A Operation in a Bangkok Hospital

Tuesday 21st November 2001

The day of my admission to Siriraj Hospital started well enough. I felt surprisingly calm after a trouble-free night's rest. I had thought I would be petrified, going for the first time in my life for an operation which required a general anaesthetic, but I felt no qualms at all. I happily picked up The Bangkok Post from my doorstep and read through the headlines ('Three election candidates fall off elephant: minor injuries') while I waited for the water to boil for my necessary cup of tea. I pottered, showered and prepared a breakfast of muesli and orange juice just as if I was going off to teach. I knew I would be away from the house for 4 days so I busied myself with tidying up so I would not embarrass the maid. (It is my observation that people with maids or servants are generally cleaner and tidier than those without. One tends to avoid being shown up by slovenliness) I left her an alarmingly large bundle of laundry to deal with including the sheets. Do elderly maids, like mothers, I wondered, inspect sheets for tell-tale stains?

John and Dennis had very kindly brought a load of books over the day before yesterday so I packed them and my toothbrush, this computer and enough cigarettes to keep me going, into my hold-all. I looked round for anything untoward, switched off the fans and closed the doors behind me.

Apart from Venetians and perhaps Bangla Deshis few people, I imagine, go to hospital by boat; but I did. I marched resolutely the short walk from my house to the Krung Thon pier trailing my wheely-case behind me. The motorcycle taxi boys, waiting for custom, gave me splendid grins as I passed by. They lifted my spirits. It was before 9 o'clock so I had to pay the surcharge on the water-bus. This irritated me, and I found myself - like any Thai would on the same salary - thinking what a waste of 4 baht (6p or 9c.) that was, when I could have waited a few more minutes and paid the cheaper fare. The boat was full so I stood at the stern leaning rather precariously on a thin, upright pole; any lurch of the boat could have seen me topple overboard. Fortunately there was none.

It is a short ride of about 20 minutes to the hospital's pier; under the dark recesses of Krung Thon bridge, past Wat Po and the warehouse which houses the splendid golden King's barges, past the King's private landing stage, looking for all the world like a municipal bandstand (or perhaps municipal bandstands are modelled after the King of Siam's pier?) and past the tall construction of yet another planned river crossing. As we chugged under the grimy concrete of Pin Klao bridge, past Thonburi Railway station as splendidly sited on the waterfront as Venice San Marco station is, I could see the mess of buildings which was my nemesis. It is sited like St. Thomas's Hospital in London; it looks and functions much the same. Siriraj Hospital is a teaching hospital attached to Mahidol University where I am an Ajarn. I had been told to report to 'Building no. 84' so you can get some idea of the sort of place it is; a jumble of buildings ranging from louvre-windowed colonial to steel and glass post-modern, their different styles giving an instant potted history of the growth of the hospital.

To be in any large hospital is daunting, to be in one alone is worse, to be in a foreign hospital alone gave me a curious sense of helplessness; I was 
beyond caring when I leapt from the moving water-bus onto the landing stage of the hospital.

To make matters for me even more surreal, when I got inside the maze of buildings not a single sign was in Roman script. Everywhere was only signposted in Thai script. I couldn't even read Way Out let alone find 'Renal Unit Building No. 84'. In the centre of this confusing agglomeration of buildings is a rather pretty garden square with 
a statue of the seated Queen Siriraj at its centre. People stop by here and quietly pray to their former queen, make small offerings and burn incense in front of the statue. (This is much in line with our own custom of praying to St. Jude, but unlike St. Jude, Queen Siriraj is not expected to scan the personal columns of every provincial newspaper for the rest of Time.) At this garden I spotted three handsome junior doctors walking towards me, stethoscopes nonchalantly slung round their necks in an attempt to look like old hands at this game. They will know some English, I thought; undoubtedly Gray's Anatomy has been translated into Thai, but surely not Picken's The Organisation of Cells? They must have to understand English to learn specialisms.

