Thursday, December 6, 2018

Day 883 to 909 of the Third Voyage: In which while normal people buy a t-shirt to commemorate their travels, the Deck Boss collects body parts.

Lest you think that all we do is fix things in the morning, huddle in front the AC during the heat of the afternoon, then stand around in a swimming pool from four to six imbibing in two-for-one cocktails while bitching about boat repairs and the heat, we do in fact engage in other activities.

For instance, the Captain and I volunteered to “teach” English-conversation classes as part of a program started by some local expats. I use the term “teach” loosely because basically all we did was follow a weekly themed curriculum (on topics such as work, food, travel, health, etc.), help the students with their pronunciation and comprehension, and then banter back and forth to get them comfortable speaking English in a social setting.  We were a bit nervous at first because A) as noted above, we’re not teachers and B) our (and by “our” I mean “my”) Spanish skills leave a lot to be desired. Case in point…I’m constantly mixing up “vacio” and “vaca”, but by now our water-delivery guy knows that when I say, “the tank is a cow” what I really mean to say is “the tank is empty.” You know, that kind of stuff. But I think the kids got a kick out of the fact that most of the volunteers had minimal (aka “just enough to get by”) Spanish-speaking abilities. They liked correcting our pronunciation or helping us find a corresponding word in Spanish and I think it helped them to realize that it’s okay if you’re not fluent so long as everybody sort of understands one another. Proficiency comes later. (And with some of us…much, much later. If at all.)

Most of the kids ranged from tween to early twenties and you had to admire their dedication. Although the classes were free of charge, attendance was required in order to graduate, so they came after school, before work, in-between jobs…rain, shine, or monsoon, all desiring to learn English to improve their employment prospects. These were kids whose aspirations ranged from teachers and pilots to professional chefs and charter boat captains. One 12-year old boy, dressed in neat jeans and an ironed white shirt, said his dream job was to be an “agricultural engineer” and that he planned to own a farm with a sizable field, a barn, eight cows and two horses by the time he was 20.  Given his determination, I don’t doubt that.

At the end of the 10-week program, we held a graduation ceremony at the Rosy Mar restaurant that had so graciously allowed us to use their space for the classes. Each student got up in front of the crowd of family and friends, introduced themselves, and gave a short speech in English on a topic of their choosing before being presented with a certificate and an English-Spanish dictionary. They all then sang the CCR song, “Have You Ever Seen the Rain” (apropos given that it was rainy season and we had just come off of a week where we got 30+ inches) before it was time to dig into papusas and cake.

Pictured: First graduating class. Future president of El Salvador is in the first row, second from the left.

Most all of the cruisers were there, and we brought along the Deck Boss so she could meet the kids and see first-hand what we had been doing with our Wednesdays. As the festivities wound down around seven, we put her in a car to go back to Bahia del Sol and, as there was limited room in the vehicle, the Captain and I walked the mile or so to the estuary to catch the panga back to the marina. It was in the middle of the mooring field, dropping off some of the other cruisers, that the message came through on my phone saying that “Jan had fallen” accompanied by this picture:

Deck Boss Down.

By the time we got to the marina and up to the hotel lobby where they had taken her, a couple of the other cruisers had gotten her cleaned up and two others—one a nurse by trade and the other in construction (aka a trauma specialist)—were on their way to assess the sizeable gash above her forehead. Technically, she should have gone to the emergency room for stitches and to be thoroughly checked out. And had we been back in Barra or Puerto Vallarta, we totally would have. But here, the nearest clinic is in the town of Zacatacaluca—about an hour away—and, unlike the tourist towns of Mexico, the likelihood of someone speaking enough English to fill in the gaps of our meager Spanish made this course of action extremely daunting. So when Lucy, the nurse, determined that some butterfly tape and bandages should suffice until we had time to assess the damage, we went with it. In hindsight, this was a good decision.

Besides, she looks okay. Right?

Now when she fell, she fell hard. She sustained the gash on her forehead, a nasty cut on her hand, and was experiencing some pain in her right leg, which makes sense when you choose to fall on some sharp rocks and not, say, on a grassy lawn.

Pictured: The opposite of a soft landing.

The hotel lent us a wheelchair to get her down to the boat and with the help of our fellow cruisers, we got her up and onto the boat. Moving around inside was easier because if there’s one thing a boat has, it’s lots and lots of handholds. The next day, she was stiff and sore. By that evening, she was starting to experience pain in her leg. By Monday it was obvious that the pain was getting worse. On Tuesday morning, we took her to Hospital Diagnostica in San Salvador, arguably the best private hospital in the city, and awaited Dr. Pablo, who is technically a cardiologist, but is unofficially the go-to physician to the gringos. While she was being examined by the emergency room staff and having her head stitched up, Dr Pablo arranged for an orthopedist to come check out her leg.

Now pretty much from the get-go, the Captain kept saying, “She’s broken her hip.” The Deck Boss was inclined to believe him, but I kept holding out. She was getting around okay, nothing seemed to be protruding or otherwise looking weird, and the pain was to be expected given that she had fallen into a rock garden. But he kept insisting, and when I asked him why he thought this, he replied, “All old people break their hips. It’s just what they do.” And I’m thinking, “Well…that’s just a cliché. Next you’ll be telling me that all cruisers do is fix shit, stand around in swimming pools drinking two-for-one cocktails, and bitch about the heat. Oh, wait. Shit.”

And damned if he wasn’t right.

