“Can you hear me? Hello!”
Yes, I could. Just that my body was limp. I was two minutes late in starting from home, to catch the university bus. I didn’t see the iron pipe protruding from the ground.
My pulse was slightly low but I did not lose consciousness. The doctor at the University health centre recommended a CT Scan to rule out any blood clot in my brain. I had no option but to go to the hospital, which I wanted to avoid. I was taken in an ambulance. My first and last hospitalisation was 29 years ago when my daughter was born; I was 23 then.
‘Levipil’
The neuro-surgeon confirmed that there was no blood clot, and asked me if I had lost consciousness. I asserted that I hadn’t, but reported being disoriented for about 10 minutes.
“We need to hospitalise you and keep you under observation for 24 hours, or give you medicines and release you. But then, someone has to watch over you for the next 24 hours.” I stay alone; so I agreed to the hospitalisation, where they created a channel for a administering an injection.
“What was the medicine?” I asked. They said: “Levipil”
I googled it and found it’s an anti-epileptic drug. It’s side-effects include breathlessness and suicidality. They didn’t tell me why they were administering it or it’s side effects. They did what they did because without inject-able meds through channel, and without hospitalising me for a day – insurance claims cannot be extracted.
I messaged a doctor-friend who specialises in emergency medicine. He enquired: “Why did they give you seizure med if you did not have one?” He confirmed that anti-seizure meds cannot be given as preventive measure.
He advised me to sign a bond and get out of the hospital. A colleague called and said, when she had a blackout a couple of years back, they gave her anti-seizure medicines for three years and she got addicted to it. Getting out of that was a whole new story.
On a different occasion, just a year ago, I was recommended an unnecessary hysterectomy by overplaying the risk of cancer, after my uterus was deemed useless beyond the reproductive years. 67% of hysterectomies in India are done in the private sector and 95% of these might be unnecessary. 40% of women have hysterectomy by the age of 64, world-wide, but less than 10% of these are performed with any type of cancer or pre-cancer indications, and are done simply with the intent to avert ovarian/uterine cancer. They do not warn you about the increased risk of other kinds of cancer when you remove your reproductive organs, like that of thyroid or kidney; or association of hysterectomy with cardiovascular events, cancer, depression and dementia. Withholding of information, and instilling fear and uncertainty in patients is a business strategy.
Next morning, when I told the junior doctor that I wouldn’t take anti-seizure med, he screamed at me: “Well, then you clear your bills yourself; don’t expect any insurance-coverage.” The hospital wanted to give three dosages of anti-seizure medicines. Finally, it was negotiated down to two.
The CT scan report surprisingly mentioned ‘loss of consciousness’. Not only did I not lose consciousness, I had no prior history of seizure. Anti-epileptic drugs cannot be administered, as a preventive measure. It is a malpractice.
The line of medical-malpractice was quite clear. I had to be compulsively hospitalised with the sole motif of claiming (read extracting) insurance. If a conscious patient, who has suffered minor injuries, feels so helpless, one can imagine the belittled condition of those who are unconscious. The system takes over, decides and retains the rights of admission, administering, excluding, or doing whatever it deems necessary with our body.
A common practice
Here is another example of total loss of agency of the patient’s family, the unequal power-relation and its extractive tendencies. My neighbour lost her dad in the same hospital a week back. When her Dad was in his last stage, they did a bronchoscopy without the consent of the family. When they were in the ICU in his last hours, they got bouncers to get the family out of the space, and her dad passed away alone surrounded by tubes and beeping machines. They fleeced out as much as they could.
Another person my neighbour knew, was kept on ventilator for two more days after she had passed away. A colleague confirmed from her experience that hospitals will declare a patient dead only after medical insurance money has been completely exhausted. The system – premised on maximisation of profit – conceives patients purely as consumers, offers packages, exploits every bit of the insurance-coverage, and denies treatment to all those who are unable to pay.
Patient-doctor relationship, where patients are at the receiving end – is often fraught with mistrust and contention. It has turned out to be entirely transactional in the neo-liberal era. The system of expertise-asymmetry, makes it dark, closed and unreceptive. The patient is at the mercy of an arrogant and extractive system. A system that is dripped in rampant malpractices due to incentives, commissions, sales targets of big pharmaceuticals. In such a context, resistance of the medical system to prescription-audits is self-explanatory.
The clinical gaze was always unequal. It offered power to those who are in the position to gaze. Now, it is even more detached and utterly disinterested to empathise with our pain and stress. Its sole commercial interests lie in prescribing tests, mandating scans, manipulating medical records, charging medicines, at times over-medicating, and conducting surgery even when it is unnecessary – making health-care more expensive, inaccessible, discerning, dehumanising and literally ‘pathological’. The power and monopoly of the medical system over patients can literally strip the patients of dignity and expose their vulnerabilities and lack of choice.
To say that the system does not care about its subjects is not the right diagnosis; rather the system relies on converting the patients into objects of impositions. Medical decisions, financial burdens and unchallenged authority of the system are often enforced at every stage. Even if one remains perpetually suspicious about the inner and outer operating procedures of the system, one can do little to alter its proceedings.
Once you are admitted behind the glass-doors, you surrender completely to the unequal power-equations and lack of transparency. You are at the receiving-end. You have very limited access, limited knowledge and almost no power to make decisions. The greedy system, takes advantage of the ‘information asymmetry’, ‘power asymmetry’ and ‘fear psychosis’. They have a free-run and you have nowhere to escape. And most importantly, the system does not care much about caring.
Paromita Goswami and Sreedeep Bhattacharya teach at Shiv Nadar University.
This piece was first published on The India Cable – a premium newsletter from The Wire & Galileo Ideas – and has been updated and republished here. To subscribe to The India Cable, click here.
