When Dreams Turn to Nightmares

Brett Fontain was a head in a box. Electrodes stuck out of his skull from all angles, connecting him to the glass frame that contained his entire being. He was a frankenstein monster, crippled and grotesque. The doctors presented his head to his parents. “I’m sorry. This is the best we could do for your son. From now on, he’ll be a head in a box.” Then, his dream changed. Now he was an amputee living without any legs.

This was how Brett lived for 25 days, living nightmare after nightmare, unable to wake up. Each scene was a new reality. It wasn’t until his dream changed that he realized the previous reality was only a figment of his imagination. In a normal sleep, one would jolt awake from night terrors such as these. They’d be shocked back to the real world to realize that everything is okay. It was just a dream, and everything is just as usual. However, Brett was not in a normal sleep. He was experiencing a medically induced coma that trapped him in his worst nightmares.

After being diagnosed with a severe case of falciparum malaria, Brett suffered from ARDS or Acute Respiratory Distress Syndrome, which caused his lungs to shut down. Because of this, his doctor quickly induced the coma that would lock him into his own mind.

***

Brett was born in 1974, and growing up was tough. His mom was diagnosed with manic bipolar depression. Many of his early memories involve her violent outbursts. At four years old his mom slammed him against the garage door with a metallic, echoing thud. Then, she slammed him again to the cold, concrete floor. “If you don’t cry, I’m going to make you cry,” she said, screaming centimeters from his face. It wasn’t until another member of his family wrestled him out of her grasp that he was safe again. This was Brett’s first memory. His parents divorced when he was two years old. His dad left, and his mom was sent to live in a psychiatric ward.

Living with a bipolar parent makes it impossible to know what’s real. Every reaction is so out of the realm of reason that it can make growing up extremely confusing. Brett found himself constantly second guessing what was real. When you're a child, you haven't yet learned what is a reasonable reaction and what is unreasonable. “I could see how someone growing up in an environment like that might go one way or another, head right to disaster, or grow up really fast,” Brett reflects. For him, it was the latter. By the time he was in highschool, he was much more emotionally intelligent than many of his peers. Today Brett is an energetic person, always smiling and laughing. A mop of curly brown hair sits upon his head as his signature trademark.

For much of his childhood, Brett lived with his grandparents. It was a strict household, and he did not like his grandmother much for her intense expectations and stern mannerisms. However, once he was older, he was able to appreciate everything she taught him. He learned to be respectful and have good manners.

Eventually, his mother left the psychiatric ward and married a recovering alcoholic named Tom, who was 20 years her senior, old enough, in some cases, to be her father. Brett and his brother went to live with them. Tom was an angry man, angry at life and unafraid to take his anger out on those around him. He would never drink and he never physically abused them, but there was emotional abuse. Brett remembers some of the things his mom and his stepfather said to him during this time. “I don’t love you. I don’t give a damn about you,” his mother said once. “You’re a piece of shit,” said his stepfather.

This turbulent home environment caused Brett to take asylum in his high school. He became heavily involved in leadership and student body, eventually leading to his election as student class president. He worked hard in his classes, played football for the school team and did track and field. This level of involvement led him to be very popular among his peers. “The more I could get out and apply myself in the school system and programs, the happier I became,” Brett said.

This success in school led him to college at Carnegie Mellon in the fall of 1992 where he studied mechanical engineering. He counted down the days until he could leave his home on a calendar in his bedroom. On August 18th, he left and wouldn’t return until 10 years later.

After college, Brett’s career led him to Huntington Beach, also known as Surf City. He would surf in the morning and work during the day. At night he would go out with friends. “Life was great,” he said.

While all of this was happening, the life of his brother, Daniel, was going very differently. He spontaneously ended his technology career and became a nomad. He bought a one-way ticket to Jakarta, Indonesia. After four months, in September of 2003, his brother asked Brett to come visit him. Among the many preparations and tasks to be completed, Brett skipped over taking the preventative pill for malaria. The city of Jakarta has almost no risk for malaria even though it is densely populated. His brother told him that a pill was not necessary, that he would be perfectly fine without it. And he was right, for the most part. Daniel and his friends had been living in Jakarta without any preventative measures against the parasite, and he was completely fine.

