Sukhumvit Stroke

In response to an earlier article about the Chang Mai heart attack along with Stick's encouragement to write submissions concerning serious medical treatment in Thailand, I thought I would share some of my experiences.

The title tells you the story.

I spent most of 2013 / 14 in Thailand and towards the end of 2013 I was spending a considerable amount of time in Bangkok. It was a late November afternoon and I was rushing to the Ploenchit Center to catch lunch on the 6th floor at the food stall restaurant. It is open for the lunch rush from 11 AM to 1 PM, I believe. It is filled with everyday working Thais after an inexpensive lunch. I was too late for lunch so I went downstairs to the Villa Market and bought a small bag of Lays potato chips as a snack to see me through until dinner. As I left the store, I sat on a bench to eat the chips and wanting to get every crumb, as I finished the bag, I tilted my head back and poured the crumbs into my mouth.

I noticed my throat was somewhat numb upon trying to swallow the last bit. Somewhat curious as to the cause, I then noticed the right side of my face didn't feel right. I also felt like I couldn't speak, although I did not try.

I became quite frightened with thinking about the possibilities and quickly walked back to my room at a tiny guesthouse on Soi 4 across from the 7-11. I went to my room and looked in the mirror. I tried to smile but couldn't lift the right side of my face. My denials quickly fade as I tried to speak and couldn't understand what I said. I know what this is even though I tell myself this can't be as I am much too young for it and too healthy. I'm 53 at the time and have never smoked, never had high blood pressure, work out daily (I had lost over 40 lb in the past 4 months on a new intense workout program and was in the best shape of my adult life), have been an accomplished amateur athlete and have no risk factors other than a passion for pizza.

Nevertheless, I pick up my passport and insurance ID card and head downstairs and decide to go to Bumrungrad Hospital. Bumrungrad is about a 12-minute walk from my room. I have been treated there before for other minor ailments and am comfortable there. The big question I wrestle with at that moment is what is the fastest way to get there? I consider a taxi but I can't speak and the time of day was a concern. The last thing I need is a run-around with a taxi driver. Traffic was already an issue so I decide it's quickest to walk. I walk down Soi 4 to that crazy busy stoplight where it intersects Sukhumvit and as I walk I monitor myself looking for any sign of imbalance. I notice I am a bit uncoordinated with my right leg but I keep pushing, hoping I don't suddenly drop along the way. Along the way I run into a bar girl I am friends with just in front of Stumble Inn. She stands in front of me and wants to talk but I forcibly grab her shoulders and move her out of the way and continue. I wait at the light with the rest of the herd and when it's safe, I cross.

Flashbacks of a previous trip crowd my mind. I remember seeing a very overweight farang laying towards the middle of Sukhumvit Road with another farang doing CPR on him along with a crowd of Thais gawking at the scene. I think to myself 'am I going out like that?' I am determined this will not be my fate and continue onward.

After crossing Sukhumvit, I then wait again and cross Soi 3 towards the side of the street that Bumrungrad is on. I walk quickly to the hospital emergency room.

I sit down just outside the intake desk and reassess the issue. Maybe I am imagining it? I try to speak again and it's garbled. So I stand up and head to the desk. I pull out my passport and insurance card, I grab a pen and piece of paper and write, in English, my symptoms and the word 'STROKE?' and hand it to the young female attendant at the desk. Her eyes get very big and she takes my IDs, makes a call and takes me by the hand to the ER triage area and sits me on a bed and grabs the attending physician. He then examines me and asks me what happened and how long ago. My speech has somewhat returned although impaired and I tell him. It has been just over an hour since this all started. He reasons Bells Palsy. I am no Dr. but I know intuitively what this is. It's not Bells.

He then calls the neurology department and arranges for me to be examined by a neurologist upstairs. An attendant takes me by the hand, up the elevator to, I believe, the 9th floor and I see the doctor immediately. I start to tell him what happened and he loses his cool in a very un Thai-like manner. I don't mean he got angry, he got visibly nervous, almost shaking. He makes a call and within 30 seconds a team is there with a gurney. Oh, and what a very beautiful team they are! If I am leaving this world, I think, this is the way to go! Young, beautiful, sweet, gentle, kind and caring. They begin a well choreographed 'dance'. They pick me up, put me on the cart, insert an IV in my hand, other electrodes and monitors on my body, draw blood, take my shoes and shirt and pants off and give me one of those smocks that tie in the back and tell me we are going to ICU. I tell them I can walk but they say no, and off we go.

What I am impressed with is the complete lack of drama and the very gentle but firm behavior.

