Wednesday, April 2, 2008

Stones in My Mouth

Derek Bose

Whoever heard of stones forming in anybody’s mouth?

Well, I hadn’t, till an ENT doctor examining me for an oral infection pronounced sialolithiasis. Effectively, it meant that I was having a set of tiny calcium stones lodged nicely in my salivary duct — the way some people have stones showing up in their gallbladder or kidneys. The stones were blocking the flow of saliva, and the option before me was clear: I had to get them surgically removed, or else, die of starvation. Food stimulates the secretion of saliva and if it does not find a way out, I could be in for trouble — big trouble.

The good doctor gave me a third option: I could be on antibiotics and pray fervently for the offending particles to be dislodged on their own. It could take a week, well, maybe ten days, before my prayers are answered. Till then, I would have to be on a diet of semi-solids like banana milkshake and watery khichdi.

Two days passed. On the third morning, I could see a lump forming below by right jaw, the size of a ping-pong ball. Swallowing was getting difficult. I took a sedative and slept off. Next morning, I woke up with a start. My mouth was on fire. I looked into the mirror and could not recognise myself. The lump had become to the size of a tennis ball and the jaw line had disappeared. My right cheek and neck was now one. I panicked. The doctor prescribed a painkiller and doubled the dose of antibiotics. That brought some relief. But by night, when I found I could no longer talk and even my breathing was getting affected, I knew my goose was cooked. I had to be hospitalised.

Everything happened so fast that I did not have the time to think straight. (In distress, nobody thinks straight.) I just went with the flow and found myself at Nanavati Hospital in the Bombay borough of Ville Parle. If only it had occurred to me that I could as well have gone to a private nursing home rather than a hospital that was no different from a snakepit. Money was not an issue; my medical insurance would have taken care of it. I needed relief — a fast one, goddamn. And Nanavati happened to be the hospital closest to my house.

* * *

So there I was lying, spread-eagled on Bed No 339, Ward 16, on the afternoon of 22 January 2008. My left arm was attached to an intra-venous drip by a long, orange tube. Across the room my wife, Bhaswati was seated on a narrow divan, staring at me in open-eyed horror, her north-eastern features prominent. This was the first instance of hospitalisation for us both; well not hers, mine. No tension, no complaints, nevertheless. The room looked comfortable: no major stains on the bed-sheets. There’s an air-conditioner. A telly. A bathroom commode that’s clean. Well, you cannot ask for more.

Earlier, at the OPD too, luck was on my side. An insanely friendly doctor was on duty. Peering into my mouth with a torch, he said: “Say, illyaaaaaaa?”

I could say, “Ullllllll…”

“Got it!” he exclaimed and, with his forceps, picked something from underneath my tongue. He held a tiny white pellet, the size of a baby’s tooth, and dramatically dropped it into a steel platter. It fell with a toink. I could not believe my eyes, and my ears. So, this was what a salivary stone looked like — the cause for all my grief, eh?

“Wait,” he screamed. “There’s another one.”

Within seconds, he plucked another stone and held it aloft, jubilantly. I blinked at the tiny trophy, tears in my eyes. The pain was excruciating, but somehow it felt light. The two stones were a huge load, from out of my mouth. I knew I would survive now. But this was turning out to be a theatre of the absurd. And the doctor screamed: “Hang on, there could be more!”

My heart sunk.

“Let me see,” he said, lowering his voice, almost pleading. “If you permit me…”

I had it enough. Is it a tragicomedy? Abruptly, he stood up, removed his gloves and announced: “We will have to admit you. There are some more stones, but deep inside the duct. The area looks infected, in which case we would have to remove the sub-mandibular gland. With the operation and the tests, it could take up to three days of hospitalisation. Let me consult my senior.”

The senior turned out to be a jovial Santa Claus character: Doctor Morwani. He gave me one amused look and said: “Admit him.”

* * *

Morwani breezed into my room that evening, a wide grin pasted on his bearded face. He pulled my chin down, flashed a torch at my face and mumbled, loud enough for my wife to hear, “Pathhar ke Sanam.” I liked that. Instantly, the tension in the room eased and the anxiety on Bhaswati’s face disappeared. I could see Morwani had a way about putting people at ease. He seemed a man one could implicitly trust. If only I had known how wrong I was.

