A Medical Saga
I recently spent a few days in the hospital here in David, Panama. This article over-views that experience and is intended to assist other ex-pats living in Panama sort through some of the options available when hospitalization may be required. Let me assure you, from my personal experiences things are not equal in the two private hospitals – Mae Lewis and Chiriqui Hospital.
I am not trying to 'sell' anyone on anything, for I realize that there are a variety of factors that could cause an individual to chose one hospital over another, including the physicians affiliation. All I can do is itemize for you the differences that I experiences in the two private hospital in David in treatment, patient services and (for want of a better phrase) medical professionalism.
As background, 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, and any hint of an infection or anything more serious sets off alarms.
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 the proper medications (and luck?) the situation improves over a couple days. But then sometimes it gets worse and, when it turns bad it gets worse fast!
Four times in the past six years I have had to be hospitalized, and ended up tethered to an oxygen mask while modern antibiotic medications fought to clear my lungs. My first hospitalization outside the U.S. was in Golfito, Costa Rica (horror story), which I mention as an example of how one can get through what could be a crises merely because they have been through it before. So even though no one in the Golfito Hospital seemed to speak one word of English, the treatment and tests were what I was expecting - what had occurred in a USAF hospital – so my limited Spanglish got me through.The last attack (Jan 2012) I had myself admitted to Mae Lewis because I had used them before for a totally different problem and was satisfied with the experience. I only realized later that my satisfaction level was more a result of the physician, than the hospital itself.
I documented those experiences in a blog posting last January, which you can go to for background using this link. "Healthcare or Horror Story?"
In doing this comparison I need to emphasize that my 'going-in' medical condition when I processed into Chiriqui Hospital last week was a repeat, a mirror image, of my condition entering Mae Lewis in Jan 2012. Both times when it hit me, I went from from sitting on the balcony overlooking Parque Cervantes reading the newspaper to (15 minutes later) laying on my bed gasping on an oxygen tube calling for an ambulance. But after the ambulance ride to the hospital for the next few days, my stay at Chiriqui there were few similarities to my previous experiences in Mae Lewis.
Welcome To The Hospital
Late afternoon in January when I arrived at Mae Lewis in the ambulance I had an immediate problem. The ambulance's oxygen supply was an installation in the ambulance - It was not portable. So although the ambulance techs stayed with me, I ended up sitting in the hallway outside the emergency room facilities without oxygen, turning blue (until I threw a hissy-sit). Then I sat inside the emergency room basically unattended for about two hours, but at least on oxygen.
I was questioned by an aide of some type, who spoke enough English that my Spanglish got us to the point that I made him understand that this was a chronic lung problem. I only realized later that the emergency room worked more or less on a first-come, first-served basis. They would get to the guy suffering on the end of an oxygen tube right after the lady with the runny nose.
They finally put me in a bed in the corner of the emergency room, hooked up the oxygen and put me on an IV drip to fight off dehydration, and pulled the curtain. And that is where I still was when the hospital-assigned pulmonologist showed up about 10AM the next morning. (It turns out they were waiting for a hospital bed to come available).The doctor was 60ish, spoke no (NO) English, and did not make any attempt to get others help when required to assist in my understanding what he was trying to tell me. (That tendency did not change throughout the week). He studied my chart for a while and then, when it became apparent I wasn't understanding him, he shrugged and left. I did not see him again for about 24 hours, when commenced a repeat performance of the earlier session.
About two hours after the doctor left, a young nurse showed up at my bedside obviously making preparations to move me. When she showed up with a wheelchair, we had a problem because she did not have an oxygen bottle. We 'debated' that subject back and forth (I figured out later that she did not want to be bothered with getting one of the portable bottles. She finally convinced me it would be a quick trip to the oxygen supply in my hospital room – and it would have been if she had not have stopped at the nurses' station to have a conversation. It also would have been a good idea to have the oxygen equipment in the room when we got there instead of having to go get it someplace. I was blue! Phew!
Last week when I rolled into the Urgent Care area at Chiriqui Hospital we did not even slow down going through the waiting area. I was pushed directly into the emergency area, transferred to a waiting bed and put on oxygen. The 'welcoming party' consisted of two nurses, who immediately started doing vital-sign checks, and a young man (who spoke impeccable English) armed with a checklist on a clip board, doing the '20-Questions' thing (history, prescriptions, allergies, etc.)
In the next 1 1/2 hours in the emergency room, I had blood-work done, a chest X-ray, received two IVs, and two anti-biotic shots. I found out later that this was all being directed by the pulmonologist the hospital had assigned to my case, and his visit to the emergency room was being delayed only until he had the lab results from the blood tests in hand, so he knew what he was dealing with.
Dr. Rafael Rodriguez was THE high point of this entire experience. He speaks English with subtleties and nuances that make it hard to believe, except for his accent, that English is a second-language for him. He described in details my condition, what needed to be done, the sequential steps required and the timing of how it would be done. He also advised me that the daily medical routine I was on for my lung condition was outdated by about three years and what we would do going forward. (I was stunned when I realized how long it had been since I had seen any doctor other than a general practitioner. A chronic condition and you don't see a specialist for years? Duh!).