There are no abrasive commands to their co-workers unlike what you might experience here in the States. It was all so smooth and peaceful.

We arrive at ICU and I am given a private room and placed in a bed and a lovely female comes in and asked me what happened along with some other questions. She then says a specialist will see me and in walks a youngish male doctor. He is very friendly, composed, and introduces himself. He tells me he trained in his specialty (neurology) for 2 years in St. Louis. He asks questions and administers a few tests he has on the Iphone. Some kind of mental and visual tests. He then says it's likely a stroke but is very encouraging given that the symptoms have somewhat reversed and sends me for an MRI.

I return from the MRI and he returns and tells me I have had a small Ischemic stroke. We review the MRI images together and he showed me the area affected. Elapsed time is around 2 hours since the symptoms started. He then complements me on getting here so quick and explains that there is just under a-4 hour window of time when a stroke occurs. If a person can get intervention in that time frame there are drugs that can dissolve a clot and thus minimize the brain damage and reverse some of the effects. He then talks about the possible causes and wants to do investigative tests over the next few days. He also explains that the next 7 days are critical so I will be hospitalized for at least 7 days. Statistics say, the likelihood of a second, larger stroke is high during this period. I wonder, is this the small tremor before the big quake? 7 days and 90 days are the benchmark hurtles I need to clear and then the 2-year mark is also significant.

Given the swift improvement of my symptoms and results of the MRI (he can find no blockage), he reasons there is no need to inject the medication.

The only FDA approved treatment for ischemic strokes is tissue plasminogen activator (tPA, also known as IV rtPA, given through an IV in the arm). tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within 3 hours (and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment; this is why it’s so important to identify a stroke immediately.

– Source American Stroke Association.

Let me be very clear on something – this is not a Viagra-induced stoke or anything of that nature.

Being in the ICU with help all around me, I relax somewhat and my thoughts turn to my possible fate. I text a friend of mine in Bangkok and tell him I can't go out tonight as I had a stroke and I mention to him I am surrounded by the most beautiful, kind and caring women I have had the good fortune to encounter. He texts me back, laughing at my priorities at this moment.

I then text another friend in Bangkok and inform him what has happened and tell him I will need to undergo tests in the next few days and be sedated. I tell him in the event I become incapacitated or worse, the hospital will notify him. He gladly agrees to handle any arrangements that may be necessary. I am fortunate enough to have a social network in Thailand that will make proper arrangements during a crisis like this and it an immense comfort.

I remain in the ICU for 2 days to clear a critical risk time. The care is fantastic. The room and the ward are spotless and kept that way. The nursing care? Outstanding. Kind and gentle, yet firm and exacting.

One objectionable issue is they want me to use a bedpan. I will not. I finally get them to let me use the toilet and they want to use a wheelchair to take me. Again, I will not submit and they finally get the Dr's permission to let me walk there as they wait outside.

I am fortunate to come from a medical family and as such, I know how to conduct myself in the hospital environment. First and foremost, it's important to remember doctors are not God. They often act like it and if one is not careful, one can surrender decisions and autonomy beyond what is wise and necessary. When dealing with doctors and medical staff, my rule of thumb is to use the Fox News model- 'they report- I decide'. Second, I am VERY polite and kind to every hospital person I must deal with. I need these people and I need them on top of their game. They deal with lots of people – patients, family and are under considerable stress. I don't add to it by being difficult. Bad karma in a hospital is not what I want to experience. At the same time, I know how and when to assert myself without being a jerk.

After 2 days in the ICU, I am moved to a regular 2-person room. The room is spacious with a nice view looking over Bangkok to the north. It is immaculate. I am alone in the room for 2 nights before I get a roommate. More on that later. I am constantly visited by several hospital staff during this time. The doctor is a regular, daily visitor with information and instruction during this time. He tells me they will do several tests to determine the cause of the stroke. Genetic blood tests that will take several weeks to complete, a few more heart tests to look for irregular patterns. They would like to observe me for a weeks' time. They give me some kind of heart-tracking device to wear all the time so they can monitor my heart from some central location.

I called the woman who runs the guesthouse where I am staying and she graciously volunteers to bring me some of my belongings that I will need. I also call a bargirl friend of mine from Hillary's and she does a bit of shopping for me and comes to see me. No charge. She is an old style girl of about 30 years old. I can buy her a drink and she will sit and talk for an hour and not ever pressure me for anything more.

I find my Thai friends happy to help at this time.

