A Snakebite Turned This Woman’s Thailand Vacation Into a Fight for Her Life

Doctors raced to find an antidote as the snake’s venom spread through Shalabha Kalliath’s body, attacking her organs and inching her closer to death.

Snakebite illustrationIllustration: Mathias Ball

A dream vacation—and a dangerous snakebite

When Shalabha Kalliath arrived on Thailand’s Ko Phi Phi Don Island last spring, her plan was to sightsee, sunbathe and check out the island’s nightlife with her high school friend Santra Navas. The 26-year-old Kalliath lived in Waterloo, Ont., where she was completing her master of applied science degree at the University of Waterloo, while Navas was working as an assistant art director in Singapore. After four years apart, they were excited to catch up.

The Phi Phi Islands are known for their white sandy beaches, turquoise ocean and soaring limestone cliffs. At the end of the day, crowds flock to beachside bars and restaurants. That’s where Kalliath and Navas found themselves on their first night in Thailand, still wearing their swimsuits, cover-ups and flip-flops while watching one of the island’s famous fire shows. The pair looked on as young Thai men spun flaming staffs, ropes and balls of fire on chains, their choreographed motions set to pulsing dance music.

During an intermission, the pair opted to explore the beach. But as they stepped from the sand to the sidewalk, Kalliath felt a sharp pain in her right pinky toe. She lifted her leg and saw a skinny, half-metre-long brown snake dangling from her foot. She instinctively kicked, slamming the reptile against the wall of a nearby building. Seconds later, she was hit by excruciating pain. It started in her toe and swiftly moved to her ankle, calf, knee and, finally, her thigh.

“It was like hot lava travelling upward through my system,” she says.

Kalliath’s leg buckled and she fell to the ground. Navas and a passerby picked her up and carried her to Ko Phi Phi Don’s WorldMed Center, a medical office with a small walk-in clinic, while another passerby followed with the dead snake.

Within minutes of reaching the clinic, Kalliath’s leg started swelling and the pain became even worse. “We held on to each other’s hands, and I kept telling her that she would be okay,” Navas says, “but I was uncertain of my own words.”

Kalliath had been bitten by a Malayan pit viper. Found throughout Southeast Asia, these snakes typically grow to around 50 centimetres in length, though some can reach more than a metre. Malayan pit vipers are not considered aggressive, but they will bite if disturbed—and bites can be serious, leading to swelling, pain, skin discoloration, blistering, hemorrhaging and necrosis—the death of cells in tissues and organs. Severe necrosis can require limb amputation, and in cases of hemorrhaging or a bacterial infection, bites can even cause death.

At first, the clinic staff weren’t sure whether the viper had actually injected venom—roughly 25 per cent of pit viper bites are “dry.” But Kalliath’s leg was so swollen that her flip-flop no longer fit her foot. The staff administered pain medications, IV fluids, antibiotics and a tetanus vaccine. Then they performed a blood test to determine whether there was venom in her system. While they waited for the results, Kalliath and Navas called their respective fathers, who are both doctors. Kalliath’s father was half a day away by plane in Brunei, but her symptoms were progressing so quickly that they worried about him being unreachable for even that length of time. Both men offered advice over the phone.

Seven hours later, the results were in: Kalliath needed antivenin, and fast. Snake venom doesn’t stay at the site of a bite—it floods into surrounding tissues, where it can start to destroy cells and impact the blood’s ability to clot. The doctor told her that there was no guarantee she’d survive.

The terrifying news was made worse by the fact that Kalliath was extremely weak and fading in and out of consciousness. “I could hear everything, but I couldn’t respond with anything other than a yes or no,” she says.

Antivenins are made by injecting animals—usually horses and sheep, both of which have very strong immune systems—with snake venom so they can produce antibodies that neutralize its toxins. Then the blood is harvested, purified and concentrated into antivenin. Venom has different qualities depending on the species it comes from and even where that species lives, so every bite must be treated with a specific antidote. In Kalliath’s case, the clinic didn’t have the right type on hand. She had to be transferred to Phi Phi Island Hospital, a larger facility about 10 minutes away.

There, the hospital staff decided to run blood work again to confirm that Kalliath needed antivenin. The added delay intensified the women’s sense of helplessness. But antivenin can cause an anaphylactic reaction in the short term and an uncomfortable immune response known as serum sickness in the long term, so the attending doctors didn’t want to risk giving her a dose unless it was necessary.

When the second test confirmed she had venom in her system, the doctor administered the antivenin, then waited to see how Kalliath’s body reacted. If her blood started clotting normally, she wouldn’t need additional doses.

Unfortunately, her blood didn’t clot. And another problem had arisen: the doctor was concerned that the venom was causing tissue in Kalliath’s foot and leg to die, which could mean she would need an amputation.

The language barrier made the already tense situation more stressful. Neither woman spoke Thai, and the doctor struggled to communicate complicated medical information in English, saying they might need to “chop” her leg.

Ten hours after Kalliath’s first dose of antivenin, the doctor tried a second. This time, it worked—but not without side effects. Kalliath’s grip on reality began to disintegrate. As she slipped in and out of consciousness, she was unable to differentiate between dreams and reality. Kalliath would fall asleep mid-sentence, then wake up seconds later, feeling like she’d slept for hours. She was disoriented, scared and in constant pain.

But by the following morning—her third in Thailand—she was beginning to see small improvements. She was still in pain and her leg was very bruised, but she was alert. The doctor even allowed Navas to take her out of the hospital in a wheelchair so she could get some fresh air.

