My Heart In the Dirty Hands of Essaouira Hospital

Going to the Provincial Hospital of Essaouira (Hospital Sidi Mohamed Ben Abdellah) was quite an experience. Having traveled around Morocco for 2 months, this was our first real reminder that we were, in fact, in Africa. Read on for some tips on how to go to the hospital if you have an emergency in Essaouira, Morocco or maybe just for an interesting story...

Out of nowhere...

So, I had this strange heart incidence. It’s funny really - we’ve been going for two years without anything happening, and then within 2 months, Alex crashes in Vietnam and almost drowns in Indonesia and I get a super strange hand rash in Bali and get hospitalized in Morocco with tachycardia and arrhythmia… 

On Saturday we were just beginning an extended weekend – Monday was going to be Memorial Day in the US (or something like that) – and were enjoying our amazing breakfast on the rooftop patio. Our riad in Essaouira was one of the most magical places we’d ever stayed with candles along the stairway in the evening, a scarf on the parasol flowing in the wind on the sunny rooftop with a sea view and a room with a super high ceiling and a cave-like atmosphere. We loved it there. Even the city of Essaouira felt like a welcome break after some less westernized stops – in Essaouira, we could enjoy both local tagines, a beach and clean cafes.

As we were savouring our fresh orange juice and hot croissants, I started feeling a stabbing pain in my chest. For the billionth time over the course of the past 5 months, I was expressing my irritation and confusion over weird, recurring heart sensations to Alex, who at that point had gotten so used to the topic that we quickly went off track. But as we went downstairs and sat for a while in our room – Alex taking care of some work and me drawing “henna” with a pen on my hand - the pain was replaced by a sinking feeling and a nauseous, dizzy sensation that almost had me blacking out.

I sat up and told Alex my heart was acting strange. He calmed me down, saying we’d just take it easy, do nice things like relaxing in a coffee shop and play DuoLingo. He said it with his face right in front of mine, leaning in as I was sitting at the foot of the bed in our dimly lit room, but the last of his words drowned as I fell into a bottomless darkness behind my eyes. To pull myself out, I grabbed his arm and opened my eyes wide. I really wasn’t feeling good. My chest was hurting, my limbs were tingling and I felt a kind of dizzy I’d never felt before in my life.

Finding the hospital... and a doctor.

We started walking towards the local Hospital of Essaouira – a nice 10 minutes walk from our house, just south-east of the Medina. “Hospital Provincial de Essaouira” aka “Hospital Sidi Mohamed Ben Abdellah” aka the only hospital within 20 miles. I told Alex from the beginning we probably wouldn’t go all the way there – I would probably start feeling better soon, but it was a strange sensation, so just in case. On the way, I had several half blackouts and by the time we made it there, my nails were blue. I started to get scared and so did Alex.

It took us another 10 minutes inside the building to find someone to ask for a doctor. The reception area was an abandoned booth with broken glass, and everyone else just seemed to be flocking outside what looked like a consultation office. I had to sit down and did while Alex went looking for a way to get us registered or something. But there was no way. Instead, he pushed through the crowd to “talk” (point to me) to the guard outside the consultation, and the guy nodded and gestured for us to wait. I was feeling increasingly shaky and had Alex sit close to me so I could hold onto him and concentrate on breathing calmly while my heart was performing acrobatics in my chest. It didn’t help that the office was attacked by the crowds of people eager to be seen next each time the door was opened with no kind of queue going on whatsoever.

For the next 10 minutes (maybe it was 20 or 30), I was concentrating on relaxing and breathing. I knew that when it comes to the heart, panicking only makes matters worse. Breathing in. A girl with Asperger’s was twirling in the middle of the room. Breathing out. She was wearing pink and looking into the ceiling with her arms out to the side.  Breathing in. My heart felt like it fell from my chest and into my stomach as my vision darkened and all my limbs went numb. I fastened my grip around Alex’s arms and pulled myself back into reality. My heart was still there but it felt like it didn’t belong to me, like someone else’s heart had been placed in my chest and was beating vigorously, trying to break free.

