Are Elders Safe in Indian Hospitals?

The blue and red flashing lights pierced the quiet darkness, as the ambulance pulled up in front of the gates at my home in Thiruvananthapuram. A young male doctor in his twenties, a male nurse and a tall, burly driver stepped into the room where my mom lay unconscious, breathing furiously and frothing at the mouth. As the male nurse slapped her cheeks to revive her, he yelled at me, panic lacing his voice, “how long has it been going on?” He then explained that she was having a seizure due to low blood sugar. It had dropped from a normal 120 to 30. It was 2 AM in the morning. This was first of three times she would become unconscious on the same day for the same reason. The doctor said she should be fine until 9 AM when I could bring her to see the diabetologist. The next attack happened at 6 AM at which time we decided to go to the hospital. Every time the sugar level hit 60 she would regain consciousness. The tall burly emergency driver stated it would be hard for them to carry her to the ambulance in the stretcher. He suggested I should enlist the help of my neighbors to carry the stretcher at 6 AM in the morning! I looked at the three men – a doctor, a nurse and the driver and said “Can the three of you carry her ?” The driver sneered, “Well, I cannot ask the doctor to carry, but we can get your 93 year old dad to help. At this point my mother decided to walk to the ambulance with support.

She was then asked to climb the 3-feet high steps to get into the emergency vehicle on her own. I was shocked. Did these people, who claim to be working for a hospital, really expect a 83 year old frail woman just been brought back to consciousness from a severe seizure with edema in her feet to climb into an emergency vehicle on her own? The doctor and the nurse remained silent. There was no ounce of humanity. Where is the India that takes care of elders and gives them a place next to God? 

These are the thoughts running through my mind as the ambulance jolted and bounced over stones and swerved potholes as it sped towards SK Hospital in Thiruvananthapuram. I thought about the needle, gloves and other disposable items strewn on the windowsill next to my mom’s bed at home. The nurse had refused to take it with them because he said they have no place to dispose the medical trash.

At the emergency room in the hospital another young doctor in his twenties came over to be briefed on the situation. Then came a long exciting list of tests they wanted to do on my mom: ECG, Chest X-ray, various blood tests … I sat down for a questioning session with the doctors who tried to come up with different reasons that could have caused her to lose consciousness such as chronic liver problem for instance. I had decided enough is enough. I put my foot down and said “Do not do anything until the diabetologist comes and clears up the existing issue.” Meanwhile, they hurriedly asked my dad to “settle the bill”. Then began the long wait for the diabetologist to show up. These specialty doctors only show up around 10 AM. Meanwhile I tried to feed my mom oats, porridge, chocolate milk, juice anything to keep the sugar level going up!! Finally the diabetologist, a lady doctor, thankfully showed up. She examines mom, looks at her reports, turns around and inquires if my mother has had enough to eat. Keeping my emotions under control, I responded, “Doctor, I think you have given too much medication that was really not required” and listed all the items I had almost force-fed her: masala dosa, oats porridge, pomegranate … She asked me to stop all the diabetic medications which was my plan in any case. She asked me to keep her at the hospital till about 1 PM and asked me to return home after her blood tests came back normal.

As night approached I was nervous and ready with adequate glucose packets. I also made sure mom had enough food. In spite of all these precautions she still had the third attack at 11 PM. I started feeding her spoonfuls of glucose but her condition deteriorated really fast. She could not swallow any more so I had to coat her mucosa and tongue with glucose. My neighbor immediately called the ambulance. One good thing about the third ambulance call was that they did not even need to ask our address, they knew it was us ! In the twenty minutes it took the ambulance to arrive, I was feverishly coating her tongue and mucosa with the glucose and finally as the doctor stepped into the room she slowly opened her eyes because I guess her sugar level had gone up from 30 to 60. We decided it was best to go to the hospital and stay there until we could be certain that she will not have any further attacks due to low sugar level. At the hospital we were assigned a totally new doctor with whom I had a detailed conversation regarding the whole situation and insisted that she not be given unnecessary medications. He agreed and said he would never have given these diabetic medications to an 83 year old woman for whom low blood sugar resulting in brain damage is a greater danger than high blood sugar. Another diabetologist in the same hospital also agreed with the statement. At this time I thought it was important to have a conversation with the hospital superintendent. He mentioned he had decades of experience as a doctor and a medical superintendent in different hospitals over the years. He immediately agreed that he would not have prescribed anti-diabetic medications for an old person. His main intention was to do damage control, so I do have to admit I was very impressed by how they had appointed a person who was really able to sweet talk their way out of trouble. He tried to bribe me with coffee, masala dosa, and vada. Finally he called the diabetologist who prescribed the anti-diabetics to his office. I did not really want to be present for this awkward conversation because my intention was not to insult a doctor. The diabetologist was completely on the defensive. She stated that “in her 17 years of experience this is the first time she has been called to the medical superintendent’s office and it is her “kashtakalam” (hard times). My mom was initially admitted for severe breathing issues, and all her sugar and blood pressure levels were abnormal. As a result, she was prescribed glycomet, PPG (used to treat type 2 diabetes) and insulin at the hospital and the diabetologist’s explanation for continuing these medications at home after discharge was that my mom was still on a cortisone medication for COPD. When the cortisone was stopped her sugar levels dropped. Thankfully, I had decided to discontinue insulin. I tried to explain to her how if my Dad were alone he would have no choice but to follow all the instructions to the letter because he does not know any better. In which case he would have given her the insulin too and she would not be alive today!

It is up to the doctor to consider all the possibilities and think of the person as a whole when treating them. She needs to be the advocate for the elderly as she would do for her own parents because they are old, helpless and defenseless. What surprised me is that she thought about her ‘kashtakalam’, but not about the intense traumatic experience that an 83 year old woman and a 93 year old husband had just gone through. She said her “sorries” and left. I felt my task was not complete until I made the owners of the hospital aware of this situation. The medical superintendent tried his best to dissuade me from taking that step declaring that he had already reprimanded her and got her to apologize to me. I smiled and nodded my head and left because I knew there is no point trying to convince him anymore.

My intention was not to cause furor and threaten the hospital with lawsuits. I just wanted to make sure this will not happen to yet another elder citizen. Furthermore, I wanted the doctor to be careful in the future. I have had so many Indian friends come back to United States with stories that India’s hospitals and doctors are incompetent, uncaring, and negligent and their sole concern is to extract the maximum payment. I truly wanted this narrative to be false and felt confident that people in the country I grew up in are intelligent, and have their hearts in the right place. India in its quest to become like the West has built fancy hospitals with expensive procedures but in the process it has lost its real inheritance. The day to day struggles of life has made the driver forget his humanity, while the doctor and the nurse forgot to stand up for what is right! The sheer number of patients that doctors have to see, in the short time they are in the hospital (10 AM – 2 PM), has stopped them from caring about the person behind the problem, as they flit in and out of rooms.

I want the Kerala that is caring, intelligent, respectful, that takes care of its loved ones and makes my heart swell with pride every time I am in India. My Kerala, the only state with 100% literacy with equal rights for women in the entire country!