Recently a very close relation of mine suffered a brain hemorrhage. This rupture of a blood vessel in the head can leave a person paralyzed, or in a coma, or leave him dead. And it happens without warning; one moment you're ok, then a sudden pain in the head and you're unconscious. You might survive a hemorrhage once, but a recurrence is almost always deadly.

He was admitted in Ramachandra Medical Center, Chennai (that's in South India, if you're an international reader), under the initial care of Dr Santosh Rajan the Interventional Radiologist. Initial reports said that a major artery in the head ruptured, leaking about 15-20 ml of blood into the brain - and that's a large amount. He was rushed to the ICU.

A day later Dr Santosh performed the Angiogram procedure - essentially sending a thin probe through the blood vessels to find out the location of the leak. Diagnosis: patient had an Aneurysm which ruptured.

Dr Santhosh patiently explained to us what it meant. An Aneurysm (definition on MedlinePlus) is a bulged portion of the blood vessel. The bulge is the weak spot which gives way and blood leaks out. The bulge could be existent from birth. Three possible solutions existed: coiling, clipping and stent-ing.

Coiling involves sending the probe through the arteries to the point of the aneurysm and filling the bulge with a coil of thin wire, thus blocking it and preventing a re-rupture. This is quite a safe procedure since the only cut on your body would be the millimeters long one made to send the probe through the artery.

Clipping involves tying a wire around the bulge. If you would imagine the bulge to be a balloon attached to a water pipe, clipping is the equivalent of tying up the mouth of the balloon. Of course, this means they have to open a portion of the skull to get to the aneurysm so that they can tie it up.

Stent-ing involves putting a wire scaffolding made of platinum inside the blood vessel. This prevents the blood vessel from collapsing on itself when it starts healing.

Of course, Dr Santosh Rajan explained, Stent-ing was impractical. And coiling in this case was not possible because of the unusual topography of the patient's blood vessel. So Clipping it was. Dr Santosh was specialized in Coiling and Stent-ing. But the right person for the Clipping job was Dr Damodar Rout.

Dr Damodar Rout. Experienced. Calm. Pioneer of Aneurysm Research in India. Handles the hardest cases. Caring for his patients. Ferocious towards patients' relatives. Respected in his field. Revered by his colleagues & assistants. Feared by nurses. Loud. Cranky.

The let down when we met him was he wasn't willing to explain much of the technical side to us. "You won't understand", he said. I won't blame him. He comes from the old school of doctors who trained to be technically superior and not wizards in human relations.

He kept the 55 year old patient in the ICU for three weeks without much explanation why. But he had his reasons. And he explained them all after the successful 6 hour long surgery, which took place three weeks after he was admitted. Apparently, the body could react in a number of different ways to the rupture. All the reactions would happen in the first three weeks. Once the uncertainty was over, they could operate.

Pre and Post Operative care was superb, thanks to Dr Ganesh and more to Dr Rajesh Nair. I must add Dr Nair was a superb new school doctor - technically sound and great on handling the "person". Jovial, soft-spoken and firm he would dish out encouragement while he pushed up his large, sliding glasses back into position and smiled.

Unfortunately the nurses at the ICU were terrible in service. Of course, they did their job, but it wasn't done well. I mean, if you have to poke the syringe three times just to find the correct artery to take a blood sample, think of the number of holes on the patient! But the nurses at the private wards were much better, much more humane.

10 days later, stitches removed, back on two feet, the patient walked to the car which took him home. Oh, just for the record, although they did open the skull, the opening was small, only about 1.5inch x 1.5inch, roughly. Maybe less.

Finally, Ramachandra Medical Center. Hospital & Medical college. Large number of specializations under one roof. Well qualified doctors, with some well known ones under it's roof. Good care; not excellent, but good. Affordable. Neurology department: excellent. It's got Dr Rout. Then it's Head of Neurology was awarded one of the highest civilian awards of the country recently.

Our whole hospital bill came up to just under Rs 4 lakhs (about USD10000), which I think was quite low, considering how complicated the procedures were. Most of the other hospitals in the city would easily charge at least 2-3 times more.

And they also have a Medical Tourism wing; in case you're not from India and you're interested.

On the downside, you will have to put up with the efficient but lousy canteen and the not so pleasing surroundings. Being affordable brings in a lot of low income people some of whom are not trained in hygiene and others who can't afford hygiene. Some of them are so poor they have to pawn away their possessions - house, bike, jewelry - just to pay the hospital bills. But I sure do admire the doctors and the nurses for their willingness to work on such patients. Great job people, keep it up!