The Death of a Hospital

MANIPAL HOSPITAL, Bangalore – If your loved one is in this hospital, then you should be reading this.

It was the morning of September 19th. Very early in the morning. 4.00 AM. And my wife Ranjini was calling from Bangalore. Quite unusual for someone who loves to sleep late . Instantly I knew something was wrong. She asked me if I could come down to Bangalore immediately as she felt like going to a hospital. She was a asthmatic and thought she was having another asthma attack. I called her aunt who lives close by to take to a hospital while I started for Bangalore.
With that 4:00 AM call, my life changed forever.

I reached Bangalore at 4 pm and went straight to the hospital and a shock was waiting. Dr.Padma Kumar , the doctor- in-charge of the critical care unit, took me to the counseling room and told me that my wife is suspected of swine flu and that she has been put on a ventilator and has been administered Tamiflu and other anti-biotics. While I protested that she had no symptoms of swine flu like fever, body ache , diahorrea etc; he sternly put it to rest stating that he has treated more than 25 swine flu cases with only 2 casualaities, which is some kind of a record and he is more than ‘ 99%’ certain that it was swine flu. He also asked me to be prepared to see my wife on the ventilator atleast for three to four weeks. She was placed in an open ward in the MICU with other suspects and also some confirmed swine flu patients. Resigned to my fate, I watched my wife deteriorate day by day:

Day 1. I saw my wife completely sedated and on the ventilator, with tubes inserted all over her. Not a sight I expected to see for someone who went in with a breathing difficulty on account of her asthma.

Day.2. Accompanied by my daughter, I visited my wife. Although sedated she recognized us and strained to speak which of course she couldn’t, because of the tube… and the mask…and all. She wanted to write something but was so weak to do so she couldn’t. The doctors reassured that all her parameters are normal except that she was doing only 85-90% oxygen saturation and this needs to improve. I also observed she was vomiting violently. This was explained away by the nurse as a result of being fed only intravenously… or something to that effect.

Day 3. Something didn’t look right and I started calling for help from all the doctors I knew and was reassured that she seems to have a viral infection which could only be treated by giving support to her lungs. Since all her parameters read normal there was no cause to worry and she should be on the ventilator atleast for a week before the pneumonia subsides.

Day 4. My wife’s uncle ,a physician with three decades of experience behind him , visited her and was appalled to see her condition. He felt that it was quite unnecessary to have put her on a ventilator as the x-rays showed some congestion that may not even be a viral pneumonia as suspected and suggested a good pulmonologist to take a look for a second opinion. What followed in that ICU could have shamed any hospital anywhere in the world. A heated argument followed, and Dr.Padma Kumar upset on the advice that he should take a second opinion suggested that we take my wife elsewhere if we wanted. But he was not going to ask for a second opinion. While this drama disturbed me much, I was worried for my wife’s health who was lying in her bed, oblivious to what was happening around her.
Late in the evening we received a call from the hospital to come over immediately. My daughter and I rushed to the hospital only to find my wife off the ventilator completely and be put on a non-invasive one. That surprised me because I was told by some that there is a weaning process where the patient would be slowly ‘weaned ‘off the ventilator. Nevertheless we were happy and Dr.Padma Kumar suggested us to keep engaging her in conversation since her gas exchange was poor and she has the tendency to go back to sleep. We did that for a while and then the duty doctor asked us to leave and promised he would take care. We left with a lot of hope to see her looking better the next day.
The Tamiflu results had come after 5 days. HINI was returned negative. And so was the bacteriological report. ’No growth’. Dr.Padma Kumar with a record of 25 swine flu cases to his name, was wrong after all. What surprised me most was the swab test results took a full five days to come. And she has been treated the full course without waiting for a confirmation.