I was bold: "Excuse me. I'm lost. Can you tell me where building No. 84 is?" They consulted amongst themselves in worried Thai. My heart sank; the hospital was so large and so sprawling even they didn't know where building No. 84 was. The tallest and most handsome struggled with carefully phrased English: "Mmm. Excuse please. Mmm. What is the - mmm - nature of your ailment?"

"I am here for an operation to remove a kidney - er, renal stone."

"Ah! Renal Unit! Building No. 84. Follow please."

This kind young man - having nothing better to do - then took the trouble to lead me by the hand through a warren of buildings
and crowds of people aimlessly wandering until we came out into an open square. He looked triumphant and held out his hand in a dramatic gesture of accomplishment. "Building No. 84! Thank you" He announced.

"No.No!" I exclaimed. "Thank YOU!"

He beamed and slid away to rejoin his friends.

Now my troubles really started. No-one in reception spoke any English. Despite the splendid computer on the reception desk, there was nothing under my name except the fact that I existed: no operation was listed, no room or bed booked. The receptionist was joined by another who said "O.P.D." No! No! I knew what OPD was, I wasn't an outpatient and I didn't want that department. "O.P.D." she said again firmly, and she was joined by a man who stared blankly at the computer screen willing it to burst into life to tell them what they should do next with this recalcitrant foreigner who didn't make sense. The terror of the ordeal and the frustration was beginning to get to me and I started to shout like an American in Paris: KIDNEY STONE? OPERATION? DR. SITTIPORN? TOMORROW? ME? Telephone calls were made, more Thai talk in which was included the dreaded initials O.P.D. all over again. I was about to beat my head on the reception desk when suddenly a nurse hove into view. She spoke English - of a kind: "What you want?" After explaining, she directed me to the second floor. I positively ran there. But the anguish started all over again. I thought they were expecting me on the second floor, but it quickly became apparent I was in alien country again and I began the whole explanation anew. No-one spoke English here either, and I realised the nurse had directed me to the first place she thought of; just to get rid of me. I was beginning to despair when suddenly a gentle voice from behind said: "May I be of assistance? I am a supervisor here." Oh! The relief! "Please follow me to the eighth floor." She said after I repeated my saga a third time and she had made a swift phone call. When we were in the lift she told me she had studied in New Zealand for a year and one month. "I tried to learn as much English as I could in that year." The lift slowed down. "You did very well." I said as the doors opened and we decanted onto the eighth floor. Matron was standing there waiting for me.

"Mr. Lobert?" Said Matron. "My Engriss no so good. Solly. Your loom is waiting. We put you in firss loom next to reception." I was led to a private room No. 831 with a balcony, air conditioning, fridge, phone and TV which I later discovered received CNN. I was in an hotel! Matron pointed to the floor. "It clean. Just look dirty. Velly OLD!" she whispered and she screwed up her nose in shame. "It's lovely!" I said, for all the world as if I was viewing a new apartment. The supervisor talked with Matron. "Do you have a friend coming to stay with you?" Suddenly I was back in Bali where all the family sleeps on the floor round the bed of the invalid, and takes turns to keep watch. "Friend? No. I don't have that sort of friend yet. I've only been here a short while." They consulted together again. "Oh! We think you should have a friend to sleep with you tomorrow night after your operation. It is much better. It is not good to be alone. The nurses will look in from time to time, of course, but they cannot be here all the time." I said I quite understood, but in my country no-one was ever allowed to sleep with patients, and even visits were quite strictly limited; we were quite used to long hours of solitude in hospital. Matron and the supervisor look at each other horrified: it merely confirmed their suspicions of how barbaric foreigners are. "If you cannot find a friend, we will try to organise a private nurse for you." "I'll try to find someone." I said humbly, but could only think of dear, faithful Sumon who had been such a brick when I broke my foot. Would he come?

Matron inspected each item as I brought it out of my bag: the books, the computer, my dressing gown. I tried to hide the fags. "But where are your clothes?"
"Clothes? Do I need clothes?" "You will need some fresh clothes on Thursday after your operation. I will see if I can find you some."
"I only live at Krung Thon bridge. Shall I go back and get some?"

