Dr. Hackenbush I presume?

Mrs. Upjohn: Dr. Hackenbush tells me I'm the only case in history. I have high blood pressure on my right side and low blood pressure on my left side.
Dr. Leopold X. Steinberg

: There is no such thing. She looks as healthy as any woman I ever met.
Dr. Hackenbush
: You don't look as though you've ever met a healthy woman.

A Day at the Races (1937)

I think I may have mentioned a time or two that my darling tee-rak is ever so frugal with our money. Hardly a baht gets spent in our household without hearing some all too familiar phrases: “Everything is soooo expensive!” or “Do we really need this?” or one of my favorites, “You always like to spend money!” It’s true. I do like to spend money, but that doesn’t mean I enjoy frittering it away.

I’m not much of a drinker, except when on holiday or during Songkran when I will cheerfully accept any and all alcoholic beverages handed to me. Most of the time, I am content with an occasional beer. My “bar tab” then is pretty meager. I don’t smoke, so I’m not wasting money on cartons of “coffin nails”. I don’t gamble. I never have, and I never will. Okay, I did spend a short time in a casino while on a cruise 25 years ago with my ex-wife. Before walking through the doors I said to myself that I had $100 to spend…precisely. When the money was gone, so was our “casino experience”. It took about 90 minutes to help enrich the house by another $100. Then we left to attend some silly on board activity.

When making a major purchase I do careful research, looking for the best product within my budget. I look around for a reasonable price without running all over creation to save a few dollars…or now baht. Then I take care of what I bought until the end of time, or until by its very nature it simply wears out. Back in the U.S., I owned two Toyotas, each of which racked up close to 200,000 miles…and when I traded them in, while not in pristine “showroom” condition, both looked (and ran) pretty damned good!

If I suddenly came upon a buried treasure, and thus had a pile of loot to spend, there are a few “toys” I wouldn’t mind having…a vintage Shelby Mustang Cobra and the “ultimate” home theatre come to mind. A no expenses spared world tour? No problem! But, not living in a fantasy land, I am content with what I have…except for never having enough new books!

When pushing my shopping cart down the aisles of Rimping Market in Chiang Mai, I dearly would love to fill that sucker with imported delicacies, but knowing what’s in my bank account, I instead sigh and settle for a few cans of chick peas, a jar of apricot preserves and perhaps a large bottle of red wine vinegar. Alas for my un-tasted Pepperidge Farm Chocolate Macadamia Nut Cookies and Ocean Spray Cranberry Juice!

So, while not nearly as frugal as my wife (thank God!), I am certainly not a spendthrift either. My father did manage to pound into young S2000’s head the necessity of “living within my means”. Neither I, nor any member of my family has ever been in debt, other than having the usual monthly bills which are always paid to the penny. That’s as true for me here in Thailand as it was in Farangland. I am filled with fear and loathing at the mere idea of owing money.

Since the amount of money I am earning here is considerably less than before, I have learned to compromise as much as possible…except when it comes to medical care! I’ll be god damned if I’ll compromise my precious little body for the sake of saving a few (or not so few) stinkin’ baht! My tee-rak has no such qualms. (I’ll get to the results of that sort of “thriftiness” eventually.) I suppose growing up as a dirt poor (and I do mean dirt poor) farmer’s daughter, she never had the luxury of much in the way of quality health care. That’s the reality for much of Thailand’s rural poor.

The prestige of being a doctor is even greater here than it is the west. In this status conscious country, becoming a doctor is beyond the dreams of most folks. It is an astounding achievement.

I certainly take my hat off to the entire medical profession: doctors, nurses, technicians…anyone who can help heal or save a life. They all get my respect.

That being said though, not all doctors are created equal…especially here in the Land of Smiles, where a fat envelope of money can do wonders for the matriculation process! The quality of hospitals can vary tremendously, from top-notch to well, “less than stellar”. While there are many genuine, highly skilled, up to date physicians in Thailand, quite frankly there are plenty whose qualifications are more on the par of the good doctor Hackenbush here.

Hey, somebody had to rank at the bottom of their class, didn’t they? In every country on the planet you will find “doctors” who have no business treating a goldfish, let
alone a human being! Even so, generally speaking, medical care in the developed world meets and often exceeds established medical standards. Here in Thailand, despite many highly qualified physicians, walking into a doctor’s office
or a hospital is often like rolling the dice. So my friend, as they wheel your gurney to the operating room, I have one question for you. Are you feeling lucky?

I’m using hyperbole folks. I have experienced the best and the worst that Thai medical care has to offer…up close and personal!

