November 25, 2006

Health Care in a Thailand International Hospital Versus Health Care in the USA: The only difference is the difference between night and day
I (Mark's Mom) once worked as an office nurse for Dr. Tom Masters in Springfield, Illinois. A better doctor never existed. We actually ran our appointments on time. He studied each medicine a new patient was on to determine if the patient benefited from it or not and made certain that each client from the governor and the CEOs whose physicals we did to our elderly nursing home clients and the guys in the jail he and I visited got what they needed and were well informed about their health status and needs. Occasionally, a new client would ask a question like: " Doctor, it wouldn't make any difference if I did "x" instead of the "y" you are suggesting, would it?" Doctor Masters would get a serious expression on his face and peer down at the client and say: "The only difference would be the difference between north and south." That expression comes to mind as I think about the care Mark received at Bumrungrad International Hospital in Bangkok compared to the care he is getting and will likely get at the VA hospital and the care reported to me by friends including nurse friends.

I have to ask "What has happened to nursing (as well as health care) in this country?" The Thai nurses seem 100% compassionate, caring, respectful and always ready to help you. Your IV monitor beeps and you don't have to ring a bell. The nurse or aide comes to fix it. Far too many American nurses give the impression they are way too busy to help anyone, even in situations where I see them chatting with each other and moving at a snail's pace. Recently, when Mark had waited way past his appointment time and been begging to lie down at the VA, a nurse implied he could not be in pain as his blood pressure was not up. Doesn't morphine and compazine lower blood pressure and isn't it possible other factors allow a patient to be in pain without elevated blood pressure? A while later , I asked the nurse if she could estimate how long before Mark would be seen. She said: "I think you can have too much information." Mark finally solved his need to lie down to get relief from pain in his chest due to tissue and bone damage from the chest wall tumor and 15 very recent radiation treatments. He went out into the hall and laid down on the floor. This action caused a flurry of activity and produced a place to lie down in the treatment room. His appointment was at 9 and he was told he must not report in later than 8:30 sharp. He saw the doctors at 12:30 and I must say the doctors were exceedingly respectful and compassionate as were some nurses in the treatment room. By the time Mark left the oncology clinic and waited in line at the pharmacy three times and waited until his number came up to wait in line, it was 4:30 when we left the VA: a long day for a very sick young man who still had to ride the 3 and a half hours back to Austin.

Other stories of nursing care in Austin Texas and elsewhere: After thyroid surgery in Austin, a friend reports that she rang the bell for pain medication. She could not talk above a whisper due to swelling from surgery. The person at the desk said: "Speak up. We can't help you if you don't speak up." No one was sent to check on the patient and pain medication was a long time in coming. Another nurse friend on vacation recently in Colorado had an occluded ureter and could not urinate and was in pain. She reported that the emergency room staff treated her as if she were a drug seeking addict. The nurse who catheterized her, took only a specimen and did not empty the bladder. When asked why she had not emptied the bladder since the patient was unable to urinate and was uncomfortable, the nurse offered to do another catheterization. There also seems to be a rash of people falling off of guerneys or being dropped in transfer from guerney to bed . The hospital staff often say they are way too busy and too overworked to help a patient especially with something like getting a tooth brush out for someone told not to get out of bed after surgery. I had this experience in an Austin Hospital. "Everyone is busy and can't help you." Why did I find this hard to believe when after asking for a hour for the tooth brush whenever someone came into the room, one nursing assistant who was too busy to help me, spent a long time telling me that she had bought a farm and all about the farm and then asked if she could have my potted plant if I didn't want it. A social worker wandered in eventually and got the tooth brushing equipment for me. How can nursing education and nursing texts and journals in the USA claim the nursing profession is still all about compassion, caring, thorough head to toe assessments, and holistic nursing when nurses and nurse's assistants today are "way too busy and overworked to listen to and attend to client's needs "? Today in the USA you never know if you will get a compassionate, caring, competent nurse or a Miss Rachet behave-alike from One Flew Over the CooCoo's Nest or something in between. What's your opinion? I invite comments/stories from anyone who agrees and from those who don't. Your thoughts are important!
PS FROM MARK - "So sorry that I can't answer e-mail right now. I am trying to get the pain under control and get some healing of my chest. When I am able, I will e-mail you all. Thanks for all your support. It means everything to me. " Mark