"Good idea! Have you had breakfast?" Said Matron beaming.

"Yes, thank you. I might as well get my clothes now."

So, no sooner had I settled into my hospital room, I was out again, past Queen Siriraj's statue, out to the river, past the shops and restaurants, onto the pier and buying my ticket for a return trip home on the boat.

The water-bus was fairly empty going up river but I still stood at the stern letting the wind and hot sun hit my face as we ploughed through the wide river water. I was beginning to enjoy this: everyone was so friendly and helpful, the room was better than I'd hoped and I was not now in the least bit fearful.

At home, I gathered together a couple of T-shirts and knickers and a few letters which needed my attention, saw the maid and told her I would be back on Friday. I pointed to the huge bundle of laundry and 
made sorry-sorry gestures. "Ka, ka." She nodded laughing. "Mai phen rai!" It's no problem.

Sitting on the pier for my return journey to the hospital I was joined by a khatoey. He/she was not in drag, but in surprisingly muted blue jeans and black sports shirt. However, he sported a ring on every visible protuberance: both ears, nose, every finger and most toes. Her/his hair was dyed a fantastic shade of yellow which I think was intended to be blond but had somehow gone wrong. The effect was shocking, and not helped by Edna Everage spectacles which also did nothing to hide a deep-lined scowl across his face. She was the first unhappy khatoey I have come across.

Back in the hospital I positively bounded my way up the eight floors to room 831 in building No. 84 where lunch was already waiting for me: vegetable soup in a Thermos cup (very sensible), two fried chicken wings in an aromatic sauce, with croutons and a green-leaf vegetable not unlike my father's spring greens, fresh papaya and, rather curiously, two slices of steamed, white bread and butter. Whether this was done for the foreigner's special delight, I don't know; but I can't imagine a Thai ever eating it. Neither did I.

The afternoon was a continuous stream of hospital visitors. First my resident nurse came to take a blood sample, then Matron with an ECG machine sticking suction cups all over me, then FOUR nurses to take my blood pressure, temperature and pulse; another nurse came to take me personally by the hand to the X-ray department for a chest X-ray. Here I got a little anxious, for the rooms were old and dirty and the equipment chipped and well past its replacement date. Still, the pictures turned out all right so I suppose it was O.K. Later came the anesthetist with a gaggle of his students in tow. He explained to me the options and I chose NOT to have an epidural. Good choice, he said. Do I drink? Do I smoke? Have I a history of heart disease? Yes Yes No. "You'll know me tomorrow behind my mask because I have a very nice hat of many colours." "Can I have one too?" I ask. "Nah! Only anesthetists are allowed. And no smoking in de loom!" He said wagging his finger. His students laughed. "Of course not!" I said, but he hadn't mentioned the balcony...

After this little party a second party arrived headed by another doctor: pre-op and post-op. I was beginning to get dizzy with so much attention. Each time a specialist came, everything was carefully explained to me; what would happen and why it was happening, and did I have any questions? My final visitor was my first nurse who explained about measuring the quantity of liquid going into me against the liquid coming out. I rang Sumon and asked the nurse to explain to him about my friendless plight. They had a long chat over the phone.

Then the evening meal arrived. Huge tiger prawns deep-fried in breadcrumbs with baby sweetcorn, french beans and, oddly, fresh pineapple as a vegetable. Another thermos cup had some warm liquid in it which I took to be the sauce for the prawns, so poured it all over them. It turned out to be carrot and orange soup. To save the Thais any more jokes about the idiocy of foreigners ("Guess what he's done now! He poured the soup OVER the prawns! Don't they know anything?") I used the two slices of bread to mop it all off the plate. I would leave no trace of my savage ways for them to mock. As I was eating I mulled over my current experience with the one other time I have stayed overnight in Northampton General Hospital. Both are large hospitals but the first striking difference is how much more a human being I feel here, rather than a number to be processed there; one always got the impression the hospital would run so much more efficiently if it weren't for the inconvenient presence of patients. Secondly, the doctors and surgeons are not embarrassed by their high intellect and elitist status. There is no dumbing down here. They expect their patients to be intelligent and treat them accordingly. Everyone, I have noticed, is treated with the greatest respect. I shall never forget the horror on an orderlies face when I asked in Northampton General Hospital if they had a Guardian newspaper to read. That the highest they could aspire to was The Daily Express was deemed sufficient. In Siriraj hospital they address me with the honorific Ajarn - guru or teacher. But I also remember a chilling moment in Northampton: when in great pain, a too pert nurse came to my bedside and asked "Do we call you Robert, Rob or Bob?" "You may call me Mr. Walker." I replied icily.

