Those considering the life of an expat must consider how to deal with serious medical issues while abroad. Not only must you determine if your chosen country has quality care but you must determine if you will have ready access to that care and how it will be paid for. Being able to accurately communicate with your medical professionals is also crucial, particularly in critical care situations. Here is part one of my story.
The soft mechanical and electronic noises that awakened me sounded, at the same time, both strange and painfully familiar. These were not the sounds of the Caribbean surf that have been greeting me for the past 8 months as the sun climbed above the horizon.
As I fought my way through the drug-induced fog of sleep, the beeps, whirs, clicks, chirps and hums of cardiac monitoring equipment, the automated blood pressure cuff, the vacuum pumps attached to my chest tubes and the tiny I.V. pump slowly penetrated my consciousness. I could hear Diane’s voice echoing in the distance encouraging me to wake up. Oh yeah! We had rehearsed all this before surgery. That was her job. My hands were restrained as I knew they would be and I had a tube down my throat assisting my breathing. The sooner I opened my eyes and awakened the sooner that tube could come out and they would untie my hands. I was fighting as hard as I could to stay awake but those drugs kept dragging me under.
I was trying to open my eyes and managed to get my right eye open but not the left. It was stuck shut…some secretions or something. I desperately wanted to wipe my eyes but my hands were literally tied. I probably couldn’t have coordinated that movement anyway. Then, a man’s voice and two fingers extended into my palm.
“Mr. Murray, can you squeeze my fingers for me?”
“Can you squeeze harder?”
Oh yeah….and I did.
“Great”, came his response. And then he was gone.
I continued to struggle to wake up and open my eyes. Diane’s voice was reassuring telling me how good I was doing and I was “over-breathing” the machine, whatever that meant. I guess my lungs were working. I desperately wanted them to wipe my eyes so I could open them. I was sending all kinds of mental telepathy but they weren’t receiving!
I tried to make writing motions with my hand. I was unable to talk with that tube down my throat so I wanted to write. Unfortunately, my hands were tied just below my waist and my erratic hand movements, to my wife and the nurse, were interpreted to mean I was asking for something very different and very personal. Hey…I was doing the best that I could! They began to chuckle while telling me that this was hardly the time or place for that type of activity.
Quickly, the nurse realized that I wanted to write. She took the dry erase board from the wall, placed it flat on my abdomen where I could not see it and placed a marker in my hand. It promptly fell out. I simply wasn’t awake enough or coordinated enough to hold the marker. After several unsuccessful attempts I managed to scrawl “Wipe My Eyes”…or at least that is what I was trying to write. The nurse finally understood and said it out loud.
“He says to wipe his eyes. No one has ever asked for that before. They usually write ‘I love you’ or ‘thank you’ or ‘I made it’ or something like that. In just a moment, a moist gauze pad wiped both eyes and I could finally open them.
Soon after, I proceeded to do my version of a happy dance lying fully reclined with tubes down my throat, 2 lines in my jugular vein, two drainage tubes sucking fluid from my chest cavity, 2 IV lines in each arm and a bladder catheter installed where no man wants to have a rubber tube shoved within as well as supporting a bundle of electronic wires coming from leads on my chest. I raised my hips from the bed and gyrated best I could, keeping some kind of time with my restrained hands for 5 or so seconds.
“Will you look at him? He’s really something”, I heard someone say.
Hell yes! I’m alive!!!
I was able to keep my eyes open for longer and longer periods as the effects of the anesthesia wore off. Shortly, someone came in and removed my breathing tube and untied my hands. That was a huge relief!
My eyes focused on the I.V. tubes trailing from both arms and wrists and electrical leads attached to my chest dragging me closer to full awareness. I had been in a similar place several times before but never quite this severe! I looked like some kind of cyborg!
A week before, an attempt at an angioplasty/stent procedure had been unsuccessful. They had awakened me during the procedure, pointed to a computer video image and showed me the condition of my cardiac arteries which were in such condition so as to necessitate a bypass. I had just undergone a triple bypass procedure.
