11 October 2014

Ill on the road: Mr Peter the patient patient (Part 2)

Sometimes, when a desperately desired goal draws near, the effort required to reach it increases exponentially. That's how I feel after the taxi drops me outside the hospital and I shuffle into reception, the last of my physical and mental energy draining out of me into the Delhi heat. No one's attending the desk. I try a nearby counter but they have little English and just direct me back to the vacant reception desk. I can do without this. But a young man appears; I must go to the Emergency Department in the next building, he says, pointing. I creep out the door and across to Emergency, lean on the desk and say I need to see a doctor.

A few questions, then I'm taken to a gurney where a gentle, smiling orderly helps me lie down. A doctor and nurse arrive quickly; I'm questioned, prodded, and assessed; tests are arranged. A nurse inserts a cannula into a vein in the back of my right hand. Most of the rest of the day consists of visits from various doctors, all of whom ask similar questions to which I try my best to give consistent, accurate answers; of being connected to drips; of having blood samples taken; of being prodded -- one doctor palpates my abdomen with such vigour I wonder if he's trying to take a biopsy with his bare hands. I keep my yelp moderately dignified.

The smiling orderly comes with hospital pajamas and helps me change, then eases me back down onto the gurney. He puts his hand on my shoulder in solidarity and says something in Hindi; I have no idea what he's saying but understand him perfectly, and his kindness threatens to undo me. I hold it together and thank him.

On a gurney opposite me lies an ancient, yellowed woman, her eyes closed and sunken into the dark hollows of their sockets, her breathing shallow and strained. She looks to be barely alive, and compared to whatever affects her, my own illness seems trivial. On the gurney next to her, a man groans and, somewhere down the corridor, someone screams. A monitor bleeps regularly and monotonously -- the kind of sound that could be used to torture a prisoner. When a nurse checks to see I'm still O.K, I ask to sit up; she adjusts the bed and at my request places my bag next to me. I retrieve my pen and notebook and write a little. I don't like labels -- I prefer to say 'I write' rather than 'I'm a writer' -- but these roughly scribbled notes fulfil a commitment I made years ago to write every day, and in maintaining this perfect record even under these circumstances I consider I'm justified in calling myself a writer. Of course, what I see as dedication, others might see as obsession -- harmless enough, but ridiculous. Maybe they're right.

The gentle orderly comes and wheels me to the ultrasound unit. This involves a short trip between buildings, into the pleasant heat of the evening -- I've been continuously cold in triage, even after my kind orderly has tucked a blanket around me -- and I look up at the darkening sky with its tinge of orange. Crows fly overhead, black silhouettes, free to fly where they will. The sight fills me with joy and longing and hope; I'll get through this, I'll once again share the world with crows and kites and rose-ringed parakeets and the ubiquitous pigeons; I'll see babblers and palm squirrels again in the Deer Park, and maybe barbets or even the grey hornbill in the Lodi Gardens. Then the door swings shut behind us and we carry on to Ultrasound.

I'm given a thorough going-over. The doctor spends a long time going back and forth over the painful area, then calls someone else to confer. Part of the lower bowel has thickened, she says, most likely because of inflammation. This means a CT scan will be ordered, and the preparation for this is one of the most unpleasant experiences I've endured for many years.

A nurse wearing a mask appears at my bedside, clutching two one-litre bottles of pale pink, frothy fluid.
   'You must drink two litres in two hours,' she says, waving the bottles at me. She repeats her instructions, holding up two fingers for emphasis: 'Two litres in two hours.'
She puts the bottles on my tray. I look at the soapy froth and just know this won't be pleasant. I don't know the half of it.

It tastes like disinfectant mixed with dish-washing liquid, and for all I know, that's what it might be. I time my gulps, sometimes managing three in quick succession, sometimes just two. I want this over and done with, so I force the vile fluid down, finishing the first bottle ahead of schedule. The pace slows for the second bottle, though, because it's so nauseating each gulp makes me feel like vomiting. Surely there must be a better way? Once again, sheer will-power keeps me carrying on, but I wonder about people who simply can't manage this awful requirement -- how much is really necessary for a good CT scan? With about a third of the second bottle to go, I gulp another mouthful and somehow suppress the gag reflex so I can swallow the foul fluid. Involuntarily I shudder and grimace, and look up to see an orderly watching me as she waits by a wheelchair. She smiles, and I grimace and shudder again, deliberately this time, and say, 'It's horrible!' and she shakes with laughter -- not unkind, but understanding, and I feel a little better. I finish it all well within the two hours and the nurse with the mask comes and gives me the thumbs up; beneath her mask, she's smiling, as if proud of me.

