South American Healthcare

I have been terrible about keeping this blog updated, but I have had some great adventures. I’m not going to write about any of them right now, though, because I almost died last Monday.

That is a bit melodramatic, and I admit that I used it primarily to grab your attention. However, I thought now would be a good time to update my blog, so that my family and friends have an idea of what has happened.

I spent the weekend in Córdoba, Argentina, with Erin, a friend from my study abroad program. I hunted the area’s world-famous doves and shot 1,302 in two and a half days, but that’s another story (and a happier one—though not for the doves, I suppose).

A teaser for an eventual installment to this blog: "Doves for Love."

We had flown back to Santiago and spent the day in the capital. We had lunch in the Bellavista neighborhood and went to one of Chile’s famous café con piernas. A café con piernas is a type of coffee shop in which the waitresses dress revealingly and cater primarily to businessmen. Though the outfits may have been risqué for Chile, they were hardly racy. The waitresses wore a tight skirt that melded into a long-sleeved shirt. Scandalous. Afterward, we spent some time soaking in the sights in the Plaza de Armas.

At about 9:20 p.m., we were walking in La Alameda Terminal in Santiago and were getting ready to take our overnight bus back to Valdivia. All of a sudden, I felt a sharp pain in my chest and a crippling pressure on the upper-left side. I didn’t know what it was, and I tried to continue walking, but Erin could tell that something was wrong from my gritted teeth and grimace. I refused to let her take my backpack, and we stowed our packs on the bus and actually went to our seats. The bus left on schedule at 9:40 p.m.

Erin called a friend in Valdivia and had her use WebMD to look up my symptoms. Every single result advised me to “seek immediate medical attention.” I didn’t want to go to a hospital for no reason, but I finally relented and told Erin that I needed to go to the hospital, because the pain had not diminished for over a half hour. My left hand had also gone cold, which was frightening. We weren’t sure what it could be, but “heart attack” was never far from my mind.

Erin got to fulfill one of everyone’s life wishes by yelling out, “Is there a doctor in the house?” though in Spanish. Predictably, there wasn’t, but the bus employees came over and talked to me. We told them we needed to go to a hospital immediately.

They waited a few minutes in order to drop us off at their next pick-up site. They had to pick up more passengers anyway, so it was more convenient for them. They told us to take a taxi, because waiting for an ambulance would take too long. I asked them for some sort of help—anything—but they responded with, “Sorry, we have a schedule” and left us on the side of the highway in what we later found out was one of the most dangerous neighborhoods in Santiago. If you would like to personally boycott a Chilean bus company on my behalf, the company that left me on the side of a highway, doubled up in pain, was Pullman Bus.

Erin and I crossed the highway on a bridge, with her lugging both of our packs out in front and me trailing behind, gasping for breath. I had to stop three times on the bridge, in order to breathe. We found a taxi right away, and the driver took us to the nearest hospital. He began winding through darkened streets and through neighborhoods that looked a little flaite (sketchy, with connotations of poverty). Erin and I both admitted to each other afterward that we had been afraid he was going to take us somewhere and rob us.

He didn’t, and we soon arrived at what he assured us was a hospital. The Hospital Parroquial de San Bernardo was surrounded by a flimsy, metal fence whose old, blue paint was chipping away, revealing the rusty metal underneath. We hurried to the front desk, where we told them that I needed help immediately. The lady behind the desk looked flustered and took a copy of my Chilean ID. She sent me back past the desk and told me that’s where the doctor would be.

I looked around in confusion, but no one seemed to be in any particular hurry to help me. I kept asking people for help, but they said that I would get some eventually. It was maddening. Finally, they sent me to a dirty room, where I laid down and waited for help.

Erin came rushing in and told me that they would not do anything unless I paid them upfront, so I gave her my credit card. She rushed to reception with my wallet in hand and quickly brought me back a receipt to sign. I continued to wait, with the unrelenting pressure crushing my chest. I was furious with the absolute lack of hurry or, really, concern. Nurses walked by making jokes and when I confronted them, they seemed offended that I expected immediate help. I don’t mind that Chileans arrive late to social gatherings, but this lack of respect—when I was sure that I was in danger—was infuriating.

