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Monday, September 29, 2014


Some people are arguing about Medicaid in the USA.
Democrats and Republicans differ.
But that is too far away from us.

Here, however, is an example of what Medic[p]aid looks like.

On the 20th September, at around 3pm I started a rising pain in my stomach. It got worse and worse until 5pm when I was in tears and called Dr Shamim who gave me an injection. The pain remained for a while and stretched now to my back. Nuzhat arrived, too.

The pain abated … but very slightly. Shamim told me to go see a doctor. I was taken to NMC (DHA - Karachi) by Nuzhat and him. Injections and medicine and more injections followed and the pain disappeared in about half an hour. I went home.

We all thought I should get an Ultrasound Test done and on the 21st I went again. The results arrived the next morning.
The report concluded with this: Gall bladder is slightly thick walled and distended. Multiple calculi are seen. One of them measures 1.0 cm. Sludge is also seen. These findings could be secondary to acute cholecystitis. Clinical correlation would help.
I checked on the Internet for what Gallstones really were

… and the effect the surgery would have on my diet.

The sites I visited said after surgery I could not have Ice Cream, Cream, Butter, French Fries, Burgers, Steaks, Sweets, Cheese, … and, much much much worse, no Coffee or Espresso

Of course the site holders live in the Glorious West and didn't mention Bundu Khan's Kabaab, Paratha, Tikka … or the Burns Road Sheermaal & Kabaab. And heavenly Mangoes!!! Obviously, those were not allowed, too.

I decided that this was it. No surgery! You can't ask a man to go through the last year(s) of his life like that! Jehan Ara visited and said Rukhsana has had the surgery and eats everything. A friend's daughter said she eats her usual meal. I was still not convinced.

Rather surprised, I phoned Shamim. He said you can eat whatever you like. He knew a couple of Doctors (Professors Aziz and Asad) who specialise in this and sit together at NMC. He phoned them up and made an appointment for me.

Shamim, as is usual for me to ask him to come along, went with Nuzhat and me. Dr Asad was not there but Dr Aziz saw me and the report and said you should get an operation. He gave me a prescription for being admitted to the hospital whenever I wanted to. His paper said Cholelithiasis. That's from the Greek: chol- (bile) + lith- (stone) + iasis- (process).

I have had a Quadruple Bypass 4 years ago and a Pacemaker put in a few days ago … so I asked if it was ok to have the surgery. Dr Aziz said I should check with my Cardiologist. Shamim spoke to him and he said it's fine. I can do a Laparoscopy and there is no need to for Cholecystectomy.

My next - and a much more important - question: What could I EAT after surgery? (Ohhh, of course, you CAN'T talk about DRINKING here.) Dr Aziz said, "Everything." I listed all my favourites and he said that's ok. I can have all of those things and get my wife to make a nice Biryaani, too. (I am not a Biryaani fan, but it helped to know this.)

Apparently those diets on the Internet are for the West! Don't you think some Pakistani or Indian Doctors should write about our diets, too?

I took the prescription home and thought I'd go into the hospital on Friday so that I could be out by Sunday. Shamim phoned me and said it'll have to be an open surgery as Dr Aziz's Cardiologist said that it would be risky. "Fine", I said. I will be in hospital on Friday.

3:00 pm was the time that NMC gave us after we phoned. Nothing to eat/drink from 1.30 pm. Surgery scheduled for 8 pm.

Now the show starts.

3:01 pm I am in the hospital.
4:04 pm I am in a room.

Or is my dead father in the room?

A young RMO (Dr Zohra Ghanghro) arrives. She is an extremely pleasant girl and is almost the main feature in this story. People take my Temperature. Blood Pressure. Blood is taken for checking if I have Hepatitis.

It's 5 pm. The Assistant Anaesthetist arrives. He is followed by the Cardiologist. Both say they will inform the surgeon before he starts the operation at 6 pm. 

Nuzhat calls Dr Ghanghro. Says I have eaten at 1:30 pm. Why has the surgery been brought forward. Doc goes out and phones people and says it could be 7:30 pm. At least that's what she thinks. I said that the Anaesthetist has not seen me yet. Nor has my Surgeon. She says she was told that the Surgeon had seen me. "Not at all", I say. And she rushes out to phone them both.

It is now almost 6 pm and the Assistant Anaesthetist arrives again. He asks me to sign a form that allows the Surgeon to go ahead. He says its a 'High Risk' operation. We ask him what 'High Risk' means. He says, "You might not come out of Anesthesia. Your age. Your previous operations. Your Pacemaker. Your Bypass. All that make the risks very strong. If you don't come out, they'll have to put you into an ICU. Maybe 1 day. Maybe 3-4 days. If that doesn't work, then they'll put you on a Ventilator."

