The $40,000 bill




It’s around 9:25 am on Thursday 30 July, 2015. Both of my wrists are strapped to an operating table. The theatre feels as cold as everyone's facial expressions. I am already consumed with guilt and embarrassment because my body has 'failed me'. "Now turn on your side." I wasn't ready for that horribly long needle to be inserted at the base of my spine. There is little explanation about what's taking place- even though my credit card is taking a major hit.

My anxiety causes my body to flinch. The anesthesiologist is obviously annoyed with me. “If you don’t stop moving, I'm going to have to put you to sleep!” His tone triggers my tears.

They tried to induce labour but he decided to change his position at the eleventh hour. Had I actually attempted delivery, his left hand may have been damaged. He wasn't in any distress, though. Just chilling inside of his sac. Yet, I couldn't help but sense an eagerness to just cut me open and get this over with. Disclaimer - I am not a doctor.


Emergency cesarean section it is. Before wheeling me into the theatre, a nurse briskly walked into my room with what felt like a manual. Disclaimer forms authorising doctors to do the needful to preserve life. Imagine signing a form where you confront your own mortality. And of course, there's the part where you will honour ALL COSTS. It didn't matter to them whether my husband walks out of there without his wife and child; they just needed their payment. I hadn't eaten for almost 12 hours and my frail left hand signs the documents.

It begins.


The fetid scent of burning flesh pervades the room as they make their incision. The tears multiply. My husband and the Pediatrician; the only medical professional who spoke with any modicum of empathy, stood on the periphery of the operating table. There was a male nurse next to the anesthesiologist.


I grabbed the stranger's hand as though we'd been through life together. I sensed his discomfort.

But he soon realized my desperate attempt to be consoled. My legs feel heavy and numb at this point, and there's fluid gushing out of from the 10 cm line. It's around 9:36 am and my son is about the enter this world. I held on to the table and the nurse's hand with dear life. Without warning, I felt several hands forcing this mass out of my body. It felt rough. Routine. Callous. I tried searching for reassurance. "They are competent professionals, Amrita. Just shut up and bear the pain."

I finally see him. His wrinkled body is partially covered with that cheese-like substance. He is delicately wrapped in a dark green cloth. I gently kiss him, crying as my husband records the moment on his phone. "I am now a mother." But I'm too exhausted and medicated to grasp the gravity of the moment. I remember being wheeled back into my room. The epidural had left me shivering for the next couple of hours. I am covered in layers of blankets. My doctor comes into the room and asks to speak to my husband aside. We were expecting a synopsis of the surgery or some kind of congratulatory message.


“That will be $6000 (TT) extra. There’s an ATM in Grand Bazaar (nearby mall). Can you settle the payment by tomorrow, please?” My husband was stunned, and not wanting to leave my side, phones a relative and the transaction is done. Two days later, I was discharged. My son was still not breastfeeding properly, and my mother tried to console me. "Don't worry, give it some time." There were no follow up phone calls. Nothing. Just a $TT40,000 bill.

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Almost three years later, our daughter was on the way at 33 weeks. But something went wrong. Her weight and abdominal circumference were lagging behind. Clearly I have zero luck with bringing children into this world. There’s a fear that her lungs may be underdeveloped. Funny enough, my husband and I had toured another private health institution two weeks prior. Once again, we were willing to cough up the $40,000 or so to ensure that we received "the best care". But my conscience was not having any more of this "private delivery" experience. Much to the disapproval of family and friends, I asked my doctor for a referral letter to join the Mt. Hope Women's Hospital. She felt as though I was insulting her intelligence.


"What would happen if my baby doesn’t survive?".


“Well, we'll just put things in place as best as we can.”


"Does (name of hospital) have a ventilator?"


"Unfortunately, they don't."


That meant shipping me off in an ambulance to the nearest hospital if things got critical, and of course, holding my credit card accountable. I was reminded that if I were to proceed with her services, I would have to make the downpayment ($20,000) by the 36th week. That was the end of our relationship.


"You really going to Mt. Hope?"


"Seriously?"

I walked into the hospital one afternoon to commence the registration process. The facility felt like a snapshot from the 1970s. But at this point, a cozy, air-conditioned private room was the last thing on my mind.


It’s the first day of clinic. It's 6:15 am and I pull up outside the Mt. Hope Women's Centre. I was surprisingly whisked into modernity- the building felt "first world." But I'd quickly learn that the system was rather overwhelmed as it took me three hours to see a doctor.


One of the older nurses walks in. It’s 7:40 am and before the clinic starts, she asks all pregnant mothers to bow their heads in prayer. She begins praying to Jesus, asking him to walk with us throughout our pregnancy. Well damn, I didn't see that coming. We actually have human beings like this in the public service. I found something so comforting in her voice and words. I was alone (my husband was taking our son to daycare) and pregnancy takes your emotions for a daredevil's roller coaster ride. I've heard horror stories about this place: rude nurses, incompetent doctors, non-functioning equipment, deplorable bathroom facilities. But today and for the rest of my pregnancy, I saw dedicated women (and men) turn a frustrating system into a well-oiled machine.


