Belle Vue Clinic, Preventable Medical Disasters, and Stoic Lessons

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(Photo: Dirty Bunny)

[Warning: This post is one of my rare rants, perhaps my only rant, written last week when the reality-bending fury was fresh. Almost never seen, like a snow leopard, my angry self has come out to stretch his arms a bit, perhaps punch a few deserving people after warming up. The reasons -- primarily the safety of other people -- will become clear shortly.]

SEPTEMBER 25, 2011, CALCUTTA, INDIA
SAFE AT THE OBEROI HOTEL

Earlier today, a hospital superintendent snickered and offered me a feedback form if I had complaints. I declined, as I figured this blog would be a faster way of getting the message to the CEO in question, P. Tondon. Mr. Tondon, nice to meet you.

Forthwith, our promised programming…

The Power of the Checklist

Atul Gawande is an outstanding surgeon, Associate Professor of Surgery at Harvard Medical School, and author of “The Checklist Manifesto,” which details the power of checklists to prevent catastrophes or simply improve outcomes.

From the prevention of airplane crashes to decreases in hospital-based bacterial infections, having a clear, repeatable process is key. I read his book while flying to Amman, Jordan, and I ensured beforehand that I knew exactly where the best hospitals were close to our hotel, the fantastic Evason Ma’in Hot Springs. It’s as simple as calling the US embassy or consulate (if that’s your nationality) via Skype before you land. Here’s a list for your future use.

This week, I violated my own process: I didn’t check on hospitals before traveling.

“Ah… but where to?” you ask.

To Sweden? No, sir. To Japan? No, ma’am. I landed in Calcutta (Kolkata), India. Home of Mother Theresa and pathogens galore.

Ultimately, I ended up spending 3.5 days in two ERs and hospitals.

Before I explain the comedy of errors that led to this post, a few caveats to flavor the haterade for the anonymous ankle biters we affectionately call “trolls”:

- After 30+ countries visited, I don’t believe I’m a spoiled American. Puking on the floor of Chinese hospitals? Check. Getting probes and pokes (not that kind) in Argentina? Done. I’ve roughed it plenty of times and know the world isn’t covered with linoleum.

- I’ve been in dozens of hospitals and ERs around the world, had multiple surgeries, had food poisoning 4 or 5 times, and spent hundreds of hours with MDs for The 4-Hour Body.

- There were a few heroes in the following story, so this isn’t “us versus them” nonsense. Among the heroes: Pawan, our guide; Dr. Gunjanrai from Belle Vue, who saved our asses; and all of the friends I traveled with, especially Dr. Kareem Samhouri.

The Avoidable Pain of Poor Checklists

Preamble complete, here’s an abbreviated version of what happened:

- I ate a usually delicious local Bengali fish, Bekti, at the Tollygunge Club’s Belvedere restaurant, which my girlfriend Natasha later dubbed The “Tollygrunge” Club.

- Diarrhea and vomiting ensued through the following morning, as did fevers. I hit 101 and Natasha passed 102. I made the executive decision to go to the hospital for, at the very least, intravenous (IV) fluids.

- To stabilize my girl, who was incoherent, and avoid 1-2 hours of traffic, we first visited the closest hospital, the name of which I can’t recall. Now things get interesting.

- Enter war zone — Dr. Sumon and Dr. Chatterjee admit us to the ER. Natasha is wheelchaired in and put on a cot. No vitals are taken besides blood pressure. One of the doctors then alcohol swabs the arm, to prepare for IV insertion, following by slapping her forearm with the bare hand he’s just coughed on. I stopped him to correct course, as I had to do so with both doctors multiple times. Eventually, once her IV was delivering saline solution and lost electrolytes, I had to lay down, as I’d declined an IV and could barely stand. My only choice for rest was a cot with dried urine all over it, which Kareem covered with a towel. Who says chivalry is dead?

- The good news: when we leave, the grand total cost is 150 rupees for both of us, or about $3 USD.

Round Two at Belle Vue Clinic

- We leave for a reputedly much-better hospital, Belle Vue Clinic, where we’d be meeting an expat specialist named Dr. Ghosh. Sigh of relief. Natasha is still delirious and nonsensical, so I’ll be the only one coherent for our first day there. The pamphlet for Belle Vue Clinic is seductive:

Equipped with the finest resources of medical science, the clinic’s emphasis is on relief, reassurance, recovery and rehabilitation.

At Belle Vue Clinic, a patient is not a bed number. He or she is consider as a member of the Belle Vue family. A scrupulously clean and homely ambience is provided. There is always service with a smile.

- Without further ado, here are a few highlights from our slapstick treatment. Keep in mind, Belle Vue has good materials and drugs on hand. Their “Rules and Information” brochure reads “44 years of proven and trusted medical care of international quality.” In retrospect, I realize that “international quality” could mean “From St. Lucia to Somalia, we combine the most preventable mistakes possible.”

The following are process fuck-ups:

* Upon being properly admitted, a “sister” — or nurse attendant — takes my armpit temperature without paying attention. It’s half in contact with my shirt, resulting in a 98-degree output. “Fever, ne,” (“No fever”) she says and starts to walk away. I yell for her to wait, pull an electronic oral thermometer out of my pocket and repeat the drill: almost 102. “Fever, yes.” She later insists twice that I have no fever, until the doctor puts a hand on my forehead and settles the matter in my favor.

* Natasha had a terrible reaction to pain medication they administered, Drotin® (drotaverine), and collapsed on the floor that night after going to the bathroom. No one was watching her properly, so I had to leap out of bed with my IV and help her get up. They administered it the following day and Natasha’s temperature skyrocketed and she began to shiver uncontrollably. I called Dr. Ghosh, got no answer, and did what I could: tell all staff to absolutely NOT administer any more Drotin. When Dr. Ghosh arrived around 7pm that evening, I told him the same, which he said he’d note and convey to all staff.

That evening, as Natasha was falling asleep and I was going to bed, a nurse comes in with — guess what? — a syringe of Drotin to give Natasha. Fortunately, I wasn’t in the bathroom and intercepted it.

* Natasha ran out of toilet paper — as we did several times, which diarrhea will do — and rang the call button. The sister who came in asked her to use water instead to wash off. My girl, as I would hope, refused. The sister then took a dirty towel she’d used to wipe Natasha’s feet and offered that. Again, no dice. Eventually, we got the toilet paper with a chuckle of “fussy” in English. Bonus anti-hygiene points: The bathroom featured a used bar of soap from the prior occupants and nothing to dry your hands with.

