Friday, 21 December 2007

Unfortunate encounters of the medical kind

It is nearly Christmas, and the fact is unavoidable, here as at home. We don't celebrate Xmas ourselves (but are glad to accept invitations!). However, I went out to Polanco a few weeks ago with my cousin Elias and bought a small menorah so we could light the candles here for the eight days of Chanukah. But our celebrations have been somewhat overshadowed by various medical encounters, so I have not been keeping up with travelblog entries, though there is a draft of our trip to Zacatecas waiting my attention. As recent events have impacted on my return to Australia, I thought I might depart from my usual theme and sequence to tell you about what has been going on.

As any of you who have visited Mexico City know, the pavements here are a disgrace. A combination of geological factors (e.g. Mexico City used to be a lake and is fundamentally unstable and prone to subsidence, as it is to earthquakes); totally unsuitable street trees whose roots destroy pavements; lack of maintenance budgets for repair or street lighting; allowing vehicular access to the narrowest lane ways leaving virtually no footpath; loads of construction and development ( apparently you are responsible for providing your own driveway across whatever footpath was there, so there are steps, tiles, bricks, spoon drains, deep fissures, huge cracks, smooth or sudden changes in level) - you get the picture. And this is without considering the need to dodge the abundant dog poo, the cars, trucks and motorbikes stopped or parked on the pavement, the street vendors of food and other merchandise while negotiating your way through the streets. Unfortunately for Barry, nearly 2 weeks ago on Saturday evening we were walking in the dark on our way to the movies from a friend's house when a particularly vicious piece of pavement disrepair got him. He tripped and fell heavily, and while trying to break his fall with his right arm, fractured his right humerus near the shoulder.

He said he couldn't move his arm, got a severe cramp in one leg, and was just lying there in the filthy dust-covered street while I tried to get him back on his feet. Several passers-by obviously thought he was a drunk and avoided us. But three people stopped and helped me get him upright. I called to alert Margarita, as we were still only a couple of blocks from their house, and we managed to walk back there. She and Enrique helped get the worst of the gravel out of his cut hand, gave him a brandy as he was deathly pale and obviously in shock, then, after checking by phone with our medical insurer, Margarita drove us to the emergency department of a nearby large private hospital she has used in the past and trusts. I have since come across 3 different friend who have had surgery on arms or legs right there in the past two years, and our experience has confirmed that it was a good choice.

Saturday nights in emergency are similar the world over, except in private hospitals I guess there are fewer drunks and victims of violence. It certainly was interesting in the waiting room! Poor Barry was pretty much out of it, and Margarita and her family were due to go to Acapulco the next day, so by about 11PM when he had been X-rayed and we were waiting for an orthopaedic specialist to arrive to prescribe the treatment, I suggested she go home and stayed around to handle the admission procedures myself. A bit of a challenge under stress and after midnight, when my Spanish seems to deteriorate, but by asking people to go slower and reading the fine print, I coped.

The orthopaedist who came in to review the X-Rays insisted that the only treatment for a patient over 60 with a humerus fractured in three pieces was surgery, and when he pointed out the damage on the X-Ray, we didn't think we needed a second opinion. Once we had agreed to the surgery, there were tests and other procedures needed till Barry eventually got into his room (where I had taken his things and had been napping for about an hour) by about 2AM. I then got a taxi home with his filthy clothes, and returned in the morning before he went into surgery, with the usual gear one needs in hospital. Being totally unaware of the Mexican hospital system, I did not realize that I could have got an extra bed for myself and stayed there, and I believe our medical insurance would even have covered it! But even after this first night, I still didn't realize this would have been a good idea so went home again the next night.

The surgery took place as scheduled at noon on Sunday, and the surgeon professed himself delighted by his handiwork. I am going to try to photograph the "after" X-Ray and post it here:

Barry's arm looks like a violin ( puts a different slant on the old "but doctor, will I be able to play the violin" joke). Herzonia came in to sit with me while Barry was in surgery and recovery, and we went out to lunch and read newspapers and novels and even napped a little till he returned. Maggui also came in to visit - Barry was very groggy and depressed after surgery so once I had fed him a little supper and lots of fluids, and checked he was functioning OK, we left him to sleep and went out for dinner (chicken soup and tacos) before going home.

