Posted by: facetothewind | February 20, 2007

In Search of the Perfect Colonoscopy: my medical holiday in Thailand

Somewhere after turning 42, it occurred to me that it was high time for that oh-so-American medical ritual: a little spelunking trip into my own bowels with a camera and DVD recorder. Being that my family has a history of intestinal disorders and I often have questionable digestion, I signed on for my first official colonoscopy. (The amateur pleasure cruises up my lower colon don’t really count.)

Being one of America’s 47 million citizens who go about their lives without health insurance, I have the distinct privilege of charting my own medical course rather than leaving it up to the actuaries. Health insurance companies in America recommend that the colonoscopy be done at age 50, by which time many people have already grown an entire polyp forest in their intestines. I figured I’d rather know now than wait.

In case you’re too young to know what a colonoscopy is, well, imagine a team of strangers blowing you up like a balloon from your rear stem and stuffing a garden hose with a claw and camera and lights into your large colon in search of things like diverticulosis (areas of thinning of the intestinal wall), polyps and the early signs of colorectal cancer. They also search for lost toys, Lee Press on Nails and that Rolex watch your date is still missing from that romantic night in the sling.

I made a couple calls to local physicians in Arizona who conduct the procedure and priced them as high as $2,500 for the uninsured. The procedure calls for general anesthesia for the patient’s comfort, though I think they don’t take into account the sexual practices of many gay men.

It was about this time that my friend Darren called to tell me he was going to Thailand to accompany his friend for an extreme makeover at a renowned hospital in Bangkok. The plan was to rent a hotel suite adjoining the hospital and plow through her checklist: boob reduction and lift, tummy-tuck, and facelift. I got to thinking, why not give a Thai hospital a chance for my colonoscopy? I had heard they were state-of-the-art and at a fraction of the cost. I signed on for the trip and cashed in my frequent flyer miles.

I got on the web and searched the myriad hospitals in Bangkok that cater to Western patients on medical holiday. Images of women doing the wai (bowing with their hands clasped) and luxury hospitals popped up on the screen, completely narrated in English. Medical packages are offered from web-based menus: male/female check-ups, prostatectomies, breast augmentations, hip replacements. All things I might consider sometime down the road, but for now I clicked on the colonoscopy and began corresponding with 3 different hospitals: Bumrungrad, Bangkok Hospital and Vejthani Hospital (listed in descending order of price for a colonoscopy.) The most expensive hospital offered the procedure for 26,000 Thai baht (about $740). The cheapest, Vejthani, weighed in at a rate of 13,000 baht and then just a few weeks later, their price jumped to 18,000 baht. So, I chose Bangkok Hospital which quoted somewhere between 12-17,000 baht ($340-485 depending on how much of a polyp forest they would have to fell.)

I sent an email to info@bangkokhospital.com and received a quick reply from a woman named Sonia from “Thailand Vacation Tour,” an organization that I suspect is contracted to deal with westerners booking their face lifts in English. By email, Sonia gave me an appointment and explained how the process worked. She set me up with a doctor named Jaturong, at the Bangkok GI & Liver Center. He is pictured on the web with a fresh baby face and cupie-doll haircut and is a 1993 graduate from Chiang Mai University medical school.

Sonia and I went back and forth several times explaining methods of payment, length of stay at the hospital and how to get to the hospital in a city foreign to me. She offered to send a car to the hotel on my appointment date. I marked my calendar and made the trek across the oceans to Bangkok.

On the morning of my procedure, I rang the hotel concierge and told them to expect a hospital transport for me. “Mister David, it is already here.” I rushed into my clothes and headed down.

The driver spoke no English and I only spoke about 3 phrases of Thai. So we silently navigated through sunrise traffic to the hospital swatting mosquitoes on the windshield and smiling at each other with each victorious splat. As we neared the hospital, he radioed someone and as we pulled up the big circular driveway of what looked more like a luxury hotel than a hospital, an impeccably dressed woman in a beige pant suit and corsage approached the van and opened the door for me. I couldn’t help notice how Thailand puts its most beautiful women in front-line positions. It reminded me a bit of an old James Bond film: Goldfinger. Bangkok Hospital’s version of Pussy Galore escorted me to the revolving door where a security guard and 3 concierges saluted me. Not knowing exactly what to do with a salute, I returned it with a smile and a nod. (A little pointer for traveling in Thailand: when in doubt about social customs, when unsure what someone is saying, when in crisis, when needing to apologize, even when you’re angry, smile. It is used as a social panacea that smoothes over a multitude of social bumps.)


