February 2007 Trip (delayed post - yikes!)

Well, no *wonder* I couldn't find any information on our trip to Monteverde (and picking up our *Cédulas*!) on my blog - it's not *posted*! I seem to recall that we were having trouble with the internet on that trip, so I saved it as a draft email. You know how well *that* works - lost until I decide to do some spring cleaning...

As they say, better late than never. Here is my (detailed, sorry) trip report for our fourth trip to Costa Rica - we made the trip in February 2007, specifically to pick up our Cédulas :D, and added some sight-seeing into the bargain.

2/8/07 (Thursday)
We were able to change our return flight - easy, and no charge :)
The flight was uneventful (only a little late, and a reasonably short layover), and we got in the "citizen" (and resident) line at immigration instead of the "tourist" line. Both lines were long, so there was no real advantage this time. Our bags were waiting for us, instead of the other way around, and both guitars made it unscathed. When we got the airport taxi this time, I stayed out of sight with our bags, and Rick ordered the taxi - $3 instead of the $4 charged last time.
On to Vida Tropical; more people to meet!

2/9/07
More bank problems!?!? Didn't I say I was an optimist?
We tried to get money out of our bank's ATM, and it ate the card...
We walked inside, and stood in the wrong line for a couple of minutes, then Rick looked around - found the right place. The bank guy said someone had reported the card stolen. We could either get a new card today in San Jose, or a new card Monday in Alajuela - we elected to wait. Then (yay!!) he asked if we wanted money out of the account, and then got it for us. This was fabulous, since the line to the teller was looooong.
On to the pharmacy - got some of Rick's scripts, but I forgot to bring the box for mine with us, so I couldn't remember the name.
We confirmed that our immigration appointment is on the 19th, so we have a week to do something semi-touristy.
Massage for me on Friday night - no chiropractor, unfortunately.

2/10/07 (Saturday)
Ahhh - these mornin's were made for drinkin'!
We went to see Joe today in Grecia, and Jim (from Vida Tropical and CR forums) joined us. We had a taxi take us to the bus stop, since we had 2 guitars with us - Joe is keeping them for us until we move there. We brought chocolate and whiskey as thanks - inevitably, we opened both pretty quickly; drinking in the morning again!
We went to a late lunch (~2:30), then drove to Linda's lot in Bodegas, near Tacares (I always mix up the name of this town with the Tecate beer). She has a "storage shed" nearly built, and plans for a small house. The "storage shed" is the biggest you can build without a permit, and has 3 windows with great views, a bathroom, electricity... (can you say guest house?)
Since we were half way back to Alajuela by now, Joe took us all the way back to Vida Tropical, and stopped in for a little visit with everyone.
He is going to Cahuita (on the Caribbean coast) soon - we'll have to bug him for a trip report.
When we got back to VT, we arranged to stay near Monteverde for a few
days - it is a rain forest park about 4 hours drive north. The town we will stay in is between 2 reserves. Monteverde (the town) started as a Quaker community. We're leaving our plans fluid this time - if we find we want to leave Monteverde early, we can...

2/11/07 (Sunday)
We looked a bit for a museum or other point-of-interest, but (it *is* Sunday) all were closed. Heard there was an orchestra playing in Alajuela's central park, but it got "trumped" by a small job faire. We sat around the park talking and people-watching. I lost myself a few times watching the white cathedral and green trees against the blue blue sky - ahhh. This was interrupted here and there with a trip to the pharmacy and the ice cream store (all the drugs you need, and *so* close!).
We got my scripts, and some sunscreen to replace the one we "lost" at the airport security gate (you just gotta figure that you're gonna lose *something* you packed in the wrong bag).
Something learned: this pharmacy didn't stock the dosage that Rick takes, but the one we went to on Friday did - so, if one pharmacy doesn't have something you need, keep trying others.