Before the malaria, before the coma, and the ARDS, and the near death experience. Brett had the most amazing trip of his life, a trip that was worth the never ending nightmares. He got to surf, “the waves dreams are made of,” as he recounts with a cloudy look in his eye, lost in the memory. The journey there was long and complicated. After an eighteen hour flight, Brett followed the cryptic directions his brother supplied. He was with his friend Brian Appelton. Neither of them had ever been to Indonesia. The weather was incredibly warm and humid. Once they got off the plane they lugged their surfboards out of the airport and up onto the roof of the bus that would supposedly take them to Daniel on the island of Sumatra, one island over. The drive lasted sixteen hours. They drove over marshy farmland, and took a ferry over the bluest water Brett had ever seen. Then they drove over the lush, green mountains of Sumatra. Finally the bus driver yells out the name of their stop. “KRUI!” They grabbed their things and jumped out of the bus. The whole journey had been confusing. Now, they are at a random, seemingly insignificant bus station at five or six in the morning where it was completely pitch black and pouring rain.

They stood on the dirt road under an awning unsure of where to go next. Suddenly, a man appeared out of the shadows, a local peaking to them in Bahasa, the language common in Sumatra, Indonesia.

“Ke mana?” the man said. Brett’s brother taught him a few key phrases in the language, so he knew that the man was asking where they were going. Brett responded in Bahasa with the name of the beach they were trying to reach.

The man responded, “Daniel?”

“Saya kakak laki-laki Daniel,” Brett said. This means Daniel is my big brother. In Bahasa the man in the shadows said he would take them to Daniel. They got in his truck and drove for about forty-five more minutes. They leave town completely. Brett and Brian had no idea where they were being taken, and felt completely out of control. He could not tell if the man was actually taking him where they wanted or if they were being kidnapped by a stranger, taken to some unknown place. They had no choice but to keep driving.

Luckily, the story doesn’t go downhill, yet. They meet Daniel at a surf hostel without water or electricity. It was nothing but the shell of a fully functional house meant to shelter them from rain at night. That was all. But Brett had no desire to be indoors. They were in a sunny paradise. Pumping, glassy waves glided over the water as evenly spaced as if they were on a conveyor belt, perfectly sculpted tunnels of turquoise. Rainbows shined from end to end over the surf zone. As Brett describes, “It was magical.The craziest place I have ever been in my life.”

***

Three weeks later, Brett’s dreamland trapped him in a world of nightmares. He dreamt that he was in prison, gripping the bars of his cell, trying to escape his cellmate. They stood in the shadows waiting for him to let his guard down. Then he attacked Brett and raped him. He was helpless and hurting.

Malaria is transmitted through female mosquitos. The mosquito must be female, because they bite in order to produce eggs. They do not eat blood as commonly thought, but instead feed on the nectar of flowers, similarly to bees. The blood meals are actually used to produce eggs, which are then fertilized by the males later. However, if a mosquito is a host for malaria, the disease will be transmitted to the person or animal it bites.

Brett believes he got bit by the infected mosquito on the bus ride back to the airport from Sumatra to Jakarta. This is because Jakarta and Krui are both considered low risk for malaria. However, the space in between these two places is medium risk. He believes a mosquito must have bit him on their stop for lunch or on one of their bathroom breaks. But, it is impossible to know for sure. The mosquito definitely bit him towards the end of his time in Indonesia, because he did not get symptoms until one week after he had returned home. The gestation period for malaria is approximately 6-14 days.

He woke up on Sunday morning with a fever, after having spent the first week home telling all his friends how amazing his trip had been. There was no congestion, sore throat, or flu symptoms, just a fever out of the blue. He suspected that it could have been malaria, so he immediately got his blood checked the next day at the Seal Beach Family Medical Clinic. He was prescribed the most common treatment for all strains of malaria, chloroquine. Tuesday morning, he began taking the pills. However, his fever skyrocketed that morning to 104 degrees. He had chills, hot flashes, and muscle aches. He felt terrible.

