Thursday, June 04, 2009

All about Wockhardt, Bannerghatta Road, Bangalore

A Small Note... and a Request


I hardly know Rashmi. In the 30-odd days since I met her, I have grown to admire her courage and strength of conviction.

As many of you know, I have grown up around doctors, and tend to shy away from lending credence to "hospital horror stories". As you also know, I tend to be a very unemotional person. And very hard to convince.

So it's taken me a little over a month to agree to post this. A month in which I myself have presented the medical facts to several leading gynaecologists; met the medical services director of Wockhardt in an attempt to convince the hospital to conduct an unbiased investigation; done a lot of independent reading and research of my own. My conclusion: THIS IS JUST PLAIN WRONG.

Please do your bit to see that as many people as possible read it. Circulate it via email, via Facebook, and any other means you can think of. Talk about it. If it can help prevent even one more incident like this, it will have done its job. Hopefully, someone, somewhere will lend their voice to Rashmi's.

Thanks.
--
Regards
Vijayashankar

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Rashmi's Story


My name is Rashmi B.T. I am 35 years old, married to an air force officer, Vivek, and have a four year old son, Dhruv, delivered by emergency Cesarean section in 2004. On March 4th, 2009, my life was changed unalterably. I lost a baby that I had carried inside me, completely healthy, for a full 41 weeks.

I understand that doctors are human, that mistakes happen. However, I have come to believe that what happened to me could have been prevented if the doctor and the hospital had provided the most basic level of care and expertise. What's worse, they refuse to take steps to prevent someone else going through the same nightmare, simply because they want to protect themselves from the possibility of litigation - something I am not interested in unless it is the only way to force them to change their protocols.

The Beginning

In June 2008, Vivek and I learnt that we were expecting our second child. The pregnancy was uneventful. I was healthy and fit. Every prenatal visit and test showed that the baby was healthy and developing well. During my 35th week, I decided to consult Dr. Latha Venkataraman at The Nest, Wockhardt's Bannerghatta Road maternity facility to see me through the rest of my pregnancy.

Despite the fact that I had already undergone a C-section, she urged me to opt for a V-BAC (Vaginal Birth After Cesarean Section) or in layman's terms, a normal delivery. She brushed aside my concerns, telling me that a second C-section would be six times more risky and assuring me that a V-BAC would be less risky and almost pain-free.

My due date was estimated as 26 Feb 2009. I visited Dr. Latha on 28 Feb. She wrote on my record: "delivery will be attended by Dr. Latha/Dr. Prabha." Since I had neither met, heard of, nor been examined by Dr. Prabha before, I was concerned. Dr. Latha explained that Dr. Prabha Ramakrishna is another consultant at Wockhardt, and that it was a hospital requirement for her to write both their names down as possible attending doctors for my labor/delivery. However, she assured me that it was just a formality, and that she would be the one to attend to me when I went into labor.


On 3 March, I visited Dr. Latha again. Since I was so far past my due date, I requested that a scan be done to check on the baby.

When I called her to read out the results of the report, she did not want to know anything other than the liquor content, though I specifically asked her if there was any other information she would require from the scan. She told me I could either wait for labor to start or choose a day to come in and have my labor induced.


The Nightmare Begins


I went into labor at 2am on 4 March, and got admitted to the hospital at 5.15am.


By 7.45 am, I was experiencing contractions less than a minute apart. Dr. Latha came and did a quick examination. I was shifted to the labor ward at 8am where I remained until 1.50p.m., under the sole care of nurse Savitha. Dr. Latha was not present at all.

A junior doctor, Dr. Shirley, was available intermittently. She spent most of the time on her cell phone, talking to her husband. She was keen to see him before he left on an 11-day vacation. A Dr. Chetna substituted for her while when she went to see her husband off.

There was no other doctor present. Dr. Prabha was called each time the fetal heart rate fell (this happened a couple of times). She was seeing outpatients and attending two other deliveries simultaneously, so she was only able to come to the labor ward to see me four times, for less than 5 minutes each time.

At 10am, I was given Syntocinon, a drug used to enhance labor; the dosage was increased at 10.45am. At 12.30, there was vaginal bleeding, and the nurse phoned Dr. Prabha, who advised her to "keep a watch". The bleeding reduced, but I began to feel pain of increasing intensity during contractions. Dr. Shirley reappeared at 1.00 p.m., examined me vaginally and announced that I was almost fully dilated and would deliver by 1.30pm. I complained several times of excruciating pain but was told that it was normal. At 1.30pm, Dr. Prabha came in and was told by Dr. Shirley that I was fully dilated and would deliver any minute. Despite that, Dr. Prabha breezed off to visit another patient in the OPD.

