The Costa Rica Adventure: Looking for CAM sites and finding a new profession for Mary!


As many of the locals here know, Mary and I departed for Costa Rica to evaluate its wildlife.  The trip got a most unexpected start.  The trip south was carefully planned so we would arrive in San Jose, CR at 08:00 in the morning -- to give time to get the car and head out of town during daylight.  Great idea - but we arrived at midnight after the plane was diverted to other countries.  We had been up and travelling 41 hours!!  The first change happened "on final" into the San Salvador airport.  At the last moment the aircraft had to pull up and was diverted to Honduras -- where nobody had visas to land -- or get out of the airplane.

The San Salvador airport had lost its radar and the flight was diverted.  OK, so we sat a few hours in the plane in Honduras waiting the re-opening of the San Salvador airport.  About 5 hours late, we got back to San Salvador to find that our onward flight to San Jose was long gone and we waited another 7 hours.  Finally we arrived in San Jose, got our rental car and negotiated our way across town in the dark amidst Latin drivers and no signage, to arrive at the Bougainvillea Hotel just after midnight. What a relief!!  All seemed good. This was our only pre-booked hotel for the entire trip and it was gorgeous and very comfy.

The next morning Mary and I did the Heredia market to load up on fruit and water to carry -- still good but a very hot market morning!!  While I took a brief lie-down-on-the-bed-moment Mary started to make coffee -- but the water would not drip.  I jumped out of bed, as best I jump with the knee replacement, took two steps to where Mary was making the coffee.  On the third step I saw the world horizon rising from my lower eyelids.  I instinctively reached upward for the corners of the coffee alcove.  The next recognition was a loud crack as my head hit the tile floor. 

Apparently I had been 'out' for parts of a second -- the time to collapse.  I instinctively put my hands under my head expecting to see blood from such a loud 'crack'.  No blood, nothing.  Now Mary was standing over me saying, "What happened. What happened?"  She had been facing the coffee pot and had not seen me fall. She only heard the 'crack' -- and then saw me lying on the floor.

Again my hand revealed no blood -- after checking about 4 times in astonishment.  My thoughts immediately went to, "Did I just suffer a stroke?  Did I faint?" Then Mary said, "Your surrounded by blood".  I again checked the head -- nothing -- well, no bleeding from my skull!!  Then Mary pointed to my elbow, then both elbows.  In the fall I had split them wide open -- later resolved by 3 stitches in each.  After a few moments I got back on the bed and Mary was finding out about the hotel doctor -- who does not exist.  Soon the ambulance arrived and we started off on an incredible adventure, Mary to start a whole new career and I to be totally disillusioned by the Costa Rican medical practices.

Mary`s new career at least started in daylight -- forty minutes following the flashing red lights of the ambulance to the hospital in our fine grey Toyota Yaris.  This was Friday just after lunch and coming into the hospital, from an ambulance in a wheel chair, we bypass the rooms of waiting patients -- I believe all scowling at this line jumper -- and were instantly attended by an emergency specialist and an attendant to sew up both elbows.  The two hours of testing, basically reaffirming I had no pain in my heart (I already had a pacemaker due to a weak heart), it was announced that I likely fainted due to the stress of the travel and the San Jose heat and that all I needed was a double-check of the pacemaker timing.  OK - sounds very good.  

The very friendly doctor, who during these times invited us to his weekend retreat in the mountains when this was over, then said, "We won't have a Cardiologist who can adjust your pacemaker here until Monday but I have phoned around and found Costa Rica's most famous heart specialist, the one who looks after the President.  The specialist will await your arrival at Hospital Catolica."  WOW -- sounds excellent.  In the meantime Mary had phoned the RBC Medical Travel Insurance, that she took out without telling me before we left, so they have approved the transfer to the new doctor in a private hospital.  I later learned that the last 3 hours of our wait for this new ambulance was likely waiting for the RBC approval of the advancing treatment.

After several hours of waiting the new ambulance arrived to cross town to another hospital.  It is now dark and guess who gets to cross San Jose following another set of flashing lights.  It is indeed Mary who is not allowed inside the ambulance with me.  She does not want to abandon our rental car -- particularly since all the reports on me are great and that we would be discharged immediately after the 10 minute pacemaker adjustment.  This trip was kind of special.  The ambulance attendant and the driver are part of an elite team and normally only attend helicopter and air rescues.  By coincidence he had a huge 24  x  30 inch binder of photos showing all their incredible rescues.  Very exciting stuff.  Then we remembered Mary -- supposedly following in the dark.  But there was no Mary.  The ambulance stopped and eventually Mary appeared. The attendant got her to put on her flashing lights so she can be identified by the ambulance driver -- as extra insurance that she is keeping up.  A few blocks and the attendant was again out on the street trying to find Mary.  She had her flasher on but the head and tail lights were off in the totally chaotic traffic.  Forty minutes later and we were through the fine photo album of rescues and the ambulance with Mary following at a 3 foot distance arrived at the new Catolica hospital.

The service is incredible.  A team of doctors were awaiting my arrival.  I was re-hooked up to ECG machines, my blood is re-tested and the heart specialist, Dr. Saene, not only said everything is testing out well but he invited us to spend the weekend at his mountain retreat on the outskirts of San Jose.  Two invitations by Costa Rican  specialists for stays in their holiday homes in the same day -- boy were we travelling in the right circles!!  Great!!  He said I should spend the night there, so we did as instructed.  Mary booked into the adjacent Catolica Hotel which is exclusively for family members of patients.  (It was formerly a nunnery.)  The next day was slow.  Every 3 hours during the night and day 5 to 7 nurses (or somebody!) came by, woke me up and took my temperature and blood pressure.  So much attention and two to three people for each function -- temp and pressure.  It's very reassuring!!