His roommate grabbed bags of ice from the store. While Brett laid in the bathtub, they poured four bags of ice over his body trying to get his temperature down. A fever of 106 degrees can kill a person, so the situation was dire. At 103 degrees, it’s recommended to go to the emergency room. The next day, Brett immediately drove himself to the hospital.

He walked into the emergency room with a blanket around his shoulders, pale and shivering. “I-I have malaria,” he said, stuttering since his entire body was shaking. “I f-feel terrible.” A team of doctors emerged around him without having him sign any paperwork. There was no wait time. He was laid down on a hospital bed, and wheeled into the facility.

A doctor finished checking his blood and said, “You have falciparum malaria.” There are five species of malaria ranging from benign to deadly, according to the World Health Organization. The most common strain is Plasmodium vivax malaria, which does not kill its host. The species that infected Brett Fonatine is the second most common, severe falciparum malaria. It accounts for nearly all malaria related deaths. In 2003, the year Brett got malaria, there were about 1 million deaths worldwide. 90% of these deaths occurred in sub-Saharan Africa where malaria is most common. The remaining 10% occurred in cases scattered across South-East Asia, the Eastern Mediterranean, the Western Pacific, and the Americas.

The parasite is so deadly because the amount of parasites produced by this specific strain complicates or even blocks blood flow to the organs, primarily the liver, the brain, and the lungs. It attacks the red blood cells, and destroys them so that they clump and block blood flow to the smaller capillaries. This can lead to severe brain damage, jaundice, seizures, and an inability to breathe. Fontaine states that when he first entered the emergency room, the doctors were not worried because the parasite levels were at a very low level in his body.

“I’ve had falciparum twice in my life,” the doctor said. “While doing my doctoral research in North Africa. We’re going to beat this.”

They checked his blood every hour. “The number of parasites in your blood is very low. You are stable,” the doctor told Brett at 6am. Later around 10am, the doctors and nurses developed worried looks on their faces. They began shuffling around and injecting him with all sorts of intervening medications. The amount of parasites in his blood had suddenly increased to near lethal levels. He was moved to the ICU.

Luckily, blood flow to the brain was unobstructed. Instead, the blood flow to the lungs became so backed up that they went into shock. He developed a condition called ARDS, or Acute Respiratory Distress Syndrome. This condition occurs when the lungs undergo extreme trauma. It often occurs with high risk lung surgeries, high impact collisions, and drowning. The lungs constrict and fluid from the blood capillaries leaks into the lungs. This is life threatening and can lead to liver failure, brain damage, and permanent loss of lung function. Brett’s oxygen levels began to fall. They hooked him up to a ventilator and put a mask over his mouth. The ventilator can cause patients to become agitated or stressed, which increases breathing. This is extremely hard on a body that is already deficient in oxygen, Therefore, the doctors medically induced a coma in order to slow his breathing as much as possible.

“I’m going to put you to sleep,” Brett remembers his doctor saying, but he was not able to respond. Brett’s mind was foggy beyond cognizance by this point. He watched as the doctor injected him with the drugs that would put him to sleep.

His parents were called and told to come down to the hospital immediately to say their goodbyes. They were told he would not make it through the night, that he would not wake up. The survival rate from ARDS in 2003 was 40-60%. About 2 or 3 out of every 5 patients died from his condition. His family was beginning their grieving process.

Meanwhile, Brett was having night mares. In his final dream, he was being flown to Philadelphia for a lung transplant. The transplant was successful. He was healthy, but they would not let him get up. The doctors kept him tied down to the gurney, a rope around each limb. He stayed like that for the entire plainride from Philadelphia to Santa Ana, a nine hour flight that played out in real time in his head.

Then, Brett woke up.

“Hi Brett,” said the nurse who happened to be in the room. “You’re really sick. It’s October now.”

He could not respond. A tube was stuck down his throat mechanically taking his breaths for him. Needles attached to his neck and both of his arms, making movement nearly impossible. He may as well have been having another nightmare. But, he survived. The malaria had passed from his body, and his lungs were functioning normally.

