‘Is this the real life? Is this just fantasy?’ sang Freddie Mercury back when Queen dominated the music charts.
Imagine the medics explaining to you that a patient’s pulse is dangerously low but no one can diagnose the cause. The next day the patient is much revived and you are pleased he was hospitalised. What do you do on the third day when his pulse drops dramatically for no explicable reason?
There’s a medical history that you don’t yet know. So you make the call, the only call you think should be made. His health is your priority. So you arrange for a medical evacuation to a country with better medical facilities.
He’s a colleague and you are both a long way from home. In this instance it matters that you are his boss. Despite the training and protocols, responsibility and accountability for your office co-workers were just concepts before a crisis. Suddenly your egalitarian approach to office and project management needs a hierarchy to function to preserve a life.
An air-ambulance arrives first thing the next day and it needs fuel to return. It’s a gleaming, hospital equipped Learjet. The first of a new set of problems is that although the pilot has brought a colossal amount of cash, the airport says they only accept US dollars. No USD, no fuel. To replace the 300 gallons burned every hour, you need to find $4000 instantly in a country that has no official banking system. A deal is struck and a 15% premium rate is paid because of the inconvenience caused to the vendor by payment in Belgian Francs. You make a mental note: who was the idiot who provided the pilot with wads of Belgian Francs?
The second problem is that the evacuee is not allowed on the airport apron without a passport duly stamped with an exit visa. You have the passport but lack one vital piece of paper that confirms the valuable items declared on entry to the country. You are frantic and convincingly determined to make the medevac go well. An exasperated airport administrator escorts you to a room where the hassle of filling each customs form in duplicate suddenly makes sense. The documents from every flight for months, perhaps years, are stacked on shelves, wrapped in ribbons and bows right in front you. You are not the first in an exit crisis judging by the untidy scatter by desperate searchers who hadn’t the time or courtesy to put things back as they should. You feel the same desperation because a plane is standing by but worse, the patient is supine in an ambulance unable to get to the plane.
Everyone who has an opinion on the potential causes of the low pulse rate notes that there is no obstructed breathing nor an increase in temperature. So it’s probably something systemic rather than an infection or a mosquito-born disease. Congestive heart failure is one scenario. Faced with the many ribbons and bows, you wonder if he’ll have a fatal heart attack while you search for his customs declaration. And you hope there’s nothing declared that is not already in his hastily packed suitcase because you’ve already seen one former colleague get arrested on attempting to exit from the country with undeclared items of personal jewellery.
You see a clue to the order in which the customs forms are stored. The ribbons over a paper wrap appear to change colour each week. You don’t need to understand the bows, they seem to indicate an administrative detail, perhaps they tie a bow on the piles they’ve read. It’s five weeks since he arrived. You scan for the colours, find a colour change series that looks promising. Date order is confirmed. Amazingly quickly, you have a couple of hundred forms in hand from the very day he arrived. You recognise some names as you flick through the forms despite only having been in the country for about five months. And there it is, his declaration, you beauty! And it’s short and lists USD cash and no camera or rings or necklaces or anything that might not be packed.
A customs man appears at the ambulance. He signs off on the exit forms returning a copy. The security gate in the airport fence is opened and the next problem is that no locals are allowed onto the apron. Fortunately, another colleague who is acting as your translator is well known in the airport as your expeditor. They record his details and allow him drive the ambulance across to the plane. You have been allowed to follow, walking after it with an airport official and a uniformed, side-armed military officer with mismatched epaulets and betel stained lips.
A nurse appears at the top of the stairs. Is getting the patient up the steps going to be the next problem? She’s stunningly beautiful, with bobbed hair and here in the tropics, she incongruously wears her immaculate uniform like a catwalk model. But her appearance does the trick. Several minutes of examination and questioning the patient follow and you stay at a discrete distance. A doctor has joined the nurse and the patient has been motivated to carefully climb out of the ambulance and walk gingerly up the stairs. He’s clearly enjoying the nurse’s attention.