WTF! All the doctors here have seen my reports. Why didn't they tell me this before I decided to have the operation? I was not going to take this risk for a Gall Bladder surgery. I'd rather have the pain and come back for medication. So I got up. Called Dr Ghanghro. Told her I am not having Surgery. Phoned Shamim and he said, "One shouldn't take such risks on a Gall Bladder or Appendix operation. Don't have the surgery."
(Later Shamim told me that it is the Anaesthetist's job to make sure that he gives the right amount of the right Anaesthesia and make sure I come out of it. There was no reason to think of the last part at all … unless the Anaesthetist had no confidence.)
Shamim phoned Dr Asad who said the surgery is due at 8(!) and he will get there by that time. Shamim decided to come there at 7:30 pm. We told Dr Ghanghro at 8:05 pm that I wasn't having the surgery. We'll inform the doctor when he comes in.

We waited.
And waited.
And waited more.

Dr Ghanghro said she'd get the blood reports ready. It was way past 8:20 pm. Had there been a surgery, the reports should have come in earlier. Anyway, she came back and said that the Hepatitis B report was here. The Hepatitis C would take a while. Right! After the operation, I guess.

My Hepatitis B report showed that the Max Count is 1.00 (One) but my count was 146 (One Hundred and Forty Six). Damn. I had a Hepatitis B problem. [Later at home I checked (Thank you, Google!) and in the USA the treatment was almost over a year and could go unto $25000 per year.]

Ohh … and I am now the w/o rather than s/o!

At 9:40 pm I decided to have a biscuit and water. Starving for 8 hours was making me (and my Diabetes) feel really bad. Shamim said he cannot believe this report to be right. I should check it at AKUH Lab the next day. Meanwhile Dr Ghanghro came back with the report on which she had added by pen that I don't have Hepatitis C. She found this out by phone since the report wasn't still ready.

Isn't that wonderful! I hope the Hepatitis C Report is OK.

We were now told that Dr Asad was in hospital and was operating another patient … after which he'd call me in if I agreed to have the surgery. I had, of course, said no to two people by now. So I was ready to go home. But I couldn't. Dr Asad had to sign the form before I could be released.

Shamim phoned him up and spoke with him. Do Surgeons use the phone and speak to the caller during an Operation? I guess in Pakistan they do. He asked Dr Asad to please tell Dr Ghanghro to speak with the Desk and release me. That was done … and I was finally home.

The next day I got checked for Hepatitis B at AKUH Lab.

0.361! No Hepatitis B.


I wonder where our 99% illiterates go with false reports.
They take the wrong medicine.
They die, I guess.


Thank you Nuzhat and a zillion apologies for all the trouble I have always caused you. Thank you, Sabeen, for being constantly in touch from UK. Thank you Jehan, for all your wishes and constant calls and visits. Thanks Ruhi & Misha for a short but delightful visit from UK.

Thank you, Shamim, for always being there.
Let's have more coffee tonight … and every night.

And thank you, Dr Zohra Ghanghro for being so helpful, full of energy, and being a good RMO. This is no place if your Professors are so faulty and unreliableI am sure your mother will allow you to go abroad and study. C'mon. Press mom hard. Her UCLA background will make sure to let you go and become a great Doctor.


The above was written yesterday. But I have an addition to make. Nuzhat went to NMC to collect my report for Hepatitis C and was given it … as well as another copy of my Hepatitis B that they had given yesterday. Except that it now read 0.25 instead of 146! Wow!!!


Will write more about today … in the next day or so.

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Friday, September 19, 2014

"… And there's one more thing"

Sorry, this post is not about Steve Jobs. Or Apple.
It's about my Pacemaker, fitted on
August 25th, 2014.

In case you (or someone you know) is going to get one,
this is what happens in Karachi.

As you can see, my Pacemaker came from Meditronics,
a world-famous firm that makes great stuff.
Yes, it works. Don't worry.

But "… there's one more thing". Or maybe even more.

The Cardiologist I went to was Dr. Zia Yaqoob (ZY) who was also my Cardiologist during my Quadruple Bypass in 2009. He works at National Medical Centre, which is just a couple of minutes from my house. Very convenient.

(You can read this and this, if you've missed out the past!)

I was admitted and was to have my surgery performed in the afternoon. ZY said he had asked the Vendor to supply the Pacemaker and it would be here in a while. A little later I was taken to the surgery and was being prepared.