But then, I was already responding to the medication Morwani had prescribed at the time of admission. My face was getting back into shape. The painkillers had numbed all the sensations in my mouth. I had also got my voice back, voila. The only worry was hunger. Living on liquids for days on end had made me dreadfully weak. At home, I was having banana milkshake, which gave the feeling of fullness. But here all the nutrition I was getting was glucose through the orange tube and an occasional glass of tender coconut water. So when my blood pressure crashed to 80/70 on the second night, I was not surprised.

“Are you getting any chest pain?” I could hear a distant voice in my ears.

Then there was light. I opened my eyes and promptly sat bolt upright. Eight eager faces were looking down at me. I recognised Morwani and a couple of nurses. “What time is it?” I quizzed enigmatically.

“Relax,” Morwani said. “Are you feeling giddy?”

“No, but what is going on?”

“Uneasiness?” a youngish, bespectacled-face asked.

“Not at all,” I quirked.

“Palpitation, a choking feeling, breathlessness…”

“Of course, not,” I said. “But what is happening?”

The eight faces were still studying me as though I had just escaped from Jijamata Udyan. Bhaswati was at the far end of the room, equally dumbstruck. “What is happening?” I questioned her.

A murmur ran through the group. I could catch someone saying: “He can’t be sitting up and talking like this…”

The door opened and an elderly nurse wheeled in a mini ECG unit.

“What’s wrong with me?” I asked her.

“Any kind of pain?” she countered, smiling as she strapped me.

“I am starving,” I protested. “You have been giving me only coconut water for the past two days. Nothing solid has gone to into my stomach.”

“Let me explain,” Morwani suggested. “Your BP has dropped below normal. There’s no need to panic, but we must know how this has happened. These doctors, you see, I’ve called them all from their homes. I myself was sleeping when the night nurse called. This is the first time in six years that I am in this hospital at 1:30 — at night.”

“I told you, I am on an empty stomach. Give me food and I promise you my BP will be back to normal.”

Morwani raised an eyebrow and looked up: “I think we can allow him home food?”

All fell silent. One by one, they were moving out. Morwani got up to join them. I tried to stop him: “What about operating my gland tomorrow?”

“Let’s see,” he said, without turning back. And he was gone.

Alarm bells began ringing in my head. Something about this drama told me that I was not getting discharged any time — not in the near future. These people had not visited me out of love or duty. Much later, I would learn that every time a doctor entered my room, which included Morwani, I would be billed for it. (Ahem, I should have known that.) And night visits got them extra money. Surely, there was a bigger plan to all this. I felt trapped. I knew calamity would strike, sooner than later.

* * *

Calamity struck early next morning, soon after breakfast. I was given a sumptuous meal of two half-boiled egg whites and a glass of orange juice and I was feeling quite happy with life for having recorded a healthy BP count of 114/70 when in walked a tall, smartly-dressed man with a load of questions. Is there a history of cardiac problems in my family? Do I smoke? How many cigarettes? Am I diabetic? Do I suffer from fainting fits, giddiness, momentary blackouts? Do I drink? Am I on drugs?”

Vivek Mehan was obviously a man in a hurry. For, without waiting for a reply he was simultaneously dictating instructions to a sidekick. I decided to ignore him. After he was done, I reminded him politely that I was here with a problem in my mouth and not my heart and since I was off solid food for days, my BP had dropped. Now that I have had eggs for breakfast, the BP was back to normalcy.

“Eggs!” the doctor shrieked. “You had eggs in the morning?”

“Yes. What’s wrong with having eggs in the morning?”

He did not reply. Turning around, he dictated: “Recommend ‘Cardiac Injury Profile’.” He strode out, just as abruptly as he had stormed in.

There are times when I have wondered whether much of the nonsense one has to put up with in life is the result of past karma catching up. This was one of those moments. And it was clear as day that Mehan was up to no good. He had successfully sidetracked the main issue (of surgery, dude) and was now determined to send me on a merry-go-round trip of totally unwanted tests and extend my stay in, yawn, hospital.

Morwani was an obvious accomplice. It would be the same old familiar story of doctors taking patients for an adrenaline-rushing ride, running up fancy bills and eventually reaching nowhere. I am a poor scapegoat, admit it.

But scapegoats, patient(s) as they could be, lose their heads beyond a point.

In two days I was hopping mad, refusing to take any more humiliation and harassment. I caught Morwani in the corridor and asked him about the surgery. He looked startled.

