A Thai hospital saves a Wyomingite’s life (and finances)
By Wayne Thomas For Wyofile.com
I made a spontaneous decision to travel to Southeast Asia after nabbing a pet-sitting gig in Oahu, Hawaii. I was looking for a change from Wyoming, and after booking my flight to Honolulu, I made the decision to stretch the trip west and go to Thailand for some exploring. I’d completed a master’s degree in photojournalism in May and the main thing waiting at home was a discouraging job hunt.
I’ve had the travel bug since 1991 when I toured Mexico with a college choir. We ate and slept in the simple homes of the audiences that came to see us perform in their churches. It was eye opening for me as an 18 year old, and at 39, I still look for that sense of amazement and wonder. Asia seemed like a logical and easy destination.
The next day I flew eight hours to Tokyo, waited four hours at the airport and flew eight more hours to Bangkok. It was my longest flight by double. I became nauseous on the first flight and developed a stitch in my left shoulder and collarbone when I inhaled. I didn’t give it much thought except to moan about it whenever I could.
“It will pass in a day,” my 20-year-old mind said to my nearly 40-year-old body.
I checked into a cool guesthouse on the outskirts of downtown Bangkok and ascended two flights of stairs to my room. Before I even got the door open, I realized I was gassed. It was like hiking through heavy snow at the top of the Beartooth Pass. In Bangkok, however, I was at or below sea level so altitude was not my problem. I had hiked in Hawaii just three days earlier and had no difficulty breathing on the steep trails. But now these two flights of stairs were too much for me. I was noticeably out of breath.
I slept that night on my right side, because the pain in my left side hadn’t passed in a day as I had hoped. While I waited for sleep, I listened to guests laughing downstairs, a ukulele strumming an island melody and the motorbikes buzzing by. It all reminded me that I had seven more weeks of travel ahead with lots of walking and adventure. The next day I climbed those stairs just enough times to realize that something was not right. I needed a quick checkup by a doctor. Reluctantly, I dragged myself to the guesthouse reservation desk where they recommended Mission Hospital. I hailed a cab and was on my way.
As we pulled up to the hospital, a doorman appeared and opened the car door to guide me to the registration desk. A friendly Thai woman welcomed me. She spoke good English and wore a pastel blue uniform straight out of the 1950s. I signed in and was directed to the waiting room. At home this is always a grueling step. The waiting room can easily suck hours from your day and seemingly days from your life. I scanned the area thinking that it must be Easter. Rows of pastel yellow and blue padded chairs lined up facing a nurses’ station set so precisely that even Disney would be proud. There was a TV playing Thai soap operas with such overdone acting that I thought for a moment I was in India. I settled in for a long wait, but after only 15 minutes I was called to see the doctor.
What followed was a series of tests designed to rule out major issues like heart attack or collapsed lung. Early on they saw from the EKG and a blood test that something was wrong. The CT scan was the final test. It showed blood clots had lodged in my lungs. I had a pulmonary embolism. I had heard the term before, but I didn’t realize how bad it was. When the doctor started an IV and told me that I would need to stay in the hospital for at least four days, it dawned on me that I had a serious problem.
Even after learning that I had a life-threatening condition in my lungs, it was my financial health that scared me most. Scratch scared – terrified is more like it. As I waited for each test result, I checked the Internet on my phone to keep up with what the doctor was saying – and to assess my hospital’s standing in Thailand’s medical community. Through my quick scan of websites, I read phrases like “medical tourism” and “highly regarded” and “major medical destination.” Even my Facebook community was reassuring. I kept hearing that I was in a good hospital.
I was ushered by wheelchair into the small office of a short well-dressed gentleman resembling an accountant. He displayed for me choices of hospital accommodations including room size and meals, with escalating prices in Baht (Thailand’s currency). I chose the cheapest option available and then was asked for a 15,000 Baht deposit. That’s just under $500, although I was not clear enough about the exchange rate to know that at the moment. I was sitting in a river of perspiration as I pried my credit card from my wallet and handed it over. Later, I would see that my blood pressure skyrocketed during this time.
