Six Days in Hell
or
(A Stay in a Mexican Hospital)
Note - This is the story of my October, 1998, stay in the Juan Maria de Salvatierra General Hospital in La Paz, Baja California Sur, and is part of the continuing saga I call the Fun Chronicles. My thanks to the entire staff of the hospital, who went to extreme lengths to make sure I was comfortable, acted professionally in treating me, cured a dangerous infection, and did all of this in an operating environment devoid of many of the medical conveniences we take for granted. - Sr. Divertido
It's Monday, October 5th, and if you had told me 10 days ago that I'd be spending most of the next week in a Mexican hospital, I'd tell you you're crazy - I mean, who winds up in the hospital for what looks like athlete's foot? Thinking back on the past few day's events, it seems like a bad Movie of the Week plot.
It all started about 10 days ago, when I first noticed what looked like athlete's foot on my right foot. I made a mental note to pick up some ointment my next visit to town, and then promptly forgot about it. That evening Agueda and I were supposed to go out for dinner, but as I was on my way to her place, she frantically called me on the cell phone exclaiming that her 9-yr old son, Alex, had just fractured his collarbone, and I should meet them at the local clinic in Los Barriles. Upon meeting them there, the doctor indicated Alex had to get to La Paz immediately for an x-ray, so you know how the rest of my evening turned out. Once we got to the hospital in La Paz, I left Agueda and Alex with the emergency staff and headed to the drug store to pick up the forgotten ointment. Returning to the hospital to pick up the now-bandaged Alex, I never would have guessed in a thousand years that I'd be a patient there myself very soon.
The next morning began the ointment therapy - unfortunately without a great deal of success - the affected area on my fourth toe just seemed to be getting worse. On Monday, the 28th, I finally sent for the local doctor to check things out [amazing - a place where you can still get a house call]. A thorough cleaning of the toe and a prescription for antibiotics later, and the doctor said I'd be as good as new in 2 - 3 days.
Day 1
On the morning of the 30th, it was looking worse - the telltale signs of infection were there, a reddish discoloration and a slight swelling appeared. I again summoned the local doctor and upon examining me he decided a trip to La Paz to visit a specialist at the hospital was in order. He made the appointment while I completed payroll and arranged for a taxi to transport us. We expected the doctors would cleanup my foot, give me some stronger medications, and send us home. On the off chance I'd might have to stay overnight, I threw a change of clothes in a bag, grabbed some money and away we went.
Upon arrival at the hospital, we were ushered into a treatment room while waiting for the doctor. After a few minutes, I was bumped into the hallway so the staff could treat another patient. In a few minutes the consulting doctor showed up and we all patiently waited in the hall for a treatment table to open up. Just a few minutes more and we had a table. Jumping on up, I removed my sock and was amazed at the infection's progress in just a few hours - half my toe was now black - I immediately had visions of having some type of flesh-eating bacteria at work. The doctor efficiently took a culture sample and looked up at me and said I was here for at least 3 days of IV medication. I ask the doctor for a straight answer to the question - "Can I get this properly treated here, or should I bundle up my foot and head to the USA?" He chuckles and responds that not only can they treat this properly here, any US doctor would laugh if I made a trip home just for this.While the doctor arranged to check me into a private room, I was sent back to the emergency room to wait, and wait, and wait. It was around 2 hours later they said my room was ready, then I got my first inkling of what I had in store. The nurse very efficiently and painlessly established an IV - then proceeded to take a blood sample by pulling the plug on the IV needle and allowed my spurting blood to drip into a vial, which she then capped with a piece of gauze. I'm beginning to wonder what I've gotten myself into. An attendant wants to lock up my valuables, including my Rolex. I'm a little queasy about this, but as I see he's inventorying everything on a written list, my fears subside, however you should have seen his eyes when I handed him 10,000 pesos in cash [about US$ 1,000].