A physical therapist comes to visit, a very attractive speech therapist, (whom I end up dating for a short while). A nutritionist comes in and takes my meal requests. Nurses and nurse aids come at regular times, take my vitals and give me medicine. They are never late – always on time and very kind and professional. They don't seemed harried like those in the US hospitals. A representative from accounting and billing comes in as does a guy from patient services. Patient services has a visa extension service and immigration visits once a week to issue extensions to those eligible. The attending physician must sign off on the paperwork and the immigration representative usually approves the extension.

Two days later, I am taken to a different floor for a test and I return to my room to discover I now have a roommate. It's an old, frail Thai man. I return to find the heat cranked up to the maximum in the room. I prefer it cold. His wife has accompanied him and settles in for the long run. I am not interested in having a roommate but I really have little choice as my insurance covers only a semi private, so I settle in and accept the inevitable. In the rooms there are small sofas for visitors and they are big enough to sleep on. The man's wife settles in on her side of the room, on the little sofa. I have extra pillows and blankets on my sofa and they are not being used so I offer them to her and she accepts. She had given her blanket to her husband as he is old, thin and frail. I think this goodwill gesture will enable good relations and mutual consideration while I am there. Not quite. Over the course of the time I am there, this woman thinks she is at home and shows absolutely no regard for me. She dominates the bathroom, using it for over an hour at a time. Her husband doesn't use it as he is bed-ridden. She acts like I do not even exist. I am in no condition for conflict as I am not wanting to raise blood pressure or heart rate in any way. I end up using the hall restroom quite often. She also keeps the TV until all hours of the night. Again, I do not exist in her world. She keeps the heat as high as it will go and does not even consider what I need. However, the old guy is clearly thin and cold even with 2 blankets so I don't make it an issue.

What makes me angry is the dominance of the bathroom. I should not have to work around her bathroom schedule and to use it for an hour at a time is just rude. I just let it go as again, I don't need to raise my blood pressure by getting upset.

The doctor cannot find the cause of the stroke and he concludes that it's possibly due to dehydration given my recent intense workouts. Likely, a piece of plaque came loose and went to my brain. Drink your water, people.

A few days later I am released to go home, with instructions to follow up for the next 3 months with the doctor.

I must also settle the bill. Below are the charges for 7 days and nights in the hospital, with 2 days in an ICU room, in late 2013:

Cardiac Investigation- 14,870.00

CT Scan- Radiologist's Fee- 1,450.00

CT Scan 6,400.00

Doctor's Fee 44,700.00

ER Service 370.00

Lab-Clinical 32,600.00

Medical Equipment 17,495.00

Medical Supplies 7,987.00

Medicine 6,195.00

MRI-Radiologist's Fees 4,000.00

MRI 17,700.00

Nursing Service 19,200.00

Physiotherapy 5,800.00

Room 26,690.00

Speech & Language Therapy 1,200.00

X Ray-Radiologists Fee 155.00

X-Ray 1,000.00

———–

TOTAL 207,812.00 Baht

I went to the finance office to settle the bill and learn my insurance company has done nothing on my behalf. The hospital has called them but received no response. I must do the dirty work of getting the insurance company to comply. In order to be released, the hospital makes me sign paperwork where I am given the choice to pay in full by a certain date or to set up an instalment plan. I elect the pay in full option as both myself and the hospital know my insurance is valid, it's just a bureaucratic issue with the insurance company. I also pay the deductible of about 49,000 Baht ($1,500).

Later that night, I haggle with the insurance company and get the necessary 'promise to pay' letter and bring it to the finance department the next day and settle it. Good to go.

Being an expat for over 10 years of my life in 5 different countries, I have been treated in many countries for many issues. This is also the second life-threatening issue I have been treated for overseas. Another time, some 25 years ago, I was working in the Middle East and found myself on the wrong end of an AK 47 and spent 6 weeks in the hospital and an additional several months in rehab. I can evaluate medical care with some experience.

As far as my experiences at Bumrungrad, I'll break it down in to different categories:

Emergency room: Fast, efficient, polite, respectful. No issues. I hate the ER here at home.

Acute Stroke Protocol: As good as it gets. They were well-trained and followed FDA (US Food and Drug Administration) established guidelines to the letter. They knew what they were doing, executed their duties with precision and were very kind and comforting. I felt very comfortable with them.

Doctors: I found the 2 neurologists I worked with very competent, adept in English, caring and meticulous. I was very comfortable with their knowledge and background and I never felt like they were in a hurry (as I usually do here in the US). They do have a bit of the God complex and didn't seem to like it when I challenged their judgement but that is more the norm of the profession than anything local. I have been treated for a number of conditions at Bumrungrad over the years and only one time did I find a doctor who I didn't like and felt he didn't care about my concerns. I would not go back to him. On the positive side, several years ago I had one doctor that prescribed medication and flat out told me not to buy it at Bumrungrad as it's much too expensive. He directed me to many nearby pharmacies.

