Belle Vue Clinic, Preventable Medical Disasters, and Stoic Lessons

(Photo: Dirty Bunny)

[Warning: This post is one of my rare rants, perhaps my only rant, written last week when the reality-bending fury was fresh. Almost never seen, like a snow leopard, my angry self has come out to stretch his arms a bit, perhaps punch a few deserving people after warming up. The reasons — primarily the safety of other people — will become clear shortly.]

SEPTEMBER 25, 2011, CALCUTTA, INDIA

SAFE AT THE OBEROI HOTEL

Earlier today, a hospital superintendent snickered and offered me a feedback form if I had complaints. I declined, as I figured this blog would be a faster way of getting the message to the CEO in question, P. Tondon. Mr. Tondon, nice to meet you.

Forthwith, our promised programming…

The Power of the Checklist

Atul Gawande is an outstanding surgeon, Associate Professor of Surgery at Harvard Medical School, and author of “The Checklist Manifesto,” which details the power of checklists to prevent catastrophes or simply improve outcomes.

From the prevention of airplane crashes to decreases in hospital-based bacterial infections, having a clear, repeatable process is key. I read his book while flying to Amman, Jordan, and I ensured beforehand that I knew exactly where the best hospitals were close to our hotel, the fantastic Evason Ma’in Hot Springs. It’s as simple as calling the US embassy or consulate (if that’s your nationality) via Skype before you land. Here’s a list for your future use.

This week, I violated my own process: I didn’t check on hospitals before traveling.

“Ah… but where to?” you ask.

To Sweden? No, sir. To Japan? No, ma’am. I landed in Calcutta (Kolkata), India. Home of Mother Theresa and pathogens galore.

Ultimately, I ended up spending 3.5 days in two ERs and hospitals.

Before I explain the comedy of errors that led to this post, a few caveats to flavor the haterade for the anonymous ankle biters we affectionately call “trolls”:

– After 30+ countries visited, I don’t believe I’m a spoiled American. Puking on the floor of Chinese hospitals? Check. Getting probes and pokes (not that kind) in Argentina? Done. I’ve roughed it plenty of times and know the world isn’t covered with linoleum.

– I’ve been in dozens of hospitals and ERs around the world, had multiple surgeries, had food poisoning 4 or 5 times, and spent hundreds of hours with MDs for The 4-Hour Body.

– There were a few heroes in the following story, so this isn’t “us versus them” nonsense. Among the heroes: Pawan, our guide; Dr. Gunjanrai from Belle Vue, who saved our asses; and all of the friends I traveled with, especially Dr. Kareem Samhouri.

The Avoidable Pain of Poor Checklists

Preamble complete, here’s an abbreviated version of what happened:

– I ate a usually delicious local Bengali fish, Bekti, at the Tollygunge Club’s Belvedere restaurant, which my girlfriend Natasha later dubbed The “Tollygrunge” Club.

– Diarrhea and vomiting ensued through the following morning, as did fevers. I hit 101 and Natasha passed 102. I made the executive decision to go to the hospital for, at the very least, intravenous (IV) fluids.

– To stabilize my girl, who was incoherent, and avoid 1-2 hours of traffic, we first visited the closest hospital, the name of which I can’t recall. Now things get interesting.

– Enter war zone — Dr. Sumon and Dr. Chatterjee admit us to the ER. Natasha is wheelchaired in and put on a cot. No vitals are taken besides blood pressure. One of the doctors then alcohol swabs the arm, to prepare for IV insertion, following by slapping her forearm with the bare hand he’s just coughed on. I stopped him to correct course, as I had to do so with both doctors multiple times. Eventually, once her IV was delivering saline solution and lost electrolytes, I had to lay down, as I’d declined an IV and could barely stand. My only choice for rest was a cot with dried urine all over it, which Kareem covered with a towel. Who says chivalry is dead?

– The good news: when we leave, the grand total cost is 150 rupees for both of us, or about $3 USD.

Round Two at Belle Vue Clinic

– We leave for a reputedly much-better hospital, Belle Vue Clinic, where we’d be meeting an expat specialist named Dr. Ghosh. Sigh of relief. Natasha is still delirious and nonsensical, so I’ll be the only one coherent for our first day there. The pamphlet for Belle Vue Clinic is seductive:

Equipped with the finest resources of medical science, the clinic’s emphasis is on relief, reassurance, recovery and rehabilitation.

At Belle Vue Clinic, a patient is not a bed number. He or she is consider as a member of the Belle Vue family. A scrupulously clean and homely ambience is provided. There is always service with a smile.

– Without further ado, here are a few highlights from our slapstick treatment. Keep in mind, Belle Vue has good materials and drugs on hand. Their “Rules and Information” brochure reads “44 years of proven and trusted medical care of international quality.” In retrospect, I realize that “international quality” could mean “From St. Lucia to Somalia, we combine the most preventable mistakes possible.”

The following are process fuck-ups:

* Upon being properly admitted, a “sister” — or nurse attendant — takes my armpit temperature without paying attention. It’s half in contact with my shirt, resulting in a 98-degree output. “Fever, ne,” (“No fever”) she says and starts to walk away. I yell for her to wait, pull an electronic oral thermometer out of my pocket and repeat the drill: almost 102. “Fever, yes.” She later insists twice that I have no fever, until the doctor puts a hand on my forehead and settles the matter in my favor.

* Natasha had a terrible reaction to pain medication they administered, Drotin® (drotaverine), and collapsed on the floor that night after going to the bathroom. No one was watching her properly, so I had to leap out of bed with my IV and help her get up. They administered it the following day and Natasha’s temperature skyrocketed and she began to shiver uncontrollably. I called Dr. Ghosh, got no answer, and did what I could: tell all staff to absolutely NOT administer any more Drotin. When Dr. Ghosh arrived around 7pm that evening, I told him the same, which he said he’d note and convey to all staff.

That evening, as Natasha was falling asleep and I was going to bed, a nurse comes in with — guess what? — a syringe of Drotin to give Natasha. Fortunately, I wasn’t in the bathroom and intercepted it.

* Natasha ran out of toilet paper — as we did several times, which diarrhea will do — and rang the call button. The sister who came in asked her to use water instead to wash off. My girl, as I would hope, refused. The sister then took a dirty towel she’d used to wipe Natasha’s feet and offered that. Again, no dice. Eventually, we got the toilet paper with a chuckle of “fussy” in English. Bonus anti-hygiene points: The bathroom featured a used bar of soap from the prior occupants and nothing to dry your hands with.

* The second or third afternoon, Natasha’s feverish temperature was put in my chart, resulting in them attempting to switch our medicines. I had to make the correction.

* Critical requests for water (we’d been instructed to drink a certain number of liters per day), IV bag changes, IV blocks, etc. often took 10+ call button rings over 30 minutes. Calling Dr. Ghosh, as he encouraged us to do “anytime” did little or nothing, as he didn’t pick up 90%+ of the time. If he did, he said he’d speak with staff and then nothing changed. This meant we had no reliable English or supervising physician at the hospital until Dr. Gunjanrai rescued us by sheer good luck. Achtung: there appear to be quite a few people who speak English at Belle Vue. I’m not being an uppity entitled American; they had the capacity to triage this, even if it meant making the dietician, who was outstanding and spoke excellent English, our point person at additional out-of-pocket cost.

* Dr. Samrat Chatterjee (I ALWAYS write every doctor’s name down when being treated) enters our room to tend to us: a blood draw for me and a new IV for Natasha. He points to Dr. Kareem Samhouri, my friend who was visiting during proper hours, and says brusquely without looking at him, “You can leave,” while pointing at the door. I make it clear that Dr. K is my physician on the trip and listed as next of kin: he’s staying. Dr. Chatterjee then starts taking my blood sample and refuses to answer any of my questions, which focused on an odd yellow liquid in one of the collection tubes that mixed with my blood. Then to Natasha: Dr. Chatterjee rushes into the new IV insertion as Natasha screams in pain. He laughs and tells her she’s overreacting, repeating “fussy” with shake of the head. Later, when Natasha’s forearm skin swells up like lemon holding liquid, Dr. Gunjanrai will try and aspirate (draw out) blood from the IV — nothing. If you can’t get blood out of an IV, guess what? It ain’t in a vein. It’d been pushed into the tissue and several liters of fluid had been forced into Natasha’s worthless sham IV.

