Helpless days in port blair
I am not a writer by profession so i don't know how to right this story, from where should I start, but i will try my best to cover in short.
Summary :
I, Rupesh Kumar Rastogi, am a Software Engineer by profession. I found myself stranded on Port Blair Island in India with my father during a family vacation. Our family trip included my father, my wife, and our two daughters, aged 5 and 1.5. The journey began on January 19, 2023, from Allahabad, and we arrived in Port Blair on the morning of January 21. We explored Havelock and Neil Islands, but unfortunately, my father fell ill and was hospitalized on January 26 at G B Pant hospital in Port Blair.
From that date until February 26, my father's health deteriorated due to a lung infection (COPD + viral pneumonia), requiring the expertise of a pulmonologist. However, G B Pant hospital did not have a pulmonologist, and efforts to find medical assistance were challenging due to limited manpower and medical resources on the island. There were no private hospitals equipped with an ICU, and leaving the island was not a feasible option for a middle-class family due to cost constraints.
In my attempt to arrange medical evacuation, I had a distressing experience with an air ambulance provider called Vedanta Air Ambulance. They promised a chartered aircraft for 6.5 Lacs but failed to secure permission from ATC, deducting 1.62 lacs for processing fees, which were not outlined in our contract. I then engaged another provider who assured rescue through Air India commercial flight with necessary medical equipment and a medical team. However, Air India denied the stretcher booking, citing a lack of oxygen cylinders. Despite this, the provider charged me 1.93 lacs, later providing a refund.
I discovered that there were no viable options to leave the island, even with a budget of up to 10 Lacs. To my knowledge, no other airlines accepted ventilator patients. G B Pant hospital had a 10-bed ICU, and four of those beds, including my father's, were occupied by patients on ventilators and semi-ventilators, all desperately trying to reach the mainland. The hospital lacked an expert doctor in the relevant medical area, making our situation even more challenging. I want to emphasize that while G B Pant hospital had capable doctors, the absence of specialized medical professionals like pulmonologists, neurologists, and surgeons posed a significant concern.
This is the account of the helpless days I endured in Port Blair. I strongly urge everyone not to travel with someone who has pre-existing medical conditions. Additionally, if someone falls ill while in Port Blair, it's crucial to find a way to leave as soon as possible. If you want to understand why, please read this story.
19th January : we started journey from Allahabad by train to Delhi in night 9 PM
20th January : We arrived at our relative's residence early in the morning and stayed there throughout the day until the early morning of the following day. This day marked my final day of remote work.
21st January : On January 21st, we departed for Delhi airport terminal 2 at 3 AM and arrived in Port Blair around 11 AM after a flight. This journey marked the first flying experience for all family members except me. After reaching the hotel, we had lunch and set out to visit the nearby Samudrika museum. Later in the evening, we visited Marina Beach and then returned to the hotel, had dinner, and rested, preparing for an early morning ferry to Havelock.
22 January : it was an incredible experience as we traveled by ship for the first time. Makruzz offered a 10% discount for booking multiple trips, so considering our middle-class budget, I booked the entire journey in advance, covering the route from Port Blair to Havelock Island and then to Neil Island. We arrived at Dolphin Resort around 11 AM, and while we waited for our rooms to be prepared for check-in, we explored the beautiful beach and took some photos. We spent the entire day at the resort, enjoying the surroundings.
23rd January : we witnessed the sunrise at Kala Pathhar Beach and marveled at the lush greenery of Havelock Island. After lunch, we dedicated the entire evening to the stunning Radha Nagar Beach.
24th January : On the morning of an unexpected turn, my father developed a high fever around 4 AM, catching us off guard. Desperate for medication, I inquired at the reception for paracetamol, but unfortunately, there were no supplies available. They informed us that only two medical shops on Havelock would open around 8 AM. With his fever spiking, we resorted to using a wet towel to alleviate the fever until the shops opened. Once the shops were accessible, we purchased Dolo-650 and Levofloxacin, an antibiotic, after consulting with a doctor over the phone.
After his fever subsided, we advised my father to rest and sleep in the hotel room. If he felt better, he could sit on the balcony overlooking the sea. Accompanied by my daughters and wife, we proceeded to Elephant Beach, engaging in water activities. Since my father was alone, we cut our visit short and returned to the hotel around 2 PM, spending the rest of the day in the room. We had to administer paracetamol three times as the fever kept recurring.
Although I had wanted to experience scuba diving, I didn't get a chance to arrange it in advance. However, in the evening, I impulsively approached a scuba center and inquired about the possibility of scheduling a dive the next morning before 8 AM, as we had to catch the return ferry at 9 AM. Fortunately, they accommodated our request and booked a slot for 5 AM the following morning.
It was a somewhat sleepless night as I struggled to rest, given the fever's recurrence around 1 AM. I administered another dose of paracetamol, staying awake until 2 AM. I managed to sleep for two hours before waking up at 4 AM, feeling concerned about scuba diving with inadequate rest, especially considering I would be underwater in the sea within the next hour.
Break: As I pen down this account on February 16th at 5:29 AM, I sadly learned that one of the ICU patients desperately seeking an air ambulance within a middle-class budget has passed away. As mentioned in the summary, initially, there were four of us seeking a way out, but now only three of us remain,
25th January : On January 25th, I geared up for the scuba diving adventure, and at 5 AM, a cab picked me up. I completed the scuba dive and returned to the hotel by 8 AM. My fever had subsided, so I quickly had breakfast and headed to the jetty to catch the next ferry to Neil Island. We reached Neil Island around 11 AM. During disembarkation from the ferry to a wheelchair, my father experienced breathlessness. Finding a cab on Neil Island was challenging due to its small size and limited availability of cabs and taxis. It's advisable to disembark early and secure a cab, or pre-book one from the hotel, a tip we were unaware of.
Although the fever was not severe, it persisted. My daughters also had coughs and colds, so we decided to rest at the hotel for the entire day. The natural bridge stairs were right in front of our hotel gate, so in the late evening, we decided to visit. The sun sets around 5:30 PM on the island, so we spent the time from 4 PM to 6 PM at the natural bridge. Meanwhile, my father rested in the hotel room, facing breathlessness with minimal physical activity. He already had COPD, limiting his mobility to approximately 100 meters. To ensure he could enjoy the vacation without too much strain, we brought a collapsible wheelchair from Allahabad.
This breathlessness with limited activity wasn't new to us. He had experienced it during previous infections and fevers at home, where proper consultation and medication, including Levoflox and paracetamol, had helped him recover in a few days. We hoped for a similar recovery this time with rest and medication. However, by evening, I discovered that his rotacap had run out.
The night was daunting as he experienced frequent breathlessness even with minimal movement, an unprecedented situation. He was coughing up dusty-colored mucus, for which we had arranged a dust bin by his bedside. Concerned, I inquired about the medical facilities available on the island in case of an emergency. I learned that this small island had only one government medical PSU with around 4-5 rooms, if I recall correctly. Our next day's ferry was scheduled to depart at 3 PM for Port Blair, as our plan was to explore Neil Island. However, based on his current condition, I decided to leave as early as possible. I checked the Makruzz website to shift my booking from the 3 PM ferry to the 11 AM ferry, but there was no online option for such changes. Although 66 seats were vacant, when I called the Makruzz call center to request a shift to the 9 AM ferry, they denied the request, stating all seats were blocked. The hotel owner informed me that Makruzz had an office near the jetty, and we could reach out to them to request a departure at 11 AM on medical grounds. This sounded like a plan, and we decided to pursue this the next morning.
26th January : On January 26th, we prepared ourselves and packed our belongings. My father's breathing deteriorated rapidly; he struggled with breathlessness even while changing clothes. We made every effort to keep him in the wheelchair. He was so breathless that he refused to have breakfast. We asked a cab to take us to the medical center. It was Republic Day in India.
We arrived at the medical center, and they promptly provided an oxygen mask and injections to stabilize his breathing. His oxygen saturation was around 75 without oxygen support. While the treatment was underway, the Medical Superintendent (MS) visited Neil Island and saw us there. He inquired about the number of guests, as my wife and daughters were outside with all the luggage. I briefed him on the situation, and the MS mentioned that he would arrange an airlift for my father and me, and he would also organize assistance for my wife and daughters to reach Port Blair. Additionally, he assured that he would communicate and manage the time change with Makruzz.
