…the unexpected, yet inevitable medical emergency. After announcing to friends and family that we decided to live full-time in our Costa Rican home, one of the FAQ (frequently asked questions) is, “where is the nearest hospital?” In my younger decades, the location of the nearest hospital was the least important. I was more concerned about where was the nearest subway, what is the travel time to work, the nearest grocery store, restaurants, bars? As my social circle has aged, access to doctors, clinics and hospitals is an important factor.
M has visited this area since 1998 and access to medical attention was even more remote then it is now. On my first trip in 2015, I was sitting on the terrace of a friend’s beach house enjoying my coffee and the sunny warmth of the morning when a older man wearing board shorts and pushing a bicycle equipped with a surfboard carrier and surfboard entered through the gate. Kenny, who was the other side of 70, was returning from the beach after a mostly successful surf session. Chatting with us, he was pretty pumped at a couple of waves that he rode. Then he casually mentioned that he crashed out and may have cut his back. Asking if we could take a look, he turned around and revealed a 6” long gash in lower left area of his back just above his hip. It was more of a flesh wound as it wasn’t bleeding much. A conversation ensued on the merits and necessity of getting stitches. There was no urgency in the tone of the conversation and it was generally determined by the 3 surfers (I’m not including myself) that stitches would be a good idea. Living locally was a retired medic, Rooey, who could be called upon. A cell call was placed, a message left for Rooey and Kenny said that he’d keep walking up the road towards his place. The emergency, non-life threatening, medical system at work in the Southern Zone.
M and I have been fortunate in maintaining good health. About a decade ago, I had an attack of appendicitis, drove myself to the hospital in Monterey and it was removed a few hours later. In the year before I met M, he suffered a slipped disk that almost incapacitated him. With excellent physical therapy and positive meditation, he fully recovered without the need for surgery. I take a low dose thyroid pill daily and M needs no regular medication. Therefore, we are satisfied that there is a doctor with a private clinic attached to a pharmacy in a small town about 35 mins drive. The couple of times that we’ve visited Dr. Andres, he is immediately available. Since we received our Residency cedula (ID cards) and are paying a monthly fee for the “Caja” (national health insurance), we can go to the pubic clinics and hospitals for medical attention.
Life-threatening emergency medical attention is problematic in our rural, coastal area. Our friends and closest Gringo neighbors, Mike and Nina recounted their story. A few years ago, Mike was replacing some boards on his 2nd story deck and early one morning, (as men are wont to do) he went out on the deck to urinate. His repair was almost complete but he happened to step in the one area that was not secured and fell through. He was hanging on to the edge of the deck by one hand for a brief moment and then dropped down the 15 feet to the gravel driveway. The fall fractured his leg and hip. Screaming for help, he woke up Nina, she called neighbors and they fashioned a backboard to place under him. There was discussion of calling an ambulance. That would take at best 1 hour and realistically 2 or more hours and the ambulance would only take him to the hospital in Golfito. The public hospital in Golfito (1 hour drive) has a varied reputation. Some people, Gringos and Ticos think it is good. Others say that friends and family have gone in and became sicker. Mike and Nina opted to drive to the public hospital in Cuidad Neilly, (1 hour 15 mins drive) a town on the Inter American Highway going north towards San José. Mike was in severe pain and riding in the back of a pick-up truck with the first 10 miles of bumpy, gravel road required a good portion of bottle of whiskey. He didn’t pass out completely due to the intensity of the pain but the alcohol helped somewhat. The doctors determined that they were not equipped to handle Mike’s condition. He and Nina decided to transfer to a private hospital in San Isidro (a small city in the mountains, a 2.5 hour drive from Cuidad Neilly.) Nina found a taxi driver with a large van that could accommodate a gurney and they took it up to the private hospital. Mike spent six weeks in the hospital there.
The other horror story occurred when Canadian friends who own a home but don’t live here full-time had other Canadian friends visiting. Dave, after multiple warnings from Beth to NOT urinate off the edge of the deck at night, proceeded to and fell off. Beth’s husband Brad is an EMT and determined that Dave had severe injuries. Dave’s wife had excellent Canadian medical insurance through her employer. They contacted the insurance company while Brad fashioned a backboard. Put Dave in the back of the pick-up truck and drove to the Golfito hospital. They chose the Golfito hospital because there is an airport in the town. He was stabilized in the hospital while they waited for the air ambulance to fly him to CIMA, an excellent hospital in San José. Neither Beth or Brad speak Spanish. Their niece Coco was with them and she speaks some. Beth was grateful to a young man who was a janitor at the hospital who had lived in the US and spoke English well. He acted as translator and was a kind and helpful man during the extreme stress of the situation.