November 19, 2006

Mark is back in Austin.
Not at Amy's ice cream like the song goes, however he was Chuy's for lunch and out later for a short time (8 pm until 11) to listen to music at Artz Rib House and in the 6th street area : all these short but important adventures with his friend Ken Walker who came over from Mississippi with his brother to visit with Mark. Ken has moved to Mississsippi to help his brother care for their mom. Although Mark is in pain, isn't out of bed more than three hours at a time, and his energy level is way down; he plans his rest and sleep and medication so he can get out a bit and make life seem worth living. Friends, both old and new, are extremely important to him and he loves live music, so isn't it neat that he is in the self-proclaimed live music capital of the world: Austin, Texas . Mark did have to cut his visit with Kenny short one day because of an appointment with the oncologist in Houston. He gave up going to look at motorcycles with Ken to see about treatment at the VA. Mark's friend Ken is a neat guy: retired bank examiner. His brother works for google.

Our trip home from Bangkok was very rough. Through a series of e-mails to the Bangkok United Service team, I had arranged good seats on a United flight home as well as a wheelchair for Mark. We arrived at the new Bangkok airport at 4:30 am. There was no wheelchair and we stood in line only to learn that our packed flight had been cancelled. We were instructed to go stand in line in the Japanese airline lines (JAL) to get another flight. We were 4th in one line. None of the lines were served until 7 am. Although we were 4th in one of the 6 or 7 long lines of people trying to get on this flight due to the United cancellation, we could not have a seat with extra leg room. Eventually we got a wheelchair for the trip to the distant gate. There is little or no compassion for anyone traveling who is ill or needs anything special unless you are traveling business class, which we were not. The airline staff on this trip frequently reminded me of cattle herders prodding the cattle to be in line and load up for the cattle car. Even fellow passengers can't be counted on for compassion. I was trying to load a heavy carry on bag of Mark's in the overhead bin. The stewardesses and stewards were yelling at people to get out of the aisles and get things in the over head bins or under the seats. Ever try to load a heavy bag in the overhead while out of the aisle? I nearly fell over the back of my seat trying. No offers of help from men around me. A guy loading the food carts onto the air plane finally helped me and the stewardess yelled: "That's not his job. He can't do that", but the deed was done. Thank-you Lord for compassionate people. We were 4 hours late getting to Tokyo and lost Mark's chance to rest there. We had to run a long distance accross the airport to barely get on the plane. We were late into San Francisco and missed our flight which was a straight flight to Austin. Again, no wheelchair which I had ordered. The agent at the gate looked his list over and said no we were not on his list for wheelchairs and acted like it would take an act of God or intervention from the CEO of the airlines to get one so Mark walked. He can walk but it just saps his energy and causes him pain. We then had to stand in another long line to be re-routed and a leg was added through Denver. While I went to the bathroom, Mark apparently began to look so pale and in pain that a nice couple in line made him go sit down and told the agent that he really had to have a wheelchair. Ironically when we boarded the plane I was able to trade seats with the husband of this couple who helped us so they could sit accoss the aisle from each other instead of far apart. What goes around comes around. Right? Do airline employees reap good or bad karma depending on how they treat passengers? It is surely possible.

After our long hard trip home, Mark had about 18 hours rest before heading to Houston on Wednesday for a bone scan on Thursday. We'll leave again for Houston today (Sunday) for an appointment with the oncologist on Monday. It is good he was able to have some outings with friends yesterday...otherwise life would just be a series of struggles with airline employees and hospital staff who have no compassion at all and are doing a job for a paycheck; a life of waiting in airport lines and waiting in hospital waiting rooms. When your life is shortened, it seems a shame to have to spend so much of it just waiting.