“This is getting too far,” I threatened him. “They haven’t found anything wrong in my ECG reports. The [so-called] Cardiac Injury Profile is normal. Even then they put me through a 2-D Echo Test. That too is normal. I have just done a Stress Test, too, and it is also normal. Where is all this leading to?”

“How do you know the Stress Test is normal?”

There was aggression in his voice.

“What do you mean?” I snarled. “The doctor, who did the test and the technician… well, both said I had done fine. There was no abnormality in my goddamn heart. In fact, I felt no strain walking on the treadmill. Now if someone wants to invent a cardiac problem…”

“Look, I must clarify, I will not operate on you till the cardiologist would give me a clearance,” Morwani said throwing up his hands. “I just heard you will need an angiography done. Now if you go back to your bed, I will join you with the reports.”

I was zapped. What do you tell an elderly man who thinks nothing of taking you for a jolly good ride? Did he think I was so dumb as not to know what angiography meant? It would inevitably lead to angioplasty, well, even a bypass surgery. And both Mehan and Morwani would laugh their way to the bank, shillings jingling. Surely there was a dignified way for doctors to make money. What about the poor and the hapless at their mercy? At least, I was covered by insurance and did not feel the pinch, even as I knew I was being fleeced… These guys were no less than common criminals. They ought to be gaoled.

* * *

When Morwani dropped in with the reports, I was ready to take his case. Before he could speak, I told him, tongue firmly in my cheek: “Doctor, I had come here to be treated for a salivary gland problem and now I am supposed to be having a heart condition. What is this? Nobody has a clue. So I must go for an angiography. And till I do that, you will not attend to my salivary gland. Is that what I am to understand?”

Morwani was obviously ready with his answer: “A salivary duct infection is not fatal, but anything to do with the heart can be. When your BP fell drastically that night, we were, you know, concerned. We felt it necessary to eliminate all chances of a cardiac arrest. Why don’t you understand that we are here only to help you? Besides, I don’t want to end up with a dead body on my operating table.”

That got me. “You know very well that my BP fell because I was literally starving. From the next morning it has been normal. You know too that the ECG reports are fine, the blood tests found nothing wrong. The 2-D Echo report says I am normal. What more do you want? I give a damn about your equation with Mehan, but honestly, I can’t trust you guys. I’d rather get the hell out of this place and seek help elsewhere.”

Morwani studied me for a while. “In case you want a second opinion, I can discharge you for a couple of hours at my risk. You can take your cardiac reports to the Hindujas or anywhere else... whatever please you.”

“I will do nothing of the sort,” I said in a sombre voice. “Once I am out of this pit, I will never come back. I am done — with Nanavati.”

This was raw war and Morwani knew it. Suddenly his face broke into a smile and he quipped: “Arrey, you must know that I am a surgeon; I do make money. So why should I put a block on it? Now, if you are unhappy with Nanavati, I have my clinic in Khar, we can do it there. But I will have to mention that in my discharge report that patient is unwilling to undergo angiography.”

“Do that.” I was exasperated. “I do not want to stay here one extra minute.”

Post Script:

I was released from Nanavati Hospital on 27 January 2008. On 2 February, Dr Dhruman Desai of Sunflower Hospital, Juhu scrapped the Nanavati report and recorded under his signature: “Patient fit for surgery of removal of salivary gland under general anaesthesia.” On 24 February, Dr Carlton Pereira did the surgery at Kripa Nursing Home, Seven Bungalows, for a mere Rs12,400, all charges inclusive. At Nanavati, without surgery, I paid Rs 46,330.40... So much for the medical ethics of some senior doctors of one of the biggest and most reputed hospitals in Bombay. After this experience, I am seriously planning to start a Society for Prevention of Cruelty to Patients.


(Excerpted from Urban Voice III: Bombay)


abha said...

Such tales are now becoming common patient folklore. I remember when my husband had a gall bladder problem, and the hospital people kept trying to find something wrong with his heart. No kind of explanation or pointing in the direction of the area of discomfort etc., could get them to change their mind. He had to start throwing a fit before they decided to examine the real problem. And this was a private nursing home.

mk said...

Dr Dhruman Desai- honest hardworking and brilliant

Anonymous said...

I agree dr.Mehan is a doctor with no ethics,i too have had a very bad experience with him.

Anonymous said...

Dr.Vivek Mehan,the lesser said about him the better it is.He cannot be trusted with anyone's wife,sister or daughter.He should never be trusted with any "female patient".