Sunday, August 12, 2012

A Visit to the Ward Healers

After 6 days of off and on fever and diarrhea which had turned bloody even though I self medicated (correctly it turned out with Metronidazole) and with substantial tenesmus (a new word for me that is clinically defined as having the urge to defecate without the material but which I define as your colon trying to turn itself inside out to empty your own intestines into the bowl and boy does it hurt) I finally dragged myself to Padre Billini Hospital, the venerable public ward healing hospital in the Colonial Zone. It takes up nearly an entire city block and was built around 1880. I remember bringing Niningo here for what he thought was a hernia but turned out to be constipation some years ago and being pretty shocked. Feces in the waiting room, blood drips following gunshot victims into the emergency wards, broken tiles, flies, dirt etc. Just months ago the Hospital was reinaugurated after an extensive renovation—all new plaster outside, new stone entry steps, glass doors, all new tile floors and walls, air conditioning and huge atrium garden with a giant statue of Padre Billini himself.
Hospital Padre Billini in the 1940's

At 7:30 am it was not crowded and after giving the watchman a short list of my symptoms he led me, forgetting to pass his metal detector over me, to the emergency room and introduced me to a nurse or maybe a doctor, very few name tags here, and she led me to a bed. My history was taken down a couple of times, sometimes by students, and I was handed two specimen jars for urine and feces. The bathroom was sparkling with its new white tile job but had no running water, no soap, no toilet paper and nowhere to hang your IV bag while you worked—floor or back of toilet. When I returned the canisters to her she had to ask which was which—the urine sample was the color of Coca-cola and the feces flask contained only a thin pool of blood with a corn flake or two sunk in the bottom. At least now she believed I was sick. Blood was taken (from my arm) and I was given a bed and froze to death on it for four hours waiting for the first test results. There were about 14 beds on the ward with a central nursing station where they let me use some hand sanitizer. I was the only patient all day who did so. Positive for Amoeba, no surprise, but the blood came back with a high white count and almost no platelets (13,000 of a recommended 150,000). She took another sample to reaffirm the results and said they would be back fast. Someone graver than I came in and was given my bed and I was given a piano stool to sit on next to my IV tree, which dripped cold saline into my arm. It was so cold parts of my hands turned white. I asked to wait outside in the lovely sweltering waiting room but they were afraid I was a risk to flee, since I had talked about going to work. Four hours later the doctor apologized saying that the lab had damaged the second sample and they would need a third and I obliged. They found me another bed and by around 7:30 PM confirmed that I had too few platelets to leave and I would be interned.
An atrium within Padre Billini today
I was wheeled through the beautiful atrium garden and down some hallways to Room 109 in the Gautier wing. Three bed suite with a giant bathroom (sans H2O) and I was the sole occupant. Silence. Two sheets. Adjustable bed. Perla brought me juice and bread and the plaid flannel sheet from Egremont.
An X-ray upstairs in Padre Billini costs $200 pesos or about $5 usd. For fancier blood tests I had to cross the street to one of the many freelance medical labs within walking distance since most of the patients here are too poor to use taxis and the Hospital has meager capabilities. Leptospirosis was the only expensive one at about $50 usd (result negative which I understand is a good thing) blood and stool cultures run between $8 and $15 each.
Every day a sheaf of prescriptions come in signed by a different doctor ordering me to go get such and such a test and some of them repeat tests that I am already waiting for results on and some are for Billirubins (not yellow), LDH cholesterol (I fail to see. . .), they had demanded twice that I get a sonogram (which would mean a taxi ride) and one for transaminasas (the doctor thinks it’s for liver enzymes). I spoke with an epidemiologist, gruff but distinguished white haired man who filled out forms while he sat and asked me questions, who did not know if there were other cases of amoebiasis similar to mine and when I asked him why I needed a cholesterol check he said it was all tied together. Said he wanted me to get another check for dengue fever even though I had no dengue symptoms. When I mentioned that I slept under mosquito netting he mentioned that the dengue mosquito is only active in the daytime and when I pointed out a live one which was resting on the wall next to us and asked him, “like that one?”, he said, “yes.”
