24 hrs to nowhere!

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?

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9 thoughts on “24 hrs to nowhere!

  1. What to say Madam about this kind of treatment and behavior? Supposedly this is the new emerging face of medicine in India which is ugly and bereft of any notion of responsible behavior, leave aside the humane touch, professionalism, dedication and compassion.

    Charak Samhita states the characteristics of a good physician as: “They are imbued with memory, intelligence and theoretical and practical knowledge. They nurture cordial feelings towards all creatures as they would towards their mother, father, brother and kins. Physicians having such qualities give life to their patients and cure their diseases”.

    Today’s huge curriculum of medical education have no space for ethics and morality. We select students based on their capacity to memorise certain facts and not their creative intelligence and aptitude. Questions papers have no space for such things. Hospitals hire doctors not for their humane qualities but for their technical skills and their market value. But we shy away from calling these hospitals as some kind of degenerate or rotten enterprise for many reasons – social inhibitions, a few rotten fish should not provoke us, we hope for a change, ——, ——, and lastly CHALTA HAI.

    AK Baronia.

  2. Hello Madam, my regards. You write so well, the picture so perfectly created, I lived each moment with you as I read on. It spoke volumes of the system of medicine I have come to detest. It is high time we cared more for the patient and less for the rituals and algorithms. They have their own place in medicine but so do caring and compassion and common sense, and I see no reason why they must impinge upon each other.

    Madam, I wonder if you still remember mg PGI interview, I was asked what I would do for the Institute/Department. I had answered at that time, that I would walk in with the patient from emergency and oversee him till discharge and try and smooten the wrinkles and potholes and craters along the way. Mechanical processes, mindless staff and caretakers, uninvolved clinicians who talk but haven’t developed the art of listening and the cash counter ticking away. The maladies of a corporate hospital!!

  3. My deepest sympathy about what you have detailed as personal experience with the cold, impersonal conveyor belt medicine practiced in corporate hospitals of today. Hope the future brings back some of the warmth in patient doctor relationship of the bygone era.

  4. Not only patient suffers in the short-term when they visit these hospitals, but in the long-term these hospitals will produce incompetent doctors whom the patients have to bear outside as well.

    Thanks for publishing tis note! You are an expert in this area, so you can understand the scenario. The common man cannot tell whether this is doctors’ incompetence, an advance way of diagnosing, or the disease itself is complex.

  5. If this happens to a doctor,I suppose I need to keep my impatience in lock and key before leaving home for the hospital.The moral of the story I feel is,stay in small towns,go to small hospitals and trust your destiny more than high flying
    doctors

  6. I can understand how you feel. When my 83-year-old father was admitted to a hospital for a minor investigation, he was kept nil orally till evening. From seven in the morning we were told that he would be taken in soon. When we protested we were told that this was a minor matter. And this was after getting VIP treatment because of Vijendra.
    I am sorry you had to go through all this.

  7. Sad. Inhuman. And, above all, Frequent occurrence. We in medicine need to stop and think. Where are we going? Everyone seems to be running ahead without pausing to think of the trail we are leaving behind.

    Let me use this opportunity to look at the bigger picture. Money is one facet. However, it is likely that the treating doctor would have ordered an EPS for his mother in a similar situation. Today’s doctors seem to live in in awe — of technology, and fear — of not missing anything. Their brains conjure the worst possible though rare scenarios (fall being due to a cardiac arrhythmia) than the much more common ones (an occasional fall would be par for the course at 82 years of age). That invasive interventions at that age carry higher risks than in younger people is forgotten. Common sense is gone.

    The doctors are obviously responsible, but the society also has a role to play. We need to accept occasional missed diagnoses — due to a doctor’s decision not to order an investigation since the probability of disease was too low. For instance, think of a 50-year-old man with chest pain whom a doctor advises against angiography based on his honest clinical assessment and simple tests — there is always a small possibility that he would later turn out to have heart disease. If we, the society, are unwilling to accept that, we have to live with unnecessary angiography procedures (and stents). Somehow, it appears that urban India is increasingly unwilling to accept such a risk.

    Our society needs informed debates that discuss the real issues that face us and our professions. However, all we have are the political debates — e.g. on our TV — that generate heat but no light.

  8. THanks for the wishes and sympathies everyone. Amma is fine – none the worse for those 24 h fortunately. All the points raised by you folks are relevant – the commercial angle, the attitude change of the urban elite, the general exploitative climate – but none of the people caught in the cog are really happy with the situation. The problems with the individuals will sort themselves out is if the system gets re-aligned.
    The wheel is turning full 360 degrees in systems that have gone down this path to its extreme. Read this article, which in essence says that a large number of US doctors prefer the salaried structure to percentages etc…

    http://ideas.time.com/2013/07/02/the-epidemic-of-disillusioned-doctors/?iid=biz-main-mostpop2

    Do we also have to ,make all the mistakes ourselves before we are forced to change? A debate is called for – that is all I am trying to say

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