Colonoscopy in Bangkok

Colonoscopy in Bangkok
Much to my relief my colonoscopy exam today 2/12/2008 at Bumrungrad International Hospital, Bangkok, was a complete success. No polyps or tumors were found, not even one, only one little internal hemorrhoid to explain the minor but alarming blood loss detected last week during my Welcome to Medicare Physical in Ajo, Arizona. My fears were based on an overactive imagination, which has often happened before. One of these days something is going to get me, of course, but I have to learn to accept inevitable changes with equanimity. Now I have a few weeks to spend before my ticketed return to Phoenix, Arizona, on March 5th. After a short rest to restore circulation in the legs and adjust for the time difference, I plan to continue on to Costa Rica for a month of long anticipated and postponed reunion. This Thai medical expedition turned out well even though the experience was a bit stressful, both the trip and the exam. When I arrived at the Bangkok airport at 2:00 am in the morning after three flights of 2 hours (Phoenix to San Francisco) + 13 hours (Taipei) + 4 hours (Bangkok) totaling 19 air hours, I was amazed to find my duffel bag circling on the conveyor belt, following me like a faithful puppy. Miraculously it did not miss making any connections. After clearing customs and obtaining a standard Thai 30-day tourist visa, when I exited to the public area, fully expecting to be stranded in a foreign airport in the middle of the night, I was really thrilled to see a sign with my name on it in bold print Jonathan Jarvis, held up by a young Thai man wearing an dressy suit and tie, the Bumrungrad airport representative, who bowed to me, picked up my bags and escorted me to the Bumrungrad desk, offered me a courtesy bottle of drinking water and informed me that my taxi to the residence would be free of charge. However, he explained that the only room available on the short notice of my email was a luxury suite for $70 per night on the 14th floor of the residence building opposite the hospital. I did not know then that there were many other hotels in the neighborhood, so I accepted the offer gratefully. On arriving at the residence building, a concierge welcomed me by name and handed me the keys to a suite with a large living room, a huge bedroom, a large bathroom with marble floor and a 15 by 20 foot stone patio balcony with benches and tropical plants outside in the humid, smoggy metropolitan air, surrounded by towering buildings dim in the distance, something like the futuristic scene of decaying Los Angeles in the Blade Runner movie but without the lights and crowd movement. The eerie scene at 3:00 am, eerie for such a vast cacophonous city during the day, reminded me of a herd of gray elephants silently waiting for dawn before a royal battle. The ancient suite with hardwood floors did not have free Wifi or the right voltage to recharge my Asus laptop batteries, in this respect it was not modern. There were some other odd deficiencies for such expensive lodgings. The cheap TV remote control did not have a mute button. There was no DVD player. The fridge and microwave were not stocked with food, sodas or coffee. I scanned about 35 channels in many languages mixed in no order: Thai, BBC English, CNN English, Chinese, Hindi, Russian, Arabic, French, German, Spanish. Many programs had subtitles in alternate languages such as Arabic. Intimidated by the imposing size of the king size bed and unwilling to turn on air conditioning which wastes energy and eventually makes me uncomfortable, but not finding any electric fans, another odd deficiency, I spread my travel nylon ground cloth and blue foam pad on the hardwood floor and slept poorly because of travel fatigue, jet lag and anxiety about the coming tests. The next morning I changed to a nearby hotel much less expensive ($18) and with an electric fan, and with a 24 hour Internet café downstairs (this one). It is next to the Pakistan Embassy in an Arabic neighborhood, two blocks from the hospital. The hospital exam this morning was my first colonoscopy ever. I firmly declined all sedation because I wanted to see the screen, converse with the doctor, avoid the risks of medication and walk out afterwards without a two-hour recovery period. The prep nurse insisted on intubating my hand anyway with needles and dangling plastic tubes, "just in case". Unexpectedly, the hospital later gave me a discount for waiving sedation because of the cost savings (final bill was US$530.00, deposit paid in advance with my Visa card). My valuables were sealed in a manila envelope, initialed and stapled. The exam procedure was not really as uncomfortable as I had been warned. It lasted only about 10 or 15 minutes. I kept my glasses on to watch a small monitor beside the gurney. The hospital has assembly-line type procedures for a daily turnover of 1,000 foreign patients per day (total, all departments, I would guess about 40 in the colonoscopy ward). In my case no complications were found such as polyp removal which would have taken longer. I thought the doctor assigned to me was competent, brisk and slightly impersonal. Contrary to the erroneous boilerplate report given to me afterwards, I was not consulted by the doctor in advance except for a one-minute meeting and I was never sedated at any time. He did take the time to point out some landmarks during the exam. The preparation took much longer, about five hours, two liters of laxatives and eight (8!) cold one-liter enemas. The patient waiting room was so cold due to excessive air conditioning that I began shivering under my blanket. Most of the other patients in the room were Arabic or Bangladeshi or Thai, few Westerners like me. The Thai nurses were young, pretty and pleasant. For the total of eight enemas required, about four of the nurses took turns with me, whoever was currently available. Some were more experienced than others. The single young male nurse wearing braces who undressed me for admission was pleasant and attentive. I appreciated how he carefully folded my clothes and laced up my pajamas and robe ("Is it too tight?"). He came up to me afterwards at the checkout desk and asked about my results. He even asked to see my souvenir printout with its captured key photos. He would not let me give him a tip. The personal attention from the staff really helped make the experience more bearable. They even gave me a souvenir DVD of the exam to take home. Weighing pros and cons, I am very glad for the successful outcome and pleased with the courteous treatment received, but now I feel lost in Bangkok. I cannot understand the Thai language, therefore have to depend on the English of others which is often minimal. Next time I might be inclined to stay in the United States or consult a doctor in Costa Rica recommended by friends. The airplane flight is also exhausting and costly ($1400 on short notice via Taiwan EVA Air, otherwise about $1000, versus about $500 for Costa Rica). I don't know what all this would have cost under Medicare in the United States or in Costa Rica. Maybe I should have investigated further before making the decision to fly to Thailand, but I was upset by the Ajo exam and I did not want to wait a month for an appointment. I was worried about the possibility of further costs of treatment by surgery or radiation. Now that I am in Thailand I would like to profit from my stay here in some way, such as the last time doing a retreat at Boonkanjanaram (2004) or my stay at Hotel Selee in Surat Thani (2005). I might go up to visit Chiang Mai in the northern hills. There is a tendency to sink into inertia and just stay in my hotel room, but in that case I must at least avoid channel hopping on the TV which never satisfies (the seventh precept to avoid entertainments such as shows). In spite of a lifetime of feeble practice, I have never really experienced the joy of meditation which I have only heard rumored, a joy that does not depend on external conditions. There are five hindrances or obstacles to be set aside: greed, hatred, sloth, doubt and restlessness. So my practice goes on. Home Page (jwleaf.org) ei

