12 July 2013

Today we are celebrating our 2nd anniversary living the good life in Costa Rica

Two years ago today, we said our goodbyes to loved ones and flew from Houston, Texas, to start our new life in Atenas, Costa Rica. What a wonderful time we have are having. Everyday we have to pinch ourselves and ask, "are we really here... are we really living this dream?"

Everyday we wake early up to the sounds of birds singing in the trees. Some mornings you can hear the howler monkeys down by the river below our property. At certain times of the year we get large flocks of parrots in trees picking the seeds mother nature has provided. They cause quite a ruckus with all their squawking.

Upon our arrival in 2011, we moved into our little 300 square foot Casita and immediately started the process of building our Rancho to give us some outdoor living space. This was completed in November, and then it was time to start construction on our new home. The Casa took about 6 months to complete. In June of 2012, we moved all our furniture and personal belongings from the Casita's garage to the Casa Grande.

We are loving our new home and this wonderful town of Atenas. We have made many new friends and I think we have more of a social life here than we ever did back in the States. The culture just lends it's self to socializing. So unlike the big city we came from. There everyone is always in a rush and has no time to stop and just enjoy life. Just today, we went to the local farmers' market to pick up the week's fruits and vegetables, and I thought we'd never finish with the shopping. We kept running into both old and new friends at the different vendor stalls, and of course we had to stop and chat with everyone for a few minutes.

A few months ago we decided it was time to turn our little Casita into a vacation rental. This has worked out very well. We have met some great folks and picked up enough extra income to cover the expenses of maintaining the Casita and the main Casa.

Do we have any regrets about moving to Costa Rica?

Absolutely none!

Do we miss family and friends from back in the old country?

You betcha!!! No one can ever replace them and we miss them everyday. We just hope they will come visit us soon and see this wonderful place we now call home.

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05 July 2013

What's an "emergency" in an Emergency Room?

It's 10pm on the Turd of July.

"There's an elephant sitting on my chest," she said. Her blood pressure had spiked to over 160; she was pale and clammy; her demeanor was noticeably languorous. My EMT "load and go" brain kicked in. We loaded. We went. But we probably went to the wrong place.

"Shouldn't we call Cruz Roja (the Red Cross ambulance)? You're in no condition to drive." she said.

The girl has obviously never seen me totally in The Zone. One might be "impaired" by too much scotch but when it's time to fight and the explosion of adrenaline kicks in, you fight like a maniac -- a very cold, calculating, sober maniac.

(On top of being aware of my above "skills," I was determined to take matters into my own hands because I had visions of the Cruz Roja responding at about the same speed and enthusiasm as the Fuerza Publica, i.e., "whenever".)

I decided that we were going to the Caja Hospital de Alajuela. Patricia had received excellent treatment there one night for a bout of pneumonia and my treatment at the Atenas branch for 2nd degree burns had been exemplary. How bad could it be? He said.

During the drive, there were a couple of times she touched my leg as a signal to be careful when I achieved the terrifying speed of 100 kph out on the autopista (63 mph ... pfttt!). Other than that, for your reference, it is exactly a 30 minute drive with the new Coyol connector road between Hwy 27 and Hwy 1. Other than the patient's angst, the trip was uneventful.

So, I wheel up to the ambulance dock at the back emergency entrance of the sparkling new Alajuela hospital and ... nobody there but a sleepy old guard. Oh well.

I help her out of the car and we walk the few steps to the ER reception desk.

"Corazon!" I exclaim, thumping my chest and pointing to her (wishing I had paid closer attention in my Spanish For First Responders class in California.)

The dude says something that doesn't process in my brain but he's pointing to the line standing in front of a door marked "Triage." Noooooo!

But, as part of my extensive Pura Vida training and two years of practice to NOT grabbing clowns by the shirt front and jerking them up over their desk for "attitude training" I simply nodded and we went to the line. Wow!

The Triage office is a very tiny room with one guy in it. It has two doors. One faces the general ER area (a HUGE waiting room) and one faces the ambulance back entrance area, where we were. The line at the general door was long. Our line only had two parties in front of us. Luckily, it seems that the policy is to clear the line on our side while the "walk ins" on the other side have to wait. And, the Triage guy was attentive, if not a little non-chalant about a cardiac emergency. He sauntered out of his office, sat her down and took her blood pressure while asking a couple of questions. He then executed a computer printed form (the ONLY computer or computer form we were to see during this odyssey) and he put a red tag onto the form. Oh boy! A red tag. Now shit's going to start happinin'.

He pointed us to a semi-open doorway, indicating we should "cross over". I say "semi-open" because it was hung with opaque 4" wide, vertical plastic strips, such that you could move them apart and enter but that the people outside couldn't see in.