* The second or third afternoon, Natasha’s feverish temperature was put in my chart, resulting in them attempting to switch our medicines. I had to make the correction.

* Critical requests for water (we’d been instructed to drink a certain number of liters per day), IV bag changes, IV blocks, etc. often took 10+ call button rings over 30 minutes. Calling Dr. Ghosh, as he encouraged us to do “anytime” did little or nothing, as he didn’t pick up 90%+ of the time. If he did, he said he’d speak with staff and then nothing changed. This meant we had no reliable English or supervising physician at the hospital until Dr. Gunjanrai rescued us by sheer good luck. Achtung: there appear to be quite a few people who speak English at Belle Vue. I’m not being an uppity entitled American; they had the capacity to triage this, even if it meant making the dietician, who was outstanding and spoke excellent English, our point person at additional out-of-pocket cost.

* Dr. Samrat Chatterjee (I ALWAYS write every doctor’s name down when being treated) enters our room to tend to us: a blood draw for me and a new IV for Natasha. He points to Dr. Kareem Samhouri, my friend who was visiting during proper hours, and says brusquely without looking at him, “You can leave,” while pointing at the door. I make it clear that Dr. K is my physician on the trip and listed as next of kin: he’s staying. Dr. Chatterjee then starts taking my blood sample and refuses to answer any of my questions, which focused on an odd yellow liquid in one of the collection tubes that mixed with my blood. Then to Natasha: Dr. Chatterjee rushes into the new IV insertion as Natasha screams in pain. He laughs and tells her she’s overreacting, repeating “fussy” with shake of the head. Later, when Natasha’s forearm skin swells up like lemon holding liquid, Dr. Gunjanrai will try and aspirate (draw out) blood from the IV — nothing. If you can’t get blood out of an IV, guess what? It ain’t in a vein. It’d been pushed into the tissue and several liters of fluid had been forced into Natasha’s worthless sham IV.


This is Natasha’s sham IV arm one week later.

Dr. Chatterjee, you’re a motherf*cker and should have your medical license revoked. Hopefully this post gets you part way there. You’re welcome.

* The next day, my IV clogged at least a dozen times. Somewhere between 6-12 times, I was therefore given “Hep-Lock,” named after it’s principle ingredient, heparin. Heparin can be quite dangerous, fatal if you overdose, and neither the nurses or Dr. Ghosh were remotely concerned. The blocks were blamed on me getting up to go to the bathroom or on me bending my arm. My left arm was so swollen and red from heparin that I had tingling in my fingers and couldn’t straighten my arm.

Dr. Gunjanrai, our repeated savior, replaced my IV when she removed Natasha’s sham IV. Problem fixed and perfect flow. No blocks. The only issues that cropped up were, again, process-related. On two occasions later, there was no drip; the nurses wanted to use more Hep-Lock (not a chance), so I used sign language to show they’d forgotten to put an additional needle in the IV bottle to create necessary vacuum and flow.

* On our last morning, we were to have fasting blood draws for follow-up testing. Natasha’s blood was drawn but mine was not. Since Dr. Ghosh had told us the night before we’d both be tested, I asked the sister, who replied with “Not you.” But yes! About 30 minutes after I’d finished breakfast, I was told that I’d have a sample drawn (we also had our temperatures taken right after we’d downed water). “Doesn’t it need to be fasting? Typically 8-12 hours?” No problem, I was assured.

Now, I’m no MD, but I’ve had compared hundreds of my own blood values. Blood readings taken 30 minutes after eating are not the same as from fasting. Not even close.

The End Result

We survived.

Even though I was more coherent than Natasha, I was a mess of delirium. My diarrhea was about three-times worse that hers (by frequency), I vomited more, and there were some episodes I won’t describe here, as they’ll make you nauseous. To maintain hawklike spider-sense while incapacitated, quality-controlling everything to avert disaster, is taxing beyond belief.

No one should have to do it when such simple measures can fix it. All of the above issues can be fixed with proper protocols and checklists. This is not the first time Belle Vue has had serious process screw-ups. Read this appalling news flash of a newborn baby declared dead, only to be later found alive.

But perhaps Belle Vue is too poor to make things work? Not likely, at least not based on my bill.

Cost: about $1,350 USD per person.

Dr. Ghosh’s fee? Almost 50% of each bill. Extortionary. He’s an outstanding ER physician, and he’s saved many people with horrifying injuries and infections. That said, if he’s almost never available to his patients (us in this case) and can’t manage staff to follow his life-saving directions outside of his 7-8pm visits, his expertise does next to nothing. I suspect he’s amazing when on the case 24/7. In our case, it was as if he weren’t there. 50% of the bill is an insult.

Dr. Gunjanrai’s fee? Less than $20. Give that woman a raise. She’s a superstar. I know she doesn’t have Dr. Ghosh’s credentials, but she fixed every problem she encountered, undid the messes created by others, and did it all with a Zen-like calm that made us calm. That’s a good doctor.

P. Tandon, fix your hospital. If you didn’t know already, now you do.

If you choose inaction at this point, you should be charged with premeditated homicide.

Here’s your feedback form:

The Bright Side

Experiencing pain allows you to appreciate pleasure.

Looking at the creature comforts of San Francisco, the world-class medicine I perhaps took for granted, my experience in Calcutta was a useful recalibration.

Getting the Belle Vue treatment is not necessary to increase your appreciation of what you have. This should be a principal goal in life, of course, as gratitude will determine your happiness more than achievement. In fact, Stoic philosopher and master statesman Lucius Seneca encouraged his students to practice poverty for precisely this purpose. From Martin Frost’s excellent introduction:

The second type of apathetic training proposed in the Moral Epistles is practical training, which is essentially a Stoic modification of a common Epicurean practice. In Epistle 18, Seneca informs Lucilius that Epicurus frequently set aside a number of days in which he satisfied his hunger with cheap food. The goal of this exercise apparently was to develop enough self-sufficiency that he would be able to remain happy, regardless of what his circumstances might be. Using this example, Seneca similarly advises Lucilius to practice extreme poverty for limited periods in order to test the ability of his mind to withstand the loss of his wealth in the future.

Although Seneca does not expect this type of practice to go on indefinitely or to be too severe, he makes it clear to Lucilius in Epistle 13 that it should be more than just a “mere hobby” that rich young men might play to “beguile the tedium of their lives.” Even though it is meant to last for only a few days at a time, the method should be harsh enough that it can prepare the subject for the most extreme reversal of fortune—the possibility of utter destitution.

