Sunday, January 29, 2012

The Bloody Kidney Stone

Saifi Hospital located at Maharshi Karve Marg in Mumbai is a grand, regal and handsome building, outstanding amidst her neighbors that show age, torment and scars from Mumbai’s infamous monsoons. Built by the Bohri community of India, the hospital, unlike Leelavati in Bandra or Kokilaben in Andheri where the stiff upper lips of Mumbai’s recouparate, caters to the less financially endowed. The inside of the hospital is similarly striking; clean, efficient and modern. It is here I find myself laying on an examination table being scanned for woes in my abdomen. A smartly dressed (very) young doctor (intern?) frowns and asks me for the third time what ails me.
I have been told I have gall bladder stones…
He frowns. Huh…by who? By…a Doctor? A pause. A medical doctor?
Huh…really? Where, which Doctor? Did you have an ultrasound done to confirm this diagnosis?
I hesitate, don’t want to tell him I have flown all the way from Florida for treatment; this hospital is not very accommodating, understandably, to foreigners using subsidized facilities for Indian nationals. I give a vague response.
The Doctor grunts, prods my abdomen some more then utters Gall bladder stones my foot in disgust. A senior Doctor takes over prodding and stabbing the ultrasound scanner into my bladder, nods at his head wisely at his junior and walks away, leaving me rather bothered and perplexed.
Problem? I ask the young Doctor. He shrugs his shoulders.
Well, you have no gall bladder stones, for sure; whoever told you that is talking bakwaas. That is the good news. Bad news is you have a .9cm stone lodged just under your right kidney and other smaller ones as well. These are blocking the flow of urine, giving you pain and may cause major problems. You will have to talk to a urologist and have him remove the stone as soon as possible.
So within 45 minutes, I have a professional verdict that has cost me about US$25, for a (very) painful, uncomfortable matter that has been vexing me for over a month. How come Indian doctors are so good and accurate in their diagnostics? I saw 3 doctors in Florida; one said I have a bad back and 2 diagnosed gall bladder stones, none bothered to recommend an ultrasound, which would have confirmed a cause. Now, what medical books and or training do these doctors in the US read or go to?

Good doctors in India, at least here in Mumbai, are super busy and super rich. Later that morning, Dr. Ashiq Raval, a renowned urologist has promised to meet me at the crowded Prince Ali Khan Hospital Outpatients Ward. When I tire waiting over an hour, I approach a disorderly crowded desk and demand to see the doctor.
He is delayed, the irritated receptionist snaps, because he is still in OT.
And what is OT? I ask, equally annoyed.
The Hindu lady, with a slightly dislodged large red tikka on her harassed forehead widens her kohl-laden eyes in surprise, as if I have asked the most stupid question of the day.
Aree, OT yaar! OT! Operation Theater!
She clicks her tongue impatiently, dismissively and attends to a shrill telephone demanding attention. Dr. Ravel, when I meet him, is a short, heavy-set man with large doe-like eyes, sees me for but 3 minutes. He studies the ultrasound report, nods his head several times, as if what he sees is exactly what he expects, says he can remove the stones day after tomorrow, Friday at 10AM at this hospital, instructs me to get several blood, urine and x-ray tests done and meet him later in the day for pre-surgery orientation. And how much will he charge for the surgery? Lazy eyes appraise my worth for a moment. US$1,000 or thereabouts he replies carelessly, but pay US$20 for this consultation now. And the deal is done. When I come out of his office, there are about 50 other people seated outside, waiting to see him. I do the math; $1,000 earned in about 2 hours ain’t so bad. Later on, I learn he performs average of 5 surgeries daily, so that’s about $2,500 after splitting profits with the hospital. Yes, earning US$1.2 million a year living in Mumbai ain’t bad at all. I am not attempting to demonize Dr. Ravel’s earning skills here, mind you, he is a very good and adept urologist; more power to him.