This is Natasha’s sham IV arm one week later.

Dr. Chatterjee, you’re a motherf*cker and should have your medical license revoked. Hopefully this post gets you part way there. You’re welcome.

* The next day, my IV clogged at least a dozen times. Somewhere between 6-12 times, I was therefore given “Hep-Lock,” named after it’s principle ingredient, heparin. Heparin can be quite dangerous, fatal if you overdose, and neither the nurses or Dr. Ghosh were remotely concerned. The blocks were blamed on me getting up to go to the bathroom or on me bending my arm. My left arm was so swollen and red from heparin that I had tingling in my fingers and couldn’t straighten my arm.

Dr. Gunjanrai, our repeated savior, replaced my IV when she removed Natasha’s sham IV. Problem fixed and perfect flow. No blocks. The only issues that cropped up were, again, process-related. On two occasions later, there was no drip; the nurses wanted to use more Hep-Lock (not a chance), so I used sign language to show they’d forgotten to put an additional needle in the IV bottle to create necessary vacuum and flow.

* On our last morning, we were to have fasting blood draws for follow-up testing. Natasha’s blood was drawn but mine was not. Since Dr. Ghosh had told us the night before we’d both be tested, I asked the sister, who replied with “Not you.” But yes! About 30 minutes after I’d finished breakfast, I was told that I’d have a sample drawn (we also had our temperatures taken right after we’d downed water). “Doesn’t it need to be fasting? Typically 8-12 hours?” No problem, I was assured.

Now, I’m no MD, but I’ve had compared hundreds of my own blood values. Blood readings taken 30 minutes after eating are not the same as from fasting. Not even close.

The End Result

We survived.

Even though I was more coherent than Natasha, I was a mess of delirium. My diarrhea was about three-times worse that hers (by frequency), I vomited more, and there were some episodes I won’t describe here, as they’ll make you nauseous. To maintain hawklike spider-sense while incapacitated, quality-controlling everything to avert disaster, is taxing beyond belief.

No one should have to do it when such simple measures can fix it. All of the above issues can be fixed with proper protocols and checklists. This is not the first time Belle Vue has had serious process screw-ups. Read this appalling news flash of a newborn baby declared dead, only to be later found alive.

But perhaps Belle Vue is too poor to make things work? Not likely, at least not based on my bill.

Cost: about $1,350 USD per person.

Dr. Ghosh’s fee? Almost 50% of each bill. Extortionary. He’s an outstanding ER physician, and he’s saved many people with horrifying injuries and infections. That said, if he’s almost never available to his patients (us in this case) and can’t manage staff to follow his life-saving directions outside of his 7-8pm visits, his expertise does next to nothing. I suspect he’s amazing when on the case 24/7. In our case, it was as if he weren’t there. 50% of the bill is an insult.

Dr. Gunjanrai’s fee? Less than $20. Give that woman a raise. She’s a superstar. I know she doesn’t have Dr. Ghosh’s credentials, but she fixed every problem she encountered, undid the messes created by others, and did it all with a Zen-like calm that made us calm. That’s a good doctor.

P. Tandon, fix your hospital. If you didn’t know already, now you do.

If you choose inaction at this point, you should be charged with premeditated homicide.

Here’s your feedback form:

The Bright Side

Experiencing pain allows you to appreciate pleasure.

Looking at the creature comforts of San Francisco, the world-class medicine I perhaps took for granted, my experience in Calcutta was a useful recalibration.

Getting the Belle Vue treatment is not necessary to increase your appreciation of what you have. This should be a principal goal in life, of course, as gratitude will determine your happiness more than achievement. In fact, Stoic philosopher and master statesman Lucius Seneca encouraged his students to practice poverty for precisely this purpose. From Martin Frost’s excellent introduction:

The second type of apathetic training proposed in the Moral Epistles is practical training, which is essentially a Stoic modification of a common Epicurean practice. In Epistle 18, Seneca informs Lucilius that Epicurus frequently set aside a number of days in which he satisfied his hunger with cheap food. The goal of this exercise apparently was to develop enough self-sufficiency that he would be able to remain happy, regardless of what his circumstances might be. Using this example, Seneca similarly advises Lucilius to practice extreme poverty for limited periods in order to test the ability of his mind to withstand the loss of his wealth in the future.

Although Seneca does not expect this type of practice to go on indefinitely or to be too severe, he makes it clear to Lucilius in Epistle 13 that it should be more than just a “mere hobby” that rich young men might play to “beguile the tedium of their lives.” Even though it is meant to last for only a few days at a time, the method should be harsh enough that it can prepare the subject for the most extreme reversal of fortune—the possibility of utter destitution.

Rehearse worst-case scenarios and they lose their power over you. Practice what you fear and ask all the while: “Is this the condition I so feared?”

You’re more resilient than you think.

The Tim Ferriss Show is one of the most popular podcasts in the world with more than 500 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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278 Replies to “Belle Vue Clinic, Preventable Medical Disasters, and Stoic Lessons”

  1. Tim

    Glad to see you and your friend are both back safely. We take for granted the lifestyle and quality of medical people in North America. That being said I like how you ended your post. Going through something like this especially on purpose will trigger the mind to become strong.

    Stay healthy and get some rest.

    Leonard

  2. Tim…

    …we need you to stay alive!!!

    …and that from a man fast chasing 70 years olde!

    …Next trip, you either take your personal physician, or me to be your man Friday to take care of you.

    …extra thankful you’re still here

    …very much appreciate your writing

    …one problem with this post, though…where’s the rant

    …read like you were just telling the truth

    …taking the night train from Switzerland to Paris a few years ago, I’ve my own story 🙂

    …glad we’ve both lived to tell about it.

    …keep writing…I’ll keep reading…and take good care of that girlfriend…what a trooper

  3. This may have been pointed out already, but I just wanted to single out the comments I have read saying “Wow, reading it is far less scary than the situation actually was”…? For me, reading this was *fricking terrifying*. So being there on the ground or hearing from it live as it was happening must have been stupidly intense. I’m glad everybody’s okay.

    Can we put together a fund to bulldoze the facility you were in and turn *that* into a library? Just asking.

  4. Wowzers

    Great post Tim!

    Got a new vocabulary word for you:

    iatrogenics: Disease or death (iatrogenicide) caused by medical examinations or treatment. i.e. doctors, drugs, hospitals.

    Errors abound in hospitals because of the constant rotating shifts of doctors, nurses, med students, many of them working 18 hour days nights.

    Care providers get tired, mixed-up, distracted, some of them don’t know what the flip they’re doing, and some just don’t care.

    What might surprise a lot of people is that iatrogenics from drugs alone is the third leading cause of death in the U.S.

    When I was in the hospital in 2003 for colon cancer at 26 years old, I remember telling one of the doctors, “Man you look worse than I do!” (That was the morphine talking) Seriously, he looked like the walking dead. Yellow skin, dark eyes… I remember thinking “How is this guy going to get me well?”

    If malpractice, unsanitary hospitals, etc. are added to the tally of drug related deaths, one could make a strong case that iatrogenics is the leading cause of death!

    Dr. Gary Null (Death By Medicine) is an authority on this subject.

    Glad you and your lady didn’t end up completey iatrogenified!

    (((c)))

  5. Natasha’s arm… if that happened to my girlfriend I would’ve tore some new holes in people. That’s F*ckin ridiculous.

  6. Sincerely glad you’re both ok Tim. I read 4HWW earlier this year and follow your exploits and advice closely. On that note, any advice on what to watch out for to prevent getting sick from food poisoning in India?

    btw: The way you looked out for Natasha was inspiring. Something I’ll keep in mind when I think I’m “too sleepy” to do anymore.

    Take care!

    Raj

  7. This is so unusual that it happened because of having cooked (I’m assuming) fish. During my multiple travels to Bali, Egypt and other countries where we are not used to the bacteria I always pay attention and never have raw vegetables and tap water. And in your case it was fish…

    Scary.

    I’m glad you’re both better. I hope you’re enjoying your vacations!

  8. Tim

    I know of so many people who went to India and almost died. I have travelled troughout Asia and lived in a few places and to be honest Bagkok is as far east as I will go from now on ! I pushed my luck last winter in Cambodia and was feverish a few days and also a bit of vomitting and liquid coming out of everywhere.

    Yes they all talk about Incredible India bla bla bla … But you know what there are other places in the world where I can see incredible things .If I want a spiritual journey i have no need to risk my life in a place like India.