Rehearse worst-case scenarios and they lose their power over you. Practice what you fear and ask all the while: “Is this the condition I so feared?”

You’re more resilient than you think.

Posted on: October 2, 2011.

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278 comments on “Belle Vue Clinic, Preventable Medical Disasters, and Stoic Lessons

    • Wow! I was in India over 20 years ago and was very lucky to only get bacterial dysentery and an American doc there gave me antibiotics and cleared it right up. Still, it took me at least a couple years to get my lower g.i. tract functioning normally again the illness was so violent (blessedly short though!). I had friends there on same trip (a guru chasing bit of foolishness) who were not nearly so lucky. They had experiences much more along the lines of yours (Tim). Some are still dealing w/ health issues resulting either from their treatment in hospitals there or from the nature of the parasitic bugs they acquired in India. Hopefully you dodged all bullets and have escaped only a bit “bloodied but unbowed…”

      Like

  1. Wow, this was a crazy account of serious malpractice.

    I’m glad both you and your girlfriend were able to at least make it back to the US and survived this crazy ordeal. 50% for the $1350 hospital bill is ridiculous – I can’t imagine what this translates to in Rupees. It sounds like a deliberately structured fee schedule to induce indentured servitude in patients.

    And I’m amused that you “cannot tip” the very doctor who deserves your money.

    Like

  2. Im guessing that tourism India won’t make you an ambassador for travel there, but this needed to be said…It is not intelligence, money or even systems , it is shear laziness and a desire not to get better that is at fault here.

    Like

    • I had a food poisoning just 3 days ago but that one was resolved without hospital visits and in few hours but was very f**ng unpleasant. Could imagine what few days felt like… Good to hear you “survived”.

      Might be a good idea to write a post about check-lists for:
      - Dealing with medical doctors (what to check, what to ensure, etc) and
      - Dealing with food poisonings (how to do your best to prevent them, what medicines to have with you and take immediately when you start feeling less than perfect, etc)

      Like

  3. This story is exactly why I’m hesitant to visit doctors, clinics and hospitals in foreign countries. If you hear of any action taken by the clinic to improve down the road as a result of this post, it’d be great to hear an update.

    Like

  4. It’s good you’re alive :) I believe this is the worst problem with traveling. Sepcially with countires without good medical care. You’ll be suprised that even in EU contries like mine – Poland, stories described by you are also normal….

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  5. Are you still in India? I would consider recalling this post until you are out. You never know how politically powerful the head of the hospital is…just sayin. Good luck in any case and I hope you both recover fully.

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  6. Tim, if you could redo the trip, what what would you do instead? Go to a different hospital to start with?

    Glad things “worked out” — thank goodness you both survived. No telling what could have happened if she went through another round of the pain meds.

    Like

  7. Glad to hear you are both recovered and well! I suddenly realize how immensely lucky I was when put under general anesthetic (this is after about 4 hours waiting) without my knowing of it (madness when i think of it now!) to relocate my shoulder in some dodgy clinic in Manali India. Sounds like you had a hell of a ride there – and Calcutta is deserving of this review, it seems passing though that place gives you a 50/50 of some dodgy sh*t.

    Good thing its all but a memory now & Seneca was around for some good mental support. btw real grateful for having discovered Seneca through your site, massive wisdom!)

    Disgrace on the clinic and always good to read your rants or other more hygienic informative posts ;-)

    Yoni

    Like

  8. Glad you guys are ok now.

    What scares me is you’re pretty knowledgeable in the treatment you were receiving, but the average traveller probably wouldn’t spot half of these errors, and it might have gone horribly wrong. I’ve travelled a lot also and like to think even in places like Calcutta, surely you’re not going to be killed by a hospital.

    Do you think you were particularly unlucky checking into this particular hospital? And what would you do differently next time — for example getting reviews for hospitals in every major city you visit seems a bit over the top, but perhaps it’s not?

    Like

  9. Most of us don’t have your medical knowledge and few have the wherewithal to challenge the actions of the staff. I wondered if a less informed person would have died.

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  10. Perfect example of ,under probable cause, questioning the tactics,procedures,and logic of the God complex that many physicians are susceptible to indulge in. Always respect, but always question.

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      • Dear Tim,

        Dam’n sorry to hear of your ordeal.I am from Calcutta and am a member of ‘Tollygrunge” club and I agree the food if often suspect.There are world class hospitals in Calcutta if you were staying at the Grand they should have advised you correctly.Bellevue used to be good at one time.If you want these m..f..rs fixed send me a full written report NOT by email but courier.I will see that some asses get kicked!
        Krupa David
        Goodricke Group Limited
        14,Gurusaday Rd, Kolkata 700019

        P.S I got this link from my son in law Jake Townsend ,CA

        Like

    • Certainly have to echo Mark & Roman – it was a hard time that reads a lot easier than it was to experience. Glad both of you are feeling significantly better and recovering.

      Like

      • I guess I can’t really complain about the healthcare we receive. Glad to hear you and Natasha survived. That story pisses me off. Wish all those sisters would get fired. F*** them!

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  11. Mazal F&^%ing Tov for having a Girl!!!! Kulululululululululululu

    Thanks for doing this, you are saving life!

    Good to hear you guys are safe n sound.

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  12. That’s terrible, glad you made it through alright.

    I’m continually amazed at how many people will tolerate bad processes that actually make them WORSE off. I can’t imagine constant complaints are fun/cheap to deal with. It sounds as though the fixes aren’t expensive.

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  13. Sounds like a nightmare Tim. Glad you’re safe and well anyway!

    Sounds like the pair of you need some much deserved time off to recoup. Did they serve slow carb meals in the hospital lol? ;-)

    Take care.

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  14. Hi Tim, Have you read Shantaram? Maybe you should for perspective on India. It is very common for us frequent travelers to forget to take essentials like I did when not packing a first aid kit for a trip to Laos then stepping on broken glass that tore through my flip flop into my foot. Luckily the corner shop had all I needed to fix it (amazing what a little blood can do to get you what you need even if they don’t speak English). The next day at the hospital was a similar experience to the chaos you may have encountered in India, mainly lack of hygiene and privacy. I guess sometimes it’s part of the trip. Get well wishes to you both.