Our small Gringo community communicates any medical emergency stories so that we all have as much information as possible in case any one of us has a problem. With all this in the background, we were barely prepared when on the last day of my Dad and Gitte’s 2 wonderful weeks vacation, the left side of my Dad’s body went numb. He was getting out of the 4WD after body surfing at the beach. Being dehydrated from 2 hrs in the ocean among who knows other factors, by the time we had returned to the house, he had lost use of his left leg and arm. He recovered after hydrating and wanted to see how he felt after a nights sleep.
My Dad is 85 and athletic. He plays golf and hockey (more like skating up and down the rink while passing the puck) and we went snorkeling earlier in the week. On the downside, he has always had very high blood pressure and diverticulitis. The numbness passed within 15 minutes, he lay down for a nap then got up to eat dinner. We weren’t too concerned. They were scheduled to fly out of Golfito the following morning. Dad got up, had some breakfast and had a 2nd “attack.” M the most clear thinking of all of us, looked the symptoms up online and determined that Dad was having a stroke.
Rapidly packing, we set out taking the road to the border where we could head to Panama and twenty minute drive to the hospital in David. After filling the gas tank and assisting Dad to the baño, the Gitte and I decided it would be better to stay in Costa Rica and find a hospital. If you want to know about crossing the border, read my blog entry. Friends told us that with medical emergencies, the Panamanian side will wave you through without delay. Against M's desire to head to Panama, we made a 1 1/2 hr drive to a hospital that was recommended by a Mike and Nina on the Inter American Highway towards San José. They took him right away but the doctor was on lunch break, after taking vitals and following protocol of a blood test, x-ray and arterial scan, they admitted him for observation. We were staying the night in Cuidad Cortes. The doctor recommended a small hotel near the hospital but it was booked. Thank goodness for booking.com, through it we found a lovely place to stay.
During the night they transported Dad to the San Isidro public hospital in the mountains (an hour drive.) M’s cell phone was the contact and it had run out of juice and was recharging when they tried calling. We didn't get the message until the following morning when we arrived at the hospital in Cuidad Cortes and discovered that Dad wasn’t there. The unsettling issue was that no one at the desk knew who he was or where he was. The shift had changed since his departure. We knew that he was in a hospital somewhere because as M was parking the car, he received a call from a nurse saying that the doctor was going to see Dad soon.
An hour driving up to San Isidro on the narrow and winding road with steep drop offs around some turns, M knew that the steering pump was very low on fluid. Around the sharp curves, it was making strange noises. It didn’t help the anxiety level. M dropped Gitte and me off at hospital entrance while he headed for repairs. Luckily it was just a matter of fluid replacement for the car (not my Dad.)
Meanwhile Gitte and I entered a maelstrom of people. It was 8:30 am on a Monday morning, the banks of chairs in the waiting area where at least 100 people were sitting was next to 4 long, snaking lines of people lined up to speak with the staff behind the glass windowed reception area. We were dumb-founded. We decided that we couldn’t wait in line and we knew that Dad was under the care of the neurologist so we went in search of his office. All along the corridors were service windows with people waiting in lines. We found the neurologist’s office and the service window next to it only had 1 person waiting. I asked the young man in my broken Spanish where I’d find my father. He told me to go to Admissions (aha!) At Admissions, I walked up to a window with a nurse behind it who was busy doing paperwork. I tried getting her attention without being an ugly Gringo. With no luck at being subtle, a kind security guard sitting nearby got her attention for me. The kindness of the Costa Ricans who worked in the hospital was deeply appreciated. The admissions nurse gave me a visiting pass. Only 1 pass with my name on it. We walked to the elevators to go to the 2nd floor when we were stopped by another security guard. She was not letting us pass. I failed to see that the visitor pass was only valid between 12:30 pm and 3 pm. It was 9 am!
I pleaded with her in Spanish that my elderly father who spoke no Spanish was upstairs and that my mother (technically Gitte is my step-mother but I wanted to simplify the story) needed to be with him. She relented, wrote down Gitte’s passport number but did not allow her to take Dad’s clothing or medications bag upstairs. I waited at the elevator bank not knowing what to do next. M was at the mechanics and I wanted to be someplace where Gitte could find me again. After an hour or so, a young medical attendant asked me if I was Christine. He kindly led me upstairs to where my Dad’s bed was. He was not there but I saw him being wheeled down the corridor with Gitte. A 30something man wearing "civilian" clothes and pulling a folding luggage cart with a plastic toolbox stopped to speak with me in English. He told me that they would be back shortly. The man was maybe a maintenance worker and was kindly helping Dad and Gitte as a translator with the hospital staff. He'd lived in the U.S. and spoke very well.