Finally, I sat in front of someone wearing a stethoscope. How had I gotten into the office? Had I really made my way through the mass of people claiming their turn at the door?.. She asked me in broken English what was the problem. I think I told her I was shaking and felt like passing out, but this was around the point when I realized I couldn’t talk comprehensively. I had a hard time getting even the simplest words across my lips and I was annoyed that I couldn’t hold onto a train of thoughts. Of course the fact that most words had to be accompanied by some sort of hand gesture for the communication to go through with the confused looking, stethoscope wearing, maybe-doctor didn’t make things easier.

Setting up the equipment... and plugging it in.

I am not sure of the order of events that followed, but I know they tore Alex away from me and placed me on a stretcher in the “intensive care” room where a few other people on similar, blood stained metal stretchers without sheets watched as my blouse and bra were removed for the young “nurses” to cover me in a layer of blue gel and apply the ECG suction mounts. I remember wondering in the back of my mind what the older gentleman in the bed next to me thought of this vision, considering how I was in Morocco where women are usually completely covered up. I think one of the 7 girls at some point had the presence of mind to put a divider in front of me and my exposed chest. There were literally 5-7 girls – all younger than me and wearing pink robes. It took me a while to realize that more and more of them flocked around because no one seemed to be able to make the ECG recorder work, now that they’d finally managed to fasten the suction cups right (although they applied them way to hard and with way too much blue gel).  An older woman luckily came to their rescue and fixed the problem – the machine wasn’t plugged in. Oh boy. I was close to passing out and my heart was pounding out of my chest. I remember thinking I might die before I made my way to the hands of someone that would have the slightest idea of how to help me. I was beginning to realize that this hospital was more like a building of rooms collecting sick people but not really doing anything about them: On the stretcher next to me, a woman was screaming in pain while everyone was just looking confused at each other. The next hint towards the standard of the establishment was that no one had ANY tissue to get all the blue stuff off me once they finally managed to make the ECG machine spit out a print of my fast paced and irregular heart rhythm. All seven 15-year-old girls were looking around, trying to find something to wipe me with. Finally someone removed the larger chunks of gel with a small piece of gauze… Being a former nurse, I could not comprehend how there could be no paper of ANY kind, but later I’d begin to grasp the scope of the hospital’s insufficient resources.

I remember a wheel chair although I don’t remember not being able to walk. But thinking back, I don’t really remember not being able to do anything at all, so it was probably for the better that I was wheeled down to the radiology room. It seemed the ground floor consisted of nothing but endless white, flaked off walls and these three crowded rooms: the consultation filled with noisy people, the intensive care filled with little girls in nurse clothing and the radiology room with all the big machines. In there, I managed to stand up for a few seconds while the guy made a machine go beep and printed a regular x-ray of my thorax. I had expected to get an actual heart scan and was confused. The blue-black print looked like any other thorax. I think I joked to Alex about how we could hang the x-ray in our bathroom so guests could look at my lungs while pooping. Of course we didn’t even have a house at all and most of me was just concentrating on staying above water. It didn’t really help though. I kept falling backwards into nothingness and forcing myself back up and my heart kept doing back flips. The paint was really coming off the walls…

I know I talked to my Danish insurance, but I could barely speak when I did. If I had a hard time speaking in one language it didn’t make it easier to have to switch back to my mother tongue too.

The bed... and the bathroom.

Then I was in a bed. It didn’t have any sheets, and the bare, grey leather surface had several stains. I was cold, shaking cold actually, and my toes were oddly violet. A woman finally gave me a sheet with dirt on it as well as a blanket, and I was just thankful I’d gotten blankets at all. Why was I in bed? What was next? Oh yeah, I had to see a cardiologist, that’s what I’d been told. Because they had no idea what was going on with me – except I had an abnormally high pulse and high blood pressure. At this point no one had even bothered to check my oxygen saturation – the simplest test in the world – a pretty obvious place to start when your patient is shaking and turning blue.