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  15. Glad you and Natasha are OK, must have been a terrifying few days. Like Dave, I’d be hesitant to visit a hospital in a foreign country, which raises a question: Based on your prior travel experience, had you contacted the U.S. embassy or consulate, do you think you could have found a hospital that met your criteria and expectations? Or is it more that you’d be choosing the best of a few bad options?

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  16. What the f*ck, that’s scary.

    While reading your account of what happened, I kept wondering whether anyone less knowledgeable, and without their own Dr. Gunjanrai, would came out of that place alive.

    Glad every thing turn out alright, I don’t have any medical background but I would guess Natasha’s sham is mostly harmless and will eventually go away without permanent effects right?

    Like

    • Unlikely (after having checked his CV in pdf format available on that page). The one you linked to is a doctor in Mathematics, not medicine.
      I guess the surname could be a popular one in the area of Calcutta, in which case it would be simply be incidental name sharing.

      Like

  17. Thank you for sharing, and bringing us back to the “worst-case-scenario ” lesson. I just practiced this for a month (not intentionally) and know it will make you a kinder gentler person:Humble.

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  18. “More water-butt cleaning, please.” LOL

    Methinks you should vent more often Tim – it’s worth the quips, alone ;-)

    On a more serious note, I’m glad ya’ll made it out alive and I’m sure a few days of leaning and loafing at your ease about your SF home felt amazing after that nightmare!

    I’d like to share an interesting anecdote with you and the other commenters, as both my grandfather and grandmother were doctors in Kiev, Ukraine during the Soviet era. She – a head anesthesiologist, and he was a surgeon and oncology specialist.

    A common practice at that time, which evolved out of the “normalization” of wages (e.g. doctors getting paid as much as steel workers), was clandestinely tipping particularly capable doctors for their services and endeavoring to engage them on behalf of friends and family with life-threatening conditions and sometimes not-so life-threatening conditions that could easily have evolved into something serious if left untreated.

    Granny Dorfman, with a strange moral compass that HAD to have been built in the USSR, refused any such “bribes”, as she viewed them, and forbade my grandfather from accepting them, either.

    After a lifetime of working for next to nothing and after splitting up with my grandma, grandpa Dorfman began accepting moneys for his services and ran what was, in effect, a profitable, if illegal, private practice.

    I propose that Belle Vue and hospitals with similar “no tipping” policies are doing their doctors and their patients a tremendous misdeed by not allowing patients to help enrich the doctors who deserve it, help weed out the incompetents, and help motivate the apathetics with an exchange of value deserving of the killingly hard training and schooling that every doctor has to go through in order to save our fish-eating asses when things go sour.

    Would love to hear ya’ll’s’ thoughts on the matter! :p

    Best Wishes,
    Vic Dorfman

    Like

  19. That is some scary, scary stuff. It is one thing to go through something like that alone, but when you have to watch someone you care about go through the same thing (or worse), I’m sure it tears you up.

    Is there anything you need people to do to enact change in this “hospital”? If so, just say it and I’m sure you could get some attention.

    All the best!

    Like

  20. I’m so sorry you had to go through that.

    I’m from India. I left the country five years ago and I hope I never have to go back and live there. Doctors don’t really give a shit about you and there’s not much you can do about it. I very much doubt they’ll ever respond to this post either. If they do, please let us know!

    And it’s not just “foreigners”, they treat everyone like this.

    The only exceptions are if you’re a relative, a friend or have a contact who knows them on a friendly basis, they’ll treat you like royalty. If you ever decide to go back, perhaps find someone who lives in the city you’re going to, become friends with them and keep them as your point of contact for situations like this.

    Glad you’re both ok! Take care.

    Like

    • Neha, I’m from India and i still live here. I know that Tim had a really bad experience with this hospital, but that is not the rule for all hospitals. In all cities there are many shammy hospitals and clinics. Tim was unlucky in picking the wrong hospital. Calcutta is one of the less clean places in India (from what i’ve heard…i have relatives there), but i’m sure they have some world class hospitals. This particular one seems like the bottom of the pit.

      I live in Delhi and have all my life…and i can assure you all that there are wonderful doctors in India here who will go out of the way for a patient. Some even treat you like first family. India has become a destination for world class health care in the past few years and there are wonderful places to get treated here.

      Tim, I’m a big fan! Sorry about the ordeal you had to face. Promise me you’ll go to a better place next time. It was agonising for me to read about the way you were treated. TC Tim and Neha.

      Like

  21. Great rant Tim and good to know you made it out alive.

    Got to say I feel a little bad that I enjoyed reading this so much… All the health for you and your girlfriend.

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  22. Tim, great to hear you and Natasha survived.

    It’s a mixed bag though. Upon initial visit to the Ampang Puteri in KL, my dad’s Doctor diagnosed his badly bleeding ulcer and later stomach cancer.

    Something they missed in Canada for 2 years.

    But more along the lines of what you experienced, myself and about 8 other foreigners were fighting in a “Draka” event in Siberia one time.

    One of my comrades suffered a brutal knockout at the hands of his Russian opponent. At the after party, as the promoters were toasting our bravery to step in the ring with the Russian behemoths, my buddy was speaking gibberish, completely unaware of where he was and what he was doing.

    So we figured we’d take him to the local Khabarovsk hospital.

    The doctor, who reminded us greatly of Dr. Nick from the Simpsons, agrees we should scan his brain.

    He finally shows us the X-Ray and says everything is good… lol, good to know his skull was still intact ;-)

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    • Chad, good point. There are good and bad doctors everywhere. Since that’s the case, it’s all the more important to have good processes in place that prevent the less-capable MDs from screwing up.

      Head trauma is scary, and Draka is no joke.

      Tim

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      • It’s interesting, you see it here even. The nurses trained me on administering TPN to my dad, I had to be “extremely careful” to keep things sterile. However, observing the nurses doing the same procedure, they rushed through things far more than they should of.

        Maybe this is all just a matter of complacency. “Well, we haven’t killed THAT many people.”

        I agree with you on having processes in place, but heaven forbid wouldn’t that mean someone is accountable then?!

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      • Tim doesn’t have to hire her for anything. The praise he gave her here is practically guaranteed to get her hired away by another hospital, for more money. Sometimes positivity is the best revenge. Best part of this whole story, IMO.

