An Unexpected Adventure in Phnom Penh

         “Uh oh.”

          Midnight in Phnom Penh.  I awoke with the realization that something was wrong.  I felt my pulse.  It was very rapid.  I tested it was my oxygenation meter.  Twice.  The first time I was at 197 beats per minute.  The second time, 207.  I didn’t dare test it again.  My usual heart rate is around 60.

          Then I realized I had chest pain.  I already knew that I had arteriosclerosis, and that I was approaching my 75^th birthday.  As a consequence, I was reasonably sure what these two symptoms in combination meant.

          I will not say that I processed this news with a cool head.  Actually, I panicked.

          I called the number of everyone I knew on my Cambodian cellphone, but nobody answered, including the special speed dials for police, fire, and, notably, ambulance.

          I forgot that I had nitroglycerin tablets and that this was obviously a time to take one.  This was the panic part.

          I decided that I preferred not to die and put on a pair of pants and my sandals.  I took my wallet and passport, but forgot the nitroglycerin and cash.

          12:15 AM.  The elevator delivered me to the lobby of the condo where I was staying.  There was nobody there.  A young girl walked out of the other side of the building and I asked her for help.  She ran away.  Then the night security guard returned to his desk.

          “Help me.  Emergency.  Doctor.  Hospital.  Ambulance.”

          A blank stare was his response.  He spoke less English than I spoke Khmer, which was none.

          I staggered out to the street, and in a short flash of rational thinking, called a car service called “Grab,” the Cambodian version of Uber.  I remembered that somebody had told me that the “Khema Clinic” was equipped to handle foreigners, so I told the driver to take me there.  This was my first big mistake… well, maybe the second, after forgetting to take the nitroglycerin.

          12:30 AM.  We sped off into the night and fifteen minutes later he delivered me to the… “Khema Maternity and Obstetrics Clinic,” which in any case was shuttered for the night.  The night guard said something to my driver and we sped off again.  Fifteen minutes later we arrived at… another “Khema Maternity and Obstetrics Clinic,” which happened to be open.  The doctors there said they couldn’t help me and that I needed to go to a hospital.  At this point I must have lost my presence of mind. 

          The next thing I knew, a tuk-tuk appeared at the maternity clinic, and the obstetricians told me to get in.  For those unfamiliar with a tuk-tuk, it is a ubiquitous form of transportation in Phnom Penh for Khmer people, vegetables, live chickens, dining room tables, and, oh yes, foreigners who think they are dying of a heart attack.  It consists of a motorcycle with an open cab at the back, no extra charge for sucking motorcycle exhaust.  Apparently there is no ambulance service at night, and this was the best they could do.

A tuk-tuk.

          1:00 AM.  To his credit, the tuk-tuk driver, whose lack of English perfectly matched my lack of Khmer, was concerned about my well-being.  I had no idea if he knew that I needed to go to a hospital, but we once again sped off into the night.  After what seemed like a long time, we arrived at… a hospital!  It took him another 15 minutes to find the emergency room, and I wish that I had been able to thank him or at least pay him (remember that I forgot to bring any cash).  I think he was mostly worried about having a foreigner die in the back of his tuk-tuk, and he seemed relieved when the emergency room welcoming committee told me to get out of the tuk-tuk and sit in a chair,  Behind me there was a gigantic, open-air waiting room (although it had a roof), with what appeared to be at least 100 patients in beds, all with IVs and multiple hovering family members.  My tuk-tuk driver was my first lifesaver.

          “Uh oh,” was my next thought.  My symptoms were worsening and I was by then convinced I was having a heart attack.  I vaguely remembered something about “the golden hour” during which action had to be taken to avoid death or at least permanent damage to the heart.  It was getting close to 1:45 AM, which was well past the golden hour.  Nobody seemed to speak any English.  I learned later that this was Calmette Hospital, which is a government-owned and -operated health care facility that serves the whole country.  Luckily for me, it is also the best hospital in Cambodia.  Foreigners rarely go there, at least until tonight.  It was clear why – we cannot communicate with the doctors.  It is our fault, not theirs.

