Tick followed tock followed tick followed tock

T-0 - Delhi

My bandages were fresh, discharge set for 2PM and we waited. At 3 my consultant bade us au revoir and we were free but for the small matter of a large bill. A bill that in it's compilation took longer than The Domesday Book. First it was a two hour wait (incredulity) then another hour (incensement), wars have lasted less time. Indian efficiency and mindless, box-ticking beadledom was set to 11 and suddenly an extra hour on top of the 700ish already spent in the Apollo Hospital, Delhi seemed intolerable. We threatened (and nearly effected) a walkout which, credit to Indian resolve, speeded the process not one bit. I feel in hindsight and looking at the 37 page document that eventually arrived that the problem lay partially with the communication of the complexities of the task. How on earth the hospital accounted for 955 individual items on that bill I shall never know. From the syringe (7.7 rupees) and it's needle (3.1 rupees) to it's contents and the gloves the Doctor wore to do the injection, everything was here. It might have been easier to charge me for bandages by the mile. This gargantuan compendium could have been readied for the discharge time and the staff's intonations of "protocol, protocol" merely served to goad us further. But I am glad I can flick through it now with faint curiosity rather than mounting horror as I read the final page and it's total of 1,112,017.00 rupees (or about 15 grand in Britisher monies). I have also been issued with reams of documentation and X-rays (a hypochondriac's dream) done during my stay. Illuminating reading that reminded me of the (minor) brain haemorrhage I suffered during the fall and apprised me of the fact I have Spina Bifida in my S1 vertebrate, ho hum.
Suddenly I found myself sitting in a hotel bar wearing normal clothes and drinking a cold beer. My great, white swaddled leg allowed no fancy that the past month had all been a dream but certainly my world had altered once again. It was all taken in one's initial stride though and it is only later, now, at this ungodly hour of the morning that I contemplate my....unsettledness. No sleep has been had, the air con is too cold, too noisy, the pillows too soft, too different. Everything is too different and I am trying not to loathe it. One month in a hospital and I am institutionalised, oh dear. Suddenly I feel more invalided than I ever did at the hospital and am playing quite the mewling infant it appears. The outside world seems to leak in through every gap in the door and every chink in the curtains. Only now when everything sleeps do I feel buffeted by it and unprotected from it's uncaring bustle. I need rest really, my thoughts are piqued and contorted. These sleep-deprived entries never want for hyperbole though they do, I fear, for lucidity. Yes rest perhaps before I start screaming 'put me back!'

