Wednesday, December 12, 2007

Joe's Hospital Adventure

Joe is our friend in Grecia - he is kindly allowing me to post his recent hospital experience.

(March 2006)

I´m happy to share my days off the radar.

I sure consider it a happy ending to a very scary experience and one that had so much drama and unfortunately sadness too. I think this will be an interesting narrative of my latest Costa Rican adventure and it won’t always be a pretty picture so the sensitive and those with weak stomachs are forewarned.

On a Wednesday I was feeling kind of down and not really breathing right. I assumed it might be a little congestion and when it got worse that day I dropped in on my doctor for advice. After a couple of days of typical cold therapy and no improvement the doctor had some x-rays done and decided if no improvement by Monday I’d go into the hospital for oxygen therapy. By Sunday night I was miserable and at 6 AM on Monday morning I yelled at Linda to call 911 and I collapsed into a chair and pretty well lost consciousness. A Red Cross ambulance arrived with just a driver and fortunately the house construction crew from across the street was just arriving and they came over and carried me on a stretcher downstairs and out to the ambulance.

I was brought to my local hospital and they stabilized me. My blood pressure was barely readable and I was hardly breathing. My doctor met us there and he recommended transfer to a private hospital, CIMA, where I had my hip surgery done. First mistake! I was admitted to CIMA and entered an intensive care room and ended up spending five days there. During that time I had a barrage of tests and it was determined that I had pulmonary hypertension and embolisms in both lungs. I was hooked up to all the standard ICU devices including some very uncomfortable and personal ones that were just down right nasty.

I had a cardio guy, a pulmonary guy, an internist and other specialists all poking and prodding. On the third and fourth days my lung doctor said I needed an infusion of some medication into both lungs to liquefy the clots and after that an insertion of a device into my lungs that would filter any future clots. He literally leaned over me and nose to nose he told me that if I didn’t have it done I would die. I told him I did not have insurance, I did not have the money for such procedures and there must be some other way. Still nose to nose he said to call my friends and family and ask them to pay or I was going to die. I told him to transfer me to a socialized medicine hospital where I had insurance. The next day I went to Hospital Mexico.

I was admitted into an observation room shared with 50 or so other patients under observation and evaluation and those determined most urgent were admitted into a ward. I went almost immediately to the intensive care floor. This hospital is one of two research hospitals in the country and it has 600 beds, specialized buildings attached, e.g. eye specialties, physical therapy and others.

I was hooked up once again to all the typical fluid drips, electro recorders, waste eliminators, oxygen and who knows what else. I shared a room with six other patients, all intensive care and all in awful conditions. I was medicated and put to bed for the night. I know I was visited just about every hour by those recording vital stats and giving shots for who knows what. I woke the next morning to 11 Spanish speaking doctors all reading my chart from CIMA and doing their own touching, listening, and feeling. I´m not so sure I wanted to understand all they were saying anyway so the babble was almost comforting. As a result of this conclave, I went down stairs for echo cardiograms, x-rays, blood work, electro cardio grams and other various look/see tests. That afternoon I was visited again by my ¨team¨ and this time they were looking at their records and pictures and making their own evaluations. At the end of their examination, two of the doctors stayed behind to talk with me, in English!

I had been told numerous times that one of the most difficult things to handle if ever staying in a Costa Rican hospital was that no one speaks English. On the contrary, most of the doctors, many of the nurses and quite a few of the general help speak some level of English and the doctors speak it fluently.

In a very professional manner the doctors that spoke with me, and who I found out were my personal doctors, told me that CIMA´s diagnosis was not completely accurate and I did not have pulmonary hypertension. I did have embolisms in both lungs and I also had a deep vein thrombosis that extended my whole right leg. They said that that clot in my leg was the result of my surgeon at CIMA prescribing a blood thinner for only six weeks instead of the necessary three months and the clots in my lungs had come from the DVT in my leg. They also suggested that the correct way to treat my condition was with an immediate Coumadin drip and a continued oral treatment for an extended period of months. They said this would correct the blockage in my lungs immediately and protect from a recurrence.

This was started while they stood there and I was also given medication to make me comfortable and help me sleep. On the fifth day of hospitalization I was breathing almost normally, blood pressure was better than it had been in years and I was actually aware of my surroundings and other occupants. I was also aware that other than those tasty liquids dripping into my veins, I hadn’t eaten any solid food in, oh… three years! A real breakfast showed up, well a typical Tico breakfast of a hunk of papaya and a big slice of crispy bread with a black bean spread on it and black coffee. I managed about two bites and found that that was about all I was going to eat at any of the meals I ate while there. It also accounts for the twenty pounds I lost while I was there.

I continued to improve and the hospital staff continued to take blood pretty much every two hours, take x-rays and test for whatever they thought necessary. The team evaluated me every morning and my doctors met with me every day to probe my general feelings and to keep me informed of their intentions and my progress. I had lengthy discussions with them regarding the health care system, how it works and how good it really is. He admitted that the small hospitals in the system, like the one in my hometown of Grecia was perfect for emergency situations and the clinic it ran, however they did not have the ability to diagnose nor treat more serious conditions. I would, in fact, be going to Hospital Mexico for all my follow-up appointments and I should consider them my doctors from now on.