The treatment continued, including nebulization. A helicopter was available, but I learned that being mainlanders, we had to pay 3500 per person, including the medical staff. I agreed to the charges and made the payment via Google Pay. However, there was some confusion regarding the charges, as I had initially heard it was 900 for islanders. This confusion caused a delay, and the medical staff also needed time to gather necessary equipment and emergency devices. We were supposed to go on the same helicopter in which the MS arrived to pay a visit. We had all our belongings with us and started moving toward the helipad in an ambulance. However, upon reaching the helipad, we discovered that the helicopter had already left due to fuel constraints. We had missed the airlift by a few seconds or hardly a minute.
We returned to the medical PSU in an ambulance. The next plan was to take my father to the Makruzz departing at 11 AM. It was already around 10:15 AM, and due to the increased travel time, we needed larger oxygen cylinders. Additionally, a nurse and ward boy were required to take care of him during the journey. The ward boy took some time to get ready, and we reached the jetty. After some requests from MS officials, they allowed us to travel with the stretcher. I made an additional payment for the medical staff. Finally, we reached Port Blair. I asked my hotel to arrange pickup and assistance for my wife and daughters, who had all the luggage. We proceeded directly to GB Pant Hospital, where he was admitted to the Medical Intensive Care Unit (MICU). Tests were conducted, and they started medication while providing oxygen through a mask with a setting of 8-10 liters per minute. The fever was gone, and breathing remained the primary concern. In the ICU, one attendant was required to be present at all times, so I stayed there throughout the night, sitting on a stool.
27th January : they closely monitored my father in the Medical Intensive Care Unit (MICU) until midday. Afterward, they transferred us to a regular ward. I was inquiring about hiring a paid attendant and successfully arranged for one to be present during the night. During the night, I went back to the hotel to get some rest while the attendant looked after my parent. My father found some comfort in rest with the aid of oxygen cylinders. The oxygen flow was set at 10 liters per minute to ensure a safety margin, considering his recent transition to the ward.
28th January : I arrived in the morning with breakfast for my father from the hotel and attempted to reduce the oxygen flow. He managed to maintain a saturation level of 96-97 at 4-5 liters per minute (LPM) of oxygen. Our return flight was scheduled for the 29th with Vistara, so I began searching for a way to travel with oxygen support. I found information that Vistara provides oxygen support for medical patients, but there was no online option, so I contacted their support number.
To my surprise, the support team wasn't well informed about medical facilities and how to arrange them. They advised me to go to the airport and make the booking there. When I reached the airport and approached the counter, the staff informed me that the support team should handle this. I called the support team again from the airport, and they instructed me to drop an email to custrelations@airvistara.com and then call back after an hour. I followed their instructions accordingly.
I also learned that a Fit to Fly certificate was required, so I approached the treating doctor, Shiv Shankar Singh, to obtain the certificate. I was in a rush since our flight was scheduled for the next day at 12:15 PM. I managed to catch the doctor just as he was about to leave. We had a discussion, and he attempted to provide a Fit to Fly certification. However, considering the oxygen needs on the ground versus in the aircraft, he realized that my father might require more than the 4LPM he needed on the ground. He informed me that airlines typically provide a maximum of 2LPM, and due to this policy, he couldn't grant the Fit to Fly certificate. The doctor suggested that I send the family back, which was a burden as I needed to take care of them. Consequently, I canceled the bookings for both me and my father. Later in the evening, I received a response from Vistara (attached). The doctor also mentioned that if my father could maintain a saturation level of 90-92 with oxygen support, he could then consider providing a Fit to Fly certificate
29th January : we were residing in a family suite during our stay in Port Blair, but the costs were high. Consequently, I sought out and reserved a homestay near the hospital for Rs. 1500 per day. However, it was still approximately 1 km away from the hospital. In addition to this, I organized round-the-clock assistance for my father to help with his needs, allowing me to handle tasks outside like arranging breakfast, lunch, dinner, and procuring any required medications for him.
The government hospital offered meals, but they didn't suit our usual dietary preferences. The typical meals consisted mainly of rice, fish, lentils, and a vegetable. I refrained from trying them as the appearance was unappealing. In most eateries, lunch options were centered around rice or biryani, and dinner choices were limited for vegetarians, often being oily and heavily spiced. After some effort, I located a restaurant that served chapati for lunch, though finding simple vegetables and basic yellow lentil soup was a challenge. I would go about 2 km to bring lunch from there, considering I had already returned the rented bike to the previous hotel.
As for my wife and daughters, they had returned to Delhi, and arrangements were facilitated for them to travel from Delhi to Allahabad on the same day with the aid of relatives and friends in Delhi and Allahabad
30th January : the rest of my family reached Allahabad early in the morning. Only my father and I remained in Port Blair. He required oxygen mask support, and we would carefully remove the mask for feeding him. If we observed a drop in saturation, we would quickly put the mask back on to stabilize him and then resume feeding.
Considering my prior experience with my father's earlier infections that were treated with oral medications, I wasn't overly worried. His condition was slowly improving, and I believed that he would recover soon, allowing us to fly, with or without oxygen support, within a week. I had set up a system to work from the hotel while attendants cared for him, and I coordinated the supplies for feeding. I arranged for my laptop to be delivered to the office, and a friend named Aditya deposited the laptop at the Noida office.
31st January : my father's health condition was relatively stable, and we could observe some improvement day by day. By improvement, I mean how he could maintain his saturation levels while feeding, even when the oxygen mask was temporarily removed. On the 26th, his saturation levels were dropping below 75, but now, if I recall correctly, it was ranging between 75 and 80. This indicated a 2-4 point correction from the previous day whenever the oxygen mask was off.
I received a response from the office, informing me that the transportation of the laptop would take 7-8 days. I thought that by the time the laptop arrived, I would have reached Delhi.
1 February : until this point, I had been relatively less anxious about my father's recovery. I believed that within a week, he would make significant progress. However, as one week passed today, I decided to reach out to my family doctor, sharing the reports and details of the treatment so far, seeking clarity on the recovery timeline. The family doctor informed me that the treatment was time-consuming and would require more time. The initial focus was on infection control for about a week, followed by one or two more weeks to stabilize his saturation levels. Full recovery at his age would likely take a month or two. Given this, I asked my friend in Delhi to collect the laptop from one of my office colleagues and deliver it to me in Port Blair so that I could start working. Additionally, the chest X-ray showed some improvements, which was a positive sign.
2 February : A friend arrived in Port Blair with the laptop, enabling me to commence work from the hotel starting today. Moreover, there was a noticeable improvement in my father's physical breathing condition.
3 February : While there was a slight improvement in my father's breathing, it had not yet reached a level close to 90 without the mask, which is necessary for him to be deemed fit for flying.
4th February : my father's breathing had improved slightly, but it hadn't yet reached a level near 90 without the mask. However, today I learned from the doctor that the Port Blair airport would undergo maintenance and would be closed from February 7th to 10th. Given that the saturation levels were still below 90 without the mask, my only viable option was to plan a rescue with a medical support team to exit the island, as advised by the doctor. Although I was unaware of the process and the associated costs for a medical team rescue, and even though there had been some progress in his reports until the last examination, flying with oxygen alone was not a feasible choice. Consequently, I decided to extend our stay until he stabilized and the runway reopened.
His saturation levels were ranging from 85 to 88 without the mask during feeding, indicating that we didn't need to put the mask on. The doctor also recommended maintaining a low level of oxygen support, allowing his lungs to work harder to fulfill the body's oxygen demand. He could manage to use the toilet with the assistance of a wheelchair without requiring oxygen support. However, he experienced breathlessness upon returning.
5th February : there was a positive development as my father managed to maintain a saturation level of 88-90 for an hour without oxygen support. Even with a 2-3 liters per minute (LPM) oxygen flow, his saturation levels were above 95+. During sleep, he would remove the mask, and if no one noticed, the oxygen levels would drop. This happened twice during the night, and I believed it was due to the negligence of the attendant on duty.
Tragically, today we witnessed a death right before our eyes, and this deeply affected my father, leaving him visibly frightened.
6th February : I spent the entire day closely watching my father. He was able to maintain a saturation level of 95-96 on 5 liters per minute (LPM) of oxygen. Today, we received confirmation for a private ward, and he was shifted there. I informed my dad that he had made significant progress and had been moved to a private ward. I assured him that we would be able to fly back home in a few days, which made him very happy. The location of the private ward was wonderful, with a balcony opening to the seaside. I planned to leave the homestay and shift there. However, fate had other plans.