Given what I knew of medical care, I had every reason to be worried. In the United States a CAT scan can range from roughly from $1,000 to $3,000 depending on the clinic and location. According to a 2004 study by the Agency for Healthcare Research and Quality, an average overnight hospital stay costs about $10,000. By the time my first week in Asia was finished, I had been treated for four days in a hospital and a fifth day in tests. My best guess was that my bill at home in Wyoming would have been $60,000 with follow-up treatment and medicine.
To make matters more alarming, I am an independent contractor, which currently means I don’t have a full-time job and can’t afford health insurance. My last medical insurance coverage ended with my time in graduate school four months earlier, as the university required all students to be insured.
The first day in the hospital, my doctor came by to visit and update me on my situation. His name is Nick Walters. Dr. Nick, as he is generally called, is from California. He was the same doctor who ordered most of the tests and is one of the nicest doctors I have ever experienced. He is understandably very busy. I watched patient after patient stream into and out of his office. But when I was talking with him, it seemed like he had all the time I needed. He was all smiles, full of empathy for the fact that I was spending my first week in Asia at his hospital. I quickly confided that I had no insurance and was concerned about the cost of this treatment.
He kept smiling and told me that my bill would be what many people pay as a deductible in the United States. I couldn’t believe it. But after searching the Internet and inquiring with friends that have been here before, I began to realize that I might be in for a pleasant surprise.
I had chosen the cheapest accommodations and therefore had no TV, DVD or refrigerator. Expecting a humid room with moss growing on the floor, I found it was more like a small hospital ward at home. Three beds spaced evenly on one side and a single bed on the other between the utility closet and the bathroom. I had a curtain I could pull for privacy and a bed that would tilt, lift and probably tuck me in if I could find the right button.
The nurses were patient and friendly, although I had a more difficult time communicating with them than the doctor. My Thai is nonexistent and their English skills weren’t great. But we made do. The little discomforts were the same as in every hospital. I was prodded awake in the middle of the night so someone could check my blood pressure, temperature and oxygen levels. I was even poked awake for a 5 a.m. blood draw.
Most of the little miscommunications with the staff were quite ordinary. I could imagine similar issues at an American hospital. (I paid especially close attention to what the staff did, but I am not as extreme about it as a friend back home. He has the letter “L” tattooed on his left foot and “R” on his right.) I’m nervous in the hospital, but I know I’m not the only one.
After two days the doctor removed my saline drip. I felt free. I roamed around at will and even walked out of the hospital to make pictures on the King’s birthday as revelers streamed past the hospital.
On my last day at Mission a short, well-dressed man in glasses meekly came into my room with welcome news of my discharge. He presented me with my itemized bill. Besides the surprise that each mealtime brought from the hospital cafeteria, a – vegetarian creation that looked like sausage, and the morning bowl of rice swimming in a watery fish-like juice, this was the moment I dreaded most.
As I opened the bill, I thought of my car that needs replacing, the monthly payments I would have to make to a hospital on another continent, and the fact that I might not get another vacation for five years. Then I saw the total and final amount owed: $2,500. Not that this is a small amount of money for me, but it doesn’t spell doom, the way $60,000 would have. I was even able to negotiate the price down a little bit by paying it in full with a credit card – and by paying for a membership fee to the non-profit hospital.
In the end, Dr. Nick gave me his contact information, in case I needed to ask any questions. He sent me away with paperwork and a disk with information for the next doctor I encountered on my travels. I had required weekly checkups wherever I went.
As you read this, I will have moved on to Laos or Cambodia. I had my first checkup with a hospital not long ago in Chiang Mai. My blood readings were perfect. By the way, that checkup cost $100.
I am scheduled to return to Wyoming in January, but since I am on medication for six months and will have more follow-up visits with a doctor, I am seriously considering extending my stay. I miss my loved ones back home. But I don’t miss the snow – or the prospect of big medical bills if something goes wrong during my recovery. Dare I say it out-loud, but nurses in ’50s style pastel uniforms might even make my travel highlight reel.
Pulmonary embolism is typically treated as an outpatient in the US with Lovenox (an injectible blood thinner) or newer oral medications. While the CT scan is likely to be more expensive in the US, you would have avoided a hospitalization. The total cost to treat a PE should be similar to costs you quote in Thailand, perhaps even less.