Saturday, February 9, 2013

Recovery In The Recliner......

Today is the first day of Carnival here in Panamá, the biggest celebration of the year.  Businesses are closed down for the four day, pre-lenten celebration that's evident throughout the country.  But for us we'll  be hanging close to home as I recover from surgery.

Apparently, Clyde is dreaming about Carnival Queens


Lounging on the reclining sofa with my legs propped up and laptop on my legs, the past week has been a roller coaster of emotions.  The whole thing started when I decided it was time for my annual checkup of the lady parts and decided to try out a new clinic near the beach town of Coronado.  The results of the pap test showed abnormal cells growing in my uterus that were pre-cancerous in nature. Since I had the exact same results pop up about eight years prior to this appointment, before we even went to talk to the doctor my mind was made up.  I had decided that IF one of the choices was a hysterectomy I would certainly choose that option.  After all eight years ago I was told by my doctor in Texas after he scraped out the cells in a D&C procedure, that "these things CAN come back."  He instructed me to never skip a pap just in case, so I've never let a year go by without having one.

So here we sat before my Panamanian gynecologist who presented me with two treatment options.  One was to treat the pre-cancerous cells with creams and pills for one month and then re-test.  The other option was a hysterectomy.  I chose the later and we proceeded to contact our insurance broker in Panama City about our insurance coverage that we purchased through her.  Assuming that the insurance would cover the surgery without a doubt, but we were soon told differently.  Our agent Priscilla explained that the insurance would not cover this procedure until I was on the policy for at least ONE year, and then it would need to be pre-approved.  As of February 15th I would have been on the policy for one year, so all seemed good there.  But then Priscilla told us to wait another month or so, just to be sure the insurance company didn't think we were waiting until that one year period was up to get them to pay for major surgery.  And then the doctor would have to submit for a pre-authorization first, after which the insurance company would probably want a second opinion. 

The doctor on the other hand felt that the surgery needed to be done as soon as possible, because pre-cancer could turn into cancer.  Also he said that insurance companies have doctor's on staff and that doctor would realize that this condition didn't develop overnight which made it a "pre-existing condition" which they also didn't cover.  So at his recommendation we decided to self-pay for the surgery as not to jeopardize my health any further.  I also had that female "gut feeling" that the surgery needed to be done now, and not in a few months.

Since  I'm no stranger to surgery as I've had many in my lifetime, I certainly wasn't afraid of a surgical procedure. But I was afraid of what it would be like in a foreign country where I didn't fully understand the language.  Although we've heard many wonderful stories about health care here in Panamá, this time it would be my story and that was the scary part.

Hospital Nacional in Panama City, one of the older hospitals here

On the morning of February 6th we made our way into Hospital Nacional in Panama City around 9 am as instructed by my doctor.  We were sent to "admissions" where we were immediately attended to by a Spanish speaking women.  Just like in the states she asked me a bunch of standard questions and I signed some papers.  Once done I was sent to "recovery" which turned out to be a large room full of beds like many I'd seen in the states.  This room resembled a "day surgery" or "recovery" unit where a dozen beds divided by curtains are centered around a nurses station.  I signed in with the nurse who told me in Spanish that my surgery was scheduled for noon and I was to have a seat in the waiting room.

The lobby made us feel like we were walking into a
four star hotel instead of a hospital.

So we played the waiting game for several hours in a crowded, over-air conditioned room full of people waiting for their loved ones having surgery.  Several families nearby had balloons and flowers announcing "it's a girl" or "it's a boy" in  English....apparently waiting for babies to be born.  Clyde instructed me that I was definitely NOT to come out of surgery with any little critters, and we laughed to lighten the mood.

A view of admissions office in the background and a statue of hyppocrates on the wall.

Finally around 11:30 am I was called by the nurse.  I kissed Clyde and left him behind in the waiting room, nervous about the story that was about to unfold.  The nurse took me into a little room where she handed me a gown to change into.  She explained as she handed me little blue covers that they went on my feet and head, just like in past surgeries I'd had in the states.  I put my clothes in a bag and was escorted into the big room and over to one of the beds.

