Hospital Adventures

Yes, following closely on the heels of our car adventures, we decided a few days ago to experience some hospital adventures as well. (Hey, anything in the interest of providing useful info to my readers!)

So, what in the world happened, you ask?

Let’s back up a week.  Last Friday night, while David was doing the dishes just before bed, he found that quite suddenly his right ankle was painful.  It didn’t feel like a sprain, he said — plus he clearly hadn’t “injured it” in any apparent way standing there in the kitchen. During the night it continued to hurt and even after a wee-hours-of-the-morning dose of ibuprofen, he was distinctly uncomfortable the following day with pain in both his ankle and foot.

Our initial presumption was tendonitis (or tendinitis, depending on which dictionary you use) since he’s had this same problem before when he’d been using his body funny.

Huh?

You know, when one part of you hurts so you end up walking funny, or holding your back in strange positions, and so on.  In the past when his sciatic pain flared up, he’d ended up with tendonitis in his foot because the pain shooting down his leg makes him walk strangely, putting pressure on his foot in weird ways.

In this case it seemed reasonable because he’d broken his little toe the week before — trying to avoid stepping on GrisGris in the middle of the night and slamming his bare toe into a chair accidentally — and was definitely walking funny to keep the weight and pressure off the painful toe.

So, the whole tendonitis thing made sense and we started off with the appropriate treatment — staying off of it as much as possible and keeping it elevated, using ice, and wearing an ace bandage. (Standard RICE treatment — Rest, Ice, Compression, Elevation.)

He went to his wonderful physical therapist and felt it was better after that, but as the week went on, the overall “progress” of healing seemed to be going the wrong direction and after close to a week, it was much worse.  Now he wasn’t just hobbling around the house but actually forced to use our wheelchair, in substantial pain, and the poor skin on his foot was so tight from the swelling it looked like he might explode.

On Thursday morning, we were pondering whether to go to the doctor and I was researching online to see if there was any guideline I could come up with about how long he should expect that it would take to get better.  I was also trying hard to remember anything else we’d done in the past for treatment.

I had a flash of recollection that we’d successfully used steroid shots and sure enough, we actually had a few on hand, so although I’m anti-steroids in general, they have helped and the injections seem less likely to cause the candida overgrowth effects than oral.

So, Nurse Arden (or, Doctora Arden as I’ve taken to calling myself) proved she still had the magic touch with injections — who would have ever thought that would turn into one of my life skills! — and then we headed into town for yet another therapy session with Milena.

(Although the needed part isn’t in yet for our car, Javier has “tweaked” something and it actually runs much better and he’d said it wouldn’t hurt for us to drive it “lightly” while waiting for the part.)  So, feeling the great freedom of wheels again, I dropped David (in the wheelchair since at this point he couldn’t put any weight at all on the foot) at Milena’s and headed off for some much-needed shopping.

I’d barely made it into the store when he called.  I figured he’d remembered something I needed to buy, but instead was calling to report that Milena felt quite strongly that something was deeply wrong and we needed to go to the hospital.

The hospital?!?

(I sort of forget that here that’s basically the process of “going to the doctor” if you’re “sick” in some way since it’s all the same system.)  She’d offered to go with us, so I came back, picked them up, and off to the hospital we went.

Using the local CAJA hospital (the government run public hospital) is a process that seems like it would be mysterious at best, even assuming fluency in the language.  With our level of Spanish — which is “functional” but still falls well short of “fluent” — it would have been a nightmare.  Oddly enough, Milena doesn’t really speak English, although she knows a little bit, so it wasn’t like we truly had a translator with us.

But she speaks wonderful Spanish for folks like us — slowly and clearly enough to help ensure comprehension — and with her professional appearance as a physical therapist, she just helped smooth out the process for us.

And what is that process, you might ask?

Well, although none of this is clearly marked — in any language — first you see a sort of “triage doctor” in a private office off to the side when you enter the “Urgencia” (Emergency Room). He determines whether you have green, yellow, or red status and sends you off with some papers.

You then pass through the waiting room to a different room with three service windows and present your papers to some sort of “admissions” person.  You show your CAJA card and theoretically your receipt that shows you’re current on your payment. (We didn’t happen to have said receipt with us, but did have the CAJA card so were accepted through this first step.)

Out the door (literally outside) and you walk (or roll, in David’s case) around the corner to another window where you again show your papers, CAJA card, and payment receipt.  Again Milena helped “translate” that we could continue on our medical journey, but would need to come back later in the day or the next morning at the latest to present our proof of payment.