I returned to the hotel around 9:30 PM, had dinner, and then went back to the hospital at around 11 PM. I went to bed, knowing that the attendant was keeping a watchful eye on my father.
Around 1:45 AM, I was awakened by a noise. My father was struggling to breathe, and his saturation levels had dropped significantly. We urgently called the nurse and ward boy, and with their assistance, we moved him to the ICU. There, he was put on CPAP NIV (Continuous Positive Airway Pressure Non-Invasive Ventilation) support, and he received treatment to stabilize his condition.
7th February : my father's condition took a turn for the worse. He was put back on the oxygen mask, and the oxygen flow requirement had increased. Tests and an X-ray showed that the infection had worsened, covering most of his right lung. Consequently, we were shifted back to the general ward.
My worry intensified at this point, especially since the airport was closed, and I strongly felt that he needed the attention of a specialized pulmonologist. I began exploring the available options. I spoke to an ambulance provider in Port Blair Dr Vivek who offered transportation to Chennai for 4,00,000 and to Delhi for 6,50,000 via a commercial flight with 4 liters of oxygen support. However, the oxygen support was capped at this level, and it would only be available after the 11th, which made me consider other possibilities.
Traveling by ship was not a viable option as it could take 3-7 days to reach Kolkata or a similar distance. Additionally, managing a large number of oxygen cylinders personally was not feasible. At that time, I had only about 2.5 lakh rupees in my account. I began thinking about seeking help from pulmonologists at AIIMS or PGI who could remotely discuss the situation with the treating doctor and suggest medication. I reached out to contacts to explore this possibility.
I had trust in AIIMS and PGI due to their extensive experience with a large number of referred patients and their expertise in dealing with critical cases. COPD combined with a major lung infection is a deadly combination, and I had witnessed this in my mother's case multiple times. In Allahabad private hospitals, my mother's condition had turned critical three times. On two occasions, I took her to PGI, and they managed to save her life. Once she had a severe lung infection, and I took her to AIIMS. After 10-15 days of treatment, she returned home. My mother had been in good health until 2016, but she faced acute renal failure at the end of that year. We took her to Ganga Ram Hospital, but they couldn't reverse the condition with plasmapheresis, so she had to undergo hemodialysis twice a week. Renal failure patients are susceptible to infections, and we experienced 9-10 hospitalizations in 4 years. Through these experiences, I learned about hospital selection based on the patient's condition. Sadly, in December 2020, she passed away
8th February : there was no improvement in my father's health condition, and he continued to experience breathlessness. A contact from one of my friends suggested reaching out to Dr. G.C. Khilnani, the former professor and Head of Department of Pulmonary and Critical Care at AIIMS. It was an excellent suggestion, so I contacted his Personal Secretary, Chetan, discussed the situation, and booked a teleconsultation for February 9th.
The appointment was scheduled for 9:20 AM. However, Dr. Singh, the treating doctor, had some urgent work and arranged for a discussion with his junior doctor. Unfortunately, I didn't receive a call at the scheduled time, and the junior doctor left. Later, I received a call from Dr. Khilnani himself. He mentioned that remote monitoring would be challenging, but upon my request, he agreed to discuss my father's condition with the treating doctor. I obtained the treating doctor's contact details and shared them with Dr. Khilnani.
I didn't have the courage to inquire whether they had spoken or not, understanding that doctors typically might not entertain such requests. I chose to remain quiet and assured the treating doctor that if he needed any assistance with obtaining medicines or arranging tests outside, he could ask me at any time.
9th February : there wasn't much change in my father's condition, and the oxygen requirement remained the same. When the doctor visited in the morning, he had a discussion with another doctor regarding changing the antibiotics. After this discussion, he inquired about the input from Dr. Khilnani. I then learned that there had been no conversation between the two doctors. However, Dr. Singh expressed his willingness to talk, which was unexpected but boosted my confidence. I connected with the Delhi doctor and facilitated a call between both doctors. Dr. Singh described the condition to Dr. Khilnani, who then suggested a new antibiotic combination to try. This change in treatment was implemented from the same day.
On this very day, I received news that Dr. Singh, the treating doctor, was going on vacation. This worried me, and I decided to plan for our departure. As tourists in the area, we had no knowledge about the doctors at GBP Hospital, and it took us 10 days to develop faith in the treating doctor, only for him to be leaving for vacation.
10th February : in a desperate attempt to secure a means of evacuating my father, I contacted Dr. Vivek from an air ambulance service I had spoken to earlier. He conveyed that Delhi was not an option due to some issues but suggested Chennai as a possible escape route. However, Chennai was not a viable choice for us, given our lack of familiarity with the area, especially in terms of medical facilities. Undeterred, I continued scouring the web for alternatives and found the contact number for Vedanta Air Ambulance.
Upon reaching out to Vedanta Air Ambulance, they initially quoted a rough estimate of 6.5 lakh for an air ambulance to Delhi. After expressing the need for precise details, we were presented with this quotation of 6.5 lakh I called in my office and told them about how badly we stuck here, and need a loan from office also i asked them to cross check about vedanta air ambulance, they have credited amount in my account and also said it looks legitimate.
which we agreed upon quotation of Vedanta and promptly paid. We were given assurances that the rescue operation would commence on February 11th around 11:00 am. Throughout the day, I remained in constant communication, diligently following up for flight confirmation. However, as the day progressed, no confirmation was provided. It wasn't until around midnight that I received a call, delivering the alarming news that ATC had denied permission for their aircraft to take off.
In light of this unexpected turn of events, I requested a rescheduling for the following day. To my astonishment, Vedanta Air Ambulance demanded an additional 30 lakh rupees to proceed with the rescue. Faced with this exorbitant demand and the critical deterioration of my father's health, I insisted on an immediate refund, recognizing the urgency of finding an alternative solution.
11th February : engaged in a conversation with Vedanta Air Ambulance, urgently requesting a refund. However, they informed me that the refund process would take some time and mentioned the possibility of charging a processing fee. This led to a heated discussion, as I emphasized that the delay was due to their failure to cancel the flight in time and questioned whether a simple email for ATC permission should warrant such charges. They had not disclosed the specific deduction amount, leaving me frustrated. Given the situation where my funds were tied up with them, I tried to compose myself, guided by the advice of the office admin, who suggested we accept whatever they offered for the time being and deal with the matter later. At that moment, our main priority was to retrieve the funds and search for an alternative ambulance service.
Recognizing the urgency of the situation and the need for funds, I explored the possibility of a personal loan with a few providers. However, I also recalled the option of a salary overdraft account, as I was certain that I didn't require a loan for an extended period. Thus, an overdraft was my preferred choice. I submitted an application through a mobile application, but unfortunately, it failed at the very end.
Our office administrator took charge of the task of finding an alternative ambulance provider. During this time, I also reached out to other ambulance service providers. However, I discovered that they were all quoting approximately 30-35 lakh for a journey to Delhi. This steep pricing is attributed to the fact that ATC only permits the use of jet aircraft or light jet aircraft as ambulances in Port Blair. There was no change in the health condition, but the oxygen demand increased to about 8-10 LPM. No airlines provide more than 4 LPM in commercial aircraft, making it an impractical option. Private charter jet aircraft was beyond my budget.
I tried to explore more options on the island. MIOT has an outreach center there to provide online consultations, and if necessary, they asked the patient to visit Chennai. There are two other hospitals named Pillar Hospital and Chekravarti. Both had ICUs earlier, but they no longer have doctors in the ICU, rendering them non-operational.
I was in continuous communication with the office, arranging food, and managing affairs in the hospital. Given the situation, I was hoping to secure at least 6 LPM in a commercial flight, or for the health condition to improve enough to manage with 4 LPM
Shailesh sir provided a few options and quotation, we figured out lifewings has lowest quotation of 4.5 lakh for delhi and assuring 6LPM so we agreed on option for this one, Shailesh has sent me one medif form to fill by doctor, I kept waiting for doctor but he haven't came.