          Despite my linguistic limitation, they put me in a bed and wheeled me into Stall #76 where I was confident that I would soon expire.  Then a technician came up and took an ECG, which I felt was a hopeful sign.  He read the report, grunted, turned on his heel, and walked away.  My optimism faded.  But just as suddenly, a doctor appeared.  I later learned that his name was Ren Sokpich.  He explained that I had not had a heart attack but that I had had an ischemic incident, in which plaque in one of my arteries had become dislodged and blocked the passage of blood to the heart.  This caused the pain and the rapid pulse as the heart tried a work around.  Meanwhile, somebody hooked me up to an IV and the pain started to go away, which I assumed meant that I was either slipping into a coma or somebody had given me pain medication.

          Dr. Sokpich said that this was a fixable problem but that surgery was needed and probably immediately.  Well, at least somebody who spoke English was paying attention to me.  The next thing I knew, I was being wheeled into the cardiac ICU, which itself was an interesting anthropological fieldtrip.  Dr. Sokpich asked me how I got to Calmette Hospital and I explained.  He then asked if I had any family members in Phnom Penh, and then wondered what I was doing in Cambodia all by myself.  When I explained that I was a volunteer teacher at the Cambodian Children’s Fund, suddenly his demeanor changed.

          “Really?” he asked incredulously.  “When I was in med school, I volunteered to speak to CCF students about health and hygiene.  I also spoke to them about my journey in education as well as to encourage them to pursue their dreams.  I was impressed with how committed and motivated those children are despite their difficulties and countless struggles.”

          He put his hand on my arm.  “Thank you,” he said with a warm smile.  “I do appreciate that you are a volunteer for CCF.”

          From then and for the several hours, Dr. Sokpich was constantly at my side.  I sensed but did not fully understand that he was advocating for me as I threaded the bureaucratic maze of a large government hospital.  Dr. Sokpich was my second lifesaver.

          2:30 AM.  The cardiac ICU, as noted above, was an anthropological field trip.  There were eight beds in a fairly small room,  There was a patient in each bed, and I counted three family members surrounding each bed (with the exception of mine), meaning that there were 29 people in the cardiac ICU.  Three of the narrow interstices between the beds were occupied by family members who were sleeping.  Other family members were tending to the cardiac patients.  When a family member goes to the hospital in Cambodia, they do not go alone.  “Visiting hours” are a Western invention, since nobody is ever left alone in Cambodia. 

          Dr. Sokpich explained that the ECG and blood tests confirmed that I had not had a heart attack, but that my blockage was quite serious and required immediate surgery, although he did not say anything about the golden hour.  He brought me a palate of medications that he said were prerequisites to the surgery.  I thought of the expensive, extensive, and sophisticated machinery that was used in my first angioplasty and stent insertion in 2019, and hesitated.  “Can this hospital provide the same level of care?” I asked myself.  “Or do I need medical evacuation to Singapore?”

          To buy time, I told Dr. Sokpich that I wanted to consult with my cardiologist in the United States.  We got his nurse on the phone, she took down the list of medicines that I was being asked to take, consulted with my cardiologist, and reported back that the cocktail was appropriate for the proposed surgery.  I took the medications and tried to weigh the possible options.  By that point I realized my goose was cooked; there would be no time for medical evacuation to Singapore. 

          7:00 AM.  Several Cambodian Children’s Fund staff members, Hem Len and Claudia Turkington, arrived at the ICU and quickly became my third and fourth lifesavers.  For the next two days, they would constantly be at my side.  I appointed them my honorary daughters for their service, which was far above and beyond anything that a CCF staff member could be expected to provide to a volunteer assistant teacher.  They are both wonderful, caring, thoughtful individuals.

           I had left a message for my friend Chanthol Sun, Cambodian Minister of Roads and Transportation and a member of Prime Minister Hun Sen’s cabinet.  At 7:05 AM, I received a message from him:  “Are you ok?”  My response was, “No, I am not OK.”  His response:  “I am on my way.  I will be there in 20 minutes.”

          7:25 AM.  Chanthol strode into the cardiac ICU and all of a sudden, the environment changed.  He is well-known and highly respected by a wide swath of the population.  He dresses impeccably in dark blue suits and muted Hermès ties, and projects a commanding presence.  Doctors started gathering around my bed.  Chanthol had the President of the hospital on speed dial, and called him on the spot.  Chanthol got a quick briefing from the lead doctor in the ICU and immediately placed a call to the Head of the Cardiology Department, Dr. Sok Chour, who was sleeping but who had inadvertently forgotten to mute his phone.  He asked Dr. Sok if he did this type of surgery.  Upon learning that he was the country’s premier surgeon in the field, Chanthol explained that he would consider it a personal favor if he would perform the surgery on me.  Dr. Chour agreed and said he would be at the hospital in 30 minutes.  Meanwhile, the president of the hospital had pulled the emergency cord.  The supervisor of the VIP section in the hospital walked in and informed Chanthol that I would immediately be transferred to a VIP room.  Dr. Sokpich’s eyes were as wide as saucers.  Everybody in the ICU was watching intently.  I smiled for the first time in about 12 hours.  Chanthol was my fifth lifesaver.