Off around another corner, up a ramp, into the hospital main entrance, veer off into another room and we’re at the lab where blood work had been ordered. (Now, bear in mind, how anyone would know this is the “path” they’re supposed to be taking is a complete mystery.)  Amazingly enough there was no one else in the lab waiting room at all, so blood was quickly drawn and off we went again.

Milena explained a couple of times a “sequence” that we understood entailed waiting an hour for the blood work results, and that something else was supposed to happen in about 10 minutes.  It was the “something else” that neither David nor I quite “got”, but again Milena took us under her wing, delivered us back to the Urgencia waiting room and disappeared for the aforementioned 10 minutes.

She returned with a little vial which we eventually sorted out was the very same Deltasone that I’d given to David already that morning.  After we explained that he’d already had a shot of this, she went back to Triage Doc to double-check, and he said it would be fine to have a second shot.  Outside again, this time in the opposite direction, and we found ourselves waiting in a long open hallway at the doorway to the “Injections Office” where eventually they took David in and gave him the Deltasone, this time intravenously.

Back to the waiting room where the real waiting began.  Even before we’d had any ideas of a day at the hospital, we’d made sure to bring books with us. (You should take a book everywhere you go in Costa Rica; waiting is the national pastime.)  Interestingly, although perhaps not surprisingly, we were the only people in the waiting room with books.

Although this was the Urgencia, most folks there didn’t look all that urgent.  No blood, no moaning or writhing in pain, no heart attacks or apparent broken bones… definitely more like a doctor’s waiting room than the Emergency Room at the hospital.

This has already turned into somewhat of an epic-length post, so I’ll spare you the blow-by-blow of the rest of the time there, but we did finally get called in to see the “green room” doctor who took a look at the foot, had presumably looked at the blood work results (which had been done primarily with the Triage Doc thinking it presented a bit like an acute gout flare-up), and without further ado declared it to be an infection.

An infection? From what? She pointed to a small scrape several inches up David’s leg and declared that to be the “point of entry” for the offending bacteria.  Notwithstanding that there was no sign at all of infection at that site, or any other wound that seemed more “connected” to the affected foot, she was quite sure.  No temperature taken, no blood pressure or even any questions about his overall health or condition.

Our guess is that he had an elevated white blood cell count indicating infection to her, but that’s strictly a guess.  I did ask for confirmation that she’d seen the blood work and he did not have elevated uric acid (which would have indicated that gout, indeed, was the culprit) and she said “it was fine” but no further explanation was forthcoming.

A second doctor appeared in the hallway behind this examining room and she called him in to take a look, telling him it was infected.  He glanced at it, agreed, and confirmed that the prescription she was writing out for Cipro is what he, too, would have done.

Not counting the waiting, we were in and out of the doctor’s presence in about 5 minutes with what sure seemed like a questionable diagnosis, but clearly that’s all we were going to get.  We emerged clutching still another stack of papers and instructions to go to the secretary first, then the famacia (pharmacy).

Luckily our trusty and able assistant, Milena, reappeared just as we came out (she’d had to take a break for a while to go tend to a client) and she again helped us through the maze of the person in “admissions” who took our papers and printed out more for us to add to the stack, then outside and around the corner again to Mr. Prove You’ve Paid Your CAJA Premium, to whom we again confirmed we would return later with the receipt and he stamp-stamp-stamped our papers.

Off again to the pharmacy — which appears to only be accessible by a set of eight or so steps — where Milena left wheelchair-bound David and me at the base to go turn in our prescriptions.  “They’ll be ready in a hour” she declared, “which means an hour and a half” she added. “But don’t wait much longer than that because they close at 4.”

So, when all was said and done, we were home just before 4:00, bearing three prescriptions — all “free” (other than the approximately $80/month CAJA premium) — and a marginal diagnosis.  But, the good news is that the Deltasone (steroid anti-inflammatory) shots really seem to have helped. David was actually somewhat better just by the time we got home.

I’ve given him the other two we had on hand in the days since then and he’s continued to greatly improve.  I’m heading off to town now to pay our internet bill (more on that another time) and buy several more vials to continue the shot series.  Since we have no way to prove that there was not an infection, with some reluctance (at least on my part) David is also taking the series of antibiotics.

(I would say “it can’t hurt” except in our experience it actually can, but still — like many things in life it’s a matter of picking your battles and deciding which “risk” is riskier: taking them unnecessarily, or not taking them and having them be needed.  Sigh.)

The good news is that he is feeling better.  And at least it was an adventure and in the end didn’t really take all that much more time than ER adventures we’ve had in the states.  And the price was right.  So, no real complaints.  I think I’d feel better if we’d gotten actual medical care that seemed to make any sense.  But, that might be asking too much.  ;-)

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