  9. And one more thing about the far east… Always make sure the food is hot…or your noodles boiling. Stay away from eating fish, clams or oyster, stick to rice, chicken and beef well cooked.. Stay away from milk and milk products especially in China where they are known to add agents , forget salads and mellons full of waters. Eggs well cook are fine….but stay away from buffet scrambled eggs

    And dont assume because the restaurant looks 4 stars and the floors are all marbles that the food is without risk ! The local corner shop with 5 tables full of locals can be a better choice if you see they have lots of business and reasonably clean tables and floor.

  10. Mr Ferriss,

    I am a great fan of your work. Sorry to hear about your plight. I have had pretty nasty medical experiences in Calcutta. The last one being my maternal grandmother who had severe abdominal pain. The doctor gave her iv pain meds without even bothering to do imaging, or even basic work up, she died last month. I am an MD myself, and fully picture this happening, not only to you, but also to thousands of patients. I strongly encourage you to get your article published in the Indian media so that stringent action could be taken. As Dr.Jerome Groopman points out in How Doctor’s think patients should question their doctors always- what else it could be ? is there anything which does not fit ? But I guess these questions seem remote in your case, where even basic medical care is not delivered, bedside manners, care and empathy were oblivious of its absence, the hospital violates its own mission statement. It needs to come to the light of public attention.

  11. Sad you guys had to go through that, and though I would unequivocally feel the rage just like you, it is not surprising because I have an idea how health/medical systems are in other parts of the world. (And I would not be considered well-traveled).

    Aslo that one can encounter unsanitary nurse/doctor (dentist in my case – shudder) everywhere (even in the US).

    What I am completely taken by is one of checklist – hospital near the hotel? I can see why people would think it is a wise idea, but…this also means that you anticipate your rushing to the hospital or the ER (and not for research purposes)??? I have a couple of friends who travel the world extensively for pleasure, and do not recall hearing any “hospital” stories.

    I’m sure the author of the blog understands what energy law I am referring. After all, is not one’s energy the same main factor in one’s financial success???

  12. That is one of the worst hospital nightmares I have ever heard and by all accounts in reality it was even worse! Shocking. Glad you and Natasha are both ok now. Though clearly mentally scarred forever! Not quite sure how you had the wherewithal to document everything, but then you are super-human!

    Goes to show that even if you had all the money in the world (I know you don’t but you’re getting pretty close 😉 it can’t help you if you’re in the wrong place at the wrong time. We all like to think we’re invincible, but sadly we’re not. Guess the saying: ‘Fail to prepare and you prepare to fail’ is annoyingly apt right now.

  13. Hi Tim,

    Talking from travelers point of view-I was flight attendant for international carriers for 8 years,traveling from one continent to other in a week, if not in matter of days.

    However,i totally vision your experience.Poor skilled doctor in a western named hospital…god knows how he ended up there.

    My similar experience was in London-Uk, had a stomach virus.

    Doctor was called in, checked me and he left after 5mins.His words, you got Stomack virus,take paracetamol and plenty of fluids.

    Damn,take fluids??? reaching the toilet with crawling from my bed was like climbing to Mount Everest…:) it was that painful.

    I asked him while he was leaving..thats all? He looks back,shaking his Head and say’s you will be fine..i got to go..:((

    Luckily experience saves you sometimes and you deal with the problem.

    Wish both you and your girlfriend to stay healthy..

  14. Tim,

    Has this dampened your traveling spirit? Or only convinced you in the superiority of better checklists! Safe Travels

  15. @ T Fizzle,

    I would have to disagree with you – in that this is not a rant session – but a valid warning for anyone who might have gone to Belle Vue Clinic in search of medical tourism, or like you, because they had to.

    Think of how many people you could be saving from your same experience – who knows if you have saved a life, saved someone from infectious disease, or just from a bad experience.

    I endured light surgery on my left arm with no anesthesia at a hospital in David, Panama – and sat in the emergency waiting room in Panama City, Panama for hours as my face infection made me look like the “elephant man” and blocked me from breathing properly, only to be turned away because the nurses didnt believe it was an emergency and had more urgent matters to attend to, like texting and eating.

    However, I would recommend Hospital Punta Pacifica in Panama City – which is affiliated with John Hopkins International Medicine.

    By the way, any girl who can endure vomit, diarrhea, passing out, and being stuck with needles…is probably a keeper:)

    “pretty pretty fren”,

    Thomas Crown

  16. Glad you’re not dead because I was really looking forward to The 4Hour Chef, and more random shows. That was serious, you seemed to have more patience than most people.

  17. Sometimes Visiting or Change of place may cause this problem. As i am having the experience in health care and hospitals, I didn’t see that much bill in my life for emergency food poisoning.The average biil might be not more than 500 dollars. That’s only because you non natives.

    If you can give one message , any of ur followers in culcutta might be take care of this time

    I hope you are ok.

  18. Tim what’s happened to you? You went from an adventurous, bootstrapping worldly travel to a high-maintenance, hypochondriac. Haven’t you ever heard a little Cipro, tons of water and a few days of suffering. Ridiculous post. Get over yourself.

  19. So, basically, what you’re saying is:

    Someone could make a mint creating an app that would tell you where the best hospital is – per ailment – based on your gps position in the world.

    Glad to hear you and Natasha made it out of this alright.

  20. Jay, I was just thinking the same. Someone get on it!

    If I have time, I may…I love the idea of a project that might actually solve a problem. Seems like this could come in handy for a lot of travelers.

  21. Tim,

    Great to hear you both made it through.

    A very important, and unacknowledged, lesson of your experience is to make sure you are educated and not to let doctors bully you. You are your own best advocate. People, especially under distress, are too often willing to let others dictate to them, even if they realize that something wrong is being done.

    It must of been doubly tough to stay aware under such condition.

  22. What a nightmare! I’m looking forward to more stories from Roman when I meet him in NYC in November. I sure hope you had a good reason to go to India and it was half worth the agony you all went through.

  23. A few quick points in order of importance:

    1. I’m so very glad that you and your girlfriend are ok!! If y’all are still healing up, heal up quickly!

    2. Thank you for your anti-troll preamble. Especially the “it’s not us v. them” part. As an Indian-American, you have NO idea how much I appreciate this. I know that both the US and India have their respective(if not at times, similar) problems, but framing it as a nationalist or racist incident does nothing to solve the problem(s). Thanks for being a better person than the morons who would’ve blown this out of perspective and the doctors who mistreated you and your gf.

    3. Just wanted to say thanks for being such a great person. If anyone of Indian/Asian descent throws anything negative your way, let me know and I’ll handle that crap myself. (Not saying that you can’t handle it, just saying you’ve got some back-up if you need it).

    You’ve earned my respect a long time ago. Let me know if there’s anything I can do for you.

    Cheers,

    – Varun

  24. Wow, that is pretty scary. I know how bad food poisoning is. I am actually getting over it as we speak. Lying hunched over for 3 days barely able to talk or use the bathroom isn’t much fun at all.

    I can only imagine how much worse it is having to go to a hospital that sounds like it’s making your situation worse not better.

    It is very true though that in times of pain you learn to appreciate what you have.

    3 days of bed rest will make you think a lot about life and in my case how fortunate I am not to have to spend months or even years laying in a hospital bed or facility.

    On a positive note, I’m glad you guys are feeling better.

  25. I’m glad everything worked out. Having traveled extensively as well, this is despicable and immoral. Unfortunately, it occurs with more frequency in some parts of the world than others. They say you can judge a society based on the value it places on a human life. By that benchmark, USA is still the greatest place in the world and many of us need to travel if only to understand that.

  26. Haha, being German, I had to check my language’s equivalent for little word “triage”: „Bestimmen der Handlungsreihenfolge während einer Notlage“

  27. From reading this and the comments, it seems like a terrible hospital experience is possible anywhere in the world. (As is food poisoning. I got it once on a short trip to Tulsa, about 2 hours drive from home.) Though apparently some places are much worse than others.

    Yet Tim has a chapter in 4HB about the wonders of medical tourism. This makes me ask: What would be a useful worldwide checklist for finding a good hospital *and* monitoring the quality of service? Obviously steps 1, 2, and 3 would be to call the embassy, ask trusted locals, and have an advocate present. But there must be more to the list beyond that.