It took Brett two days to stand again. His muscles had completely deteriorated from laying down for 25 days. Each limb was reduced to half its normal size. He could barely hold the weight of his own arm. The nurse's spoon fed him. The first day he stood, it was only for seconds, braces wrapped around his legs for extra support. Then, he collapsed back onto the bed, too weak to try again until tomorrow.

The next day he was able to walk about six feet to the door and back. The next day a little further. For a week he stayed in the hospital walking through the halls and around the corridors, until he was discharged with weekly physical therapy appointments back at the hospital.

He only went to two of them. Brett was 29 when he was infected with malaria. His body was at peak physical health, so he was able to make a full and quick recovery. The morning before his second appointment roughly two weeks after waking up from a coma, Brett went surfing with his brother. He floated through the cool, salty water and thought about the surf that dreams were made of. The physical therapist told him later that day he did not need to return again if he was already surfing.

So, Brett came out of the experience physically unaltered. It was only his mindset that had changed. But, he did not change in the way you might expect. There was no sudden revelation at the fragility of life, no new need to cherish every moment because each one is fleeting. Brett already had that mindset to begin with. Instead, he realized how connected we all are. How the increasingly possible end to his life had triggered people he never thought could possibly care about his well being to stop and pray. To think of him and wish him well in a mind bending spiritual connectedness.

While he was still in recovery, a nurse whom he had never seen before came down to visit. “Hi, I’m Nancy. I work upstairs on the sixth floor. I just wanted to come down and see the miracle patient that everyone is talking about,” she said.

Another man six months later approached Brett at a hotel that he would often bring clients to. The man ran to Brett when he saw him and gave him a big hug. “I’m so happy to see you alive. I have been praying for you, and my sister in Vermont has been praying for you at her Mosque. For months we have been praying for you to be alive. I’m so happy to see you,” he said, overjoyed. Brett was dumbfounded. This man wasn’t his close friend. They had only distantly made each other's acquaintance through business, yet here he was praying for him. And his sister across the country had been praying for him.

He got phone calls from people from all over the world from people he never knew. One man from Germany called, “Hey someone told me you were sick. I just wanted to call and see if you’re okay.”

Brett recounted this experience twenty years later, still deeply moved by the prospect, tears leaking down his cheeks, “I was always positive on life, and optimistic, but I have felt this direct experience of prayer, and I think it saved my life.”

Bibliography

“A 4-Day Incubation Period of Plasmodium Falciparum Infection in a Nonimmune Patient in Ghana: A Case Report - PMC.” PubMed Central (PMC), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335624/. Accessed 15 June 2023.

Association, American Lung. “ARDS Treatment and Recovery | American Lung Association.” Home | American Lung Association, https://www.lung.org/lung-health-diseases/lung-disease-lookup/ards/ards-treatment-and-recovery. Accessed 15 June 2023.

“CDC - Malaria - Malaria Worldwide - Impact of Malaria.” Centers for Disease Control and Prevention, https://www.cdc.gov/malaria/malaria_worldwide/impact.html. Accessed 15 June 2023.

Dixon, Matthew W. A., et al. “Shape-Shifting Gametocytes: How and Why Does P. Falciparum Go Banana-Shaped?” Trends in Parasitology, no. 11, Elsevier BV, Nov. 2012, pp. 471–78. Crossref, doi:10.1016/j.pt.2012.07.007.

“Malaria.” World Health Organization (WHO), https://www.who.int/health-topics/malaria#tab=tab_1. Accessed 15 June 2023.

“Plasmodium Falciparum Malaria Endemicity in Indonesia in 2010 | PLOS ONE.” Home - PLOS, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0021315. Accessed 15 June 2023.

“Prognostic Indicators in Adults Hospitalized with Falciparum Malaria in Western Thailand | Malaria Journal | Full Text.” BioMed Central, https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-12-229#:~:text=Results, Accessed 15 June 2023.

World Health Organization. “Severe Falciparum Malaria.” Transactions of the Royal Society of Tropical Medicine and Hygiene, Oxford University Press (OUP), Apr. 2000, pp. 1–90. Crossref, doi:10.1016/s0035-9203(00)90300-6.