Rule Number One

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The list of items to bring Eric in the ICU included sheets, soap and toilet paper.  This freaked me out more than the phone call letting me know he was in a Colombian hospital.   In my Amero-centric view of healthcare — one that emphasizes sterility above all else and technology as cure-all —  these items shouldn’t be left to family discretion (and laundering skill).

Eric has broken Rule Number One of this trip, which is: Never require Colombian medical care.  This trumps Rules Two and Three (“Avoid involving the police” and “Never need embassy intervention”) not because Colombian healthcare is bad per se — there is significant medical tourism in big cities like Bogota and Medellin, but possibly not as frequently at the dingy Clinica Mar Caribe in this poky little seaside town — but because of the need to handle something urgent and critical by myself and in a language that I do not speak at all when I’m upset or scared.  Nothing of meaning goes in, and nothing of use comes out.

But he’s home now, and shows no signs of sepsis or other scary hospital-borne virus (at least not yet) and so the whole experience can begin to fade into an amusing anecdote to entertain friends with later.  Besides providing fodder for every petty marital negotiation for the next forty years — “As long as you don’t end up in a Colombian ICU, okay?” — this “adventure” also illustrated the cultural relativity of health care values.  Which is a fancy way of saying, “Damn, it’s different here.”  How so?  Glad you asked…

HIV isn’t a thing here.  I mean, of course it’s a thing here, but their infection prevention tactics are (ahem) lacking.  The nurses place sharps in the biohazard bucket, but then the cleaning lady dumps everything in one big trash can and wheels the cart into the elevator.  And they fill blood vials by hand, needle facing their skin.

The ICU ExperienceGrinchAnd then! Oh, the noise! Oh, the noise! Noise! Noise! Noise! There’s one thing I hate! All the NOISE! NOISE! NOISE! NOISE! … They’ll blow their floofloovers. They’ll bang their tartookas. They’ll blow their whohoopers. They’ll bang their gardookas. They’ll spin their trumtookas. They’ll slam their slooslunkas. They’ll beat their blumbloopas. They’ll wham their whowonkas.

“Patient-centered” isn’t a thing here either.  A significant portion of my real job (when I’m not lounging on tropical beaches and navigating immigration mazes) focuses on improving the patient experience, a.k.a. making the system work better for those who are stuck in it.  Anticipating patient needs.  Removing barriers.  Making the whole interaction with the Health Care Industry more comforting/healing and less scary/annoying/baffling.  That sort of stuff.  This “patient-centered-ness” concept hasn’t made it to Clinica Mar Caribe yet. The staticky TV played a continuous stream of Good Friday-themed movies, because nothing says, “Rest and heal” like graphic portrayals of Romans whipping Jesus thundering through your room <sarcasm font>. The ICU bathroom is in the janitor closet, between a ladder and mop.  The toilet has no seat and you have to step over a bedpan to get to it; apparently, most ICU patients never leave their bed.  Not once did someone ask Eric how he was feeling or if he needed anything; just a vital check and out.  And the all-night noise! In the end, Eric MacGyver-ed an earplug out of his oxygen mask.

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Through the grimy sea-themed glass, you can see the security guard blocking the way of family members locked outside, and a man hunched down talking to the medical records-keeper through a window designed for toddlers, or midgets.

There’s no Colombian HIPAA, or fire marshal? The walls between ICU beds were glass and the doctor was happy to tell Eric’s dive instructor anything he asked.  But to pass through any door — including the emergency exits — you had to knock and wait for a heavily armed security guard to undo the deadbolt, shift the door open just 1.1 centimeters wider than your body and allow you to squeeze out. But they leave their clipboard listing all patient names on the glass door, for convenience and so we can all see who’s in there.

Family-friendly isn’t a big concept either.  Visiting hours are from 11:30 to noon, and from 5:30 to 6pm sharp.  There are no chairs or other accommodations in the ICU for family members.  That is, unless you happen to look in imminent danger of passing out because your husband is pale and hooked up to a million tubes and hospitals aren’t really your thing and semi-rural Colombian hospitals with their peeling linoleum and dirty food trays are really not your thing; then a chair is produced. If you would like to know if your loved one made it through the night, you present yourself at the front door at 6:45am — exactly — get checked in by the security guard, make your way to a waiting room without chairs and the lights inexplicably turned off, lurk until the ICU nurse opens the door and a scrum of family members press toward him. He then allows one person at time into a dim vestibule to provide two lines of update and you leave straight back through the crowd of other anxious family members, preferably not hysterical over what you just heard.  The upside of this drill of multiple visits was the opportunity for me to explore eight different routes to the hospital and have eight different Easter-themed conversations with taxi drivers, all of which circled back to, ‘What’s up with that Easter bunny thing?”  Other, poorer families or those who live far away just sit on the steps outside the hospital for days.

They are overly cautious.  Eric really didn’t need to be in the ICU.  When the night-shift came on, Eric had unhooked his various monitors and was doing some yoga (try to erase the image of him doing this in a hospital gown); they appeared perplexed.  This may explain why they fed him pulled-chicken on white bread and coffee for dinner.  Also why they ignored the beeping and binging from his monitors as his antics turned them yellow and then a frantic red.

Why, yes, that does say that his chest x-ray cost $25.

Why, yes, that does say that his chest x-ray cost $25.

But the most startling difference between this experience and any medical experience in the US was the final bill.  USD$549.92 for an overnight stay in an ICU.*  Maybe it’s that list of “discretionary items” — the mouthwash and paper cups — that causes US health care to be so expensive.  Maybe if we asked families to bring a roll of toilet paper and a bar of soap for their loved one — sort of like teachers who have to send home a classroom wish list of items like antibacterial wipes and reams of printer paper — the average hospital stay wouldn’t cost a year’s wages. But I doubt it…

*Of course, getting that final bill has taken three additional trips to the hospital after discharge (so far), and we still haven’t received our refund on our credit card deposit. But they printed his medical records out instantly (and for free) when we asked.

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That small bench is the only place to sit near the ICU. The Home-Depot door barring entrance was propped open with a folded piece of paper. And yes, you must crouch down to discuss anything through that window, which I’ll admit I never saw open.

Curious what actually happened to Eric?  He explains the technical stuff here.  The non-technical stuff is that he’s done free-diving for a little while and may not be going that deep for a while longer — or until we’re back in the US, or ever, depending on how negotiations go in our household.

I’ve wanted free-dive for a long time.  The warm, calm Caribbean waters are an ideal place to learn.  The two things that most people (including me) think will limit the depth of a free dive are (1) how long you can hold your breath, and 2) how easily you can equalize your ears and sinuses (that uncomfortable popping sensation most of us get on planes).  But there is an insidious third limit that isn’t immediately obvious to the uninitiated and those new to the sport  — it’s called a squeeze.
When you go below 40 meters, the pressure is 5 times higher than at the surface so your lungs shrink down to 1/5 their size.  The alveoli are generally ok with this, but the cartilage-filled trachea and the bronchi are less so.   The negative pressure (especially when combined with quick movements or twists) can cause capillaries to break leaking some blood into your lungs.
Surfacing short of breath and coughing up blood was probably one of scariest experiences I’ve had in my life.  My passion for the sport hasn’t waned, but I’m looking forward to two more months of enjoying it, rather than racing to new depths.
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