For good reason.

I said "cross over" because on the other side of the plastic strips we entered a 25 meter hallway that would be a perfect setting for a Stephen King horror movie. Both sides of the hall were lined with gurneys holding the sick and dying off casts. Almost all of them looked terminal to me and all of them were just "parked." Several of them had IV pouches hung above them but all of the pouches were empty. Great way to enter The System.

Undeterred, we pushed through the stygian gauntlet and made it up to the real nurses station. "Now that red tag is going to get me somewhere."


With a big yawn (10:30 PM) the clerk/nurse/whatever (everyone is wearing scrubs and "corporate" namebadges too small to read) looks at the paperwork, tosses it into a basket on the top of the counter and points us to a line of 8 metal chairs. I think about doing the chest thump and "corazon" pantomime thing again but figure that this is just the Pura Vida system. Let it go. If my darling collapses or suddenly arrests, there's still plenty of time to grab some shirt fronts and drag them out to where she's lying on the floor, I figure.

The line of 8 metal chairs once had 1" thick plastic-covered pads on them. The pads had been upholstered onto a plywood base. But all that's left now are raggedy bits of plastic with a sporadic showing of loose fiber to tease one into imagining how comfortable these chairs must have been ... 30 years ago. There were already 6 folks on the 8 chairs with one end of the line empty -- almost. At the far end of the chairs was a woman in a wheelchair, all bundled up, asleep, with a heavily bandaged foot resting on the edge of the last chair. We made ourselves as small as possible and sat, taking care not to push that blood-seeping foot off the edge.

Presently, a 12 year old kid walked up to the counter and took our file out of the basket. Well, he looked 12 to us.

He read and read. It was a single page. And he read some more. Then he called Pat's name kind of "out there" into the general time-space continuum, as if he didn't know where the line of chairs was. We waved our hands and he turned to look at us, then motioned toward a nearby door. Holy reflex hammer, Batman, this guy's wearing a stethiscope around his kneck and he has a ballpoint pen in his pocket. This must be a real doctor!

Since Pat and I are joined at the hip, we both stood and headed for the door together, whereupon the kid (we promptly began referring to him as Doogie Howser) waved me away and mumbled something.

"He says you can't come in," Pat said. Ahhh. Yet another test to see if my self control system against choking little shits is sufficiently strong to overcome my emotions.

So, they go alone into the sanctum sanctorum room and I'm left outside trying to decipher doubly unintelligible mumbles issuing through the door. Nada.

Pat comes out and states that she's headed (on foot ... no wheelchairs if you're only suspect of being about to die) to the EKG room and I cannot come with.

I am shooed back to the little chairs. Like a dog. I obey like a little dog. Oh, woe unto them if I were still a Real Man. Sigh.

But, hey! An EKG! This should change their attitudes and get some action around here!

In no time at all, Pat was back.

"The EKG is negative. He says they have to do a blood test and a chest x-ray"

Well, O.K. Some high blood pressure congestive episodes won't show up on an EKG, I guess. Goodie, let's wait over on the swell chairs. I wonder where you get to the point of getting one of the ER beds and a little medication, etc. Crazy thought.

'Bout an hour later, amidst the chaos of employees stampeding past us to get to the employee break room across the hall from our chairs, an unidentified scrub-clad woman walks up to us with a handful of pills, still in their individual Costa Rican foil wrappers, and dumps the mess into Pat's hand and hands me a plastic shot glass, generously filled with water. "Take these," she says to Pat in Spanish.

I'm starting to think about bolting from Hades and heading to the private CIMA Hospital over in Gringolandia, even if it does cost your life savings to barge through their ER doors.

Pat doesn't think this is a good idea (yet) and I hunker down.

Actually, I stand up because my nether regions have gone fast asleep sitting on the hard plywood-seated wonder chairs.

First thing I do is walk back towards the nurses station to get a peek around the wall beyond which a lot of moaning and stuff is issuing. Holy Crapola! This is a Wednesday night. What happens here on Friday or Saturday nights?

There are 8 open-fronted examination chambers, each with three gurneys, all full; and, there are 3 rows of better looking chairs and wheel chairs, all full. And it seems every single patient has an IV packet -- almost all collapsed and empty -- with a tube running to their arm or hand. Must be the standard treatment around here. "Dehydrated? Plug 'em into a half liter on fast drip." "Broken foot? Plug 'em into a half liter on fast drip." "Influenza? Plug 'em into a half liter on fast drip."

"Heart attack? Nah. They don't need no stinking IV. Stick 'em over in dem freakin ol' chairs we moved over from the old hospital. Maybe they'll croak and that'll rid us of one so we can free up a chair."

