The Diogenetic Light: March 2020

Gut Check.

It was a few days before Christmas in Hanoi. I had been working abroad in Vietnam and couldn’t wait to see my wife and daughters in southern Thailand. I flew from Hanoi to Bangkok, then hopped a southbound train. Trains takes a bit longer, but planes emit 3 to 7 times the carbon as trains. ⁱ It smacks of stupidity to choose an option that helps leave a ruined planet for my kids.

Trains in the Bangkok depot preparing to depart.

It’s annoying that you cannot buy train tickets electronically. This means I usually get stuck in a train car without air conditioning. That also means keeping the windows down and, depending on the breeze, some diesel exhaust from the train engine blowing in your face. Stepping into one takes you back in time to when Thailand was just starting to break into the modern industrial era. These train cars must date back to the 1970’s or before. I didn’t even care, though. As a dad, I love the excitement and wonder in my girls’ faces during this magical season. Watching them play within their innocent imaginations are moments too precious to miss.

I purchased a ticket and went to the 7-Eleven across the street to get some food. (You can’t swing a dead cat without hitting a 7-Eleven here. One school I worked at had two main entry gates a couple hundred yards* apart, and there was a 7-Eleven on the other side of the road from each gate!) A lot of people like the street food in Thailand. Honestly, I do too, but 7-Eleven has their own line of pre-made meals that they make in line with modern food safety practices. They are like our frozen meals back home, but only refrigerated because they sell so fast. I don’t like the extra plastic waste, but street food vendors don’t always follow good food safety practices; this is a safer option. My belly was beginning to feel a little off; I must have been quite hungry.

The train left a few minutes after I boarded, sometime around 5:00. I had food, internet data, earbuds, and dozens of books on my tablet. It wouldn’t be the most comfortable ride, but I was set. I planned to read a research article or two, maybe catch up on the news; it was all good. The Pad Kapow (Thai spicy stir fried pork with holy basil) was still steaming as I began to eat. Salty, spicy, savory, spicy – it’s Thai, so you have to mention spicy at least twice, – and delicious. I kicked back to read a bit, but my eyes grew heavy. I dozed off with a nice, happy belly and thoughts of seeing my lovely wife and girls.

I woke around 7:00. It wasn’t a dream or sudden stop that awoke me. It was a brick sitting in my stomach. I felt half the brick's weight physically. The other half was the feeling of deep dread that just sucks your body into the chair with its own dark, dire void.

I had felt this before after eating some bad street-food barbecue in Hanoi. I knew what was coming. If I was lucky, I would just have a really crappy night.

If I was lucky . . .

A minute later my stomach began swirling and churning – warning me that we would not be that lucky.

I’ve had touches of bad food back home in America before. At most, I would have an uncomfortable tummy for a few hours. I never had really bad food poisoning until I came to Southeast Asia. With the bad barbecue, I could not eat for 30 hours because both ends of my gastrointestinal tract were trying to discharge, projectile-style, the entire tract's contents simultaneously. (The gastrointestinal, or GI tract, for the non-geeks, begins where food enters the body; it ends where the food exits.) I chose to avoid street food for that reason, despite its deliciousness. (It is really good. There is a trend of restaurants that specialize in street food cuisine in a sit-down atmosphere because it is that good.) But no good deed nor health conscious decision would go unpunished this day. . . .

And then my gut felt as though it had punched itself. “If only we could be that lucky,” my belly gurgled, doubling me over in the chair. Nope. Food poisoning is when you get bad bacteria inside the GI tract. This would turn out to be enteritis: food poisoning’s evil, psychopathic twin. Somehow, some of those nasty little buggers went from inside the intestines into the intestinal wall. I imagined that is what it would feel like to be stabbed with a spear, just without the extra pain of cutting through flesh. It was enough to make me lose my balance and have to squat down while my guts writhed and twisted themselves about like a python squeezing the life from its unfortunate prey. On a pain scale of 1 to 10, this was a take-me-out-back-and-shoot-me.

This already made food poisoning feel like a walk in the park.

Around 7:30 or so – I lost track of time as the world spun and swirled – I made my first mad dash to the toilet. First came the vomiting. That was a temporary relief at least. Later rounds would include diarrhea too as my body tried to exorcise the evil residing within.

When expecting multiple rounds of vomiting, you need some food in the belly. It’s easier letting the stomach vomit something up than sitting there for 5 minutes in a fit of the dry heaves. It’s amazing how vomiting causes all your internal muscles to create so much havoc. It’s like an entire gym workout in a matter of moments, complete with pain and exhaustion. I wiped the dripping sweat from my face and returned to my seat. I ate a cookie and drank water in preparation for the next round. Just a single cookie, though. I could tell this bout was going beyond the standard 15 rounds.