The tests all done, I show up at the hospital to get a shock of my life; why, I would not have been more shocked if the Doctor had slapped me silly.
Yusufbhai, kaise ho? Now, I am going to insert a tube up your pxxxx and try removing the large stone, but I doubt that will work. So I’ll have to crush the stone into tiny fragments first and these will flow out with urine, theek hai?
I nearly choke at the protests that spring to my lips. You are going to do – what!!!?
I think the Doctor is as surprised at my shock; a lazy smile appears on his lips.
Hahaha, you didn’t think I’d cut you up, did you? Don’t worry, noting is going to happen to your pxxxx and you’ll be fast asleep to feel anything. I have done thousands of these procedures. They are very routine these days. And 100% safe. Now chalo, I will see you Friday, theek hai…?
Now, I not only have to deal with the pain but also fret about some guy messing around with my very private parts (VPP). I call up my cousin Dr. Afzal Yusufali in Dubai for advice but he is nonchalant about the procedure, recommends doing it.

Friday morning I am sleeping on my back on the operating table in the OT, waiting for the abuse to begin when I see Dr. Ravel peering down at me. But it is not only one set of eyes that gaze at me, there are several eyes, feminine eyes. I am introduced to the anesthesiologist, Dr. Patel, a pretty petite lady in white; I notice other eyes as well, all female. Eyes that will have unfettered view of my body, tubes being poked in me while I am dead, my VPP being violated. OMA, this is unfair, what about my dignity! I want to protest at the top of my voice, but these are unexpressed complaints, screams that echo only in my head. The humiliating process is already underway; I feel a prick of a needle, a mask is clamped on my face. From a distance, as if through a tunnel, I hear Dr. Ravel yell Sleep tight and a faint sound of feminine giggle before overpowering slumber overwhelms me.

I wake up to sting of slaps that Dr. Ravel’s heavyset assistant is tormenting me to. Mr. Yusufali, Yusufalibhai, uuthoo, uuthoo. Operation hojaya, the procedure went very well, Dr. Ravel managed to crush the stone, the bloody kidney stone, you are now very fine, very very fine.

I want to, because of this experience:

1. Thank Dr. Abbas Vakeel and Aliakberbhai Ratansi from Najfi House, Mumbai for arranging and facilitating the doctors, specialists and hospital. As easy as all these appointments seem from my write-up, the actual process can be a maddening maze of woozy headaches.
2. Thank driver Sarfaraz of Najafi House for all the care, attention and running around undertaken on my behalf.
3. In December of 2011, two poor full-term pregnant women in complicated labor attempted to drive to a government medical clinic, about 5 hours away, in the remote district of Dykoondi, Afghanistan. Tragically, their rented vehicle skidded in the ice and snow and crashed into a ravine, claiming all 4 lives, amongst others. While I have the blessings of Allah (S) and the good fortune to travel over 10,000 miles for my ailments, the poor and destitute of Afghanistan, especially women and children, have these tragedies to reckon with, daily.
This particular 35,000 strong community has no medical facility whatsoever and the government clinic may or may not have a doctor or (proper) drugs, even if the sick do make it to the clinic. CAI will, insha’Allah open her 3rd medical clinic in Afghanistan this spring in Dykoondi; this personal experience makes me want to redouble my efforts towards (attempting) some relief to these wretched people.


Wednesday, January 18, 2012

A $50,000 Surgery…

I am near to finishing a nine-mile run about a month ago when, with about one mile to go, when I slow down considerably for the mandatory cooling off stretch, I realize something is amiss. At about this time in the run, the good feeling hormones in my system get released and I cherish the feel of accomplishment; legs aching comfortably, sweating profusely and looking forward to a well deserved hearty breakfast. Today, however, there is a dull ache in my lower back instead, a pain that accelerates by the time I complete stretching and final cool off. I do have the hearty breakfast, but it is a forced feast, not enjoyed, a feel of nausea dominates.