2/12/07 (Monday)
We got to see the chiropractor! And we got appointments for the day before we fly out as well :)
After the chiropractor, we got back to the Vida Tropical and did laundry; then Soda Palmaras for lunch and on to the bank. We got our bank card - it is now *gold* and is an international version - oooohhh.
Back to VT and our massage - ahh.

2/13/07 (Tues)
Left for Santa Elena / Monteverde this morning - got a taxi to the "Garden Court," then Interbus. It was on time (even a little early), and nearly full - everyone going to Santa Elena, so we didn't have to change buses. The last 45 minutes of the trip is all on dirt and gravel (and pothole) roads; the road follows a ridge (up and up and up), and changes from one side to the other - so everyone gets a chance at vertigo.
Santa Elena is *very* dusty; our hotel is about 3 blocks up a very steep hill from the main part of town. We go into town for lunch, but one trip per day is enough - we feast on snackbars and nuts for dinner.
We are at "Cabinas Don Taco" - don't ask me about the name... It is the *one* place that I got the blank (arrogant?) stare when I asked for a simple towel in Spanish. Most people are happy to have you try Spanish, and happy to help you with words.

2/14/07 (Wed)
Santa Elena actually gets *cold* at night! At 6:00 am, it is 64 degrees F (inside). Since the showers are nothing to write home about (hmmm), we save them for afternoons. We get breakfast at the hotel, and catch the 8:30 bus to the Santa Elena Reserve, about 6 km uphill (more dust and potholes) :).
It is suddenly *cool*! and *green*! Rick shows our residency paperwork, and we pay the resident's rate - $3 instead of $15 - nice! We take off on the shortest route; it is supposed to take 45 minutes, but we stop every few feet to gawk and take pictures. So, about two hours later, we get back on the bus to town. Others on the bus took a different route, and saw more wildlife (including wild Quetzals).
Back in town, we grab lunch and hit the supermarket for dinner supplies.

2/15/07 (Thurs)
Today's the day! We spent part of the morning on a "nature" tram (another resident's discount), and the rest of the day in town, then fell off a tall sidewalk - at least it is over; our once-per-trip accident is over (and it's Rick's turn).
We make it back to the hotel, but realize that Rick cannot make that trip again, let alone enjoy a hike in the reserve. So, we decide to see if we can leave tomorrow.

2/16/07 (Friday)
We enlisted the help of the hotel folks, and got reservation on the afternoon Interbus to Alajuela. They also called the Santamaria hotel for us - we were already booked there for Sunday and Monday, and they were able to add today and tomorrow for us.
While we were waiting for the bus, a couple dropped in and asked about a room. While one was checking out the room, we talked to the other - we told him about the shower (not very reliable), the beds (ok, not great), the noise from the town, and that it was $45. When the clerk came back, he said it was $50 - our guy said "not $45?" and the clerk said "ok" - hmmm.
We got the 1:30 interbus back to Alajuela - about an hour left on the drive, and the bus overheated (there were a lot of overheated cars on the road, as it climbs up the mountains from the beaches to the meseta central). We waited about 45 minutes, and also refilled the radiator from a nearby sprinkler, and we were off again.

2/17/07 (Saturday)
Rick and I go to a great Italian restaurant in Alajuela - Cugini, near the Cathedral.
We had "Brachiole" - it is a Sicilian dish - and yummy!
We're staying in the Hotel Santamaria (VT was full). BUT! we met the owner's wife (Rosaria) just now, and it turns out they live 5 houses down from VT - she *recognized* me - fun fun fun. We had a lovely conversation in Spanish.

2/18/07
Italian again tonight - can't get enough! Leaving the restaurant, we see Norman and Greg, and tell them about Joe.