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  23. I’m half Indian and have visited Kolkata many times as it’s where my family is from – every other time I do get something mild and I have had it as bad as you once or twice in the past (notably when I was a child.) Kolkata in general is a way behind other Indian cities in most ways mainly due to the repressive policies of the previous communist government (which have recently been voted out for the first time in more than 30 years so hopefully things should start improving soon.) It is ESSENTIAL in Cal to have a friendly doctor who can take care of you without having to rely on the health system if necessary – obviously not useful advice now but helps explain why it still remains one of the toughest places for travelers who can’t take advantage of a support network. I hope you still got something from your trip and hope one day you’ll have a better time in Cal :-)

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  24. Terrible story. This is the nightmare I always picture takes place in foreign hospitals.

    I hope they didn’t inject any germs or viruses into your body which you eventually discover when your arm in a year or so suddenly falls off.

    Lets hope for the best!

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  25. When in India stay vegetarian and drink only bottled water (always check the seal). Seafood might me ok too but is not completely safe.

    When I got sick I went to Apollo hospital which is generally considered one of the best in India. I had a similar experience to you and flew out to Singapore to get treated there.

    I hope you get better soon.

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  26. As an Indian raised in the US with experience in both health systems, it’s episodes like these that make me grateful for the quality of care we receive and provide here.

    In India, if you don’t have relatives who are doctors, you’re f***ed. And we still blame Indian parents for wanting to make their kids doctors… look at it from their shoes.

    Like

  27. I would like to hear more Ferriss rants in the future – this was interesting reading – although very unfortunate that it had to be said. I would add to the comments about your knowledge and assertiveness – the really scary situation is that the vast majority of people would not (or could not) second guess this dangerous treatment. There was a good episode of “ER” that went over the importance of checklists. It keeps ordinarily good people who have perhaps grown complacent or egotistic from doing really stupid things with real consequences.

    BTW – loved your spots on the Carolla and Rogan podcasts – you should do those more often :-)

    Like

  28. Wow, crazy stuff Tim. I wonder how this story would have ended for somebody who’s much less knowledgeable when it comes to medical treatment… :/

    By the way: how are your plantar fasciitis and ultra running plans going? In Berlin you planned to get this done by end of this year :)

    Regards from Greece,
    David

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  29. Wish I could say I’m surprised but based on my travels there, I’d call India the nation of Tijuana. The knee jerk response to any inquiry or issue raised by a Westerner is “No problem,” bullshitting their way through the moment.

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  30. Glad you and Natasha are on the mend.

    Aside from process issues the other one is perhaps an issue of attitude on their part, and that’s deeply seated in culture.

    Stay hungry, stay foolish Tim!

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  31. Hi Tim,

    Looong time reader but first time commenter. It’s 4am here, and I just spent the last 2 hours or so catching up on your recent content. Then I found this:

    “For the rest of the night, as my friends fed me shots, I thought back to 2007, when The 4-Hour Workweek was turned down by 26 out of 27 publishers.”

    As an activist, digital entrepreneur and aspiring writer with a good NYC agent but who’s still struggling to find a good publisher and who sometimes gets frustrated after 3 years of trying, despairing and nearly giving up, and now finally being so close, I’d like to say, THANK YOU.

    Thank you for the 4HWW which made me dramatically change my career path towards something MUCH better aka the New Rich. Thank you for all the tips you share on this blog and insights that have inspired me and kept me inspired for a long time. And thank you for just reminding me that with patience and perseverance great things can be achieved, even if the publishing industry is in a crappy state now.

    Seriously, thank you dude.

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  32. Tim,

    Sounds like you guys had several close calls there – glad you are both safe.

    Disclaimer before I say this next piece: I have never had a hospitalization in India, but I grew up in India up to adulthood, have several relatives there, and have had experience dealing with doctors who were caring for my grandparents.

    I don’t know if your rant will have the consequence you are hoping for.

    First problem, Indian doctors have major god-complexes. Indians deify them, consider it a blessing that a doctor even agreed to admit them to the hospital / see them / cure them etc, and consider it their duty to never question the doctor since the doctor knows best. If the someone dies in the hospital, this was because God works in mysterious ways, and the doctor couldn’t have done anything anyway.

    Second problem, the legal system in India isn’t set up to prosecute medical malpractice with any level of efficiency. So what if this doctor almost killed you – who is there to hold him accountable for it?

    Third problem, you went to a hospital without getting a referral, and you actually expected their marketing materials to be true. Enough said. We Indians know better than to do that. Granted you weren’t in any state to be conducting meticulous research and you admitted that you forgot to do prior research, but us Indians remedy that by having scores of relatives who all step in to do this research.

    Fourth problem, Dr. Tandon is not going to care about your post because few people in India ever think to Google the hospital they are going to. Expats might, but they’re a small percentage, and Internet is difficult to access, as you well know. His marketing sounds just slick enough to get those who think that someone charging this high must actually be good (That’s a self-regulating-market type of thinking. Doesn’t always work in India).

    One of your other commenters mentioned that he had a bad experience in Apollo hospital. I know of the hospital, and I’m mildly surprised, but not really shocked. In my experience, the ONLY way of getting 100% awesome care in even the best Indian hospital, is to be a direct or indirect sort of stakeholder in the hospital (know the wife of the managing director/CEO personally, be recommended by an important businessman / politician / actor / VVIP).

    What happened to you and your girlfriend is terrible, and I genuinely hope your post serves its purpose and pushes Dr. Tandon and his hospital to develop better procedures and checklists. Reality? I’m not so optimistic.

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  33. I’ve had food poisoning twice on the road. Nothing is worse.

    The only preventative measure I’ve come up with is to be unreasonably anal about sanitation. Don’t drink out of glassware or coffee machines in hotels especially.

    Also go to the ER early. I’ve made the mistake of waiting till the morning. This only prolongs the torture.

    I keep antidiareals in my first aid kit, along with a couple Gatorade packets. In a remote location this may get you back to civilization.

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  34. This episode also serves as a reminder that in much of the world Doctors are still considered gods, and beyond reproach. This mindset encourages patients to surrender control of their care, and for the doctors, well, they simply want to maintain the status quo. For someone less knowledgeable and with less of a forceful personality, this episode could have ended in disaster.

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  35. Hope you are all feeling better now

    I normally don’t eat seafood if I don’t think its fresh so I think it could be the culprit but what do you attribute the food poisoning/ilness to?

    Also do you think it could have been easily prevented as I want to visit India some time in the future…

    That’s all I just hope all the people that survived this experience are now recovered emotionally

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  36. Tim,
    So glad to hear you survived. And glad to see you promoting Atul Gawande’s idea about checklists (we talked about them and his work, I think, at “Hogwarts”). Though the care you and Natasha received was certainly egregious, mistakes that arise from lack of concern on the part of caregivers do indeed occur everywhere, even at bastions of care like American academic medical centers where I work.