A white paper on healthcare reform

Day T-2 - Delhi

I've no love for private healthcare. For all its myriad imperfections the NHS can stand proudly (if not literally) next to the Great Pyramid as one of humankind's greatest wonders and most transcendent creations. Having been in the Indian health industry's life pricing clutches for the best part of a month i'm left faintly disappointed. For all intents and purposes and since I have insurance (thanks ma!) this experience differs very little from the one I would have had if I had thrown myself from a train back in the UK (or a less impossible but equally deleterious deed). Surely they're missing a trick here? My treatment won't be cheap but it has been standard, where are my choices? Wheres the menu Doc?
I guess i'm getting the best the hospital offers but how can I be sure unless there are clearly deliniated tiers of care? Health tourism is growing massively not least in the Subcontinent but apart from competitive prices whats the USP? The array of Doctors i've seen have done sterling work on my flayed leg and mutilated foot and my physical health has been most excellently attended to. The neglect lies with my mental health. Recovery is dull, long, unvarying, an unnecessary imposition on a person's receding idea of normality. The answer(s)? Keep reading.
Any person upon inflicting a heinous wound upon themselves (or possibly having said wound inflicted upon them, I only speak from personal experience) would surely dream of closing their eyes and on waking finding themselves fully restored, or at least restored to the extent that modern medicine permits. Induced comas must be the answer! My last month could have been passed in blissful ignorance of gaping, vacuumed heels, extensive skin grafts and modesty shredding ablutions. So theres our top notch offering right there "your family are weeping but you're sleeping!" (n.b this line needs work). The next option down the list might involve consciousness but a consciousness greatly enhanced. My last month was relatively pain free but barring a couple of pre general anaesthetic sedatives failed to be really mood lifting. For all the painkillers they've shovelled down my neck none have cheered my drearier days, none have expanded my mind. I thought I saw a familiar friend in the little vials of Tramadol amongst my cornucopia of chemical adulterants. Alas it seems a poor cousin to the stuff the NHS bunged me after a broken knee - back then I gently floated in seas of tranquility with the soft ripples of time trickling between my toes and caressing my outstretched fingertips. Imagine such relaxation combined with the occasional bed bath and you've practically got a spa. Perhaps spas could be the pioneers in this development of the industry? They already have the cucumber slices, get some doctors on the books, a job lot of morphine, a.....do you need a license to practise medicine over here?....i'm gonna say no, and you're set.
The next tier of treatment would be the one that I am currently receiving. The physical repairs are competant, the equal of those on 'Gold' and 'Silver' services (aforementioned) but you make your own entertainment here, you might be staring at the sky but there ain't no diamonds and its Lucy's day off. I'm afraid your recovery will be in what we call 'realtime'. A little like prison you'll have to serve every second of your sentence (n.b don't use ANY of this in the advertising materials). There will be drugs, painkillers you shall have but only enough to, well, kill the pain. Euphoria is off. Our Doctors will aim to maintain a status quo with regard to your pain, angst or suffering, you should experience no more than you would on an average (injury free) day. Bronze service might be long, it might be tedious beyond reason, it might result in some sort of psychological breakdown (which we can treat, for a fee) but you are saving the rupees.
The final tier is 'Lead' (might need to think of a non-toxic metal to represent this service) and is our most 'interactive' level of care. You're familiar with how everyone becomes an amateur Doctor when you have an ailment? Well silence their baseless and ill-informed pronouncements with some real hands on medical experience of your own, physician heal thyself! The Lead service keeps costs to a minimum by allowing the patient to take charge of their own wellbeing. As a patient you've seen your bandages changed a hundred times, "I could do that myself!" you say to yourself. With this tier of service you will be doing it yourself! No longer will you be a helpless bystander to your own recovery you'll be in the thick of the action 'getting your hands dirty' (latex gloves will be provided at extra cost). Doctors and Nurses can be hired by the hour (discounted rates for operations >3 hours) so you can keep in control of your costs and customise a healing programme to suit your needs. Do you need minor surgery? Can you assist? Then dispense with the support staff! The only limit to the money that can be saved is you (and your ability to stay conscious). There will likely be numerous legal waivers required with Lead tier and possibly some basic medical accreditation but I can see it revolutionising the medical industry. If you can sew a ripped seam you can suture a gashed leg.
I am convinced the future of consumer medicine has just been conceived. There are options to suit all budgets and tastes. Wanna sit the whole thing out? Go Gold and dream it all away. Wanna soar above it all? Go Silver and recline on fluffy clouds. Wanna read a lot of books and eat bad food? Go Bronze and count the hours. Got no money and nothing to lose (except your life)? Go Lead and pick up a scalpel. 

Included with this post a voucher for reclaiming 2 minutes of your life (5 if you`re a slow reader)

Day T-6 - Delhi
There seems to be a lot of shouting coming from outside my window. Either there is maintenance going on or the hospital has realised how grossly underutilised the roof space is and has created a new ward out there populated by the most vocal patients. The hands of the clock draw slowly around its face, 40 hours on the same piece of furniture, surely a new personal record. My new(er) wheelchair (freshly pilfered from the 3rd floor, kudos Attendant) stands forlorn and empty. All pleas for early release on the grounds of good behaviour have been flatly denied. It might be just me but the less you can do for yourself the less of a person you actually feel. I sit up, I lie down, 90 degrees of movement, 6 degrees of separation  from the person you were. All high melodrama really but also an injection of sensation into a vacuum of stimuli.
Anyway the doctors came and unwrapped my leg after 46 hours, a slow roast if ever there were one. For those of you more concerned with my physical health than the tiresome verbosity of my mental wellbeing they were pleased with what they saw (though,and to paraphrase, only a physician could love that leg). So...another milestone, back to a healthy quantity of holes in my body (9). I try not to look too far down the road of recovery because it seems awfully long and doesn't appear to be bending in a direction entirely favourable to my wilder ambitions. But somehow, in some part of my head, and I can't really explain this, i'm already standing at the end of that road, about to take a fearless and unhindered step. It' already happened because it will happen and each second that passes will be forgotten,will cease to be a meaningful unit of time or at best will be compressed and packaged up into a tidy memory of 'The time I fell off a train'. Time is relative, i'm sure someone smarter than me said that once.     