2/19/07 (Monday)
We get our Cedulas today! And then some!
6:45 am - out the door and to the bus to San Jose - what a long line!
7:50 - at ARCR, ready for our appointment with immigration. Sindy takes a bunch of us over; on the way, she tells us it could take anywhere from 2 to 6 hours, depending on how long it takes to find our files. She has had an assistant holding our place in line, so it isn't long before we get our files checked and in the system. Then on to get our pictures and fingerprints taken for our cards. After a few more "waits" we have our Cedulas! Sindy has gone back to ARCR for another batch of new residents, and none of us can remember how to get back. We pile in the car, and drive around San Jose for a half an hour before finally finding our way back - I'm navigating (back-seat driving?), with a compass and a map.
11:15 - we're finally eating breakfast/lunch! We'd had no chance to eat before now, so we're a bit cranky.

1:00 - back to ARCR to get our driver's licenses. We pay about $40 for help, and hop in a taxi w/ Alfredo. First stop is a "Doctor's office" where we pay $20 and they fill out a health form. We take that across the street and start the driver's license process. The first stop is closed for lunch until 2:00 (it closes at 2:30), so we wait... The woman comes back and checks our documents (health forms, copies of our California driver's licenses, and copies of our cedulas), stamps them, and we go to the next line. This is considerably shorter than when we first got there (Since no one could proceed without the first check), so this is pretty fast. They ask for our address and phone number (Alfredo gives them the ARCR info). Then we go to the "pay" window - drop another $16 and get our receipt. Then to the "picture" line - here's where we get to sit (many of the lines in Costa Rica are rows of chairs - it's like musical chairs without the music). At the front of the line, we get our pictures and fingerprints taken and then they produce the card. We sign for it, and we're done!

We catch the Alajuela bus towards the Hospital Mexico (see these posts for why Joe is in the hospital), and ask the driver to tell us when we get there. He says he will, but... Of course, we miss the stop. We get off on the next stop - fortunately not too far, walk back and on to the Hospital. The hospital is like a circus, so we ask for help at an information window. They can't find Joe for quite a while, but finally tell us he is still in emergency. At about 4:00, the nurse leads us downstairs, and we wave to Joe through the window. She tells us to wait for the Doctor; it should be about 20 minutes. Well, about 4:30, we walk back to where we saw Joe, and the security guard shoos us into a waiting room - we have to wait for visiting hours at 5:00. Linda is there right before visiting hours start - she's been through this before; we give Joe's name, and they let us see him one at a time for about 5 minutes. He seems ok - he has a full face oxygen mask on, and can't talk without taking it off - we're just there to let him know we are looking out for him.
5:15 - we're back on the bus to Alajuela; it's rush hour, so we don't get to the last stop for another hour.
Boy, are we tired! We have our leftovers and conk out.

2/20/07 (Tuesday)
Yesterday was so busy, we decide to take it easy today. We put off going to ICE about the phone, and just plan to visit Joe. We caught the 11:00 bus, and got off at the correct stop for Hospital Mexico. As we got off the bus, a very nice lady helped us cross the "muy peligroso" street. She just grasped my hand, and we followed when she crossed. I am finding that this is so typical - so many helpful citizens. I felt like a Boy Scout in reverse :)
At the hospital, we go directly to the emergency waiting room (doesn't that sound like an oxymoron?), and wait for 12:00 visiting time. Linda appears, and we queue up. Then we find out that Joe is no longer in the emergency room (why didn't we check on this before?). We run around for a few minutes, then Rick asks the right guy - we have Joe's bed number, but (of course) visiting hours for the wards don't start until 2:00. So, Linda drives us all into San Jose, and we go to ARCR to get our hands held. Annabel is very nice - she talks to us a lot, and we feel a bit better about the situation. The hospital will not release Joe just to get him out of the way (what were we thinking?!?).
We grab a bite to eat, then head back to the hospital. My navigation skills are excellent - I was always able to point to the correct turn-off as we passed it :).
At the hospital, we get in the line for the 6th floor visitors just before 2:00 (we're about the 4th group). Well... The people who run the visiting center don't even show up until 3:00 - by this time, I'm sitting down, and Rick and Linda are very tired of standing. To accommodate the long lines, the hospital folks had opened the doors to the outside. It was very strange seeing all these people zip up jackets and pull up their hoods against the breeze. It had to be 74 degrees! I guess it is all what you're used to.
We got to see Joe one at a time, but there was no time-limit. He was *much* better! He gulped down the yogurt drink I brought (he probably wasn't supposed to have it tho). He had a better oxygen system - no full-face mask, so he could talk easier without reducing his oxygen. He told us about the other patients in the room (there were 6 beds in the room). He said he was going to write a "report" on his experience, but essentially, he is very happy with the care he is getting at the public hospital (all covered by his $36/month insurance).
Linda drives us all back to Jalapeño's in Alajuela, then Rick and I catch a taxi to the Chiropractor's office for our 5:00 appointment. Well, I don't get cracked until 7:00, and Rick is pretty upset that we had to wait so long. But my back is so much better, I'm glad we didn't give up and leave (She also didn't charge us for the visit, and apologized profusely).
But by the time we get back to Jalapeño's, Linda has eaten and is gone - we'll have to catch up with her the next time. We closed the place down with scotch and camaraderie.

