Return to Hell - The Sequel
Note - This is the story of my November, 1998, stay in the Juan Maria de Salvatierra General Hospital in La Paz, Baja California Sur, and is a continuation of my previous experience there (see http://www.rancholeonero.com/divertido/salvatierra.html ) part of the continuing saga I call the Fun Chronicles. - Sr. Divertido
Day 1
It's Monday, November 2nd, and I'm on my way to see Dr. Collins for my daily treatment. I've been seeing him every day now for nearly three weeks in an attempt to save the fourth toe on my right foot. Those of you that have read my previous documentary, Six Days in Hell, will know I've been fighting to save the toe since getting a staph infection about a month ago and spending a week in the hospital.
The daily cleanings have been producing results, as the soft tissues have been starting to heal. Up until yesterday the doctor was optimistic about the prospects of a full recovery. Personally, I've been less enthusiastic than the doctor, as there doesn't seem to be any bone support - the top half of the toe just flops around. Yesterday the second bone segment popped through the wound opening. Dr. Collins set the bone and tied the toe to the third toe, but the look in his eyes said he had given up. Today a new perforation developed in the side of the toe, upon inspection, he gazed at me with the look of someone who'd just lost his first born son and uttered the words we'd been trying to avoid, "It's time for the toe to go". Apologizing for his vain efforts, he makes a few phone calls and sets up an appointment for me with a surgeon in La Paz. I ask him how extensive he believes the surgery will be, and he says they will probably remove the toe at the base of the third segment and that the surgery could be performed under local anesthetic and might involve a one-night's hospital stay.
Armed with this information, we return to Leonero to grab a change of clothes and some money. On the way to La Paz, the full impact finally hits me, and I have the van pull over as I nearly vomit from nervous anticipation. As we get to the hospital, I start feeling a bit better in the hope this will be all over soon. We meet the doctor in the examination room, and he takes one look at my toe and rips out the offending piece of bone, saying "You won't be needing this anymore!", as he unceremoniously dumps the bone in the trash. Escorting me to his office he shatters the pretense of this being a minor surgery, as he outlines the normal surgical procedure for this type of amputation - making a V-shaped incision going from each side of the toe to the middle of my foot, removing all the bones related to the fourth toe, then relocating the little toe over next to the third toe. He also indicates this will involve a nerve block and means at least three nights in the hospital. I ask about general anesthesia and he says they routinely don't like to use general on English lineage patients, as there have been several mishaps with the medication they use. He checks with admissions, and indicates I'm to return at 3pm to check in.
Now that the bad news is out in the open, I feel like enjoying my last couple of hours of freedom. With the full knowledge of the quality of the hospital food, we head on to a local restaurant to partake in my personal version of the "last supper". Fortified with a good meal, we return to the hospital to get checked in. Deja Vous - they don't have any private rooms and are putting me into a semi-private room until one becomes available. I'm envisioning more nightmare neighbors, but to my surprise I get a room to myself. The obligatory x-rays come next, and I wind up having to make a second trip as they forgot to take a chest x-ray. Dinner arrives, making me glad at my foresight of eating before checking in, the fare is tuna salad - almost as bad as the dreaded fish machaca. Later on, Rudy Vargas pays me a visit, and we spend the evening reliving his knee surgery experience. After he leaves, the nurses show up to give me the required electrocardiogram. I manage to persuade them with my broken Spanish into not hooking me up to an IV until morning. My efforts at sleep are continuously being interrupted throughout the night by nurses and interns checking my temperature and blood pressure.