Each nurse spoke to me the way a pregnant woman ought to be spoken to. I felt as though they were older aunts who helped raise me. They were frank but their words were packaged with care. As my clinic visits progressed, I felt less shitty about my pregnancy. I did not feel like a glowing angel; more like a beached whale with awful bladder control. But a few hiccups came along the way. As I said before, I have zero luck with birthing children. Around 36 weeks, I was admitted to the hospital one Saturday morning at 6:30 am. I felt no movement for 15 hours straight. The two attending nurses immediately swung into action. They started fetal monitoring, gave me ice chips to eat, examined my abdomen, talked to her, and thirty minutes later, she decided to awake from her slumber. The nurses did not let me off the hook that easily; I received a stern lecture about coming into the hospital earlier accompanied by "the look". They also kept me under observation that weekend with more well-intentioned lectures.


Then there was that dreaded 7.2 earthquake on August 21st. I was standing on the second floor of a supermarket when it struck. Dislodged ceiling tiles came crashing around me. There was no place to shelter safely. I did exactly what you're NOT supposed to do- I ran down an escalator and out of the building. My blood pressure never stabilized.

It's Wednesday 28th August and I'm at the 38-week mark. Due to my gestational diabetes and elevated BP, time was not on my side. The entire country heard me screaming during the final probe. The doctor said, "we need to admit you now and schedule your surgery for tomorrow." What was supposed to be a routine visit before heading to the office turned into a panicked frenzy. I called my boss immediately, sobbing on the phone.


"It's happening tomorrow." There was silence since we were both absorbing the shock of my words.


My parents were on a flight back from their European vacation. They had no clue what was transpiring. Thankfully my hospital bag was with me; a faithful third wheel for the past month. I was admitted to the pre-natal ward and all my husband could do at that point was take a family photo- our last as a trio. I spent the entire night panicking about the things that went wrong during my first delivery. The way I felt like a number and not a person. Guessing which doctor/nurse was going to yell at me on the operating table. Whether this was an auspicious time for her to enter the world (according to Hindu astrology). I did not sleep at all.


It's 11:00 am the following morning. My blood sugar is dangerously low since I had not eaten for more than 12 hours. A nurse came into the room and asked for all of my baby supplies. I pulled out her newborn outfit- the first piece of clothing she'll ever wear in this world. My eyes were welling up. I put on my surgery robe and the wait to enter the operating theatre felt like an eternity.


Eventually, I was wheeled off into the delivery room for a second (and final) time.


Listen. The way I was cared for in the delivery room was award-worthy. Every doctor and nurse meticulously explained each step. When it was time for the epidural, a doctor cradled me, rubbing my lower back gently and coaxing me to relax as the piercing needle began entering my body. When the numbness kicked in, she gently placed me on the table. My body began to tremble the same way it did the first time. The scent of burning human flesh returned, more pungent this time. But this experience was different.

The odd, friendly chatter amongst themselves distracted me from the awkwardness of delivering a child. I didn't even know at what point they took her out. I heard a nurse's awestruck expression, "Papa yo!" She must be beautiful, I thought. Two of them were commenting on her doll-like features and extra-long eyelashes. I then saw another nurse writing on the whiteboard:


"Anapoorna Dube"

Time of birth: 11:48 am

APGAR Score- 9' 95

Weight: 5 lbs 8 ounces

I remember waking up in the recovery room. A nurse approached me and started cleaning my bloodied body. A woman is stripped of all dignity at this point, yet she’s rather professional about the task. She holds my body upright and helps me to get on my feet. The way this woman walked me across to the postnatal room made me feel like precious cargo. The room was not one with a private balcony and mountainous backdrop. There was one ceiling fan for five women. Add five babies, each taking turns testing their vocal cords. I struggled to find some peace that night. At around 1:00 am, I force my pained body along the hallway to the nursing station. She's not feeding well, and the attending nurse remained by my side until she was latching on like a pro. I am not even trying to exaggerate the kindness meted out. It's discharge day. The day I ended this chapter of my life. I was relieved to be leaving the hospital with two little humans whom I proudly gave birth to. A nurse walked in bearing gifts for all of us- our stash of antibiotics and Clexane. She helps each mother to inject themselves with the blood clot reducer; something I had to do for the next ten days. The real inspiration behind this post came two weeks after. I received a phone call at 6:20 am. Groggy from the pain and medication, I was swearing in my mind.


"Who the hell is calling me at this hour?"


Two nurses from Mt. Hope were on their way to my house for a post-delivery checkup. I thought it was a prank call and went back to sleep. But five minutes later, they called back and my husband directed them to our house.


My incision was examined. My BP and blood glucose level were checked. They asked me to breastfeed our daughter to ensure that she was doing well. They made me write tips for increasing breastmilk production. I was the first patient of their very long day, but they made me feel as though I was the most important person to them. And this entire ordeal cost me the two bottles of water I gave to them before leaving my home.


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My daughter's second birthday is approaching. I called the hospital to see if a thank you gesture was possible.


"Check us back in two months. Because of the pandemic, we can't do anything right now. But they will love to know that they are appreciated."

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© 2020 by Amrita Maharaj-Dube