2/21/07 (Wednesday)
Flying home today!
The hotel got us an airport taxi for 6:00 am. We were ready early, and the taxi showed up early, so...
We whiz through the lines, and get to Phoenix with no trouble. We had about 1 hour to get our bags, check them through customs, and board our plane to Oakland. Again, no problems - no line at immigration, and our bags were waiting for us by the time we got to them. We even got home in time to return the rental car on the same day! No worries about how to deal with it *and* work tomorrow!

April 4, 2008 - Public Health Insurance (Caja)

We finally decided to sign up for Caja – the Costa Rican public health insurance. This covers you for any pre-existing condition, prescriptions, and emergencies. Everything we’ve heard (though I don’t have personal experience here) says it doesn’t do so well for regular health maintenance – long lines (everyone gets a 10:00 appointment), not-so-full workup (e.g., usually cholesterol is measured, but not HDL/LDL breakdown), and slow timelines for some time-critical procedures (e.g., cancer treatments can be scheduled months too late – I know, yikes!). Many people use a two-tiered method, where they have Caja *and* either private insurance or no insurance but use a private doctor. Since many doctors provide treatment under both Caja and private, you can often use the same doctor for your health – he will be able to tell you when to get something done under Caja.

So, one afternoon we went to ARCR (Association of Residents of Costa Rica) to get signed up. We are already members; this is an additional benefit provided. Normally, premiums for Caja are 13% of your income. But, since we are rentistas, we are not allowed to work. Our residency deposit isn’t really income in the same sense. But ARCR has an arrangement with the government that allows them to cover members under a corporation. So, our paperwork consisted of “getting on the payroll.” I know, this sounds suspicious, but it is legal, and has been for at least a decade. We filled out information, paid three months of premiums, and $5 to activate. Then we got a “payroll” certificate for Rick to take to the Caja office in San José. By this time, it was a bit too late to go there, so we came back to SJ the next day.

We got the Alajuela bus to San José, then caught the cementerio (yellow/orange with purple) bus to Caja (cattycorner from the National Theater). We asked the guard at the entrance where to find the “area administración de planillar,” and stood in a short line. Then we showed the payroll certificate and got a Caja number for Rick. We called ARCR and gave them the number for their records. As of now, we are both covered if we have an emergency. But there is one (only one?) more step.

Since we live in Alajuela, we need to register at the clinic in Alajuela before we can get regular treatment. This is also where we get the insurance cards. The next day, we take a taxi to the new hospital, ask the guard where to go, and he says (arg!) we need to go to the clinic, not the hospital. We take another taxi to Clínica Marcial Rodríguez (which happens to be pretty darned close to our apartment), go to the area marked “afiliación,” show copies of our electric bill and wedding certificate, and Rick gets his insurance card. However, I have a problem. I am supposed to be covered under Rick’s Caja, but the copy of our wedding certificate is not good enough – it is too old (it probably also needs more stamps and translations). Who knew? We have no other proof that we are married – our cedulas don’t indicate this. So we leave with Rick’s coverage secure, and mine a bit iffy – ARCR assures me that if I get in an accident, I will get treatment. We can provide the coverage proof afterwards if needed.

