully unresponsive my bike was to any attempts to bring it back to life. He looked at me, looked at his watch, then held up his hand and said “five” then hurried around the corner.
By this point I needed to sit down anyway. The day was heating up in more ways than one, and I was lightheaded. I found a corner of shade and waited to see what tricks Made had up his sweat-soaked cotton polo sleeves. The next thing I knew, he came zooming around the corner on a different motorbike (his, I presumed) and motioned to me to get on. He tapped the back seat excitedly and said “on, on!” I had no better ideas, so I grabbed my antibiotics and got on.
My little goodie bag of antibiotics was the only buffer between me and the hospital parking attendant I was straddling. We whizzed down one of the main roads in Denpasar for about ten minutes before turning onto a more local road. Another two minutes and we pull up to what I can only describe as the most quintessential Southeast Asia motorbike shop one could ever imagine.
About a dozen motorbikes in various states of disrepair decorated the entrance to a corrugated-metal-and-plastic-tarp shantytown of tools, barrels of oil, and dangling wires. The place smelled equally of cigarette smoke and gasoline, and at least 3 of the motorbikes were idling for no apparent reason. In the back, there was a family of chickens that may have outnumbered the humans and the bikes. Aunties and uncles attended to toddlers and motorbikes, respectively. Around the corner, one of the guys was smoking a cigarette and filling a gas tank. Next to him, another uncle was squatting in flip flops and welding with no face shield.
I hope it goes without saying that this is not the type of place where English is spoken, but it is the type of place that can solve any problem you might have with a few hundred thousand Indonesian Rupiah (IDR). About now, I was starting to wonder what the plan was. The Scoopy’s battery was almost certainly the issue, but I didn’t know that for sure. Were we going to buy a battery here and bring it back to try to install it ourselves? How does one even install a Scoopy battery?
I sat by helplessly, clutching my antibiotics, as I watched Made explain my situation to one of the uncles. After a minute or two of emphatic Bahasa and hand gestures, a different guy comes from the shadows of the shop, jumps on the back of Made’s bike, and the pair zooms away.
Great. Now what? Are they going to go assess the bike and come back? Maybe do another trip with a battery and then retrieve me? The plan is unclear, but my brain is hazy anyway. So I sit and wait, watching the chickens peck and scratch at the grit on the surface of the cement, taking in the sights and sounds and smells. I texted the Airbnb host and explained the situation. They said we could have an extra hour to get out of the villa, but the cleaning staff will be arriving as planned.
About 30 minutes later, to my disbelief, Made appeared first. Alone on his motorbike, I gave him an inquisitive look. Then I saw that right behind him, the other man was running with my dead Scoopy beside him, like a kid rushing to meet curfew, coaxing his unexpectedly broken bicycle over the finish line. This man was absolutely soaked in sweat, and clearly parched from the ordeal, but he was nevertheless ornamented with a lit cigarette at the corner of his mouth - quite literally huffing and puffing.
The main guy in the shop got right to work, unscrewing the footplate and lifting out the old battery. Within minutes a new battery was installed. I stood and approached and asked Made, “how much?”
Made and the shop owner exchanged a few words then Made typed onto his calculator app on his phone “400,000” (about $25 USD). I motioned to my credit card, hoping that there was some chance. The man shook his head. Yeah, this was not the type of place that takes card.
At this point, Made realized the situation and was clearly over it. “ATM?” I asked. Made got back on his motorbike and tapped the back seat once again. “On!”
Again we were zipping through the streets of Denpasar in search of a bank. The first ATM we stopped at was out of cash. The next didn’t take my card. The third was not the charm as it, too, was out of cash. At the fourth ATM, I withdrew 1,000,000 IDR, and we hurried back to the motorbike shop.
I slid off Made’s bike and handed 500,000 IDR to the shop owner. He gave me one nod, walked the Scoopy to the curb, and even started it for me in an act of triumph. I turned to Made and thanked him. I handed him the other 500,000 IDR ($30 USD for saving my ass on a day like this was the least I could do for all of his troubles). He got off his bike, took the cash with both hands, folded it up, and put it safely in his pocket. He put his palms together in front of him and bowed. I thought to myself “I’m the one who should be bowing” but I’m pretty sure I would have passed out.
I got on my bike and Made walked into the street, holding his hand in front of oncoming traffic to ensure I could get out okay. “Safe” he said, and motioned for me to go. And away I went, in absolute disbelief of the morning I had just had.