12th Feb : I get the form filled by treating doctor and sent the same to shailesh, doctor has mentioned 6LPA so airambulance asked me to get this changed, thr form will get rejected if we show consumption above 4LPA, I search for doctor told about it and he modified to make it 4LPA.
oxygen demand reduced by 2 liter per minute now it is set at 6LPM, i have sent the documents, since i had conversation with other ambulance provider who told me that they will send one team memebr first but if patient in not condition to fly in commercial airlines they will reject and charge me both side ticket charges +20000 Rs
We were not in mood to pay a penney till someone confirm first. sailesh told me that shivangi from lifewings has asked for patient video, shivangi will discuss with air india medical team and after his nod we have to make payment
At the end of hopeless day, evening comes with some good news: the infection count(WBC) decrease from 18k to 12k. Hope will be able to fly as we get approval
13th Feb:
14th Feb:
15th Feb : he has lost consciousness in the morning, in ABG test doctors found out the reason as CO2 retention, CO2 was 110, so they decided to intubate him(intubation is a process in which a tube inserted in to mouth to lungs so that oxygen can reach directly), I was so scared what will happen, Sumit from life wings air ambulance service(LWAA) reached airport for stretcher booking in Air India, intubation process was going on I was waiting outside the ICU crying and praying internally, suddenly one junior doctor came out and asked to read and sign one more paper, I already have signed one paper for intubation, I was too scared thinking negative side, he told me they were unable to find the nerve to place the canula so they have to place central line(put one pipe in neck to give IV fluids and medicines). Once process completed I have seen him with intubation for breathing, central line for medicines and sample, and rice tube for feeding if required. He was still unconscious must be due to anesthitia but still he was responding on pinching him, around 11AM he got little bit consiousness, but Dr. allowed only IV fluids no feeding from rice tube. the whole day he was consious, Doctor has changed the antibiotics as moxifloxacin + meropenum didn't worked, so i was hoping for the some betterment on those antibiotics, Initally FiO2(in ventilator this is a setting which insures how much oxygen is being supplied in the air passed by ventilator to tube) was 100. Dr were planning to reduce it to see if this can be lowered to around 40 as Dr is aware we are planning to air lift by Air India.
Sumit came with Doctor team to examin the patient, they came from delhi to take him with medical support, He told me that request has been sent delhi Air India, once he give stracher and oxygen confirmation we will be good, the plan was to connect Air-India given oxygen cylinders output with POC (portable oxygen concentrator medical team has) output to increase the oxygen supply levels upto 6LPM. For this, patient need to be dependent on Fio2 between 40 and 60 not more than that.
Around 1 PM Fi02 has been reduced to 80 and saturation was 96+, we were hoping to get rescued from here tomorrow morning, I already started my conversation with Dr khilnani's personal secretary to discuss the process and treatment plan in PSRI hospital delhi, i booked appointment with Dr. khilnani and put note to discuss treatment plan and admission procedure
I was waiting anexiously to get Air India strecture, i followed Sumit couple of times to get update, he told me we are in discussion with Air-India to get oxygen cylinders from chennai. Around 5'o clock i got call from sumit, he informed me Air India has declined the strecher booking quoting lack of oxygen cylinders, he has also shared email communication snapshot. I was shocked and asked sumit why he haven’t informed me early, i might have tried my sources to get these oxygen cylinders. I called pravesh chaudri(PS to kesri devi patel) and Mr. Ganesh Kannujia(from aviation ministry office) and explaind the need of oxygen cylinders, Mr kannujia said he will request to Air-India chairman office to do the needful.
I still have some hope the situation can be managed as its just oxygen cylinders i asked sumit to stay here and complete the rescue either tomorrow or day after tomorrow when we get oxygen cylinders but Sumit told me sir i know its your father, so you are trying but if Air-India delhi has denied means its no more possible now, I followed up to Mr kannujia, he said he has done what he could, its not office hours now so we will probably get response tomorrow.
I will brief about oxygen cylinders later ...........
16th Feb : he is on ventilator, gained more consciousness, Around 11 AM Dr has allowed to give him 100ml water 4th hourly by rice tube, its day two after the antibiotics changed by doctor here, I have lost all my hope to escape, now I have nothing in my hand, office team has also lost hope and feeling helpless like me, doctors keep asking me on when you are going him to air lift. I am writing this story and initiated twitter campaign hoping some magic will happen we will get some help and able to get out from here, I got a call from delhi PSRI hospital from PS to Dr. G C Khilnani asking what happened to our shifting plan, relatives, wife, sisters all are asking have you reached delhi, I am tired describing my helplessness to all of them.
He is conscious whole day on IV fluids and medication and 500 ml water, I no longer trying escaped path as there were no options now, In the evening i got a call from one air ambulance service to which i have contacted on 7th Feb, he was coming to hospital with Dr from Chennai to air lift by commercial flight so he said he will see my patient as well if we can make upto Chennai, I agreed if we reach Chennai still we can get better medical facility and in future if required we will get road and train ambulance to carry him anywhere with full medical support in ambulance.
17th Feb : He is full conscious, FiO2 was 80 and saturation was maintained 97+, Dr visited around 9 AM, he spend good time going through treatment and fluids in and out, and examined my father, asked to repeat investigation CBC, KFT, LFT and chest x-ray, and allowed 100m ml water+milk in a day by rice tube, as he is still on ventilated with oxgen tube in mouth, rice tube in nose and central line in neck. Dr has discussion with technical staff and did some changes in ventilator settings and put Fio2 at 70, Dad's saturation was 96+ on this settings, i was keeping an eye on FiO2 as still i have some hope to get out as FiO2 reduced.
I went back to hotel to get fresh, i got call of attendant, she told me some outside Dr is here asking about me, I immediately came to hospital on a bike which i have rented for commute. Met the amubulance provider and Chennai Dr., they said patient in condition to recover if we reach Chennai, i had detailed discussion on how he will make it during the oxygen cylinders crises, are they able to manage oxygen cylinders from Chennai. He told me oxygen cylinders crises is going on from last two three months, they are mostly relying on their own POC, for this patient need to be on 40 FiO2. I was surprised,how Sumit from Flying ambulance was not aware of it, and how he has made promise to provide upto 8LPM for our rescue, looks like i have been cheated again. He said he was taking ICU bed number 6 patient tomorrow, they have tried their portable ventilator and POC in Hospital and he is doing good, Saturday and Sunday there wont be any processing, if there is some improvement in dad's health condition by Sunday then on Monday we can start the procedure and probably we can make move by upcoming Wednesday i.e 22nd Feb 2023
Now i am hoping for current medication to do some magic and FiO2 reduced to 40 as there is no way get cylinders. i returned to hotel to get fresh now.
Around 11:30AM i got a call again that dad extubated (pulled out oxygen pipe) himself, i came back instantly and saw he was being put on CPAP (a mask which will cover nose and mouth connected to ventilator so that it will forcefully push oxygen via mouth) support, with Fi02 at 100. My expectation to escape reduced a bit, because CPAP support can't be given in commercial airlines it takes more power and oxygen. He must be suffering badly that's why he pulled out. There is nothing in my hand. After some time i have given him 200 ml milk and 100ml water quickly by putting off mask, the way he drink looks he was super hungry, we have to put mask again as saturation goes down to 80. during mid day i asked Dr to reduce FiO2 as my desire to escape not died yet. so after that he was on 85 FiO2.
In the evening i have given 400 ml milk and some water in two breaks. in the night dad was not able sleep he tried to pull and throw away mask, he used to do such thing from last few days, he also has last hope by now as he can feel no improvement happened after this long time, nurse and staff tried to mange, but mask got broken, there was no replacement so they managed to somehow fix the broken one and at 100 FiO2. During evening i got a call from my sisters contact 'Gaurav' he got a link to Mr. B C Biswas who is Eastern Director AirIndia(Kolkata) he asked me to talk to him to arrange oxygen cylinders, I called him and told the name, he was already aware of my need so he told he will try to get it, he also told that Air India has already placed order for oxygen cylinders but they didn’t get the order by now that's why there is crisis and many people are suffering like me. Two patient expired in today's eve. RIP
18th Feb : he was on full FiO2 with saturation at 95 because of broken mask, he told he was hungry, i don't have dare to open the broken mask and feed him, as it would be difficult put same back, I asked nurse to get it replaced, after replacement i have given him water to gargle but he drank looked very thirsty then 100ml of milk then we have to put mask back as he felt breathless.
Dr came on round and asked for latest report but reports were still awaited, he said we are doing level best rest pray to god, he also added one more nebulizer medication acetylcysteine to reduce the cough which i din't find in port blair, so i bought water dissolving tablets of it. I haven't tried to get it from mainland because its not such medication which will change anything.
after some time i tried to feed him more as in last 4 days he get little orally, even you are getting nutrition via IV fluids but if you are conscious you will definitely fill thirsty and hungry, we kept ready the glass of milk and one medicine dissolved in water We put off mask and offered water first he was facing difficulty in drinking somehow finished glass few inside few outside, he was such hungry he tried to grab the glass of milk by opening hands toward glass on the same time he said he is feeling breathless badly while saturation was on screen 90, I have to immediately put mask back, I just went out and cried on his situation, I pray to god that no one will see his loved once in such pathetic situation. you are hungry but can't eat or drink due to the mask. I called my youngest sister and told situation is very bad we both cried, the way its going one made me to think on worse case i.e. death how we will transport his body, I am not aware how it will work id there a way what would be process, I asked sister to search for it, I don't have dare to search and learn the process to transport body now, but god knows when we do need it. my eye's are full of tear while writing this.