It took three days and a few headaches, but we have coverage! Since we are under 55, our cost is $61 per month. Once we (that is, Rick) reach 55, our cost drops to $43 – nice to look forward to a *drop* in cost!

I’ve since heard of someone who went in to *renew* her Caja insurance, and had a problem with her wedding certificate. Their solution was to get re-married in Costa Rica – it took a couple of hours, 2 witnesses, a lawyer, and $150. We’ve been married over 15 years, and it looks like this might be the answer for us as well. Why not? We already “got married” again in Hawaii – all that was required there was kissing in the wedding grotto…

March 11, 2008 – Health Focus in Costa Rica

I’ve just passed my first year of retirement! It’s hard to believe that much time has gone by. One of the main things I wanted to do was to focus more on my health. I have found that my method for most of my life is to focus on one or two things at a time – everything else takes a back seat. I had been spending almost all my effort on work, often without leaving enough time in the day to even get a full night’s sleep (let alone all the other important aspects of life). Well, I was determined to change that. So, I spent the first few months just relaxing; downsizing my stress. We spent a few months in Costa Rica – learned some more Spanish and just lived. Then back to the states to work on our house – worked outside in the yard (and the sun!); definitely spent less time sitting at a desk! Then back to Costa Rica for a few more months. This time, we rented an unfurnished apartment within walking distance of downtown (no car). This meant we walked a *lot*! After 2 months, without thinking too much about it, or trying at all, I lost 20 pounds and knocked the bejeezes out of my blood tests - over 50 points off my cholesterol level, 40 off triglycerides, and almost 20 off glucose levels. Of course, doing the laundry by hand helped, and I can´t entirely discount the effects (beneficial?) of food poisoning…

But I knew from past experience that I could only go so far, and at least a partial rebound was likely in my future – and I also had so much more to fix. So, we took the plunge, and I had gastric bypass surgery in Costa Rica. This is where your digestive tract is re-routed a bit – 90% of your stomach and the first part of your small intestine is bypassed. It makes you eat less, and digest more of your food lower, so you absorb fewer calories (and vitamins). It also means you have to let your stomach re-learn how to handle food – it has been about a month, and I finally get to try solid, near-normal food.

Rick was uneasy with the idea of my having surgery – let´s face it, it is a serious undertaking. But then he thought about this – our bodies have evolved to be efficient, and to store fat for the times when we need more fuel than we can take in. In these times, that is just not very often… So, if your body is not working the way you need it to, there is nothing wrong with changing your body. It´s still a bit scary, of course…

The long-term effects for most people is that you lose 80% of the excess weight. Some people gain some back, but not all of it. This is a permanent change, and basically forces a change to your eating habits. The other options for bariatric surgery were either not permanent, or were not as positive.

In the short-term, most of the excess weight is lost in the first 6 months. Something called ¨malabsorption¨ continues for 3-5 years – this is where the vitamins are not absorbed completely by the body (you need to take supplements).

One interesting side-effect of this surgery is that your glucose levels stabilize *immediately* - if you have Type 2 diabetes or glucose intolerance, 90% of the time the surgery itself cures this. This is because the section of intestine that triggers glucose over-production is bypassed – so no more triggering. This has led to a modified surgery for people who have Type 2 diabetes without a weight problem. They have been doing this in Costa Rica now for 5 years, with a high cure rate (~85%). The USA is a bit behind the times – the procedure is not FDA approved (yet). Cynics believe this is in large part caused by the pharmaceutical industry – diabetes is a real cash cow in the states, so why would they want it cured?

Some of the differences in health care here in Costa Rica are mind-boggling!