    Much has been written about the kinds of thought errors doctors commit that harm patients but for anyone interested, my two cents about why those thought errors occur and what patients can do to ensure their doctors don’t commit them can be found by clicking the following link (don’t know if you permit links in comments, but I mean this to be helpful):

    http://www.happinessinthisworld.com/2009/04/26/when-doctors-dont-know-whats-wrong/

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  37. It’s good to hear that you’re better. I would follow up on this as nowadays if someone is running any kind of medical facility they really should be striving for excellence, and responding to feedback. Anything less is a dis-service to everybody passing through their doors. And that’s not even considering the people that are less fortunate and can’t afford top notch health care.

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  38. No on can say you dont suffer for your art Tim. Im living the dream in the Philippines, being very careful, still get a lot of bugs but never full on sickness like this.

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  39. I give you a 6 on the rant, not enough F-bombs or profanity in general. You never questioned their sobriety or even cast aspersions on their parentage, try harder next time will ya?

    Seriously, glad yer home safe and sound!

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  40. OBTW, forgot to share a good story of crap medical care in Baja.
    While in the midst of destroying a perfectly good motorcycle 100km north of Cabo, I found myself with a stick stuck in my stomach, (say it three times fast)
    The darling new Grad from Tijuanas finest Medical shchool. (Hi Dr. Vicki!) managed to stitch me up with two 1″ pieces of wood still inside me. All done while her capable assistant attended with a boogery nosed baby on her hip.

    Yay for third world medicine! Gotta love a good adventure!

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  41. Sounds like you were lucky to make it out alive! My brother has some crazy stories about his time in a hospital in India many years ago. His are more funny than life threatening, however.

    My experiences in even U.S. hospitals convinced me that one needs a personal advocate in any hospital.

    Checklists work but if the people don’t care or won’t follow them, you have different problem.

    I am impressed that you could focus enough to advocate for both of you.

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  42. Jeez Tim, that sounds like a nightmare. I’m glad your OK!

    In happier news:

    I subscribe to the Cal Berkeley Wellness letter. Did you know that you have been mentioned on the front page in no fewer than TWO letters in the past few months? In the most recent issue they even stole your headline “Forbidden Fruit.” They also refer to you as “Lifestyle Guru Tim Ferriss.” Try not to let it go to your head! haha
    =)

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  43. Never mind guys and girls just ignore me hahaha

    does anyone have any similar experiences to tim and his gang?

    I always get food posisoning when I go to Egypt especially cairo but last time I went I didn’t eat dairy or wheat and fortunately I didn’t get sick

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  44. Tim, reading about your experience, I feel compelled to share a link for Responsible Charity, a secular charity operating in Kolkatta. Our founder, Hemley, experienced conditions much like yours and worse while working with Mother Theresa’s Sisters of Charity. In response, his non-profit now works hands-on with some of India’s neediest families, providing food, medicine and educational opportunities. It’s really worth a look! http://www.facebook.com/responsiblecharity

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  45. Tim, I’m glad you and your girlfriend have recovered well and are now fine. The situation you described is very serious and I’m sure that the actual experience must have felt even more nightmarish than what you have expressed.

    The details in the post upset me. I grew up in India, studied pre-med before I changed my mind about becoming a doctor (one of my better decisions). Since the issue involves the quality of medical care in my country, I would like to offer my perspective here.

    1. India has cutting-edge medical infrastructure that is comparable to western standards and generally, money (still cheap by western standards) can buy top-notch healthcare services. However, this does not guarantee that the doctors providing these services will also be equally dependable.

    2. The most significant factor in an experience at an Indian hospital (as in a hospital anywhere else) is the doctor overseeing your care. There is remarkable medical talent in India. I have met and spoken to doctors whose medical knowledge would place them among the world’s best. Unfortunately, there are also a lot of doctors that do not deserve to enter a parking lot of a hospital. The good ones may not answer every one of your questions (see #3 below), may not have the finest language skills, may not be overflowing with courtesy (there are cultural aspects at play here), but they will always give a satisfactory medical explanation of what they are doing. If they offer anything less than that, walk away (unless it is an emergency). A doctor who cannot make you feel comfortable about the medical rationale of his actions should not get to treat you. This is my general advice when seeking medical care in India (and perhaps, at other places too). There are a lot of good doctors in India and you should not suffer a bad one just because you are in a foreign country. I understand that this particular institution in question proclaims to be a premier institution but such a title means nothing if you are assigned a crappy doctor who cannot give proper instructions to his support staff.
    3. Being a doctor is the most venerable professions in India. A lot of people in India look up to their doctors as demi-gods possessing ‘superhuman’ ability to save lives. While this is changing with the new generation, the concept of two-way information exchange between patients and doctors is not welcome in India. Usually, the doctor prescribes and patient follows. A patient is not expected to question a doctor’s expertise. In fact, doing so would be equivalent to an insult to the doctor’s knowledge. As an example, for certain high-risk drugs in the US, the FDA insists that the physician should thoroughly discuss the benefit-risk of taking the drug with the patients and make a joint decision with the patient about prescribing. Such a concept is hard to find in a society like India where there is a perceived inequality in knowledge between a doctor and a patient. Therefore, I can see how a “western tourist’s” suggestions questioning an Indian doctor’s medical judgment (and their “unreasonable demands for luxuries like toilet paper”) would have been ignored/dismissed due to cultural biases. All I can say is, in such a situation, go with your instincts: if you feel something is clearly wrong and doctor cannot satisfactorily explain his actions, walk away.

    Again, I am not trying to justify anything. This was clearly an emergency situation, so there was not a lot of time to window-shop for doctors and you did everything that seemed right at that time. However, while not intentional, it seems like the issue is being generalized to some version of the following; “medical care in developing countries is not as high quality as in some of the western countries.” I just want to emphasize that this one incident, while unforgivable, should not used for such a generalization. It is a case of a few rotten apples in a bunch, and not of a rotten bunch.

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  46. Tim, Certainly an interesting post. Clearly one knowledgable about travel to foreign lands where GI bugs are prevalent should carry prophylactic antibiotics. A few doses of cipro could have possibly prevented your trip to the hospital in the first place. Don’t get me wrong antibiotics have their own problems like antibiotic associated diarrhea and C. diff infection but the benefits clearly negate the risk when heading to somewhere like India.