And, bless his heart! Sumon suddenly appeared in the room. "I come. Sleep with you. Don' wolly." Dear, kind, happy Sumon who seems to spend most of his days looking after me in hospitals. It was Sumon who cared for me when Ibroke my foot in June and who washed me when I could only hobble dejectedly around on one foot. Now he had answered the call once more. He has recently had an operation himself (his sister, apparently, rang me to tell of this but was completely flummoxed by the answering machine: "He wouldn't stop talking!" she told Sumon) so Sumon is sympathetic. We spend a few contented hours watching films on television and occasionally sneaking 
guiltily out onto the balcony for a smoke. ("If doctor see, he velly mad!")

Only the arrival of the shaving and enema man reminded me I wasn't in a hotel. He was Bangkok's version of Sweeney Todd with a cadaverous head, pencil moustache and thin lips. He obviously enjoyed every moment of his work. Without a word he calmly let the bottom fall out of my world as he stripped me of hair and any last vestige of dignity, then compounded the felony by urging the world to fall out of my bottom. I did not take to him; the more so when, after his fell work was done, he refused to leave and sat in the one chair watching MY television.

Wednesday 22 November

I was woken by a nurse at 5.30 a.m. to give me a pill. I went out like a light but came to again in the operating room looking at very large lights. The surgeon, Dr. Sittiporn (not to be confused with my doctor Kittiporn) was studying the X-ray taken yesterday. "Unfortunately" he began without any preliminaries, "I can't see the stone; the picture isn't clear." Oh Marvellous! I thought. I'm just about to have an operation to remove something which might not be there! "But we had better go ahead with the operation - it's up to you of course (famous last words) - but I think we should do it because I would need to have a look inside you with the telescope in any case."

"O.K." I sighed "Go ahead." 

After that I remember almost nothing except ceiling lights moving past until I came round in the post-op room. It was 2.00 p.m. I noticed on a wall clock. When I was finally wheeled back to my room, there was Sumon - and his sister too - waiting for me. The Thais have got it right: you do need a friendly face at such moments.

Today has been an experience not to be repeated. Neither Dr. Kittiporn nor Dr. Sittiporn nor any kind of Ittiporn here had thought to mention the catheter I must have for 24 hours. ("Oh didn't I?" Said Sittiporn the consultant surgeon wide-eyed when he came to check on me and I charged him with this deception.) The pain has been quite dreadful, particularly when there was a blockage and my temperature suddenly shot up. I would have swapped it with the stone any day. Later I was told he has left a plastic tube inside me to keep the passage open from the damaged kidney. I must have another operation to take it out!

 This is not at all what I expected. It's 7 p.m. and I don't want to write any more.

Thursday 23rd November

Awful day. In great pain and peeing blood and glass shards incontinently all day. Nobody warned me it would be like this. Why don't doctors tell you the truth? Half of the stress is wondering whether what's happening to you is normal or not. Nothing is half so bad if you know it's part of a regular pattern and to be expected. This half-truth nonsense which doctors go in for 'to spare the patient' is a foolish deception which only rebounds on them. It's why doctors are never really trusted.

 My friend and artist Tongsoek arrives at midday with armfuls of bananas, oranges and I know not what else. He is a little ray of sunshine in a gloomy world. I am less enamoured with the hospital today. It is not as clean as I first thought; and yesterday's lunch, which of course I didn't eat, is still sitting there waiting to be removed. There are small flies hovering over the plate.