The pain stays with me, a dull ache, increasing in intensity instantly after meals, with the feeling of wanting to barf every time; very odd, as I am alham’Allah, quiet healthy, careful what I eat and generally conscious about my health. This feeling and uneasiness continues for the next two weeks I run, but these are forced runs, my mind willing but the body stubbornly, strangely reluctant. When I get an acute pain in my back about two weeks later, fearing reoccurrence of kidney stones, I quit running, making my variable temperament more disagreeable; I love running. Now, I know women claim there is no pain greater than childbirth; I digress. Kidney stone pain, I think, comes straight from jahannum as a warning.

When the pain does not abate, I am forced to seek medical help, but there is a problem. I am, you see, one among millions who make up the uninsured statics in this great country we call United States of America. Not that I have not tried to insure my family and me, I have. Since my return to the US from India, I have tried three different sources, two declined saying I have no established history (?) and the one that accepted wanted a huge bite out of my IRA in premiums, enough money for me to pay an average monthly mortgage and lease a nice vehicle. So I suffer in pain (in barf mood) that is dulled only by healthy dosage of OTC medication.

A caring member of HIC community Fatema Manekia tells me about free medical services by Shepherds Hope, a church financed medical care run by volunteers. After a four and half hour wait, I get to see a bored, tired doctor who examines me robotically, says he sees nothing wrong, cites the reason for pain from a bad back perhaps, gives me (strong) pain medication and sends me home. I am relieved by the verdict; begin planning for a run next day. The doctor is awfully wrong, I am convinced next morning however, acute pain persists. So I become a doctor instantly, a degree conferred to me by Google search engine. I spend an entire day researching the symptoms I have and they all point an accusing finger to gall bladder stones. I talk to a couple of people who have been through this; yes, our experiences tally. Hmmm.

I turn to Seminole County medical services and they grudgingly give me an appointment to see a doctor at reduced cost. This service is much better; they give you an appointment and you see a doctor in about thirty minutes. The doctor is a young medical trainee from a medical college. Supervised by a qualified women doctor, who is handicapped, riding on an electric wheel chair, I am examined. Both of them are thorough, professionals and seem to know what they are doing. The verdict comes in minutes – gall bladder stones. Many gall bladder stones. I get slips for blood tests and an appointment to meet with a surgeon.

Now, just because Seminole County let me see a doctor for twenty bucks does not mean they will test blood and remove the gall bladder for free. No-no, this is the great USA; I must pay. How much, I ask? Well, nobody at the clinic will tell me (officially) but a young sympathetic Hispanic nurse confides it may be in the region of fifteen thousand dollars if the County coordinates it for me (it’ll take about two months, I stay on pain killers until then). Else, it’s about fifty thousand, give or take a few thousands. I stare at her, flabbergasted. She stares right back, nodding her pretty head sadly, understandingly; yes Sir, that’s how much it’ll cost. Or, she leans forward and whispers conspiringly, if it gets really bad, you are in bad pain, call 911, then tell the hospital you have no money, they’ll write if off eventually. They wont let you die, hehehehe…’

Huh, that much? I am sure she’s made a mistake. I try to find out. I call the Central Regional Florida Hospital but nobody there understands surgery without insurance. I finally get to talk to a PR guy who says its impossible for any hospital to quote rates for any surgery, depends on many variables but yes, fifty thousand dollars is not a number to be surprised at. Now I know how a person can go bankrupt getting sick in this country. Well, to hell with this nonsense, I cannot stand the pain and feel of wanting to vomit no more. I call my friends at Najfi House in Mumbai, India. An appointment is set at Saifee Hospital for January 25 and probable surgery for January 27. I had a planned visit to India in February anyway, I’ll simply prepone it and have the surgery there for fraction of the cost here.

God bless you, may He bless me and may He bless United States of America, the greatest, most developed, most mighty, most civilized, especially her health care services industry, country in the world.