Much to my relief my colonoscopy exam today 2/12/2008 at Bumrungrad International Hospital, Bangkok, was a complete success. No polyps or tumors were found, not even one, only one little internal hemorrhoid to explain the minor but alarming blood loss detected last week during my Welcome to Medicare Physical in Ajo, Arizona. My fears were based on an overactive imagination, which has often happened before. One of these days something is going to get me, of course, but I have to learn to accept inevitable changes with equanimity.

Now I have a few weeks to spend before my ticketed return to Phoenix, Arizona, on March 5th. After a short rest to restore circulation in the legs and adjust for the time difference, I plan to continue on to Costa Rica for a month of long anticipated and postponed reunion.

This Thai medical expedition turned out well even though the experience was a bit stressful, both the trip and the exam. When I arrived at the Bangkok airport at 2:00 am in the morning after three flights of 2 hours (Phoenix to San Francisco) + 13 hours (Taipei) + 4 hours (Bangkok) totaling 19 air hours, I was amazed to find my duffel bag circling on the conveyor belt, following me like a faithful puppy. Miraculously it did not miss making any connections. After clearing customs and obtaining a standard Thai 30-day tourist visa, when I exited to the public area, fully expecting to be stranded in a foreign airport in the middle of the night, I was really thrilled to see a sign with my name on it in bold print Jonathan Jarvis, held up by a young Thai man wearing an dressy suit and tie, the Bumrungrad airport representative, who bowed to me, picked up my bags and escorted me to the Bumrungrad desk, offered me a courtesy bottle of drinking water and informed me that my taxi to the residence would be free of charge. However, he explained that the only room available on the short notice of my email was a luxury suite for $70 per night on the 14th floor of the residence building opposite the hospital. I did not know then that there were many other hotels in the neighborhood, so I accepted the offer gratefully. On arriving at the residence building, a concierge welcomed me by name and handed me the keys to a suite with a large living room, a huge bedroom, a large bathroom with marble floor and a 15 by 20 foot stone patio balcony with benches and tropical plants outside in the humid, smoggy metropolitan air, surrounded by towering buildings dim in the distance, something like the futuristic scene of decaying Los Angeles in the Blade Runner movie but without the lights and crowd movement. The eerie scene at 3:00 am, eerie for such a vast cacophonous city during the day, reminded me of a herd of gray elephants silently waiting for dawn before a royal battle. The ancient suite with hardwood floors did not have free Wifi or the right voltage to recharge my Asus laptop batteries, in this respect it was not modern. There were some other odd deficiencies for such expensive lodgings. The cheap TV remote control did not have a mute button. There was no DVD player. The fridge and microwave were not stocked with food, sodas or coffee. I scanned about 35 channels in many languages mixed in no order: Thai, BBC English, CNN English, Chinese, Hindi, Russian, Arabic, French, German, Spanish. Many programs had subtitles in alternate languages such as Arabic. Intimidated by the imposing size of the king size bed and unwilling to turn on air conditioning which wastes energy and eventually makes me uncomfortable, but not finding any electric fans, another odd deficiency, I spread my travel nylon ground cloth and blue foam pad on the hardwood floor and slept poorly because of travel fatigue, jet lag and anxiety about the coming tests. The next morning I changed to a nearby hotel much less expensive ($18) and with an electric fan, and with a 24 hour Internet café downstairs (this one). It is next to the Pakistan Embassy in an Arabic neighborhood, two blocks from the hospital.

