A Harrowing Experience with our Medical Establishments

I will remember the entire former part of 2024 as an extremely busy episode for me. While it was partly caused due to professional commitments, the biggest contributor was my mom's health related issues. During the nearly 3 months she spent with us in Bangalore, we must have been in and out of various hospitals and clinics as many as 30 times. Probably more. This involved general health checkups, dental procedure, cataract surgery and gall bladder removal, all in the midst of an unrelenting professional routine. It left me completely drained.

But what I want to write about here is not the prolonged episode concerning my mom's case, but the brief one that followed it, concerning my wife.

All the necessary treatments and examinations had been done. My mom visibly looked better than when she had joined us in March. I was exhausted, but ready to heave sigh of relief, satisfaction, and even feel slightly proud of myself for having level-headedly handled the process. That's also when I was saying words full of praises about how professional the Narayana health system is: it's expensive, a bit too elaborate. But it instils trust in the heart of the patients and their caregivers.

That's when, one day, Shilpi, my wife, started getting high fever and vomiting accompanied with severe headache. Her BP readings were worryingly low. Our relative, who is a doctor, prescribed some antibiotics and other medicines, but also suggested that we shouldn't wait too long before we visited the hospital, if the BP readings didn't improve.

Our regular place to go in all health-related cases is the Narayana Clinic on Neeladri Road, Electronics City. It was a weekend and Narayana Clinic was closed. By Saturday afternoon, Shilpi's fever showed no signs of abetting, and she was almost screaming and delirious because of headache. It was a panic situation. And we headed off to Cauvery Hospital, a corporate hospital of significant scale and repute. We were taken in the emergency ward.

They put Shilpi on drip and started tracking her vitals. They also were pushing some drugs through IV, likely to bring down her fever and headache. There was a ward doctor handling the case. I still think all this was quite regular and the reasonable course of treatment in the given situation.

While they were still exploring the further course of treatment, we thought it right to mention a particular condition Shilpi had been suffering from for the last couple of months. Her prolactin levels had been found to be higher than normal a month or two before, and she was under medication for that. We shared this piece of information with the doctor in all good faith, assuming that more information is always better than less. However, this piece of information seemed to throw the whole diagnosis and treatment into a completely different direction. Suddenly, all symptoms started indicating a somewhat serious medical condition called prolactinoma - a tumour in the pituitary gland. An immediate MRI was suggested. Against meek and helpless protests from me, within an hour or so, Shilpi was undergoing head MRI scan! I will not easily forget those silent desolate hours I spent all by myself outside the radiology room wondering 'What just happened?'.

We came back home by around 11 pm. Shilpi's fever and headache had come down for now, most likely because of the medicines. The night went by uneventfully. We had our appointment with the hospital's neurologist the next day. So, we visited the hospital the next morning, collected our MRI reports and saw the neurologist. She said that there was nothing worrisome found in the scan. However, she thought, and sounded so confident, that it was migraine. She prescribed some migraine medicines. Great!

As for actions on our side, we were not yet done. Another symptom Shilpi was suffering in the day or two was some difficulty in passing urine. Next day, Monday, we visited our regular family doctor in Narayana Clinic. On hearing the entire story, our doctor ruled out migraine. Because of the urine retention, he suggested undergoing ultrasound scan of stomach. A blood test was also prescribed. Or were these suggested by the neurologist? I realise now that I am losing track of some of the details. However, I do remember the highlights.

The US scan report showed swelling in gall bladder. And some issues with the liver. The doctor said that these add up to a clear diagnosis of urosepsis -- that starts with a urinary tract infection which affects the kidneys, and eventually sends the body's immune system on an overdrive whereby it starts attacking the body itself, another serious medical condition which could turn potentially fatal. The doctor said that we should watch for symptoms like difficulty in breathing and tightness around chest. These would indicate that the condition is worsening. Otherwise, if things went well, the current course of antibiotics (suggested right in the beginning by our doctor relative) was adequate.

That night -- or rather the following early morning around 4 am -- Shilpi woke up saying she was feeling tightness around her chest and some difficulty in breathing. That was a meltdown moment for me! I panicked completely and didn't know what to do. I froze. We didn't do anything. Just slept away the remaining hours of the night.