After spending a few days detached from my life saving umbilicals and walking the hallways to regain my strength and build up my stamina, I was delivered home by a Red Cross ambulance. I was sent home accompanied by a month’s supply of seven different prescriptions. I’ve been home now four days and feeling great, eating less than normally which is a good thing and behaving normally which is not a good thing. I am counting every day as an added blessing and not taking one breath for granted.

So ends my gentle description of the past weeks events and now I want to share other experiences and a few opinions. Some may not want to read further because I am going to be graphic in a few instances.

My trip to the hospital in Grecia from home was done with little awareness on my part and my stay in CIMA was in a private room so there’s really not much to tell about either. My stay at Hospital Mexico however was dramatically different because I was aware, I shared a room with six other people and my bed overlooked the main corridor and nurse’s station. There was no door in my room and other than the caregivers pulling the curtain around the bed when they gave a patient a bath, there was no privacy.

Other than the cardiac wing, the most intensive supervision and care was given on my floor. There are no law suits in Costa Rica so doctors are not under that threat when they want to treat a patient. For that reason they will do things here that you would never see happen in the states. A man in the bed immediately to my right, four feet away, was in a coma. He was a boxer, in his 30´s, and suffering from multiple brain tumors. His prognosis was the worst. One afternoon, his team of doctors was holding one of their daily discussions, unintelligible to me. It wasn’t until later when I had a chance to talk to my doctor who was a part of the coma patient’s team also that I found out what actually occurred.

As the discussion ended draped carts started to roll in and get positioned around his bed. Some of the doctors returned, gowned and masked, and it was obvious they were about to perform surgery. Surrounded by me, four feet away, and four other patients in their assigned beds, they opened this man’s leg from groin to ankle and inserted some kind of device that led from his leg and terminated in his brain via a blood vessel. The doctors had determined that this patient had one more opportunity to regain consciousness and that was if he did for just a moment come out of the coma this device would ¨fire¨ and continue to stimulate his brain and keep him out of the coma. Remember, my doctor only told me this later on.

After closing the wound, the doctors were picking up and discussing whatever. While this is going on the patient blinks, the device fires and there he is delirious but out of the coma! Talk about emotional. He was attended to and immediately he and his bed were moved to some other ward.

I watched a 19 year old with juvenile diabetes have his foot infection cut away every day for five days in a row, in his bed and moaning in agony. They were trying to save as much of his foot as possible and would only cut away those signs of gangrene.

A very elderly man was being treated for cancer and they were keeping the pain down. His daughter and her children were there as we all watched his heartbeat and breathing work down and stop. We all shared in their loss.

I became friends with a woman and her mother as they cared for a 47 year old man, brother and son, who had fallen in the shower, broke a hip and hit his head and had not yet regained consciousness. While the hospital took care of the life support needs, the women took care of his comfort and their own need to be compassionate.

While I was there I met another gringo who was just about to leave the hospital after three months. He was admitted paralyzed in both legs and diagnosed with a bacterial infection. He was leaving, able to walk, but with a lot of therapy ahead. Another gringo, 47 years old and a resident of Costa Rica for the past 27 years was admitted with a collapsed lung, emphazema and spots on his heart. Not a good prognosis. I have visited him since I left the hospital and he does look better.

I was able to watch the care and how it was given while lying in my bed. I can evaluate the care I received in this socialized medicine hospital and compare it to the care I’ve received in private hospitals both here and in the States. I can say that I would not hesitate to be admitted to Hospital Mexico again, in fact, I don’t ever want to be admitted to a private hospital again. I have never experienced more caring doctors and nurses, not seen so much attention and an effort to do the right thing and a real evaluation of the treatments to be used without the consideration of money.

My five days at CIMA produced a bill of $5400. Sure, intensive care is expensive, however this was but the start if I had ok´d unnecessary surgery and devices. My stay at Hospital Mexico cost me nothing other than the $36 a month I pay for insurance. My follow-up visits to my doctors will cost me nothing. The prescriptions I went home with and every prescription that will be written in the future will cost me nothing.

Right now, I feel confident that I have an excellent health care plan. Hopefully I can avoid getting run over by a bus or swallowed by an over anxious volcano. I am very dismayed by my experience with the major private hospital here in Costa Rica, one that is associated with Baylor University in Texas. Yes, my new hip is excellent. However, the treatment following the surgery almost killed me. The obscene pressure to buy a device and have it inserted in my body wasn’t bad enough, but to know that it was unnecessary and coupled with a misdiagnosis is criminal. Don’t even mention the word litigation. Nope, doesn’t exist and I’m not interested. There’s way more value to me knowing and acting accordingly.

So, there it is, another adventure in paradise.

Love to you all,

a breathing and happy Joe

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