The toilet was only a few rows away – maybe 10 yards* or so. (*Meters, for my international friends.) I lost track of how many times I stumble-ran between the two. I couldn’t make it the entire way a few times because of the cramps. It’s tough to walk with your intestines clawing their way out from inside your own belly. The cramps also make you feel like you're having a constant diarrhea attack too, causing the GI tract to attempt to evacuate from both ends at once. Fortunately, I was able to withhold the vomiting until I reached the toilet. Even more fortunately, the sink in the tiny bathroom was close enough to the toilet that I didn’t have to puke on the floor when the other end of the GI tract decided to join the fun.

Stepping into one of these train cars is like being transported back to a time when Thailand was just starting to industrialize.

After the millionth trip or so to the toilet (I’m rounding down here for sake of convenience), I was exhausted. I lost count of how many times I vomited; there were several times that I had multiple vomiting bouts in a single trip. You know how, after you puke, you feel like you’ve just done a total ab workout at the gym? This felt like a dozen of those workouts back to back. Finally, thankful for exhaustion, I made my way back to my seat and collapsed for a nap.

I caught a few needed winks when my heaving stomach lurched me awake and doubled me over. There was no time. With a quick check outside to ensure there were no overhanging tree limbs, I stuck my head out the window while my stomach shot what little was in my belly out like a cannon.

Kinda like this, except with projectile vomiting.

And on it went through the night: cramps, puking, diarrhea, and occasional short naps of relief. You know how, when there is nothing in your stomach, that you dry heave when you vomit? I found out that night that the intestines will do the same thing when trying to disgorge something evil. Lucky me - I had the privilege of experiencing the dry heaves and dry diarrhea simultaneously.

Finally, around 3:30 AM, I was done. Not done being sick. That was still hours away. I had reached my pain threshold though. Barely able to walk and exhausted, I gathered my bags and decided to crawl off the train at the next stop where there was a local hospital. That took a couple more stops though. I think it was between 4:30-5:00 when I finally got to an appropriate stop. It’s hard to remember for sure though; time flies when your stomach contents are flying too.

So, there I was, nearly crippled from pain and exhaustion in a land where I barely spoke the language and had not spoken it for months, in some tiny little hamlet town of rural Thailand. This town was too small to have a car taxi service, but there was a scooter taxi.

My Thai words were escaping me. Something about feeling like you might die tends to interfere with remembering foreign languages. Luckily, my tablet could translate a request for help to grab a taxi to the hospital. A Thai gentleman kindly helped me to flag a scooter and gave instructions to the driver to take me to the hospital. The driver listened, looked at my exhausted, ill foreigner face, and promptly took me directly to the local high school. Yeah, because where else would a saltine-cracker white guy like me go in Thailand, except to a school to teach English?

I was able remember how to say, in Thai, that I was sick and wanted to go to the hospital now. So, after repeating again, the driver gestured me to climb back on the bike, and off we went. As we finally began heading to the hospital, I realized my vulnerability. I was even cold! Back in Michigan, I used to walk barefoot in the snow for fun. I start wearing shorts at 40°. (That’s Fahrenheit for my international friends; about 4° C.) For me to feel cold told me that I was in much worse shape than I realized. If this guy wanted to mug me, there was no way I could have fought back in that condition. Like most Thai citizens, though, the driver was a decent, kind person.

By the time we reached the hospital, my ears were ringing from the pain. I was shivering from cold and too dizzy to walk. Man, this was turning out to be a sucky vacation. Worse yet, I forgot to buy insurance before this trip. At that point, though, it didn’t matter. I needed the pain to stop. In America, many think of healthcare like a heated seats option from a car dealer instead of the life and death issue that it truly is.

Fortunately, the doctors in Thailand all know English. Thai medical schools follow an accelerated 6 year program. Thai students that want to study medicine must not only score well on science and math exams, but English as well because every textbook they use is from either an American or British publisher. (The med students I used to teach told me that most are from America. Why? That’s because, despite the MAGA crowd’s inane, idiotic ideas, America always was and still is great.)

While Thai doctors know how to use the language in written format, many of them have had little opportunity to practice speaking the language. I have taught medical English. It is amazing to see these brilliant young minds that can fluently compose a written sentence, often with better grammar and vocabulary than people who grew up speaking the language, but still struggle to put that into speech. My doctor was one of those folks, so we had to write some messages back and forth.

Make no mistake, though, she was smart. I worked in healthcare for a decade back home and am very familiar with medical terminology, different medications, and a lot of basic protocol. She understood my questions and responses as long as the morphine wasn’t slurring my words. (So, if you ever come to Thailand, don’t worry, the docs here are well-trained professionals.) When my English-fluent wife arrived later she helped translate, but she doesn’t have a medical background. This created an interesting circular, instead of a back and forth, conversation. But there was no doubt that this doctor knew what she was doing.

For those of you familiar with medical costs, go ahead and take out a calculator . . .

They did the ER thing: vitals, x-rays, blood draw, intake questions, etc. The first shot of morphine came while we were awaiting blood test results. The morphine didn’t so much take the pain away, but made me tired enough that I could pass out for a while. Thank goodness.

