Archive | December 2015

The Final Trip Home

We had arranged to pick up our Ngobe friend at 7AM.  He was ready.   He loaded several trash bags of presumably personal articles into the back of our car; our first indication that this was not to be a round trip for him.

Before 7:30 we were in downtown Boquete at the Municipio office.  He indicated where we were to wait and then left the car.  A half hour later he was back and said he should be done by 8:30.  OK, no problem.  The day was his.

It was closer to 9AM by the time he had his paperwork and we went to the local funeral home.  There he picked up a very basic infant-sized casket.  The body was in David, as it turned out.

We went to the morgue at an old, run-down hospital that we didn’t previously know existed.  There was another waiting period whereupon he was sent to the Tribunal Electoral  building n downtown David for yet more paper work.  Within half an hour or so we were back at the morgue.    We waited.  And waited.  We had the windows down in the car as it turned in to a long wait, beyond which I was willing to idle the car with the air conditioner running.  But then the smells from the morgue started drifting in.  We had to relocate the car.

It was fully two hours after our return to the morgue that the baby was put in the casket and we could be on our way. By now it was 12:45.    There was not a lot of conversation during the drive.  We would have been at a loss for words in English, not to mention Spanish.  The road started off decent enough but soon went from bad to worse to absolutely terrible.  Adding to the drive’s difficulty, we encountered thick clouds going through the mountains.  Visibility was less than 100 meters much of the time.

After about 2 hrs on the road he had us pull over at small grocery store,  essentially identical to one of hundreds if not thousands that dot the country.  We were expecting to drive another hour or hour and a half.  There were 6 or 8 men hanging around and he seemed to know them all.  From here we went maybe 2 km on an uphill, unpaved road.  The countryside was beautiful.  The road made a dead-end at a river and we stopped a couple hundred yards before that to unload the casket at a quieter spot on the same river.

This is where we left Benicio and the small coffin.  He had another 2 hr walk from here to his destination.

This is where we left the small coffin.  Benicio has another 2 hr walk from here to his destination.

One or two old people and several young ones were waiting.  Nobody smiled.  We took a photo of the setting but not the people.  I thought it would be in poor taste.   Besides, the Ngobe are known for being averse to photography.

Our friend indicated that his destination was yet another two hours away on foot, but for now we took him back to the store at the main road.  We didn’t exactly understand what was going on but we didn’t query anyone either.  We did ask him when he would return to La India and he said it would be 3 weeks.

We would thankfully be home before dark, something that looked quite unlikely not too much earlier.

 

 

Unexpected Ending for the Day

We were almost home from a day trip to Volcan when Jan stopped the car on La India, ½ km from the house, to closer examine what she thought might be an orchid lying on the ground. It was a false alarm, but we had stopped almost directly across from a shack where one or more Indian families sometime live. We’ve never really figured that out.

A young man that we recognized came over to talk to us. We’re actually better acquainted with his wife. He needed some transportation tomorrow and was unable to pay for commercial services. He said his baby died two days ago. He needed to pick up the body in Boquete tomorrow morning, take it to David to get a permit to buy a coffin, then go to Changuinola on the Caribbean coast for burial, a very good 3 hours of driving one-way. Could we do it and what would we charge?

As all of this was in Spanish, we told him to wait there while we got our neighbor Frank (Cuban ancestry) to make sure we had understood everything correctly.  We had.

It will be a very sad day tomorrow but one we cannot realistically avoid.  We’re certainly not looking forward to it but on the other hand we’re thankful that we were placed where we can hopefully help ease the burden on a young family in this tragic situation.

This entry was posted on December 29, 2015. 2 Comments

My First Medical Experience in Boquete

 

Few people enjoy hearing about other people’s physical ailments, but Jan thought this would be a good topic for a post.  Just for the instructional aspect and perspective offered, I think she might be right.

Our first night back in Texas, in the first week of November, 2015, I picked up a backache after sleeping in the bed of our former next-door neighbors. I’d spent nights before in this bed without any problems whatsoever. It was nothing major, just annoying. And for me, a very rare event. I never get backaches.

After 3 weeks of putting up with this, I’d had enough. Especially since it was going from annoying to somewhat debilitating. I broke down and went to see a doctor.