We didn’t know how much time I had to get help. The entire ordeal was surreal, partly because—contrary to my expectations of a “hospital”—I was not surrounded by modern medicine. I was surrounded by a filthy white room, with bloody tissues on the ground, a used bandage stuck to the wall, and people screaming out in pain the other rooms. I decided that I had to rely on my own strength and, without knowing whether my condition was serious or not, firmly refused to die. Not knowing was the scariest part.

Finally, a nurse came and gave me an electrocardiogram; she told me the results were good. My heart was OK. I then had to get X-rays. Of course, I had to pay up front and sign my receipt, and afterward, they told me to follow a red line down the hallway by myself and wait outside the door. I did so and had to wait 15 minutes to get the X-rays and another 15 to get the results. As I was waiting on the bench to get my results, a young man about my age was brought in on a wheelchair. His clenched teeth and the sweat on his forehead belied the calm manner in which he was trying to tell his nurse about his injury. I saw a bullet wound in his leg.

While I was waiting for the doctor, the nurses hooked me up to a saline drip. I made sure that, despite the general lack of cleanliness in the hospital, the needles came in a sterile package.

This picture does not do the frantic atmosphere of San Bernardo justice. Neither does it capture the general lack of cleanliness. It was not one of my better moments in life.

The doctor looked at my X-rays and then came to talk to me. He said that I had a pneumothorax, which is “neumotórax” in Spanish. Unfortunately, I didn’t know the word in English, so he had to explain it to me. He told me that San Bernardo was a very poor hospital—which I had no trouble believing—and that I should go to a different one. He said that he could probably stick a tube in my side and drain it there, but I told him I definitely wanted to go to a different hospital.

He called La Clínica Alemana, who told him that they would have an ambulance there to pick me up within an hour. In the meantime, they hooked me up to oxygen and sat me down. I was out of it, but Erin was getting itemized lists of everything they had done and of all the costs for me and my insurance.

While I was sitting in the back room with the oxygen, we heard gunshots outside. Someone ran into the hospital, grabbed Erin’s bag, and tried to run out with it; luckily, she had it around her arm, and they gave up and retreated outside right away. No one in the waiting room moved a muscle to help her. From what she has told me, everyone in the entire room was staring at her, and someone even asked her if she had a lot of money.

This incident is one of the most disgusting aspects of Latin American culture I have ever had the misfortune to witness. Trying to take advantage of someone who is in the hospital—no matter your own economic misfortune—is absolutely repulsive. I realize that poverty breeds desperation and crime, but to try to take advantage of someone in a hospital—where people die all the time and where your victim could be dying—is worthy of a special circle in Dante’s Inferno.

Soon, the ambulance arrived, and they strapped me to a gurney and hooked me up to oxygen. I could tell immediately from their equipment and their crisp, green uniforms that this hospital was worlds apart. As I was being carried out, I heard someone mutter “cuico,” which is a pejorative word that carries implications of being rich, having wealthy parents, going to private schools, and, in some places, being a foreigner.

The ambulance ride was uneventful, and I nearly fell asleep, because I was exhausted. Soon, we arrived at the hospital, and, though I couldn’t see it, Erin tells me that it is an impressive building from the outside. On the inside, the floors go from something like 5 to -4.

A photo that Erin took of the outside of Clínica Alemana, a couple days after I was hospitalized.

They took some of my information and transferred me to a different gurney, while removing most of my clothing. A doctor came to talk to me, and I was thankful at 2 a.m. to hear that he spoke English well. They sent me downstairs to have new X-rays taken, because the ones from San Bernardo were so bad as to be unusable. The X-ray machine in La Clínica was obviously top notch.

A second doctor came in and talked to me—all in Spanish, this time. He told me that I had a pneumothorax, which, in my case, basically means that the upper part of my left lung had collapsed and the air was leaking out, in between my lung and the surrounding membrane. He said that it happens most often in tall, skinny people and that it can happen spontaneously. Since I have no history of lung problems (or, really, health problems) and I do not smoke, he said that my case was likely spontaneous.