Clacking over the highly polished marble floor in her high heels, my escort walked me past the grand piano, water feature and giant portrait of the King and Queen and up an escalator to the receiving desk. Unlike American hospitals, there was no strange smell or announcements on the PA about your double-parked car or Doctor so-and-so please come to cardiology. There was a hush in the practically empty lobby. At receiving I was the only patient – it was if I had the whole hospital to myself. I filled out some paperwork, struggled with whom to call in an emergency (my mother in Florida?), and smiled for a picture.

I was issued an ID card then escorted out of this building across the street to the GI and Liver Center…another quiet and immaculate building. I was turned over to the endoscopy unit and their team of beautiful nurses in high heels – all wearing the classic white nurse’s cap that looks like a folded napkin in an elegant restaurant. I sat and waited for my technician to escort me to the colonoscopy ward. The first and only ball was dropped – after sitting in the lobby for 10 minutes watching a Bangkok local news story of traffic cops delivering a baby while the mother was stuck in traffic – a nurse approached and asked me if I had an appointment. I explained that I did and then she immediately scrambled and returned in a couple minutes apologizing and explaining that the doctor would see me as soon as my bowels were ready. I inquired about doing the procedure without anesthesia and she seemed slightly taken aback. “Oh, no. This would be too discomfortable.” Although I was willing to try it without – I dropped the issues so as not to complicate things.

I arrived at the hospital at 8 am and at 8:20 was banded and led by an adorable technician to the “bowel preparation room” which was appropriately upholstered in brown. I looked for poop stains on the chairs but couldn’t find any. I was given a locker and kimono to change into. I could not figure out how to tie the pants so I held the string tight and put on the slippers and went back into the lobby. My worst fear was losing my pants in front of the terribly modest Thai people.

A tall Thai man with long sideburns and a big smile came out to greet me in his pink scrubs (he was not in high heels, alas.) He spoke nearly perfect English and greeted me as “Mister David.” I asked him how to tie the pants that kept inching down – he showed me how to make a knot out of a loop in the front. I was still baffled, but at least I got to be close to him for a moment and at one point, he actually had to reach into my pants to tie them up. I was beginning to swoon – great – I needed a little distraction for an otherwise unpleasant procedure. He handed me a gallon of warm liquid in a bottle that looked like urine but smelled like orange Tang. He told me to drink it and let him know when I was completely cleaned out. He came to check on me a couple times and chatted briefly. I offered some of the beverage to a couple of the women sitting in the lobby accompanying their spouses. They smiled and laughed – crazy Westerners.

Finally, after 2 hours of drinking that bitter orange liquid and 6 visits to the bathroom, I was ready! I found the smiling technician with the sideburns and told him I was ready. He walked me into a room with a gurney, computers, flat screen monitors and a big black hose that I figured was bound for my ass. Everything looked brand-new and spanking clean, in fact there really was no difference between this and any first-rate American hospital, except that the nurses wore high heels instead of comfortable gum-soled shoes. A smiling nurse came in and put an IV line in my right hand and taped it up. Everyone left the room as they waited for the doctor.

This is when the waterworks started. I knew it was going to happen at some point but up until now I had gone into the role of reporter diligently scribbling notes every step of the way. I had to take off my glasses and put my notes under my pillow and so I just lay there for the 10 minutes of anticipation. No longer the reporter, suddenly I was just myself, very alone in a hospital for the first time at 42, and a foreign hospital no less. It seemed like I was a long way from home. And what if there was a complication, who would I call on? Tears just poured out of my eyes as I came to grips that this is what I can afford as an aging man without health insurance in America: visits to foreign hospitals which would ensure braving these things on my own. I wanted to be a “big boy” but I couldn’t stop crying.