It’s amazing how thankful we become for little things like sleep when accosted by a constant, stabbing pain. Or how we count ourselves lucky when the sink is close enough to vomit into from the toilet.

I didn’t contact my wife until later in the morning, just before the train was scheduled to arrive in her home province. My poor wife.

My head was swimming from morphine so I gave the phone to the doctor to explain. My ears were ringing so loudly that I could barely hear. I’ve had a touch of tinnitus for years, but I could not even make out the words she said on the phone. I could text back and forth, though. Come to find out, the pain had spiked my blood pressure and the medical staff wanted to know if I had a history of high blood pressure. After clarifying, they gave me something to bring my blood pressure down. The ringing subsided enough to hear again. The IV antibiotics were beginning to work too. It still hurt like hell, but at least I could stand up and walk if I needed to use the restroom.

This happened on a Saturday morning, and this small town hospital’s cafeteria was closed. One of the nurses found some ramen for me. I asked if they had any bananas, as they are about the mildest food to put in your tummy when you know they won’t stay there long. Bananas commonly grow wild here, but they didn’t have any. So another nurse went to the local market and brought some back for me. (This is typical of the kindness you see from Thai people, by the way.)

I went through a round of x-rays, blood labs, a bag of saline, IV antibiotics, blood pressure medicine, and 3 rounds of morphine. I was in the ER for close to 16 hours, taking space in one of their beds.

For those of you with calculators, do you have a tally for what that ER bill would be in America yet? Oh, . . . . but wait – there’s more!

The doctors in the ER treated the enteritis professionally and kindly, but my ears still rang constantly and made me dizzy. I knew it was tinnitus, which is tough to treat, but have never seen a doctor for it. Now, though, I was having episodes where I was too dizzy to walk. Crud, that meant more doctor’s bills.

My wife took me to the local hospital for a referral to a university teaching hospital in the provincial capital, and we went a couple days later. (Yes, I was uninsured and still able to get a specialist appointment in 2 days.) While there, they conducted a hearing exam in a sound-proof box before I saw the specialist. There’s not a whole lot one can do for tinnitus, but he gave me a prescription for a Thai manufactured medicine made from ginkgo biloba. The medicine didn’t eliminate the ringing completely, but it made it barely noticeable. That’s pretty darn good for tinnitus.

I had a follow-up a few days later, with another sound-proof box test and a hearing specialist consultation. He prescribed more of the gingko biloba medicine. That medicine is fairly expensive by Thai standards. It’s about $30 for a month’s supply if you don’t have insurance.

So here’s a second and third round of unplanned and uninsured healthcare expenses I was gifted with last Christmas. Care to posit a guess at the costs if that were in America?

The Thai healthcare system, by the way, is a universal healthcare system that also allows private hospitals and practices. Private health insurance is available, and it’s one of the world's top medical tourism destinations. ⁱⁱ There are many doctors and dentists running private clinics, though most work through the government system. At the public hospitals, family usually come to watch over the sick person, and they do pay for a few things out of pocket, but hospital stays are covered for Thai citizens and those enrolled in the social insurance program.

Foreigners working in the public schools are automatically enrolled in the social insurance program and the cost, limited to no more more than 750 baht, is deducted from one’s salary. 750 Thai baht is about $23 US. ⁱⁱⁱ Per month. That’s less than $300 US per year for comprehensive health insurance.

While American hospitals were charging $2 per Tylenol back when my dad was injured in 1988, Tylenol from the hospital here costs the same as you would pay over the counter. It is a little less than 3 cents per tablet. That is, unless you are in the social insurance program – then it’s covered. Plus hospitals throughout SE Asia, all developing nations, have access to the modern pharmacopoeia of medicines in addition to traditional herbal remedies.

Ready with those prices?

Translated to US currency, the ER visit was a little under $40. That included reimbursing the nurses for the ramen and bananas. Seeing the hearing specialist twice was under $175 for both appointments and the medicine. And the quality of care was excellent. On top of it all, even though their cafeteria was closed, one of those nurses even went out to find bananas for a sick patient with a bad tummy.

If a developing third-world country can provide healthcare of this quality at this cost, why do we tolerate the out-of-control costs in America? Why do we tolerate a system that is designed to profit by refusing to treat people who pay hard-earned money for their insurance? Why is it acceptable to tell some of our fellow Americans that it is better for them to suffer and possibly die in pain than to get the treatment they need that allows them to get well and return to work? Why do we tolerate healthcare CEO’s raking in millions while their customers all-too-often suffer and die because the companies refuse to provide the coverage we were led to believe that we bargained for?

Thank you for reading. If you need a break from lock-down boredom, I've linked some satire pieces below to give you a laugh. If you want to see something that will make you further scratch your head about the American system, check out the video I made of a Vietnamese grocery store below. I made this video when there were empty store shelves back home in the USA. (Apologies for the video quality. I don't do videos often. I was also wearing a heavy mask that was tough to breathe through, so my breathing is kinda heavy here.)