I felt no urge whatsoever to push, yet was asked to do so. The stirrup on the delivery table kept breaking off - I was told that this is a recurring problem that "needed attention". At 1.50 pm, the fetal heart rate dropped to 80 beats per minute. Dr. Prabha was called again. She checked the fetal heart rate on the CTG, explained that this was normal when the baby was passing through the birth canal, and asked me to hold my breath and push hard. I felt no sensation in my cervical area, but felt intense pain tearing my stomach apart. I felt like my baby had rolled into my stomach and could see its body pushing up against my ribcage. I was screaming, pointing at my stomach, and telling them that my stomach was hurting, and there was no urge to push. But she told me to "push, push harder". I then heard Dr. Prabha saying "Get the OT ready". She told my husband that she was going to attempt to deliver by forceps - if that was unsuccessful, she'd have to do a Caesarian.

The OT wasn't on standby, wasn't ready. I was numb with pain. They wanted me to get up and move to the operation table. I couldn't move. They eventually slid something under my back and I pushed myself on to the OT table, as there was no transfer stretcher available. I complained of severe shoulder and chest pain. No one paid me any attention; everyone was busy preparing the OT, and the anesthetist was attempting to top up my epidural. The fetal heart rate was never monitored in the OT. Dr. Prabha unsuccessfully attempted a forceps delivery at 2.20 p.m., and then cut me open. I heard a deafening sucking sound, after which I must have passed out.
Later, I learnt that my uterus had ruptured along the scar of my previous Caeserian section. My baby was found floating in my abdomen. He had no heartbeat and he wasn't breathing. He had been deprived of oxygen for a long time - 43 minutes. They "resuscitated" my son and put him on a ventilator.

When I opened my eyes I saw Dr. Latha leave, followed by Dr. Prabha. Dr. Shirley was suturing me while laughing and talking with another nurse. I felt reassured that my baby was okay, even though I had neither seen nor heard him.
"Don't Worry, You Can Conceive Again"
At 3.30pm, a nurse struggled to take my BP reading; the BP apparatus wasn't working and had to be replaced. Dr. Latha met Vivek at the NICU and told him that the baby was doing fine and had to be kept under observation. She also told him that my scar had ruptured, but said that I was okay. At 4.30 pm, my husband repeatedly begged the nurses to give me pain relief. I was then shifted to the ward.

At 9.30 pm the neonatologist told Vivek that the baby had been deprived of oxygen for over 40 minutes, possibly resulting in "some extent" of brain damage. This was the first inkling we had that something had gone wrong.

The next morning, I was given a sponge bath at 6am. I then lay unattended until 2.30 p.m., when Dr. Prabha, Dr. Latha, and Dr. Prakash (the neonatologist) saw me for the first time after the operation. Dr. Latha unceremoniously ripped the dressing off my wound without using any gel or spirit, and pronounced the wound clean.


We were told that our baby would be kept under observation for another 24 hours. Later that night Dr. Latha came in at 9.50pm. Her only words to me: "Don't worry, you can conceive again. Your uterus is intact."
"Do Japa and Tapa To Get Better""
None of the consultants saw me on 6 March. That night, my milk came in, and my breasts became swollen and painful. I asked in vain for assistance. After repeatedly begging for help, I sent Dr. Latha a text message at noon on 7 March. At 4pm, a nurse told me that the doctor had instructed them to use a breast pump to relieve my pain - however, since the hospital didn't have one, I would have to go and buy one.

Dr. Latha finally visited me at 7.30 pm. She confessed that she was unaware that there had been a 43 minute delay in performing my C-section. She also admitted that instructions delivered over the phone could never substitute for personal supervision. She said, and again I quote, "Do some pranayama, japa, and tapa to help you get better."


Throughout my stay, nurses didn't know what medication I had been prescribed. They kept asking me what medication I was to be given. They had to be repeatedly reminded to give me medication.



For the next 13 days, Arnav was in the NICU on a ventilator. Throughout that time, he was completely reliant on ventilator support, his eyes were dilated and non-responsive to light, and there was no sign of movement. After a week, the neonatologist asked me to express milk and said they would feed the baby with a pipe inserted from his nose to the stomach. I did this for the next six days.


On 16 March, we decided to let Arnav go. We requested that he be removed from life support.

"We Would Do Exactly The Same For The Next Patient Who Walks In"
Vivek and I wanted to learn what had gone wrong with such a healthy pregnancy. Basic reading indicated that scar rupture is a well-known risk when you attempt to deliver vaginally after a first C-section, and must therefore be monitored very closely by a doctor if attempted at all.


