Sunday lunch. My father in law is in town and lunch was at his house. He has unearthed this fabulous cook who has cooked up a fabulous fish curry. While we are all doing homage to this dish (by wolfing it down, I mean), Amit chokes on a fishbone. Well, there are five of us, and thus far maybe 20 pieces of fish have been consumed, so one person choking is par for the course. He did the usual things – first coughed, then, because there was no rice, gulped chunks of bread and potato hoping it would engulf the errant fishbone and carry it down the gullet.
To be sure, choking on a fishbone is not a matter to be taken lightly. It can be fatal. Amit, however, did not seem to have the fishbone in his windpipe. He could talk through all this and he was still breathing and not turning blue. He even ate another piece of fish, though the bone was still lodged.
Over the next three hours, he tried gulping various other items to no avail – rice flakes, boiled eggs, banana, and, when all those failed, he even made rice and waited for it to cool and then gulped that. In the end, he went to the doctor across the road, who is a neighbor, friend, and pediatrician. That too was to no avail. He couldn’t see the bone by peering down Amit’s throat with a flashlight and sent him off with a recommendation to go to a hospital.
So we sighed and girded up our loins and dropped the kids off with Amit’s dad and went to Manipal Hospital. It was Sunday evening, of course, so all the departments were closed and we were sent to Emergency, where they took one look at us and did nothing for a very long time. It was close to 90 minutes before we got the X-ray they thought we required and then the on-duty doctor declared himself unable to see the fishbone in the throat (though he could see it on the X-ray) and called for the ENT on-duty doctor. A pretty young female came and took us up to the ENT department and proceeded to peer down Amit’s throat, again to no avail. Then she called for her Consultant (senior doctor) and that was also when she called the anaesthesiologist and started talking about OT and GA and suchlike things.
She explained to us why we needed an OT and what was to be done and then we asked the million dollar question: What would it cost? She hemmed and hawed and came with up a number: 30k.
Luckily we had a good 45 minute wait on our hands till the consultant extricated herself from her Sunday evening activities and came to the hospital. In that interval, we decided we really didn’t need to be pressurized into a 30k surgery for a measly little fishbone that wasn’t stopping Amit from breathing, eating, or talking.
Well, it was 8 p.m. when the consultant arrived and I have to say, she did a good job – at least, the bedside table manner part of her job. She was patient and deft and appeared to be very in-charge and expert. All cool and zen. All good.
For one full hour, she poked and peered and tried to see the fishbone, but kept saying she wasn’t sure she could see it. In the middle, Amit had an extremely violent coughing fit and we all hoped that had done the job. Except the doc kept telling him not to cough so violently and I wondered what harm it could do.
In the end, Amit said the bone was still there and the doc said there was nothing she could do outside an OT and without GA. But why, we asked. She gave us a vague reply that it would be too dangerous. The anaesthesiologist had already been called, she said. The OT would be busy in the morning, she said. You shouldn’t wait, she said. She seemed all very earnest and concerned, all “doing my best as a doctor”-ish. Don’t leave here without your surgery, she said. If you do, I’ll have to make you sign a big long statement saying that you left against my advice.
Woooo, scary! Go under GA unnecessarily versus sign a big long statement. Which would you rather do?
Since we’d had our discussion beforehand and decided that to us ignorant laymen Amit’s situation did not appear to be life threatening, we were not easily swayed. I don’t say that we weren’t swayed, mind you. Amit told me later he was 50:50 about it. But to his credit, he wasn’t entirely swayed.
For me, there were two things that were suspicious. First, why did this doctor want to do this procedure in such a hurry? Why was she not able to clearly explain to us why she could not do a simple outpatient procedure? Why did her assistant hand us a form for admission before the consultant had even arrived and assessed the situation? It looked as if they had already decided what was to be done and the rest was a charade for our benefit.
The second: As soon as we started to give the “hmm, maybe not” signals to the doc, she promptly asked whether it was the cost that was putting us off and then asked if we had insurance. We’d prepared for that one. Nope, no insurance, we said, making a sad face. (He’s an entrepreneur, I’m a home maker – that was our back story, but we didn’t need it.) And then do you know what she did? “Oh, no worries, we’ll reduce the price, we’ll just bill it as something else. Let’s see, how about this? Then it will come to 12-15 k.”