A meander of thoughts

T-8 - Delhi

I'm afraid the precise day of the trip on which we're on is impossible for me to pin down as time seems to pass in a different manner inside the walls of a hospital. I have therefore resorted to using possible days until discharge. Any stay beyond a few days in these places sees the familiar structure of your normal life break down or, more aptly, decay. The only constants would seem to be the times at which drugs are administered. Sleep is fitful and disjointed but is infinitely better than if I were on a ward with its perpetual twilight, its dimmed quiet. I like the isolation of this room, when the doors are closed it is my kingdom and I order it as I fancy. Of course there are limits to my power imposed by a pantheon of higher beings beyond the door. But they check my actions for my own good, benevolent gods if you will. I feel an odd contentedness this morning but I'm loathe to trust a feeling of positivity without knowing from whence it sprung. Has my favourite nurse flashed me her restorative smile? No sign of her. Have housekeeping replaced my aged wheelchair with a jetpack and turned the balcony into a launchpad? No, it's against hospital policy to open the balcony doors. Perhaps I've simply derived pleasure from the simple? From the completion of my morning tasks? Waking, taking my pills, wrapping a fresh dhoti around my waist. Nothing dramatic. Eating my breakfast, reading the paper, attending to my 'donor' (as opposed to doner) leg and its scorched skin (see below). Even something as insignificant as a bit of tidying, ordering the items on my bedside table gives a feeling of control in a wider situation in which I have little. Curious adaptation that, do we all grasp for a sliver of control even when we are largely powerless? Does it help us to reassure ourselves that we still exist, that we are still relevant? I tidy, therefore I am? It brings to mind my last extended sojourn in a medical facility. I recall reveling in the wonderful simplicity of my life for that period. All around was fervour and impotent anguish but I basked in the uncomplicated imperative of survival. It is different this time, 6 years ago the world beyond those disinfected walls seemingly offered little to me, I felt ensconced and protected from it's cruel vicissitudes. Nowadays these walls restrain me, hold me back from the world's wondrous possibilities. It's the same view out of the window as it was back then but now it's a different person looking.

Knock knock

Further to my previous post you may be wondering how all those people find sufficient activities to fill their time. Well wonder no longer, the list of tasks for maintaining just this patient is innumerable.I have cataloged a random day from around a week ago up until lunchtime. N.b. 'peek' denotes when a hospital worker opens the door to look inside but does not actually enter the room (the purpose is never known), the number in brackets is persons required for task.

00:01 - 05:45 Drip stand check every 45 minutes or so
05:45 - Blood test
06:00 - Tea
06:05 - Sheet change
06:10 - Drip stand check/robe change
06:28 - Housekeeping (2)
06:45 - Blood pressure check
06:49 - Tea collection
07:07 - Drip stand check
07:10 - Papers
07:30 - Drip stand check
07:50 - Drip stand check
08:05 - Peek
08:08 - Drip stand check (2)
08:14 - Breakfast
08:18 - Doctor's questions
08:25 - Peek
08:27 - Drip stand check (2), blood test, breakfast collection
08:46 - Doctor's check
08:55 - Medical supplies
09:03 - Leg dressing change (4)
09:50 - Cleanup
10:10 - Head dressing change
10:15 - Drip stand check
10:28 - Drip stand check redux
10:47 - Pain nurse
11:15 - Pills
11:35 - Blood transfusion
12:00 - Transfusion check
12:25 - Urine collection
12:35 - Blood pressure check

So you see a formidable army of staff must be needed to maintain such a schedule, pass the sleeping pills.

A hospital taxonomy

The Apollo Hospital in New Delhi employs a multitude of staff in various different roles. To aid in their visual differentiation they usually wear different coloured uniforms. I have described the types below according to my experience of them.