    Part of my confusion could be a difference between something planned and researched well in advance versus emergency care. Even so, what’s to stop a medical tourist from being suckered by a slick web site?

    One other point: Don’t knock the water-butt method until you give it a fair try. I’ve kept a medical squirt bottle by the toilet for the past few years. Now I just don’t feel clean when I have to use dry paper. The traditional paper-only method also takes a lot longer and on bad days can cause irritation to the point of bleeding. Water is much better. (Toilet paper is good for drying off afterward and for blowing your nose though.)

  28. Tim, So sorry that you had to go through such a nightmare in India. I’ve informed whoever [in India] I could about your experience. We’ll try to make things better for your next visit.

  29. Wow Tim! I am really glad both you and Natasha are well. You make me want to read up more on medical treatments just for my own health`s sake.

    I encountered some hospital problems when I moved to Buenos Aires for a few months. I woke up one morning with acute asthma, using 70% of my energy to breathe, panicking because I felt I didnt get enough oxygen to stay awake, frightened to experience game over in my apartment while waiting for google to list nearby hospitals…

    Luckily Google quickly listed a hospital 4 blocks away.

    I ended up spending 9 hours in confusion at the hospital. I spoke little spanish at this point and was pushed around the hospital understanding nothing…

    -Nurse losing syringe with cap on the floor before giving me I.V.

    -Forgetting me in a corner with a smokey gas mask thing for 3 hours straight.

    -Saying my X-rays looked NO PROBLEMO. BUT I had to show them at home to get to a specialist??

    All in all, it turned out well…and they charged me nothing, not a dime.

    Lesson learned: If you don`t speak the language, bring a phrasebook or a translator. It`s hard for people to help when they don`t understand shit.

  30. I had the same symptoms early this year. I went online before going to the doctor and they all suggested staying away. I sent the Westin Hotel staff to the pharmacy many times, lived on Imodium and Benedryl for days. Love the book and have lost 26lbs on the diet. Stay well, JRM

  31. Tim,

    Sounds like you had a very unfortunate and frustrating ordeal.

    If you find yourself traveling often to places such as India, or just in the SF Bayarea where ERs over prescribe antibiotics, you can look into an “open-source” remedy called MMS (http://www.miraclemineral.org/). It can be used to disinfect water as well as be taken internally to deal with infections, bacterial, viral, fungal, even detox heavy metals from your system.. something that costs pennies and can easily be included in everyone’s cabinet, at home or while traveling. Widely used and tested in Europe but of course banned by the FDA. May be worth checking out!

    Best,

    Hooman

  32. Tim. I am glad that you and your loved one are safe now.

    I have to ask, did you stay through this nightmare for a test or you were caught in a situation that even your resources were limited?

    I believe that there is more to this than procedures and checklists. Do you think that this hospital in question treats like these their governors and high positioned people?

    You are taking a stand I am totally behind you because this needs to change and all be treated as equal and in the best interest of others well being, not cash in the pocket.

    Thanks for this post.

  33. Tim,

    Can’t you sue the hospital or staff? No offense (seriously) but I don’t think stoicism or an angry post will save anyone’s life, you need to hit them where it really hurts before they kill someone (if they haven’t already). The only reason they keep such worthless staff is because it’s cheaper than to hire or train good staff, so if you make it expensive, they’ll fix their policy.

  34. Damn I got frustrated by how they were treating you just reading it. It must have been a thousand times worse in person. Glad to hear you and your gf made it out okay. Easily could have been much worse, or even fatal.

  35. Wow, scary story, a man less involved in the medical market would have been in that hospital a lot longer with a lot more pain.

    The UK has had a major outcry over the past couple of years about MRSA and after months of investigation they came to the conclusion they had at the start – it was caused by lack of washing hands/hygiene.

    So even in developed countries with great healthcare these basic checklists can make a difference. One practitioner ignoring the basic health standards can cause an epidemic so it’s of the utmost importance.

    I’d also like to add lastly your advice on checking local hospitals is something I’m going to start doing now, I’ve travelled for the past 2 years and never done that but it’s great advice. More so for a place like India which has a big reputation for making people ill.

  36. I’ve also read the Checklist Manifesto, and was impressed that he drew knowledge from the construction industry, and airplane operation checklists, into the medical world.

    It is no joke that you (Tim & Natasha) might have been better off by *not* going to that hospital. A friend of mine ran into a similar situation in Santiago, Chile. He ate ate some restaurant (I recall he was very sure of the source), and he got violently sick. His appendix burst, and he was taken to the hospital. Not the best hospital, or even a good one, because he was trying to save money. Long story short, due to sloppy hygienic practices, he got another infection at the hospital, and very nearly died. He ended up losing an incredible amount of weight, like a prisoner. Well, I can’t recall the details, but if his wife had not been there helping him (she studied biology and knew a bit about medicine), he probably would not be around today.

    I think it is good to call out these morons, who seem to be utterly ripping off their clients due to their stupidity and incompetence, while meanwhile others are trying to do a decent job, such as the helpful doctor you mentioned. And certainly this is a problem not relegated only to third world countries, as we have seen in Atul’s book about U.S. hospitals, of course, perhaps not to the extent of the hospitals mentioned in the post. Drs are held in high regard in the U.S too, and they are not used to being questioned, but the old saying holds “patient, heal thyself”. You don’t have to be as knowledgeable as Tim (and consider he was in a delirious state), to *question* things. In software, there is the idea of the “Five Whys”, which is to keep asking “why” till you get to the bottom of the question, such as fasting blood draws.

    Interesting message about Seneca. Given the current hoopla surrounding #OccupyWallStreet, and the news of future stock market disasters, perhaps we should all learn to live simply, and see if we can change ourselves. In a way, this is a bit altruistic, if the champagne swilling bankers knew what life was like, as they peer down from the balcony at the protesters, suffering from the ruin the banksters have manifested, perhaps the world would be a better place.

  37. Hey Tim,

    Great rant and I wish this does lead to something being done and action be taking against that prick. Little bit of advice if you ever do end up in India again and in need of medical attention.

    I’m a dialysis patient and travel to India quite often. I have experience in some of the best hospitals in India and ones where mice run around in the pharmacy. I thankfully, made it out unscathed every time. Calcutta is one of the WORST places to visit in India (as confirmed by most Indians) next time you are in India try to find one of the Apollo hospitals (I’ve been to the one in Delhi) and the staff, sanitation, and doctors were great. Aside from some of the snobby “sisters” but the doctor knew what he was doing. The best hospital in India I have ever been to is Kokilaben Dhirubhai Ambani Hospital (there’s a mouthful) in Mumbai (formerly Bombay). The NICEST staff I have met in any hospital in the world and I’m Canadian lol. Amazing doctors who care so much that mine went out of her way to check up on me every time and she only had her one time consultation fee when I arrived. Everyone speaks English, and made feel very comfortable, welcomed, and always checked up to see if I needed food or anything. Unparalled (in my opinion) to any other hospital in India.

    There is a huge discrepancy in medical care in India and the only hospitals I would EVER visit are in Mumbai and Delhi. But, don’t every compromise for anything other than the most reputable ones, even if its life and death (in fact especially if it’s life and death).

    Hope this was of some use to you.

  38. Ferris!! What an account..!!..Hopefully your girl is right as rain for some lattes, fine dinning and sensational Melbourne shopping in a few weeks time!! Thats about the best remedy for any female…

    Looking forward to you in action on stage while your down under…

  39. Dude, I surely expected some of your fans to keep you grounded on this one. Let me get this right, you went to a third world country, ate some dodgy fish, got the runs and a high temp, and instead of toughing it out you gambled with getting an IV at an indian hospital rather than staying home and vomiting in your own 5 star hotel??

    C’mon Tim! Toughen up man and give yourself a few days to calm down before you write your next rant!!!!

    You can get shitty health care where ever you live, there are crap doctors everywhere. No different to getting good service for anything else, you need to know someone or have plenty of money or both, or leave it to the gods.

    I do like your blog and your books dude but jesus there are people with much bigger issues out there. Just chalk it up as another good story for your next million dollar book!

    Now bring on the haters for my opinion!!

  40. Tim,

    We just finished spending two weeks teaching in a slum school in Delhi and living with two Indian doctors. I often wondered what the quality of care was like and your story provides a terrifying answer.

    We’re nearly finished with a 7 month RTW trip and no country has been more fascinating to visit – or made us appreciate home more – than India. Glad to hear you and your girl are alright.