After that, I couldn't care less what they do to me, which is just as well, considering the indignities I'm put through for the scan itself. This is when I start thinking about dignity and wondering why what would have horrified me before my illness now seems trivial. All I want is to know the scan's successful, and the more thoroughly they prepare me, the better.

The operator tells me the machine will ask me to hold my breath and I must do as it says. What he doesn't tell me is that if the machine does indeed issue the instruction, it must be in Hindi, because all I hear from time to time is something incomprehensible. Fortunately, it doesn't matter, and when I finally collect the report over a week later, I'm astonished at the clarity and resolution of the images.

Back on my gurney in triage, I'm visited by a doctor who breaks the good news to me.
   'It looks like appendicitis,' he says, 'so we'll start getting you ready for a laparoscopic appendectomy.'
   'That's great news,' I reply, aware of the irony of joy at having my appendix whipped out.
The doctor smiles and agrees this would be a simple and straightforward solution, but he points out they still want to do further testing to be sure they've correctly diagnosed the problem. This is when I'm so grateful I'm in one of India's best hospitals. Who knows what would have happened if I'd been diagnosed and treated in some place less thorough, with rudimentary facilities? I'd probably have lost my appendix and continued to deteriorate. The outcome doesn't bear thinking about. Here, though, in the hospital that can list as patients some of India's most important people, the doctors take no chances.

However, while appendicitis still seems likely, the preparations for surgery continue, and I'm taken for an echocardiogram. Usually, I imagine, this would be comfortable enough, but I've lost so much weight I'm nothing more than skin over skeleton, and at times the pressure of whatever it is he's rolling over my ribs feels like being massaged with a knuckle-duster. I keep quiet and put up with it. Something seems to worry him, though, and he calls someone else in; they keep pointing to blue and red flashes on the monitor. I learn later that I have a small amount of fluid around the heart, almost certainly related to the infection; fortunately, this isn't serious and I'm cleared for surgery.

That surgery doesn't go ahead, however. Late in the afternoon an administrator arrives, saying I'm to be admitted but I must pay 20,000 rupees deposit. I tell him my insurance company will pay; he asks for the name but isn't interested in contact details or policy number. I still have to pay myself, he says. Fortunately, my credit card works and I spend my first night in a room with three other patients, up to a dozen visitors, and no privacy whatsoever. In the morning I'm visited by a doctor who updates me on the test results -- my total leucocyte count (TLC; the concentration of white blood cells, which fight infections), is about double the normal figure, he says. The gastroenterologist also arrives, and this is when I learn of the change of plan. After a closer review of the CT scan, he says, they've decided the inflammation of the appendix is secondary, and the likely problem is an infection around the junction of the small and large intestine. They want to do a colonoscopy.

This, he says, means they'll give me a laxative in the evening, and when I'm 'crystal clear' (his phrase), they'll do the colonoscopy in the morning. Fine, I think, do whatever's necessary. If I have to make 7 or 8 trips to the toilet in the night, I'll manage that.

What I don't realise is that the laxative isn't a simple dose of something I can swallow in one go -- it's another two one-litre bottles of some other fluid within two hours. This vile stuff is even worse than that for the CT scan; it tastes like salty, lemon-scented floor polish. Don't ask me how I know what floor polish tastes like; I just know that with every mouthful my brain shrieks, 'Floor polish! Floor polish!' I try replacing the thought with 'Peach schnapps!' which I've never tried but had heard was revolting, but it doesn't work. The weird association with floor polish is too strong.

I force down the first bottle but fall behind schedule. Given I've eaten almost nothing for about four days, surely I don't need to swallow the lot? By the fourth trip to the toilet, I can guarantee I contain nothing solid whatsoever, but, doing my best, I keep attempting to swallow what tastes like distilled evil. Halfway through the second bottle, however, I realise another mouthful will turn it from a laxative to an emetic. I stop drinking it. The report I see later lists the quality of the preparation as 'Good'.