The hospital exam this morning was my first colonoscopy ever. I firmly declined all sedation because I wanted to see the screen, converse with the doctor, avoid the risks of medication and walk out afterwards without a two-hour recovery period. The prep nurse insisted on intubating my hand anyway with needles and dangling plastic tubes, "just in case". Unexpectedly, the hospital later gave me a discount for waiving sedation because of the cost savings (final bill was US$530.00, deposit paid in advance with my Visa card). My valuables were sealed in a manila envelope, initialed and stapled. The exam procedure was not really as uncomfortable as I had been warned. It lasted only about 10 or 15 minutes. I kept my glasses on to watch a small monitor beside the gurney. The hospital has assembly-line type procedures for a daily turnover of 1,000 foreign patients per day (total, all departments, I would guess about 40 in the colonoscopy ward). In my case no complications were found such as polyp removal which would have taken longer. I thought the doctor assigned to me was competent, brisk and slightly impersonal. Contrary to the erroneous boilerplate report given to me afterwards, I was not consulted by the doctor in advance except for a one-minute meeting and I was never sedated at any time. He did take the time to point out some landmarks during the exam. The preparation took much longer, about five hours, two liters of laxatives and eight (8!) cold one-liter enemas. The patient waiting room was so cold due to excessive air conditioning that I began shivering under my blanket. Most of the other patients in the room were Arabic or Bangladeshi or Thai, few Westerners like me. The Thai nurses were young, pretty and pleasant. For the total of eight enemas required, about four of the nurses took turns with me, whoever was currently available. Some were more experienced than others. The single young male nurse wearing braces who undressed me for admission was pleasant and attentive. I appreciated how he carefully folded my clothes and laced up my pajamas and robe ("Is it too tight?"). He came up to me afterwards at the checkout desk and asked about my results. He even asked to see my souvenir printout with its captured key photos. He would not let me give him a tip. The personal attention from the staff really helped make the experience more bearable. They even gave me a souvenir DVD of the exam to take home.

Weighing pros and cons, I am very glad for the successful outcome and pleased with the courteous treatment received, but now I feel lost in Bangkok. I cannot understand the Thai language, therefore have to depend on the English of others which is often minimal. Next time I might be inclined to stay in the United States or consult a doctor in Costa Rica recommended by friends. The airplane flight is also exhausting and costly ($1400 on short notice via Taiwan EVA Air, otherwise about $1000, versus about $500 for Costa Rica). I don't know what all this would have cost under Medicare in the United States or in Costa Rica. Maybe I should have investigated further before making the decision to fly to Thailand, but I was upset by the Ajo exam and I did not want to wait a month for an appointment. I was worried about the possibility of further costs of treatment by surgery or radiation.

Now that I am in Thailand I would like to profit from my stay here in some way, such as the last time doing a retreat at Boonkanjanaram (2004) or my stay at Hotel Selee in Surat Thani (2005). I might go up to visit Chiang Mai in the northern hills. There is a tendency to sink into inertia and just stay in my hotel room, but in that case I must at least avoid channel hopping on the TV which never satisfies (the seventh precept to avoid entertainments such as shows). In spite of a lifetime of feeble practice, I have never really experienced the joy of meditation which I have only heard rumored, a joy that does not depend on external conditions. There are five hindrances or obstacles to be set aside: greed, hatred, sloth, doubt and restlessness. So my practice goes on.

Home Page (jwleaf.org)