  41. Holy shit dude, sounds like you went through quite the ordeal.

    Think that was Salmonella you guys picked up? My wife said that it couldn’t be caught from eating fish, and I don’t remember if it gave me fevers, but I do remember stuff shooting from both directions, so to speak, and I wasn’t exactly feeling fantastic…

    Good to hear that you made it back (roughly in one piece)!

  42. Great post Tim.

    It struck me that with so many organisations focused on cutbacks (including my city, Toronto) and nations facing austerity measures in this economy, there’s huge need for this kind of analysis.

    The typical uninformed response to sub-standard service levels in any organisation (especially government-run services) is that as a rule it is a result of poor funding. This example highlights the effect that a few simple managerial tweaks (at minimal additional cost) could have.

    I’d actually love to see you take this kind of magnifying glass to more examples….perhaps a new book? How to hack systemic inefficiency. I would buy it.

  43. Wait, did I miss the rant where you criticized your own pre-departure processes? The rant where you took responsibility for not adequately preparing yourself for travel in a foreign country with health care facilities of variable quality? The one where you realized you should have done some research and learned that in said country you would have a high likelihood of encountering pathogens with which your body was not familiar? The one where you kicked yourself somewhere appropriate for not taking easily procurable medical supplies – antibiotics for a start – with you? The one where you realize first and formost that YOU could have – fairly easily – prevented this medical disaster?

  44. Your post hit close to home. A few years ago I got an infected wound while staying in the countryside close to Kolkata and it got pretty bad.

    I went to Woodlands Hospital in Kolkata (supposedly one of the best, if not the best hospital in town) and it was a mixed bag. I never stayed overnight, only went there a few times to do some X-rays and see a specialist, but overall the service was great. I could call the doctor anytime and the staff was generally nice.

    However I’m still not convinced the involved doctor was all that competent. For weeks he refused to remove the infected scab over my wound, until another doctor finally agreed to do so, allowing the wound to finally heal. Besides the antibiotic treatment could have been performed a lot more efficiently.

    So yeah. Travelers beware around Kolkata, there appears to be a pretty high infection risk and medical treatment quality is at best a mixed bag… But do go there, it is an amazing and interesting place in the world.

  45. Hi Tom,

    I am from India but currently stay in the US. Your post doesn’t surprise me at all. I have personally had such experiences from top notch doctors who have diagnosed me wrongly for Tuberculosis when i just had fever which ran for 5 days. On other occasions i have had unwanted tests taken just to make more money. These include blood samples, scans, etc taken.

    If there was ever a website that rated doctors or had reviews taken for doctor from patients i believe it will solve for a big problem out there in India.

  46. had a similar experience but it was with a corrupt psychologist who i had to threaten with mal-practice for trying to give me very harmful drugs for psychosis, loosing touch with reality which i read up on only to find i had none of the symptoms, i have lived in india for 4 years as a general rule Tim stay the hell away from india their education system is corrupt anyone graduating from that country is a joke i am indian myself so i can say this without being racist, all the way to the cops who make daily runs to collect money from all the shops like the mafia in plain sight in bangalore and the beating of women who dont cloth themselves to the corrupt officials to let this happen because they are associated with them stay the hell away or atleast avoid ever having to depend on anything or any one in that country associated with the service industry from if you are in india, when you are out of india and their is a legal accountability that i would make an exception to i actually visited brickwork when i was in bangalore but all the names and titles there are a joke that is why i left my architecture course after a year and a half, this is not angry blabbing i have a scar on my wrist which should not be there for a doctor who operated on it and it still experiences pain i was also not given any pain killers during the healing process, with all the words i could possibly use stay the hell away from that sort of stuff in india, responsibility and legal action is almost impossible let alone possible with let lines and the corruption of the judges and police make it impossible to get anything done, i can say this because i have tried it out.

    all the best to you tim cant wait for your new book

  47. Tim,

    I feel your pain brother. Last week I returned from Sanya, China (Hainan) because of some medical reasons. After reading your store I can relate. I came down with a rare case of food poisoning (according to the 4 docs that saw me) that caused a large amount of internal bleeding. I went to all three of the hospitals in Sanya. The first doc sounds like your bad doctor and the conditions of the hospital were insane, blood on the walls, rats, fecal material on the floor – really it was like a scene out of SAW. After passing out on the floor (from God knows what) my two translators and I agreed that I was more likely to be killed from something in the hospital rather than whatever was inside of me.

    The second hospital pulled a “well you seem ok” and didn’t allow me to come in.

    The third hospital made me prepay my visit and ended up having the same conditions at the first (blood, poo on the floor in the anal probing room). After seeing how and where I was going to be tested I started to feel better – really I think my adrenaline spiked and the extricating pain subsided for a hour.

    At 5am after staying in a room with 10 other very sick Chinese men, waiting for a colonoscopy I decided it was best to go back to my apartment.

    Next the day I went to hospital 2 again and found a good doctor who admitted me and took a series of tests. Nothing is conclusive, but he suspects that it was a extreme type of food poisoning – I’m not convinced. Im back in the States now to make sure everything clears.

    The interesting thing is that the doc who tested me yesterday said that if I would have been infected with a specific type of e coli – the meds that the doc gave me could have caused kidney failure – I guess the e coli releases toxins when it is killed by antibiotics. I guess I got lucky there…

    Sorry for the long comment, but I want to know that I can completely relate with this post and I agree. We are very blessed to have the medical treatment we have here in the states. Its not perfect, but it is way better than what most people have.

    Pressing on…

  48. Tim,

    I feel your pain. I am Half-Indian and Half-American, but since I grew up in the States I’m more inclined to Western Culture. On every visit to India I have always had to sit down and complain about something or the other concerning the systems that are set in place. I mean if you just look around you can see that there is obviously no civil sense prevalent. When I was in Medical School here I got into a few drunken mishaps and went for stitches afterwards and I had to do a little micromanaging myself when it came to proper disinfection practices before sticking a needle in my arm!

    It’s really just the state of India’s mentality at the moment. People are not properly educated and the people in charge of the country are more worried about embezzling all the tax money for themselves rather than setting up good systems. I don’t know if it will ever change when you have a billion plus people to contend with on the social ladder. Every one is just worried about themselves including, as you can see, the doctors.

    Just the other night I was confronted by some cops about my friends and I sharing a cigarette and beer at a hill near my mom’s house here in India. They jumped off their motorcycle with a bamboo stick and I just let loose on them. I started yelling so loud and grabbed the bamboo stick from him and said, “Are you going to beat me like I’m a dog?” He got so scared he and his partner ran away!!! They brought back up and I yelled at all of them as well and their egos were crushed. They did end up calling the chief of police and I so we bribed him and them with 4000 Rupees (about $87) and they treated us like kings and told us to call them if they ever needed someone “taken care of” or any other help. I’m not justifying what I did as right, but just giving you a glimpse into how things really work here.

    As for the water-butt thing, that is how Indians wash their butts. Water and their hands are the standard method, so that is why the lady mentioned it. I don’t think she was being lazy or nonchalant about the situation. She probably just got back from the crapper after having washed her butt with water. Every Indian I’ve ever questioned (high class and middle class) think that using toilet paper is the single most gross thing Westerners do concerning personal hygiene. It’s just a very different cultural element, I guess. But there is no excuse for a used soap bar in your bathroom. If it was such a good hospital they really should have had soap dispensers… but alas, it seemed like a pretty janky establishment.

    Any ways, I’m sorry for your terrible experience. I hope you and your girlfriend came out alright.

    Raj H.

  49. When we need to see a hospital in a third world country (and we try to prevent it absolutely!!), we call our doctor at home (got his mobile number) and then tell the foreign staff/doctors what exactly to do.

    A good thing about third world hospitals: You pay AND you are the boss (unlike at home, where you pay but the doctor is the boss).

    By the way, we would NEVER go to a hospital to get some intravenous fluid.

    Vomiting and diarrhea often happens in such countries. We then pump salted water rectally (a big injection without needle will do, or a clyster of course).

    You can put in as much as you want – the body absorbs as much as it needs, the rest will come out again.

    Works very great with babies or kids as well – no need for a hospital (which is always a big risk, as you know!!), no need for needles.

  50. I never would have created that checklist when travelling. Now thanks to you, I will.

    Another moral here: Do NOT piss of professional bloggers or seo experts. They can do a lot of damage. 🙂

    I’m glad you are both ok.