With everything full, I count like 50 souls needing attention in the ol' ER on this "quiet" hump night. Maybe a word about the staff is in order at this point.

There's Doogie, of course, and maybe (we're never sure of this) one other guy who might have been a doctor because he periodically pulled patient files from the counter-top basket and read them and read them and read them.

Then there were 6 ladies, all in scrubs, messing with papers, going to the employee break room and occasionally delivering pills with dem little bitty cups of water.

There was Working Man, who must have been a boss nurse or something because as often as he messed with paper, he would also get up and go do something with a patient. He's the only one that I saw change anybody's IV bag. One other of the women inserted an IV needle, that I saw.

Speaking of needles, there was Blood Girl. She came with her little cart full of vials of blood and alcohol wipes and needles. I loved her modern asceptic technique. She walked up to the girl next to us on the chairs, (who spent almost the entire night passed out on her mother's shoulder,) and slipped the surgical tubing "tourniquet" around her arm to pop out a vein. Then, with an alcohol swab, she wipe and wiped a spot on the girl's arm. Then she switched to a clean wipe -- just to be sure -- and wiped some more. Then she dropped both wipes into a bio-haz bag ... and wiped her own nose with the back of her index finger ... then picked up the blood-draw needle between that index finger and thumb and shoved it home. Do you think my eyes betrayed me when my eyelids flopped back over the top of my head upon observing this textbook example of medical safety and sterility? I tried to be good. Minded my own damn Pura Vida business.

Then there was the "escort boy." His job seemed to be going to and from the break room more than anybody else; and, then he was the one who motioned us to follow him (again, on foot -- no wheelchair) across the hospital to the x-ray department. He was a little put out though, that us damn old people couldn't walk as fast as he, because, hey, he had to get back for, um, break time.

The radiology dude was a really funny guy, I guess, because he kept escort boy in stitches the whole time we were down there, regaling him with ... I don't know ... stories or something. Anyhow, it must have been mighty funny material.

Last, but certainly not least, is the cleaning lady. We were there from 10:30pm on the 3rd until 7:30am on the 4th, and she never stopped moving. She'd sweep and then mop. She'd empty waste baskets then clean the employee break room. Never. Stopped. Working. And she was probably getting paid $10 per day.

So, back to the story. We're both pretty sore from the chairs and Pat is freezing. I guess they keep it cold in there to hold down the germs or something because no normal organism could live in there for long without a lot of protective clothing. We noticed that many of the patients were obviously experienced with The System because they had brought their own blankets and extra clothing. Not us. We're stupid gringos.

At some point Pat's blood work came back from the lab and they were mystified. Nothing.

Time for another EKG. Pat came back from that little trip and said that they had decided to run a different type of blood test on her. Ya know, they didn't want to waste a whole extra blood test strip on her the first time around because, well, not every cardiac patient presenting with an elephant on her chest develops the proteins or antibodies or hooper-gloopers or whatever they were not going to test for the first time around. Much better and more efficient to run Blood Girl down for yet another draw, send it back upstairs for processing, checking off another box on another form, running it back to the ER and .... oh, hell. Then they told us it would be at least another 3 hours to get those results. It's 3am.

My butt is killing me and I've got a plan.

"Hey, since it's going to be "forever" to get the results back on this test, why don't I run back to Atenas and get you some warm clothes?"

"But it's so far."

"Oh ... but I want to," I'm saying, thinking of the rather plush-ish drivers seat in our Subaru and the hour away from hell that such a trip would entail.

So she assented; and, I went.

Now, I need to do a quick little back story here to put the following into perspective. We had just paid to have two little gated fences built on either side of our main house so that we could confine our dogs to the back yard/side yard areas, keeping them away from visiting guests of our casita and away from any gates to the outdoors. You see, they love to jump up on strangers and they love to get out of our compound and run around the neighborhood. When we left for the initial hospital run, we had put the dogs out behind the new fences. (Plenty of dry shelter areas, water and doggie beds but no way to run off and no way to irritate anybody.

So I pull off our neighborhood street and into our long driveway (3:30am) and waaaaay of up the drive way I see two glowing eyes. Then the eyes are bounding down the lane in big gazelle-like leaps of joy. In the fog of my brain and darkness something is circling the car like a ... well ... crazy dog. It's our mini-pin, Goose. Happy as a pig in poop and you can just about see the laughing smile on his face saying, "Haha. You can't keep me penned up." We still haven't figured this one out. He has never figured out how to get out of the back yard before. He had to either climb the 2 meter back yard fence or he had to climb the new 1 meter gate and then the front 2 meter fence. Baffling.

Anyhow, I grabbed clothes, snacks & drink and ran back to Alajuela.

