Saturday, March 16, 2019

Day 946 to 1013 of the Third Voyage: In which I think I speak for all of us when I say we’re totally over hospitals and definitely done with hoops.


The new year brought a new knee. The Deck Boss was admitted into the hospital on January 7th and went into surgery the next morning. Everything went according to procedure with the exception that her knee had become so pronated over the past few years that Dr. Zeledon had to shorten a tendon which had become stretched and straighten a nerve that had become pinched. But after two hours of surgery, the new hardware was installed, the kinks were worked out (literally and figuratively), and her leg was the straightest its been in probably ten years.

Now the doctor had warned us that the first two days after knee replacement surgery could be the worst from a pain perspective so not only did the nurses duly administer pain meds on a regular schedule, but they were administered via an epidural going straight into her spine. Which sounds awful except that it did the trick and she was not in any terrible pain. She was also rarely conscious. As per hospital regulations, I was required to stay with her, so for two days I got to look at this…
Riveting.


On day three, they started easing back on the neural blockers and she was encouraged throughout the day to stand up, put weight on the knee, and take a step here and there to get the juices moving so to speak. Of course, with the epidural, she had zero feeling below the waist so during these little exercises, she had to be assisted by myself and a nurse—not an easy task (anyone who has ever tried to manhandle a mega large bag of dog food into a shopping cart that keeps rolling backwards should know what I mean.) I’m still feeling the effects of it and will most likely return here in about 10 years for a back replacement. But things continued along uneventfully until the evening of the fourth day when the vein that the IV administering the antibiotics and anticoagulants was in collapsed and it was necessary to find a new one pronto-like. The first nurse did her best, but after 45 minutes of trying different veins in the arm, wrist and hand and with the Deck Boss in pain and in tears, she gave up and called in one of the emergency room nurses. This nurse came in and over the next 45 minutes tried all the tricks of the trade to get a vein…clinching, rubbing, slapping, etc. At one point, she even filled a latex glove with hot water and placed it on her arm in the hopes that a warm vein would rise and I will never look at hand-turkeys quite the same way again. When everything failed, she prayed. Literally. She readied the needle, looked towards the heavens, said a few words in Spanish, eased it in, and hit pay dirt. A minor miracle and one that elicited much whooping, hollering, and hugs all around.

The next day the epidural was removed, and the nerve began to crackle back to life. This part was decidedly not fun but at least now she could feel her legs and, as you know, it’s way easier to do physical therapy when you can physically feel what’s being therapied. After another day or two—and once the doctor was satisfied that she could walk a few steps (i.e. to the bathroom and back) —she was released to the small, hospital-owned hotel across the street which, because this is San Salvador and you can’t get there from here without going 16 miles out of your way, took one hour. One hour in the back of an ambulance winding our way through the various neighborhoods because all the two-way streets are so narrow that oncoming traffic creates an impasse and all the one-way streets outnumber the way you need to go by about three to one. And when you do finally reach the main street, there’s a big nasty median in the way so you have to travel the opposite way of where you want to go until you get to one of the many traffic circles (all built around a massive monument to liberty, freedom, and/or the end of the civil war) in order to go back to where you really need to be which, in our case, was literally across the street from the hospital.

The hotel (for lack of a better word—we heard it referred to as a hotel, hostel, and hospice so I guess it’s all things to all patients) was typical of a lot of places in El Salvador in that from the street it looked like an austere, windowless concrete building surrounded by a high wall crowned in barbed wire—not unlike a mini-prison—yet on the inside, it was bright and airy and the back opened up onto a large patio overlooking a lush, tiered garden with a green belt beyond that. I spent a lot of time out here because the room—while large and comfortable—did not have a lot of natural light. The lack of large windows not only kept the whole place cooler, but more secure (important given the amount of medications on the premises) and quiet (important because many of the 15 rooms were occupied by recuperating patients and the rest by families with loved ones across the street in the hospital.) We opted to stay here because the Deck Boss was scheduled for daily physical therapy along with follow-ups with the orthopedic surgeon and here, at the hotel, they make house calls. Add three meals a day and on-call assistance (if needed) and all-in-all it’s an absolute bargain for $50 per day. Even more so when you factor in its secondary function as an immersive language course because with the exception of one of the day managers, no one spoke a lick of English. Editor’s Note: I’m not sure they spoke Spanish either. I once asked for some milk and they brought me corn flakes and I know my Espanol isn’t THAT bad. At any rate, I really had to up my game and came out all the better for it.