At lunchtime, after a checking visit from the surgeon, the nurses announced I could go home this evening. I dreaded the idea of a taxi journey (would I pee in my pants?) but was pleased to be going home.

A kind telephone call from Nancy Wei, my colleague at the university, lifted my spirits. She was about to come to visit me so I told her not to bother. I was leaving the hospital shortly (I thought). She reassured me that my classes were taken care of and I should only come back to work when I really felt fit enough. "Your health is more important than anything else." This was cheering: I had gained the impression the university was so intent on getting the last ounce of work out of the staff ("I want 110% from you all!" Dr. Sugree had said at the last full faculty meeting), in the scheme of things health took a poor second place. But then, Nancy is Taiwanese so perhaps she has a different outlook on life.

The afternoon dragged on; only elevated by a visit from my New Zealand-trained supervisor with the bill. It was to be about 20,000 baht (about £330 or $480). Cheap at the price and I hope I can claim it back; but nothing is sure because my travel insurance has stopped in the intervening period between when the first signs of the stone appeared and now. Ironically, with my new salaried status, I am poorer now than I ever was in Bali where I simply ate lotuses. It seems to be expensive - having a job.

By six o'clock I was wondering when 'evening' began in Bangkok. There was no sign of my being released. Suddenly John and Dennis appeared in the room. I had left a message on their answering machine to say I was being discharged, but they hadn't heard it. I was glad of that: their Oxbridge witty humour was the best tonic. I was beginning to get depressed.

The post-op doc arrived. I had developed a rash on my arms and it was decided it must be an allergic reaction to the antibiotic. Can I go home? I would have to wait an hour while they got another antibiotic to replace it. Amoxycillin?!! I can buy that over any pharmacist's counter here! Why do I have to wait an hour for it? At 7.45 I was getting fretful. Orderlies were already clearing up round me as though I wasn't there. I didn't want to be too late home. The Amoxycillin finally arrived and I was presented with the bill. I presented my Visa card. Oh! Well! I would have to go to the chief cashier if I didn't have cash. Follow me. So in great pain I walked to the lift, went down eight floors, walked past three cashiers (not the CHIEF cashier) out of the building, past Queen Siriraj, though another building, out the other side, down a corridor to the chief cashier. She looked at the bill and I gave her my card. "Fifty Baht" She said firmly. "Cash!".

"But I don't have fifty baht. What's it for?"

"Telephone" She said. "Cash only."

"But I don't have it!" I screamed, "I don't have any cash on me. I'm ill. I've just had an operation! Can't you put it on the credit card?".

"Cash only for telephone." She was unmoved and unmoveable.
"Thanks for telling me beforehand." I mumbled as I scrabbled around in my wallet and back pocket. "Here: I've got thirty three baht. Will that do?"

"Fifty baht." I was talking to an automaton. Just then the nurse who had brought me to the chief cashier returned. She gave me the extra twenty baht and I thanked her with many profuse bows to make a point which was lost on the chief cashier. Then the chief cashier couldn't work the credit card machine, and an underling had to explain to her that she needed to punch in the hospital's code. I stood and stood. My bladder was screaming. Computers computed, printers printed and still I stood. Finally at 9 o'clock I was cleared of all encumbrances and allowed to leave. I couldn't get out of the place fast enough.

With rather more possessions on the way out than I had on the way in - bananas, oranges, books, water and I know not what else - we were led with a trolley by the same nurse who had lent me the twenty baht to the taxi place. No taxi. But no problem. This kind nurse went looking for one, and shortly one arrived with her inside it. Sumon gave her a handsome tip.

The traffic was Bangkok at its worst and we sat in a jam for 30 minutes. My bladder started screaming again. Finally - Oh blessed relief! - we were home. On the answering machine were two messages from the pianist Jamorn Supapol. He had heard from Dr. Kittiporn I was in hospital. Was I O.K.? I rang his mobile and told him my saga. He will call in tomorrow.

Some people are really nice here.