Published: April 27th 2012April 27th 2012
This whole experience has been a real test of perserverence, trust, cross-cultural communications and empathy.
It's also been a challenging test of our developing Spanish language skills. As a result of everything that's happened, I have a few suggestions for developers of Spanish language courses and phrase books. In addition to "I'd like a coffee with milk, please." and "How much does that cost?" I think others may find it handy to learn the following phrases, should they find themselves in a similar predicament to our own:
"You are a police officer...why aren't you calling an ambulance for us?" and "Yes, of course the ambulance is an accident 100 feet from where we need it to be and now the driver must await the arrival of the police to file a full report. We'll just take a taxi. No problem." Also, "No shit, you can't find the doctor and he's not answering his phone." You just never know when these phrases may come in handy.
But this is actually a story with a happy ending and I don't mean to come across as cynical. Before I continue, though, I need to correct a minor detail. Cheryl read my last blog post and pointed out that the issue with the women's bathroom at the public hospital in Granada was that it was completely covered in mud and blood, including the toilet with no seat. THIS is what made having toilet paper a necessity (to wipe away other people's blood before you squat over the toilet with no seat). Perhaps this merits a bit more sympathy than the "OMG, there was no toilet paper" situation I described previously :- )
Okay - so it's the morning after we returned from Nicaragua. Marilyn has barely slept, having endured severe pain all night. Dr. Andrea showed up in the morning accompanied by a doctor friend that used to live here in Playa Grande. Dr. Beth (an American) just happened to be in town visiting AND just happened to be a hand specialist! So we were REALLY blessed to have two very good doctors here to do a complete assessment of Marilyn. They immediately expressed concern over the hand injury.
a) It was never cleaned properly > it still had rocks embedded in it
b) It was already oozing chocolately infection
c) It looked like there may be nerve and/or muscular damage
I was just backing out of the driveway to go pick up our friends at the airport: Steve, Sue and their son Sterling, when Cheryl ran out from the house and waved me down. The doctors had agreed that Marilyn had to go to the hospital immediately
. I came back in the house and called a friend (you read about Jake previously) to go pick up the gang. In the meantime I was preparing to drive Marilyn to Liberia, an hour away, when the doctors clarified that she needed to get to the CIMA hospital
in San Jose, "TODAY". CIMA is a private hospital that was built primarily to cater to wealthier Costa Ricans as well as Americans that come down on medical vacations (surgery + recovery). The quality of healthcare is very good, the hospital is brand new (originally built as a hotel) and the rates are much lower than in the USA.
I found an afternoon flight to San Jose for Marilyn, Norm and Cher. In meantime, Steve, Sue and Sterling arrived at our house in the midst of this chaos. I can only imagine what that was like! "Bienvenidos, welcome to the emergency ward."
I left our friends here on their own while I drove Cher, Norm and Marilyn to the Tamarindo airport. They flew in a small twin-prop airplane with local airline Sansa
. Everything was great until bad weather forced them to land on a private, grass airstrip in Alejuela, outside of San Jose. The co-pilot kindly made a call and arranged for a driver to pick them up and take them to the hospital. They checked Marilyn in to the hospital and then Cher and Norm checked in to the Holiday Inn next store.
It turns out that Dr. Andrea (our Playa Grande doctor) was good friends with the top plastic surgeon at CIMA. She called ahead and he was ready to see Marilym as soon as she was admitted. What we found out was that Marilyn had already contracted a severe staph infection
(as evidenced by the chocolately ooze coming out of her wound). Cher was freaking out because she had been watching the "red infection line" slowly progressing up from Marilyn's hand to her wrist.
After a series of tests at CIMA they determined that she did in fact have a broken rib (no wonder she was in agony), that she did NOT fracture her skull (as they initially suspected) and that her hand required major
care. She went into surgery and the hand was cleaned again, as it would be for the next 4 days. A lot of the skin had peeled away and turned gangrene
. The wound was left open (unstitched) so that it could be cleaned each day. They hooked her up to an i.v. of anti-biotics that were so strong they were burning her veins. She was left to rest for the night but had been complaining that the i.v. didn't feel like it was inserted correctly. In the morning, her arm was completely swollen. It turns out the i.v. was not properly inserted after all and the medication that needed to get into her bloodstream had instead been absorbed by her arm muscle. It was painful and required her arm to be massaged to work the medication into her blood. We were really panicking because it seemed as though we'd lost a critical day in the fight against the infection. Dr. Beth explained that this kind of thing (with the i.v.) was very common, and not to worry too much about it. She also added that this did mean that Marilyn did not get the level of medication that was needed. Not good.