I came back and asked doctor either put a rice tube(feeding tube by nose) so we can feed him and able to give him acetylcysteine medication by dissolving it, she said will try after some time, then i requested Dr. to give him some sedation(medication to sleep) so he wont feel hunger, Dr. said they cant give sedation if he is calm, but she understand my condition and ready to put rice tube immediately, after that i have given dad some more milk and water then he goes to sleep.
on escape options there is no way as in commercial Air-India flight it is not possible to give sufficient medical equipment support using portable instruments, as portable instruments has a limit.
he slept in afternoon i came back to hotel and written all the sotry of today, then once i came back at 6 i have seen dad in some better condition, we had talk after so many days it was difficult to understand voice coming from CPAP mask but still i can understand that, FiO2 was on 100 and saturation was 99, i asked nurse to decrease FiO2 on which she replied she will ask doctor, i enquired about the awaiting report and seen WBC count was came down to 11600 which was little bit up to normal level, I was surprised to see such progress and thanked GOD, I was a bit happy after so many days, I have reduced FiO2 to 80 myself, after an hour once the Jr. resident doctor came he seen doing well on FiO2 80 so he reduced to to 60, saturation came down to 86+, that looks not normal to go from FiO2 100 to 60 in an hour, In general Doctors are used to reduce it by 20 and wait for 3-4 hour for next decrement, Doctor was not aware that its me who decreased it to 80 just an hour ago, so as i get chance i increased it to 65 and saturation was 88+, I have spent all the time with him. returned back to hotel around 10 had dinner and some phone calls, I still want to see him doing good also i was worried about 35% reduction in FiO2 in one go, so reached hospital again at 12 mid night, saturation was 90+ but still i don't want to have any chance so again i increased FiO2 to 80 so that there won't be any problem in night and then return to hotel.
18th Feb : the dad's phone has an alarm at 4, I wake up at that time, once i thought to go, to see the progress, after so many days i was hope full to get him in better condition but my body not allowed me to so, i i get to bed again. There was something which is not letting me sleep longer, I reached and seen, he is doing good, on the current FiO2 settings saturation was 96+. I decreased FiO2 to 60 and he was able to maintain 92+, I was happy, still given him some medication and milk via rice tube, doctor visited and seen the progress, he said to keep the settings same and discussed with junior Dr. to continue the antibiotics for next two days. I thought to get him brush as its too many days now when he is on ventilator and semi ventilator, but dad denied, I was also not sure how long he can hold while putting CPAP mask off, given him some warm water to gargle a few times then offered him juice, he is going to rest, I also returned in afternoon and taken rest. I was full of happiness by seeing him recovering.
whole day he was on oral liquid diet, in the night he was able to take roti with milk.
waiting for some more improvement so that we can take him out with medical support and portable ventilator.
19th Feb : physically he is a bit recovering, still on CPAP NIV support but saturation now 98-99 on Fio2 40. but chest x ray was still showing downside. able to feed soft food whole day after putting CPAP mask off (on nasal prompt).
Around 11:00 a.m. I got a call from AeroCare Dr pradeep he said I'm in hospital to rescue one patient, want to see your patient as well, so I reached and meet doctor pradeep and had a conversation on how he will be managing that, he told me the oxygen cylinder crisis is still going on with the Air India, so he can offer only for Chennai as he has some outside oxygen cylinder which is approved by Chennai engineering team to be safe to travel in flight. He will face difficulty doing the same for Delhi or Kolkata because the the engineering team there will take the whole process to approve for cylinders. but to be honest I was thinking like Chennai is getting more problematic because it's too far from my origin City.
Dr pradeep arocare had seen patient and said he he will be doing the rescue on Monday for the other patient and then he can plan for my father on Wednesday or Thursday if we started the process on Monday for Chennai only.
20th Feb : In early morning when I reached hospital i have seen one patient died in ICU, when I inquired I get to know that five people died from yesterday night till morning in 10 bed ICU. That was too horrified.
It was curious to know the patient who is supposed to be rescued, either he survived overnight and get rescued or died, so I get little bit late relieved and get to know she has been rescued.
Today my father also maintaining good on 40 fio2 mean he can also be rescued with medical team now I thought to talk to aerocare for chennai what are the same time one news hit my ears that airport runways again going to set for 4 days starting from 21st feb i.e. tomorrow, I called Dr. pradeep for confirmation, he was also not aware of it, after taking some time he just confirmed the news is true. Now there is no option to escape in next 5 days the only thing I can do is to pray to God to improve the health conditions
I thought a lot about Escape options from Kolkata Chennai and Delhi, Delhi was not an option anymore because of the flight time which require more oxygen cylinders I have to choose between Chennai and Kolkata, Chennai is too far from Delhi and my original City and there I will face the language problem as well so I thought to lock Kolkata. No I know I know pretty well that vistara will take 2 to 3 days in processing the cylinders, airport will open on 25th is that also need one or two days to port the cylinder to Port Blair, so I decided to make a booking on vistara for 27th of Feb, I booked the starter for two passengers get the money from better printed so that I can get that Filled from treating doctor.
In the afternoon I got a surprise call from Port Blair Airport the call was from Air India officer in Port Blair, he told me that he got one later from MP Smt Kesri Devi Patel also he got call from Kolkata Air India director G C biswas to help me out from Port Blair, he asked me to visit the Air India office in airport and collect the from, when I visited Airport he asked me about my story and worried about my losses, you told me the complete process that you should get this form filled by GB pant hospital and then you have to go to the Air India doctor Markar to get this signed and and then number that form to Air India Port Blair office.
In the evening I have forgiven both the forms to the resident doctor akanksha fill it, she said Dr pradeep padhey who is a senior resident will signing these forms so she can fill the form but I have to wait for tomorrow to get this signed.
21 Feb : I reached in the morning with some breakfast, nebulized him and then waiting for Doctor to get the form filled. Doctor visited and instructed to continue the same medication. My father is on simple oxygen mask and maintaining good saturation, doctor has signed the stamped both the forms, he asked me why these two forms? I said in best case scenario we will choose vistara with oxygen in sitting position, in worst case Air India if they able to manage oxygen cylinder with stretcher this time.
Still getting call from Air India Port blair, to get the form complete and submit by afternoon as they have to revert back to some email. But I was not in hurry this time because I want to get the okay from vistara first for oxygen cylinders , as he could make in sitting position if he made some improvements in upcoming days. With vistara i can save more money as they will only charge for oxygen cylinders in Addition which will going to cost around 15 to 20,000 extra. In case of Air India I have to book stretcher which is going to cost 3 lakh extra (2.4 Lakh for stretcher 15-20k for oxygen and 23 k for oxygen mask).
As I get the form field, I scanned vistara medical form and send them via email, I don't want to skip any option so I called my hotel owner to come with me to get the Air India form signed in evening by doctor Marikar(air india), Dr Marikar is available between 10:30 to 12:00 a.m. And then 4:30 to 6:00 p.m. So we went at the hospital at 4:30, after around 30 minutes wait we get chance to meet Dr Marikar, he asked why you came along with your father in this hell, are you not aware this is a hell? He signed the form and permitted with a stretcher and oxygen.
In the afternoon I got a revert on email from vistara saying
"As per submitted MEDIF form, in part-2 in point 'MEDA 05', the treating doctor has mentioned, 'YES' for current infectious disease.
On the other hand father is doing well with just a simple oxygen mask he was eating normal food now, i made a video group call to family members to show his better health condition. I came back around 10:30 p.m. After getting him dinner, this was a busy day.
22nd Feb : In the morning the i have seen my father in breathlessness, saturation was 82-84, it looks like he didn't get nebulized properly in night, he was also looking drowsy, I have given him nebulization instantly but still he was facing breathlessness, When doctor visited, he asked to perform ABG test as he suspecting carbon retention in the body, he has been put on CPAP again, the ABC test reflected same, the carbon retention level was 98.
