The Incident of the Stuck Fishbone

April 15, 2014

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.

 

Wait, what?

 

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.


The Incident of the Cat Litter

April 14, 2014

Once in a way, you come across a weekend that just knocks the stuffing out of you. This past weekend was one such. The events that unfolded this weekend could actually be told in four parts, but I’m going to leave out the least eventful two and treat you, dear readers, to only two parts. Get yourself a cup of coffee (or green tea or whatever) and settle down, because I am going to tell you all about it.

The Incident of the Cat Litter

The problem with keeping cats, instead of dogs, is that you need to do something about their litter. And I’m not talking about the sweet little babies they give birth to, but to the disgusting brown yuck that they eliminate into. You know – pee and poop.

So you do get some commercial cat litter, but I don’t know what it’s made of, and I’m pretty sure it’s expensive. And I doubt it’s biodegradable. And seeing that I’m married to this environmental nutcase, who collects every scrap of paper and plastic to sell it to the kabadiwalla (recycling guy), not to mention assiduously composting our kitchen waste… well, I obviously can’t think about using non-biodegradable kitty litter.

So we have been buying vast quantities of coco peat to use as litter. It’s actually a very good kitty litter – it’s lightweight and very absorbent, a good natural fertilizer, not too bad at absorbing odors, and extremely cheap at Rs 4 per kilo. I use about 2 kilos per day for our two boys. The only problem with this solution is that nobody bloody keeps coco peat. Gardening stores keep only some kind of highly condensed blocks that you are supposed to dissolve in water and use in the garden – not suitable for litter, obviously. Coco peat is made from the husk of coconuts, and in India, especially in south India, coconuts are big business. So we have the Coir Board of India and they keep infinite supplies of coco peat. Only hitch is, you have to go to Kasturba Road to get it. So that’s what I spent Saturday afternoon doing.

Now, to really appreciate what follows, you have to know me. I’m the sort of person who manages to not get lost only if I’ve been to a place at least 20 times. And even then, it’s chancy. I can get lost in a shopping mall, and not even a new one, and it doesn’t even have to be very big. I have a long and terrible history of getting lost. I got lost more than once in Italy, I managed to get lost and lead our whole party astray in the Himalayas, and I even outdid myself by getting lost in Chandigarh, the city I grew up in, and in a part of it I ought to have been extremely familiar with; a part I was, in fact, extremely familiar with – but that doesn’t mean I can’t get lost.

It was only the third time I was going the Coir Board. I know Kasturba Road alright, but I haven’t really had too many opportunities to drive there. Still, get on to MG Road and keep going straight, it doesn’t get easier than that. And even I can find my way to MG Road after 16 years in Bangalore.

The first time I went to the Coir Board, Amit drove, I got off across the road and he went all the way to Kanteerva Stadium to do the U-turn to get on to the other side. By that time, I had crossed the road (no easy task, since there’s a six-foot high barrier running all the way down Kasturba Road, to prevent people from crossing), gone to the Coir Board office, placed my order, got the sacks, paid the money, got the bill, and was waiting on the pavement outside to load the sacks. Perfect. No problem at all.

The second time I went, I had dropped the kids off for Saturday afternoon tennis. I dashed across to Kasturba Road, did the whole U-turn thing and parked on the roadside (a strict no-parking zone) and got the sacks and paid up and everything and got back to the tennis court only 5 minutes after their tennis class ended. Not bad at all. (It helped that I had taken precise directions regarding the u-turn business from Amit just before I started. And in my defense, it’s not actually just a u-turn. It’s kind of like you have to do this huge left-turn, right-turn circuit around Kanteerva stadium.

Still, I had done it all by myself, so the third time, I thought, would be a breeze. It was after the kids’ Saturday tennis and I had Amit in the car with me and the kids as well. No stress. I dropped Amit off across the road from the Coir Board and breezed off to Kanteerva Stadium to do the U-turn.

Now, you really need to know the city to make sense of what follows. If you don’t, here’s a map that explains how I wound up in the places I did, but it doesn’t really convey the flavor.