Back in the spring of 2015 when I was getting the contents of the storage units ready for transport, I recalled trying to move a really heavy plastic storage bin. It weighed several hundred pounds easily. I was holding a plastic handle at one end and pulling with all my might. It felt as if my body was at a 45 degree angle to the ground in an effort to get maximum leverage. I remember thinking at the time that this plastic handle is not going to hold. It’s not going to hold. I was right. It didn’t. In a heartbeat I was holding a handle that had suddenly become very, very light. I landed on the concrete floor with my butt absorbing the full force of contact. Ouch and damnation! Eventually the excruciating pain eased.  Thereafter it bothered me only occasionally.

This, it was agreed by all the medics who would hear the story, was the start of it all.

My first inclination was to visit the new doctora in town that advertised her arrival back around September. But I couldn’t remember her name or location. I’m sure I saved it somewhere where I could easily retrieve it later. Know what I mean? But as we gringos so often do when we’re unfamiliar, we went on the referral of another gringo. Another doctor was recommended, not cheap we were told, but good. But “not cheap” is relative.

Appointments seem to be the exception rather than the rule here, so we just showed up at the office. Turns out the doctor is a doctora, but she wasn’t in. Come back at 2PM. OK, we did that.

Her office bore not that much similarity to a stateside doctor’s office. A set of drums just behind the receptionist was our first clue that maybe this place serves double duty.

Reception area

Reception area

But it was a fairly nice office. Especially considering the one Jan saw upon returning from her last trip to Europe. (I don’t know what bothered me more. The fact that the doctor looked more like a kids’ soccer coach, or the fact that he did his training in Cuba, or the fact that he admitted to being 27 years old.)

The nurse/receptionist weighed me and took my temperature and blood pressure. Then we were shown into the doctor’s office. She invited us to call her by her first name. Can’t remember the last time a doctor did that. I liked it. A good sign. No hint of pretension.

Then she interviewed me for my medical history, drug regimen, etc. She palpated the left lower back area and agreed it was sore, not tender. I guess that meant something.  She gave me a double-dose injection of something along with prescriptions for a muscle relaxer and an anti-inflammatory. And she ordered x-rays. And a blood test, to look at uric acid levels. I took the opportunity to get a lipid panel test at the same time. for an unrelated reason.

She suggested that I might end up better off with a chiropractor. I was surprised to hear an MD say that, but I’m told the times they are a changing. But let’s give the shot and the meds time to work and see what the x-rays say, if anything.

As I didn’t have my (temporary) pensionado ID with me, we decided to wait until morning for her various prescriptions. (The pensionado qualifies one for a 20% discount on medical services and prescriptions. But Jan didn’t realize this at the time. She thought it applied only to prescriptions. As such, we paid full price at the doctor’s office and everything else.)

The first order of business the next day was the blood lab, as I was fasting for the lipid test that I had wanted for some time now. Somehow two years had elapsed since this was last done. This test cost $25. The uric acid test that Lilliana wanted cost $3. We would have results by noon.

From previous experience, we learned that the drugstores in town can have prices that vary wildly. So we checked at two before making a purchase. In this case the prices were very close. And high. The muscle relaxer was only $12 but the anti-inflammatory was over $80. Those of you who know me, and those of Czech heritage, can readily understand how I chose to use ibuprofen for my anti-inflammatory.

The soonest we could get an appointment for the X-ray was the coming Thursday.

We took the x-ray to Dra. Lilliana’s office and she looked at it at great length. Made me wonder if she really knew what she was looking at, especially since she asked if we had a radiologist’s report, which we didn’t. This was never mentioned until now. She suggested an MRI at this point.

As my pain showed no significant signs of abatement, I got another injection, triple dose of something. What the hell.

The pain got much worse over the weekend and Jan and a visiting friend made arrangements for me to see both an acupuncturist and a chiropractor at a resort spa called The Haven. The place had a good reputation. I have never been to an acupuncturist in my life and not a chiropractor since my childhood years, but with the pain I was in I was willing even to see a witch doctor.

Howard, the acupuncturist and spa owner, made me initially wish I’d never shown up. The acupuncture was not painful but his reflexology and especially the pressure he applied to the sore spot on the back, most assuredly was. But by the time I left his office, I was tremendously improved.  Not cured, but improved.

From Howard’s office I walked just a short distance to Rhody’s chiropractic office. More interviews. He reviewed the X-rays, which we had on a CD, and right off suggested an MRI. The x-ray just lacked sufficient detail. The MRI could tell if it might be time to get a neurosurgeon involved. (Groan!)