Day 2
I get up a little after sunrise and jump in the shower before the nurses can hook me up to an IV bottle. The doctor shows up about 8 and advises me not to eat or drink anything until after the surgery, which is scheduled for noon. Gabriel shows up to see if I need anything - he picks up a couple of medications I need - I don't think I'll ever get used to their system here. I spend the rest of the morning preparing myself for the inevitable. About 11:30 an attendant wheels me down to one of the operating rooms. On the way, the doctor took my bag of valuables and says he'll get it to Gabriel for safekeeping. As I jump up unto the operating table, I start to get the shakes. Not knowing if the cause is the cold room or my nervousness, the anesthesiologist tries his best to calm me down. He turns me on my side and scrubs my back in preparation of the nerve block. He asks me to let him know when I feel an electric shock in my legs, as he moves the needle around searching for the main nerve to my legs. I feel a shock down near my upper left leg, and he considers my involuntary reflex twitch as a confirmation he found the right nerve. I feel the cold fluid being pumped into my back and start to relax. After a few minutes nothing is happening, so I ask how long it should take - he reassures me that it normally takes about 15 minutes to numb. After a few more minutes the surgeon comes in and starts to prep my foot. I'm a bit alarmed as I can feel the cold surgical soap scrubbing my foot. I can't feel the incisions, but the extraction of the bones is excruciating. I complain to the anesthesiologist, and his response is to pump more medication into my back, which isn't doing a thing. He finally injects something through the IV, and the pain subsides to a manageable roar. Before you know it, the surgery is over and I get wheeled into recovery. On the way the doctor shows me my severed anatomy laying on the table, but I'm too groggy to comment on it. In recovery it seems somebody is poking at me or checking my blood pressure every 10 minutes. After a couple hours of this the nurse says they're ready to send me to my new private room. After transferring me to three different beds, I finally get to my surgical ward. I don't know whether to scream or laugh as I get wheeled into the same room I had during my October visit. I'm anxious to see Gabriel as my eyeglasses are in the bag he's holding - as is my cell phone, so I have no way of contacting him. Finally I get a nurse to call him from the desk phone - he's been downstairs the whole time waiting for someone to give him the OK to come see me. With the surgery over and my eyesight restored, my attitude improves dramatically. Maybe it's because of the drug residue in my system, but tonight's sleep comes with some extremely graphic dreams, including one where I'm playing ice hockey. About 10pm my rest is ruined by a throbbing pain in my foot. Someone forgot to give me my pain medication and now my chart says I can't get any more until 2am. The next 4 hours are brutal, and was I happy to see the nurse walk in at 2 with my pain medication. I soon resumed a fitful sleep.
Day 3
Today is a recovery day. Lots of visits from doctors and nurses continually poking and probing. I spend lots of time on the cell phone calling people trying to stave off the endless boredom. I get a surprise visit from Agueda's grandfather. I begin to think he's worried there may not be a rich gringo in his granddaughter's future. Gabriel stops by with a couple of pillows - substantially raising the comfort level. Sleep is a bit rough - more odd dreams.
Day 4
Agueda calls me first thing and says she's on her way to see me - a nice start for a new day. Even the breakfast tastes good today. The doctor checks in on me and says I might be able to go home this afternoon. He's going to return at about 3pm and if my foot looks good I'm outta here. Agueda gets here and picks up some medications for me. After a nice visit she heads back over to the bus terminal for a ride home so she can get to work on time. About a half hour later she returns - all the buses are being used for a political rally and she can't get a ride out until 5pm. I watch as she calls her boss, Isabelle, and can hear the yelling over the phone from across the room. We joke about her now having lots of time to be my nurse, as she's lost her job. She makes a few more calls and finds a girlfriend who can take her home. We say our good-byes again and I continue my wait for the doctor and my pending release from medical prison.
The doctor finally shows up about 5pm - too late for me to get a ride home. I finally get to see his handiwork and am pleasantly surprised as he unwraps my 4-toed foot to change the dressing. You can hardly tell I'm missing a toe. He asks if I want to go home, and I tell him I might as well spend the night. At least I get him to agree to disconnect my IV after my next medication. About 6 Agueda's mom drops by. The family is pulling all the stops in their efforts to get Agueda hitched. About 7 a nurse disconnects me and I enjoy a good night's sleep free of my medical umbilical cord.
Day 5
First thing on this morning's list is a sponge bath followed by a change of clothes. The doctor shows up about 8:30 and gives me a list of instructions for Dr. Collins. Changing the dressing for the last time, we shake hands and he wishes me good luck and a speedy recovery. As is customary, I pay the doctor directly for his services, while Gabriel pays my hospital bill for me. Another amazing aspect of the medical system here - major surgery, 4 nights in the hospital, and the total bill is about $1,100.
I finally get the OK to leave about 11. As they wheel me out to Gabriel's car for the trip home, I couldn't help but hope that my next trip here is as a visitor instead of a patient.
On the way to Leonero we stop at Manana's for lunch before getting home and a return to normalcy. Thus concludes this episode of the Fun Chronicles. Thanks for allowing me to share the experience with you.