The scene has washed out All My Hope to get Escape in sitting position now, i was also worried if he would be able to make stretcher and oxygen only. There is nothing I can do except Expediting the process of Air India booking. I reached Air India airport office around 11:00 a.m. With the MEDIF form, in AirIndia MEDIF form there is one column to fill the medical attendant name who will be going along that was not filled, there are two staff nurses who provide this facility to move patients, after spending 20-30 minute they have given contact number of one nurse, I talked to the nurse to get her permission to write her name, they asked me to submit the form along with two Xerox copy, available at the counter I got a call from vistara medical team they have asked about number of oxygen cylinders required, I was not pretty sure on this, it's a great about the capacity of oxygen cylinder, she was not aware of it she said our medical team is asking to book four cylinders for which I have to pay 19,600 I agreed, on which she has generated a payment link, i made the payment. I was still not sure he would be able to make in sitting position. I'm not confident the Air India would be able to arrange oxygen bottles this time, still there was hope since we are travelling to Kolkata and there is Director level person trying to help us out.
There is one more arrangement I have to make which is one medical staff, medical staff is mandatory with stracher booking so that in odd situation during the flight time s/he can help patient with medicine or injectable.
I got one staff nurse number of GB pant who used to do such rescues, I talked with her and stated about father's condition and plan for movement, she agreed to go along, she told that she will meet patient, collect the medication details from treating doctor on final day, I have to book his return ticket, stay at hotel in kolkata and pay her some money which she didn't disclosed, she said you can pay any amout she will be okey.
I am doing all this as I know there is no way otherwise after losing money and time two times. Now I can't rely on Air ambulance provider.
23 Feb : In morning situation was still same, he was on CPAP and drowsy, we were not able to offer him some liquid diet orally, When Dr. came he suggested to buy an bipap as he need them and we can use same in home as well, he asked one hospital staff where i can get that and shared the address.
I want to purchase a machine which can be used in the flight, there are some guidelines FDA for using machines in flight, those machines need to be battery operated so produce less sound I believe less than 40 DB and some more guideline on signals or something they generate. I have to find one model which is FDA certified.
I went there to buy but came to know that they usually don't have it in stock they can order it with my selected model from brochure. It will take 4 to 5 days to get the item delivered I told the shopkeeper lady that I don't have that much time on which she said he will see share his supplier number, I can talk to him directly.
It means there is no way I can get BiPAP machine in Port Blair, I tried finding options from Kolkata to get this delivered here, connected to some businesses in Kolkata and Delhi they have offered some models but no one was your on the delivery timeline, one of the Kolkata guy told me they can deliver this in 2 to 3 days via a normal Courier, when I asked for Air Cargo, they can probably do the delivery next day on additional payment of 3 to 4000. I asked him to check with his career partner for the next day delivery confirmation. In the evening he called me and said the delivery will take 2 to 3 days because the air cargo won't accept the battery in The Courier, the battery has to reach via some other medium. In case of Island the other medium is a ship which will take 3 days at least. Now there is only one option get BiPAP machine is : via someone who can come along with the BiPAP machine in a flight to Port Blair. At the end of the day I was able to finalize two providers, one in Kolkata who is offering to buy at 1.68 lakhs which I can get from one of the my relative 300 km away from Kolkata, the other provider is from Delhi who is offering at 12000 per month rent which can be bring by one of the friend from Delhi to Port Blair.
I was following up with my contact in airport Kolkata for arrangement of oxygen cylinders, he said they are facing challenges but they are trying their best. I followed up with doctor on co2 retention and get to know CO2 is it still there at level 93, I searched on web for how we can wash out CO2, I was able to find one medical document that was not easy to understand by a normal person but it was talking all about changing the mechanical ventilator settings based on the patient need which help to wash out, but I am not seeing any changes in the ventilator setting from last 24 hours looks like the doctor there was not well aware of how to play with the ventilators settings
24 Feb : On the health side nothing has changed much, he is still on CPAP and drowsy, we can say less drowsy as compared to yesterday, but it's still not significant change I can see. He's on IV fluids. When the doctor visited he asked for the biPAP I told him the problem, he also wanted to know the flight arrangement I've told him about my current situations that we have Air-Vistara ticket confirmed but it is in sitting positions, In Air India we still didn't get confirmation on oxygen cylinders for streture booking,
Doctor said you can buy one Ambu bag(this is a manual rubber balloon attached to a face mask which can be connected to the oxygen, one has to put that mask on patient and keep squeezing the balloon to Pump oxygen to patient.) and use the same during the complete fly time. He said we are giving the highest possible antibiotic, we can't do much so you shouldn't miss any chance to escape from here even you know you may face problem during the onboarding and have to return to hospital still you should go to the onboarding place.
Anyone can understand what doctor want to say, means that situation is out of control on doctor's end. This is a do or die situation now. I connected with the airline officers in port Blair and Kolkata and get to know they are still trying and they are positive about getting the oxygen cylinders, I called the Air India Kolkata contact and told him what doctor said, I wanted him to arrange those oxygen bottles, in the post afternoon when I have followed up I get to know they have planned some arrangement and I will probably get the oxygen bottles. I asked him how many oxygen bottle he is expecting to be arranged, he was not pretty clear on this, I told him based on my discussion with different Rescue Team and Air-Vistara we probably need three to four bottles for Kolkata and for Delhi we need 6 to 7 bottles, that was a surprise for him I believe he was thinking one or two bottles are gonna be more than sufficient. I told him these Oxygen bottles or the only reason I'm planning for Kolkata not for Delhi.
Around 11AM i got a call from Air India port blair staff that oxygen cylinders have been arranged, he was still not sure on count, he asked me to come with some papers to complete the formality and book tickets by making payment.
I have to arrange fit for fly from hospital, one affidevit for taking all the responsibility for any mishappening during the flight, he has shared one such a document as sample. I have to tell the name of staff nurse who will fly along.
I called the nurse and she asked me to wait, she will meet patient and then confirm. Then I asked my friend aditya from delhi to check his availability for delivering the machine from delhi, on which he promptly agreed, I called the machine provider made security and rent deposited in his account which were around 1.12L, booked flight ticket for aditya of tomorrow early morning so that he can reach by tomorrow 11AM. We have to setup try and practice on that device.
Its around 1:30 i called nurse again to pay visit and confirm but she didn't picked phone, I asked hotel owner to help with affidavit, he has sent his elder brother to go along with me to show the place where this can be prepared.
After some time we went to the place and get the stamp of Rs 100, printed matter and get it notarised, airport guy was calling me to come fast and complete the formality ASAP, they used to close the counter around 2 PM but specially for my case they asked the booking staff to stay on hold.
After completing all the documents, collected all and went to the airport. There was no one at booking counter, I made a call to indian airlines authority and he has sent booking guys there, submitted all the documents and asked about the final amount and the booking process. unfortunately nursing staff is not yet final, in booking he want the name of medical assistant, he told me that after booking the name can't be changed. Now the next problem was making payment so I thought of swiping multiple cards to make the payment i.e. going to be around 4 lakh, The problem was making all the payment in single transaction because they told me they have a single field to enter the transaction number in booking form, I had one high value credit card but that was AMEX which airline swipe machine was not accepting, there was not an option for online transfer so I left with arranging cash requested for some more time to arrange the cash and get ready with medical assistant name on which he insisted to get this done as soon as possible because if the vacant seat is going to be booked and if we don't have 9 seat then stretcher booking can't be done.
I have two debit card with daily limit means i can get 160000 from here in two days, Asked hotel owner to arrange cash of 1.5lakh against bank transfer in his account, he said he has around 90k but he will try to manage rest 60 by eve, for remaining amount i was thinking to get from Aditya's account when he reach tomorrow morning. FYI its friday evening so bank are close by now and will be shut tomorrow morning, ATM was the only source to get money. After return visited hospital after return to hotel managed all the money as per the plan. followed up for machine delivery in delhi all was as per plan.
i had some earlier experience with my mother so i knew once all the antibiotics in culture report get resistant(not working) still we have some antibiotics which are called as last line medication, I had the mother's case paper of AIIMS delhi in mail that I have shared with Jr. Doctor there and asked if we can try that medication, i knew by the time those medication were not there in hospital and hard to get from market.
25 Feb : In morning visited hospital and get to know one shocking news, one young married lady hardly 24-25 age group on the next to next bed has collapsed(due to lung infection), the couples was from mainland working in island, its hard to digest that someone in this young age cant be saved, her husband was worried about transporting the dead body to mainland. he asked hospital staff to shift the body to Morchari till he figure out way to transport body.
