Operation Vacation

She notes that at the Bangkok Hospital Medical Center, a long walk or short cab ride from Bumrungrad, personnel are frantically preparing for a visit from the Joint Commission International, one of the steps in seeking accreditation. The medical center is campuslike, with separate buildings for a hospital that caters exclusively to foreign patients, a heart hospital where innovative heart stem cell research is conducted, a cancer hospital, a general hospital and an orthopedic center. Turns out the JCI was satisfied: Accreditation was awarded this month.

Samitivej Hospital Sukhumvit, in the same general neighborhood, is smaller and more intimate and received accreditation in January. Cathedral-style windows frame the lobby, where a musical ensemble plays on weekends. There is a small tropical garden. Patients' rooms all have balconies.

The hospital's "fusion food bistro" includes Thai, Japanese, Middle Eastern and Western dishes, and it all looks delicious.

Don't expect that quality of food as an inpatient, Shaw's friend Roy Burson tells me later. Burson spent two weeks in Bumrungrad and concluded that "there's obviously an international law which decrees all hospital food must be the same."

At Samitivej, one waiting room is for Japanese patients, complete with Japanese-language magazines and videos. Another is for Arabic speakers. Southeast Asia has become a favored spot for Middle Eastern patients, especially since the Sept. 11, 2001, attacks.

In 2000, for example, Bumrungrad treated 5,000 Arabs, according to the hospital. Last year, 93,000. Whether the gain for hospitals in Asia will represent a long-term loss for American hospitals remains unclear. Bill Ruschhaupt, chairman of global patient services at the Cleveland Clinic, says the number of foreign patients "dropped precipitously" after the 2001 terrorist attacks but has subsequently been inching back to pre-9/11 levels.

The Operation

On the day of his surgery, Shaw's apparently carefree attitude has disappeared. At 8 a.m. he is wheeled away for the operation, which is scheduled to take two hours. His wife sits silently with her missionary friends, Doris and Roy Burson. She appears on the verge of tears, and things only get worse as 10:30, then 11:30, come and go without any word.

In the waiting room, Kathy Shaw is becoming ever more distraught. She frets that the couple's two children, ages 23 and 27, are home waiting for a call. It's tough, she says, to be so far from family.

Roy Burson, a retired police officer, chats about the two knee surgeries he had at Bumrungrad, one three years ago, another eight weeks ago. After his first operation, he says, he stayed in the hospital for two weeks, doing hours of therapy each day. Total cost: $10,000. He was in the United States for an eight-month leave when the pain in his other knee became almost unbearable. Although covered by insurance, he put off surgery until he returned to Thailand.

"There are great doctors in the U.S., but you have to go through a cattle chute to get to them," he says. "And I'd rather my doctor tell me it's okay to go home than some insurance company."

If it turns out Shaw has to stay in the hospital longer than the two days scheduled, he'll be charged $150 a day.

How services can be delivered for so much less is not mysterious: Labor accounts for 18 percent of Bumrungrad's budget, marketing director Toral says, compared with about 60 percent in a U.S. hospital. Second, these private hospitals don't have to shoulder the burden of the uninsured, which costs the United States nearly $100 billion a year, according to the AMA. Most overseas hospitals and doctors don't need to pay huge malpractice premiums. A majority of patients pay in cash, and the hospitals don't have to wrangle with insurance forms and companies.

As the clock ticks long past the time Shaw was expected to be out of surgery, his wife and the couple's friends keep visiting the nurses' station, anxiously seeking word. Kathy must repeat her questions several times to be understood. Finally, at noon, they have news: Shaw is fine. The surgery started late because the doctor had an emergency.

A few hours later, Shaw is in a bed in intensive care, wishing he could eat. He says he was awake but in "la la land" during surgery, and that he'd been surprised when he was suddenly shocked in the chest with electric paddles.

"There was no 'One, two, three, clear,' " he says. "If I had never seen 'ER' it probably wouldn't have scared me. I asked the doctor, 'Are you worried?' She said, 'No, you just had an irregular heartbeat. It's fine now.' "

The next day he moves to a regular room. He's amazed, he says, by how many nurses are in both wards. Nurses in Thailand are readily identifiable because they wear the old-style white hats.

After two days in the hospital, Shaw is roaming the streets of Bangkok with his wife and friends, chowing down and loading up on computer accessories, silk and souvenirs. A week after leaving Dallas, the Shaws are on their way home, with reports to show his cardiologist and a week's supply of drugs.

Shaw says he feels better than he has in years. He's dieting and exercising and planning to run a 10-kilometer race in December.

He has one regret about his trip: "I wish I had allowed more time to see Thailand."