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Background: I have lived in David for over 4 years and have had my own physician here most of that time. Dr. Cattan owns Clinica Cattan a full-service primary care clinic in downtown. He speaks excellent English, has an engaging bedside manner, seems to really enjoy interfacing with the ex-pat community, and is the type of guy that has given me his cell number and instructions to call it (rather than the office) when I need him.
On two different occasions over the last three years Dr. Cattan outlined and administered comprehensive treatment programs to combat a recurring staph infection in my foot. His care was praised by the specialist at Duke University’s Infectious Disease Department when I conferred with them on my normal trips back to the U.S. to visit my regular physician.
My last battle with the staph infection (in May 2010) took an unexpected turn however. About two weeks into the treatment cycle, I experienced a different type of pain. Alarming in that the pain associated with this staph is very unique, and this was different. When I called Dr. Cattan had me come straight to his office even though it was 8pm – none of that ‘call me in the morning’. An hour later he had called a friend of his, an orthopedic surgeon, to the office – turns out a staph infection invading the skeletal structure is a serious turn of events.
The orthopedist, who had attended Cornell Med. School (I have forgotten his name), within 30 minutes had arranged my admittance to Mae Lewis Hospital. Turns out he had also called back into the hospital the young lady who handles the TriCare insurance program (retired U.S. military) to insure that I got processed in properly. This point is particularly important because I did not even know I could use my TriCare here in Panama. Duh! I mean if you are bullet-proof, why would you bother checking on your healthcare before you need it?
The long and short of it is I was in the hospital for a week, under an intensive antibiotic treatment and my total cost out of pocket was $100. In addition, the young lady at the hospital took care of all the TriCare paperwork and filing. Even more important, she advised me that all my TriCare needs in the future should be brought to her, not just those associated with the hospital. She represented TriCare, not just the hospital’s interface with it. Wow!
A Current Crises Erupts: The first of January I revisited Mae Lewis under a very different situation and conditions. I have a long-standing chronic lung problem, Chronic Obstructive Pulmonary Disorder (COPD), the genesis of which was a nearly fatal battle with TB that was misdiagnosed back in 1995. The ravages of the TB left me with approximately 60% lung capacity, a limitation that can be worked around fairly effectively on a day-to-day basis. However, a chest cold is a cause for concern, anything more serious sets of alarms.
Twice in the past six years I have had to be hospitalized, and tethered to an oxygen mask while modern medications fought to clear my lungs. A couple of times a year like most everyone, I will get the sniffles and have what could be the start of a problem, but with meds (and luck?) the situation improves over couple days. Well this month it got worse fast and 'stupid me' put off calling for assistance because it was getting better? Oh yeah.
When I FINALLY decided to call ambulance it took an hour to get ready before I could call. I had to put on underwear, pants and shirt that I HAD ALREADY LAID OUT! But I kept running out breath and had to set down and recover. When I finally called the ambulance I emphasized bring oxygen. They did - but in ambulance NOT in their hands when they came in room. I ultimately passed out as they were putting me in ambulance before we left the hotel, looking the whole downtown regular population square in the eye.
My Return to Mae Lewis: The fact that I required the oxygen support system evidently did not make me an emergency case, and we just worked our way through traffic across town, sans siren. That distinction did become important when we got hospital because we did not go to the emergency room entrance. I was wheeled into a waiting area outside the admissions office. After some encouragement on my part (primarily because I was turned blue ‘off oxygen”) the ambulance driver got me hurried into the admittance office where one of the doctors running admissions got me on oxygen while I waited my turn.
The younger of the two doctors in admissions spoke excellent English, and in between cases he was processing in, he contacted the TriCare rep at home. She got on the computer and confirmed for him my status and account information and I was subsequently processed into the hospital. I was put in a bed right there in the admissions office and ‘parked’ with two other beds (separated by curtains) while the processing continued. About 30 minutes later, a 60-ish gentleman introduced himself as my pulmonologist and started taking information from me. However, to do so, Dr. Sanchez had to rely heavily on the admitting room doctor because he spoke virtually no English. The adventure had really begun.