The next day, we visited the doctor again. I think, by now the blood reports were in. So, the new diagnosis was dengue! We were sent back home with some medicines to help her urine retention and very little instructions. Rest. Check your platelet count every other day. We did that for the next couple of days. The platelet counts held up through the next few days eventually starting to rise. Shilpi had started feeling better, though suffering from acute weakness for a few days. Though, dengue was itself a serious enough medical condition, thankfully, it didn't take us all the way down this time. The worst was behind us!

An ordinary fever/headache to prolactinoma to migraine to urosepsis to dengue! It was a long circuitous route through series of misdiagnoses. But it still left our pockets lighter by thousands of rupees due to an MRI scan which, now I feel, was completely unnecessary. I would say that it was forced on us at a moment of panic and helplessness. And let's not even talk about the extreme anxiety all this caused us.

I don't want to name or shame anyone, especially the doctors involved.  I don't think that there is any question to be raised on the competence of the doctors involved. But I would like to ask them if all this was done right. Is this how our modern medical system is supposed to help patients? Is the extreme and protracted episode of anxiety that we tolerated unavoidable? Why so many misdiagnoses? Retrospectively, we can say many things. But aren't doctors supposed to help us reduce our suffering, instead of merely theorising about them retrospectively, and that too sitting on piles of prohibitively expensive tests?

It was a harrowing experience. I have tremendous respect for the medical profession and doctors. I have seen many times in my life how doctors have gone well beyond their call of duty and acted like angels in moments of suffering, being epitomes of integrity and capability. Yet, this expensive and ineffective process is clearly not a success, and I want to call it out without malice to anyone. I hope, members of the medical community will take heed of my humble appeal. I don't want to make allegations without having adequate proofs. But all this smells heavily of corruption too. Somehow, incentives all all medical establishments are stacked up in favour of pushing patients through expensive treatments. Doctors, though by themselves not corrupt, are probably under pressure from their employers to push for inefficient and unnecessarily expensive examinations and treatments. Anecdotal evidences are in plenty. They all can't be false!

I have nothing to say. It's saddening!

Side-Effects of Healthcare

The other day, discussion over lunch turned towards the popular subject of Jews. How brilliant they are. How shrewd they are. How most of the Nobel prizes in basic sciences have gone to Jews and so on. We also got to hear the natural selection arguments -- that says that the centuries of persecution of Jews has made sure that only the best of the best of them survive. That has resulted in a small but extremely purified gene pool among the present Jewish population.

This naturally led us to the undying arguments about the fundamental effect of improved healthcare on human race. In short, healthcare's main function is to support the life of the diseased. In general, it also means that it supports those lives who would otherwise have been lost because their bodies are too weak to survive. That means, healthcare is defying the basic law of natural selection which results in the survival of the fittest. Healthcare will result in the survival of the unfit too. We being in the healthcare industry can say how much rejoicing there is in the industry because the world population is growing older and there's a huge growing market for healthcare products and services. How, then, do we expect the human race to become stronger in the long run?

I think the argument is strong. But I have the following doubts:
Is it possible to defy the law of natural selection in the long run? If these bad guys whom healthcare is making live longer are finally going to meet their grievous end a few hundred generations down the line, the point of natural selection is reaffirmed, albiet a bit late. What big deal is that in the billion year long Earth calender? Natural selection seems to prove its point whether it sets in or not. What I mean is if these bad guys do manage to survive till doomsday, then they are the fit ones. It's just the 'fitness' gets redefined. Whoever said that fitness is just physical fitness?
The above point apart, is there any harm done by letting these unfit individuals exist by the side of the fit ones? OK, there will be cross breeding resulting in poorer gene pool. But there will still be some to carry the pure genes. How does that reduce the chances of the survival of the entire species is hard to comprehend.

Anyway, just to give a corny philosophical close to the discussion, it's said that death is nature's way to give way to new things. Had there been no death, there would have been no need to evolve, no need to innovate, no need to improve. No species would have seen the best of itself had there been no death. Death is after all not such a bad thing. If the average human life is about 75 years, we anyway lose 1/75 of the world population every year. That must be a huge number! Then why does death shock us so much? Why do we care so much to avoid it? These are innocent comtemplative questions, not condescending ones. Which means, death does shock me. And I care to avoid it at all cost for myself and my dear ones. But I don't know why!