Back with Pat it's back to sitting. And sitting.

Then, 6am. It's obviously shift change as new faces roll in and old faces start to gather up their personal stuff to go home. Damn. This is certain to add an hour or more to the stay because the newbies won't be up to speed and won't know Pat's history and ....


The pneumatic tube drops into the nurses station a package full of test results. Oh, could we be so lucky?

Working Man retrieves the tube and starts leafing through the reports. He looks over and gives us "the look" meaning that our results are in. He staples them to our now-considerably-thick pile of papers and STICKS THEM INTO THE "TO DO" BASKET!!! Hot damn! We're either out of here or Pat gets a bed and some action.

Shift change here entails lot's of laughing; chatter; hugs; leering male something-or-others-in-scrubs checking out the butts of the newbie female something-or-others-in-scrubs; and ... one 20-something is braiding the hair of one 50-something as several others observe. This just ain't the time for reading charts, yo.

But then Doogie comes back. We thought he'd gone home. He grabbed the pile from the To Do basket and he read and read and made notes and read and read and made notes and read and read. Then he called out the name ... of someone else. That patient and he left the area together. Pat had heard the intake of that patient during my 3am absence as someone also having chest pain issues.
"But he was way behind us in line!" I say, beginning to think that maybe we're in the gringo line and that guy was in the tico line. Plus, that guy looked to be about 30. Where's the fabled "taking care of seniors first" treatment?

They come back. Doogie disappears. Now it's pushing 7am.

Doogie reappears and picks up the files and reads and reads ... well, you get it. Then HE CALLS PATRICIA'S NAME!" Then he takes her away because he wants to do another EKG. (Somebody's cousin must own the EKG-paper vending company that supplies this hospital. Is this the 3rd or 4th one?)

I'm shaking my head, muttering and generally looking like a genuine curmudgeon when a really tico-looking man about my age squeezes into the chair beside me.

Just then, a guy and girl, in scrubs, come walking up with the apparent intention of moving down the line of chairs taking everyone's blood pressure. As they get to me, they ask indecipherable stuff and I can only say, "Mi esposa," and point toward the EKG door. Then the guy next to me says something to them in Spanish and they move along. I'm a little confused by this until he leans over and whispers conspiratorially into my ear, in perfect unaccented English, "If you think this is bad, you should see the Caja hospitals in Guanacaste and Limon. They really are nightmares compared to this."

My head could have exploded. Worse than this? And who is this "masked man" who came at just the right time to save me with his perfect Spanish and perfect English? Turns out he is a dual national with 18 years of residency in the U.S. and the rest of his 60-something years in Costa Rica. Then he gave me a little taste of how "good" things could have been for us during out fun vacation to the hospital.

"I've been peeing blood for 3 days. Yesterday I started sitting here at 6am, having nothing to eat or drink since midnight the day before yesterday because they needed my system totally empty to do a kidney ultrasound. Then, they delayed the ultrasound until late yesterday afternoon. It was so late that the only doctor who could read the results had already gone home. So they told me to go home and come back today for the results. I figure that I'll be here all day today before I learn anything."

Oh, good, now I'm ready for all kinds of good things to happen.

Pat returns.

"Well, Doggie did 3 EKG runs and then 3 blood pressure tests. My blood pressure is back up a little but the EKG is negative." she says, mournfully. "Oh ... and the new blood test is negative so he's just going to prescribe a different type of blood pressure medicine and aspirin."

And here I'm thinking of that ancient old joke punchline of a doctor saying, "Take two aspirin and call me in the morning." Maybe I should give him a "punchline" of my own.

Ah, no. Pura Vida.

So Doogie writes and writes and writes into Pat's chart. Then he chats with some of the newbies for awhile. Then he writes some more. Now it really is 7am. Finally he fans out a handful of prescription scrip and waves Pat over to his throne desk.

We're free! We can leave. Or not. It seems that the scrip written at this caja location is no good in any other pharmacy other than theirs, which is over on the other side of the hospital and generally good for another hour of "waiting to be served".

But finally, the gods are smiling on us and there are fewer than a handful of peeps ahead of us at the Ye Olde Dope Spot and we're out o' there in less than 20 minutes. Record time for once.

Drove home wide awake. Rustled around with Pat and made breakfast of some sort. Sat down and jotted a little stuff on the computer ... and then ... the big crash. Not the computer ... my brain and body. Pat's too.

With only a few minor interruptions of phones and people at the door, we both slept the 4th of July away. Hope we didn't miss much. Hope we don't EVER need an ER again. If we ever do, I'm thinking of heading straight to CIMA. What the heck. A little bankruptcy never hurt anybody.

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