    Also, interesting enough it is common place to administer large doses of IV heparin to patients with blood clots and the like. A tiny volume of heparin is used for a hep lock and even in the states we do not worry about having an overdose with a hep lock.

    Axillary temperatures are BS. Core body temperature measurements- like oral temp and rectal temps- are really what docs order to document fever. Even temporal temperature scanners are unreliable when it matters.

    Suggestion why not carry cipro and learn how to start your own IV just to be a bad ass? IV fluids are great for hang overs too by the way.

    Hope this helps.
    - your local (exhausted) ER doc

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  47. Am glad you and Natasha are alive! The nightmare scenario you describe is all too familiar to me (having lived in India for 19 years) and your systemic alertness paid off in averting truly disastrous results.

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  48. Hi, Tim.

    For a guy who has written a health book, you get into a lot of medical misadventures. :) Let’s see. Injuries, surgeries, quite a few temporary illnesses, blood drawings, biopsies, and so on according the 4 hour body and this blog. (sounds almost medieval) of course, you did say in your book that medical science is kind of your thing.

    One thing that is pretty scary about your post/rant/story is that a normal person doesn’t even stand a chance. Of course, you, tim ferriss, have the medical knowledge to spot mistakes and make corrections, Plus the confidence to stop a medical professional to voice your opinion. But how would a person without any medical knowledge fare in that situation? I don’t know the first thing about properly hooking up an Iv or If Heparin/Drotin is correct/incorrect as a treatment for food poisoning. It is a scary thought.

    I think we are living in a world where one has to be his or her own advocate in all areas. (Medical, financial, nutritional, and so on) It is quite the burden to have to all the research on all of these areas by yourself.

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  49. I am from Calcutta and horrified at what you have gone through.. Belle vue is horrible…I wish you had been directed elsewhere. Woodlands hospital is where you should have been sent if you had better connections or information. I have treated there and your experience would have been different. Everybody gets delhi belly who visits India so you need to come prepared. In fact, if you plan to visit there again, email me and we can provide better information. We have had good experiences at the tollygunge club so it could have been a number of factors that led to you getting a bug. My father is now going to try the 4 hour diet.

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  50. Great illustration how primitive, 3rd-world medical practices facilitate the spread of such problems as NDM-1, a gene conferring high levels of resistance to almost all antibiotics to nearly any bacteria- and it is moving primarily from India to the West . There’s a reason this crap comes from India. I’m surprised they didn’t use leaches.

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  51. Glad to hear you made it out alive. I had an almost opposite experience in Mexico when I went to the ER after a knife accident in our hotel. Hospital was in a sketchy area of Cabo San Lucas, but the doctor, staff, building, and medication was top notch.

    Great suggestion on writing down doctors’ names. I will take heed to this advice and begin doing so if I need to see a doctor who is not my physician.

    Keep up the outstanding work you do on this blog, your books, and videos.

    Thanks.

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  52. Damn Tim. Glad your ok! We need you to finish the new book for us.

    Also, it surprises me that, despite the ridiculous experience you went through, your comment card was still fairly considerate. I would have expected something meaner. Be meaner next time.

    Tim

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  53. Sorry you had to deal with so much crap. At least it did not hit the fan literarily. On the bright side, you and Natasha have something negative to bond over.

    K

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  54. Wow.

    My friend’s Dad went through a similar experience last month and almost died several times at a hospital in… LOS ANGELES.

    His wife was a doctor and was able to jump in and stop some of the process mistakes from killing him, but governments’ licensure scheme doesn’t magically remove the need for one to research and find good service providers.

    It’s funny that the last post mentioned credentials, gave the normal caveat disclaimer for licensure schemes like in medicine and law, and yet we see these real world examples that, in some cases, oligopolist licensure programs are no less valuable to society than other kinds of credentials.

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    • Jeff,
      Brad Hallonquist’s cousin Jarryd here in Austin, Tx. Recognized the name figured I’d say hello. You a fan of the 4 Hour Work Week?

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  55. Tim,
    I am an Indian based in New Delhi.
    First, I would, as an Indian citizen, like to apologize for the harrowing experience that you went through with respect to medical treatment in Kolkata. Hope that both of you are well-recovered now.
    True, the medical practice here is more of a commercial venture than a noble calling. True, most highly-qualified doctors are more brusque than compassionate. True yet again, the level of hygiene in Indian hospitals is not comparable to that in the US.
    And an absolute fact : your ‘rant’, as you call it, will NOT have even a passing effect on the perpetrators of the medical malpractice !

    Yet :
    - in a country of about one billion people, teeming with pathogens, food poisoning is a relatively minor ailment, and was probably considered such in your case ! the Indian physical constitution is probably inured to quite a few pathogens (comes with living in a tropical country !) and most people get well after self-medication with OTC meds !

    - culturally, doctors are revered as Demi-gods, and whatever they utter is considered as the word of law. Many unscrupulous men take advantage of this fact to serve their own ends, rather than the patients. (you are lucky that you are medically-conversant. Most medical-speak is Greek and Latin to me ! I would probably blindly follow whatever the doctor asks me to do.)

    - dedicated and competent medical professionals DO exist ! ( you met one of them – Dr. Gunjanrai ) But, a majority of doctors do their best to vilify the profession !

    - there ARE good hospitals/clinics, where proper and comprehensive medical care is provided. Unfortunately, you landed up in one of the many that was not !
    Always, always, always visit a corporate healthcare provider; rather than a shady back alley ‘clinic’, unless you have a referral.

    I have been extremely lucky in avoiding doctors (and nurses) of the kind you happened to encounter. And I am still hale and hearty, inspite of (pretty) frequent visits to the doctor !
    Hope this one incident doesn’t turn you off visiting India and enjoying Indian food and culture. Next time, just be prepared !! :)
    Cheers !!

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  56. I’ve traveled to over 100 countries. My worst fear is to end up in a hospital overseas. I just got back from Shanghai and Vietnam. 16 days straight of diarrhea is nothing new and doesn’t bother me if there’s no pain involve. I don’t mind the colon cleanse. I’ve been blessed to have traveled so much and not end up with serious food poisoning requiring hospitalization. Reading your rant makes everyone appreciate how orderly and cautious doctors are here. Imagine the locals and what they have to put up daily. I’m saving India last because I’m too chicken to go now.