Next thing you know you are in the plane checking on him. He’s already lying on a bed, plugged into something and very much alive and in their care, smiling and apologising. You are impressed by the set-up inside the plane after doubts due to the currency confusion.
The doctor explains that the cardiac risk necessitates a low altitude flight and that a return flight plan has just been approved. They are ready to depart.
And that’s it. He’s being taken to a ‘better’ place. You leave, thanking the several airport functionaries who have come to look at the gleaming LearJet as it accelerates down the runway and roars back to the future. And it is going to the future from a country that has been in suspended animation if not moribund for decades.
There comes a telephone call to confirm safe arrival at the ‘better’ hospital. Observation is the initial treatment because the patient showed no signs of illness in the plane.
There comes a second call, the next day. The patient is perfectly healthy. The team in the ‘better’ hospital are recommending discharge because the patient is healthy as an ox.
Now your boss is livid that ‘he’ just spent $35,000 flying a healthy employee, as he says, for a first class weekend break. You become even more livid when you realise that cost-cutting accountants had recently decided to cancel global medevac insurance. Self-insurance was new the mantra. It wouldn’t be the cash outlay that bothers you but perhaps you are exposed to lower priority medevac coverage without an annual subscription to an insurance service. And there are the whims of management staff who treat every expenditure as if it’s a waste their personal cash. The corporate edict wasn’t correctly assessing the risk to any one of 80,000 faceless individual employees. Wouldn’t self-insurance make you feel expendable and disempowered, or both, while managing workers in a remote location?
Imagine that you had met a doctor and a fellow countryman of the patient during that first hospitalisation. Imagine that this very informed doctor had a job in an embassy and had kindly consulted in an unofficial capacity. The patient had been discharged from the ‘better’ hospital when you meet the doctor at a function the following weekend. You have a chat over a beer or two. Your conversation is suitably guarded and discrete. You presume the need to respect patient confidentiality. You realise the doctor has been gathering information. He’s most certainly an officer, an agent, a spook.
The tone of the conversation has changed. The doctor knows things about the patient that surprise you.
‘Goodbye, everybody, I’ve got to go
Gotta leave you all behind and face the truth?’
continued Freddie Mercury back when Queen dominated the music charts.
Remember that the tone of the conversation had changed.
Imagine the patient has been sent home to recuperate from the mystery illness. You are having an increasingly indiscrete conversation about other illnesses and accidents that have occurred in less than twelve months. A picture is forming that suggests something unusual but you agree with the doctor that there’s not much more to say that isn’t speculation.
Imagine a few days pass and the nurse who was on duty in that first hospitalisation is back on duty. She learns of the medevac and asks why it happened? She had wondered why the patient was being treated for high blood pressure. But the medics hadn’t known he was being treated for high blood pressure.
And it all became clear. The patient had reminded the nurse that he’d not taken his blood pressure tablets that day. He persuaded her to find them in among his personal effects. He took one or more tablets and he became so sick that he needed a first class weekend break.
You’d learn later that he’d brought a year’s supply of hypertension tablets with him to work in this remote place. He’d later admit to you that he had hypertension at one time and that he brought the meds as a precaution.
‘Remember the scar on the leg?’
‘The leech scars?’
‘Recall the dengue fever?’
Each of these could be stories in their own right but it’s the pattern that suggests the problem. Some people feign diseases, illnesses, or traumas to gain attention or more bizarrely, reassurance. You can imagine a guy who is having one episode in each of his rotations at work is a threat to himself and others.
He would come back to work. Corporate managers would not be allowed re-assign him without a diagnosis that no one could force upon him. And one of the symptoms of this kind of challenge is a reluctance by the patient to allow doctors to meet with or talk to family, friends, or prior doctors.
You would sit down with him and agree terms. Foremost was that any emotional problems had to be discussed. Your work schedules would be aligned because someone, you, had to watch over him.
And he behaved properly for the remainder of his overseas contract. Which was good because there are no treatments for factitious disorders.