Using standard hospital procedures known the world over, an attendant then wheelchaired me to their x-ray facility. Although the machine looked like a relic from WWII, they quickly snapped a couple of pics of my foot before sending me on to my room. I soon found out why there was such a long wait - there were no private rooms available and I was being placed into my own private hell - a dormitory-style room with no bath and two of the world's most miserable creatures for neighbors. Across the room could be Freddie Kruger's father, a grizzled old man with piercing eyes which never leave me, while in the next bed is the poster child for emphysema, another aged Mexican who cannot go for more than 5 minutes without having a hacking attack loud enough to wake up the dead [which I'm sure he will soon be]. This situation soon gets compounded by one of the realities of the Mexican medical system - the hospital doesn't provide any medications - all patients are expected to have family or friends available to purchase any necessary medicines from a nearby pharmacy. I'm handed a list of medications I need to provide - after a few minutes of teary-eyed explanations that I have no one nearby, one of the attendants takes pity on me and offers to go get the medicines for me. This crisis solved for the moment, I lay back and study the paint peeling from the ceiling as I call Agueda to let her know what's going on. She has a panic attack upon hearing that I'm in the hospital for at least 3 days, and says she'll be right out after work. There are some things to be said for this culture - here's a girl I've been dating for 2 weeks, she's going to take a 2-hour bus ride in the middle of the night to get here, check on what I need, spend the night on a bench in front of the hospital, then check on me in the morning before taking another 2-hour bus ride home in order to get to work on time. I ask if any of your girlfriends would do the same for you.
It's dinnertime, and based upon everything so far, I'm a bit apprehensive - however, there's nothing to fear, as I get a tasty, but plain, meal of beef, veggies and fruit. The only down side is the nutrileche they serve as milk - highly pasteurized, it's thick and warm and doesn't resemble milk at all.
Agueda shows up around 8 - in the meantime I've discovered the hospital doesn't provide most of the hygiene products we take for granted - soap, towels, shampoo, etc. I give her a shopping list and send her off with a new understanding of why there are so many people hanging around in front of the hospital - they're here in case their patient friends or relatives need medicines or supplies. She returns with all the stuff, and I make a vain attempt at sleep, punctuated at regular intervals throughout the night by doctors, nurses, and my ever-present wheezing neighbor - such are the things that must inspire Stephen King.
Day 2
About 7am an attendant shows up to take my blood sugar. He's got an older model electronic machine without a spring-loaded lancet to draw the necessary drop of blood - he's got to use a needle to prick my finger [I sure hope its sterile]. After this mess is done, breakfast arrives, and the nightmare continues - fish machaca! Picking at the fruit on the plate, I figure it can't get much worse, and attempt my first visit to the bathroom. I soon find out the wheels on the IV stand are sticky, so I pick the whole damn thing up and carry it down the hall to the men's bathroom. As if on purpose, the doors to the toilets are too low for the IV stands, so I have to leave my arm hanging outside while stress-testing the plumbing. Ah, life in Mexico.
By midmorning Rudy Vargas pays me a visit. I seize upon his presence to see if he has any connections here to try to get me in a private room. He tries his best, but returns with the same "hospital is full" story I got last night. Dejectedly, I decided to kill some time by trying to take a shower. Getting an attendant to tape a plastic bag around my wounded foot, and again carrying the IV stand, I make it to the bathroom, only to discover the only way to get the hospital gown off is to unhook the IV bottle, slip it through the gown, then rehang the bottle. After showering and shampooing [with 1 hand, as the other is tied to the IV bottle], I have to reverse the process to get dressed with the IV attached.
By this time I'm pretty beat, and as I'm dragging myself back to the room, a nurse stops me and says they've moved my stuff to a private room - thank you, God! Settling into my new abode, I spend much of the rest of the day watching the IV drip, drip, drip. Ken Toot unexpectedly drops in for a visit on his way to Leonero, and I talk him into getting me a lifesaving pillow. There's no phones, TV, radio or other distractions to my endless boredom - oh pues! At dinnertime I finally figure out that every meal is the same, carrots, zucchini, papaya, and sometimes some meat or chicken.
The medical service is surprising in its thoroughness. Doctors, nurses, and interns are continually checking in on me. Twice a day I get a visit from an intern, to clean and redress my foot. Exhausted from last night, and having a bit more privacy, I sleep much better tonight.