• Everything happens at its own pace, so sometimes appointments take hours (much of it waiting). But of course, that has happened plenty of time in the states too. However, most of the time, appointments were spot on.
• I had a consultation with the surgeon ($48), and left with his cell phone number – and instructions to call at any time. Over the course of the surgery and recovery, we must have called him over a dozen times – each time, he was happy to hear from us (really? Well, it seemed like it…).
• Once we got the surgery go-ahead (passed all the pre-operation tests), we paid for the procedure. This included all the visits to all the doctors, all the tests, and over a week´s worth of prescriptions. It also included a follow-up endoscopy at 6 months.

The question of insurance requires its own entry…

Visitors to Hospital Mexico

You can see our friend Joe's account of his experience with hospitals in an earlier post. Here is our experience *visiting* him. Rick and I agreed - we're very glad our first trip to a public hospital was as visitors. Now we will be a bit less worried when we go as patients (you know it will happen eventually).

So, after getting our Cédulas and driver's licenses in San José, - yes, all this on the same day :)

We catch the Alajuela bus towards the Hospital México, and ask the driver to tell us when we get there. He says he will, but... Of course, we miss the stop. We get off on the next stop - fortunately not too far, walk back and on to the Hospital. The hospital is like a circus, so we ask for help at an information window. They can't find Joe for quite a while, but finally tell us he is still in emergency. At about 4:00, the nurse leads us downstairs, and we wave to Joe through the window. She tells us to wait for the Doctor; it should be about 20 minutes. Well, about 4:30, we walk back to where we saw Joe, and the security guard shoos us into a waiting room - we have to wait for visiting hours at 5:00. Linda is there right before visiting hours start - she's been through this before; we give Joe's name, and they let us see him one at a time for about 5 minutes. He seems ok - he has a full face oxygen mask on, and can't talk without taking it off - we're just there to let him know we are looking out for him.
5:15 - we're back on the bus to Alajuela; it's rush hour, so we don't get to the last stop for another hour.
Boy, are we tired! We have our leftovers and conk out.

... The next day...

We caught the 11:00 bus from Alajuela, and got off at the correct stop for Hospital México. As we got off the bus, a very nice lady helped us cross the "muy peligrosa" street. She just grasped my hand, and we followed when she crossed. I am finding that this is so typical - so many helpful citizens. I felt like a Boy Scout in reverse :D

At the hospital, we go directly to the emergency waiting room (doesn't that sound like an oxymoron?), and wait for 12:00 visiting time. Linda appears, and we queue up. Then we find out that Joe is no longer in the emergency room (why didn't we check on this before?). We run around for a few minutes, then Rick asks the right guy - we have Joe's bed number, but (of course) visiting hours for the wards don't start until 2:00. So, Linda drives us all into San Jose, and we go to ARCR to get our hands held. Annabel is very nice - she talks to us a lot, and we feel a bit better about the situation. The hospital will not release Joe just to get him out of the way (what were we thinking?!?).
We grab a bite to eat, then head back to the hospital. My navigation skills are excellent - I was always able to point to the correct turn-off as we passed it :(.
At the hospital, we get in the line for the 6th floor visitors just before 2:00 (we're about the 4th group). Well... The people who run the visiting center don't even show up until 3:00 - by this time, I'm sitting down, and Rick and Linda are very tired of standing. To accommodate the long lines, the hospital folks had opened the doors to the outside. It was very strange seeing all these people zip up jackets and pull up their hoods against the breeze. It had to be 74 degrees! I guess it is all what you're used to.
We got to see Joe one at a time, but there was no time-limit. He was *much* better! He gulped down the yogurt drink I brought (he probably wasn't supposed to have it tho). He had a better oxygen system - no full-face mask, so he could talk easier without reducing his oxygen. He told us about the other patients in the room (there were 6 beds in the room). He said he is very happy with the care he is getting at the public hospital (all covered by his $36/month insurance).
Linda drives us all back to Jalapeño's in Alajuela - whew!

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