Diane and I had discussed it. I was hopeful, although not entirely optimistic that my problem could be fixed by the insertion of another stent through angioplasty. If not, I knew it would be time for a bypass. We agreed that Diane would stay in Cancun unless I needed a bypass. She had flown to Tampa.
I had flown alone, to Tampa on December 19th from Cancun. I landed and took a taxi directly to the emergency room at the VA Hospital. I walked up to the counter and told the nurse on duty that I had flown in from Mexico and was having chest pains. Things happened fairly quickly after that as you might suspect. Once inside the depths of the emergency room, I was ushered into a room, told to strip and put on one of those classy gowns. I was immediately connected to a running EKG machine. A blood test was done to measure, among other things, the levels of enzymes and proteins that are linked with injury of the heart muscle. These include the enzyme creatine kinase (CK), and the proteins troponin I (TnI). A small amount of these chemicals are always present but become elevated during a heart attack or when heart muscle has been recently damaged. My levels were 4 times normal.
The ER doc was in charge for a short while until a specialist from the cardiac team arrived. She began to go over all my test results with me, essentially telling me I had had another heart attack, explaining the special enzyme test as well as the irregularities on my EKG. “It’s good that you came here”, she said.
On October 1st, after stepping onto the scale and completely freaking out, I determined to take immediate steps to improve my overall health while losing some weight. My plan was fairly basic in concept; increase physical activity, drastically change my diet to reduce calories and increase raw food nutrition. I set my initial goal to lose 25 pounds by Christmas, not quite 3 months away. I wanted to build my physical endurance and reduce my need for the numerous meds I had been taking for a number of years as a heart patient. I built a spread sheet to track all my health indicators that I intended to regularly measure. I also utilized a great program to track every bit of food I put into my mouth, measuring calories and total nutritional content. In my mind, I intended to manage my own health as if it was a business and in a business, you can’t manage what you can’t measure! I measured everything! I was treating myself like a management project and there was no way I would fail!
My health was improving drastically! I was able to reduce my medications to about one third what I had been previously taking. My weight was coming off right on schedule and I had begun to walk every day. The first day of October, I think I walked about half a mile. The last 2 weeks before leaving for Tampa, I had increased to walking 6 miles every morning. I was maintaining regular contact with a couple of docs on my treatment team in Tampa who were thrilled with the results I was reporting. All was going great….until….
A few days before I left for Tampa, I noticed some tightness in my chest while walking in the morning. I slowed my pace and the tightness went away. I increased my pace and the tightness returned, perhaps with a bit of pain and tingling in my left arm. Uh..oh!!!
The next day, as I walked, I was more aware of my body. The discomfort only happened during light exercise and diminished and disappeared when the exercise stopped. It happened two mornings in a row. I stopped walking and slowly returned home at a much slower pace, resting a couple of times along the way. That night, we went out to dinner. After dinner, we wanted to walk around and the high level of nighttime activity in the area. I could not do it. I had to stop and rest as the tightness and pain returned, this time with a tingling in my left arm. I told Diane of my situation. She became instantly attentive and concerned. We walked back to our car at a very leisurely pace. The next morning, we made reservations for me to immediately fly to Florida, a flight of just under 2 hours. I wanted to get to the VA Hospital in Tampa ASAP.
Now, some among you will be mentally chastising me, thinking I should have gone to the nearest hospital here in Cancun at the first indication of a problem. I can understand that reasoning and believe me, it was always an option. Unfortunately, while the medical care is excellent and far less expensive here than in the states, all hospital care must be paid for at the time of discharge by either participating in a local insurance plan or paying cash. My pre-existing conditions precluded my participation in any health care plan. For me, paying cash would be my only option. For smaller emergencies such as stitches or a broken bone, no problem! However a heart attack necessitating the insertion of a stent or even worse, a cardiac bypass operation could cost from $35,000 to $250.000; cheap compared to stateside prices but well beyond the current balance of my checking account. My last stent procedure in the states (insured) cost $132,000.
End of Part One