We drove into the swank, new, Emergency complex of one of the large corporate hospitals around 10.30 am, in order that my 82 year mother could have a check up following a rather unexplained and bad fall the previous night. This was not her first unexplained fall and although she was fairly lucid and not ready to go to a hospital that night, we thought a visit with the neurologist was indicated. So, why this hospital? Well, it is near to where I live and I have many friends working there. So, getting in was easy, and after 24 or so hours there, the getting out was not so easy – this is the saga of those 24 hrs.
My mother has lived in Chennai for the last 2 decades or so, and has spent a few weeks every summer with me in Lucknow earlier and now Gurgaon. She has been reasonably healthy, and so like a lot of us, never needed to access a doctor – occasional troubles being sorted out by a doctor-nephew. At Lucknow I had a whole Institutional mechanism and her annual check ups there had detected her as diabetic about 6-7 years ago. She has been fairly disciplined about diet and kept her sugar levels under control. The first encounter she had with the medical system was when she fell and broke her hip 2 years ago. This led to a hip replacement, some post-op complications, a few days in the intensive care – all at the Perambur Railway hospital.
The emergency response at this swanky hospital, was quick – vitals measured, a quick history and a bedside sugar estimation. Although not super busy and with no major casualty in sight, there was enough chaos for her needing to be pricked twice for the blood sugar. Between the many people attending to patients, they could not decide which reading was hers from the first prick. The Neurology and Cardiology consultations happened fast enough, as did the ECG. I am presuming that this part is equally quick for all emergencies – and had nothing to do with the fact that I was introduced to the system by one of the senior most consultants of that hospital!!I was informed that they would do a CT for the head, and if it was normal further tests would be considered. I was also advised that I should take a room for a day as they would shunt us out of the Emergency – and my mother was in no position to sit in a waiting room. In between the ECG and the blood drawing and the trip for the CT, a young doctor filled out the history by asking me a few sketchy questions and the Nurses filled out a long proforma which had questions related to existing diseases, past illness, medications, allergies etc…
I booked a single room, and got hold of another old friend in Radiology to expedite the CT, which he did. By this time it was after 1 pm and Amma was getting irritable due to hunger – she is an early eater. There was no sign of any food being served in that area, nor were you allowed to bring food from outside (including from the fancy food court!!) – when I made an issue of it, a fruit juice tetra pack appeared. We were then told that the room was ready, and lunch would be available there. We reached the room around 1.30pm and on learning that the lunch order would then be generated by the dietician, I showed my irritation. So a couple of sandwiches appeared – and the lunch itself took another hour to arrive. In all this time (4hs), not a single doctor had examined her and no recourse offered for the big bump on her L forehead, bruised L cheek and a drooping L eyelid!! In fact, if anyone had bothered to talk to her, she would have had only complaint – the pain in her head.
In the room, the senior neurologist appeared and said that since the CT was normal some cardiac physiology tests and then neurology tests would be done in that order, to establish the cause of the black-out – which we were presuming had been for a few minutes. I did put it to him directly as to what therapeutic options could follow these tests – to which he rattled off a list of things and marched off – the designated 45s per bed may have expired, I thought! But, as the time passed, there was no activity, and on persistent enquiry, I learnt that the EPS (electrophysiology study) would only be done the next morning!!
I was not quite comfortable with the situation, but having paid for the room I was buying time and mulling over the actions ahead. The evening passed quietly, dinner arrived (fairly mediocre stuff) and I made a quick trip home to collect some night gear, a book and iPad. The nurses drew blood again from Amma, the 3rd puncture in the day, since bleeding time and clotting time were needed prior to the EPS. This should have warned me – but the bell did not go off then. She was restless, not happy to spend the night in the hospital.
So, essentially Amma was a 82 year, old female patient with a history of fall and hitting the head the previous evening, and who was perfectly fine in every other way. But, another young doctor took the history again from me, brushing aside my plea that I had already given it in the morning with a “that was in the emergency” – however, his was in no greater detail and neither did he do any kind of general examination or talk to Amma. Two young nurses filled out the same proforma that had been filled in the morning – I could not get any reasonable answer to my queries regarding the duplication – of effort on our part, and precious time on their part. There was no respect for the inputs of their own colleagues in the hospital – and obviously no electronic records.
But there was more in store as the night progressed. Amma, normally a good sleeper, struggled to fall aslnep. And around 10.30 pm, soon after she had done so, a young orthopaedic surgeon came to check out her leg – provoked I guess by the fact that in her history I had mentioned the hip fracture and the surgery. He did a cursory exam, told me that an X-ray had been ordered and when I asked “For what?” sheepishly said that it was not really indicated and could be cancelled. She once again struggled to fall asleep and around midnight, the attendant comes with a wheelchair saying that Amma has to be taken for an X-ray chest. On enquiry I was told that it was needed before the EPS studies the next day. “But was it not ordered in the afternoon?” I asked? Was there any logic in disturbing the sleep of an old patient for a routine X-ray? I was asking these questions to the wrong people – the staff in duty were only cogs in this giant wheel – and all the Nurse could tell me was that her “turn” had just come. I could imagine this highly efficient 24 h Radiology department where a computer generated queue was honored without fear or favor !! But, I put my foot down and refused to let Amma be moved for an X-ray. It was not taken kindly, but they had no choice.
And then at 6 am the nurse woke us up again – the request was to shave the perineal area which really upset my mother!!! And finally sent the alarm bells in my head did go off – at that hour there were no doctors I could talk to and I did not want to wake up my friends !! So, I waited impatiently till I could call friends whose opinion I valued and trusted – and at 8 am informed the staff that I was taking my mother home and did not want any further tests!! This was followed by some feeble “whys” from the nursing staff, no response from the resident doctor (who feels no ownership of the patients, in any case), and finally an uninterested ‘OK, if that’s what you want!” from the Junior Consultant in Neurology.
Although not painful, the process of discharge took another 4 hours – the advance they had taken was large enough for me to get a substantial refund!! But this was a Friday afternoon, and I was told that I could collect the refund cheque after 3 working days. And that terminated a transaction, in which a complaint ( a fall) was dealt with through an algorithm, using the latest technologies – that it was a person who fell and she was bruised and in pain was not something that the algorithm or the technology could address!!
The experience has left me concerned and wondering – can we only be treated in our smaller parts with no heed for the whole? How do I face the times ahead as she – and I too – age and are faced with niggles and piggles which then will not fit into any specific body part with a designated specialist?