Over the course of the next 4 hours, I was told that there was no cardiologist – they had to call him and get him to come by on Monday. I was in a room with 6 other women in bed, all looking pretty healthy although I’m sure they were not. Neither of us had any type of medical equipment attached. I hadn’t even been given water or food in spite of the fact I was pretty sure my vitals were way off the chart and my hydration levels were falling as the blood pressure pumped liquids through my kidneys… Making sure, by the way, that I got to experience the very worst part of Essaouira hospital all too intimately – the bathroom.

I had to pee every 10 minutes. There was just one bathroom at the end of the women’s ward, and inside was just one stall as well as a long, broken sink. The sink has an apple core in the drain and remnants of puke on the wet floor beneath it. The door to the stall didn’t have a handle or a lock, but a string had been attached to the side of the frame so that one could hold on to the end, pulling the door shut from the inside while taking care of business… squatting of course, because there was nothing but a Moroccan toilet (hole in the ground) inside the booth. A hole covered in human excrements. As I staggered in there and got my shorts down with one hand while holding the string with the other, I felt extremely glad I was familiar with this type of toilet, because the first few times I (or anyone western I’m guessing) had to deal with that kind of installation, the result was not exactly pretty. Not surprisingly, there was to toilet paper. In fact, I had asked a nurse for some and she had returned 15 minutes later with another piece of gauze. Yes, gauze! There apparently was no paper en the ENTIRE hospital! The only way to flush was by pouring water into the hole, but, considering the state of things, I was trying not to touch anything – especially not the gross bucket that other people had probably used to clean themselves due to the lack of paper. Back outside, a stray cat hat joined the miserable scene and was licking puke off of the floor beneath the sink. That obviously didn’t have soap. Welcome to Africa.

Checklist when going to the hospital in Essaouira:

  • Toiletpaper!
  • Water/food
  • Sheets if possible
  • Disinfecting gel (another resource that really should exist in a hospital)
  • An insurance that can get you transferred...

Getting away from the hospital of Essaouira... and to a real hospital

I was lucky enough to have an amazing insurance that not only sent an ambulance to get me to a real hospital (with both nurses, doctors and cardiologists!) in Marrakech but also got me on the phone with a doctor in Denmark, which helped a lot considering the incompetence of the only maybe-doctor in the Provincial Hospital of Essaouira. I was even told later that the young “nurse-girls” down stairs weren’t nurses but locals trained to help the few real nurses out. No wonder they had no idea how to work the medical equipment.

The ambulance was a long time on the way and my condition wasn’t even mildly better until an hour before it made it there at 7pm (we had arrived at the hospital at 10.30). Alex went to our house, packed our stuff, bought us some food, carried both of our backpacks to the hospital and even brought me a rose. The 2 hours he was gone were the longest of my life, and with no one but 6 old, Moroccan women around me I was scared I might feel worse and not have anyone around to help me. While I was waiting, I spent most of my time staring at a palm tree swaying in the wind outside the window and a few strange stains in the ceiling above my bed while focusing on breathing and trying not to black out. I had cell signal on my phone but Alex only had data, so we couldn’t even keep in touch. When he finally came back, I was almost crying with happiness and a lot of the pain in my chest went away. The rest of the time until the ambulance came was bearable, although my heart still felt foreign and as if it could fall down into my stomach any minute.

We then tried to leave the hospital, asking for my papers and trying to find the place to pay the bills. I only got half of all the documents that had been written and half my results. On the positive side, we spend 15 minutes asking around for the place to pay the bill, and when we finally made it there, the guy took one look at everything and said we didn’t have to pay anything… I still don’t understand how that happened – I got a short consultation, a bed in “intensive care”, an echocardiography, a bed in “observation” for half an hour, a thorax x-ray, and a bed in a regular ward for 7 hours (unclean sheets, yes, but one bottle of water!)… And they told me to leave without paying a single rupiah!

