Is it all money that matters ?

A true story narrated by an unfortunate person. Is this the prevailing life in India for helpless people ?

LIFE AFTER DEATH – real life (rather death) experience

This is not a philosophical statement on one's life after death, this is about how my wife, Padma died in a hospital in Chennai. Whatever I have seen only in movies so far, is experienced by me. We were living in the UK for few years; our family includes me, my wife (Padma), and our 7 yr old son and 8months old daughter. My wife had a symptom of ventral hernia (slightly bulged abdomen), we had consulted General Physician and Surgeon in the UK and advice was that she needed a surgery to have a mesh to fix the problem with a few weeks rest. We were also told that this is not an emergency and it can be done anytime though earlier is good. In fact the surgeon whom we consulted in UK talked about an example of a lady having this done for 30 years of the symptom. My wife did not have any specific pain or something except a small discomfort of bulgy abdomen (like a 2 months pregnant lady) and she was in her normal routine of taking care of our children, taking our son to school, household work, etc.

We were planning for Christmas vacation in India in Dec 2007, we thought we will consult some 'good' doctors over in India and take a decision of when we will do the surgery if required and possibly felt doing in India is good because of family support. We have got a reference of Dr J S Rajkumar of Lifeline hospital and we booked an appointment to meet him.

We landed in Chennai on 14th Dec 2007 for a three weeks vacation, met Dr Rajkumar at his city hospital (Rigid hospital) in Chetput on 15th Dec 2007 (Sat) at about 730pm. We have explained him the background, shown him all the comments of UK surgeon, medical reports related to my wife pregnancy, deliveries, etc (she had delivered both our children normally). After few minutes of assessment Dr Rajkumar told us this hernia requires laparoscopic surgery and we can do this next day itself. We were little concerned initially of getting this surgery done the very next day (particularly we were still not out of jet lag and she was feeding our baby) and got convinced with the 'salesy' words given by the Doctors. To quote a comment from the Doctor "she will run in two days time and can lift two suitcases and you can return to UK as per your plan on 3rd Jan 2008"). Also Dr Rajkumar told us that he will be on travel for 3 days from 17th Dec and moreover he was teaching Post Graduates on 16th Dec about laparoscopic surgery and let us get it done on 16th Dec.

Then my wife was put into all sorts of equipments in the hospital (in the name of assessment); blood, urine, ECG, MRI and so on and the tests were conducted till about 11pm on 15th Dec. In fact they have opened the labs after closing hours and got the test done and handed over the test results to us. They had some problem in the ECG and we were told that ECG can be done on the next day at Lifeline hospital.

We were asked to report to Rigid hospital at 5am in the morning. Think of it, we went our residence around midnight and my wife had rush on some food to keep compliance on the fasting 8 hrs prior to surgery. After preparing for the hospital visit that night and a couple of hours sleep (3 hrs or so) we reached Rigid hospital on 16th morning at 5am or so and from there we were transported by an 'ambulance' to Lifelife hospital in Perungudi (outskirts of Chennai).

We reached the hospital at 630am, paid some initial advance for the surgery and we were given a room. Padma went through some more basic checks like height, weight, etc. Padma was taken to the operation theatre at about 10am in the morning on 16th Dec. After the laparoscopic procedure she was moved to post operative ward at about 12 noon and I have met her in the afternoon to say a small hello when she gained consciousness. Dr Rajkumar met us on 16th Dec afternoon and he in fact congratulated me for successful surgery and said he has used proceed mesh (costly one) and advised his staff to move Padma to normal ward in the evening as she had to feed her baby. But, Padma was moved to normal ward only on 17th Dec morning, she was on IV fluids as per normal post operative procedure.

Padma started to develop some fluids in her abdomen which duty doctors / surgeons have 'rightly' observed. She was put in some series of tests on 17th, 18th, 19th and 20th – tests include multiple ultra sound, multiple CT scans, pricked her abdomen and taken fluids, she had a long tube through her nose overnight to collect fluid for tests, etc. We were told the fluid is normal after surgery and it will be alright after she passes stool, etc.