We met with the hospital administration and the doctors. All we wanted was an explanation. To hear the words, "I made an error in judgment". Instead, we were met with a wall of defensiveness. Dr. Latha said that despite knowing the outcome, she would take exactly the same steps with the next patient who walked through her door.


I decided to get a second opinion. And then a third, and a fourth, and a fifth. Three of Bangalore's best-known gynaecologists (and other doctors too) categorically stated that given my age (35), the estimated weight of the baby (> 4 kilos), and the duration of gestation (>40 weeks), a vaginal birth should never have been attempted, and scar rupture was a logical, obvious outcome.


All reading I have done has backed this up. Even a layperson's book like "What to expect when you are expecting" (pages 363-364) says that abdominal pain during a V-BAC indicates a scar rupture and outlines the procedure for safe delivery of the baby. Given that I was complaining of excruciating abdominal pain, shoulder pain and chest pain, the doctor should have known my scar was rupturing. I should never have been asked to push; it exacerbated the rupture. Nor should I have been given a drug that intensified my contractions. By Dr. Prabha's own admission, she did not know about the rupture until she opened me up.

Several doctors have also told us that keeping Arnav on the ventilator for 13 days was an exercise in futility from the first. At no point were we told that he would never survive if taken off the ventilator - had we known that, we would never have subjected him, or ourselves to two weeks of anguish. All we were told was that he "might be" brain damaged to "some extent" but they couldn't predict how bad it would be.

A Brick Wall of Defensiveness; Discrepancies Galore

When I attempted to engage with the hospital to ask them to change their protocol of treatment based on an unbiased review conducted with the inputs of external gynecologists, I was met with a brick wall of defensiveness. They refused to conduct a fair, transparent investigation, claiming that their internal investigation showed that they had done everything right and that losing the baby was "my destiny". Dr. Latha went so far as to say that since I am educated, I should have been better informed about the procedure.

I don't want to sue them for money. I just want them to change their policies and protocols so that this doesn't happen to someone else. I have been hitting a brick wall for two months, and feel that the only way to make them pay attention is to tell my story to people.

There are many discrepancies and attempts to cover up the hospital's inefficiency (to name a few: baby's weight recorded as 3Kg despite the fact that he was never weighed; post-facto note of fetal heart rate as 180bpm despite the fact that the heart rate was never monitored in the OT; discharge summary says "live term baby extracted" even though Arnav had no heartbeat or respiration at birth; half-hour discrepancy between CTG trace and labor room clock). I asked questions to which I was given ludicrous answers (Eg: Our pediatrician is very experienced, so he can guess the weight of any baby just by looking at it).


We were charged approximately Rs. 2,20,000 by Wockhardt. Of this, we found over Rs. 7000 billed for things that had never been done (spinal anesthetic, an extra day of room rent, food not consumed). We subsequently found more extraneous charges, amongst them an amount billed for tests that were performed on 18 March, two days after Arnav's death.



My Story Has Just Begun...


My uterus is still healing. My back still hurts from the trauma. And my heart aches for Arnav, the baby I will never hold.

More than that, I am filled with the fear that this will happen again. After all, Dr. Latha says she would "do exactly the same again" even though she knows the outcome. And the hospital agrees that she - and they - did everything right.


Wockhardt delivers approximately 80 babies each month. With BP machines that don't work, a delivery room stirrup that's falling off and that has "needed to be fixed for a while", nurses who don't know what medication they are supposed to administer, and one (yes ONE) OT dedicated to emergency deliveries. That OT wasn't ready when I needed it. What guarantee do you have that it will be ready when you need it? Sure, they claim to have nine other OTs in the hospital - but if they are all as woefully unprepared as the one I was in, my story could be yours.


I want them to change their policies, and I won't give up until they do.

Thank you for reading.

The fallen tomato cart- very interesting read

(Author of this article is Subroto Bagchi, co-founder & COO of Mind Tree Consulting)

I pass through this very intersection every morning with so much ease. Today, the pace is skewed. There is a sense of disarray as motorists try to push past each other through the traffic light. The light here always tests their agility because if you miss the green, you have to wait for another three minutes before it lets you go past again. Those three minutes become eternity for an otherwise time-insensitive nation on the move. Today, there is a sense of chaos here. People are honking, skirting each other and rushing past. I look out of my window to seek the reason. It is not difficult to find because it is lying strewn all over the place.