Not more than a few months after moving here to Lampang, I woke up in the middle of the night with all the classic symptoms of a heart attack: chest pain, difficulty breathing, sweating profusely, and numbness in my left arm. I knew it was a heart attack. I had had one some seven years earlier. And let me tell you, you do not forget what that feels like!

Luckily, a government hospital was only a few minutes away. Or should I say unfortunately. I was at the tender ministrations of an incompetent dotor who happened to on duty in the ER. This guy insisted that I was probably having a bout of indigestion. “EKG? You don’t need no stinkin’ EKG!” I was promptly rolled off to a crowded (and none too clean ward) and promptly forgotten. My symptoms worsened. Fortunately my wife had the presence of mind to call our best Thai friends. They were at my bedside within minutes, and had an ambulance transfer me to a Khelangnakorn Ram hospital (a private hospital!). There, the competent staff immediately knew I was in a critical situation. Even while I was being quickly rolled into ICU for stabilization, someone was calling Chiang Mai Ram Hospital advising them that I would be there as soon as
possible. Soon I was in another ambulance, practically flying up the highway.

In that fine medical institution, my soon to be “Best Buddy” Dr. Patarapong performed two angioplasties saving my life. Not to seem melodramatic, but I really was close to the edge that night. Dr. P. confided later that if I had gotten there much later, I probably wouldn’t be alive. Imagine the chagrin of the doctor at the first hospital I went to when I died of “indigestion”. That folks was my first introduction to the Thai medical system. With “friends” like my first “doctor”, who needs enemies? Sorry if I sound a bit harsh but when it’s my sorry ass on the line, “Cultural Sensitivity” is the last thing on my mind.

There is no doubt in my mind that I received the best possible medical care with Dr. “P”. I don’t think I could have been better treated anywhere else in the world. Not only is he a crackerjack cardiac surgeon, but the entire nursing staff is second to none. I have especially fond feeling for the operating room nurses who were a great comfort to me through it all.

Of course all this World Class Medical Care doesn’t come cheap, although arguably much less expensive than in Farangland. I like to joke with friends that at a private Thai hospital you don’t go home with a bill, but with a receipt saying the equivalent of Paid in Full stamped on it. I have three so far in my collection. During my most recent surgery in June of 2008, I joked with Dr. “P” as he was prepping me, “Hey Doc, isn’t this the buy two (stents) and get one free day?” The entire operating room was in stitches (no pun intended) at this bit of Farang “gallows humor”! Oh well, I suppose that yacht I had been eyeing wasn’t a real necessity; likewise that private jet I had been drooling over. I’m alive. What more can a guy ask for? I do think though that the hospital could at the very least put up a bronze plaque outside the door to their new angiogram machine saying, “made possible by a very generous donation by Sawadee2000!”

My sweet wife, while ecstatic that I am still among the living, nonetheless tends to blanch to a shade of white only promised in Thai skin cream advertisements each time she sees figures approaching infinity on my hospital statements. This is a woman I might add who goes over a cash register receipt from Big C with the intensity of an IRS auditor. (That’s the Internal Revenue Service to all you non Yankees out there…the tax collection people.) Actually though her single minded examination has yielded benefits. On my last hospital bill she found a 10,000 baht error…in our favor! Hmmmm. It kind of makes you wonder how many billing errors go undetected.

For my second round of heart surgery, my darling wife wanted me to go to a “less expensive hospital”, that is to say a “budget hospital”. “Why do you have to go only the expensive hospital?” Oh, you would have loved to have been a “fly on the wall” as I coolly and calmly explained my rationale for insisting on the best. Well perhaps not that coolly or calmly!

“Listen” I told her. “You really have to look at things from my point of view. During this surgery, I am awake, wide awake, experiencing the whole thing. I can feel the doctor snaking a cardiac catheter up through an artery in my groin, up into my beating heart. It is not what you would call lots of fun. By the way I’m watching the whole damned thing on a monitor. Next the doctor inflates my blocked artery with a teeny, tiny balloon, and you know it is not painless. In fact it hurts like hell. Then the doctor, places a teeny tiny plastic tube in that artery (a very expensive plastic tube, considering the size). Finally the doctor “gently tugs” the catheter out of my body, which doesn’t feel any better coming out than it did going in!

I am very lucky to have found an excellent doctor that I trust. He has done a great job at keeping me alive. So, why the hell would I want to risk my life by going to some fxxxing “budget hospital” with some unknown doctor who may or may not know his ass from his elbow, just to save some money? As long as I have any money to my name, I will never, repeat never set foot in any place but a private hospital…one where people know the fxxxing difference between indigestion and a fxxxing heart attack! Got it? End of discussion.”