I told dad we are leaving tomorrow, he got some energy by listening it, i know he has also lost hope to get away from there, What i was planning had lots of risk but lying there was no longer a choice as there were 0% chance of recovery, i offered some juice by removing CPAP mask and then travelled to airport to pickup aditya.
When we reached hospital with aditya and CPAP machine, we asked Junior doctors for helping us out to setup the machine so that we can replace dad's ventilator support with this machine, they said they called another doctor from chest and sleep department for setup so we have to wait.
The nursing staff who was supposed to drop us till kolkata paid a visit but after seeing portable ventilator support she denied going along, she said we need one technician or Jr doctor along with this machine to help us, i tried convincing her that i will take care of it but she refused.
I tried asking to staff who can help us but they were also clueless, i get to know there is one more nurse but not able to find her, I called hotel owner again and told about situation he was away but said he will try to get some help for me, I also called one of the local air ambulance provider who has done one patient shifting to chennai for arranging one doctor, but he said they are chennai based if he send someone then i have to book chennai to andman, andman to kolkata and return from kolkata to chennai plus service charge of around 50-80k, i am not sure whether there were flight available or not but i didn't opted this option, Hotel owner came after a while and we visited one hospital hoping to get some medical staff or doctor there we get to know since ICU is permanently closed in that hospital so they don't have such doctor in duty. We returned to hospital and tried doing setup as demonstrated by portable ventilator provider but not sure on that, Jr doctor from chest and sleep visited there and did setup of portable ventilator and then we replaced ventilator support with portable ventilator.
we get to know the department of another nurse who used to help patient dropping via airline, we reached hospital and visited that department, she was not there but we got her number, i called her and briefed about condition and help we are seeking, she agreed to drop patient, i haven't discussed about charges, i thought both side ticket plus 5k would be sufficient. I asked her for giving her id so that we nac make booking, she sent on whatsapp we took printout of all required document for ticket booking and headed towards airport.
It's already 2:30PM we reached there and made booking. booking staff was asking me to book oxygen mask for patient which is going to cost 26000 around, i told him there is no need patient will use CPAP mask so he cant wear oxygen mask anyhow, he told me there would be some problem with their oxygen cylinder connectivity with outside devices that why he asking us to buy oxygen mask, i denied and booked without it.
Now the next action item was finalising the hospital in which we are supposed to admit my father, the look up was going on from last few days, one of the hope option was Apollo but that was to costly and since we don't have anyone from kolkata so i am not getting faith on other hospitals, I talk to one of my friends friend who is Kolkata based and in medical supplies according to him Kolkata is not good place for treatment it would be better to go for Chennai but you don't have any option now so I ask him to a book ambulance from airport to Apollo as a timing and flight details he assured that he will manage.
Have informed hospital ambulance about timing of departure, I was in continuous sync with junior doctor for preparing all the documents and discharge summary along with complete reports so that we don't miss anything.
That was the toughest night of my life a lot of things are going in my mind, what will happen, there is a lot of risk associated anything could happen, in will return to hotel and packed all the luggage had dinner, its around 1AM still i was not able to sleep so thought of visiting hospital, reached there and sit beside of dad, the nursing staff on duty said everything will be fine. I returned to hotel and slept for 2-3 hour.
26 Feb : I reached hospital by 5AM, collected all documents, changed father's dress packed everything we need, the plan was i will come along with father in ambulance and aditya will book a cab and reach airport to do check-in collect the tickets, everything goes as per plan.
We were ready on time but the nursing staff didn't reached yet, we are waiting for her after 30-40 minute she reached and we left hospital, once we reached inside airport i have to go with checkin while father and nursing staff will directly reach on runway by ambulance, airport staff was there for my help to get check-in done quickly. we reached to plain and get sitted, father entered in stretcher but to my surprise he was wearing indian airlines normal oxygen mask, airport person said they were having diffculty connecting oxgen wire to oxygen connecctor so they have given mask for the same we have to pay at kolkata there was no time and situation for argument, i can see he is facing difficulty in breathing, the saturation was 27, it was difficult to make with current setup so i tried cheking CPAP again by myself, first i tried to connect oxygen nasal prompt to oxygen cyliner, it's bit tight but i was able to connect it, I have removed airline provided mask and put nasal prompt, then switched on portable ventilator and put it on top, he was not feeling good but there was no other choice saturation was around 50-56, There is no way to increase it, travelling nurse have given some injectible as well, the flight has taken off and we were on our seats praying to god.
once plane get stable we checked again saturation, its around 50 its quite low, oxygen was at max @4liter/minute that can't be increased, there was no other option, In ground portable ventilator,ventilator has one oxygen port to suck oxygen as per settings and deliver same to patient, but with Philips Bipap A40 it was not an option, we are carrying the best bipap approved for air travel. In CPAP mask there was one port in which oxygen can be connected i tried that on ground and get to know if we do this with limited oxygen supply(4LPM) then it will give worse result, i found out oxygen nasal prompt + CPAP on top is delivering better result. Means everything is now under gods control during the flight time. one oxygen bottle finished within and hour we have replaced with 2nd bottle, these were the only 2 airlines managed to provide, but airlines staff has given one of the crew bottle as a next, we know we need at-least third bottle to complete journey, we reached kolkata and father shifted to ground ambulance, i and aditya went to do checkout and luggage collection, i got a call to deposit money for oxygen mask, one guy reached me and goes along to make the payment, after making payment he dropped us outside, ambulance not yet reached i called him he said he is on the way, there was one Appolo ambulance standing outisde, I checked with him weather he can drop he said he is on standby and only operated on hospital direction, out ambulance reached, that was not decent also has less space to accommodate all 4 with luggage so i asked aditya to book cab for him along with luggage and i and nurse going along with father in ambulance.
on ground oxygen levels are good with normal oxygen mask so we put CPAP in bag, We reached Appolo emergency gate, i asked applo staff to bring strecther and get him in with oxgen, he asked me to do some formality first, all of sudden i have seen father is getting breathless oxygen supply stopped (there was no more oxygen in bottle) father was unable to breath, looks like breating stopped,
I started pressing his chest with both hands(CPR) to resume the breathing, seeing all someone yielded to bring streture and they have taken him in immediately, he was not breathing, they started with procedure and sent me consent form to sign i did that, then after sometime they and again given me one more consent form, i was so nervous what will happen i was waiting outside Aditya came and told me ambulance guy is asking for money i stopped him to give him any amount i said let me see my father first, its there negligence that they have connected bottle having low oxygen, its around 40 minute of journey only, they are careless i will see them after procedure.
after the proceudere i have seen him in ventilator they have to put ET tube from mouth, they told it was very hard he just left with 2% oxygen when he reached in OT. I am still not sure how he was as he was unconscious but readings are ok in terminal.
I have completed formalities for admission deposited initial 20k, he said there is no Bed in ICU so he will be there in emergency only, Junior doctor met me and i have briefed him history, shown reports, and treatment given so far, i memorised every antibiotics given and its duration and how it performed in last one month. He told me Sr. doctor might come in evening. I want to meet Sr. Doctor to discuss so i was roaming around, Sister was waiting in waiting area i haven't yet paid her, i met her and asked how much should i pay she said 15000 _ return ticket, i am not expecting this number, She said hotel nearby are very costly lodging and fooding will cost her 5000-6000 for a night, i have given her 12000 and said please manage with it and sent her return ticket details.
One of aditya's relative(cousin brother) came to hospital to meet us, his residence was 40km from hospital, aditya said he is living alone so you can stay with him, I was not in situation to make any decision as no one knows what's coming next, one attendant need to be in hospital so i can't left hospital, we went out of hospital and eated dosa. I was worried about luggage as office MAC-book pro laptop and Philips A40 device are costly item which i can't take risk, so its being decided that aditya will took all the luggage to his relatives place and from there he will take flight to delhi in evening. i left with some cloths and essential items.
whole evening i was waiting for senior doctor but he haven't came, i get to know briefing has been done by Jr. to Sr. and treatment is going on in his direction. i have been waiting in sitting area, there was nothing to do. i kept visiting emergency, i heared the is one bed Vacant in ICU so they are planning to shift my father there. around 8:30 they called me and told we are shifting to ICU, i went along, during shifting he has been put on protable bipap and from ground floor to 3rd saturation dropped till 30 as soon he reached he has been connected to full fledged ventilator and saturation becomes normal.