Going to Marrakech took around 3-4 hours, and Alex made the trip a billion times more comfortable with good music and podcast so I didn’t have to think too much about the strange sensations in my chest – not that I was really able to think about much of anything at all. The sun set behind the sand dunes as the ambulance made its way through the dessert and I felt extremely guilty that I maybe ruined the last few weeks of our 2-year trip and made it impossible for us to go out and sleep in the desert like we had planed. I held Alex’s hand the whole way and felt overwhelmed with how much his presence meant as he sat there next to my stretcher, staring out into the red horizon. By the time we reached the International Clinic of Marrakech, my heart had settled down a lot, I felt warm and I hadn’t had any blacking out sensations for more than two hours.

The amazing International Clinic of Marrakech

I was about to jump of the stretcher when they opened the back of the ambulance, but the two nice drivers insisted I lay down and pushed the stretcher through the hospital to the observation room. When I got off the and took one half step across the floor to climb the large, comfy hospital bed surrounded by machines, I was glad they’d insisted I didn’t walk myself. My legs weren’t exactly stable. It felt like my entire body had given up its energy and resources so my heart could keep pounding. When I got all the equipment on, it turned out my blood pressure had almost normalized while my pulse was still high and my oxygen saturation was – surprise – low. I felt a lot better, though, and changed into soft, clean, white hospital robes with a logo on them before a cardiologist came in and made a full radiology scan of my heart.

I had talked with my Danish physician about possible causes and had mentioned to him how I’d taken a dose of my asthma medication in the morning before the whole heart-event (I’m not asthmatic, but whenever I get allergic reactions I get asthmatic symptoms, which had happened that morning). My asthma spray happen to been 2 years expired and of a kind that isn’t even sold any more as it has too many unfortunate side effects. I had happily agreed with him that my incidence might be due to a side reaction to the expired medication. The nice, female cardiologist didn’t agree though and was very interested in the fact I’ve had sudden “heart skips” over the course of the past 4-5 months. Obviously we’d been traveling so I hadn’t seen a doctor but was planning on doing so when returning to Denmark 2 weeks later. The cardiologist finished the exam and said the anatomy was right which meant I had to have a blood test to check the chemistry and a 24hr ECG to check the those skipped beats – she thought they might have something to do with what happened. As she left, she asked the nurses to get Alex and I a room for the night (Alex had been awkwardly standing at the foot of the bed with two backpacks he didn’t know what t do with) but none were available. I felt so bad when Alex just waved me off and went to sleep on a couch in the empty waiting room. He’d been there 120% all day, never complaining and doing far more for me than I could have ever imagined. He completely took over everything when I could barely think and made sure I was safe and that everything went smoothly. Quite honestly I was surprised at the extent of his awareness and concern and it made me fall so much more in love with him to know that he’s able to be strong enough for the both of us when I’m weak. It also made me feel horrible that I was making him sleep in a waiting room and spend an entire day in a hospital/ambulance AND leave Essaouira before time...

I barely slept that night, with two different emergencies happening causing everyone to scream and turn on lights not to mention my own saturation-meter that kept beeping to alert hospital personnel that my oxygen level was falling below the limit of 89%. I was quite surprised at this considering I now felt fine and warm – I wonder what my saturation was in the morning when I was turning blue – and also surprised they were just letting the machine beep.

I was woken up at 7am by a guy wanting to extract blood for a blood test, and it occurred to me how pointless it was to perform a blood test 24 hrs after I might have been experiencing the side effect to a chemical in my blood. Breakfast was bead, banana and porridge. I recognized the porridge as what we call “soft food” in the Danish hospitals – the food you only serve to severely disabled patients that for one reason or the other aren’t able to eat well. It seemed to just be standard in ICM though, because they kept serving me anonymous fluids for the next two days….