Actually I didn’t really use the expletives, as my wife would faint at hearing such language…but I must admit that I thought them! She got the message though, loud and clear.

You can’t talk about Thai doctors without bringing up what these folks do in their “spare time”, that is when they are not working at a hospital. Most doctors here aren’t earning the kind of money that their western counterparts do. That’s why most doctors run clinics, which usually are open from 5:00 to 8:00 PM. Some open from 7:00 to 8:00 in the morning. They are always packed with people. These places are in fact where most Thais go for healthcare. Some are perfectly fine places, where a knowledgably doctor will treat you in professional manner. Others quite frankly would never be allowed to operate back in the west. In fact the worst of them should be required to hang a sign outside their doors: “Abandon all hope, ye who enter here!” When not faced with life threatening conditions, I have actually frequented a clinic or two…but only after checking out the credentials of the doctors running them. In a past submission, “Eye to Eye” I told how I had a cyst under my eye successfully removed. The doctor was young, spoke perfect English, and most importantly knew what the hell he was doing!

Not long ago I went to a clinic run by a doctor who is a parent of one of my students. I had been having some serious shoulder pain for months. It was was so bad that I was unable to sleep. Pain killers and massage did absolutely nothing. This particular doctor has special expertise in Sports Medicine, so he seemed the right guy to turn too. Once again, my doctor was young, spoke perfect English and knew “My ass from my elbow.” While waiting for my examination, I noticed that he received his medical training in the U.S. and had practiced at some prestigious American institutions. Why the hell was in Lampang? The answer is simple. He was born and raised here, and missed home. After a through examination, supplemented by a couple of x-rays, he explained in great detail about the nature of my problem. This explanation included some computer graphics and a cut-away model of a shoulder. I won’t bore you with the details. The important thing is that I had not torn my rotator cuff, as I had feared. My problem was essentially some muscle fibers that were in a state of spasm. The solution: an injection of an anti-inflammatory drug. The results: My pain was gone within hours, and has never returned. Total cost? 220 baht! (Not counting the x-rays, which were done for 300 baht at a place down the road.)

Now if I could only get rid of my other assorted aches and pains, I’d be set! Lord, have I really reached “that age” when I bore complete strangers with an account of my every ache and pain? Fear not, I’ll spare you the complete inventory. For the purpose of this piece, I will say though that these days that I often feel as though I’ve run over by a truck. I’m lucky that my wife gives one of the best Thai massages I’ve ever had, and even luckier that she often takes time in the evening to work the knots out.

Massage though hasn’t taken care of everything, so this past Saturday I decided to visit a clinic which specializes in Alternative Medicine. Hey, I’m a pragmatist. I believe in “what works”. If taking a sugar pill would make me feel better, then what the hell, I’ll go for it. Alas, the Placebo Effect has Zero Effect on me. Perhaps it’s because I’m such a skeptic…and there are soooooo many quack nostrums, therapies, and New Age crap out there, claiming the most outrageous cures. Still, if there is sufficient anecdotal evidence, I’m at least willing to listen…excluding anything to do with crystals, psychic healing and other such rubbish. Herbal medicine seems to be an area for legitimate scientific research. I think we all know a “herb” or two which contains some pretty amazing chemicals! There does seem to be an extensive herbal pharmacopeias out there worth investigating. I intend to take a close look at Chinese Herbal medicine. Here in the north of Thailand it’s not hard to find folks who are familiar with the practice. The same goes for acupuncture. That’s what I had done at the above mentioned clinic.

I had a number of acupuncture treatments back in the U.S., so I wasn’t apprehensive about becoming a human “pin cushion”. The needles used for acupuncture are incredibly thin, and I’ve never experienced any pain. Does the theory behind acupuncture hold any water? I’ve not the faintest idea if there is such a thing as “Chi”…and whether I have any coursing through me. But, there does seem to be a body of empirical data, which indicates that the practice may have some legitimacy. Oh well, for the piddling few baht it was going to cost me, I figured I might as well have a go. The lady doctor I saw spoke English well. She was also “all business”, poking and prodding me this way and that, checking my pulse and examining my tongue. She wasn’t pleased with my tongue. Not one bit. There was a lot of tsk tsking. Oh great, one more stinkin’ thing to worry about! Yes, I was one sorry case! I must say though that without being told, she guessed that I had heart problems, diabetes and asthma! Wow! Maybe there is something to this! But I reserved final judgment until after my treatment. So, after a 30 minute snooze while doing my best imitation of a hedgehog, I can say that I felt pretty good. My breathing was relaxed, my chest felt less tight, and my energy level seemed higher than it had been.