According to the x-rays, it was evident that something had cracked and/or the ball had fallen out of the socket and/or whatever it is when hips break. I don’t know; my mind was going a million miles an hour, but it came to a screeching halt when the orthopedic surgeon, Dr. Zeledon, announced, “She has to have surgery to replace the hip. I’ve scheduled her for this afternoon.” Wait. What? Next thing I know, she’s being wheeled off for blood tests, an EKG, and additional x-rays, and I’m being whisked away to sign papers and put down a deposit. And here is where healthcare south of the border differs from the US. Back in the States, the patient fills out a complete medical history, a list of medications, insurance forms, privacy statements, record release forms, etc. etc. etc.  And if the patient is really lucky, they get to go through the same rigamarole at the hospital prior to the surgery. You know what they had for the Deck Boss?  Her name, date of birth, a copy of her passport, and the Captain’s cell phone number. The 3-page form I initialed and signed was all in Spanish and to the best of my knowledge stated that I was her representative, that we gave the surgeon full authority to do what needed to be done, that we understood the inherent risks associated with surgery, and that we would pay the bill prior to her being discharged from the hospital. Aside from asking if she was allergic to any medications, no other information was asked or given. Editor’s Note: Such are the dangers of limited Spanish skills. I guess if she went in for a hip replacement and came out with an extra leg and a bionic arm, I’d have no one to blame but myself.

And at precisely three o’clock that afternoon—four hours after having arrived at the clinic—they wheeled her away for surgery. After an hour in surgery and two hours in recovery—they wheeled her into her private room where we were waiting. And about this room…it was large—200 square feet I’m thinking—and in addition to the hospital bed, was furnished with a recliner, flat screen tv, daybed, large bathroom with a walk-in shower, tons of storage, individually-controlled AC, mini-fridge, and private access to a balcony overlooking San Salvador. Seriously. The Deck Boss was, understandably, completely out of it, and unable to appreciate her surroundings, but the Captain and I were impressed. At this point, an orderly came and asked when I’d like the daybed made up with sheets and this is when we discovered another way that healthcare here differs from outside the US. Namely, a member of the family is required to stay with the patient as a caregiver. Wait. What?

Twelve years ago, at a hospital in Everett, WA—back when the Deck Boss destroyed her leg for the first time—she came back from surgery, was pumped up full of morphine, then the nurses sent me on my way and told me to come back the next morning during visiting hours. That’s not the case here. Here, the nurses make their regular rounds to check vitals and administer the scheduled meds, but a family member is expected to watch over the patient and alert the staff if any additional care is needed, which, in my case, consisted of frequently contacting the nurses’ station to request more pain meds. Because there’s no morphine here to speak of, only Tramadol. And whereas Tramadol is a narcotic in the oxycontin family, it doesn’t pack the punch of what they give you in the States. On the one hand, it means that El Salvador doesn’t have the opioid epidemic like the one plaguing the States. But on the other, it’s probable that that first 24 hours after major surgery will be a little uncomfortable. Luckily, the nursing staff was very accommodating and didn’t even laugh at me when I called to tell them that the IV bag was a cow and needed to be replaced with a full one. Because did I mention that none of the nurses spoke English? Not that I expected them to, but as I had no way of knowing that morning that I would be spending the night in a hospital, I didn’t have the basic necessities like warmer clothes, my glasses, and a phone charger. The latter being the most important because of the translation app on my phone, which by midnight had gone completely dead. So, by two in the morning, I’m thoroughly exhausted, wearing the Deck Boss’ street clothes over mine to combat the chill of the hospital room, painfully squinting through calcifying contact lenses, and trying to conjure up enough Spanish to supplement the frantic pantomimes I was using to communicate. By four in the morning, I could easily have been mistaken for an escapee from the psych ward. But my discomfort was nothing compared to the Deck Boss’ as it took several hours to get the pain meds dialed in to where she could finally sleep.

But true to the doctor’s word, by the next morning she was able to put a little weight on her leg, and by mid-afternoon—roughly 24 hours after surgery—was discharged. We spent the next week with our friends, Lin and Lou, at their house up from the marina so that the Deck Boss could recuperate where the rooms weren’t so bouncy, then it was back to the boat after a positive follow-up with the doctor. A week later, the staples were removed and that was that…with one exception. Dr Zeledon explained that she shouldn’t have any problems with the new hip, provided she doesn’t fall. So, she is now the proud owner of one of those rolling walker things with the handbrakes and the seat for when you get tired. We got her one in blue (to match the boat) and were pleasantly surprised to find that the storage container below the seat will comfortably hold a six pack. All it needs now is a cup holder and she’ll be set.

Now I’d like to say that that was the end of our adventures in orthopedics, but I’d be wrong. Because when she fell, she also landed hard on her bad knee and effectively undid all the good that the stem-cell procedure two years prior had accomplished. So, it looks like she’ll be adding a new knee to her collection right after the holidays, and it looks like we’ll be extending our stay in El Salvador until next spring. Which is okay really. Because if something else goes wrong, I think she’ll qualify for a bulk discount.

Postscript:  For those keeping track at home, here’s how much it costs to get a hip replaced in El Salvador…

The surgeon: $2500
The anesthesiologist and OR nurses: $1400
All other doctors and specialists (Dr. Pablo, ER doctor, X-ray techs, etc.): $658.5
Body parts: $1012.92
Everything else (tests, labs, meds, hospital stay, nursing services): $2057.19
Grand total:  $7,628.61
I had to put down a $3,000 deposit prior to the surgery and pay the balance before her discharge. All in all, not a bad deal. Even without the third leg and bionic arm.