Once again, what I'd have thought of as mortifyingly undignified leaves me completely unmoved. It's all necessary, all irrelevant as far as my dignity's concerned. The sedative helps, too, and I remember almost nothing of the procedure, which I later find slightly disappointing because I'm interested to know what they're finding. Perhaps if I hadn't been sedated, though, I might have felt differently.

All this time, I've been on various drips, mostly broad spectrum antibiotics and saline with dextrose. My TLC returns to normal. My gentle orderly has been replaced with one who marches around like a bantam rooster, erect and bossy -- 'Change!' he says, handing me clean pajamas -- but he's efficient and well-meaning. Most of the staff call me 'Mr Peter', and I don't correct them -- I like the sound of it. The cannula comes partly loose; I point this out to a nurse, who adds extra tape that doesn't work and eventually the cannula comes out completely. She puts a new one into a vein in my left arm. That's one advantage of being so emaciated -- all the veins beneath the skin are clearly visible. The call button doesn't work, so to call a nurse if I need a drip disconnected, I have to get out of bed and push the button on the wall. I then have to repeat the procedure to remind them to reconnect the drip. The phone by my bed has been blocked, and when my friend Sally visits she arranges to have it unblocked so she and my brother and perhaps others can call me. A technician comes, checks the phone and indicates it's now fixed. It isn't, and still no one can get through. All these I can deal with, however, and I use these inconveniences to practise being patient.

On the second day, as I lie patiently waiting for whatever will be done to me next, an elegant middle-aged woman enters the room and introduces herself.
   'I'm from the New Zealand High Commission,' she says, and is on my case after receiving a phone call from my brother in New Zealand. Ramita asks how she might help, so I point out the problems the hospital's having getting in touch with the insurance company. After repeated attempts, I'd finally managed to get someone to record my policy number and the contact phone number, but the problem seems to lie with identifying the local, Indian insurance provider that should act on behalf of the New Zealand company. Besides, an administrator tells me, she's rung the New Zealand number several times and has yet to receive a response from my case manager. Needless to say, this has added stress I don't need. Ramita promises to phone the insurance company and get the problems sorted out, and I discover later she's as good as her word: with her intervention, communication between the insurance company and the hospital is finally established, just in time for me to be discharged.

I give her Sally's number, too. This proves to be crucial at the end of my stay when the hospital won't allow me to phone Sally directly; instead, I phone Ramita and ask her to relay the message that I'm ready to be picked up. Again, she's as good as her word.

On the third day, the supervising surgeon visits. He explains the diagnosis and prognosis, says encouraging things and seems generally satisfied with my progress. I can be discharged today or tomorrow, he says; it's up to me. Today, please. He smiles, shakes my hand, and, like most of the doctors, puts a reassuring hand on my shoulder. This small gesture always moves me, and I wonder whether I'd have been so affected by it had I not been in such dire circumstances. I do know that when Ramita walked in and identified herself as being from the New Zealand High Commission, I struggled very hard to retain my composure. Sally was still returning from a visit to the UK, so apart from my friends at the Smyle, I'd seen no one I knew. The sight of Ramita, and Sally later that day, reassured me in ways words simply can't describe.

All I'd had to sustain me was the knowledge I was in good hands, and the thought of my family and friends. Very few knew I was seriously ill, although some of my closest friends had some inchoate intuition something was wrong. Perhaps this can be explained logically -- for example,  by the slightly longer than usual spacings between blog posts -- but I'm not completely convinced. I thought constantly of those great friends and how, if they knew my condition, they would be providing every kind of support and aroha they could, and maybe that constant thought, in extremis, might have a way of making itself known.