Even upstairs on the non-public floor, it was busy and noisy with patients on gurneys in the hallway. At first, the attendant took me into a general ward thinking that Dad was in there. There were 10 beds lined up against two walls with the privacy curtains all pulled back. There were men and women and at a couple of beds there was a person, probably a family member sitting. There was a desk at the back of this huge room where a few medical staff were seated. It turned out that Dad’s bed was in a room next door. There were 6 beds with "Vitals monitors" stationed at the head of each. Sort of an ICU type area. It was all clean and the equipment seemed up-to-date.
Next step was for Dad to meet again with Dr. Rincon, the neurologist. Dr. Rincon had a CAT scan performed on Dad at about 2 in the morning. He had reviewed the results and met with Dad earlier in the morning. As we were walking down to Dr. Rincon’s office, Dad said that he couldn’t spend another night there. I could see why. The medical staff were doing their best with the resources at hand and the intense demand. To be released, Dad needed to pass a few physical tests. It was sheer force of his will that he lifted his leg and pushed his foot into Dr. Rincon’s hand. Dr. Rincon reviewed the prognosis in slightly accented but perfect English. If Dad followed certain lifestyle changes, he felt that Dad would have a full recovery. He also stressed that if the symptoms recurred to get Dad to CIMA. Dad was released with caution as he really wanted to make the flight home the next day. He had had a CT scan which was clear but was still feeling symptoms off and on. Some medication prescribed and we headed to San José over the Cerro de los Muertos (Peak of the Dead) hoping it didn't live up to it's name.
I mentioned CIMA earlier in this story. It is a top ranked private hospital located in the suburb of Escazú (an ex-pat enclave) near San José. M needed some dental work when we first arrived in CR and his dentist in Monterey recommended a dentist at CIMA. We had been impressed by the medical offices then, never thinking that we’d need the hospital services. Making it through traffic and the city center we arrived in Alajuela to spend the night at a hotel near the airport. Dad couldn’t walk. He draped himself over our shoulders and we lift carried him to the room. I don’t know what we were thinking. He and Gitte were so focused on catching a flight the next morning. While we were having a bite at the on-site restaurant, Dad was supposed to lie in bed (clear orders from his wife) and wait til we brought him some food. Upon returning, he had tried to stand and had collapsed on the floor squished between the bed and wall with bleeding scraped arm. Thoughts of making the return flight were nixed and at 4 AM, I decided that we’d call an ambulance to take him to CIMA. The front desk man was very helpful. He called the local Red Cross ambulance. Red Cross runs all the public ambulances. They were restricted to carrying patients to the nearest hospital in Alajuela. The front desk guy and I tried to find a private ambulance service with no luck. Finally, we decided to drive Dad there in our vehicle. Thankfully, the paramedics carried him to our car.
It was daylight now and San José morning traffic was stacking up. I was navigating on Google maps with varying success and within 40 minutes, we arrived at CIMA. At 6 am, Dad was the first patient of the day with a fresh flight of medical personnel. CIMA caters to “medical tourists” from North America and many of the staff speak excellent English. It was quiet and calm with top-of-the-line equipment. They performed an MRI almost immediately (the other hospitals didn't have the equipment). Dr. Rincon, the neurologist in San Isidro had mentioned the name of the top neurologists at CIMA and as it turned out, one of them, Dr. Chinchilla was Dad’s physician. He suggested a stay and stabilize for 5 days before thinking about flying home and maybe another 5 days before flying. Meanwhile Gitte was on the phone at the Admissions' desk to contact their travel medical insurance company. CIMA is well-versed in using foreign medical insurance and the process of admissions and Dad’s 5 day stay with 2 times a day physiotherapy went smoothly. With the approval of Dr. Chinchilla, Dad was released after 5 days. The insurance company sent a medical attendant to accompany them home on a First Class Air Canada flight with limo service to the rehab hospital in Sarnia near their home.
Once Dad was settled, M and I stayed another day in San José at the Holiday Inn next to the hospital compliments of Dad and Gitte. It is a lovely hotel and next to the PriceSmart. We felt that Dad and Gitte were in good hands and we needed to return to Golfito to pick up our Residency cards. We had traveled 836 kilometers (on 1 tank of diesel) and visited 3 hospitals in 3 days. Fortunately, our story has a happy outcome. Dad is recovering well. M and I know more of public vs private hospital care. We experienced the kindness and generosity of Costa Ricans throughout our arduous trip. My recommendation is to buy the travel medical insurance as the private hospitals are very expensive. And guess how much the 2 public hospitals charged when Dad was released… $0. A gift from the Costa Rican people. Every experience in Costa Rica is a learning opportunity and makes me feel more comfortable with my life here.
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