Mumbai; In which Sheryl is a celebrity hospital patient (for better or worse); A billing and administration nightmare for me

Sheryl had been admitted to the hospital at midnight, and since then she’d been in the most awful pain and torment. She couldn’t eat, drink or sleep. She was poked and prodded at all hours and suffered various insults to her privacy. The vomiting and diarrhoea continued for three days. She was on an intravenous drip for re-hydration and nutrition for her entire stay, and while she improved bit by bit each day, she couldn’t keep solid food down until just before she was discharged.

She was in constant misery, and spent most of the four days tightly clutching one of her various friends, totems or good-luck charms: Spidey, Ganesh, Pumpkinhead, or one of her shells or rocks. I felt so bad for her - she was like a lost and bewildered child (in between her fits of violent temper, which only I got to witness - fortunate soul that I am). We set up a little shrine to Ganesh and gave him offerings of chocolate muffin, digestive biscuit and gum - the best we could do for sweets. The nurses loved it.

The diagnosis was a severe stomach infection, which was a surprise to no one. She was told that she’d left it far too long without seeing a doctor, and that the three-day course of antibiotics she’d taken earlier had been nowhere near enough (again, no surprise - we’ve come to the conclusion that Western antibiotics offer the same resistance to Indian bacteria as a puppy does to a tiger).

Food, too, was another nightmare. None had come by the late afternoon of the first day, and so I went out walking for three hours to find food and water. I got completely lost and walked in a huge circle around the Juhu suburb in the sweltering heat before managing to find a restaurant. I brought back bananas, plain daal and chapattis, thinking that they were bland enough. While I was gone, Sheryl had ordered something up to her room, only to have the hospital canteen immediately start badgering her for payment. Whatever she’d ordered - some sort of sandwich, I think - was too disgusting even to look at, let alone eat. This is the mess I returned to, in a foul temper.

No sooner had I settled that than, perhaps triggered by the row, the regular hospital dinner arrived. It was all a waste in the end - the nasty canteen sandwich, my restaurant food and the regular meal alike - because she couldn’t eat any of it. The regular meal was some sort of rice dish, and Sheryl is allergic to rice. Her hospital doctor was told this and said he’d give instructions for a special diet. Where was he, and why was no one following his instructions? He’d been nowhere to be found since his initial examination, but naturally he made his appearance just as she was about to try and eat one of the chapattis I’d brought, and demanded to know where the food had come from and why Vineeta wasn’t providing home-cooked food. I’d had very much enough and lost my temper, snapping at him that he clearly didn’t understand the situation - that we were travellers and didn’t have the luxury of home-cooked food, whatever his assumptions about our relationship with Vineeta, and that for this much money a private bloody hospital ought to be able to feed one of its patients properly, and that this needed to be sorted out now.

That got him off our backs, but I was later to find out that, of all things, he’d just gone off to call Vineeta’s doctor to berate him, who called Vineeta to chew her out. Poor Vineeta, who hadn’t signed up for any of this, who’d just assumed she’d be providing us a bed for a couple of days, who had no obligation to us at all, and who had troubles of her own and certainly didn’t need to be chewed out by her doctor. I’m still completely unclear on the reasoning - why on earth should it be Vineeta’s responsibility to provide food for Sheryl instead of the hospital? What an asshole.

In any case, one result of the argument was that we finally got a short interview with the staff dietician. She listened to Sheryl’s list of food allergies, read her medical report, and agreed to set up a diet of bland, soft, non-rice food to be delivered in small, frequent snacks throughout the day instead of three heavy meals. This caused another interdepartmental failure of communication when the hospital canteen, naturally, demanded payment for each snack as it came. Even after that was sorted out it only worked for two days, after which her meals inexplicably reverted to the usual. This hospital has serious problems with administration.