To my surprise, Barry called early Monday morning to say he would be discharged that day, so in I went again (by pesero and Metrobus) with clean clothes and the documentation I needed to reclaim all but about $20 of the very large deposit I had paid, as the insurers had come good and picked up virtually the whole bill. We were hanging about for a while till we got release forms signed and the doctor's assistant came by with the prescriptions for antibiotics and painkillers, and when we were finally discharged, Maggui came by to pick us up and drove us home.

Barry was pretty down, and quite uncomfortable, so bed seemed a good idea. After sleeping for about 4 hours in the afternoon and a light supper, he went off to bed again, but not before dictating a few emails to me changing his plans. For example, he has withdrawn from a conference in Chicago in January where he was on a panel, and we had to cancel our planned beach holiday in Playa del Carmen on the Caribbean coast. Also I had to start contemplating changing my own plans - I was due to return to Melbourne in early January, but given Barry's need for assistance over the next few weeks at least, eventually (on doctor's advice) I have decided to stay on in Mexico till January 20th with Barry, and then accompany him for his 3-week fellowship in Philadelphia. Bye-bye Melbourne summer, hello winter in the North Eastern United States, not my favourite time of year to be there.

As you can see from the opening photo, Barry is up and about now (the shot was taken at The Museum of Interventions, situated in the ex-convent of Churubusco in Coyoacán about 20 minutes' walk from here, a week after his fall. It is a very interesting museum and the ex-convent has been restored in parts and is also interesting. We contemplated returning in the evening for a concert but thought better of it. ) He has started physiotherapy with the recommended therapist (Kandy from Condesa - sounds a lot racier than she is). I went along to his second session - she is off on holidays for 2 weeks, so I am helping him with some of the exercises in her absence, though of course I can't do any of the laser, Tens machine or ultrasound treatments she started and probably will continue when they resume in January. We are hoping Barry will have 70% of his functioning back in the right arm by the time we go to Philly, but putting carry-ons into the overhead bin will probably still be out of his range of movement.

Still on the medical theme, I had an attack of shingles (called herpes zoster here) which started while we were on a short trip to Acapulco. Fortunately the worst of it was over before Barry's accident, because when I was at the most painful stage of this, I also was useful for nothing except sleeping. I figured out what the rash was likely to be when we got back to the city (wonderful thing, the Internet) and as I was still studying, I was able to use the UNAM medical service's Emergency Department (free - I was registered with the service as I had previously needed to get a full medical check to be allowed to use the UNAM pool) to confirm my diagnosis when I was in a fairly early, but already very uncomfortable, stage of the disease. I got the anti-viral treatment that stopped its spread and shortened its duration, and hopefully will avoid the longer term enduring pain that often follows.

For some other tests I needed I used the local branch of a clinic, at which the health insurance we have through Barry's work offered a 30% discount. (Don't worry, I am not posting the ultrasound of my bladder!) From the size of my bills, it seems to me that Mexico has a first-world health-care system at least in parts, but I don't know who can afford it. Only very few people have private medical insurance, and the costs seem comparable to US (in pharmaceuticals and hospital care costs) and Australia (in doctor's appointments - only there is no Medicare rebate). I now really appreciate Australia's Pharmaceutical Benefits Scheme - my shingles antiviral pills, 9 days' worth, and a small anti-viral spray cost close to $90 Australian. , at a purportedly discount pharmacy. Also I now appreciate that "major medical" means cover as a result of an acute or sudden incident, like an accident, rather than an alarming symptom that requires investigation. Before our next trip I will think harder about whether to get Australian travel insurance for medical events, or to use local cover, which is expensive. In Barry's case he has had his money's worth - in my case I might have done better with Australian cover.

In any case, it is never nice to have to go to hospital and undergo surgical interventions, and paying through the nose is the paradigm case of adding insult to injury. It has certainly been less fun than a beach holiday and the other activities that we have not got around to, but Barry ended up not missing any classes. He actually thought it would be easier to go in to his session where students were presenting, rather than try and contact people very late to try and cancel or reschedule, and thanks to Herzonia's offer to drive him in to the first class the day after he came home, and the use of his sling, he managed. He still can't use public transport because of the risk of getting his arm bumped - but as we don't drive here anyway, his inability to drive is no added burden. So in all he is doing very well, and we are a bit wiser for the experience.

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