Finally I met Dr. Mendez, 35ish, rough looking, short beard, but soft spoken and polite and was very reasonable. Said not to bother with the new sheaves until we had results from the first battery of samples and he confirmed that I was within my rights, at any time, to sign myself out of here as long as I did not owe any money. Since the hospital room and board is free that won’t be a problem. Waiting for the platelet count for the day, if it gets to about 80,000 I might get to leave peacefully.
I spent a total of seven days in Padre Billini. When you are interned here you are NOT allowed to leave. Nurses rotated through every few hours to hang a new IV bag and to inject various drugs and medicines into the port on my arm. Stomach calmative, antibiotics, metronidazol (antiparasitic), vitamins and some that nobody seemed to know what they were. I was interviewed often about how I was doing. My sheets were changed every day. Every patient is allowed one family member to sit with them and they can spend the night sleeping in a chair in the room. Breakfast consisted of a cup of tea around 7:30 AM and around 8:30 a wholewheat roll and a bowl of boiled milk. Lunch was a scoop of mashed plantain with a half can of tuna fish or a hardboiled egg and dinner a scoop of mashed potatoes with a little grated cabbage or a slice of luncheon meat. Fifteen hours could pass between dinner and breakfast and any additional food, and all drinking water has to be smuggled in by visitors. Some visitors were able to smuggle in fried chicken and Pepsi-cola but others had their provisions confiscated by the guards. Once Perla came in almost crying because they had confiscated her apples leaving her with only a banana and a bottle of water for me.
Although she was able to bring me something every day, after 5 days I felt like I was starving to death and I sent Perla a text message in the morning pleading for hardboiled eggs. I reasoned that they were easy to cook and easy to smuggle, nourishing, caloric and cheap if they were confiscated. The text messages got a little confused. She came at 7:00 PM and handed me a bag with a towel and a new roll of toilet paper in it. When I realized there were no eggs I broke down. She said I didn’t know what it was like to try to get stuff past security. I ripped my IV bag off the tree and left the room angry. Out in the atrium a guard saw me pacing and came over. Before he had a chance to invite me back to my room I told him my problem with the guards in the entrance and food and eventually I introduced him to Perla and he said he would let her in with the stuff and she walked back to the apartment to boil eggs and potatoes.
I sat on a bench in the garden while I waited for eggs. After a little while a white man came out of one of the bedrooms sat down and introduced himself as Thurman. Thurman is from Johannesburg, South Africa, 33 years old and has lived here for  four years teaching English at the Berlitz School but now has ulcerative colitis. A year ago he contracted amoebiasis but did not know what it was. He shat blood for 9 weeks alone in his apartment; eventually unable to work he went to the Plaza de Salud. A month later his insurance, which was the good kind, was depleted by the 30 pints of blood he’d had to buy and the medicine that costs more than $1000US/month. His Ford Bronco had been repossessed. He is in Padre Billini Hospital now trying to regain strength and hoping his family sends a plane ticket for Johannesberg soon. We talked a long time about the fragility of the human body and of the world in general. Thurman now dreams of edenic economies and of living on a commune someday. Eventually Perla entered the garden and walked up and handed me a loaded Tupperware container, spun on her heel and left. “She’s ticked off,” I said to Thurman. “She looked ticked off,” he replied.
The next day Dr. Mendez, Dr. Abreu, Dr. Sánchez and the epidemiologist all said that I would be dado por alta or released almost immediately. No infection, no fever, no virus, no untoward intestinal incidents (I continued to photograph my bowel movements for proof). But the day dragged on like the others, a lost receipt from a lab, then they wanted to wait for the sonogram, then it was my blood pressure (which had not moved more than 5 points the whole week). The next day Sánchez did not show up because it rained. The seventh day I got up early and sat on the bench, arms crossed, leg twitching, where I had met Thurman and I laid for Méndez. I plead my case with any nurse or docent or janitor who paused to chat while I waited. Most of them concluded that I would be able to leave when God decided it was time. A warm drizzle fell in the garden and at about 10 AM Méndez finally emerged from the staff cafeteria at the far end and I stood up and hailed him like I was in a lifeboat lost at sea. We shook hands and he said that he understood that I was ready to go home. An internist brought me a release to sign stating that if I died of high blood pressure she was not responsible. I packed my sheets and toothbrush, said goodbye to my roommates and walked alone to the lobby and out into the soft rain and slowly walked the 6 blocks to my apartment in Ciudad Nueva.