             I knew I needed this moment recorded, just in the very slim possibility that I would survive.  You can probably guess which person is H.E. the Minister.  Dr. Sokpich is at the left in the photo.  Len and Claudia are at the right.  Those are my legs and foot in the bottom right of the photo.

          8:45 AM.  I was wheeled into the surgical suite for catheterization, angioplasty, and stents.  The room looked remarkably similar to its counterpart at Pennsylvania Hospital.  Dr. Sok Chour walked in and introduced himself.  He had been trained in France, and his English was rusty.  I tried my rusty French, and by some miracle, we were able to understand each other.  He started telling me what he would do, and when it became clear that I had had the same surgery before, he asked me to tell him if his procedure was in any way different from a big-city hospital in the U.S.A.  It was not any different, which reassured both him and me.  Dr. Sok Chour was my sixth lifesaver

          9:00 AM.  “You will feel a little pinch when I inject your wrist with lidocaine, but then you won’t feel any pain.”  I quickly realized that, contrary to procedure at Pennsylvania Hospital, Dr. Chour worked on his patients without sedation.  Gulp.  But there was not much I could do at that point.

          As he predicted, there was a pinch when he administered the local anesthetic to my wrist, but then, to my amazement, no pain.  I did feel the probe going up my right arm, but the feeling was no different than that of a finger drawing a line on my arm from my wrist to my shoulder.  What a weird feeling.  Dr. Chour and I had episodic interactions during the surgery.  I never felt any pain or movement in my chest, but he informed me when he discovered the blockage:  “Ah!  There it is!’ and reported on his choice of remedies.  “You will need two stents,” he said with confidence.

          9:45 AM.  “All done!” Dr. Sok Chour said with a smile.  Actually, he said, “Voilà!” since we had agreed on French as our common language.

          I was next delivered to the VIP suite for recovery.  It met all my preconceptions about a “VIP suite.”  In addition to the physical surroundings, I need to give credit to the lead nurse.  She told me her name was Vichy, and she was kind, gentle, professional, solicitous, respectful, and expert.  I cannot imagine the possibility of  better care, anywhere in the world, at any price.  You simply cannot pay someone to behave the way she did.  Vichy was my seventh lifesaver.

          I slept for much of the morning and afternoon, which was not much of a surprise given the events of the previous night and early morning.  Len and Claudia brought me food.  Chanthol’s brother Kenny brought me supplies of many kinds.  I then slept through the night with some discomfort, none of which was in my chest.  At some point it occurred to me that I had survived and the surgery had been a success.  Going from the certainty of death in the back of a tuk-tuk to recovery in the VIP suite in under twelve hours was overwhelming and I felt drained of emotional as well as physical strength.

          7:00 AM.  The next morning, Chanthol arrived at the crack of dawn with breakfast from Starbucks.  Never has a blueberry muffin tasted so good.  Various doctors, including Dr. Sokpich and Dr. Chour, visited me during the morning, eager to learn of my condition.  Other than being tired and sore, I was able to report no chest pain at all.  They seemed pleased but not surprised.  By the afternoon, Dr. Chour had decided that I was much too healthy to remain in the hospital and told me I had to go home the next day, which I did.

          The bill for my hospitalization, surgery, medications, two stents, doctors, and three days of care, came to slightly over US$15,000, which was 9.6% of the cost of a single stent implanted in Philadelphia in 2019.

          I write these words with no chest pain.  I have completely returned to normal and, following a check-up with Dr, Chour, declared recovered from the ischemia and the surgery.  As I mentioned to one of my friends, I have been in greater peril on several other  occasions.  Now that I have recovered, I will add this series of events to the list of my life’s great adventures.  I met many people during the course of my emergency, and only one of them (Claudia) spoke English as their first language.  They were all without exception extraordinarily compassionate as well as helpful.  I was lucky to be in Phnom Penh, at Calmette Hospital, under the care of Dr. Sok Chour.  Thank you, everyone!

Dr. Sok Chour, a great cardiac surgeon, and his grateful patient.