Hospital Care in Mexico
One visit we don't want to repeat
Mexico...in small bytes
TRAVEL..........STORIES OF MEXICAN LIFE..........& MORE
I could see it in her eyes...this woman with her sculptured, beautiful face, expensively streaked straight hair, shapely legs in backless spike sandals. And the doctor's badge clipped to her white coat.
It was as if she had slapped me in the face and said, “Not only are you a real pain in the ass, you're a total bitch.”
Yup. That's me. Also known as La Bruja del Quinto Piso , the witch of the fifth floor, and peor del cuchillo de palo del 3°. This cuchillo de palo business was a new expression for me. The idea of being worse than a dull knife that's a constant bother sawing away appealed to me. A sharp knife gets the job done and then gets washed, dried, and put away in a drawer out of sight. But this cuchillo de palo is right out there, a constant annoyance, just like a persistent flea lodged in the seam of your pants, right around the crotch.
If I was going to keep my husband alive, I needed to be that flea.
The transformation from laughing hostess at the reunion of Paul's Peace Corps group from Bolivia to a complete bitch required less than two days. Tuesday morning, my husband said goodbye to the last PC members who came to Pátzcuaro for the reunion, then headed for a routine visit with the local doc treating him the last eight months for sinusitis and allergy.
Instead of the usual smiles and assurances, the doc put a stethoscope to Paul's chest and told him to report to Clínica Pátzcuaro immediately. “Your chest is extremely congested. I need to get an antibiotic into you right away. Here's the prescription...the nurse will get the IV going, and I'll get to the hospital as soon as possible.”
We headed to the tiny hospital on the outskirts of town and Paul got admitted to one of the tiny cubicles. While I joked with Paul about the skimpy hospital gown, I barely noticed the nurse injecting a drug by syringe into the IV tube. Paul looked around the dingy room and queried, “What the hell are we doing here?” Those were his last coherent words.
Had I been rational, I would have thought anaphylactic shock , but I was far from rational. Paul's babble soon disappeared into a losing battle for air.
Nonchalantly, the nurse checked out the flow of serum in the IV line as if choking patients were an every day occurrence while I alternated yelling “Necesitamos una ambulancia ahora,” ( we need an ambulance here now), while grabbing Paul's arms and pleading, “¡Quédate conmigo, viejo! No te vayas, carajo,” (stay here with me, guy...actually the endearing term ‘old man'. Don't go, damn it.)
“The doctor will be here after he sees his last patient,” the nurse said.
Damn it all. The doctor's office was a kilometer away. “And then he'll see a cadaver. I want an ambulance now.”
“We have to wait for the doctor.”
What was I thinking, arguing with this nurse with regurgitated baby food for brains? Why I didn't call 066 and get the ambulance on my own, galls me to this day.
Suddenly, the doctor appeared and grabbed the phone. I thought he was ordering an ambulance but found out later he was calling a pricey, private hospital in Morelia, an hour's drive away. “I've arranged for you to go to Star Médica . Is that all right?”
“Whatever.” This was not a time to toe tap and finger diddle contemplating alternatives. After all, it was a done deal, and the ambulance had arrived. Besides, the hospital had the rep as the best around. I thought I had been offered salvation. Little did I know at the time, I had opened the door to our worst nightmare.
In my peripheral vision, I noticed the doc administering a shot once he had the go-ahead on the hospital. When I jumped into the back of the ambulance next to Paul, I saw he had started to regain consciousness. Hmm. Wonder what was in that shot. Just what is going on here?
The doctor leaned inside before closing the door of the ambulance. “Tarde o temprano tuvo que pasar. Es el tratamento del cancer.”
If it had been assumed all along that Paul would become incoherent and gasping for breath because of his prior cancer treatment in the U.S., why the hell hadn't anyone informed us of this beforehand? Even in my addled state, the words sounded strange.
The ambulance took off, siren screaming. My suspicions should have been triggered by the paramedic's insistent questions about the drugs administered in the clinic. Instead I thought about all the demonstrations that we had seen on the news before the reunion and asked, “What do you guys do when a demonstration shuts down Morelia? Do they let the ambulances through?”
