State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India

Grace, Maggi Ann

Primary Category: Literature / Nonfiction

Genre: Memoir

Annotated by:
Shafer, Audrey
  • Date of entry: Oct-10-2007
  • Last revised: Oct-08-2007


In this compelling memoir, Grace, a writer, artist and teacher, unexpectedly finds herself attracted to a carpenter, Howard Staab, whom she meets when looking at a new home. Shortly after their relationship begins, Staab is told in a routine physical examination that he has severe mitral valve regurgitation and will require surgery. Staab, an active, otherwise healthy fifty-three year-old man, has no health insurance. The cardiac surgery will cost over $200,000. Thus Staab and Grace embark on a quest to find an affordable, but excellent surgeon and hospital. Grace details her efforts to find the best care possible, including correspondence with her son, Bryan, a Stanford medical student with interests in international health. These inquiries lead to the possibility of surgery in India.

After a useful, explanatory preface the book begins when Staab and Grace land in New Delhi and enter the Escorts Heart Institute. Staab undergoes a series of tests confirming the need for surgery, which is subsequently performed by Dr. Naresh Trehan. Through Grace's eyes, we also meet nurses, aides, other physicians, administrators and friends. The narrative follows the hospitalization, including dramatic complications and eventual recovery, and also backtracks to better detail the search for care and the predicament of un- and underinsured Americans. Grace also describes the post-hospital phase, including venturing out beyond hospital and hotel walls.

The book, highlighting the fact that Grace and Staab face more than one cultural challenge in this journey, contains both a medical terms glossary and a short list of Hindi terms. Ultimately, Grace concludes she would consider returning to Escorts or a similar hospital should she or a loved-one require surgery, even without the insurance issue. She states: "India, the land of contradictions. Organized chaos. A third-world country with first-world state-of-the-art medical care available for a fraction of the cost of the same procedures here in the U.S." (p. 259)


An informative guide to a type of international health that does not receive much press, this book underscores the stress, uncertainties, joys and vulnerabilities of those seeking health care outside of the US system. It is also an excellent exploration of the roles of advocacy and support that caregivers find they must assume when a loved one is ill or in need.


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New Harbinger

Place Published

Oakland, CA



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