Another view of the entrance to the hospital with
the "By-Pass Cafe" to the right



Clyde ate a few meals here


The bed was covered with bright, mint green sheets with an aqua-emerald green pad in the middle of the bed.  Once I laid down I was covered with a fluffy light green blanket as the room was frigid.  The staff was dressed in similar colors of light green and dark greens giving the room a pretty glow, instead of the stark white usually seen in the U.S. Over the next twenty minutes someone came over to start an IV, a few other people asked me questions which I tried to answer in Spanish. My vital signs were checked and eventually I was wheeled over toward the door, as if it was time for my surgery.  As I laid there I recognized the familiar face of my doctor walk into the room still wearing street clothes.  He came over to chat and handed me a paper to sign before walking away to scrub for surgery.  An attractive Panamanian women in a brown business suit approached me carrying a clipboard.  She said something to me in Spanish which I didn't understand and I looked up and said "que?"  She asked in English if I understood Spanish and I said "un poquito." 

Because I've had gastric bypass surgery for weight loss nine years ago, we've always been instructed NOT to use aspirin or any type of NSAID drugs.  So my doctor knowing this wrote down that I was "allergic" to aspirin and I was given a bright, red wrist band to wear indicating the drug allergy.  This seemed to freak out one of the nurses because when she asked "was I allergic to anything," I said, "no."  I  tried to explain in what little Spanish I remembered being nervous that it wasn't really an allergy, but instead was more of a preference because of my stomach which was different. 

The Panamanian women in the business suit standing next to me introduced herself as the anesthesiologist.  I asked her if she understood English and she seemed to indicate that she did, so I explained the thing about the aspirin and gastric bypass to her, as best as I could.  She left and eventually I was wheeled into the operating room.

Once inside the operating room I noticed that everyone was dressed in dark green scrubs with light green covers on their heads and feet.  I recognized my doctor who waved as I was rolled by and lined up with the operating table.  Someone instructed me to slide over onto the operating table as someone else began to remove one arm from the gown I was wearing.  She began to apply leads to my chest which would be used to monitor my heart rate.  The anesthesiologist was behind my head and she fiddled around with the IV starting to give me medication to put me into dreamland.  My doctor leaned into me and said "go to sleep," as did the anesthesiologist behind me.  It took a few minutes and suddenly I felt a bit drunk and drowsy and commented to my doctor that "it was a good margarita they were giving me," to which he laughed and told the others in Spanish. 

Next thing I knew someone was saying "Teresa" in a Spanish and I was back in the recovery room waking up from surgery.  Soon after I was wheeled down several long hallways and into a room where the stretcher was lined up next to a bed.  There was a male and female nurse nearby and they smoothly slid me over onto the hospital bed using the sheet that  I was lying on.  Clyde showed up and we suddenly realized that this is where we'd spend the next few days.

The walls of the private room were painted white and a 19 inch, flat screen TV was perched high in the corner.  A large window was dressed in blue and gold curtains which hung under a padded blue, floral cornice high atop the window.  In the middle of the cornice was the hospital emblem "HN" in a metallic, gold round piece.  To the right of the bed was a blue leather rocker, recliner which sat next to a blue leather couch wide enough for someone to sleep on.

Window in my room which had a sun shade on it too

The bed before they put me into it


This is where Clyde slept!

Clyde told me that the doctor came out and spoke to him after the surgery, pulling out his cell phone to show him some photos.  On his phone he showed Clyde a picture of exactly what he removed from my body.  A picture of a bright red uterus, next to a round, red, ovary and a shriveled up fallopian tube sat nearby.  My cervix still attached to the uterus was also visible in the photo.  The doctor explained that he found a cyst on one of my ovaries and removed it, but left the other ovary in place so I'd have some female hormones being produced.

I've never seen a fridge in a hospital room before.  It was neatly tucked away in the closet like in hotel rooms.

To my amazement it was already after 4 pm when I made it to the room.  Since I didn't have anything to drink or eat since the night before, my throat was dry and scratchy. Clyde asked the nurse if I could have water but was told not until 7 pm, so I'd have to wait.  It was after 7 pm when someone came in with a tray from the cafeteria.  On it I found the typical after surgery meal of clear chicken broth, green jello, iced tea and a pitcher of water.  The water tasted so good and I really had no desire to eat anything, but eventually managed to eat a few spoonfuls of jello.  I downed much water the rest of the night especially since I still had a urinary catheter in place and I knew I wouldn't have to get up to use the bathroom.