My family had found out by this point, so they called me on my Chilean cell phone via Skype and I assured them that I was OK and in good hands.

The doctor told me that we needed to insert a tube that night and that we would discuss my options the next day. So, at about 2:30 a.m., they gave me some local anesthesia in my side and inserted a plastic tube into my chest cavity. They covered my body and my face with heavy, green cloth, but I was fully awake when they inserted the tube. It was painful at times, but more than anything, having someone jam a plastic tube in between your lung and the surrounding membrane is an incredibly uncomfortable sensation.

They finished at about 3 a.m., and everything went well. I was allowed to go to bed, but my mobility was restricted, because I was hooked up to a drainage tube, oxygen, and two IV drips. I slept well, but the nurses woke me up every couple of hours to check my blood pressure, my temperature, my heart rate, and other vital signs.

This photo was taken after the drainage tube was inserted into my chest, but before I had the surgery. Notice that I am still hooked up to oxygen

I got a nice breakfast of tea, juice, crackers, bread, and a muffin, but it took me until about 11 a.m. to eat it, because any movement hurt. I found out that if I kept my left hand above my head, it seemed to hurt less; I think this may have been because it gave my chest room to expand with the tube in it.

The doctor came in and explained my situation. He said that if I wanted to live a sedentary lifestyle, simply draining my lung would probably be OK, but if I wanted to travel, play sports, or hike, I should have the surgery. Without the surgery, there is a 35 percent chance that this will happen again; with it, the likelihood drops to under 1 percent.

I agreed, and he said I would undergo surgery at about 4 p.m. that day. I couldn’t eat or drink anything until then. I passed the day in my bed, without much movement, but with Erin keeping me good company. Laughing hurt with the tube in my chest, so Erin’s perennial good mood and sense of humor kept me clutching my side—literally.

I talked to my parents before going into surgery and assured them that this was one of the best hospitals in Latin America and that Santiago was one of the best places for me to be on the whole continent. Erin also talked with Raquel, the director of our study abroad program, and many other people.

At almost 5 p.m., someone came into my room to bring me to the operating room. We arrived quickly at an upper floor, and I said goodbye to Erin.

The doctors helped me move off my bed and onto the operating gurney. He told me that he was going to put me under with general anesthesia. He warned me that first, I would get dizzy, then sleepy, and then I would be out. I laid back, surrounded by high-definition TV’s, bright lights, and shiny metal equipment. The Spanish chatter around me slowly muted until I drifted out of consciousness. Being put under was much more interesting when everyone was chattering away in Spanish; it required unconditional trust of a group of doctors and nurses in a foreign country I’ve lived in for only three and a half months.

I woke up about an hour later with all of the nurses and doctors staring down at me. It appeared that they had been waiting for me to wake up at a predetermined time. They put an oxygen mask on me, lifted me onto my bed, and moved me to the recovery room. If speaking Spanish in Chile is difficult to begin with, speaking it after just having had a major surgery and while still highly sedated is much harder still. I was still fairly lucid and asked if everything went well, and they assured me that it did.

I spent two hours in the recovery room and remember wanting nothing more than to continue sleeping, but nurses kept coming in to check on me and take my vital signs. It seemed like 20 minutes instead of two hours.

I returned downstairs to my room and got to eat dinner. I talked with Erin, but was still in quite a bit of pain and discomfort. Raquel, my study abroad program director in Valdivia, had traveled to Santiago to help me.

Erin keeping me company, while I ate my dinner.

Throughout the night, I talked with my family to assure them that the surgery went well and that I was OK. The nurses came in to check on me every hour or two, and Erin stayed on the foldout couch next to my bed.

The next morning, I was feeling better and ate another breakfast of juice, bread, and muffins. One of the nurses helped me take a shower and wash my hair, so I felt much better after that. I was allowed to get up out of my bed and take a couple walks as well. Throughout the day, two kinesthesiologists visited me and gave me a mediciser—a plastic box with three balls in it. I had to blow in through one end and get one, two, and three balls to rise at different times to exercise my lungs.