I have been told by hospital staff that they will take care of everything you don't need to stay here they will call in case of any emergency, there is fixed timing of 1 hour from 10:00 to 11:AM when one can meet with his patient, in the same slot you can meet and ask queries to his doctor, after that no one is allowed to enter in ICU.
so i called jhabbu bhai and told i am coming there. booked cap and reached his home.
27 Feb to 9th March : his health condition improved in this tenure not too much but still doctors has decreased the setings of ventilator so that he will breath normaly, as per doctor due too such long ventilator support his lungs are getting used to of ventilator so it will take time, they tried twice to put him without ventilator but after 7-8 hours it failed and they have to connect again with ventilator.
I forgot to mention that on 5th Doctors have removed ventilator support by ET(tube from mouth) rahter they made a hole in neck and connected pipe from there(this is called tracheostomy), although moth was free but oral intake was not allowed, he has been feeded by rice tube from nose, someday i found him semi conscious some day unconscious due to medication, Frankly i felt like due to fixed and limited meeting hour hospital staff can show you any picture, if they have to show you down just give medication and make unconsious and if they have to make him good stop suddetion medication, I was not sure how good or bad he is, as during andman i can meet him anytime so i was well aware how he was doing there.
my schedule was visiting hospital in morning and return to room around 1pm then start doing office Work from home.
I had a policy of 4 lakh from hdfc Ergo which was active, no one asked me for any money till 8th, as per quotation their charge was around 1 to 1.25 lakh per day so i was worried about bill His policy starts from 5th of march, I was thinking that i will get benifitted for double sum insured for this hospitalization, 4 lakh+bonus for previous year(26Feb to 4thmarch) and 4 lakh+bonus(5th march onward) from new year as i have made renewal payment. I asked about it with some known insurance agent they also said you will get benefit of 2 policy year. so on 9th i reached TPA for this enquiry, She was surprised how no one has asked me for any payment as running bill was around 11lakh, she said i dont get benifit of two policy year in one hospitalisation, in order to get benefit of 2nd year i have to get him discharged and readmit him, I asked her i will get him discharged and admit him somewhere else to get policy benefit, on which she said this can be done here as well, I asked him to proceed, bills have been generated 4,80,000 is being settled by policy rest I have paid. all this discharge and admit-ion happened in paper and new billing cycle started.
after making this payment i was now worried about further treatment expenses, i have taken loan for 8.3lakh and some balance from office loan, after making payment i was left with 5-6 lakh in account, according to the bill paid i have 5-6 days of running balance. I enquired about treatment plan and duration of further hospitalization he might take. on which doctor said he is on last line medication and that should continue as they don't have any other option left and no one can guaranty on time line, he has shown me one patient who is there from last 45 days.
I decided to travel to hometown allahabad because i believe i can manage the same treatment in low cost in hometown as hospital cost will decrease and if doctor permitted i can arrange injections in half rate from market, also i can arrange money for further treatment, I started enquiring about ambulance facility, Since now i am on mainland so things can be managed, still its 16-20 hours of journey from kolkata to prayagraj so i have to plan things better this time, i have seen what happened last time in ambulance so i am not in mood to take any risk.
due to cost and cheating two times Air ambulance is not an option, I left with train ambulance and on road ICU ambulance, trains ambulance was estimating 1,20,000 another has quoted 90000 Rs. but both are asking for time as they have to first book railway tickets so they will atleast take two days after payment day, i enquired about full ICU Van and got estimates around 60-80000 from kolkata based providers.
10-11 March : i visited hospital met doctor and told him that i am facing fund crunch so i am willing to take him to hometown, Doctor said you can wait for few more days as they are planning to try again putting him out of ventilator, I said i don't have that much money, i knew no one will stop you when you say you are out of money. he asked me about arrangements i told him i am arranging Full ICU ambulance with doctor and nursing staff.
while returning when i was on ola bike i got a call from ambulance provider to meet at one hospital where he has office i reached there i asked Ola to head towards that hospital direction, while i was travelling i called one of my friend and in general i asked about ambulance provider, he told me one of his friend took service from prayagraj to delhi recently so he will get and provide me his number.
its an hour journey during that time i made call talked with two of the ambulance providers from prayagraj, they were quoting around 35,000 to 40000 that looked like a deal, still since i reached to hospital i met this guy, he said he can manage train and road ambulance both but he preffer road ambulance as train can't be stopped in case of emergency but van can find nearest hospital in odd case, he has shown me ambulance and machinery he assured to have two jumbo cylinder full, which can easily manage 20 hours+ journey, as current consumption was around 2-3 liter per minute.
but he was quotting 90000 and after negotiation around 80k, there was no meaning as i can get in half price, i called back to one of the provider from prayagraj and finialise deal in 35000 and asked him to leave tonigh(on 10th) in next 3-4 hour, Ambulance left prayagraj arount 11PM and reached hospital around 5:30 PM on 11th, i already informed doctors in the morning about initiating discharge, once ambulance reached i followed them to final the bills, they have done billing and sent to TPA, TPA sent o insurance company and waiting for approval, we were kept watiing and following up with TPA insurance company they were asking for some more time, around 11PM policy company said investigation triggered on this so it will take time then I decided to withdraw policy approval and pay him cash, as ambulance can't be kept standing outside, I made payment for two days and after NEFT confirmation they allowed us to leave, around midnight we left Apollo
while in ambulance, doctor told me that he can maintain with oxygen only as his ventilator oxygen setting quite low, but we don't want to take chance so completed journey by giving him all medication and reached prayagraj based hospital in 12th March
12 March : i reached at hospital few Jr doctor came to van checked him and return i have told him in summary, but looks like they are not interested in admitting him, i already talked with the doctor under which we want to admit, looks like they are not able to digest why someone want to admit here after apollo, Apollo, Medanta etc are big name why someone want to come here from there probably.
I analysed they are suspecting on my pocket, so i said when you have bed and doctor then why are you delaying, i have one health insurance and also sufficient balance to pay you guys so don't worry on the payment side, then he admitted after making initial deposit in ICU, on duty doctor given prescription to bring entry level antibiotic i told him it wont work he is already on last line medication so please ask Sr. treating doctor and please read case first before starting medication , doctor came in night around 10 PM I have told him about what Apollo Dr told me for future treatment plan, there were manly two antibiotics were ongoing he changed one of then and continued other one, i treid him to force to continue ongoing both then he panicked, i better stopped myself and let him do what he think better.
13th March to 20March: he has improved and from 18th shifted to private ward with oxygen tracheotomy has been removed 19th, I ts almost two month hospitalization till now, I went to PGI lucknow with letter of one of the member of parlilament but that didn't worked i have submitted case summery for consideration in waiting list, also visited medanta and met the doctor, they have heared and seen all the documents and said he already got everything which can be given in whole world the problem is his prolonged stay in hospital, his immunity got very weak and right now he is getting hospital aquired infection, one is getting treated he is getting another, This chain has to break and that cant be done in hospital, he will keep getting new one so he suggested to prepare a setup in home take care there, he has seen many cases where patient get well in home care.
The idea hit my mind is started exploring the option, he is on oxygen support that too recently but in home care he might need more than oxygen, so i want to have ventilator and other accessories as well to deal with unfortunate event, i explored options and figured out and locked Philipse triology 202 which costs around 6.5lakh but i can get that on rent from delhi at 30000/month it comes with battery backup and oxygen port to machine, so made security payment and sent my cousin to delhi to return bipap we have and get ventilator, oxygen concentrator and suction machine. we got all this by 19th march and 20th march we have taken him home.
20March to 30 March : ups down was continue but the good thing was he is one step away from very serious, in home his bedsore gone away in first feek, although we had all emergency equipment in place but he managed with oxygen concentrator only, that too between 1 liter to 2.5 liter setting.
last line medication stopped, he diagnosed with another infection and that require some other anitibiotics so medication was continued we have hired one hospital boy doing his night shift in hospital, he took care and give him all medication.
The infection cycle was continued one goes away after antibiotics stopped another diagnosed and treatment started for that, but during the tenure he was spending time in home met relatives and firends, and grand daughters, he improved physically, he came as skelton at home now he looks way better.
May - June : in may start he started accessing washroom without support, infection cycle was continued but slowly slowly things are getting better, form june last anitbiotics has been stopped and he is back in normal life, the only thing which has changed is saturation earlier his normal was 96-97 now normal shifted to 94-95.
That how i experienced trip to Andman,
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