A tomato seller's cart has overturned. There are tomatoes everywhere and the rushing motorists are making pulp of it. The man is trying to get his cart back on its four rickety wheels and a few passersby are picking up what they can in an attempt to save him total loss. Though symbolic in the larger scheme of things, it is not a substantive gesture. His business for the day is over.

The way this man's economics works is very simple. There is a money lender who lends him money for just one day, at an interest rate of Rs 10 per day per Rs 100 lent. With the money, he wakes up at 4 am to go to the wholesale market for vegetables. He returns, pushing his cart a good five miles, and by 7 am when the locality wakes up, he is ready to sell his day's merchandise. By the end of the morning, some of it remains unsold. This, his wife sells by the afternoon and takes home the remainder, which becomes part of his meal. With the day's proceeds, he returns the interest to the money lender and goes back to the routine the next day.

If he does not sell for a day, his chain breaks. Where does he go from here? He goes back to the money lender, raises capital at an even more penal interest and gets back on his feet. This is not the only time that destiny has upset his tomato cart. This happens to him at least six times every year. Once he returned with a loaded cart of ripe tomatoes and it rained heavily for the next three days. No one came to the market and his stock rotted in front of his own eyes. Another time, instead of the weather, it was a political rally that snowballed into a confrontation between two rival groups and the locality closed down. And he is not alone in this game of extraneous factors that seize not only his business but also his life. He sees this happen to the "gol-gappa" seller, the peanut seller and the "vada pao" seller all the time. When their product does not sell, it just turns soggy.

Sometimes they eat some of it. But how much of that stuff can you eat by yourself? So, they just give away some and there is always that one time when they have to simply throw it away.

Away from the street-vendor selling perishable commodity with little or no life support system, the corporate world is an altogether different place. Here we have some of the most educated people in the country. We don the best garbs. We do not have to push carts; our carts push us. We have our salary, perquisites, bonuses, stock options, gratuities, pensions and our medical insurance and the group accident benefit schemes. Yet, all the while, we worry about our risks and think about our professional insecurity. We wonder, what would happen if the company shifted offices to another city? What would happen if the department closed down? What would happen if you were to take maternity leave and the temporary substitute delivered better work than you did? What would happen if the product line you are dealing with simply failed? In any of those eventualities, the worst that could happen would still be a lot less than having to see your cartful of tomatoes getting pulped under the screeching wheels of absolute strangers who have nothing personal against you.

All too often we exaggerate our risks. We keep justifying our professional concerns till they trap us in their vicious downward spiral. Devoid of education, sophisticated reasoning and any financial safety net, the man with the cart is often able to deal with life much better than many of us. Is it time to look out of the window, into the eyes of that man to ask him, where does he get it from?

In his simple stoicism, is probably, our lost resilience.


--
Regards
Vijayashankar

Sunday, May 31, 2009

Bill Gates Gyan


This should be posted in all schools and work places.



Love him or hate him, he sure hits the nail on the head with this! Bill Gates recently gave a speech at a High School about 11 things they did not and will not learn in school. He talks about how feel-good, politically correct teachings created a generation of kids with no concept of reality and how this concept set them up for failure in the real world.



Rule 1
: Life is not fair - get used to it!

Rule 2
: The world won't care about your self-esteem. The world will expect you to accomplish something BEFORE you feel good about yourself.

Rule 3
: You will NOT make $60,000 a year right out of high school. You won't be a vice-president with a car phone until you earn both.

Rule 4
: If you think your teacher is tough, wait till you get a boss.

Rule 5
: Flipping burgers is not beneath your dignity. Your Grandparents had a different word for burger flipping: they called it opportunity.

Rule 6
: If you mess up, it's not your parents' fault, so don't whine about your mistakes, learn from them.

Rule 7
: Before you were born, your parents weren't as boring as they are now. They got that way from paying your bills, cleaning your clothes and listening to you talk about how cool you thought you were. So before you save the rain forest from the parasites of your parent's generation, try delousing the closet in your own room.

Rule 8
: Your school may have done away with winners and losers, but life HAS NOT. In some schools, they have abolished failing grades and they'll give you as MANY TIMES as you want to get the right answer. This doesn't bear the slightest resemblance to ANYTHING in real life.

Rule 9
: Life is not divided into semesters. You don't get summers off and very few employers are interested in helping you FIND YOURSELF. Do that on your own time.

Rule 10
: Television is NOT real life. In real life people actually have to leave the coffee shop and go to jobs.

Rule 11
: Be nice to nerds. Chances are you'll end up working for one.

If you agree, pass it on.
If you can read this - Thank a teacher!

--
Regards
Vijayashankar