And there was another nice little perk…it was within walking distance of The Coffee Cup which is a Starbucks-like chain of cafes with the added bonus of not serving Starbucks coffee. Now, yes, we lived in Washington State for 25 years, most of that time in Seattle, but that doesn’t mean we’re required to love Starbucks by default (or, for that matter, the Seahawks, the Mariners, and long walks in the drizzle. But Costco? Costco rules!) But, yes, we do love coffee. And yes, we were those people that stopped for coffee every day—sometimes twice if it was a rough morning, and often times at happy hour (yes, that’s a thing at a lot of the coffee stands—half price drinks after four pm.) Add that to the urn at the office and that’s a lot of coffee. And if you ever wonder why microbrews, wines, and artisanal spirits are so popular in the Pacific Northwest it’s because we need all those depressants in the alcohol to counteract the caffeine so we can sleep at night and start the whole cycle over the next day. Of course, it’s easy to get caught up in the coffee culture when it’s absolutely everywhere. Besides the ubiquitous chains like Starbucks, SBC, and Tully’s, there are the countless independently-owned roasters, and the approximately 50,000 drive-through coffee stands found on every corner, most vacant lots, and in any parking lot with a little extra room. We frequented a lot of those. You know those plastic sleeve things you put on your car visor to hold your CD’s?  Ours held punch cards for all the different coffee stands we went to with small stars on the ones that gave out really good dog treats (because Otter was a regular, too.) The stands were also great for giving directions because in a place where something can literally be at the corner of NW 85th Place SE and W 4th Ave NE, it’s much more helpful to say, “Take a left at ‘Coffee Caboose’ like you’re going to that coffee stall at ‘Abe’s Auto Body’ and you’ll see it next to ‘Joltin’ Joe’, but if you pass ‘Hey, Joe!’ then you’ve gone too far. And while you’re there, can you pick me up a triple Americano?”

Once we got on the boat, our coffee consumption went way down—and not just because there wasn’t enough room in the galley for our urn. Rampant availability was at the core of our addiction (because the best coffee is impulse coffee!) and as we made our way down the west coast of the US, the fewer coffee stands we encountered and when we would go to a “destination” coffee place it was less “hey, let’s get a latte!” and more “buy something so we can use the wifi.” Good coffee could be found in San Diego, but bars of the juice, beach, and dive varieties seemed more prevalent. Mexico, of course, is all about the tequila, cerveza, and margaritas, with coffee and coffee drinks being relegated to page four of the bar menu. El Salvador is about the same (just change tequila to rum and page four to the small print on the back.) Starbucks, however, can be found everywhere--especially in all the larger cities and tourist towns. And, much like any other American chain operating anywhere in the world, you know exactly what to expect when you walk in…same layout, same d├ęcor, same merchandise, same food items, and same crappy coffee. There, I said it. They have crappy coffee. I know they start out with good beans. El Salvador produces some of the finest coffee beans in the world—shade grown in rich volcanic soil—and I was told that they sell an awful lot of them to Starbucks. So why Starbucks feels the need to turn around and roast these primo beans over an open dumpster fire is beyond me. And they obviously let the beans “age” in a dank cellar somewhere beforehand because that “old dirt” aftertaste has to come from somewhere. Blonde roast? Medium roast? Strong roast?  I’m pretty sure that’s just determined by rate of decomposition. Editor’s Note: Of course, this is just my opinion, and is most likely unpopular. But then I’m used to that because I also think that football is boring, In-n-Out Burger is overrated, and the only good part in that Titanic movie was when the ship finally sank and put us all out of our misery. So it was really nice to find The Coffee Cup—a Salvadoran chain that roasts its own beans (and “roasts” in the sense that the natural coffee flavor is released and nurtured and not beaten to death with a tire iron, buried out back in the septic field, disinterred with a back hoe, and blackened over a flaming tire)—and get my perc/Americano/latte fix on a daily basis. All this being said, we do go to Starbucks when other options are limited (i.e. no options and/or wifi is required), and I do enjoy their teas, smoothies, and various fruity quaffs. But if caffeine is a must and it has to be coffee, it’s best to stick with a Frappuccino or macchiatto-type concoction of some kind because nothing offsets the taste of burnt beans like 2000 calories of camouflage.