Late in the afternoon I change back into my filthy clothes in readiness to be discharged. Sally's on her way to carry my bag and facilitate the administrative details. But the supervisor at the nurse station on my ward won't let me leave; wait in your room, she instructs me. Restless, I end up sitting in the corridor outside my room with several people who've been regular visitors to the other patients. I attempt to strike up a conversation with one man, but his English is almost as bad as my Hindi. He persists, though, and we manage to communicate a little about ourselves. Raj is a farmer from Haryana; his father-in-law, the man in the bed beside mine, has just had bypass surgery. Raj has no children yet, and has been married just six months. Eventually he holds up his phone and asks 'Photo?' We sit together and smile at the camera, and once more I'm moved by the fact that this man whom I've known for little more than a few minutes has felt interested enough to want a record of our fleeting interaction. When I finally leave, I shake his hand and try as best I can to indicate I wish him and his father-in-law all the best.

What will become of the photograph?
What will become of us?

The evening darkens. Outside, three stories up, a kite swoops past, close and beautiful in its command of the dusk. Birds of various types cross the sky: pigeons, crows, parakeets. I watch and can almost feel what it's like to soar through that warm, darkening air, watching the pitiful chaos of human life anchored so inescapably to the ground. Finally, night turns the plate glass window to a black mirror, and I turn away and look down the corridor. My life seems to comprise patient waiting.

Sally arrives and the nurse arranges a security man to escort us to the Billing counter. With her usual astonishing efficiency, Sally's already phoned the hospital's International Relations Manager to sort out the protocols, and she now leads me to the International Payments desk. Here we hit a snag; the man says we have to go back upstairs and wait. Sally knows this is not correct and asks to speak to the IRM. Some checking, and the man says the approval from my insurance company for payment has just arrived a minute ago. I go back upstairs while Sally lights a fire under the bureacracy.

Upstairs, the nurse now insists I must go back downstairs to Billing, so the security guard and the bantam rooster orderly take me down to Billing. The man from International Payments stands there; he looks in horror at me then starts gesticulating wildly at the orderly, asking him why I've been brought down here. I'm taken back upstairs to wait.

Finally, Sally arrives, having managed to convey to the IRM that my treatment during discharge is far from satisfactory. The IRM sets things in motion, even arranging a taxi to replace the one Sally had ordered but which had long gone because of the delays. We go downstairs again and I'm refunded most of my admission fee. While waiting, Sally explains the fiasco to one of the nurses, who has a good sense of humour and laughs with us.

Then we have to go back upstairs to collect the reports. The nurse and security guard accompany us, and at the nurse station the supervisor looks at me as if wondering why I'm back here.
   'You have not paid your bill?' she says.
I drop my head on the counter and start laughing; everyone else laughs, too. The reports haven't been collated, and we lose more time while the supervisor photocopies, files, arranges, and finally hands me my file. She shows me the prescription for my medication and gives a hopelessly inadequate description of how I'm to take my pills. I don't care; I'll get the information from the pharmacist or a reputable online site.

Sally picks up my bag and we go downstairs for the last time, out in the hot Delhi night, and into the air-conditioned taxi. The fiasco has ended.

Sally has arranged a discounted rate at a wonderful guest house in Green Park, and while I settle in there, she collects my medicines from a pharmacy and picks up a takeaway pasta for me -- no spices, as my doctor has instructed. What would I have done without her help? Somehow I'd have muddled through; eventually -- probably the next day -- I'd finally have escaped; I'd have ended up somewhere marginally liveable, relying on food that might or might not repoison me. I almost certainly wouldn't have ended up in Delhi's best hospital, getting the best treatment possible; and I'd have been under the immense stress of trying to negotiate Delhi's transport system while barely able to walk and mostly unable to think. To have someone attending to all those things and more, so all I have to do is sit back and appreciate how lucky I am is, again, beyond words.

Similarly, I think of all the obvious help I've received from other people: Ramita from the NZ High Commission in particular; my brother, who contacted her and activated my insurance policy; the staff at the Smyle, who arranged a taxi to the hospital and made sure I paid only the true fare; the Bardia people who organised my transport to Nepalgunj and flights to Delhi; my aunt, who took such great care of me in the UK when I came down with that other illness that may or may not have been related; others whom, to my shame, I might have overlooked. But the appreciation and gratitude that finally squeezed that small tear from my eye as I lay in the emergency department extends further, including all those who simply showed some compassion for someone having a tough time, like the man at Nepalgunj airport and the orderly who didn't need to grip my shoulder in a gesture of reassurance but did so nevertheless. It includes, too, and in a peculiar way I don't fully understand, particularly those who were unaware of my troubles but would have gone to endless lengths to support me if they had known, simply because they're my greatest friends.