Was this the result of my treatment? I’m waiting to see if there are any long term results. I was encouraged enough though to schedule a second session. This time, if I’m “lucky” my doctor may attach some electrodes to the needles and fiddle about. Hmmmm, I’ll have to see how that goes! The doctor also promised me to see what Chinese herbs might be beneficial. Does this woman know anything that might be considered “genuine healing”, even if a little unorthodox? Is she nothing but a Thai Dr. Hackenbush? The jury is still out on that one. Stay tuned for a verdict down the road.

In the meantime, my wife has managed to find a whole slew of dubious doctors to turn to. Our little boy Sam, who will turn three next month, seems prone to frequent colds and fevers. My wife, being a good mother is always bringing him to one doctor or another, in search of a cure…or at least to confirm that he is not in imminent danger. I certainly can’t fault her for her concern. In this tropical climate, there are plenty of illnesses to worry about, Dengue Fever, among them. Occasionally we have brought Sam to the hospital (the private hospital!) in the middle of the night because he was running a high fever. He had even been admitted a few times, just to monitor his condition. Of course, (once again) private care costs more than what you get at a clinic. You would think my wife would just suck it in and opt for (what we hope) is a qualified doctor…but no; she keeps making the clinics her first choice when deciding on where to turn to for medical advice.

The usual “cure” just about anything is a course of antibiotics. I don’t have a medical degree, neither do most of you, but I think we can all agree that the purpose of antibiotics is to kill bacteria. That’s what they do, and all that they do! So, how effective do you think antibiotics are against the common cold or any other viral infection? What’s that I hear? Zero effectiveness you say? Go the head of the class of the class! You my friends know more than people who supposedly graduated from medical school. Thai doctors give out antibiotics like candy… “Just in case”…whatever the hell that means! I was with my wife when a pediatrician proscribed some for Sam “Just in case”! Just in case of what? The child has a cold. He has no bacterial infection. No strep throat or ear infection. Antibiotics work wonders on these. Our son has a viral infection. You (the doctor) agree. So what the fxxx do you mean by “Just in case”? Just in case the moon is really made of green cheese? Just in case the Tooth Fairy is real? Just in case all the laws of nature just flew out the window and now are on their way to Cloud Cuckoo Land? Is this what they taught you in Thai medical school? Is it only me who sees something wrong with this logic, or is only Sawadee’s “Western Cultural bias” kicking in once again? Do I “not understand” Thai culture…once again?

I keep trying to explain Science 101 to my wife, but still she believes that anything that comes out of the mouth of a doctor is the gospel truth. How can I, a mere layman know more than a “trained doctor”? That’s easy. A) I attended decent schools that taught science. B) I actually studied diligently in school. C) I read a lot, and what I read isn’t exclusively comic books…hell, many of them don’t even have pretty pictures in them. In short I have a good general knowledge of things that educated people should know…regardless of where on the planet Earth they reside…including The Land of Smiles. As far as I’m concerned, for a doctor to not understand what antibiotics are for borders on the criminal.

Last month, Sam myself and my wife had a cold, whose symptoms were taking their sweet time going away. Oh the joys of family life! In addition to the usual runny nose and cough, I had a severe
racking, painful cough. I thought that I might possibly have pneumonia. Did I go to a clinic for a diagnosis? No…I went to “my hospital”. An x-ray revealed that I didn’t have
pneumonia. What I did have was a nasty case of bronchitis. Here was an instance where antibiotics were called for. My condition cleared up in 48 hours.

A few days later my wife started having the same symptoms. Naturally I urged her to go to the hospital and have some x-rays taken. I bet you have bronchitis also. Did she listen to my well meaning advice? Noooo, she first went to a government “30 baht clinic”. The doctor told her that problem was that she wasn’t getting enough exercise. Even my wife thought this guy was an idiot. So, did she then take my advice and go to the hospital? Nooooo, she went instead to a clinic that had been recommended to her by a friend. This place was an allergy clinic, and wonder of wonders, the doctor there said her problem was due to allergy, and proscribed who knows what kind of medication. When her symptoms worsened, she finally decided to bite the bullet and go to the hospital. You will not be surprised to learn that she too had bronchitis. After a few days of once again an appropriate course of antibiotics, her condition disappeared. Has my wife learned anything from all this running around? I doubt it.

The Dr. Hackenbushes are doing a booming business here. A so called doctor down the road extols the efficacy of Homeopathic “Medicine”. That has to be an oxymoron if there ever was one. If I look hard enough, I expect I could find someone practicing leech craft, or prescribing magnetic “therapy”. It just goes to show a sucker is born every minute…everywhere!

Stickman's thoughts:

I am with you 100%. You have to stick to the good hospitals in Thailand!