Outside, my wife had someone who approached her with a package that she had to accept and pay for. It was the Pacemaker and parts. Pay? I thought the doctor had told us what it would cost and since we were paying the hospital they should pay the Vendor and bill us. But no. In this case you bought it separately.

Fine, said my wife. But could you please take it to the surgery and make sure its the right thing. No, said the Vendor. "You pay. You take it in." My wife gave the person the money (he left right away) and she handed the Pacemaker to ZY&c. It was, thankfully, the right one … but its awful that the Vendor doesn't hand it over himself. The receiver may not know if its the right item or not.

I came out of the surgery an hour and a half later and stayed in the hospital overnight. The next day I was asked to leave and was told that the Vendor would give me an Implanted Device Identification Card in two days. I should carry it with me all the time. I gave Sabeen my Visiting Card to make sure she'd call the guy up and give him the correct spelling of my name. She did. And he said in two days you'll have the card. I thought I'd wait another three days … nothing works on time here.

On the 29th I called him up again. No answer. We continued doing this for several days. No response. Finally, on the 5th September, I went to see ZY for a check-up and also mentioned to him that the Card hadn't yet arrived. He called his assistant and told him to phone up and get the card delivered to the hospital.

On the 8th September we phoned up the guy and he responded. He said he had sent the card via TCS Delivery Service. "Where to?", asked my wife. "I don't know. Could be your house … or the Hospital!", said the Vendor. Wow. Isn't that just great.

Three days later we went back to ZY without a card. He said he'd "chase the chap right away". Nothing happened. On the 15th September I visited him again and the chap at the Reception handed me an open Card and said someone had just left it there a little while earlier. No TCS. No envelope.

I thanked ZY and said I'd had to cancel my trip to Lahore because I could not have flown without this card. He said to me, "The Vendor is a nasty piece of work. There was another Vendor who was better but this chap had him removed. We have no choice. I have told the other doctors about your bad experience."

Got home and decided to scan the card and keep a copy.
Here is what had arrived.

Apart from an overtyping of my name and the Serial Number
there was Hospita.

Khaér. I scanned it.
Then I'd thought I'd check the boxes give to us.
Most people just throw them away.
And, in any case, with an English Literacy rate of 1%
they can hardly read anything.

Fortunately, I did open the boxes up!

The Serial Number should have been
(Just a digit missing, right?)

Worse, the Lead Number should have been
(Absolutely wrong on my card.)

Tried phoning the Vendor. No Answer.

I called up my neighbour and friend Dr Shamim Ahmad, who phoned up ZY, and got the address of the firm. We spent a lot of time looking for an office "above Scholl's". The Scholl chap said the building had a top floor. There was nothing there. The door was locked.

After more searching we went back to a small tailor shop at the other end of the building. He said, "Oh, the ACP store? Come through my shop. It's above us." Actually one could have seen the door from outside, too, but there were no Signs or Names to look at. This is what it looked like.

 On the right you can see a man opening the door and going up

A trip to the stair case took me to this entrance.

That's the Tailor Shop on the left.

After ringing a small bell that had the company's name badly written, I walked up through the door that was just opened by the man I had seen earlier.

What a bell!!! The company name is on it. So easy to spot, no?

There were hordes of boxes on the stairs all the way up to the office, with a couple of people pulling them up and stacking them. The boxes were from Turkey.

Of the two gentleman the senior one asked me what it was. I told him. He said Mr Waheed does the typing and he is "at the Cardiovascular Hospital. Can you wait?" 

The other person said I should come up and sit down. He'll call Waheed on the phone. In I went. Saw even more boxes piled up everywhere.

I am sure the Turks think this is a great company.

I also asked the person that the office must keep a record of what had been given and to which patient. There must be a record in the office. Accounts? Delivery challaan? Huh? Huh? No response.

Waheed came on the line. Was told what had happened.
Not even a 'Sorry' from him.

The gentleman said to me that Waheed had written on the last card they had in the office and sent it on to me. There were no cards left in office. I said it shouldnt't take more than a couple of days to print them here … but was told that they have to be from Medtronics in the USA.

Given the card that I had, it was on a rather poorly printed version with Medtronics in Blue. Easily printed here, I am sure. Specially by their Distributor. I asked him why Medtronics didn't send as many cards (plus a couple more) than the machines they sent here. I mean that seems obvious, right? "It's Amrika", he said "and they can do what they like."

Sad that in a country, with little or no literacy rate, a Pacemaker can be fitted and the card (with the wrong numbers) sent out after 3 weeks … with so much more worrying, and visits to the Doctor, by the patient. What if the patient happens to be a chap from the interior of Sind (and one who cannot even read what's on the card). He may be travelling to the UAE for a job, for example, and have an invalid card. If something happens to him, the Medtronics team will not be able to trace these boxes back, if called.