I arrived back to the villa at 11:50am. I handed Emily the motorbike key and collapsed into the pool. Ten minutes later the woman came to pick up the bike and its secret new battery.
I had a few bites of food for the first time that day and finally took my antibiotics.
As if the last few hours hadn’t already been a daze, the next 36 were even more so.
I showered, dressed, and we called a Grab to get to the airport. The 90-minute ride in traffic with limited AC didn’t do much to help. I was so weak I could barely carry my own backpack. Emily had to help me. It took all the strength I could muster to stand up straight and not look suspiciously feverish as I went through security. We had a little bit of time before the flight and we split a BBQ chicken pizza of all things.
We boarded our 7-hour flight to Auckland around 5pm. Cold sweats and fevers. The antibiotics had not kicked in yet and I was still fighting against the sepsis. At least if things get worse there will be good hospitals in New Zealand, I thought. We were flying Air New Zealand and they were serving complimentary Sauvignon Blanc. I skipped the wine. That’s how you know things were bad. We arrived at 5am NZ time and made it though customs. I had strategically timed a dose of Paracetamol two hours prior just in case they had thermal cameras at border control.
Our layover was 15 hours and we were flying to Tahiti that evening. I booked us a day-use hotel and we took an Uber into downtown Auckland for a few hours of sleep. After a prolonged nap and a coffee, I took advantage of my brief spurt of energy and we went for a walk in the city.
The cool breeze blowing in from the harbor may have been more healing than the medications at this point, because as soon as we were back in the airport I was in rough shape again. Another dose of antibiotics, another complimentary glass of wine skipped.
After a 5-hour flight to Papeete, we arrived at 2:30am and had a 5-hour layover before finally heading to our final destination in Bora Bora. I found a cement bench and passed out with Emily keeping watch over our bags and my body.
As morning arrived and we walked onto the tarmac to board our puddle-jumper, I was still praying for my antibiotics and immune system to be victorious in this fight. Emily was still carrying my bag as my dad picked us up from the airport.
We arrived at his boat and I melted into the sofa. I didn’t want to be a buzzkill. I hadn’t seen by dad in nearly a year and now here we were in Bora Bora (!) of all places on his boat. I drank a quadruple espresso hoping it would help me power through. Nope. I dozed the day away and sweated out my fever in with the help of the still, salty air. Emily finally put me to bed around dinnertime.
I slept for 14 hours and finally woke up on the other side of this 48-hour gauntlet.
The next day, my head was finally clear enough to reflect on the whole ordeal. I thought about the incredible Balinese hospitality and Made, who went out of his way to help me with no expectation of anything in return. I thought about the motorbike shop, the ecosystem of innumerable small shops like it, and all the people it takes to keep Bali’s fragile infrastructure humming despite all odds. I thought about how intensely we’ve been traveling and how we are fortunate to have the health and financial means to make it all possible.
I thought about the stories that we create as we travel the world. These stories are not ours alone. Parts of this story could just as easily be told by any member of the cast - the doctor at the hospital telling her colleagues about a patient who left AMA, Made telling his family how he made an extra 500,000 IDR, the motorbike uncles laughing about the tourist whose Scoopy died and how a hospital parking lot attendant helped him, the Denpasar airport security personnel whispering to each other about how that guy doesn’t look so good, the day-use hotel front desk person who explained my situation to her manager and got us early check-in, the other passengers at the Papeete airport wondering how someone could be asleep on a concrete bench in the middle of the airport - the list goes on. What else did they have in their stories during that same day? I’ll never know.
Most of all, though, this experience made me think about the patients I’ve discharged AMA over the years. I found myself wondering what their next 48 hours looked like, after they left the hospital. Even in my foggy, feverish state, I was surrounded by support, comfort, and options - a level of stability many people simply don't have. Many are navigating financial hardships, housing insecurity, addiction, caring for kids alone, or all of the above. Realizing that put my own situation into perspective.
All these thoughts were swirling though my head as we watched the sunset and got ready for dinner. I popped another dose of antibiotics, chased it with a swig of only-kind-of-cold beer, and all I could do is smile.
This existence, this story, this place in the universe and on this planet. All of it - ridiculous. More than anything else, I was filled with gratitude.
What an incredible life we are so fortunate to be living.
And shame on us if we don’t continue to live it to the f*cking fullest.
Until next time ✌️
Tony