In the meanwhile Dr Rajkumar returned from his travel and seen Padma on 19th on 20th Dec evening along with other surgeons. He made an assessment and he told me that he might want to do one more laparoscopic surgery to find out what is the fluid about. He wanted to do a surgery on 20th Dec evening itself, but he could not proceed as the hospital has given solid food that afternoon – hence anaesthesia could not be given. (lack of co-ordination among departments, time lost here, may be she could have survived if they have did the surgery on 20th itself)

On 20th Dec night, fluid started oozing from Padma's abdomen stitches, after the duty Doctor's assessment she was shifted to ICU. We really did not know what complication she developed in the ICU. On 21st Dec (Friday) morning around 830am I was called in to the ICU to convey that they are going to perform a surgery and I had to sign "high risk consent", they were telling this in front of my wife (just think of a patient hearing this before the surgery). I was just shocked at that and had no options to sign whatever they wanted. I said "all the best" (my last conversation with my wife) to my wife and she was taken to Operation Theatre.

While I was discussing with the Doctors at ICU, the cashier in the hospital kept on calling me on my mobile. When I met the cashier he asked for Rs.60,000 to be paid immediately and I told him take Rs.40,000 and will give you the balance later in the day. Bang a reply came, "you have to pay the money to for me to give clearance for surgery". When I expressed my unhappiness about the comment, he insisted for me to sign a piece of paper saying that I will give the money later in the day.(What money minded, in-human attitude!)

We had no news from the hospital on their own about the surgery, I had enquired the staff nurse and visited my wife in the ICU and learnt that she had a diagnostic laparotomy (open surgery) and there was hole in the intestine which was fixed.

We have meet Dr Rajkumar at about 3:30pm on 21st Dec and understood that there was a duodenum rupture and he has fixed it, at the same time he removed the mesh which was fixed on 16th Dec. She was also paralysed and put on ventilator as she was waking up. He explained it was between life threatening and beauty so they addressed the duodenum rupture problem. What we were puzzled were, how did the rupture happen? for that explanation given were

- it could be due to ulcer. My wife had no evidence of ulcer in the past. Explanation given was 40%+ cases of ulcer is silent and there will be no symptom (I lack medical knowledge to appreciate this)

- it could be due to post operative stress (so many test post operation without any explanation of what we were doing could have created the stress on Padma is my argument)

On the same night (21st Dec) at about 930pm, I was called in to the ICU and Doctors conveyed that my wife condition is critical – her pulse is high, BP is low and they were attending to her. I insisted on talking to Dr Rajkumar immdly, but they refused to connect me to him at first and finally managed to speak to him. Dr Rajkumar came in around midnight and explained that the lungs are getting affected (shown X-ray of white patches on the lower portion of lungs) and she was the most serious patient in the whole hospital that time and they were trying their best. He also said, it will need another 12-24 hours of observation before they can say anything.

We were completely panicked and just waiting outside the ICU and praying for Padma's recovery. We had to argue with the security outside the ICU to gain access to the Doctors to know her situation (no courtesy from the security personnel, who just don't understand the situation)

At about 4:30am in the morning, my friend gained access the Doctors in the ICU and came out with the low face to tell me that Padma's condition is worsened. Again I tried to reach Dr Rajkumar and the hospital says they don't have his contact number (just can't understand how they can behave like this). Finally after some hue and cry Dr Rajkumar came on line to tell me that he is not God and don't think his visit can do any thing different. I cried, begged him to come over to give some ideas to his team to recover Padma. He came over at around 6am and said they are trying everything possible, etc; but her end came quickly.

The end came to our beloved Padma at 6:30am on 22nd Dec, throwing the entire family to rude shock and a life time sorrow. Our "LIVES AFTER DEATH" of Padma has changed for ever.

I can now think of so many questions retrospectively;

1. Why did the surgeon perform the surgery the very next day of consultancy, that too for a non-emergency one like this? (Padma had just travelled many miles, she was not even out of jet lag.) Was it for money? Was it for them to get one more sample for their post grads training?