The beautiful technician with the sideburns came in and noticed that my face was all wet. He stood next to me and rubbed my furry arm and gave me a closed-lip smile of compassion blinked slowly and nodded his head. (It must have felt odd for him being a hairless Thai man rubbing my gorilla arms.) He told me there was nothing to worry about. His softness, my feelings of being alone and nervous, and my crush on him all contributed to my being a teary mess. I felt embarrassed. I’m not sure he understood why I was crying – for him this was routine, but he stayed with me, nonetheless, rubbing my arm. I wondered if he was gay…a question that is asked a lot in Thailand – a country of fluid sexuality without much use for these western labels.

All of a sudden the doctor came in with a rush of his entourage. Everyone assembled quickly and I was rolled onto my side away from the doctor. The technician untied my pants – a lovely last memory before the room went out of focus and I melted away as the drugs coursed through my open vein.

I awoke and looked at my watch. An hour had transpired without me. I felt no pain or soreness. I looked around – I was the only one in a long bay of gurneys with a view of the nurse’s station. I watched the technician with the sideburns going about his duties. I blinked a few times and sat up. A nurse noticed that I was ready to move on. She had ordered a wheelchair for me – which was waiting nearby. I waved off the wheelchair thinking I didn’t really want to be an invalid just because I was a little groggy and bloated like I’d just eaten a gallon of beans. (Your intestines are inflated with air to make viewing easy.) I waddled to the changing room and put on my civilian clothes and went for lunch. The wheelchair man escorted me because I really was still in some sort of anesthetic haze and couldn’t possibly navigate the hospital on my own.

The hospital cafeteria was characteristic of the Bangkok food courts – ducks hanging on strings, large woks full of vegetables and seafood dishes, huge pots of curry. The smells were incredible and far exceeded any hospital cafeteria I have ever seen in the US. I ordered some vegetarian dish, paid my $1.50 and ate my lunch lifting slightly off my chair as I released several cubic feet of air.

I returned to the GI and Liver desk to receive my consultation with the baby-faced Doctor Jaturong who was very pleasant and formal. He showed me the pictures of my colon and pointed out 1 polyp, which he removed, and 1 spot of diverticulosis. He would send the polyp off for a biopsy and they would email me the results. (They did and it was benign.) He handed me a DVD of my colon to watch later.

A nurse then escorted me to the dermatology center in another elegantly appointed building where I waited about 10 minutes to be seen by the dermatologist for something completely unrelated to my colon. Display cases showed various facelift and laser resurfacing techniques available. Pictured in the marketing materials were western faces, only.

While waiting, I eagerly popped the DVD into my laptop and watched my undulating bowels and witnessed the little robotic claw reach out and snatch the polyp and rip it off. I watched myself bleed briefly.

My dermatologist called me in and gave me a complete examination and removed a skin tag and froze off one growth on my forehead. We spoke about her trips to America – a rare experience for Thais. (She was probably granted a visa because of her profession when most Thais are denied and the US keeps the application fee.) She had even been to Arizona twice.

When we were done, she directed me to the payment desk. I paid for the entire day at the hospital with my VISA card. Colonoscopy, poypectomy, biopsy, and complete derm exam with 2 destructions: $422.18 total. I did something I’ve never done at the cashier: I smiled and gave a little laugh. The day at the hospital in the US would have cost me approximately 5-6 times what I paid in Thailand. I could have spent that much at a day spa. I had paid for the airfare with frequent flyer miles, but even if I had purchased a coach class ticket, I would have more than made up for my airfare, hotel and all meals with the savings at the hospital. Plus, I got to experience some of the glorious sights and people of Thailand.

It was 2 pm. The concierge at the front lobby arranged for a taxi to take me back to the hotel. Wending our way slowly through the gray and polluted streets, I thought about that woman giving birth in a taxi as we got stuck in traffic. I thought about the traffic cops of Bangkok who are trained in midwifery. I thought about the smiling technician with the sideburns. I had another teary moment feeling some odd sense of privilege to be able to travel half-way around the world for a procedure I could not afford at home. And then we pulled into the hotel and I promised myself a fun afternoon at the best gay sauna in the world with the cleanest colon on earth.

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