But I digress…

During our stay at the hotel, we didn’t spend the whole time staring at the wall. We also got to stare at the wall at Immigration, too!  Unlike Mexico, where a visa is good for 180 days, the maximum stay here is 90. That’s why we HAD to go on that cruise last July—we had to leave the country in order to reset our visa (it was tough, but sometimes sacrifices must made.) When it came due in October, we opted to get an extension through the Department of Immigration in San Salvador because we really thought we would be leaving in November (early December at the latest), had projects to complete, and didn’t want to lose days/incur the expense of flying out of the country. Editor’s Note: Driving to Guatemala, while only a few hours away, was not an option. Guatemala, El Salvador, Honduras, and Nicaragua have their own little European Union thing going on in that they form a four-country visa zone—to reset your visa requires leaving the zone. Now applying for an extension through Immigration should have been straightforward, but of course you can’t have a good bureaucracy without hoops, headaches, and a whole lot of paperwork. On our first visit, we met with the agent, got all the paperwork, and procured a list of everything that needed to accompany said paperwork (waiting-in-line time and agent time = two hours.) I spent approximately six hours getting the documents in order which consisted of translating the forms and applications into English so I knew what I was filling out, filling them out, writing an essay on why we needed to extend our stay, translating that into Spanish, procuring bank statements (to show we could pay our way), having our photos taken, and scanning/printing copies of passports and various boat documents. This had to be done three times: one packet for each of us. We also needed references from a Salvadoran so our friend, Ernesto, filled out forms that stated he knew us, we were okay people, and that to the best of his knowledge we weren’t up to any mischief. We returned to Immigration to hand in our paperwork along with our passports (waiting-in-line time, agent time, fingerprinting = another three hours.) A few days later, we returned to pick up our passports and new visas and were informed that there was now a new head of Immigration and that we’d need to fill out the paperwork again because the old paperwork had the previous honcho’s name on it (no waiting this time around but agent time and the three of us frantically copying the info from the old forms onto the new = two and a half hours.) When all was said and done—and factoring in the three-hour round trip to Immigration each time—we had over 24 hours into the process; but we did procure our 90-day extension—which would have worked out perfectly had we actually left in November or December, but when the Deck Boss decided she wanted a new hip and a new knee for Christmas, that all went by the wayside. The hip was done in October, but the knee wasn’t scheduled till January—approximately two weeks before our visas were set to expire…again. Now I guess in hindsight, we should have bundled up the Deck Boss’ knee in about five yards of Ace bandage and spent some time in Mexico, but after coming off the hip surgery it just seemed too much at the time and we had been told that medical waivers were fairly easy to come by. Yeah, right. Now one would assume (yeah, yeah, yeah “you”, “me”, “ass”, whatever) that since we were already in the system (paperwork, references, fingerprints, photos, et al) that all we’d need to do is provide a letter from the doctor, have our fingerprints scanned for verification, and pay our fee, right? Wrong. So very wrong. Not only did we have to fill out all the paperwork again; we had to procure new references (thank you, Santos!), submit new photos, produce updated bank statements, get fingerprinted again, provide a letter from the doctor, and bring copies of the hospital invoices. The agent then called me to say they also required a letter from me explaining why we needed to stay even though this was answered in essay form as part of the document pack. The fun part of this process? Between the time limits as to how soon you could apply for an extension and the office closures over the holidays, our window fell the week after the Deck Boss’ surgery which meant we had to spring her out of the hospital and bring her in by wheelchair—all nice and drugged up—to sign the paperwork and be fingerprinted.  I wish I could say that was the last hoop, but there was one more. And they set it on fire. But first I must backtrack a bit…