Amit gave me a look. Was 15 k justifiable? I shook my head. We asked for a few minutes, discussed briefly again, and decided it was just pressure tactics.
Finally, when we told the doc that we would not be opting for the OT tonight, her reaction was strange. There was a certain something. Suddenly, it was not so much as if she was genuinely concerned for the patient but more as though a candy that had been promised her had suddenly and inexplicably been taken away.
What was worse was, when we went back to the Emergency Room to finish the paperwork, the medical staff there gave me an earful – and they didn’t even know what the issue was for chrissakes. There had been a change of shift at 8 p.m. And these on-duty doctors are not specialists – that’s why they sent us off to the department and called in the consultant. If we’d had our discussion with the consultant and been given the “scary, dangerous” talk and walked away from it anyway, why was it even any of their business? For the patient’s good, you say? I would like to say so too. But really? No, it was just too pushy. It was like, “Hey, don’t leave here without your surgery, my salary depends on it.”
It wasn’t easy, though. We did leave, our pockets lighter by only Rs 1130, but it wasn’t easy. It’s a tough call to put a price on your health and call out 30k as too high, call out 15 k as a bluff. Amit said it was the first time we’d gone against medical advice. He even went so far as to tell me that if things turned out badly, I should remember that it was a joint decision. Melodramatic, huh? I wasn’t that worried. He was walking, talking, breathing. He wasn’t in that much pain, it was just an irritation. If he did manage to dislodge the bone overnight, it would hopefully just go down and out the usual way. Otherwise we’d come back in a day. Or two. This wasn’t deep vein thrombosis, after all. That time I was worried. This just didn’t look that serious.
We got home around 10 p.m. The kids had slept with Amit’s dad, so we consoled ourselves with some ice cream (which didn’t dislodge the bone) and some dinner. There wasn’t much, so I fished out the leftover fish curry, which we’d brought home from dad in law’s house. Tempting fate, eh? Considering I’m not as skilled in the art of eating fish as he is.
The next day, I went to work as usual, while Amit asked around among friends for a good ENT specialist who would not be overly trigger happy. He found one and rushed off to Richmond Road by 11 a.m. By 1.30, it was all done. The doc peered down his throat the with stroboscope – the same thing they’d used at the hospital – and saw the bone. He could have fished it out right away, but apparently just because of Amit’s extraordinary height, even his neck is too long for ordinary-sized implements, so he wasn’t able to reach it. He took him to the OT, after all, but got the little bugger out in about 30 seconds with just a local anaesthetic spray. Damages: 4500, only because of Amit’s extraordinary height. Ordinarily it would have been 2500. Total time spent: less than three hours. Outcome: success. At Manipal Hospital we spent almost 4 hours, and to no avail.
It’s extremely sad. I’ve always been very happy with Manipal Hospital. I’ve heard that they’re trigger happy, but our experiences have always been good. Or, well, at least not bad. Or, actually, there have been some bad experiences, but not this bad. This time, the way it ultimately got done so easily, I just feel cheated. There’s now no doubt in my mind that the doc and her assistant put on an elaborate charade when they had no intention of solving the problem outside of the OT. In a way, I’d rather they just took one look and said, “I can take this out in 30 seconds but it will cost you 15 k,” rather than trying to put this spin on it – it’s dangerous, it’s risky, you have to go under GA.
Paying you a king’s ransom is one thing; but if you lie to me, make me panic, play on my fears, and then subject me to unnecessary medical/surgical procedures… that is completely unethical.
When Tara cut her finger, we had to have it operated on. We checked with other doctors, we checked on the net. Surgery was required. It was expensive. That time, we played the system. We made sure that we stayed in the hospital long enough to be covered by insurance. But it’s a lousy thing to do. It’s unethical. The hospitals pump up the bill, knowing that insurance will cover it. Insurance covers it and they raise the premiums so that we all get to pay more for medical insurance. Everybody wins. Nobody wins. Only fools object. Perhaps, if the procedure itself is genuinely required, there is very little harm done. It’s only notional. Everybody else is doing it, right? It’s not even against the law. The doctors are only too happy to sign on the dotted line saying the hospitalization was required.
But forcing patients, scaring and blackmailing them, into procedures that aren’t even remotely required… how can that possibly be part of a doctor’s job description? What’s wrong with the world, when all that matters is how much money you can make? And these are not poor people. These are people with big houses and bigger cars! And these are people who are supposed to make us fitter and healthier.