  51. Tim, glad you’re feeling better. Big fan of your books, but this post is a bit depressing – mainly because it has brought out a bunch of really narrow-minded comments.

    To all of you who expect the same medical care that you’d get at home, there’s only one way to ensure that: stay at home. Travel carries its risks, and getting sick and not having the same medical care that you’d get at home is one of them. Deal with it.

    Josh

  52. I was in the Air Force medical service for 22 years and experienced Japanese/English medicine firsthand. For those of you who think socialized medicine is the “fairest” way to take care of sick people…I have news for you. You’re right in concept but most countries get it terribly wrong in application.

    Japan and England are 1st world nations…yes? I have seen Japanese ambulance drivers (few if any emt’s there) literally pick motor vehicle accident victims up and toss them into so-called ambulances (few supplies). Emergency rooms had re-usable urinary catheters!!! On the other hand…they had state-of-the-art CT scanners, MRI and other diagnostic equipment. Shocking difference from circa 1800 medical care in one room to the next isn’t it? This was a few years ago so hopefully things have improved somewhat.

    In England…we would routinely “undo” any English medical care to include suturing of wounds because local docs didn’t think that washing gravel, grass and an assortment of other items out of gaping holes would be helpful. I also witnessed the Brits as they tried to start IV’s in the field and (upon missing the vein) drop the catheter in the dirt, pick it back up and attempt again. Well, at least they try! Give me our “unfair” American medical system ANY DAY!

  53. Wow – thank god you both made it!

    How frightening, and at the same time it makes it even more apparent that we all need clear plans and paths in case of emergency in traveling to these countries. It is also a question as to whether or not to seek treatment vs. keeping some supplies on hand and doing it yourself under all but the most extreme examples.

    best of luck and hopefully you will never have to endure this again.

  54. I think all sides of the popular debate about who should pay for medical care can learn something important from this incident: Much of the quality of care, good or bad, has no real effect on the hospital’s budget. It costs very little extra to wash hands, cover coughs, disinfect wounds, use sterile needles, insert a needle correctly, or look at the name on the chart. But those practices prevent expensive complications.

    Not that I’m any kind of expert. But every hospital or clinic I’ve seen in recent memory has had this stuff on signs on every wall.

  55. Okay Tim…so I know you are all for self experimentation.

    Try this next time you eat something bad like that. Now I don’t recommend this as a daily supplement (like you see touted on the Internet), but it does work extremely well for food poisoning which is basically an out of control intestinal (bad) bacteria bloom.

    Take at least 12 oz bottle of (reputable) colloidal silver on trips to places like that. The best way to catch it early is to take two shots (aka drinking shot glass shots – 1.5 oz each) directly after a risky meal.

    However, if the deathly fun has already begun take two shots every three hours up to three times a day. Stop after two days, because it will mess with your good bacteria so it’s best to do some probiotics after taking the colloidal silver shots. The silver ions interrupt the bacteria’s ability to “breathe” therefore stopping the bloom.

    I will warn you, it tastes like you are drinking liquid pennies, but will work it’s magic in about 1-2 hours. My brother got food poisoning in Mexico on a cruise, saved his ass that I just happened to have some with me.

    You will still have a fever if the anal/vomiting fun has already begun, so just alleviate that symptom with Tylenol or Ibuprofen.

    BTW, It will also kill h pylori bacteria that causes ulcers (1shot in morning and 1 at night for 3-4 days). Do not consume for more than a few days. It can give your skin a bluish tint if you take too much taking you one step closer to becoming a real live Smurf. Do a search on the Internet, some dumbass did that back in 2000…Granted you would have to take it for months, but why risk that.

  56. Such a crazy story Tim but I’m glad you and your girlfriend made it out okay. I currently don’t have any health insurance and was curious if you have any recommendations on provider and plans?

  57. Oh dear that’s just another addition to all the horror stories my friends told me bout India – that country is a bloody shithole I’ll never go there – hope you are better! Thanks for sharing

  58. Crazy story indeed, glad you’re both back ok. I got food poisoning traveling in London, put me out for 3 days. I’m a little surprised Tim, with as many languages as you’ve mastered, that you don’t speak a little Hindi?

  59. Tim, Check out GlobalRescue, they are basically a medical travel insurance company on steroids. Their director of ops is former SEAL team commander and they come very highly recommend by a few special ops guys I know. Plus they are affiliated with John Hopkins and can get you first rate care ANYWHERE in the world. -John

  60. Here’s to you and your girl being completely recovered and never having to go through any of this again.

    Now, to one of my biggest pet peeves: please fix “named after it’s principle ingredient” to the correct version, “named after ITS PRINCIPAL ingredient”.

    It’s should be its

    Principle should be principle

    Thanks!

  61. Wow! thats crazy Tim, glad to hear everything is ok.

    I also have contracted food poisoning from dodgey chicken before and been hospitialised from vomitting blood… things were bad… real bad…., however since becoming vegetarian this is not something i have to really worry about any more and have much better health 🙂

    next time reach for some fruit instead of that fish, your body will love you for it!

    Take care! 🙂

  62. This is simply insane. We’re all just glad that you made it out of there with Natasha, alive.

    Are you going to take any action, or just going to let this rant post gain traction and hopefully reach the ears of those whom are able to impact change?

    Take good care Tim!

    //Daniel

  63. This ordeal you wrote about on Oct 2nd which is my birthday, sounds pretty seriously detrimental to your health. It almost makes me not want to ever go to India. The real reason for the comment here is to suggest a good book on a subject of doctors, and it’s a romance and a novel, so not a source for information on how to, but an entertainment. Written by Abraham Verghese “Cutting for stone”. It is set in India, I think. I got it in audible and haven’t really read it all the way throug.

  64. I don’t have any thing of value to add….I just wanted to make sure you knew that 4 Hour Work Week was mentioned in the latest episode of The Office 😀

  65. Hi Tim, this is a rant. Please feel free not to approve this comment if it’s too graphic or negative for your readers. But I had to let this out.

    Just like you, I’m speaking from personal experience here. When in India, always avoid Government hospitals and small private hospitals like plague. The small private hospitals are usually run by an experienced doctor, whose intent is to make money rather than offer quality healthcare.

    There might be only a handful small private hospitals in India, but those are rare. Also, most doctors who run their own small hospitals don’t know how to run them or have enough time to spare to see if the nurses are doing their duties properly.

    The doctors also have ego problems like Dr. Chaterjee. This is especially true if you are an Indian. In which case you aren’t treated well. In comparison, foreigners are given VIP treatment everywhere in India! But still not good enough in some cases, as I can make out from your post!

    Finally, there’s a problem of incompetency. Doctors often misdiagnose, either due to lack of knowledge or from not spending enough time to listen to the patients symptoms or take them seriously.

    I am a guy, and was admitted for a UTI infection a couple of years back at the age of 25. When a few rounds of antibiotics did not resolve it, and the urine culture was negative for any pathogens, the doctor asked me to get admitted for a invasive diagnostic procedure known as cystoscopy (endoscopy).

    He then diagnosed the problem as a urethral stricture and told me I would have to get urethral dilatation done every six months. Then he put me on a 6 month long course of Flouroquinolones. He was a very convincing doctor and runs a well known urology hospital.

    So after six months on the antibiotics, I started developing tendons problems, body wide pain, depression and insomnia. I kept telling him I felt something was wrong. He said nothing was wrong and I was overreacting. He never took my concerns seriously. Anyway, after six months, he stopped the antibiotics when they clearly weren’t working, and said I would have to tolerate the mild urethral pain since that’s how strictures are.

    I would go to his hospital to get urethral dilatation every six months which was painful. As years passed, the pain only got worse, until I couldn’t do anything but only survive. When I had enough, I went to another small private hospital. That doctor did a x-ray called retrograde urethrogram and found out that I did not have a urethral stricture, but the pain was from the previous dilatations. He said it would go away with time if I did nothing going forward.

    But the pain kept getting worse. So I went to a professionally managed big private hospital in my city. There are only a few of those in every major city in India. And within a week, the doctor there who was an American Indian, diagnosed the problem with a series of non invasive tests. He found out that I was suffering from chronic bacterial prostatitis. The bacteria was resistant to flouroquinolones, hence they never worked. The urethral stricture was a misdiagnosis. It was actually a sphincter spasm from the infection.