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  57. This kind of situation is not new to me. I heard a lot of bad stories about doctors who only want to earn. Especially doctors who are also shareholders or board member of the Hospital. They will give you a lot of crazy stuffs then charge you with a whooping amount. It’s a shame that these hospitals are the ones that are considered the best and advanced. Crazy.

    Anyway, Im glad my idol is doing well. Cheers :-D

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  58. WOW! That is probably the WORST hospital experience I ever heard of! I’m really glad you and Natasha are doing better.

    I really hope your post changes the hospital’s procedures there and in other places.

    Do you have any recommendations (ie books, articles, or links) about health related traveling information? Like, do/get this, don’t do/get this?

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  59. I am surprised that you didn’t just walked out and took a cab to another place.
    Seems like there was a greater chance they could do harm than good. Where you never considering this?

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  60. Hi Tim,
    I am an avid reader of your blog and also a fan
    Glad you made it out of the predicament.
    I am from Kolkata although living out of Mumbai for over a decade
    I come from a family of doctors and closely associated with Belle Vue. I lost my father last year and I have smelled the shit first hand. The health care system in kolkata sucks! Its a mad and pathetically managed state.
    You are correct in pointing out the state of health care affairs there in that state. The primary reason being a lacklustre state goverment punished under a pseudo communist regime. The communists have been kicked out this election after 33 years of corruption and exploitation.
    I am really sorry for your and Nat’s experience over there and its an eye opener. But now with the communists gone things should look better. But this doesnt reflect the general state of affairs though. In Mumbai where I stay we have world class private hospitals. Next time you drop into mumbai please be my guest…I would glad to extend all possible assitance…..keep up the good work…..trust with your scathing attack Belle Vue pulls up some dirty socks.

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  61. I’ve backpacked around India for maybe a year total, and I’ve been sick there. The general idea is don’t go to a hospital if you can at all avoid it. 1000 stories I’ve heard beat it into me: there’s a potential huge downside of hospital visits in the developing world (and as previously stated here, the ‘developed’ world too btw), especially if you are incapacitated. I know I’m not as tough as Tim Ferriss so running a 102 temp I probably would have gone despite my resistance to the idea, esp if my partner was sick too and couldn’t care for me.

    I live in Bali now; Indonesia might be a little better than India, though we have a good clinic here (BIMC). Singapore excellent, Malaysia very good, Bumrungrad in Bangkok better than any other hospital I’ve ever seen worldwide….

    I’m glad you and your girlfriend made it through the ordeal Tim. Doctors doing their best without having much to work with is tragic but understandable, negligence as you describe is absolutely criminal. I’ve seen it and I’ve also screamed at people….

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  62. Well I am absolutely not surprised by this post.

    I went for 6 weeks in India last year as a mini retirement. And me and my partner went through exactly the same problems : in 6 weeks of trip, I spent in total 10 days at the hospital, in 3 different hospitals : Apollo in Goa, a small privately run clinic in Pondicherry and the American Hospital in Udaipur.

    Each time I went, it was for different symptoms and bacterias, that could potentially kill me. I traveled to many countries before and was sometimes mildly sick, but never as bad as it was in India : there is defintely some hygiene problem in India.

    Then about the hospital, I really understand your story, as I lived almost the same thing in Goa and in Udaipur : people who have no process, arrogant doctors who completely ignores you, nurses who don’t give a shit and who don’t know what to do or are being rude with you… and all of that for a very very high price (even if you have travel insurance). Strangely the hospital I went to in Pondicherry was the smallest one but the conditions were ok and the staff was more helpful.

    I am anyways glad that you are now feeling better, you and your girlfriend.

    Regards,

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  63. Fucking hell Tim! Glad you are alive to tell the story.

    My experience from a lifetime of hospital admissions is that in all hospital situations you need to keep your wits about you or have an advocate ensuring the ‘professionals’ are doing their job properly. Protocols are only as good as those following them. Hospital can be a VERY dangerous place. The lesson is taking responsibility for yourself at all times, in all situations…personal protocols and standards is what caused you to get through this episode alive and without exageration save your girlfriends’ life. If this had been your exit story I would have been really disappointed in you. I’d have hoped for something more worthy involving a space-walk, some dwarfs, 20 nude dancers and a trapeze…y’know, like your average Saturday night out.

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  64. Oh my god, I can’t believe you’re writing was so coherent. I’d be livid beyond words. And anyone less knowledgeable than you would have died! What then?

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  65. It was great traveling with you, Tim. I’m so glad you and Natasha are safe and sound, and I’m happy to have been able to offer you some level of assistance during such a brutal experience.

    Your words were well spoken, but it’s hard to really imagine this place unless you’re there… the first hospital didn’t even have a sink on the entire ER floor.

    Really scary stuff! (apparently Darwinism is still taking place to its fullest degree in India – I just hope their healthcare improves for the sake of all the people who are currently under their care.)

    I’m not sure I had a chance to tell you, but one of our tour leaders has a wife in the hospital now with several broken bones and a clear head injury following getting hit by a motorcycle while walking – she’s having a lot of mood swings, etc., and they’ve decided to just ‘watch and wait’ to see if she requires any further testing.

    Glad you’re safe, and, outside of this experience, grateful for the opportunity to have had another amazing trip. There’s a lot to love in India, but healthcare isn’t one of those things…

    Wishing you the best,

    -k

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  66. As a medical student, it always makes me sad to read about malpractice of any sort, especially if it’s that avoidable – but then again, perhaps it makes me more aware of how I will never want to act like.

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  67. I was in India in April and suffered food poisoning too. It’s almost a normal part of the journey here.

    But it was far less terrible that what you and Natasha suffered. I’m glad you both survived and now have an horrible experience to compare with all your future medical problems ! ;)

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  68. Sounds like you did a great job of taking care of yourself and Natasha in extremely difficult circumstances. Wondering what – if any – medical supplies you took with you and what you will now take for future travels…

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  69. Tim,
    You bring back memories of going to India 20 years ago on a scholarship. I made the one-time mistake of having fish from the Ganges river and had the only case of food poisoning of my life. Guess the lesson is do not eat fish (at least from the Ganges) in India. Later issues–I went to a gynecologist there for some issues and saw rusty, unsterlized instruments on a dirty table about to be picked up and used on me! I’m not kidding. I left right away, and when my final health issue there happened–a kidney infection–I went back to the US to deal with it. When I returned to India, I didn’t get a single sickness for another year, as the immunity built up. I want to go back to India again, but am a little scared. If you discover good health care options there, let us know!
    Jenny

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