Well, in spite of still having a moderately high pulse and a falling oxygen level, I started feeling a lot better. Around lunchtime, the blood tests came back fine and I was informed I now only needed the last test – a 24hr ECG where I would need to leave hospital grounds so my heart rate and neuronal patterns could be measured over the course of a normal day. Unfortunately, the little, portable ECG wasn’t available until the next morning. I thought I could leave and come back the next morning, but after hours of back and forth it turned out that I couldn’t go, because the Moroccan doctor recommended I stay, which meant the insurance company said they couldn’t vouch for me leaving. I had made it all the way to the lobby before this decision was made and I was very sad to have to spend another day of my "vacation" in a hospital when I was feeling fine - although the ICM is truly beautiful. They gave me a room and I said goodbye to Alex who went alone to the nice hotel he’d booked for us in Marrakech as a surprise to me because of what had happened. I closed the door to the beautiful, large room with a view of the red city and cried my heart out. Cried about how scary everything was, cried about lost days, cried about feeling imprisoned, cried about missing home and cried about how little I deserved Alex’s love.

No one came to check on me all night, and the room had no monitors or machines. I felt like I’d been parked in the corner as an overnight investment that would suck the maximal amount of money out of my insurance company. I did enjoy the nice, spacious shower and some privacy and clean surroundings after all that had happened. I watched the last two episodes of the Danish TV-show “Forbrydelsen 2” although I was extremely tired, just to make sure I would pass out as soon as my head hit the pillow so I wouldn’t have any excess time to listen to my fragile heart.

 The next day I was extremely antsy. I was now feeling absolutely fine and even the pain had disappeared. My heart felt like normal after a bumpy 35 hours. A new cardiologist made a quick radio-scan and told me I have a genetic disease that can make my heart beat very fast, which was confirmed by absolutely nothing in my entire history or report… He said I was therefore going to wear the ECG to monitor this (not at all the reason I had originally been assigned a 24hr ECG test). I just kept silent, knowing he was misdiagnosing me. I didn’t get the 24hr ECG on until 12pm and then the reception still wouldn’t let me go because “my insurance say they not pay if you go when you’re in treatment.” I frantically called my insurance (like I had just a few hours earlier) asking them what was going on. My caseworker had apparently gone home and had forgotten to tell the hospital I was OK to go as long as it was part of the treatment. So another 2 hours later I was finally set free and went to meet Alex by the gate of the city I hadn’t seen yet. Our hotel was beautiful and I was thrilled to be free although I was covered up in chords and tape, making everyone turn their heads on the street.

The next day I went back to get the machine off and to get the results. After 2 hours of waiting a nurse finally ripped off the ECG and told me to come back the next day for the results…

Another day passed and I went back to get the results, which took another 3 hours. The misdiagnosing doctor was happy to tell me I didn’t have any occurrence of double heart beat as a result of a genetic feedback loop (no sh**) but that I DID indeed have an extra systole (a skipping heart). Normally, I feel my heart skipping 1-3 times per day but I hadn’t actually felt one while wearing the ECG. The doc told me these skips are perfectly normal, which my Danish doctor confirmed later. So I guess there was no connection in between them and the incidence on Saturday. Which means I still have no idea what happened. Only my Danish doctor has a plausible explanation (the expired asthma medication) while all the doctors that saw me in Morocco told me this wasn’t a plausible cause… But well, I was finally going home from ICM with my whole case folder in my arms, for the last time jumping into Abduls taxi. I had made an agreement with him to drive me 4 times in exchange for a better price. So instead of paying 50 per time like a tourist or 5 per time like a local, I ended up paying 25 per time like something in between. Which was fine by me.

So well, now I’m happy and fine and sort of confused. But ok. And pretty glad I had insurance!

Check list when going to the International Clinic of Marrakech:

  • A good insurance...
  • ... and PLENTY of patience