Day 5. I saw my wife again in the morning. While she seemed a little restless, she was quite awake and was in tears. I told her to stop crying and that she is going to be out of this hospital soon. She cried anyway, finally I told her that I was running out of tissues to wipe her tears, she smiled faintly. Tearfully she begged for some water to drink. Which was sternly put down by the nurse. I heard later that you could just sponge some water on the lips just to make the patient feel better. Tamiflu is proven to cause dehydration. Denied even this basic request, my wife slipped back to her sedated state. That was the last real conversation or eye contact I had with her.
Around afternoon I received a call from the hospital saying that since my wife was not responding well to the non-invasive ventilation they are putting her back on the ventilator. Like taking a thermometer on and off . I wondered what my wife was going through. She always had a low threshold of pain. My heart was aching for her.
My daughter and I went to see her and one Dr.Ullas met us and said that it was necessary to put her back on the ventilator. We said she looked well in the morning and asked what was the cause. He said it could be anything, including ARDS ( Acute Respiratory Distress syndrome ). My daughter and I stood outside the ICU, helpless and very afraid. Wondering what was happening to her. Was she fighting the illness or the hospital ? For the first time we were not sure.
We returned home and continued searching for answers on the internet, like we have been doing since the beginning of my wife’s hospitalization, to understand the jargons and terminologies we have been hearing each day. And ARDS did not seem a good word.

Day 6.When we went to see her in the morning, we could not recognize her. She had bloated even more than before. Her face was all puffed up, her hands and legs looked swollen. And there was not even a slight sign of activity on her except for the machines that kept her company. I looked around for the duty doctor to talk to. I saw Dr.Ullas , who also saw me, but looked away pretending to see another patient in the ward, who was looking quite awake and recovering.
I attempted to speak to the nurse but she had nothing to say and said all questions must be addressed to the doctor. It was also strange that the nurses kept changing everyday with their duties. So it always was a new nurse everyday, with a fresh brief, fresh charge. And hence totally unconnected to a patient’s progress or the illness.
In the afternoon Dr.Padma Kumar called me and asked me if I could sign a paper approving a tracheostomy to be performed, if necessary .This he explained would atleast take her off the ventilator and the sedatives. I immediately agreed. He promised to do this the next day or the day after.

Day 7. My daughter and I, along with my mother-in-law , visited her in the morning. As usual my wife was in the deeply sedated state. My mother-in-law tried to call out for her. There was a faint response from her. She strained to look. But her eyes looked distant and unfocussed. Actually she was looking through us, far away. I was later given to understand tamiflu can cause confusion and even hallucinations in a patient.
I wanted to talk to the doctor straight away but Dr.Padma Kumar was on leave for the Pooja holidays. A person introducing himself as Dr.Chako came along . I asked him why she was looking so critically ill. I asked whether it was ARDS. He looked at me and broke into a speech “ I think you should not be bothered about all these terminologies ..ARDS..COPD .. virology or nephrology etc; what you should be worried about is whether the patient is progressing and that she is. So please don’t waste your time on these medical jargons ” . I realized he was playing to the gallery of the two juniors with him, on how to handle over- anxious relatives of critically ill patients.
Now I was more than convinced that my wife was brought to the wrong hospital.

Day 8. We visited my wife in the morning of what would be our last visit to see my wife in that hospital bed. What worried me most was she looked completely motionless and showed no sign of life or activity. She did not respond to our calling. We assumed that this must be due to the heavy sedation and medication she was under. We asked for Dr.Padma Kumar but he was still on leave and cannot be reached. We could not get an update from him over his mobile phone as he had refused to give his personal number and preferred us to call him on the hospital phone.

Day 9. It was 5.45 in the morning when I received that dreaded call from the hospital. They asked me to come immediately and said it is a little serious. I rushed to the hospital only to find a group of doctors and staff around my wife giving her resuscitation . They asked me to wait in the counseling room. I watched thro the window, my wife lying lifelessly and being administered the resuscitation. Ten minutes later Dr.Jayanthi , one of the duty doctors, came in and told me ’ they did everything they could ’ but she died of pulmonary embolism. A new jargon which meant very little to me now.
After they wrapped her up, they invited me to see her . I looked at her and there was my wife, who I saw just a week ago waving to me before the train left for Bangalore..excited about meeting her daughter, thinking about all the things she was planning to do together with her, giving last minute instructions on what to do with the extra milk , her pet plants in the garden and how to behave myself while she was away…
I know discussing any of this is not going to bring my wife back. This is just for those unfortunate souls who have also lost their loved ones. Only they can understand.
This is also for all those unsuspecting people who, despite knowing that these hospitals are capable of wiping out their life time’s savings in a matter of days, still place faith in it to save their loved ones. To them I would say, wake up ! Big hospitals mean nothing. Equipments mean nothing. It is the doctor behind all of this that counts. For Manipal Hospital, this is not top priority. Good doctors and nursing staff don’t come cheap. For peanuts you get only monkeys.
I am writing all this with no intent to hurt anybody including the doctors who treated my wife (they will be judged by a higher consciousness) .
The doctors may feel they have done their job . Or think so they did. But every life lost should be a cross to bear the rest of their lives. Not just the passing of a statistical event in their career. 25 treated. Only 2 causalities.