“Naw. No one gets through. Someone calls us and tells us what alternate routes to take. It can get complicated.”
“Oh.” I silently thanked the gods that things had been pretty quiet in Morelia for the last few days.
The emergency ward was everything a person could hope for in an emergency ward anywhere. The Pátzcuarian doctor did make a memorable appearance to announce that a reoccurrence of the cancer must have emerged at that moment and blocked the air passage. I figured he was just covering his ass and didn't think about it until later. Looking at Paul in his calm, breathing state, I was lulled into yet another mistake. Instead of grabbing his semi-alert, semi-conscious body and heading for home, I sat in relieved shock as he was admitted to a room for ‘observation'. With this action, I almost signed his death sentence.
Tests were scheduled for all morning the next day. When we got back to his room, I asked the nurse about food.
“Oh, no, he must continue to fast until five o'clock. Not even water.”
“So what kind of a test do they do at such a time? And no water?”
“You'll have to ask the doctor.”
Paul surreptitiously sipped water during the afternoon until five o'clock came and went. I went to ask what was going on.
“Oh, that test was a mistake.”
“Well, maybe some food would be nice then.”
Two hours later, the first bitchiness arose. “This man hasn't eaten all day. How about some food here now?”
I got The Look, but at least Paul got some food. He was so hungry, he ate too fast and started to cough. The coughing continued and turned into a full-blown breathing crisis.
“My husband is having some real trouble breathing. I think you should look in on him.”
Ahorita is one of those trip-cord words that send me over the edge. Technically, it means “Right this minute.” For all practical purposes, it could mean anywhere from half an hour from now to “Dream on, sucker.”
Normally, I'm cool with the endless delays but when oxygen isn't arriving when and where it should, panic mode takes over.
Finally, I got a couple nurses to take the five steps to Paul's room where they ignored the choking and gasping and studied his IV line. They informed me that they had followed the doctor's instructions al pié de la letra or to a fault.
“And I congratulate you for that. But at this precise moment, the doctor's instructions are not helping.”
“We can't do anything more than follow the doctor's orders.”
“Yes, you can. You can call the doctor. I suggest you do that right now,” an outburst that first earned me The Bitch moniker.
Since calling the doctor was not in their job description, I noticed my voice rising some more. “Then I suggest you call one of the doctors in the emergency room.”
A nurse picked up the phone and informed me, “One is stitching up a patient, one's not authorized to leave emergency, and one can't be found.” My hand started to move over the counter of the work station. The nurse looked alarmed. “What are you doing?”
“I'm reaching for the phone, and then I'll call 066 and get an ambulance to take my husband out of this hospital to one where I can get emergency care.”
I had hit on the magic words. The doctor appeared. From then on we began our descent into hell.
The next day Paul moved from the fifth floor to third since even with invasive methods to help him breathe, the doctor had to insert a breathing tube. I'd go in during the one visiting hour and talk to him about future trips we would take together and hold his hand. Friends told me the unconscious patient hears a voice and connects with the tactile sensation. I was rewarded from time to time with an eyelid flutter or a finger twitch. Once I was sure he tried to smile but with all the paraphernalia in and around his mouth, the movement came off more as grimace. Even a grimace looked good to me.
The hospital's now familiar roller coaster ride of highs and lows continued. It brought us to dazzling heights like the day the breathing tube was taken out, and we ignored the Intensive Care Unit one-hour rule, and Paul and I chatted and laughed for hours. I couldn't stop smiling.
The coaster ride also gave us stomach-lurching dips that saw us damning the rules again the next day while I held on to Paul as he had another severe breathing spasm. He started to use my name as a mantra to stay conscious. He drew out it out syllable by syllable...Maaaaa Riiiiiiii Ahhhhhh. Every so often he would sound out Alllllllll Toeeeeee Bellll liiiiiiiii. A few times he slipped into Maria Anderson. When his breathing relaxed, I asked, “Who the hell is Maria Anderson?”