The world is full of violence, suspicion, intolerance, hatred, and innumerable other evils, and we hear about those every day. But the world is also full of kindness, acceptance, joy, concern for others, and the recognition that we all share similar needs, and those things are mostly ignored by the media or trivialised by being turned into sentimental feel-good stories. Nonetheless, these characteristics of human nature comprise the essence of what's good about us; we all have the capacity to feel these things and most of us do. The last weeks have taken a huge toll on me, but the lessons have been priceless. Maybe I did, after all, find what I was not looking for.

1. Here's Part 1.
2. Recovery's going well. I'm still tired, weak, and thin (some would say emaciated, and they'd probably be right), but I'm improving steadily. I leave India in the wee hours of 17 October and touch down in New Zealand shortly before midnight on the 18th. It's been quite a journey.

1. Butterflies at Dachigam National Park, near Srinagar. Sometimes things that look fragile are more resilient than they seem.
2. A very pale, perhaps leucistic, palm squirrel in Delhi's beautiful and fascinating Lodi Gardens.
3. Babbler in the Lodi Gardens. Love these crazy birds.
4. Himalayan bulbul at Manali. Another beautiful bird that evokes strong, good memories.
5. Indian grey hornbill in the Lodi Gardens. Judging from the very small casque (the protuberance on top of the bill), this is probably a young bird.
6. Mosquito at Manali, in healthier times. A medical cannula's one thing; this kind of intrusion into a vein's quite another, particularly where malaria's endemic. My illness in the UK would probably have been a suspected case of malaria, but I had good grounds for believing it wasn't. I was right.
7 & 8. Proof of two things: I'm recovering, and I have plenty of time on my hands. The last photograph's from the second day after being discharged; the penultimate one's from this morning. 

Photos and original text © 2014 Pete McGregor


Zhoen said...

Nurses do that, so you will let go, let down, relax. To tell you this is safe, this is the place not to worry about others, we gotcha.

It was showing in your photographs. When you are fully well, take a good look at them, the hints are there that something was clearly not quite right.

Peregrina said...

Dear Pete,

Oh! What horrifying experiences you've had. I'm so glad they were eased a little with kindnesses and compassion shown by those whom you met along the way.

What with being away from home myself, then having several (minor) unplanned-for issues to deal with on my return, I've been somewhat vague as to the passage of time and hadn't noticed the big gap between your posts. I was fondly imagining you doing the things you wanted to do in Nepal, then India. Not an inkling of what you were going through, just hoping that in Malvern you had been able to recover fully from your first two months of travelling and that the weather wasn't still too hot in India... Then, late last night, I found your previous post.

It was a huge relief this morning to find today's post with a photograph which shows you looking much more like yourself. Between the lines, it's a story of frightening "what ifs", isn't it? Best wishes for your continued recovery. I'll be thinking of you. Only a week now before you can start downing those nourishing eggnogs.

I do admire you for your stoicism, especially during your nightmare of a journey from Landruk to the hospital in New Delhi, for your determination to keep up your daily writing, and for your ability to give serious consideration to matters such as the meaning of dignity, all when you were so very, very ill.

Arohanui, my friend,


Ruahines said...

Kia ora Pete,
Just hugs to you e hoa...just hugs.

pohanginapete said...

Zhoen, I don't think it's possible to overestimate how reassuring it is to get that kind of gesture from the people looking after you.

Peregrina, thanks for the kind words. Best not to speculate too much about 'what if', I think. As you say, some could be frightening. I'm through it now, though; still weak and tired, but out of the woods, so to speak.

Kia ora Robb. Will collect them soon ;^)

Lisa Emerson said...

Pete, one of the things that struck me most about these posts was the contrast between the pictures of wildlife and the awful story unfolding. It reminded me that, while we struggle with our human stories, life continues with all its glories (and, of course, its own tragedies). BUT you'll be home soon - fresh asparagus for dinner on Sunday night! Can't wait. Travel safely.

Zhoen said...

