Experienced travelers generally agree that tourists -- especially the elderly -- should take copies of pertinent medical records with them on vacation. You can, of course, buy U.S. insurance to cover hospitalization in foreign countries. And a credit card can usually serve as ready cash in a medical emergency. But there is no insurance policy now available in this country that would have prevented the near-tragedy in French Polynesia that Dr. DeVore has called a "horror show."
THE PHONE RANG at 6 a.m. I answered it, wondering which patient was calling. The voice was barely audible: "Gregg, it's Mom, how are you?"
"Fine," I replied as my thoughts quickly came into focus. My parents had left for Tahiti three days before for their dream vacation. My father had served in the South Pacific during World War II and had always wanted to return and share the beauty of the islands with his life-long sweetheart. I wondered why she was calling, and then, before the words were uttered, I knew something was seriously wrong.
"Your father had a massive heart attack a few hours ago and was flown from a small island to Tahiti. He is in a French hospital and only two people speak English, one nurse and a hostess. I would like you to call the French doctor and speak to him. Your dad is in a lot of pain, and they are not giving him much medication."
Because I had lived in France 13 years ago working for the Mormon Church, I speak French. "Mom, I will catch the next flight to Tahiti and be there as soon as possible," I replied. I hung up, called my two brothers in California, where my parents live, and made reservations for a flight from New York to Los Angeles and then to Tahiti. My wife packed my two suitcases.
I went to the hospital and made arrangements for my patients to be seen by another physician, had the secretary cancel my surgery for the next month, and on the way to JFK International Airport obtained my passport from the State Department in Stamford, Conn. This was the beginning of the most unforgettable, sobering and exasperating experience of my life.
The plane landed at 2:30 a.m. in Papeete, Tahiti. I met my mother, who looked ashen, for she had not slept in two days. I was whisked through customs in less than five minutes and then driven to the hospital.
As I entered my father's room, it reminded me of many pictures I had seen of hospitals at the turn of the century in the United States. It was dark gray. The urinal, smelling of old urine, was lying open on the tray next to a glass of water. The bed was ancient, supported by pieces of plywood in case cardiac resuscitation were needed. The room had an odor of musty alcohol. There was an antiquated cardiac monitor with no alarm if the heart slowed or increased to dangerous limits. A portable cardiac defibrillator was in the corner of the room, a gift from the family of a former passenger on a Pan Am flight.
I beheld a once-healthy, strong 55-year-old man lying in bed with sunken eyes and an aura of impending death on his face, agonizing in pain, pleading for me to do something. It was a pitiful sight. I was his son, and yet I was a physician and could not let my emotions interfere.
I quickly turned to the nurse, asked her in French what he was receiving for pain and when was the medication last given? She explained that he was given a mixture of different drugs, one being a narcotic that in reality was no stronger than codeine, which one takes for headache. The last dose had been five hours before. With anger seething from within, I calmly asked whether, even though my father did not speak French and she did not speak English, she couldn't tell that he was in agony. She shrugged her shoulders and said, "I don't know what to do."
I asked her to give him a narcotic, stronger than what he was receiving. She did and in a short while he began to relax and then sleep. I then went to the hotel, showered and returned for a 7:30 a.m. appointment with his doctor. We met in the doctor's office, and he explained what had happened and what his plans were for management. Although we discussed some alternatives, I did not want to offend him, knowing that I would only make things difficult and would accomplish nothing at the moment.
I asked for permission to read the medical record and to examine my father. This was granted. We went to my father's room, where the doctor examined my father. He then left. I began to review the records and noted that he was hypertensive with a blood pressure of 200/130, and had evidence of an inferior wall myocardial infarction on the electrocardiogram. On examination of his heart and lungs, I found that he was in florid congestive heart failure (water filling the lungs because the heart could not pump the blood from the lungs efficiently).
This explained why my father felt short of breath. I asked for the doctor, but he was not available. I asked to see the chest x-ray taken on admission, and found out one had never been made. I requested that the nurse contact the doctor and tell him of my findings so that adequate medical treatment could begin. A few hours passed. While I was out of the room the doctor returned with an interpreter and told my mother, "Tell your son that this is my hospital, my patient, and he will not tell me what to do." My mother's reply was, "Tell him yourself."
I was angered because this had taken place in front of my father. I found the doctor in the hallway of the hospital and had a "long talk" with him about appropriate conversation in front of a sick patient as well as the appropriate management of myocardial infarction and congestive heart failure. After we resolved our "cultural and professional differences," we returned to my father's room, where Dr. Auger, the French physician, examined my father and concurred with the diagnosis of congestive heart failure. He then ordered the appropriate medication, and changed the pain medication order to morphine.
Dr. Auger later became a dear friend and was extremely helpful in the weeks that followed. My father's condition improved slowly. He remained for 12 days in the "intensive care room," where the toilet consisted of a small, rusted bucket. My mother tidied up the room, bought some toilet paper, paper towels and soap, washed his eating utensils, since they were not always cleaned, and covered the open urinal with plastic so the smell would not be so unbearable.
On Sept. 18 my mother returned home on her scheduled Pan Am flight, which originally was to conclude her "dream" vacation in French Polynesia. She went to take care of the financial arrangements for my father's transportation home. Before she left, we had spoken with the three airlines providing service to Tahiti from the United States, which informed us that we would not be able to transport my father until six weeks had passed and that he would be accompanied by an airline physician on a stretcher without monitoring equipment. When my mother returned to the San Francisco Bay area, that information was confirmed with the offices in San Francisco. The airlines explained that there were no exceptions to the rules.
Three Vietnam veterans who had been working on remodeling the family home told my mother that military evacuation of civilian personnel by military med-evac airplanes was another alternative. This triggered a costly, unfortunate and distasteful sequence of events that left me wondering how the government really functions.
A family friend, a professor of political science at Morehouse College in Atlanta, recently had told my mother whom to contact in Washington D.C., if she ever needed assistance with the military (since she had been instrumental in changing Army enlistment policies as a result of a lawsuit she initiated during the late 1960s). After she made a few initial phone calls to congressional offices, the White House and finally the Defense Department, she was told that a med-evac plane could evacuate my father with no difficulty and that the price would be approximately $2,000. The next day she was told that it would cost $6,000, and the following day $10,400.