The day after that, she was able to move around on crutches, and her doctor decided she was out of danger. With just over 24 hours left of her trip, Kalliath was discharged.

Though her leg was still painful and swollen, she wanted to see as much of the island as she could. She slowly made her way around Ko Phi Phi Don on crutches with Navas, checking out restaurants, boutiques and even a beach party. “I couldn’t dance much, but we took it slow and still made an effort to dress up,” she says. The next morning, they even went on a boat ride and snorkelled. Kalliath was eager to try swimming with sharks, but Navas nixed that plan.

“After our ordeal with the snake bite,” Navas says, “I thought it was best not to interact with wildlife for some time.”

Later that day, the friends started their separate journeys home. Kalliath had to travel in shorts because her leg was still too swollen to fit into her pants, but otherwise her trip went smoothly. Her insurance company even upgraded her to first class, allowing her to keep her leg elevated during her flights. By the time she touched down in Canada, she figured the worst was over.

Shalabha Kalliath and Santra Navas in ThailandCourtesy of Shalabha Kalliath
Shalabha Kalliath and Santra Navas in Thailand.

Six days after being bitten, Kalliath was back home in Waterloo. Initially, she’d planned to get some sleep and then call her family doctor. But after a nap and a shower, Kalliath realized her exhaustion hadn’t improved at all. Bruises began to bloom across her other leg and arms. She felt dizzy. Kalliath called two university friends, Bharat Venkitesh and Jerry Wilson, and asked them to get her to a doctor.

They first tried a nearby walk-in clinic but were quickly sent to Grand River Hospital, three kilometres away. They waited in the emergency room for several hours, chatting and trying to keep Kalliath awake. She was exhausted and fell asleep easily—sometimes in the middle of speaking with Venkitesh. Eventually, medical staff tested Kalliath’s blood to see how freely it could clot.

The results were so extreme that they were undetectable by the hospital’s machine. The medical staff ran the tests again. When the second test yielded the same results, they realized that the problem was Kalliath’s blood, which was taking a dangerously abnormal time to clot.

Dr. Russell Uppal, the ER doctor on duty that evening, usually sees patients with abdominal pain and injuries to the extremities. He’d never encountered a venomous snake bite.

He contacted the Ontario Poison Centre and consulted a toxicologist, who speculated Kalliath hadn’t received enough antivenin in Thailand, or that her body had experienced a delayed reaction to the snake’s venom.

Either way, she needed another dose. Finding one wouldn’t be easy. The closest option was at the Toronto Zoo, which had on hand an antivenin for Ontario’s only venomous snake, the Massasauga rattlesnake, also a venomous pit viper. The toxicologist hypothesized it was similar enough to the Malayan pit viper to be effective. The second option was a polyvalent antivenin, which was located at Indian River Reptile Zoo in Asphodel-Norwood, Ont., just east of Peterborough. It was more easily accessible, but the toxicologist wasn’t sure if it would be effective—no one had ever used it to treat a Malayan pit viper bite. The closest vials of Malayan pit viper antivenin were in the United States. The hospital put in requests at both of the Canadian locations. They also raced to obtain frozen plasma for Kalliath. Her blood’s ability to clot was so low that she was at risk of brain hemorrhage, bleeding from her body’s mucous membranes and organ failure. She’d need a transfusion if her health plummeted.

Lying in her hospital bed, Kalliath felt more tired than sick. “I could still talk—I was communicating, laughing,” she says. “I didn’t realize the seriousness of the situation.”

In fact, she felt so much better than she had in Thailand that she thought she must be recovering. But when Venkitesh asked if they could step out for a coffee, she quickly learned otherwise.

“The medical staff told me I shouldn’t walk,” she says. “If I bumped into something and fell, I could bleed out.”

In fact, she was so fragile that even minor ailments, like nausea or light-headedness, could cause serious damage. Even vomiting could cause a life-threatening internal tear or rupture.

Her organs were shutting down, a nurse explained, and she already had internal bleeding. “There’s a 50 per cent chance that you won’t survive the next six to 12 hours,” the nurse said, as the medical team moved her from the ER to the intensive care unit.

Kalliath was stunned. She wasn’t prepared to die.

Kalliath waited anxiously for one of the antivenin options to arrive. She was almost never alone while hospital staff closely monitored her for worsening local spread—increased pain, swelling, redness—and any signs of additional internal bleeding.

Two hours later, the antivenin finally arrived via car from the Toronto Zoo, accompanied by a police escort. After a small test dose to rule out serious allergic reactions, Kalliath received the full dose via IV. Then, more waiting, for a blood test that would indicate whether she was stabilizing.

The results came in: the antivenin was working. Doctors and nurses cheered and hugged one another, while Venkitesh ran to the only shop that was open in the hospital to buy chocolate for everyone.

Within days, Kalliath’s blood work had corrected, the internal bleeding had stopped, and her organs were returning to their normal functioning. It took a few weeks for the swelling in her bitten leg to relent and for Kalliath to get back on her feet. For a few months after being bitten, she’d still feel the tingling of pins and needles in her foot and lower leg.

A year later, she’s back to normal, living in Ottawa and working for an engineering consulting firm. Despite the ordeal, she doesn’t fault the snake. “At the end of the day,” she says, “we were the ones in its path.” But she vows to always buy travel insurance. And to always look where she walks.

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