Although ACP wanted a TCS Delivery Address I have left my phone number, instead, with them and asked them to phone me when the cards arrive. Will go and pick it up myself. And make sure its correctly filled in.

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Saturday, September 06, 2014


 On 24th October 2009 I had a heart attack.
You can read about it here.

So, what's new?

About 7 months ago Sabeen Mahmud (of T2F & my adopted daughter) went to Dr. Cyasp Nowsherwani. She asked me to come along, too, partly because I had complained about an occasional giddiness when standing up after being in a chair for a long time. The Doc asked me if this always happened. I said No. He said I should "get up slowly and hold on to something if necessary … and soon this would go away. It was only temporary." Was it Age? Perhaps!

I waited for months. Nothing happened that seemed connected. But things didn't work out too well. Read the follow-up here to see how some things did happen. But, again, it didn't seem to indicate a heart problem.

Over these months my dizziness kept happening slightly more often, even sometimes while I was walking from room to room. So I went to the Emergency Ward at NMC and the Doctor said it would take a couple of months to get all right … I should continue taking my regular medicines.

More months passed. Nothing happened. The pain attack returned once. I rushed to the heart hospital. A checkout showed that it wasn't my heart. So I came home. Dr. Shamim (S) gave me a medicine to reduce the pain … but no pains came after that.

Then the dizzyness started happening when I climbed downstairs/upstairs. Not all the time, but getting worse. Mind you, the dizzyness came for just a second or two. Maybe three. Never longer.


While Ragni was here and was visiting a doctor. I was in the waiting room. I phoned and spoke to 'Ms. House M.D.' — that's Sabeen Mahmud -  and told her I was feeling increasingly dizzy again.  She (a Lady Doctor, Psychologist, Psychiatrist … without any qualifications) said it could be Tachycardia or Bradycardia.

(See how useful that amazing TV series is!)

Looking this stuff up on my iPhone, I felt that Bradycardia could be the possible cause. For this I downloaded a Heart Rate Monitor Application on my iPhone. I checked it out and it showed 72 beats per minute.  60bpm, I discovered on a website, was low. 40bpm was fairly terrible.

I kept checking my heart rate there in the hour I was sitting in the waiting room … and this is what I saw happening afterwards: 67 - 58 - 65 - 44 -72 - 41.


That website also mentioned Arrhythmia - a missing of heartbeats or irregularity in them. There was no way to find that out unless I went to a Doc. So I had to go see Dr Zia Yaqoob (ZY).

Dr S phoned Dr ZY and told him that a Holten Monitor needed to be attached to me for 24 hours. I went to see him and had monitor fitted by 'Mike'. He asked me if his children should continue to stay in Pakistan or move out. I said if they were Jews, Christians, Ahmadis, Hindus, Shias, Aga Khanis, Bohris, or any other 'breed' that the 'incoming Pakistan' feels should be killed — and that includes several Sunni sects, too — they should leave right away. Mike - (whose real name was Mukesh, I found out later) - told his assistant that I was the second person to say this to him. I guess his kids will soon be on their way out.

Holten Monitor

The monitor records were kept on a USB card that was plugged in. After 24 hours the USB was removed and the events were checked. "You should come back for a report on Monday evening", said Mike, and off we went.

We were almost near our house when Mike phoned and said I should get back and see Dr ZY right away!!! Huh???

Anyway, I got to Dr ZY and Mike arrived there with my report. The Doc looked at it. There were 48 times in the 24 hours that my heart had stopped. Many missed beats were upward of 3 seconds. The longest one was 4.478 seconds.

Fortunately— or not — I was asleep.
I guess I could have died.

Dr ZY said to me that I'd have to have a Pacemaker fitted as soon as I can … and I should rest until then. I came home and we thought that I must have this on Monday, since Ragni was leaving in three days and could be with me at this time.
So it was on Monday, August 25, that my Pacemaker was fitted

(I also posted these pics on Facebook/Twitter)

Pacemaker 1 : The X-ray

Pacemaker 2 : Recovering at NMC

Pacemaker 3 : If I'd been a little fatter this wouldn't be seen!


On 27th August Ragni celebrated her 30th Birthday
(her first in Karachi in 10 years)
and I decided to celebrate my 73rd a little early instead of October 2nd.


 So now, Tony Afzal, you know what happened.


Oh, here's a fact to remember:

SOS is quite often 'translated' as Save Our Souls.
Apart from the fact that there is no 'soul' to save,

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