Chapter 3: Entering the Panamanian hospital system:
Dengue is something that is prevalent in Panama (which at this time in July/2017 seems to have many cases being reported) and which the health authorities warn about. As you read in chapter 2, it could be very debilitating and can lead to death. This is why Ruth (my wife) and I were quit worried.
That previous doctor that I mentioned gave us a bunch of prescriptions which I cant remember what they all were for, but we trusted what he was prescribing. Again we went home and off to the bed for me to get over it all. After a few days nothing had really improved and back to the clinic to see why there was no improvement. In all, over the next few days, we visited 2 more doctors. The final Doctor (Dr Juan) recommended that we go to the emergency at the local public hospital in our area. He felt that we had a better chance of finding what was really happening if I could get admitted. So we went to the ER and the convoluted hospital system that we encountered started to be apparent.
I'm sure by this point in my story you may be thinking that this sounds like something you may see on TV regarding different medical traumas. I wish I could say that it was, but its not. A lot of the events were fuzzy until I sat down with my wife to recount them. She was with me all the way and did what I believe many other wives might not have. Living in a Spanish speaking country and my Spanish not being up to par, I believe I would not have made it through it all without her. She is my Angel, my gift from God.
According to my wife it was the Wednesday of that week that we went to the emergency at the hospital here in La Chorrera. Again I sat and waited while Ruth lined up to pay and then another line to register me. Every medical establishment (even hospitals) we went to this same procedure and more sometimes had to be done. Panama has no real central medical registry system. (Like I have always been accustomed to in “The Great White North” (Canada), and not all Panamanians are covered under what is called the “CSS” system. At this time, I had no coverage either, NADA, so I had to pay out of pocket. I will explain a little more about that later. So after all the initial formalities and again sitting in the waiting room, the triage doctor saw me. Ruth had told me to really play it up as this way possibly quick action would happen. Even though I really wasn't feeling very well at all, I did a little acting and I guess it helped. The doctor reviewed things and saw that I was dehydrated and had a low blood pressure reading (96/58). he ordered blood tests and that I go way down into another section (hydracion) for an IV which included vitamins. Before I went Ruth had to go and pay for these services (as I mentioned above, at this time I had no medical coverage at all, which changed in about 2 weeks) The cost at this time was close to $200 US.
Now let me entertain you about the IV and the crazy procedure that you encounter. The IV room or area had about 12 or so chairs that reclined (not so uncomfortable). The nurse finds the vein in the back of you hand and puts in the needle thingy. The bag is hung up on a stand above your head, the tube connected and then your off to the races. I asked her how long for the procedure, she said about 3 hours. Ok, well I will sit back and have a nap. The thing that made me start to see the crazy system was when I had to use the washroom. There were no portable IV carts (with wheels) to put your bag on, you had to shut the flow off and carry your bag with you. Ok, well that's the way it is, but the problem with doing this is sometimes the blood backs up and the flow doesn't start again. The nurse needs to fiddle with the tube and with luck it starts, if not they need to use a syringe with fluid to prime it (possibly the wrong terminology, haha). So every time nature called, the same procedure. After the 3 hours or whenever the bag was empty, the nurse takes the bag off the stand and gives it to you. I figured she would disconnect it from the needle, no, you are given it and need to take it back to the emergency area (a crowded hallway) where you will see the emergency doctor to go over the results of the blood work. I must have seen 20 or so people carrying empty IV bags. My wife was with me the whole time. I waited in the hall for what seemed like hours. My blood pressure was still low, as I felt like passing out any second. To put it lightly, I felt like shit. The procedure to see the doctor again is just insane. I am sure he had the blood work that was taken 3 or so hours ago way before I was finished with the IV treatment, and he just didn't look at it. There system is this. They use red, yellow and green when they are assessing patients, at first I was red, and then when I was sent to the IV area it was changed to yellow. My wife kept asking when the doctor would see me and the nurses just kept putting her off. When my wife saw that I was ready to hit the floor she more than urged the doctor to get off his ass (my wife is usually a very cool headed and patient woman, but could not just settle for quiet at this time). Within a few minutes they were getting me ready to be admitted. I guess that when the doctor saw the results, he felt that I needed to be admitted. I was given some hospital clothes and brought to a shower room where I cleaned up (with the full help of my dear wife) and then brought to my room on the 5th floor via a wheelchair.
It was about 5AM on Thursday at that time (we initially arrived at the ER about 4PM the day before) so we were there for 13 hours now. I was lucky to get a bed at the end of the ward room (5 beds) near the window. I was hooked up to an IV and was ready to go to la la land. My wife was beat and went home so she could rest. She looked absolutely drained. I told her to go home and not worry about me. For any who have ever spent any time in a hospital, then you know activities start around that 5 AM hour. Blood pressure, blood pick for glucose, patient baths, etc, etc. Lights are on and then the rounds for doctors, student doctors, nurses and student nurses keep you from getting any shut eye. They did give me something for my headache and to allow me to sleep, so in spite of all I did manage to sleep.
So I was hoping that they would be able to really diagnose what was going on. Over the next few days, (I was there for a total of 8 days initially) daily blood tests were done, I had a chest X-ray, an ultrasound of my abdominal area and they were evaluating things. The hospital Doctor (whom I was never impressed with) kept telling me conflicting information. First it was that my pancreas was infected and that different levels of things were showing abnormally high. On another day he said that my liver was showing abnormalities. When I asked if I had 'Dengue”, he said he didn't really know. I know that there is a very specific test to detect it, so for him to answer as so disturbed me quite a bit. He kept going back to the pancreas, which I never ever had any pain in the lower right side of my stomach and also he never checked with pressure by his hands in that area, which is a routine procedure to detect pancreatic problems. So for 4 days blood tests were done and then no more from day 5 to 8. Ruth and I kept asking him when I could get out as I was feeling better. He kept delaying things day by day and said they were waiting for results. How could he be waiting for results when no blood tests have been done for 2,3,4 days. We were getting quit frustrated and wanted to leave. He said if we leave he would not give us any discharge papers whatsoever. WOW. So finally on day 8 he came in, shuffled through the chart and said I could leave. Hey how could he discharge me at that point without any blood tests for 4 days, and without knowing if the high levels that he was concerned about have come down or even being able to tell me for certain if I did in fact have “Dengue” We were just happy to get out of there as we could both see the incompetency of this doctor. So being discharged I still didn't know what was or has happened. As the discharge papers were being made, Ruth went down to pay whatever was owing for the 8 days stay in the hospital and all the tests and other things. She was worried that we would not be able to pay for it and would have to work out some type of payment plan. When she came back up and I was ready to go, she told me that the bill was only $30. I didn't understand but she said that's what it was. She was amazed and we both knew that the big guy above was looking after us. Lest to say we were so relieved!
After 8 days in the hospital and a few weeks previous to that, feeling terrible I was finally going home and feeling better, not great but better. My strength was still low but I was hoping it would return shortly. Arriving home I thought I would sit in the living room for a bit, but shortly after I needed to lay down. I was hoping that every day I would be able to get up and walk around the house and feel stronger, well that wasn't the case. I really only got out of the bed to use the washroom and to clean up.
To be continued!