Day 3
With all the comings and goings of the medical personnel, night blurs into day. Light through my window is the only way I can even guess what time of day it is. Upon waking up this morning, the swelling in my foot has gone down noticeably, providing me with the first glimmer of hope that I might be able to walk out of here - until now there's been whispered talk and furtive glances between the doctors that have told me they weren't sure they could save my toes.
After more carrots/zucchini/papaya meals, I'm looking forward to a visit from Al Barnett, a buddy from Los Barriles. We concoct a brazen plan for him to sneak in some real food for lunch - a roasted chicken. Needless to say, that was the best chicken I've had in my life. Later on, the eagle-eyed doctor spots the evidence in the trashcan, and proceeds to lecture me on the need to stay on their 1500 calorie per day diet.
My dreams of getting out of here tomorrow are dashed as the doctors decide they want to keep me for 2 extra days. I don't mind too much, as long as I'll be able to walk out of here on my own. Being the strategic planner that I am, I arrange for my cell phone charger to be brought out in order to recharge my dwindling battery supplies. Carlos, the attendant who took all my valuables when checking in, shows up and wants to return my stuff in case I get released. You can imagine my relief to find all my goodies safe and sound, including my Rolex and cash.
Late in the day I get another list of medicines I need to buy. Fortunately, Juana, another friend from Los Barriles, is here visiting her sick grandfather. I arrange for her to get the medications, still amazed with the system here. I'm starting to get a little tired of the endless needles in my fingers for glucose testing, so I call John in San Diego and ask him to bring me down a new tester so I can self-administer my tests. The day ends with dreams, or possibly hallucinations, of real food.
Day 4
I must be getting better - I'm starting to get cabin fever. So far, the only distractions I've had have been reading the magazines Vargas brought a couple of days ago. Today is Saturday, so I'm looking forward to some extra visitors today. After the customary finger pricking and carrots/zucchini/papaya torture, Rudy and his wife Olivia, drop by for a visit, followed by Gabriel with my charged-up cell batteries. I finally get an attendant to put a plastic bag on my foot so I can attempt another shower.
Today there is a noticeable change in the quality of the medical care - much fewer staff visits, fewer smiles, etc. I've been asking all day to have the dressing on my foot changed, to no avail. The doctor stops by about 3, and I complain to him, and even he doesn't seem to have enough juice to get anything done today. To compound the situation, at about 8pm they tell me I need to buy more antibiotics - as if I can find somebody on a Saturday night willing to run to the pharmacy for me. Vargas doesn't answer his phone, Juana's nowhere to be seen, Gabriel is already back at Leonero, and I'm starting to change into my alter ego, Sr. Coraje, kind of a cross between Darth Vader and Hulk Hogan. Fortunately for the hospital [they have no concept of destructive capabilities of Sr. Coraje], I get a call from Porfirio, a Leonero employee who's here in La Paz for a couple of days off, and he agrees to get the medicine and drop it by. At about 10pm someone finally shows up to change my dressing - I find out then that the hospital had 3 emergency surgeries today, which is the cause of the disruption in routine care. Having gotten the medicine from Porfirio [thanks, Porfi] and and a new bandage on my foot, the evil curse of Sr. Coraje returns to the black spot in my mind where he resides, patiently awaiting the next time his services are needed.
My nightly dreams of cheeseburgers in paradise are rudely interrupted at about midnight, when the nurse awakens me with some bad news - after 4 days of endless pumping of medicines into my arm, the vein has finally given up and collapsed, and she needs to reestablish the IV in my other arm. Being a bit tired of needles, I turn away as she sets up the IV in my other arm and the drip, drip, drip resumes.
Day 5
John's coming to visit today, and he's bringing my new glucose tester, computer, and some new sandals to wear out of here. I gladly tolerate the morning needle torture, as this will be the last time before I can do it myself. Vargas has come to visit, but they won't let him in as he's wearing shorts, another inexplicable Mexican rule. I quickly call John to let him know to wear long pants or he may not be able to get in to see me. Gabriel's wife, Monica, pays me a surprise visit and drops off some balloons and a get well soon card. John and Jeff Newpher finally get here with all the goodies, and my spirits soar at the sight of my computer.