At that point Doctor Rodriguez confirmed with the emergency room supervisor that he was admitting me, and within about fifteen minutes a lady from the admissions office was at my bedside with all the admitting paperwork. Approximately twenty minutes later I was in my hospital room, on oxygen and been administered two shots, three pills and had an anti-biotic IV going. Welcome to Chiriqui Hospital.
The Stay In The Hospital
Mae Lewis: Last January I shared my room in the hospital with two other patients, and
the small size of the room made for very cramped conditions. More precisely, I shared the room with about a dozen people as they came/went during my stay. Panamanians are very family oriented – they do a lot of things as a family. And going to the hospital is obviously one of those family things. To say that the room was like a bus station would ignore the fact that the bus station often quiets down between buses.
The visitor traffic volume in a small room induced a claustrophobic effect on me (probably aided by one of the pain-killer medications I was on). I was in the middle bed in the room and to further complicate things they would draw the curtains around my bed to provide me 'privacy'. Gulp! My world reduced to an oxygen hose life-line in a coffin-sized enclosure. I had nightmares for a month afterwords.
The medical staff was also not very helpful and in some cases I thought they were just plain rude. For instance, when they came in to give me an injection, a new drip bag, or a pill I would ask what it was and what it was for. I got a lot of shrugs, no lo entiendo, or just no answer. I finally cornered one of the nurses who I knew from outside the hospital (knowing she spoke some English) and ask her why they didn't at least tell me in Spanish if they didn't know the English. She said quote, "They don't want to waste their time when they don't think you speak Spanish". Oh?
Chiriqui Hospital: When the admissions clerk processed me in, she gave me the
option of a semi-private room, which I figured for $50 a day had to be worth it. It was! A large airy room with lots of windows, and just two patients to the room. And as luck would have it I only had two roommates for a total of about 8 hours during the entire stay.
My first visitor was somewhat of a surprise. Dr. Rodriguez brought the head nurse around to meet me. A very nice gesture.
My second visitor was an even bigger surprise. A young lady arrived bedside with a menu in hand so I could select my choices for the next days meals. She also wanted to know which of the daily newspapers I preferred (it would be delivered with breakfast). She said she would also be back in a few minutes – she was going to check to see what my choices were for that evening's dinner. I spent the next 10 minutes waiting for Alan Funt to pop out announcing I was on Candid Camera. Then I started looking for the hidden camera that goes with getting 'Punked'. No,the young lady was for real.
I also noticed immediately that all the medical staff had obviously been trained to tell you what they were doing. "This pill is ----- and it is for -----". It was a very professional touch. It was in a way comical also (once I got well enough to have a sense of humor). When they take your blood pressure five or six times a day, it is kind of comical for the shy little new nurse to approach with the BP cuff in her hand practically whispering, "presión arterial." It had also not even occurred to me, until the maids in Chiriqui Hospital came around every day and changed my hospital bed linens, that I spent a week in Mae Lewis and the sheets were never changed.
I also spent the next few days being introduced to new twists to my treatment – so much for previous experiences being predictive of the treatment you are going to receive. A daily injection into the skin on the stomach to open up the blood veins? A large plunger-like injection of a clear liquid prior to receiving an anti-biotic IV drip – designed to protect the stomach so that the antibiotics did not kill the 'good' bacteria. A liquid added to one of the four daily nebulizer treatments to absorb and expel phylum. On and on …..
Discharge – Time To Go Home
For those of you who have missed the pleasure of this type of lung problem, you need to be aware that you are discharged from the hospital when the tests show that the infection is dead. You are NOT ready for the outside world – or at least that part of the world where there are no oxygen tubes.
But, I knew that going in, so when the doctor at Mae Lewis said it is time to go home, I had, with the help of friends, already had the oxygen delivered to my room at the hotel.
So after seven days in Mae Lewis, I left the hospital on a gurney in the back of an ambulance (with oxygen) back to the hotel. And for about five days I was basically an invalid hanging on to an oxygen line, while my lungs recovered. I weaned myself from the oxygen over about a weeks time. A tough ride made possible by friends and hotel staff that helped me out.
Leaving Chiriqui Hospital was like everything else about this adventure, a different story. I knew I must be going home because when the oxygen tank went empty, they did not come back with a replacement tank right away. Instead Dr. Rodriguez walked in with a big smile of congratulations, a handful of prescriptions and a follow-up appointment slip for next week. I called my friend and he came by the hospital and picked me up. I walked into the hotel and went upstairs to my room. I then did go to the oxygen for about five minutes since I had been without for over an hour. Today, four days after leaving the hospital I still have a couple of time a day when I need an oxygen boost.
I intentionally saved this as the 'punch line' to top off this experience. I was in the Chiriqui Hospital for five hours short of three days (3 days!) and practically skipped down the hallway exiting, requiring neither assistance or oxygen!
And, The Bottom Line
So after all of this, what do the numbers look like? What was the cost difference?
The semi-private room was an added expense for my stay at Chiriqui Hospital and I received several more treatments and additive medications so it is reasonable to expect a higher cost. The final surprise is that there was not a cost difference.
What it worked out to is that it cost, all things considered, almost exactly $500 a day in these two instances. So which one would you pick?
Live and learn – maybe!
Till Next Time. Pura Vida
Recent Comments