To cut a very long drive short, the first time I got lost I wound up in Cubbon park, then found myself driving past the Vidhana Soudha and almost wound up in Shivajinagar (!!!) before managing to find my way back to where Jewels de Paragon used to be – that is, the intersection of Kasturba Road with MG Road. All good – only 20-25 minutes wasted. Of course I had called Amit by then and told him that I was at the Vidhana Soudha – and I would have given anything to see his expression of bewilderment right then.

So anyway, 25 minutes later I was breezing past Coir Board again, still on the other side of the road, with the same u-turn looming up again. The first time I’d gone wrong by ignoring the kids’ directions and doing what I thought Amit had instructed me to do last time (which was more than a month ago). This time, I promised myself I would trust the kids – they clearly have better navigation skills than I ever will.

So I followed Tara’s directions to the letter and soon enough found myself on NR Road.

I don’t know about you other Bangaloreans out there, but for me, Nrupathunga Road, Silver Jubilee Park Road, and all those other roads over there are the stuff nightmares are made of. I’ve almost never been there (perhaps once) and all I know of that area is that it leads to some mystical place called City Market which is like a Bangalorean black hole – if you stray near, you get sucked in and are never heard of again.

What’s worse is, not only is that area always crowded, it’s also full of *expletive-deleted* one ways. Here I was, waiting at a traffic light on a road that was clearly taking me in a direction diametrically opposite to where I wanted to be, and my only option – my *only* option – was to go straight. What’s the point of a traffic light where you can only go straight??? Haven’t these people ever heard of left turns, right turns, and most important of all, u-turns?

So I stopped on the roadside and asked some random guy the way to Kasturba Road. “That way,” he said, point back the way I’d come.
“Yes, fine, but how do I get there?” I asked in exasperation.
“Just go straight, you’ll come to City Market, you can do a u-turn there,” he said, moving off to catch a bus.

Great. I went straight and a lovely-looking flyover emerged, beckoning me warmly. It was broad. It was empty. It was oh-so-inviting. I can just imagine how Odysseus felt when the sirens called out to him. It was all I could do to exercise my self restraint to the utmost and drift to the left of the alluring flyover. Later on Amit told me that it would have taken me most of the way towards Mysore, leaving him high and dry on the pavement with only 10 sacks coco peat for company. (At this point, I should also tell you that I had been low on petrol when we started from home two hours ago and by now my situation was perilous. I had money; all I needed was a petrol bunk. On that alluring flyover to Mysore, I would likely have run out of petrol long before I found a way off it and to a petrol bunk.)

Ultimately, of course, I did find a u-turn and then I found my way to Corporation circle, and another red light (somewhat to my relief). At just that moment, Amit called. “Where are you?” he asked tersely.
“I don’t know!” I wailed. “Um… there’s an LIC building on my left.”
“Ok, good. Go straight. Don’t take the next left, or you’ll wind up at the railway station and another whole bunch of one-ways-“
The light changed. There were plenty of cops around. I cut the call abruptly and started driving, trying to remember what he had been telling me about the next left. (I blank out directions when I’m in a panic.) It didn’t help that the kids in the back seat were continuously throwing helpful hints and unhelpful questions at me in rapid succession. “Oh, I know that building. DIdn’t you come this way already? You have to go left here. No, go straight, go straight. Isn’t that where Vidit lives? What are we having for dinner?…”

Arrrrrrrrrrrrgh!

When I finally pulled up at Coir Board, I had been driving around in circles for an hour! I had taken the kids on a city tour that included a drive-by of Cubbon Park, High Court, Vidhana Soudha, SJP Road, City Market, and just narrowly avoided City Railway Station and Mysore. And I still had a tiny bit of petrol in my tank.

The Coir Board guy who had been waiting patiently to load the sacks of coco peat smirked at me and muttered under his breath, “Waste. Waste!” (You have to be a Bangalorean to understand that one, too.) Amit, much to his credit, didn’t laugh, didn’t explode, and in fact, reacted only with profound relief tinged with resignation. Which is just as well, because after that he drove us to Chitra Kala Parishat and managed to get lost on the way. Not as spectacularly as me, of course, but I am a hard act to follow.


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