Hallway of Hospital Nacional, looks like any other hospital



Just like in any U.S. hospital, all through the night staff came in to check vital signs, give me pain meds and bother me every time I managed to fall asleep. In the morning the catheter was removed as my doctor had told me days before that I would be able to get up and use the bathroom.  Nothing else was said about whether or not I should or should not get up and walk around.  After other surgeries I was always encouraged to get up and walk as a way to aid in recovery.  We waited around until sometime in the afternoon for my doctor to show up.  My incision was tender but I really wasn't feeling much pain and later on decided to get up and walk, with Clyde close by of course.  After walking around the room a few times later on I wanted to venture out into the hallway.  We walked down the hall and passed the nursery and neonate unit full of screaming babies.  As we headed back to the room the doctor showed up and his mouth dropped open in shock.  Here I was not even 24 hours after major surgery walking the halls, standing upright and feeling little pain.  He encouraged me to get back into bed and take it easy for the rest of that day, and said I was free to walk as much as I wanted to next day.

A seating area at the end of a hallway where
Clyde waited for me to come to the room


My surgery was on Wednesday and I was supposed to stay in the hospital until early Saturday morning.  My doctor assured us that he would release me very early on Saturday so we could get home before the Carnival crowds filled the highways.  But since I was doing so well on Thursday, when the doctor showed up around 8 am on Friday he told me to go home, and he'd see me in his office on February 19th.  And then just like in the states we sat around for hours waiting for the staff to bring in the discharge papers.  Eventually Clyde took action and went out to speak to whoever was working on my orders.  He received an itemized bill of everything that they used on me while in the hospital and the total bill came to around $4,600 a bit more than we'd expected.  But I did request a private room which cost more too. 

I was given NO discharge orders at all, just a prescription for the local version of Tylenol extra strength along with an anti-inflammatory drug to use for the next week.  It's SO good to be home and so much more comfy recovering in my own personal space than in a hospital bed.

One of the reasons that we choose to retire to Panamá is that the health care is as good, if not better than the U.S. health care system.  So how did it compare?  A total abdominal hysterectomy in the U.S. costs between $30,000 and $40,000 for one night in the hospital.  Here it cost $4,600 for two nights in the hospital.  We paid the doctor $2600 for him and the rest of the operating room team including the anesthesiologist.  After we added it all up, my surgery and stay in the hospital came to about  $4784.00

The hospital food here was ok and one of those things you eat, just because it's there and you're hungry.  Breakfast was some type of bread, not toasted along with a cream of corn cereal with much added sugar.  Clyde and I were able to share the bread and I enjoyed the bowl of fruit that came with it, along with either eggs one day or a slice of turkey breast the next.  We both passed on the sugared corn-meal type of cereal along with the sweetened juice drinks.  For lunch one day I had chicken breast with mashed potatoes covered in white sauce.  Along side was a pear in a creamy heavy syrup, and a bowl of carrots along with chicken soup.  For dinner some beef cooked with tomatoes and onions alongside white rice.  On the side another bowl of chicken soup, fruit and veggies.  I picked the healthier of the foods to eat and left the rest since  I didn't have much appetite anyway.

Lunch anyone....chicken and mashed potatoes covered with white sauce.  Carrots, a few potatoes mixed in, chicken soup, and a pear in creamy, sweet sauce along with a juice box of apricot nectar.  And they brought an insulted pitcher of ice water with each meal that I really enjoyed!


Due to the language barrier the staff who spoke NO ENGLISH at all seemed to leave me alone, except to tend to their normal tasks.  Each person seemed to have a different job to do and they knew it and did it well.  One person came in to check my temperature and pulse.  Another came in to take my blood pressure while still another came in to administer medication.  Someone else emptied the catheter during the first day, while another person emptied the trash.  While I was in the shower someone came in to change the bedding and once I was back in, bed a janitor came in to mop the floors.  I will say that since my feet were cold I walked around with white socks on one day and the  floor was so clean that the socks didn't even look dirty.  As I walked more, I switched to slippers which also served to keep my feet warm.  The room did have an air conditioner along with a thermostat that we were able to control. 

In general the hospital seemed just as modern and updated as any U.S. hospital I've been in.  The equipment was just as good but there seemed to be a whole lot more people on staff than I've seen in any U.S. hospital.  My hysterectomy was done "open" with about a 4 to 5 inch incision.  Had this been done in the U.S. it probably would have been done laproscopically.  Here in Panamá my doctor explained that lap surgeries are more costly.  So although my experience was a good one, I hope to not see the inside of a hospital in Panamá or anywhere else for a long, long time. 
And now I'm on the road to recovery and healing nicely, at home....along the gringo trail.

1 comment:

  1. Interesting post. It sounds like your experience went as well as it could have in any US hospital, and for a fraction of the cost. Glad you are feeling so well so soon.

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