A twinkle flitted across his eyes in one of the rare moments he had a normal breathing pattern. “I haven't the faintest idea.”
Sounded logical. Neither one of us needed another Maaaa Riiiii Ahhhhhh session. No one was in danger of forgetting my name. Especially two days later when I saw the tube was gone.
“What happened? I understood that the tube had to be left in place at least four days.”
“Your husband pulled it out on his own last night.”
“Okay, since he's heavily drugged, I can understand how he might wake up disorientated and feel something foreign down the throat, grab at it, and pull it out. What I fail to understand is how that could happen when he's the only patient in ICU. Since you won't let me stay in there, I can't help him. That's supposed to be your job. Especially since you're charging me twenty-five hundred bucks for every day in ICU.”
The story changed.
“Well, actually he didn't pull the tube out. The doctor on night duty decided to do that.”
Pin points of extreme pain appeared outside my head, pain I could almost see. Not good. I'm gonna end up on the floor, and they'll stick me in an adjoining room. “I'm going to Pátzcuaro now to calm down. Then I'm coming back with someone, and I want you to explain in front of a witness why the tube didn't stay down.”
Paul's primary care doctor tried to calm my neighbor and me down. “The doctor on night shift pulled the tube against my express written orders. There is no explanation.”
I knew I had to get Paul out of this place. Our only experiences with hospitals in Mexico had been prearranged...Paul had a German surgeon give him two great new hips last year in Querétaro. The year before that, I let Dr. Slice & Dice have a misguided go at my leg. Mistake though it was, it had been prearranged. I was unaware that it's possible, even a common practice, to switch hospitals in Mexico. When I found out, I would have switched Star Médica and their promo offering “the highest international standards of medical care” for the government's much maligned Hospital Civil . Anything would have been better. There was a glitch, however.
Any patient can be moved to another hospital, yes. But before this is done, the bill must be settled in full. Those thousands of dollars for Intensive Care mounted up and had taken their toll. No way did I have that kind of cash on hand to pay the bill and wondered just who did. I started doing a fancy two-step to transfer money, what amounted to a lifetime of saving, from Minnesota to Morelia. The ever iffy Mexican telephone system and the July 4th holiday week-end prevented the transfer. So Paul became the modern-day rehen , a hostage to his hospital bill.
In the meantime, I became peor del cuchillo del palo.
“You'll have to leave now,” a nurse told me.
It was the end of visiting hour Saturday, the day after the mysterious Friday night tube removal. Paul's hand tightened around mine while his eyes mirrored his lips as he mouthed “Don't go.” So I didn't.
“You really have to leave now. We have rules, and today there are other patients in the ward. Their family members will wonder why they aren't allowed in here as well.”
“So let them wonder. That's probably a good plan. You people broke the rules last night. Tonight it's my turn.”
“We're very sorry, but rules are rules. You'll have to leave.” Staff recited this litany in shifts...new faces, same line.
I try to refrain from inviting profanity into a language I speak as a guest in a foreign country, but that resolve disappeared. “ Me vale madre las pinche reglas ,” one way of saying fuck the god-damn rules. “Call the police or pull me out fighting, but I'm not leaving this spot.”
Paul's grip relaxed, and I watched the tension slip out of him into our pricey, germ-filled room. TV reception was good, though, with a plethora of channels, but to this day, neither of us has an idea what we watched that night. Every so often, I'd get up and massage his feet or head, and he'd slip his hand out of mine and rub my arm or pat my head. Not exactly Sex In the City, but it worked for us.
Finally around midnight, he dozed off. Living up to my name of Witch from the Fifth Floor, I folded my cape into a pillow and went to sleep on the floor of the general waiting room by the ICU, between the color coordinated chairs and under the incessant bright lights. I knew then we were in for a battle even when Paul got out of ICU the next day. He was admitted into a room on the same floor where benign neglect turned into total disregard for his safety. I didn't dare leave for a second.
The head of the nursing staff tried to mollify my outbursts. “We can move your husband to the fifth floor today. I think he'll be more relaxed in this room. Come with me. I'll show it to you.”
