Tuesday, April 20, 2010

Our Mexican Medical Adventure

“I thought he seemed pale.” That’s what our San Pancho friends said later. Probably out of politeness no one said anything at the time. I thought he looked pale, too, but we had just arrived from overcast Connecticut, and I chalked it up to lack of sun. We had no idea that a serious medical problem was brewing.

During the next ten days Skip felt tired, then lightheaded and dizzy. We called his internist in Connecticut. “Better get him evaluated,” the doctor advised. Though we didn’t know what was wrong, we suspected the problem might be more than the small hospital in San Pancho could handle. AmeriMed in Puerto Vallarta advertises that they provide “full medical services based upon U.S. standards of health care” and that their staff is bilingual, so off we went.

Lab work revealed that Skip’s blood count was dangerously low. He needed a transfusion immediately. The doctor ordered two units of blood and called in AmeriMed’s gastro-intestinal specialist to do an endoscopy, on the hunch that intestinal bleeding might be causing the blood loss. He discovered stomach ulcers we hadn’t known about and showed me the images on his monitor. He even gave us a DVD of the procedure.

Medicare doesn’t cover anything outside of the U.S., the out-of-pocket costs were mounting, and we wanted Skip to be treated by doctors who already knew him. So we decided to return to Connecticut. After lots of blood work, more transfusions, another endoscopy and other tests, the Connecticut specialist had no conclusive explanation. “I question whether those small ulcers could have caused so much bleeding,” he said. Nevertheless, after a month Skip was fine: no symptoms; blood count normal; no more pallor. The doctor cleared him to return to Mexico, and we booked the first available flight.

Health problems will inevitably arise for expats in Mexico, especially those of us who are of Medicare age. Sometimes the solution is clear. For minor problems we can go to the hospital in San Pancho or to one of the English-speaking doctors in the area. The time I nicked myself with garden shears I got a free tetanus booster in five minutes at our village hospital. If one of us had to be hospitalized for an emergency, we would use our MedJetAssist plan to cover air medical transport to a U.S. hospital.

However, there is a confusing middle ground, as in our situation. The problem isn’t minor, and yet it doesn’t require hospitalization. We have asked ourselves many times, "Did we do the right thing?" We wish we had noticed Skip’s symptoms sooner, but sometimes they take awhile to crystallize. Language becomes a factor. The doctors at AmeriMed spoke English, but the nurses and technicians typically didn’t. We muddled through, because a lot of medical words in Spanish are the same as their English versions, but pronounced in Spanish.

In the U.S. we are accustomed to a large university teaching hospital minutes from our home. In the midst of the crisis we were comparing AmeriMed to Yale New Haven Hospital—not a fair comparison. AmeriMed wasn’t world-class, but the staff was resourceful and they got the job done. The transfusion pump, for example, didn’t work and neither did the replacement. After a lot of tinkering, the nurse improvised a solution: He tied a blood pressure cuff around the bag of blood to prime the pump, blood began to flow, and the transfusion proceeded. When Skip had another transfusion in the U.S., the pump was the same type as AmeriMed’s, but in that high-tech, expensive hospital I noticed with some relief that a sign was attached: STOP! If pump fails for any reason: REMOVE from patient immediately; TAG unit as “out of order”; CALL Clinical Engineering Department.

Since this episode occurred, I examine Skip for signs of pallor, and I ask intrusive questions about bodily functions. But, except for noticing symptoms sooner, we would not have done anything differently.

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