An illness that nearly killed you, saving you from a mountain that would have, in your state.


gods. 137

pohanginapete said...

Zhoen, several other friends have pointed that out, too. While I'd have been long gone from the area by the time the storm struck, it's still a sobering thought.

pohanginapete said...

Lisa, I'm sorry I missed your comment (until now) -- but the asparagus was wonderful!
You've touched on something that I think can be very difficult about returning from a significant journey: the feeling that life in the place from where you've just returned still continues; that nothing has changed there; that regardless of how much you might miss that place and its people, it and they don't miss you. More about this in an upcoming post.

robin andrea said...

Just catching up here and have been absolutely blown away by what you experienced on your journey. Illness makes us so vulnerable, but to be someplace where you are a visitor and not a native speaker, well that just makes the situation so much more difficult. I like how you held yourself and the people around you, never forgetting the essential humanity. I am relieved to know you are recovering. Sending good thoughts to you from the north coast of California. Take care and be well.

pohanginapete said...

Thank you, Robin — I appreciate the good thoughts. My strength is returning and I think I'm even beginning to regain some of the lost weight. Still missing India very much, though.

Brenda Schmidt said...

What a gripping read. I wish you a speedy and full recovery.

pohanginapete said...

Thanks Brenda. The recovery does seem to be going faster than I'd expected, and I'm hopeful I'll regain all the strength and fitness I lost.

bev said...

Quite a story. I found myself wincing as it came a little too close to some experiences I've had. Fortunately, all were on home turf. As I travel so much, I sometimes worry a little about something happening when I am on my own far from home. That said, I don't let that stop me from going! Glad to read that you are on the mend and regaining your strength! Best wishes to you for a speedy recovery.

pohanginapete said...

Thank you, Bev. The hardest part of the recovery hasn't been regaining my strength, though — that's been remarkably quick. I've just this minute published another post that I hope explains what was much harder.

butuki said...

I knew from your Facebook photo that you had been through an ordeal, but had no idea just how bad it was until I read these last two posts just now. The thing about a grave illness (I have diabetes) is that it gets through to you just how vulnerable you really are, and how much you depend on others for your survival. It also beats down any notion you might have about your body being your own, or about your living aloof from and unassailable by the world. Traveling far from home and friends makes it all that much more precarious, and you deeply sense it. Since getting diabetes I've become both more tender toward my body, and more afraid of the world and what it can do to me. It's very hard to get this across to anyone, even those very close to you, just what this means, and why I am not as bold as I once was in my convictions about getting out there.

Your posts hit home very powerfully as I go through one of the biggest changes I've ever made in my life... quitting a long-term job, leaving a partner who had abused me for many years, being suddenly left with a very expensive apartment that I cannot afford alone after my partner suddenly disappeared, finalizing a long put-off divorce, deciding to move to a new city to be with a new partner and all the shaking up that getting to intimately know a new person does, and suddenly feeling immensely vulnerable, immensely lost, and immensely out of control. The lack of family and close friends nearby, even the lack of the presence of my new partner, who lives far away, makes it all feel that much more threatening. I want to let go and to trust to the flow, but there is that constant desire to pull the reins your own way, to make it yours. The world doesn't care about that, though, does it? Perhaps recovery is partly the ability to trust in the rhythm, to let go and know things will go on.

pohanginapete said...

Hi Miguel, and sorry for the delay in responding. As usual, your comment offers so much to think about that I've been putting off the reply.

What resonated so strongly with me was your pointing out your increased awareness of what the world can do to you. Since I've returned from India, several people have asked how I think I've changed. Answering has always been difficult, but one thing I do say is that I've become much more aware of my own mortality. Several times during my illness I thought seriously I might die — at least that death was possible — and that realisation was, well, much more real than I've ever experienced before. Years ago I took a major fall from a rock climb and I clearly remember thinking, as I plummeted, that I might die. Yet, even then, it really didn't sink in. This time it did. I had another incident just before Christmas when, if circumstances had been different, I might have died, and that also shook me up.

I understand much better now that dying isn't an abstract concept, that I am vulnerable, and that I need to take care, particularly because I'm alone much of the time. I now take more seriously Jared Diamond's views on what he calls 'constructive paranoia'.