The staff were nice, though. They all loved Sheryl, except for one nurse with whom there was an instant mutual hatred - don’t ask me why. Sheryl was a celebrity patient. The nurses (all of whom were addressed with the honorific “Sister”) would all come and chat with her and practice their English. Even the cleaners were nice, with only one exception - a creepy guy who was always coming into the room and pretending half-heartedly to swipe at something with his broom while stealing bug-eyed looks at Sheryl. He’d just arrived from the country, maybe. He behaved like a brain-damaged, mouth-breathing idiot, and was shifty besides - he was always trying to peer into our open bags, and even flipped back the top of mine once to see what was inside. We didn’t trust him for a second, watched him carefully any time he was around, and made sure we never left our things unattended (second nature by now anyway). He got bad enough that we were on the verge of demanding that he be kept out of the room. What’s worse, he was always trying to mooch tips. Every time he came in on the pretext of swiping his broom around he’d stay standing at the door, staring, grinning stupidly and trying to shake my hand until I’d have to actually usher him out the door. Just before we left the hospital he made a gigantic pain in the ass out of himself looking for a tip. What a creep. I didn’t need the signs in the hallway asking patients and family not to tip the staff - the day I tip someone in a hospital!

The whole hospital was very strange. The standard of care was fine, but it the environment was alien to me in a lot of little ways. There were the “No Tipping” signs and the “No Spitting” signs. There were the stairs covered in sleeping cleaners at night. There were the nurses in bare feet. There was the coconut that came for lunch one day, with a hole drilled in it and a straw inserted. There was the view from one window of traffic and the view from the other of a slum full of tumbledown shacks with overlapping sheets of plywood and corrugated metal for roofs and walls and goats and filthy children playing in the sewage. Tied to the room as I was by the billing issues and Sheryl’s misery, I felt assailed by the weirdness and the incessant demands and intrusions from the staff, cleaners and administration. That feeling that I’ve had the whole time I’ve been in India, of having to play a game with obscure and constantly changing rules, was intensified until I thought I’d go crazy with it. Sheryl could hardly help, and so I felt alone and embattled. I don’t know what I’d have done if Vineeta hadn’t visited every day despite her own troubles and the long trip from Malad to Juhu. It wasn’t until the third day that I was able to escape for a couple of hours to one of the cafés down the road.

Against the backdrop of the real medical drama, there was the distraction of the billing nightmare. It started the morning after Sheryl was admitted, when the pharmacy came up to the room with the bill from the night before - 1200 rupees for supplies and equipment. The man with the bill had no English and I had to drag him with me around the hospital from reception to billing until I could get them up to speed with the travel insurance and to agree to have the hospital pay their bills, instead of paying piecemeal out of my pocket.

I found out in the process that this hospital has never had a foreign patient at all - ever - let alone dealt with a foreign travel insurance company. They never for an instant stopped demanding instant payment. I had to fight a four-day-long defensive action, running frantically up and down the stairs and elevators to the basement billing department to buy time to sort out the insurance details.

This wasn’t easy. The insurance company required all the medical records, a form to be completed and signed by the doctor (not an easy man to find at the best of times), and an itemized bill - all these to be faxed to them. At that point they’d evaluate the case, decide if it was payable, and only then could they proceed to payment. The hospital, though, wanted their money instantly (notice that they were demanding payment even as we were still incurring charges). Through extended and delicate negotiations with the head of the billing department, a woman named Doctor Diptha, I managed to gain assurance - I thought - that a document of guarantee of payment from the insurance company (a legally binding document) would satisfy the hospital and get them to stop demanding payment. The insurance company was only prepared to offer an interim guarantee of payment until they were able to channel the medical records through their claims department, but I’d been assured sotto voce by one of their nurses that the claim sounded as if it were fully payable.

To complicate matters, though, I discovered quite late that the hospital wasn’t able to make international calls or faxes - shocking and sad, when every corner call-shop has that capability. It was up to me to co-ordinate between the hospital and the insurance company and make all the arrangements. I quickly burned through all the airtime on our phone and a 700-rupee phone card we’d bought and had to resort to calling people, asking them to call us back at the hospital, and then asking them to call the insurance company and telling them to call us. The hospital sat on their inability to fax the insurance company the necessary documents for two days, actually, and this was bad news for me, because it meant we had to find alternate arrangements. In the end the insurance company had to send an email with an encrypted document to the hospital, and gave me the password for the document over the phone. The document contained instructions on how and where to send the scanned medical records, and a strict injunction to, under no circumstances, send the records as a reply to the address the email had come from. Any attentive reader can guess what the hospital did, but our contact at the insurance company was kind enough to bend the rules and forward the records to their claims department.