    He then gave me very non toxic antibiotics and it cleared up most of the infection. So I learned my lesson. When in India, you have to get admitted in only reputable hospitals no matter what the financial costs are. These are usually very old and well known or are run by professional corporations from the private sector.

    But I think it’s too late for me. At the age of 29, I’ve developed a host of health problems and immobility from side effects of the flouroquinolones, including frequently tearning tendons, unbearable body wide pain, low fertility and testosterone.

    Recently, I consulted with 3 doctors, all of whom have treated me for the side effects of the flouroquinolones, without knowing that they caused the health problems I’m facing. They told me I can’t sue the doctor who misdiagnosed me, since I paid in cash and don’t have a bill (invoice) from him. The doctor had told me if I paid in cash, I’d get a 12% discount. Turns out he was cheating the government too by not paying the service tax, hence he accepted cash payments without giving invoices.

    RANT OVER! Sorry!

  66. Hi Tim

    Sorry you were sick. Fish is the worst to eat anywhere in Asia. I do not under any circumstances consume it. In Australia I eat 2 lamb chops a week then fruit and vegies.

    When I go overseas – I don’t even eat my beloved lamb chops or any meat/fish. Did in Hong Kong twice and really sick. Won’t be caught again.

    Keep well my dear friend…barbi

  67. RULE #1: Do not eat fish or seafood in India, Nepal, Tibet, etc., these foods often have to be brought in from other areas and refrigeration for perishables via truck or train is not reliable. The water is filthy, eating fish from filthy water is never a good idea. Best to stick with local, hot foods, never use ice cubes, carry a proven, reliable water filter and use it so that you can control the quality of the water you drink, avoid even a drop of water that could be left in “clean” glasses, plates, silverware….it can contain who knows what, which can make one sick. Having volunteered in Nepal for 2 years in a community clinic and in a district hospital… I totally understand what Tim F. experienced r/t the lack of understanding about cleanliness and sterile technique, which is widespread. Tim and Natasha have a bigger concern related to possible diseases that could be contracted via the needles used to infuse the IV fluids and to draw blood – hope they have had labs to check for HIV, Hepatitis. etc. and get repeat labs over the next few years…. ya just never know. My personal and economic survival philosophy: Prepare for the worst, while praying for the best.

  68. I have to disagree with Raghu above regarding his statement about this simply being “a rotten apple, but not a rotten bunch”. I am also Indian, and find that the experience you’re describing here is the norm in India, not the exception. Even outside of hospital settings, men like Chatterjee, who have callous disregard for others, are exceedingly common in Indian culture. Women like Dr. Gunjanrai are often much more amicable than their male counterparts, but women being publicly shit on (literally) is again a norm in India, with the country ranking as one of the top five most unsafe countries in the world for women. This is somewhat changing with the globalization process as Indians attempt to suck up to & appear similar to Westerners, but even this is primarily motivated by the pursuit of wealth rather than being a genuine infusion of caring or compassion into society. My advice to Western tourists is to, quite simply, avoid India altogether. This type of thing happening is just too common, and sometimes the end result is much worse than it was for you.

  69. What a NIGHTMARE!! Glad you are recovering.

    As a traveler, I’ve had many scary hospital visits as well, a few in the U.S. (Florida). What I find particularly outrageous is that most of the errors could have been avoided had they been using checklists.

    ‘Switch’ written by Chip & Dan Heath has several interesting case studies on changing procedures to make hospital procedures safer that might be of interest to those working in the medical profession.

    Keep well!

  70. You still need to consider yourself lucky. In my native Philippines people die in the hospital lobby, too ironic for country famed to be the world largest exporter of health professionals.

  71. Hi Tim,

    I read your blogs regularly. I was always pleased with your ideas, topics and suggested. Implement a couple of them as well.

    My feedback on this post. Yes, it is hard that you underwent such a pain when you were in India. But before you even got admitted into the hospital, you must have done a analysis. Indians are known for their kind heart and good service oriented people, be it any sector. There are tons and tons of very well educated medical professionals from India as well.

    A proper inquiry about hospital agencies to match international standards is at all places these days. Its not the cost that matters, I have seen people in pain, I have seen people in happiness as well. Is it that you did not find a right hospital you have posted this message? So what is your take to improvise the health system here? I see you raise funds for many people across world. Why cannot you take any initiative on how hospitals be managed?Cannot this be your business in healthcare adventure? You have not met real Indian and real Indian valued people.

    What is the difference you created by posting about this hospital? Can you see how the feedback and be implement in your guidance?

    Regards,

    A reader

    1. Tim’s critique of his experience is a service to the hospital so that they can evaluate their poor service and improve upon it. It isn’t Tim’s responsibility to remake hospital’s. This hospital clearly had access to modern equipment and training. They were responsible for choosing to misuse it.

  72. Gracious. That sounds harrowing. Should you find yourself in this sad circumstance again, there are lots of things you can do. I work in international healthcare (Patients Beyond Borders) and we run into people in similarly dire circumstances with some regularity. Your idea of checking the website of the closest US embassy is a great one. They often list recommend healthcare providers. And they have numbers to call in case of emergency. Here are few other dependable options:

    – If you are fortunate enough to have an internet connection, check the Joint Commission International’s website. They have a list of accredited organizations around the world. The Joint Commission accredits US hospitals and their international division has now accredited over 400 international hospitals. Hospitals that go through the accreditation process spend tremendous resources to achieve and maintain accreditation. In an unfamiliar location, a JCI-accredited hospital is always safest (not to say there aren’t perfectly fine non-JCI hospitals but why guess unless absolutely necessary?). In Kolkata, Apollo Gleneagles is your best (they do have toilet paper).

    – If you are somewhere even more obscure, check for brands in the JCI listing for the country you are visiting. Often hospitals that can manage JCI-accreditation are a part of larger brand with many hospitals. Although a particular branch might not be accredited, there is usually some level of consistency within the brand.

    – Another option is to find the most expensive, Westernized hotel in town and ask for their concierge … they will be able to tell you where they send all their fancy guests.

    Of course, if you are stuck in the loo or are floating in and out of consciousness, this level of research is impractical. In this case, it is best to use your remaining strength to call some competent friend or family member and get them to sort it all for you. Or, you can toss an app on your phone that has all the info at the ready.

    Anyway, Belle Vue sounds like a horror show. Glad it (eventually) ended well despite their rather shocking efforts. Vanessa

  73. 1,350 is nothing for a multiple day hospital stay! Do you have any idea how much would be charged to you insurance in the united states. Sure the care would better but in retrospect would you rather have paid 1350 versus a likely 20000-40,000$ U.S. bill? Please answer truthfully

  74. Wow! That is horrid service and I am very happy to hear you and Natosha made it through that experience. Im currently reading “Letters from a Stoic” by your suggestion. In addition to it being an amazing book, I recently read the part about practicing poverty. I tried it for only one day and it was a great experience. i discovered that being jobless isn’t such a horrible thing…and quite survivable and even enjoyable! haha Next time, I rough it even more. Great blog and thanks for the continued inspiration!

  75. HI Tim, I am a fan and have been reading your findings in the 4 hour body. What I was wondering is…I am 43 and am going through breast cancer for the second time. Would you please apply your inquisitive mind and interllect to the cure for cancer. There is so much ‘stuff’ written but really, what is the truth? It would help so many people. I think we need your ‘changing things from the outside’ mentality. Would you consider doing research on the 4 hour cancer cure????

    🙂 Andrea

  76. great story, seriously enjoyable reading (obviously glad you and your girl made it out okay)

    curious: did this piss you off enough to follow up and see what happens and bring more publicity to this tragedy of a hospital to hopefully bring some accountability down on Mr. Tondon? Or does it end at your blog post? just curious.

