And then there was rain

Rain in a tropical country is unlike anything I've seen in cities I've lived in the US. Growing up in California, I experienced rain as a rainy day here and there when I was growing up, but it wouldn't really change in intensity too much, and when it was over, it was over. Then I moved to Boston and learned that summertime meant keeping an umbrella in my bag at all times or risk being caught helpless in a torrential downpour while trying to cross a slippery bridge on my way home. Luckily, save for a few close slips on the slippery stones, I never completely wiped out in the rain. Rain would start suddenly and pour intensely, but it almost always stopped just as abruptly and it never lasted too long.

Here in Brazil, when a rainstorm is forecast, I know now that it's serious business. The past few days, it's been raining here and there, sometimes intensely with a lot of thunder and lightning. Luckily I live very close to the hospital so my walking commute is pretty short, and I've been going home at times when it hasn't been too bad. Yesterday when it started to really pour, thunder and lightning and all, a resident was taking me to see a recently admitted patient with leptospirosis. We talked about the development of the disease, arising from a bacterial infection in which a human is exposed to contaminated animal urine containing the spirochete bacteria. Then we went into the room to see the patient, and he displayed and relayed a textbook picture of leptospirosis and its severe form, Weil's disease. He was very jaundiced, was recovering from intense calf pain (myalgias esp. in the calves are common), and spoke of his flu-like illness which began a few days earlier. He was also recovering from acute kidney injury - prior oliguria resulted in a reduced urine output that he described as "like gasoline." Luckily for him, timely treatment and signs of recovery suggested that things would end up OK for this patient, but my resident emphasized how serious his illness could have become, and how she's seen a patient die of leptospirosis because of pulmonary hemorrhage.

Today I thought of that patient with leptospirosis when I was caught in an intense thunderstorm. I had high hopes of visiting the Mercado Municipal today because clinic finished a little early, but my plans were foiled when I exited the metro station. I probably got as far as a block when I had to duck into a jewelry store to avoid the literal flood of rain coming down. Not only was I a bit lost in the area, but within 3 minutes I watched from inside the store as the street became a river with the water level creeping up the sidewalk. More than half the sidewalk was flooded with water and in some cases the whole thing was submerged. The few cars that drove by while I attempted to wait out the rain seemed to float slowly by. My sneakers weren't able to avoid submersion into a few areas of the sidewalk as I made my way back to the metro station, resolved to visit the Mercado another day (my umbrella hadn't really helped me stay dry in the least). I also couldn't help but think of the deep puddles of rain and my resident talking about the rat urine contaminating flood water in the city's periphery and people wearing sandals and how it would be horrible to see a small spike of leptospirosis pop up in 2 weeks (the incubation period). Would they fare as well as the man I saw yesterday?