An Indian Senior Citizen’s 5-Hour Battle with American Medical Science
By Aloke Lal
At seventy-five, a man has acquired considerable wisdom. He knows that politicians make promises they cannot keep, that grandchildren are smarter than their grandparents, and that the human body, after a certain age, begins to behave like a government department. Nothing moves without a reminder.
Our protagonist, a distinguished Indian gentleman visiting the United States of America, discovered this last truth in particularly distressing circumstances. For four consecutive days, his bowels had refused to cooperate. Four days!
There had been no movement whatsoever. Not even a token gesture. The entire digestive establishment had gone on an indefinite strike. Initially, he had been patient. After all, he was an Indian. He had lived through bureaucratic delays, railway cancellations, demonetisation and several hung parliaments. But by the fourth day, patience had turned into panic.
His abdomen had begun to resemble a heavily inflated football. Sitting was uncomfortable. Standing was worse. Lying down provided little consolation. Even passing urine had become an exercise in agony. He decided that enough was enough.
“I need an enema,” he announced.
This was not a request. It was a diagnosis, a prescription and a proposed action plan rolled into one.
His family rushed him to the emergency department of an American hospital.
At the reception desk, a pleasant young woman asked him to describe his problem.
“Constipation. Four days. Terrible pain. I need an enema.”
She nodded sympathetically and began typing.
“Sir, do you have insurance?”
After several questions about his medical history, medications, allergies and date of birth, he was admitted for examination.
A nurse appeared.
“On a scale of one to ten, how would you rate your pain?”
“Eleven.”
She smiled. “Sir, the scale only goes up to ten.”
“Then please change the scale.” She made a note.
Another nurse arrived to check his blood pressure, temperature, pulse and oxygen saturation.
“Any difficulty passing urine?”
“Yes! Considerable pain.”
“Any bowel movement?”
“None. Four days. That’s why I’m here.”
She smiled professionally. Americans, he discovered, are wonderfully courteous people. They can be extremely polite even while refusing to do the one thing you desperately want them to do.
Enter the Doctors
The first doctor arrived. He was young, earnest and armed with a computer tablet. After listening carefully, he examined the abdomen, asked several questions and declared that investigations would be necessary.
“But doctor,” said the patient, “why don’t you just give me an enema?”
“We need to rule out other conditions, sir.”
“What conditions?”
“Several possibilities.”
The patient looked worried.
He had arrived with constipation. He was now being introduced to the possibility of possessing an entire medical encyclopaedia of ailments. Blood samples were collected. Urine was requested. This presented a peculiar difficulty, since passing urine was already an agonising undertaking. Nevertheless, the sample was somehow produced, under circumstances that deserved recognition for extraordinary courage.
Then came the X-ray. Followed by sonography.
The gentleman began to suspect that the hospital was preparing a comprehensive documentary film about his abdomen. He had travelled to America to see the country. Instead, America was seeing the inside of him.
A little later, the second doctor appeared. He studied the reports, examined the patient and discussed the findings with the first doctor. The patient listened hopefully. There was talk of additional evaluation, possible complications and the importance of proceeding systematically.
“Doctor,” he interrupted, “I have a very simple suggestion.”
“Yes, sir?”
“An enema.”
The doctor nodded.
“We’ll consider that.”
Consider? The patient was beginning to feel like a petitioner whose application had been forwarded to the appropriate department for necessary action. Back home in India, he reflected, an enema might have been administered before the ink on his registration form had dried. Here, it appeared to require the collective wisdom of the medical fraternity.
Five Hours of International Cooperation
By now, several hours had passed. The patient was exhausted, miserable and increasingly philosophical. He began wondering whether his intestines had decided to apply for American citizenship and were awaiting clearance from Immigration. Perhaps his bowels were observing a federal holiday. Whatever the reason, nothing was moving.
His family tried to comfort him. “Don’t worry. They are being thorough.”
“Thorough?” he exclaimed. “At this rate, they’ll discover the archaeological remains of my breakfast from 1972.”
A third doctor arrived. This one was senior. There was something reassuring about his manner. He had the air of a man accustomed to taking decisions after others had exhausted every alternative.
He reviewed the medical history. He examined the patient. He studied the reports. He consulted his colleagues.
And finally, five hours after the gentleman had entered the emergency department, the senior doctor delivered his considered medical opinion.
“I think we should try an enema.”
There was silence. The patient looked at him. Then at the other doctors. Then at the ceiling. For a moment, he wondered whether to applaud. Here was a triumph of modern medicine! Three doctors, blood tests, urine tests, X-rays, sonography, several consultations and five hours of clinical deliberation had finally established what the patient had suggested within thirty seconds of his arrival.
An enema. He wanted to rise from his bed and deliver a speech.
“Ladies and gentlemen, I stand vindicated. I have been advocating this intervention since the commencement of proceedings. I thank the distinguished medical panel for arriving at a consensus.”
But rising was difficult.
So he merely said, “Please hurry.”
Operation Liberation
The enema was administered. Not, unfortunately, with the delicacy that one might expect from a medical procedure costing considerably more than a return air ticket to India. There was discomfort. There were scratches. There were moments when the patient wondered whether the instrument had been designed for medical treatment or minor excavation work.
But then… something stirred.
Deep within the digestive establishment, the workers appeared to have called off their strike. A rumble. A movement. A gathering momentum. And suddenly, the great blockade was lifted. What followed was not merely a bowel movement. It was a historic evacuation. Four days of accumulated grievances were discharged in one magnificent demonstration of intestinal democracy. The patient experienced a relief so profound that it bordered on spiritual enlightenment.
His abdomen softened. The pressure eased. His face recovered its colour. Even the pain associated with passing urine began to subside.
He felt light. Had someone placed him on a weighing scale, he suspected that he might have qualified for a reduced airline fare. He emerged from the bathroom looking like a man who had just been acquitted of a serious criminal charge after four years of wrongful imprisonment. The family rejoiced.
And the patient contemplated the extraordinary achievement of American healthcare.
The Final Diagnosis
As he prepared to leave, he reflected upon the events of the day.
He was, of course, grateful. Being grateful for something does not necessarily prevent one from finding it ridiculous. Especially when one has spent five hours in acute discomfort waiting for a procedure one had been recommending all along.
He thought of the scratches inflicted during the final operation. Even victory, apparently, came with collateral damage.
Then he thought of the hospital bill, which was yet to arrive. A new anxiety seized him. Enema administration. What should be a fair bill for it? He suspected that somewhere among the charges there might also be a fee for listening to the patient’s original suggestion. And perhaps another for eventually agreeing with it.
As he stepped out into the crisp American air, still anxious about the bottom line of a paper that was under preparation, he turned to his family and made a solemn declaration.
“I have learned something very important about this country.”
“What?”
“In India, when you have constipation, the doctor tries to make your bowels move.”
“And in America?”
He paused dramatically.
“First they make the entire medical system move.”
Then, with the satisfaction of a man who had survived a major international crisis, he added:
“For five hours, three doctors tried to get to the bottom of my problem. All I wanted was to get the problem out of my bottom.”
And that, dear reader, was the end of the great American evacuation.
Except for the bill.
That was still to be passed.
(Aloke Lal is a former DGP, author of six bestselling books, painter and TedX speaker. He is the Festival Director of the Crime Literature Festival of India.)