November 12, 2006

Last Day in Bangkok Mr Mark has less than 24 hours in Bangkok left. It is 3 pm here and about 4 am, he and his mom head for the airport. Once more he gave away most of his belongings and packed up his clothes and a few gifts that readers of the blog sent him and is prepared to head for the states. He is very sad to leave Bangkok and his doctors here after 21 months of treatment. His doctors have done a wonderful job of keeping him alive. Mark was scheduled for a last minute check at the hospital today but cancelled it saying he needed to save that 100 dollars and he was going on the plane no matter what anyway. Last night he got exhausted with just a small amount of shopping three blocks away and had to come home in the taxi, so I contacted the airport and arranged a wheelchair. He may not use it, but we will be prepared. Wish us luck and good karma as we take off on our 24 hour journey home.
November 8, 2006
Recent Loy Kathong Festival in Thailand Mark was too sick to go to the Loy Kathong Festival this year on Nov. 5th . He planned to go and wanted to go, but he was in too much pain and tired. He went last year. Mom went this year with friends.
This festival, sometimes called yee ping or the festival of lights, has been celebrated since the 13th century and it is believed by some that a young queen Nang Noppamous in ancient Kingdom of Sukhothai made the first small boat with candles and incense and floated it away on the water. Some people believe the ceremony is to express gratitude to the goddess of the water for use of the water and for poluting it and for providing the bounty that comes from the water. Others think it originated as a ceremony to show respect to the Lord Buddha's footprint on the beach of Narmaha River located in India and to the great serpent and creatures of the lower water world.
Loy means to float and Krathong is the lotus shaped man made creations that float on the water. The Krathong is made of layers of the trunk of the banana tree and banana leaves and other plants and flowers and holds a candle and incense both of which are lighted before making wishes and floating it away. This is considered a very romantic occasion for couples as those who wish together are believed to stay together thereafter. Some people put coins on the Krathong and some have told me that they put a bit of hair or nail clippings on the Krathong and believe it floats away their troubles. Large balloon lanterns are also floated away through the air in hopes troubles will float away. This festival is on the full moon day of the 12th lunar month usually in November when the rivers are at their highest level and the moon is bright. (see This Website for more information about the festival.)

November 06, 2006

Brings Bizarre Symptoms and Strange Puzzles...

For months Mark has complained of something in his chest and finally it became big enough to be visable to the eye. Dr. Sunantha Ploysongsang did 15 radiation treatments to the area while Mark was also getting chemotherapy with Dr. Theera Umsawadee. After radiation, there was still a goose egg that at first was hard then soft and looked like a lump coming to the surface. Dr. Sunantha said it could be the tumor liquified or it could be an infection or something else, but using caution she did not want to open it and attempt to drain it. During our trip to Chang Mai you will recall that the evening before returning to Bangkok, the thing burst open and Mark had a lot of green drainage. He went to the hospital immediately on arrival in Bangkok and had an incision with a drain left in. He had a Culture and Sensitivity (C and S). He has been very worried about this whole deal thinking he might get an infection of the bone in the area or something worse. He went on heavy duty antibiotics to cover aerobic or anarobic organisms.

Today he had no drainage for the first time and the tissue is granulating in. The C and S showed only slight candida which would not explain the green drainage. We were all expecting a finding of something like staphlococcus. We are back to the idea of a liquification of the tumor. Doctor had applied the term cellulitis to the small area of redness and slight swelling in the area...but it never looked like the cellulitis I am familiar with in patients hospitalized with this condition. Today Mark showed me the bizarre symptom of gooseflesh (goosebumps) on only his left side of his body and not on the right. So strange to see goosebumps on only one arm.
Mark got a Cat Scan today to see if there are pockets of pus inside yet or anything else out of the ordinary in the chest. He sees the Infectious Disease Doctor tomorrow and hopefully also gets the results of the Cat Scan. For those interested in cost comparison: the cat scan, interpretation, radiologist's fee, Dr. Theera's fee, medication, and out patient facility all came to $371. The OPD fee was $3.33 We would celebrate such a small bill but it is only Monday. We won't get through this week without at least spending $1000-$1500 on medical care. With all this work toward getting to the bottom of the problem and no horrible news so far on his chest problem, Mark seems less worried and has perked up a lot.
Tuesday November 11 Today Mark is more worried and very tired of all the treatments. Dr.Mondej (Mohn Dai) the infectious disease doctor saw Mark and managed to get some yellowish drainage to culture for mycobacterium and other unusual things. The initial look under the microscope revealed nothing but the cultures will take 2-4 weeks. Dr. Mondej showed Mark the rotating view of the cat scan of the chest. There is missing cartiledge and bone and some invasion into the pleural space of the lung. This really depressed Mark. The doctor decided Mark should have something newer and better than Diflucan in case there is monilia albicans further inside his chest. He mentioned it would be expensive. I tried to get him to estimate how much but he ignored me. At the cashiers the price was revealed: $1,000 for a course of this medication for fungal infection. Mark decided to wait until we meet with Dr. Theera and Dr. Sunantha see if this is absolutely necessary or he can make do with Diflucan at 10 dollars a pill - which is not exactly cheap - until he gets evaluated at the VA in Houston next week.