At this point Cher was phoning me with regular updates. Most of which involved updating me that things did NOT appear to be going well and that if the infection did not get elimated within 72 hours Marilyn would not make it. This is an infection that affects your entire body - even cutting off the hand would not remove the infection. Only Cher was really aware of just how serious this was, both Marilyn and Norm were already overwhelmed with everything that happened and needed to have their spirits kept up. This was a terrible burden to carry, and along with her anxiety, made for a unbearable few days. In the meantime, I was home trying to put on a brave face with our guests. We still managed to have a few good laughs but it was a difficult time. I would jump out of bed at night, overwhelmed by powerful waves of anxiety, ready each morning to get the kids on a plane and rush to San Jose should the worst case scenario come to be. Cher's brother Jason was also brought up to speed and told that he should be checking flight schedules from Canada, in the event that things did not improve.
There was a second i.v. mishap, and more stress, but overall the hospital staff were very friendly and attentive, usually responding to Marilyn's many needs with 60 seconds. At one point, Cher asked one of the male nurses how it was that Costa Rican's could be so happy and relaxed all the time. He replied that "Most problems have a solution. So why should we be stressed about any problem that can be solved?". This is a great attitude that we will try to adopt.
Marilyn's room had a couch that converted into a bed so that one family member could sleep over and Cher and Norm took turns, alternating each night. The hospital provided fresh bedding and even brought drinks at night. The nutritionist would phone the room and ask Marilyn what she wanted to eat before each meal. Of course, being Costa Rica, this doesn't mean that you get what you ask for. Marilyn was not eating much of anything and not gaining any strength or energy, which was scary. Cher and Norm were excited when she actually asked for a grilled cheese sandwhich. Unfortunately, this someohow showed up in the form of chicken. She WAS craving watermelon but the nutritionist refused to give it to her because she was put on a strict "Soft food diet". The nurses were finally able to convince the nutritionist that watermelon IS a soft food.
Cher became a master at understanding how to get the hospital staff and insurance companies to do what was needed. She even kept her own log of medication (times and doses) to ensure this wasn't messed up (the hospital staff missed a dose).
At one point, the hospital presented Cher with in interim bill, which we thought we were going to get stuck paying. The medical bills, along with new flights home (we had to cancel Norm and Marilyn's original return tickets) would have amounted to around $25,000! We were scambling to find a way to pay (credit cards, loans, etc), but Cher eventually found out that there was a simple mixup with the insurance certificates and that Marilyn was in fact, fully
coverered. I won't ever question the value of international medical insurance again.
The Holiday Inn staff were amazing and enquired every morning about Marilyn's progress and wrapped up fresh fruit for Cher or Norm to bring to her in the hospital. They also provided a ride to and from the hospital for Cheryl so she didn't have to walk alone at night. The doctors (the ICU doctor and the hand surgeon) met daily with Cher, Norm and Marilyn to provide updates on Marilyn's progress and Dr. Andrea and Dr. Beth in Playa Grande communicated daily with the CIMA doctors and Cher to ensure that there was no misinterpretation of Marilyn's status and progress (not all of the hospital staff spoke english). Everyone worked really well together as a team. Despite some of the issues in the hospital, the level of care and concern was above and beyond. Without a doubt, there are wonderul people here in Costa Rica.
By Monday morning (5 days after the accident) we were told that the infection was gone. Marilyn was going to be okay! The skin was still gangrene but the doctor believed that new skin would grow in underneath so he chose not to do a skin graft. All that remained was that Marilyn's blood test be deemed healthy and on Tuesday, she was finally released from the hospital around mid-day. It was too late to catch a flight back to Tamarindo so the bell hop at the Holiday Inn arranged for a safe driver in a nice shuttle/van to bring them back on the 6 hour drive. The only snag was that he ended up taking a strange route that ended in a loooong, sloooow, and very bumpy ride down dirt roads for the last hour or so. This was pretty hard on Marilyn with her broken rib.
To make a long story shorter, Marilyn and Norm extended their stay by a week. Marilyn was tended to daily by Dr. Andrea and the wounded hand was healing slowly but well. We did end up having a lot of fun with Steve, Sue and Sterling. Maybe not the kind of visit we had planned but if we've learned anything during our time here, never count on Plan A, or even Plan B.
Marilyn is home in Burlington and doing well. Cher, Charlie, Ella and I took off to Nosara last weekend and spent 2 days at a luxury wellness hotel, surrounded by pools and jungle. It was a much needed break; a chance to regroup as a family and just destress.
That's all for now... Adios amigos!