Nursing Care: I want to die in the care of Thai Buddhist nurses at this hospital. Never in my life did I feel so peaceful with nursing care. Never. Thai women, for the most part, have a very calming effect on me to begin with and augment that with the compassion of a caring nurse and it just works for me. They were also very knowledgeable, competent, exacting, professional, polite and respectful. Oh, and on the purely lecherous side, while they all aren't 10's in terms of physical beauty, they were mostly slim and trim. Grace under pressure, sweet and pleasant. I did, however, behave myself.

Patient Services: Really helpful. They came to me and solved all my visa issues without hassle and did so for the next 3 months while I was following up. I think it cost me an extra 500 baht for the extensions beyond the normal immigration fees. No visa runs.

Food: Good for hospital food and the patient gets to choose from a menu with many nice choices.

Physical Therapy: very good. I have used them before..no problems.

Speech Therapy: Good, knowledgeable- but the woman needed to be more professional. It became much like a date but that was my fault as well.

Pharmacy: They have what you need and are efficient but way overpriced.

Hospital: Bumrungrad was very clean. Very clean. Perhaps the cheap labor in Thailand makes it easier to keep the place spotless.

I can't find hard data on their incidents of staph infections (MRCA in particular) but I know it's better than the 2 hospitals in my US city of 300,0000 people. Doctors here try not to admit their patients to hospitals if possible – the problem is that bad.

It's also easy to navigate and very comfortable in terms of the room, lobbies and public areas. Much like a nice hotel. There a few chain restaurants in the hospital, a Bangkok Bank station. The private room was very spacious with 2 flat screens and great views of the city and great AC.

They are also very friendly, polite, respectful and customer service-oriented.

Finance: Generally, you pay as you go. There is a cashier on most every floor. See your doctor and pay on the way out. It's very user friendly. Much easier than here in the US.

They are generally good at handling the insurance but in my case it was a bit of an issue mostly because of the insurance company. Had it not been an emergency, I would have pre-authorized and it would have been seamless.

Price: Well, depends on the country you are from but for me, 7 days in the hospital including ICU, with great care, kind, caring, slim, trim and sometimes hot Thai nurses for 207,812 Baht is a screaming deal.

One night in ICU here in the US is almost the same price as the entire Bumrungrad bill. I am sure there are better deals in Thailand but I was insured and had little choice to shop around.

Overall, I was quite satisfied with my experience at Bumrungrad and with the care I received. I am sure there are issues in some areas but there was nothing glaring that bothered me. Even my dissatisfaction with my roommates wife, in hindsight, was more about my own loneliness at a vulnerable time in my life than anything else.

Upon returning home the next year, I elected to keep my expat insurance. It won't cover me here in the US but it's good everywhere else in the world and inexpensive enough. In the event of anything that I can plan for, Ill elect to be treated in Thailand or other places. The US system is a nightmare.

During the next 3 months I am very fatigued as the doctor said I may be. Seems it takes lots of energy for the brain to reorganize itself. I am fortunate to have no lasting effects save for a bit of a speech issue when I get excited. I spend the next 3 months relaxing, exercising, changing my diet, going to sleep early, reassessing what is important going forward and what is not. I worry about nothing and live very much in the moment. It has been said that the Buddhists, everyday, have a little bird on their shoulder that they ask "Is today the day I die? Am I ready? Am I doing all I need to do?" Perhaps this helps explain the Thais love of sanuk….I think like this more and more now……no one really knows how much time they have.

Seems to me, what's important anymore is more about responsibility, love, awareness, spirituality……….and of course, there is the bucket list to get to work on.

I have always wanted to scuba dive and I am in the perfect place to do so. So I go to the doctor and tell him what I want to do.

I am afraid he will say no. I bring him the scuba medical form and he asks about what I plan to do. I tell him I won't go below 10 meters (30 feet ) and he is OK with that and signs off on the permission form.

He also does not charge me for the visit.

Kho Tao is my choice of dive spots and I go in the crazy heat of April. I am very apprehensive but the only way to deal with fear is to face it. I search out a nice little dive shop with responsible instructors and take the introductory and advanced courses without incident. I push the edge a bit and dive 30 meters deep.

After all, its April and 30 meters below is the only place cool enough to get some relief from the April heat.