November 02, 2006

Chang Mai Royal Flora Ratchaphruck 2006
Mr. Mark, his helper Jin, and I came to Chang Mai to see the International flower exposition. The King has a phenominal involvement in flowers, plants, and agriculture. On a miniscule scale by comparison, Mark loves flower and plants and has some beautiful well cared for ones which he will leave with Jin, along with his parakeet Petey, when he returns to the states.

Day 1 in Chang Mai. Jin and I bought tickets for the tomorrow's day of Royal Flower Expo by standing in a line at the bank for over an hour. First day tickets had been sold out for a week. We went to the Chang Mai zoo and watched the Panda Bears for a long time then headed up the mountain to visit a temple and next a modern, clean store selling beautiful inexpensive produce from the King's farms, where we ordered several kilos of beets and avocados to take back to Bangkok for a friend who is opening a restaurant. On our return to Bangkok we each had a carry on of beets, avocados and some hard to find new red potatoes that we tracked down in the back alleys and warehouses of vegetables: a sharp contrast to the store selling the King's farms produce.

Day 2 (First day of Expo) Jin and I took a long tuk-tuk ride out to the Expo thinking we might get tickets if we stood in line a couple of hours with thousands of people. We encountered no line and got right in. The gates for Thai people and farang (other people) are separate, but I went throught the Thai gate with Jin. We called Mark to meet us but he said he was too sick.

At the Expo we walked for miles viewing flower displays from Japan, Bhutan, Viet Nam, Indonesia, Quatar, Spain, the Netherlands, Africa, etc. There are acres and acres of land and exhibits from many many foreign countries. There is a rubber plantation as well as many buildings and gardens full of spectacular flowers and replicas of the homes of different tribes of Thai indiginous people and music and dancing and water displays and sculptured trees and lawns and beautiful girls in their native dress.

After walking 4 hours, we sat for 3 hours on a grassy hill directly accross from where the Princess would sit for ceremonies and entertainment. We were in a sea of Thai people wearing yellow shirts (yellow is the color of the king). Searching the crowd I could only find two other farang (foreigners)). Foreign dignitaries from all over the world were seated in front of the queen on the approach to the palace like building which had many steps up to it. The arrival of the princess and the entertainment was spectacular. Jin and I were on Thai television waving at the cameraman.

Day 3 (second Expo Day) Mark went to the Expo today to see the orchid named for the Queen and the smallest orchid in the world as well as the rarest ones and the worst smelling one. The special orchids, in two huge air conditioned rooms and adjoining gardens, were spectacular and Mark was fully enjoying seeing them. At one point, I had my back to him. He was sitting on a railing. A lovely Thai lady asked me in perfect English: "What is wrong with him?" I turned around and Mark was slumped over, looked pale, and was having difficulty breathing. He managed to pull himself together enough to drink some orange juice and see a few more orchids that were must see for him and make it to a cab to go back to the hotel. After being in bed the rest of the day, he looks better.

November 3...Mark is in a lot of pain. His chest wall tumor that was radiated opened up and is draining and we head back to Bangkok and chemo again.
Remember that you can post a note to Mark on the blog (Click the "comments" link right below this paragraph). No need to mail him anything in Bangkok as he will soon be in Austin again.