“Sorry, dude,” I told Paul after coming back from the inspection tour. “The fifth floor sounds good, but we're going into a regular room. They're trying to bribe us by giving us the luxury suite so we'll quit complaining. No way will I let them get off that easy.”
“Hey, a room's a room. But a room at home is even better.”
“Yeah, I know. I'll get you out of here fast as I can.”
“You know something? At this moment I don't care what you can and cannot do. I'll tell you what I've had to do here. I've had to stay round the clock to make my husband feel safe. These last few days I've called on friends to help with this round-the-clock vigil. I've had to hire an outside professional for two shifts so I could leave to get the rest of the money you just saw before me. Why? Because he's not receiving even a minimum of the care you profess to give in this establishment, supposedly the best in Morelia. My husband is scared, and this is not a man who scares easily. He is going home today.”
The clerk fiddled with the remaining bills.
“The way I see it, we have three courses of action available. You can lower the bill. You can wait until I get the money to pay. Or you can see a scene the likes of which this hospital has never seen. But I assure you, Paul is leaving today.”
The woman behind the desk held up the remaining bills. “We're sorry, but you'll have to pay the entire bill before your husband can leave.”
So we started with option three, and all the people in the lobby stopped to see and hear the scene I had promised. Before I could show all of what my food and sleep deprived, stressed-out self could do, we got to options one and two. The bill was lowered, they agreed to wait to collect the rest, and Paul was released.
Seventeen days after we arrived at Star Médica in an ambulance, I managed to get my emaciated, half-crazed, bed-sore-ridden husband back into an ambulance heading home to Pátzcuaro. He lay on the stretcher like a serene Buddha, albeit a very thin Buddha, as we whizzed along the highway.
His tranquil state wasn't even a mite disturbed as he was moved to our fat, soft mattress in our yellow bedroom and watched me panic over the fact that the hospital had sent us home with the wrong medication. Great. A husband with pneumonia and a full-blown fungal infection, darkness setting in out here in the boonies, and the wrong medicine. But Paul couldn't be frazzled.
He laid there, hands crossed over his non-existent belly, an all-encompassing smile on his lips. “You'll work it out. Don't sweat it. We're cool.” And the crazy thing is...he was right. As long as we stayed away from Star Médica , the hospital from hell, we were cool. We're now on the Yellow Brick Road to Recovery.
What we should have known
1. Get two (if not three) other opinions. Paul tried to do this with his Pátzcuarian doctor, but the man insisted it was a waste of money...that the specialist would say the same thing. Paul had so much confidence in the internist that he broke his own rule. It's doubtful he will repeat his mistake.
“It's been shown statistically that fifty-per-cent f doctors graduate in the bottome half of their class”. Anon
2. If a simple illness doesn't respond to treatment, insist on lab tests. The reason Paul ended up in an ambulance was that the specific bacteria and fungal infection that caused the pneumonia went untreated.
“A trip to the hospital is always a descent into the macabre”. Terry Tempert Williams
3. Avoid the wide-scale use of antibiotics so commonly prescribed in Mexico . The particular bacteria and fungus Paul had were antibiotic resistant and did not respond to the antibiotics that had been administered willy-nilly for months.
“Medicine is a collection of uncertain prescriptions the results of which, taken collectively, are more fatal than useful to mankind.” Napoleon Bonaparte
4. A visit with residents regarding a reputable doctor is probably much more important than a visit to a real estate agent if you are thinking of residing in the area. A number of names, like the second and third opinion, might not be a bad idea.
5. Make up a list of possible hospitals in the area and the next largest city that offer good service and won't drive you into utter poverty. Star Médica is a chain with hospitals in Mexico City , Ciudad Juarez , Aguascalientes , San Luis Potosí , Mérida, as well as Morelia , We can only vouch for our experience in Morelia but feel safe to assume that the fee scale is the same in each city.
“A hospital should also have a recovery room adjoining the cashier's office.” Francis O'Walsh
6. Investigate health insurance in Mexico, available for foreign residents as well as Mexicans.
In fact, the next article for Mexico...in Small Bites will be devoted to just that topic.