On the day the Deck Boss was due to be released from the hospital/hotel, I had planned everything out perfectly…Santos would drive to Bahia del Sol and pick up the Captain; when they got about thirty minutes out, I would head over to hospital administration and take care of the bills; once they arrived, we would pack up the Deck Boss and all our stuff and head over to Immigration to pick up our passports; we’d stop for a quick bite to eat, then head back to Bahia before the Deck Boss’ pain meds wore off and she cratered from all the activity. Did it go down as planned? No, it did not. The Captain called me first thing in the morning to tell me he was not feeling well. And not in a “just feeling blah” kind of way; but in a “stomach is cramping, heart is racing, losing feeling in my limbs” kind of way. But not coming was not an option. For one, if he did need medical attention, he wasn’t going to get it in Bahia. The nearest clinic is over an hour away, AFTER you procure a ride (which can take up to an hour.) Santos was already on his way and since they were picking us up across from the hospital, it made sense for him to endure the long ride just in case a doctor visit was required. And two…Immigration had already insisted we bring a semi-conscious woman into the office to sign paperwork; anything less than death would not be considered an excuse for not picking up a passport. But the closer that Santos and the Captain got to San Salvador, the more apparent that something was really wrong, and not ten minutes after paying the hospital bill to get the Deck Boss out of hock and secure her discharge, I found myself in the emergency room looking at this…
I think I've seen this show before.

Over the next few hours, the Captain was poked, prodded, and pried. They ran tests on blood, urine, stool, and every other bodily fluid that could be drawn, coaxed, or just plain induced. In between tests—while he was less conscious than not—I ran back and forth to the hotel to help Santos get the Deck Boss and all our stuff loaded into the van so they could make the hour drive to where we were in the ER across the street. And once they finally did arrive, we all waited…and waited…and waited…for the lab results. Four hours later, the results came back and the winner was…” Something you ate.” Or, more specifically…” Bacillus Cereus” aka “Fried Rice Syndrome” aka “Yes, that’s what they call it and that’s exactly how he got it.” Because a couple days before, the Captain had come out to visit us and he and I went to a Chinese restaurant for lunch. He took the left-overs home but didn’t put it in the refrigerator right away. Suffice to say, if you feel the need to nosh on some fried rice that’s been out on the counter for a few hours, the MSG will be the least of your worries. He was pumped up with medications, given a prescription, and we were sent on our way. Next stop…Immigration. Now picture this:  I’ve got the Deck Boss high on pain meds on one side of me and the Captain spaced out on antibiotics on the other side and the agents should be wondering what I’m doing to these people (and probably check those references again), but what they’re really concerned about is the letter I wrote and how very wrong it is. And what I’m hearing from the agent is, “A medical waiver is a very serious thing and must be handled absolutely correctly and this letter is just not acceptable, and your passports will not be returned.” And I’m wondering if Google Translate pranked me when I was creating the letter and turned my text regarding surgeries, physical therapy, and extensions into a manifesto to overthrow the government, and the conversation is starting to get a little animated in a frantic kind of way, but then through my feeble Spanish, the agent’s so-so English, my phone’s translation app, and lots of pantomime, I finally realize that the problem wasn’t with the content—it was with the formatting. But not all the formatting—just one part. Solution? I procured my laptop out of the van, opened the document in Word, reformatted the letter so that the text was justified, and copied it onto a thumb drive so the agent could print it out and have me sign it. Once that was done, we were given our passports, and sent on our way. So l guess the take-away is this… it doesn’t matter if your paperwork is a little off, your intentions are somewhat dodgy, or your references are a bit sketchy—Hell, it doesn’t even matter if you’re 100% lucid—as long as your text is flush with both margins, it’s all good. Also, next time…just go to Mexico.


Postscript:  For those of you keeping track at home, here’s how much it costs to get your knee replaced in San Salvador:

The surgeon: $2500
The anesthesiologist and OR nurses: $1500
Body parts: $2563
Everything else (tests, labs, meds, hospital stay, nursing services): $3215.60
Twelve nights at the hotel/hostel/hospice:  $616.50
Grand total:  $10,395.10

And if you’re thinking of visiting the ER:  Exam, labs, meds:  $102.20