After initial improvement the pain became worse again. And in an unbelievable act of carelessness (stupidity?) I rammed my left knee into the sharp corner of a coffee table. At first it seemed like no big deal, but that leg was to soon become the central focus of my pain.

It was decided to get the MRI, which requires an order from an MD. Best we could do was Monday Dec 14.

A neurosurgeon was recommended to go with the MRI. When Jan called for an appointment, she learned that he works in Panama City but comes to David once a month. She left word for the doctor to call her.

Not the doctor, but a nurse called in short order Saturday morning. The doctor would be in David tomorrow. He could have the MRI appointment changed from Monday to this same Saturday, so that he could see us and it Sunday morning.

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We showed up as instructed for the MRI at 11AM. I guess my pain was in clear evidence as “behind my back” they called the neurosurgeon. He instructed an injection and an IV for pain to help ensure that I could/would remain motionless for the 40 minute RMI procedure. I was livid. I DID NOT want or need an IV. I was about to go ballistic and Jan was begging me, do it for her. I was taken to one of the slots you find in emergency rooms and was put on a bed, still fuming. I was giving thought to just storming out of there and dealing with everything later. Then the expression about shooting oneself in the foot hit me. Hmm.  Been there, done that. I started to calm down. After about 10 min on the relatively comfortable emergency room bed I began to realize that there was no way I could lie on even this bed for 40 minutes without moving. They were right. I was wrong. Surprise, surprise.

I got another shot in the butt, a pill and a cup of water, and then while a young, attractive doctora held my attention with conversation on my left, a nurse on my right inserted an IV. Sneaky, but highly effective.

Jan and I both thought the IV ran for only a very short time but I guess it was long enough. I stayed motionless for the entire 40 min procedure.

We had an 8AM appointment Sunday morning with the neurosurgeon. We arrived maybe 10 minutes early. We know that doctors’ times are much more valuable than patients’ times, so we didn’t want to keep anyone waiting. Actually, Jan didn’t want to keep anyone waiting.

When we arrived at the anointed time and place the area was deserted. I asked Jan if she was sure she had the right place. She was. Nonetheless, I asked her to check the floors above and below us just to make sure. She did; she was.

A bit after 8AM the nurse/receptionist arrived. She said the doctor would be along shortly. At precisely 8:39AM he appeared.

We spent an hour and a half with the neurosurgeon for a whopping $60. He took plenty of time to explain the problem, as he saw it, and to discuss the options. He saw it as a stage 3 (out of 4) partially herniated L4-L5 disk, with some other (lesser?) anomalies. He agreed that the episode in the storage units months earlier was undoubtedly the start of it all. Basically, surgery was in order but it could be put off indefinitely if the pain could be managed, or dealt with. Total cost without insurance would be about $20K, of which $7K would be for him. Didn’t take much to realize that if it did come down to an operation, it would certainly be in Houston where insurance would cover almost everything.

Although he seemed confident in his interpretation of the MRI, he nonetheless wanted a radiologist’s report. That could be expected tomorrow. His receptionist would notify us when this was ready.

Ostensibly because of the medication I received in the emergency room prior to the MRI, I had the most comfortable sleep Saturday night that I’d had in 2 weeks or more. That statement precipitated a prescription from him for four more injections a week apart, along with yet another prescription for pain pills to be used in the interim.

It turned out that the restful sleep carried over to Sunday night as well. And then things started petering out. I was most anxious to get another shot after a week was up, but unfortunately this one had little or no effect. Still, my pain was no where near its previous peak levels.

After a full week we’re still waiting for the radiologist’s report.  By now phone messages were left and an email was sent to the doctor in Panama City notifying him that we’re still waiting.

It’s now three days before Christmas and this story ain’t over yet. Tomorrow we absolutely must be in Panama City. It will be a long day but if things don’t get dramatically worse, I’ll get through it.

Finishing Up Our Legal Requirements

12-24-15 Today we received our Panamanian drivers licenses! Yesterday, in Panama City, we received our permanent residency cards! We can hardly imagine better Christmas “presents”. It was a long time coming and fraught with more difficulty and setbacks than , well, than we deserved.

We left for Panama City yesterday morning bright and early. Got up around 4AM and before 5AM we were on the road.