  • Blue Shirts - Generally unpossessed of English or alternatively forbidden from talking to patients. Quite lowly, frequent surly look may indicate dissatisfaction and possibly plans of uprising against superiors. Known wheelchair thieves, always be sat in yours or have hidden it in toilet when a Blue Shirt is around.
  • Red Shirts - Housekeeping. English also tends to be limited but is given freer rein than that of the Blue Shirts. If something must be picked up from the floor then these people must be called, no-one else is qualified. Sometimes employed as limb support during bandage changes with varying degrees of efficacy.
  • Yellow Shirts - Rarer than Red Shirts, possibly a sub species as have similar habits/habitats. Have not been observed in the wild often enough to form any firm conclusions, research ongoing.
  • Beige Shirts - Security. Main habitat is entrances/exits of hospital though a population also exists in the car park areas. Occasionally heavily armed but usually courteous, if you hold your hand to your head in a salute they will often mimic you.
  • Blue Tunics -  I believe these to be female Beige Shirts though  none carry visible weapons which suggests advanced martial arts skills or ability with spells/magic. Do not salute.
  • Green Aprons -  Catering. A very clear subdivision exists within the species, those who bring standard food and those who bring 'menu' food. Each will not clear the other's dirty dishes should they encounter them. Standard food consists of 3 meals a day although some days you may receive 2 breakfasts, 1 lunch and no dinner that is still 3 meals, consider hoarding. Tea is brought at 6AM whether you want it or not, whether you are conscious or not, probably whether you lived through the night or not (conjecture). 
  • Green Aprons (menu) - Bring food that is too spicy/flavoursome for ailing patients, strictly attendants (visitors) only. Should you tire of standard food the above rule can be circumvented by the following method. 1, Order desired menu food over the phone, no disguise of voice required. 2a, On food arrival if attendant is present no further subterfuge is required, wait for Green Apron to leave, consume. 2b, On food arrival if attendant is not present first explain their curious absence to Green Apron by pointing to the toilet* or indicating that they are smoking. Then with a wave of the hand (aim for nonchalance) direct the food to be placed somewhere in the room not close to you, this not your food and therefore you have no interest in it's whereabouts. Wait for Green Apron to leave, retrieve food, consume. *Green Apron may misconstrue and attempt to leave the food somewhere in the toilet, possibly in sink, try to prevent this. 3, On collection of dirty dishes make no attempt to disguise the fact that it was you that ate it. Do not attempt to explain continued curious absence of attendant, you will not be challenged. Wait for Green Apron to leave, delight in your cunning.
  • Pink Tunics -  Nurses. Always young, always female (though one is called 'Alan'), always from Kerala. The Doctors (see below) will refer to them as 'sister', they are not related. It is your choice whether you also choose to do this, having Afro-Caribbean ancestry may influence your decision. Main duty is replenishing the vast quantities of drugs and bandages you will require during your stay.Will offer bed baths, will not offer happy finish, don't inquire.
  • White Tunics - As above but <1 months training.
  • Doctors - No definable uniform though some wear shirt and tie combinations reminiscent of the magic eye pictures popular in the 1990s. You will likely have a doctor for each part of your body but the frequency of their visits will depend on your particular ailment, my belly button Doctor has been notable by his absence recently. Their main task is communicating via mobile phone (often delegated to Pink Tunics though) however they can combine this with other minor roles like surgery. Long hours have been known to make them lonely.

The Doors

A day - Delhi

I sit behind glass doors that won't be opened looking over a city that can't be explored. A famous philosopher once said that he'd rather be living in a cave looking at the Taj Mahal than living in the Taj looking at a cave, an interesting perspective. At least my confinement allows me to conjure fanciful notions of the world outside or, more accurately, my position within it. I am become detached from its ebb and flow, its bustle, its spin. My presence in that world is just that of an avatar, given life only by my imagination. All that I have ever done or ever might do seems superimposed when I look through the window at a planet that will not stop turning, where time will not stop ticking. Did I expect it to? Surely not! Such self-inflicted interludes have been my lot before. Perhaps never before though have I been so eager to to get on with the life that I have paused. But then of course I need only the briefest respite from daily reality to conceive the most fantastical ideas of how things shall be. Not a fault in itself, the lack of will to bring these things to pass (or even attempt to) a most desperate failing. A tearing, ripping, rending, soul-shredding bloodied mess of a failing. A silver bullet to the heart of undying expectation. I fear I am ever gasping for that extra gulp of air that no person gets. Always waiting to be waited for.

Red India

Day 0 - India

The Indians believe we we have reached the Age of Kali, the final dice throw when,

If the radiance of a thousand suns
were to burst at once into the sky
that would be like the splendor of the mighty one
I am become death
the destroyer of worlds.

Shame, I rather like India.