Our insurance company’s agent (Assured Assistance, Inc.) was fantastically supportive and helpful, and I highly recommend them to any Canadian for travel insurance. In the end, though, most of their efforts and mine were in vain. The agreement I had thought I’d obtained, that the guarantee of payment document would be enough, turned out to be some sort of misunderstanding or error in translation, and the hospital now refused to allow Sheryl to be discharged until the money from the insurance company actually appeared in their bank account. Because they’d been so sluggish in sending the documents, this misunderstanding didn’t come to light until the morning of the day Sheryl was due to be discharged. I know international wire-transfers, and I know the glacial speed at which they progress, and I knew that the money wouldn’t come through for a week, at least. There wasn’t a chance in hell that I would let Sheryl stay in the hospital even one extra day when she didn’t need to - racking up more charges by the minute, which the insurance company would then have to pay, in a sort of financial Xeno’s Paradox.

We’d already had a dispute over the amount of the bill. We’d moved Sheryl to a less expensive room when one became available halfway through her stay, to keep the insurance company happy. That meant she’d been in the expensive room for two days and the cheaper room for two days. Imagine my surprise when I examined the bill on discharge day and discovered that we’d been charged for five days - three in the expensive room and two in the cheaper room. On storming down to the billing department for the thousandth time and inquiring with grinding teeth as to the irregularity, I was told that it was hospital policy in the case of room changes to charge any fractions of a day at the full day’s rate for both rooms. Our attempt to save the insurance company (and possibly ourselves) money had resulted in a higher bill. After four days of frustrations and difficulties, this latest evidence of the hospital’s mercenary business practices was the final straw, and I made enough angry noise to have the extra charges (about Rs7000 or CAD$175) removed from the bill.

Whatever the final amount, the hospital still refused to let us go without cash in hand. I understood their position - for all they knew, it was some friend of mine on the phone, pretending to be an insurance company and assuring them of payment. Finally, I was able to convince the billing department to agree to an arrangement - I’d leave a cash deposit to cover the amount of the bill (some Rs40,000 - about CAD$1000) to be redeemed when the wire transfer came through. Even getting them to agree to this was a major victory, since originally they would only countenance a deposit refund by cheque - which would be a useless piece of paper to me, needless to say, as a foreign national with no way to cash it. The deal would mean that I’d have to carry 40,000 rupees around with me in my money belt for the months it would take to spend it, but it was the only arrangement we could come to that was anything short of disastrous for me.

Finally, late in the fourth day, we’d jumped through enough hoops and Sheryl was enough improved that we could finally get her discharged. Vineeta and her “uncle” Atul came to pick us up in his car. After four days in the frigid hospital air-conditioning, Mumbai’s 35-degree temperature and humidity was unbearable and we were very grateful for the ride back to Vineeta’s apartment, where Angie the yellow lab nearly gave herself a stroke, she was so excited to see us.

Sheryl wasn’t up to much, of course, but she was able to visit with Atul for awhile. Atul’s a very cool guy - around fifty but fit and active, well-travelled and cosmopolitan, intelligent and liberal. I got the impression that he was something of a retired libertine (or semi-retired, perhaps).

Sheryl was worn out from her illness, and I from the unrelenting tension and complications of the last four days. Neither of us had had much sleep since Sheryl was admitted, and that lack made itself felt just as soon as we were able to relax. We could only handle a couple of hours of conversation before we had to make our excuses. Fortunately or unfortunately, we were stuck in Mumbai until the wire transfer came from the insurance company and we were able to recover our deposit, and that removed the pressure to be back on the road and moving immediately.

Flourish

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Chris Liberty - Dispatches from a Gentleman Adventurer
Being the internal dialog of a vagabond who chased his own tail across five continents for 4 years and 2 days from May 2008 to May 2012, in search of something that never really became clear.
This travelogue comprises 16,426 photographs and 402,515 words in 307 dispatches written from 335 places in 52 countries on 6 continents around the world.
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