I was subsequently hooked up to drip bags and given multiple shots, pills, liquid medications and spent the night right there in admittance. Since the environment of the admissions room was kind of like a shopping center, I initially thought that the three of us where parked there for observation purposes. I found out the next morning that it was because the hospital was full. About 10:30 the next morning I was moved to a room. Another exercise in futility.
When you are in the shape I was in (fighting for breath) you do not want to do anything that will trigger your respiration to accelerate – like move a muscle! For those of you who have ever had a breathing crisis you know what I am talking about. For those of you who haven’t, I will not belabor the point, but the panic that sets in when you run out of breath can not be avoided. So your logical mind knows you have to change rooms and it is going to cause another breathing crisis, and the portable oxygen will at least keep you alive until you can get back prone and motionless and recover. But please make it quick!
So, for starters, you would think that professionals would appreciate the concept of getting the portable oxygen supply hooked up and operational before they disconnected me from my bed station supply to move me into a wheelchair for transport. Wouldn’t you? And while I am on the limited supply portable system there would not be a requirement to stop at the nurses’ station to have a discussion about which room we are moving to. Nor would there be an even longer discussion once we arrived at the new room or which of the two empty beds was the winner. I should mention that two days later there was another room change requirement which went a lot smoother – because I ran it!
I am definitely not fluent in Spanish, but I do get along fairly well in normal conversations, but that does not extend to medical terms, diagnosis or prognosis. And although Dr. Sanchez came in to see me twice a day, he spoke no - NO - English. He would come in smiling with a chart in his hand, babble a bit and pronounce me “mejor, mucho mejor”. To which, after the second day, I would explain that that I didn’t understand and ask him to bring in someone to translate. But my repeated request,” Yo no entiendo totalmente. ¿Se puede conseguir a alguien para traducir al Inglés?” gained nothing but a big smile, a “si, si”, and he would disappear until next visit. And I know he understood me, if for no other reason on several occasions either other patients or visitors in the room who spoke some English repeated my request for me. I now am arranging to take all the paperwork to my doctor to determine specifically what I was treated for and how.
Luckily I had been through this (or at least a similar) treatment before, so I knew the lungs would need a healing period AND that I would need oxygen at home to get through that process. I had to explain that to Dr. Sanchez when he came in smiling on Morning #6 to say I was ‘going home today’. He did understand me when I explained I would let him know when I got the oxygen set up at my home. With a lot of help from friends here that only took about 24 hours to get in place. Now we were ready to go home.
I called and left a message with the TriCare lady to make sure that everything was in place for my discharge. When she called me back I realized I had not heard from her since I was admitted and suddenly realized why. She advised me that Mae Lewis no longer processed TriCare claims. I would have to pay cash before I was released and reimbursement from TriCare was my responsibility. Gulp! I do not know what would have happened if I had not had $3,500 in the bank accounts.
Get Me Home: But, we are not home yet. Due to the oxygen requirement we are going to need an ambulance to get back to the hotel, which must be done through the hospital by reservation. The hospital called at 3pm when they had finished processing me out and found the next available ambulance for that type of duty was 5pm. Oh Lord. The ambulance did finally arrive at 6:40pm, manned by two young female EMTs. The ‘female’ part of that equation really only became relevant when we reached the hotel and discovered that the elevator was not operational. Thankfully the hotel porters and two young guys from the cafeteria were able to wrestle me up to my 3rd floor perch. Whew, what a trip!
In Conclusion: A long story! Yes! But… my point in telling it is obviously not to make me look smart, nor to stimulate a ‘woe is me’. I am convinced I would be a goner if it weren’t for an informal support group made up of friends and acquaintances who had not up to that point had to perform in that function. And I can only rap my own knuckles for not staying up with the TriCare situation. It turns out the hospitals TriCare processing problems were known, just not by me. To make matters worse, like too many people, I ignored the whole medical situation until I needed it. That, my friends, is too late. Be smarter than me!
As an aside, a week after being released, I am much ..MUCH... better and improving daily. In fact I have now gone over 24 hours without any oxygen, although admittedly I am moving slow. And my medication regimen has another week. Yuk. But, I consider myself very lucky.
Hope this rant assists someone. It will have been worth it.
Larry
Till Next Time. Pura Vida.
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