That night, just before midnight -- this seemed to be when Dr. Saene is on duty -- he came by and said all is well but he was going to make sure by putting me on a portable ECG for 24 hours -- ouch!!  I saw this meaning another two days in the hospital!!  Mary made her prolonged daily visits up from the Nunnery and the time passed.  During the second day she got a taxi and took it across town get out things out of the Hotel.  After this 24 hr. test Dr. Saene actually sent up instructions that I am to have a stress test.  I already had discussed this with him the first night saying how, after two years of doing almost no exercises due to the knee and then re-knee replacements, my heart specialist only annually gives me a nuclear stress test --- the last being done just before we left for Costa Rica, to make sure I was fit.  But Dr. Saene says it is ok for me to do the stress test.  It turns out this hospital does not have the equipment to do the nuclear test.  But the bottom line is that he indicates that I have done well on the stress test and I am led to believe I am about to be discharged into the Costa Rican wilds -- for which we longed.

But that is wrong.  The next day with no further contact, I took it upon myself to call our RBC nurse and doctor team in Toronto, Canada to double check what is happening.  Bingo!!!  Tracy, the nurse at RBC, is astonished at my call.  She double checks that -- I am David Hancock -- three times.  Where was I she asks.  How could I be calling her was her point.  Was I not in the operating room awaiting life and death surgery? After I convinced her I was not in the operating room, never had been, did not even or ever have heart pains, in fact I had only had elbow pains, she asked me to hold on the line.  She was actually then talking with the RBC heart specialist who was at that vary moment talking to the Catolica Hopital in San Jose.  The hospital was stating that I was on the operating table and needed a life and death operation.  Furthermore, nothing would happen until the RBC transferred $20,000.00 via Western Union to them.  No -- VISA would not do -- remember you can seek redress through VISA if the product is not as advertised.

I am shocked but diligently I wait on the line.  Tracy, the RBC nurse, again confirms I have no pain.  She even said if I thought this urgent operation was necessary for saving my life they would send the money immediately.  I again went on hold as the RBC doctor was requesting that the tests which show the operation was essential be faxed to him.   Another 20 minutes (of about 75 minutes on hold) pass and Tracy, the RBC nurse, came back on the line asking, "David, where have you been just now?"  My reply was I am still holding the line, still sitting in my hospital bed!  She asks if I have just been complaining to the doctor that I was upset with the insuring agent for not forwarding the life saving money.   I most certainly had not made any such complaint.  In fact I had not even been told I needed an operation, let alone that I was undergoing one!!!

Tracy again asked me to stay on hold so she could again talk with the RBC doctor, who at that time was trying to view the faxed-in tests that were then arriving.  Something was not right.  I tried telling Mary about the one-sided conversations she was hearing.  Am I being screwed by a private hospital and their doctor or by an insurance company that does not want to pay.  It seems it must be one or the other.  The deciding facts for me seemed in favor of an honest RBC insurer and a very dishonest Dr. Saene and the Catolica Hospital in Costa Rica. The Hospital had reported me unconscious when I wasn't.  They had said I was complaining about being denied the operation funds by the RBC Insurance which I had not complained about - or even knew about.

After some more time while the RBC doctor reviewed the Costa Rican tests that seemed to indicate I had no new problems, I told the RBC nurse I was immediately checking out of the hospital.  They requested I go to another hospital where they knew a heart specialist that had worked with them before.  I hung up and told Mary the good news.   It's again dark and we were off to a new hospital, she again following in the car!  This time no ambulance. Mary was to follow a taxi that I am in.  Again it was dark but unlike many places.  San Jose has 33,450 red taxis - or about - and almost no private cars -- and she was following one of these thorough the evening traffic jams.  Mary's tales of following first ambulances and then taxis, indicate how she learned to follow at a distance of no more than 3 feet or some wiley Latin driver would cut in -- and then she would be LOST!!
So now it was early evening on the 5th day when we arrived at the third hospital, another public hospital like the second, but not like the private Catolica Hospital I was escaping.  Here we found another heart specialist waiting, Dr. Rojas, and again I went through the ECG etc.  I had had an hour's delay getting the tests given to me so I could take them but the new doctor, probably wisely, did her own basic tests.  In another 3 hours I was deemed fit to travel.  My problems were likely due to the stress of the 41 hours of travel and the hot market place.  I had no new noticeable heart problems. The RBC team in Toronto had been in touch with Dr. Rojas and both confirmed I seemed fine.  It was again nearly midnight but the kind doctor immediately had the staff arrange a Holiday Inn for us.  This last follow-the-taxi-flashing-lights-trip happened with me riding with Mary.  We paid off the taxi driver and went for a late night beer -- Costa Rica here we come.
The post script to all this is not really all that reassuring.  My Vancouver heart specialist went over all the important tests again on my return and his eye-brow-raising, under his breath comments were, "I think you were lucky to get away from charlatans!!"
If they had gotten their $20,000 would I have been under the knife for nothing?  Would that be necessary to justify the money?  I think so.  And I don't wish to think of the success rates or the easy way to cover up unnecessary operations!!  This surely makes one rethink invincibility -- or faith in the medical system of some countries!!


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