I was doing better by lunch and was pleasantly surprised to see that the hospital even brought me once (afternoon tea) before a decent dinner. The pain had diminished significantly by the end of the day.

Wednesday night, the nurses came in at 2 a.m. and 6 a.m. and made quite a lot of noise, turning on all of the lights. I woke up at about 9:30 and ate the breakfast that had been left for me. I did much better that day. My therapist told me not to stay in bed all day, so I took occasional walks and sat up on the couch, writing. When I breathed deeply, I still had some discomfort, and I had some pain still when I coughed, but when I just sat or walked, I felt pretty well. I ate without problems and had a good appetite, despite not doing much. I also was able to use my left hand better; at first, it hurt to move, because the drainage tube was in my left side.

On Thursday, I was given even more mobility and took a number of walks with my kinesthesiologists and on my own. I spent that day up and out of bed as well, as they had encouraged me to do. I was still attached to the drainage tube, and nurses would come in occasionally and make me cough in order to expel more fluid.

The machine that drained my chest. For your sake, I chose a picture before it was full of liquid.

I spent all of Thursday up and "about." I wore the green smock to leave my room and go for walks through the halls. I had to ask the nurses to unhook my from the wall, because my drainage tube and my IV drips were still in place.

Keeping a positive attitude, before the chest tube was removed.

Finally, the doctor showed up that afternoon and announced that they were going to take the drainage tube out. Raquel and Erin joked that they would just yank it out of me.

After another wait for the doctor, he came back in with a few nurses and they prepared to remove the tube. I stayed on my bed, and they prepared everything off to the side. The doctor told me that what he was going to do wasn’t going to hurt, but that what the nurse was going to do would hurt.

With this deliciously vague explanation, he told me to take in a big breathe of air and slowly expel it. I did so, and, as I was breathing out, he yanked the tube out of my chest. The nurse had been waiting for this and quickly stitched me up in a matter of seconds. Having a plastic tube pulled out of my chest was an incredibly uncomfortable and strange feeling, but it was not particularly painful.

I spent the rest of Thursday with Erin and Raquel, until they had to leave. Friday passed slowly in the hospital. I spent that day alone, but the nurses came in to check on me often. They were all very sweet to me and loved getting me to speak Spanish to them.

I feel incredibly lucky to have been in Santiago when this happened. If I had been in a more remote part of Chile—or many other countries in Latin America—this would have been much more dangerous. I am also incredibly lucky to have been traveling with Erin, who took excellent care of me and alerted my family, friends, and study abroad advisors to my situation.

Since looking at this as a life-threatening surgery in South America with my family literally a continent away (not to mention visiting a hospital in one of the most dangerous neighborhoods in Santiago), is obviously far too serious to be good for my health, I have developed other ways of looking at it. More than anything, I am trying to look at it as a cultural experience. I got to see one of the poorest hospitals in Chile and one of the best. I heard gunshots outside a hospital and had a major surgery in South America, and Erin and I did it all on our own.

I also view it as a test of my Spanish abilities. If I can successfully communicate my symptoms and get adequate medical care (not to mention a major surgery), my Spanish can’t be that bad, despite any grammatical slip-ups I may make.

I am not a melodramatic person, but I will admit that the thought of “death” flitted across my mind once or twice—especially in San Bernardo. I wished that my family could have been with me to help me. Despite the seriousness of the situation, I was determined not to let those thoughts occupy my mind. With Erin’s help, I kept a positive mood and tried to laugh about everything I could, as can be seen in a picture one of my friends christened “The Rocky Horror Hospital Show.”

"The Rocky Horror Hospital Show" came to Santiago de Chile. Lock up your daughters: No nurse is safe from my charm.

I don’t feel as unfortunate as some people seem to think I was: I just kept going and doing what I needed to do to fix what was wrong—nothing more and nothing less.

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