2. Did the Doctors made proper assessment on Padma's fitness for surgery, frankly did they even had time to go through the reports, after the tests till 11pm on the previous night for next day 8am surgery (particularly when the reports were with us till 730am on the day of surgery).

3. Patient communication and counselling. Isn't it important to communicate to patient and their relatives on the development of patient condition (fluid collection started from the next day of laparoscopic)

4. Did the absence of Dr Rajkumar for three days post the first surgery is one of the reason for this disaster? Were the other Doctors not able to diagnose or take a decision? Were they waiting for Dr Rajkumar return?

5. What is the real reason for duodenum perforation? My wife never had any history of ulcer to the best of my knowledge. Why did the hospital take so much of time to react (5 days after surgery) when such a crucial thing like perforation has happened.

6. Was there any issue in the initial laparoscopic procedure which has caused the perforation?

7. Careless attitude by hospital staff? – my wife sex was recorded as "Male" initially and corrected after I told them. The staff was not even apologetic for this, he rather asked me "why didn't you inform". Can't he make out with the name Padma. Think of it, if he has changed the blood group from A+ to B+; that is it!!

8. Will anyone with basic common sense ask for high risk signature in front of the patient? I was asked to sign just minutes before surgery in front of my wife.

9. Is the hospital money minded?: They were demanding money on gun point almost.

a. Prior to the first surgery the cashier said please give Rs.30000/- more for him to give clearance for surgery

b. When my wife going for second surgery I was told by the cashier again, please give Rs.60000/- for clearance for surgery

c. The hospital charged more than what was told for initial laparoscopic, without even communicating to me increase in charges

d. The final "bill" was just on letter head, without mention of currency, invoice number, etc. I had to insist on a proper invoice later.

e. I was given to understand that they even made arguments on ambulance charges to send my wife dead body back home.!! (making money on the dead body also)

10. Why the hospital did not made me to talk to my wife when she gained consciousness after the second surgery? If not anything else, I could have held her hand. Even a criminal gets an opportunity to communicate his/her last wishes. Am I or my wife worse than?

11. FALSE reports - After all these hospital sends me false reports (on Jan 11, 2008 – three weeks after my wife's death) :

a. They had mentioned she had LSCS (caesarean section) and large scar due to LSCS. When my wife delivered both the babies normally, how does one record as caesarean and how there will be scar when there was no caesarean?

b. The hernia was mentioned "incisional hernia" – when there was no incision on her body how the hernia is categorised as incisional? It was actually ventral hernia. Don't think one can replace any term with any term just like that!

c. Most importantly, the surgery was performed on 16th Dec 2007, the report said 17th dec 2007

12. MISSING REPORTS - From the hospital records Doctors notes were missing for 16th and 17th Dec. The first report is available for 17th Dec at 8:36pm. How come there are no Doctors' notes for about 36 hours after the surgery? Isn't it fishy? Did something went wrong on the first laparoscopic procedure?

Our entire family is still mourning and trying to reconcile the fact that our Padma is no more. My 7 year old son is aware that is Mom is not there, does he understand? My 1 year old daughter is too young to know what has happened. What will her questions be in future?

My sincere advice to all is

a) Do not get carried away by advertisement / TV shows / big buildings

b) Please do not rush

c) Do your own due diligence, particularly when things are not an emergency

d) Try and understand the medical terms, do research prior

e) Please ask questions, at every stage.

f) Don't say "I can spend anything"

g) Know patient rights I am still not convinced that Padma has died after a 'simple' laparoscopic surgery?

I am deeply upset of what has happened to Padma and for what is happening to us. What I could have done (or not done) which would have prevented this. What is that we can do to prevent this in future for others!!! Please join me in making awareness to others. While India is trying to woo many international Customers in the name of 'medical tourism'; first let the authorities make regulation on the health care system and take care of Indian people first.

Our medical system must understand the differences between MEDICINE – TREATMENT and HEALTHCARE. What we get most of the time is medicine for the symptom while we need healthcare.