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.