  77. one myth standing in 4 hour body: more muscle is a positive thing. on medical occasions sometimes yes. in general, mostly no though. 1 kilo (of muscle) makes you stronger absolutely, weaker relatively to the time you want to sustain an effort. it causes more wear and tear, on all aspects of the system.

    a simple one: 1 kilo less does more for you then one kilo stronger. if you train for strength: make muscle stronger without growing it bigger. loosing weight is also loosing muscle weight, after all when the over-all mass deminishes, the core can be reduced, the energy producing inners at that.

    the ‘4 hour body’ old as santa monica bodybuilding myth is what makes bodybuilders the ultimate losers in all lines of competitive sports and activities (measured against opponents, time, distance or any other yardstick or combination).

    above statement (if acknowledged by you) could be the core of a rewrite of the ‘body’ to be published in two-three years?, surfing on the success of ‘4 hour body’. you could present it as science does: organic writing, a la mc. gee (science and cooking). i would be glad to collaborate with you (as does the whole world). the book merits it’s energy in paper, if updated to include this aspect it is close to the ultimate guide for comprehending the functioning and toning of the performant body. it will stand the dent of time.

    just a suggestion: genetics (the absolute and severe limitation to all and every, including the of and on of genomes within the pool) hasn’t been stressed enough. it will deceive potential readers in their projections and ultimately discourage them, the dieter will drop the book.

    if these lines do not get lost as they are supposed to, success generates push (back) and discourages pull (why look for bones if steak is all), my sincere compliments to you as a fenomenon, i will not say freak since it has a negative ring. you truly have an out of the 99% personality, an out of the system attitude (how can four years of robotic feeds in university and no empirical experimenting beat your approach), and not at least an instinct for usurping the same traps of capitalistic society. i wish you a long life, so you can develop and maximize the strand of originality in method into original and lasting content.

  78. Wow, that’s a hefty bill for Calcutta! Did you consider suing them for malpractice or at least reporting it to the local medical board?

    It’s ridiculous that you could have died from things that could so easily have been avoided, especially at a place that claims to offer such great care.

  79. While I am sure Tim won’t personally respond to this, it’s my hopes that maybe one or two readers who are truely in the know and can help might.

    I’ve been heavy my entire adult life. I’ve tried diet after diet with no success until about two years ago when I actually dropped from 445 lbs to about 290 lbs over the course of about 7 months. However once I started back to my normal career, meeting deadlines, etc. I started eating on the go and over the course of two years put all of the weight back on again. I have not been able to shake the weight again despite numerous diets.

    About a month ago I had a heart-attack. It was an eye-opener that something and something serious has to be done now, not several weeks from now. A friend recommended the 4-Hour Body to me, but I am not entirely sure whether this will work for me needing to lose over 245 lbs or not. At the moment I can barely walk down the stairs or up the stairs in my home without being out of breath, and I can barely function. I won’t even go into the nights I cry going to sleep because I have let myself go this far, or the embaressing things that most people cannot imagine like going to the bathroom at home let alone in public.

    I need some direction. What exercises do any physical fitness minded people on here recommend for me. I need to shed this weight and soon or I won’t be alive this time next year. I’ve already been following Tim’s guidelines for food but haven’t noticed a difference. Please help.

    1. Hi Matt,

      I am over 6′ tall and was at 232 pounds… and growing : ) . I dropped 34 pounds over 7-8 months, my cholesterol ratio is now in the normal range as is my glucose, I have no more heartburn every night, more energy, and I’m feeling much better.. I dropped weight with absolutely NO exercise.

      My suggestion to you would be to

      1) read pages 1-99 of the Four Hour Body

      2) Activate and follow the program (religiously) after consulting a doctor

      The important keys for me were to stick to the program:

      – 30g of protein within 30 minutes of waking (for me this was 1 whole egg + 1/2 cup egg whites scrambled, 1/2 cup frozen spinach, almost 1/2 can of black beans all done in the microwave) on days that I didn’t have time or the stomach for that meal I would mix 1 – 1/2 scoops of GNC Pro Performance® 100% Whey Protein – Unflavored http://www.gnc.com/product/index.jsp?productId=3244942 and drink that instead (GNC gives a 20% discount when you buy during the first week of the month if you join their club for like $15 a year – totally worth it.. I stock up with 3 of these containers every few months… they are great when I’m traveling and can’t get my morning meal).

      – Maintain the “circle” of foods for each meal (vegetables, legumes, protein). I eat breakfast, lunch and dinner and will sometimes have a similar meal between breakfast and lunch if I get really hungry.

      – Drink a lot of water during the day (I drink about 40 oz at breakfast and try to drink multiple 16 oz bottles using an empty Snapple glass bottle throughout the day and then another 40 oz with dinner).

      – Legumes are critical… try to eat them with every meal (I usually use black beans or lentils). They give me the carbs I need to keep my energy up and they don’t burn off quickly like white carbs.

      – I eat as much as I want to eat during each meal as long as I keep to the “circle” of vegetables, legumes and protein. The guys at Una Mas laugh at me every time I come in because I order the same thing and lots of it.

      – I found it especially important not to eat fruit, not to drink my calories (I switched all my drinks to just water), and to put no sugar or milk in my coffee. It was also key to stay away from cow’s milk and cow’s cheese. No beer, no mixed drinks, no white wine… except on cheat day!

      – The biggest thing that kept me going was the promise of “cheat” day. I tell people that I lost 34 pounds by eating 5 donuts a week (of course, they were all on Saturday which was my cheat day). I always new that just around the corner would come that one day that I could eat whatever I desired. I kept a mental list (donuts, pancakes, whopper malt balls, M&Ms, pizza, french fries, bread…)

      – Nibble on baby carrots throughout the day.

      – I measured my total inches in the beginning and also took pics of myself in underwear front and side. I never remeasured my inches since I could tell the pounds were dropping by the belt notches, pants and shirts.

      – I weighed myself everyday and logged the weight. Tim has a spreadsheet on one of his sites which was put together by someone to track their glide weight. I found that I would often be losing more than the “glide” decline, but there would be days and weeks were my weight would drift back up.

      – I came to realize that the weight reading on the scale varied substantially from day to day (by +/- 4 – 5 pounds). I started to only care about my lowest reading of the week which often came as I got closer to cheat day. In fact, I stopped weighing myself the first two days after cheat day as it was just a downer. Now I tell people to weigh yourself everyday if you want, but only “count” your lowest reading of the week and ignore the rest.

      – I saw 4-5 pounds drop in the first 2 weeks, but I also had weeks when nothing was happening or I might have gained… don’t ever be discouraged and continue to religiously stick to the program. Not following the program can create setbacks in weight loss.

      I wish you luck and I know that you can do this. I have a few friends and family I wish would ask the same question you just did here.

      Peace

      Mike

    2. Matt:

      Your cardiologist should be your firstline contact for approval of any new course of action, diet or exercise, since you have so recently had a heart attack. I assume that you have had a thorough workup by a physician who specializes in extreme overweight problems. if not, get a referral from your cardiologist and get an appointment. If your health plan or HMO offers clinical help for weight loss, go there and avail yourself of professional services. Same advice for seeking help to reduce stress in your life and improve your emotional well being. In fact, this is critical for health, especially since you are experiencing symptoms of depression such as crying yourself to sleep.

      Here is what works for me on diet.

      Read Eat to Live by Dr. Joel Furhman

      Read 4 Hour Body by Tim Ferriss (the weight loss recommendations for now, exercise later.)

      Establish a firm guidline for the number of calories I will consume in a day by constructing a detailed menu. I use a spreadsheet.

      If I deviate from the menu, I list what I have eaten and the extra caloric load. If I am not consistently below 2000 daily calories, I will not lose weight, no matter what I eat. Obviously, you should not go that low, check with your doctor, but 2500 calories seems about right, until you get in the neighborhood of about 250 lbs. Ok, I am a numbers guy and you may not be, but I think that you will really benefit from a food diary.

      Follow Tim’s advice on repeating the same simple meals. If it is complicated, the tendency to drop the program is overwhelming.

      I am a 5′ 10″ male, reasonably well muscled, I should weigh about 170 and I currently weigh about 180. My maximum weight was about 230, 10 years ago. At that time I lost 40 pounds. The mental picture that I carried with me was the difficulty I had in carrying a 5 gallon bottle of water upstairs to my office. After my weight loss, I was lightened by that amount for every trip up those stairs.

      I wish you the very best.

      Toby

  80. I’ve had a similar experience at a hospital in Vietnam Ho Chi Minh City. After a bar scuffle turned into a mini-brawl, my friend ended up with a glass broken on his head. Entering the hospital with blood pouring, they bandage it and take 3 hours “To DECIDE” okay he needs stitches… The images at the hospital were sad. You just knew that people were dying literally because of their slow or obsolete processes.

    Thanks for making the world aware, and I hope the world changers (which I hope to be one, one day) will find a way to change all of this madness.

    To Change!