To end my story, I am raising some questions below for which I don’t expect answers.
Question 1.
• What made Dr.Padma Kumar feel so certain from his observations, that my wife had swine flu and that she immediately had to be put on a ventilator ?
Patients put on a ventilator normally don’t walk up to an ICU by themselves. Did the paranoia of swine flu in Bangalore and his own record of treating swine flu cases scramble his thinking ? An expert’s skills are determined by his keen observation to quickly identify a genuine suspect. Not by immediately condemning them and starting them on a treatment.
• If she was a swine flu suspect, why was she not put in a isolated ward ? Why was she put in the same ward full of confirmed and other suspected victims ? Is it not raising the level of risk for everybody around?
• Was he aware of the side effects of giving Taminflu? And that too on patients who can later turn out to be negative? In fact all the symptoms of the after effects of Tamiflu was seen on my wife AFTER the course was initiated …violent vomiting…severe dehydration… disorientation…swelling of face, lips, tongue…respiratory failure…inflammation of the lungs ..
FURTHER MORE, TAMIFLU IS NOT A CONFIRMED CURE FOR H1N1 BUT ONLY KNOWN TO BRING THE ILLNESS DOWN BY JUST BY ONE DAY ! IS IT WORTH TAKING THAT RISK? THAT TOO ON SOMEONE ALREADY WEAKENED BY A SEVERE ASTHMA ATTACK ? SHOULD’NT HE HAVE WAITED ANOTHER DAY BEFORE STARTING THE COURSE?.
• How could they postpone the tracheostomy operation because the doctors were on leave? Isn’t this supposed to be Manipal Hospital ISO 9001:2000 certified. The prestigious winner of the Golden Peacock National Quality Award, in the service category? This is no school or office to declare a holiday for the ICU.
Question 2.
• Regarding taking second opinions, the hospital and its administration seemed to be stuck with the theory that the doctor-in-charge is better informed to take decisions. Isn’t too much dice loaded on one man’s wisdom to decide the fate of a seriously ill patient? A critical care specialist need not necessarily be a good physician.
Question 3.
The report says ‘Primary cause of death due to’ : ( ? ) Acute Pulmonary Embolism and the ‘Secondary cause of death due to’: Viral Pneumonia.
• The last day’s X’ray showed her lungs were clear, the bacteriological and H1NI tests proved negative. She was stable on all other critical parameters for the entire period of 9 days. So what caused pulmonary embolism (PE)?
The only available reason is her being bed-ridden and helplessly hooked to a ventilator for 9 days, besides of course, all the heavy drugs she was forced to take, some not even relating to her symptoms, and the absence of physiotheraphy and anti thrombotic stockings, all helping the cause.
Finally, to know she died of a cause other than what she went into the hospital for, seems a cruel joke played on us and that’s hurting the most.
—————————————————————————————-
I will leave the reader with these words from William Stewart Halstead, that legendary surgeon:
“ The only weapon with which the unconscious patient can retaliate upon the treatment of a incompetent doctor is, by giving up life. To end the ordeal ”.
My wife loved life… She celebrated all the beautiful things associated with it…people.. plants.. pets. And to know that she took that painful decision , to give it all up. And that too, few days short of her 43rd birthday.
—————————————————————————————-
Please vist my blog:http://iwantolive.blog.com/

This post was submitted by Ashok Kumar.