We had appointments in the city starting at the US Embassy at 9:30, to get our Texas drivers licenses “notarized” prior to acceptance by the Panamanian agency called the Ministry of Foreign Affairs. It was reasonably tight scheduling but the best that was available to us. Our plane was 15 minutes late leaving David

IMG_6039[1]

and our contact in the city was 15 min late meeting our plane. At 9:30 we were just leaving the Albrook airport. I was tense. Jan, not so much. Que será, será.

The advantage of having a “handler” who knows his way around became immediately obvious. At the embassy he took us first into a security control building where we left our cell phones and other “potentially dangerous” articles. Then a short walk to a first floor room in the main building that was somewhat on the crowded side and a bit intimidating. But he knew right where to go and with minimal wait, and no fuss about our being 15 minutes late, we soon had our notaries in hand. This cost us $50 each. For a notary. From our own embassy.

From there we went to the Ministry of Foreign Affairs. Actually, we first went to a bank where our handler gave us a pre-filled deposit slip and instructed us to make a $4 deposit to the account named on the slip. The government agencies that perform any variety of functions do not collect for their services. You pay in advance and your deposit receipt from the bank is your proof of payment. If you don’t know this beforehand, you will go to the agency desired only to find they will send you to the bank to make a deposit first. But our handler already knew this. With the deposit receipt in hand, we went to the MFA for their acceptance of our embassy’s notarization. The handler warned us earlier saying this could take 3 days to be processed, but since we could show we were to be in town for just the day they MIGHT push it through right away. It was left to Jan to use her influence on the senior staff member on duty. Her persuasive abilities remain intact after all these years. I should know.

These were the two drivers license steps that absolutely had to be accomplished in Panama City. The other requirements were previously taken care of locally (Boquete and David) and the final act of actually getting the license would be done locally in David the next day.

The last thing to do was pick up our permanent residency cards. We were told in advance that this would go fast. In spite of the appearance of things when we arrived, it did. Lots of people. Lots of people. But our handler knew right where to go and we were done in short order. The last clerk we dealt with was a young man of surprisingly good humor. I was unsure if the “Charlie Brown” Christmas tree behind his desk was to be taken seriously or if he was just trying to get a reaction.

A Charlie Brown Christmas Tree in Panama City

A Charlie Brown Christmas Tree in Panama City

By 12:30 we were finished with all of our business but our return flight wasn’t until 5PM. There’s a huge mall across from the airport and that’s where our handler left us to while away the time. We had some expensive fast food in a huge food court and finished it off with double-scoops of ice cream cones.

Maybe 10% of food court at Albrook Mall.

Maybe 10% of food court at Albrook Mall.

Then we window shopped and people-watched before heading back to the airport.

Albrook Mall, the largest in Central America.

Albrook Mall, the largest in Central America.

Freshly invigorated with the knowledge that we were once again legal to drive, we did a little shopping. And Jan decided to go by the hospital on the off chance that she could somehow get a copy of the radiologist’s report on the MRI. I waited in the car. Incredibly, she was back in 15 or 20 minutes with a copy in hand. From here our next step will be to visit Rhody the chiropractor to get his recommendations on how to proceed. It seems pretty clear to us that if we don’t intend an operation here, the neurosurgeon we visited isn’t really interested.

A Flash! (of Lightning)

The rainy season this year is just getting started, a bit early maybe. I had just finished the minimal outdoor work I had set for myself when it began to rain. And rain, and rain. I didn’t have a gauge set up but we certainly got “several” inches.

I was out on the carport mid afternoon still trying to clean up the mess from the recent container arrival. There was suddenly a really bright flash of lightning and the roar of thunder was scarcely a second later. The strike had to be really close. I went inside to check on the animals and found they were all “OK”. Fortunately, none of our animals seem to be particularly scared of thunder.

Just a few minutes later I was in the great room facing the kitchen when an incredibly intense white light filled the room. Actually, in my mind, it followed all of the corners of all of the walls and ceilings. It happened so fast, and the light was so brilliant, I’m not sure of exactly what I did see. The thunder was simultaneous and louder than I can recall ever experiencing. At this point I did see terror in the dogs’ faces but they recovered quickly. Took me a little longer.

I went outside to look for damage and was surprised that I was unable to find any. I’m sure it’s there, maybe on the very top, flat part of the roof. We have several very tall trees on the perimeter of the property and they all appeared to be undamaged. Amazing.

I later found out that all of the fluorescent lights were fried and several GFIs were tripped. Don’t know what else might show up.