An apocryphal epoch in which to visit this this vast wedge of land with a history all of its own. It has endlessly fascinated me since I first visited, indeed it may well be the impetus for this particular journey. I have endeavored to understand the people, the culture, the esprit du corps. I have thus far failed but wholly enjoyed the toil. The dubious British gift of bureaucracy lingers and we had come together as a small band of travelers in the Kandy visa office to collectively curse, pray and wonder at the process by which we'd earn our entry sticker. After what seemed like, and was, hours we had the approval we needed, a paltry three months but surely sufficient baring any mishaps. An Aussie named Patrick joined us on the evening bus back to Colombo and regaled us with his adventures around South America, mental itineraries subtly shifted eastwards. We bade farewell to Sri Lanka, our first stop, after an uncomfortable night at the airport. It's a country I should like to see again in a decade or so and I will be interested to see if the people have hardened along with the concrete of the highways and flyovers.
Though there was never any notion of a schedule I hate to feel i'm falling behind with this writing. Minor details slip from memory and it seems like such a chore to start up again and so retrogressively recount. But then again there was intended to be a more abstract theme to this than previous scribblings (abstraction is always a crowd pleaser....). Perhaps better that the pure literal is lost and what remains is the amorphous taste of experience. We shall see perhaps.
From our landing point of Trivandrum (not its official name but that is beyond the scope of this article) we caught the train up through Kerala to Kochi (one of, I believe, four alternative spellings). It's a tropical, palm-fringed part of the country with extensive backwaters and an agreeable calm. The European influence is evident in the Fort area as successive waves of Portuguese, Dutch and English assumed control. It's also hard not to notice the hammer & sickle icon plastering walls and structures and though denoting (or promoting) a democratically elected and seemingly well run communist government it brought to mind the many swastikas I saw in Sri Lanka and reinforced the power of symbolism on us as humans.

As I write now, looking out over Delhi and its sunrise it is clear how any linearity of travel or writing has been abandoned. With a tube putting fluid into my left arm and another tube drawing it from my right leg things, one could safely say, have taken an unexpected turn. Such turnings make me feel like a naive, hubristic fool. Ever championing life's wonderful, unpredictable danger and arguing against those people who resist it. Did I feel such a pioneer laying on my back in the rail ballast, the train's emergency brakes screeching in my ear, my right leg ripped asunder? I couldn't tell you, the actual memory of the event sits in some inaccessible part of my brain or is lost forever perhaps precipitated by the twin gashes on the back of my head. Certain though is the fact that the first couple of days afterwards followed the familiar pattern of cheery, self-consciously stoic denial of consequence. OK so I fell from a train (rarer event in India than one might suppose) but it wasn't far from the ground and the thing was slowing for a station, what real harm? A lower right leg near stripped of skin and a butchered heel that wasn't just going to snap back together. Such hospitalisations have been far too common over the last ten years, to screw up one leg is unfortunate, to screw up two looks like carelessness. I detest the tag 'accident prone' yet I cannot help applying it to myself as my body collects ever more scars and impediments from misadventure. This can't continue, this fleshy form, which I treat with no particular daily reverence anyway, will not recover from every injurious dare I put it to. In short I shall end up a broken, bittered fool. My days may be much like this, resting in my wheeled seat while a nurse affectionately pats me on the head and brings me another tea.
I haven't walked in a week, I've rarely missed anything so much as I've missed my mobility. Having to call someone to complete the most basic tasks for you is a terrible vision of elderly decrepitude. Still, the wheelchair was heaven sent, the first few days limited to the 3' x 7' space occupied by the bed in my room sent me to the very edge of my sanity. It wasn't long before hot, wet tears of frustration doused my face in an uncontrollable flurry that, I think, was reality making its firm grip known. My throat lumps now to think of the emotional nadir. But a certain balance has been reached between actuality and aspiration and I feel better for it. Perhaps that is why I feel able to open up to my leather bound counsellor. I'm wary of epiphanies and resist the presumption I'll ever be anything but a wanton knave but....I feel improved. So I can't tell you much of India, I can tell you of drip stands and drug cocktails, of bed baths and bed pans? Not delectable reading I suspect and likely to smack of more self pity than any of us could stomach. So maybe I shall leave it here, still looking out of my Delhi hospital window as the sun chases the morning shadows and the chorus of hoots starts up again. Stay safe.