I still haven't had a visit from the internal medicine specialist, which we've been trying to schedule for the last 3 days, so I still don't know if I'm going to be able to leave tomorrow. I'm supposed to leave for San Diego on Tuesday in order to get to Wednesday's Jimmy Buffett concert there. In a not too thinly veiled attempt to keep me here, John offers to buy my tickets - I might take him up on the offer.
Now that I've got the computer here, I can write in real time. Early this afternoon it's apparent we've lost another vein, requiring another IV change. After removing the IV, the nurse gives me about an hour of freedom from my medical umbilical cord, and I take full advantage of the time by taking a shower without all this crap attached to me. Tired of having all the hair ripped off my arm each time they remove the needle, I ask the nurse to show me where she intends on putting the new IV, then I whip out my beard trimmer and shave the arm hair off in that area. Nodding with approval at my ingenuity, she quickly plugs me back in.
My doctor makes an appearance at about 3pm. I ask him about getting out of here tomorrow, and he responds hopefully in the afternoon. He also indicates the internal medicine doctor will be here in the morning - we'll see. Juana shows up just in time to pick up some more medicine for me. At about 5pm I try my glucose tester for the first time - the spring-loaded lancet is much easier than just sticking a needle in my finger.
As this journal is now up to date, and I've read every magazine cover-to-cover at least 3 times, I spend most of the evening watching the IV go drip, drip, drip. At about 8, the cute Jamaican intern shows up to clean and redress my foot. After watching her cut away all the dead tissue, I don't think I'll be making it to the Buffett concert, and make a mental note to call John in the morning to offer him the tickets.
It's not a very restful night, as I am repeatedly disturbed by the periodic injections of more antibiotics. About 3am I drift off to forbidden dreams of Chinese food.
Day 6
The day begins with the return of the dreaded fish machaca. Even in my emaciated condition I can't eat it. I hope it's not an omen of what's in store for the rest of the day. There's still no indication yet if I'm going to get paroled today, so I'm just hoping for the best. I call John and offer him the Buffett tix, and we discuss my new game plan of flying up on Thursday, giving me a couple of days to straighten things out before heading north. I make an appointment with my San Diego doctor for Friday morning, and wait for the doctors to show up to give me my verdict.
Vargas calls to see if I need anything. He's planning on going to Leonero later today and offers to wait to see if I'm getting out and need a ride. We agree to play phone tag later, so there's not much to do but hang out.
About 11am the internal medicine doctor shows up. He reviews my records and gives me some good news. I'm only borderline diabetic and can control it through diet only without having to take medication [don't worry Jim, I can still eat most of the stuff on the Manana's menu]. He does give me a prescription for oral medication just in case my sugar goes up, and advises me to get more info on diet control from my San Diego doctor. Now all I have to do is wait for my primary doctor to release me.
About noon one of the nurses checks on me, and I tell her I'm looking forward to getting out of here later today. She scowls at me and says I'm not going anywhere as she turns and brushes out of the room. I start to get worried and call Vargas to see if he can help sort it out. He shows up in a while and searches for the doctor to see what's going on. I'm also still waiting for the lab results on the culture they took on Day 1 [was that really 5 days ago?]. The lab indicates that the infection was one of the two staph varieties, and they would know for sure tomorrow - OK. My primary physician is the one to authorize my release, and he should be here about 3pm.
The doctor arrives at about 4pm, takes one look at me and asks if I'm ready to go home. It doesn't take more than about a nanosecond for me to respond - absolutely yes! He arranges to have the IV disconnected - as soon as this happens, I jump in the shower and enjoy having two free hands again. The next chore is figuring out the procedure for paying my bill. As is customary here, I need to pay the doctor directly for his services, then the hospital for its bill. An accounting for the entire stay is as follows:
$210 doctors + $128 hospital + $250 medications = $588 total
Not bad considering the $10,000+ this would have cost in the U.S. I commented to the cashier that it is cheaper to live in the hospital than at home.
Vargas picks me up and we head home to Leonero to wrap up this episode of the Fun Chronicles.