Mexican medical care

Q.E.P.D.

My impossibly compromised and frail mother finally died last Sunday. No matter how you try to soften it; she “passed away”, “made her transition”, “left us”, “crossed the rainbow bridge” (though I think that’s reserved for Wagnerian gods or pets) or whatever, the bottom line is that she died. And to tell the truth, her demise was horrible to watch. Thank god she was pretty much unconscious for the last twenty-four hours of her life for she was in pretty bad shape. The doctor examined her, and pronounced that she wasn’t going to last too much longer; her lungs were perforated from the emphysema, and everything else was starting to fail, too. She was, after all, 90, and had been in the process of dying slowly for at least eighteen months; and in failing health for a good ten years before that, so none of this came as a big surprise.

When it was becoming apparent that this was probably going to be it, (no more amusing revivals where after two comatose days she abruptly woke up in her hospital bed to ask for chocolate milk), Arnold and I felt that we should just stay there, with her, in her little room at the home, until the very end. Which is what we did. I will never know whether she knew I was there or not though I tried to comfort and reassure her through her last night. Although actually watching her die was heartbreaking, since there was nothing more anyone could do, perhaps when my own time comes having seen it will make me a little less frightened. At least now I sort of know the stages one goes through, from my dad’s death as well. Who knows, maybe it isn’t so final after all; now all these books are coming out even written by formerly disbelieving, atheistic, humanist scientists, that have gone through near-death experiences for one reason or another, and they’re starting to say “Gee, there really IS something out there, many people are reporting the same thing and now I’ve seen it for myself….”

Well, however the end comes or whatever follows it, I sat with her till hers came, dealt with the doctor and the funeral home and the people who run the convalescent home where she spent her last days, then came home and collapsed, exhausted emotionally and physically, into bed. A week later, I feel a little bit like an animal that has been down in a cave hibernating for years, and is just coming out into the bright sunlight, sort of blinking and stretching. It has been a long slog with poor Mother,  and both for her sake and mine I am very glad that it is over. 

Over the past couple of days I have been thinking I about what best to do to memorialize her, since at least for the moment, we don’t have plans yet finalized for a memorial service, although we are thinking about doing something for both my mother and father back in Los Angeles, the closest thing there is to a “homeland” for both of them. Even though Wendy and I had divided up all her jewelry a long time ago, I never felt comfortable wearing any of it while she was alive, even though there was obviously no way she was ever going to be getting dressed again. Yesterday one of her favorite silver chokers caught my eye in my jewelry box, and I glanced past it looking for something else of mine, as I always did, until I suddenly remembered that she was gone now. I figured “Well, it’s mine now, for better or worse, I’m gonna put it on and wear it.” Then I decided that to incorporate her things into mine, I would try to wear one piece of her jewelry every day for a month. Sort of like the cats, let the various pieces, mine and hers, all get used to each other in the drawers.

I made a couple of trips back to the home to empty out her room, and I was struck by how sad it was that my mom, who painstakingly remodeled and decorated several wonderful houses throughout her lifetime, was reduced to having just a pitiful handful of her things around her when she died. Just to make the room feel more like “her” place, Wendy and I brought over some of her Japanese prints, a couple of her tables and lamps, put some fine old Mexican textiles on the bed and dresser, and tried to make the place look a little less spartan. She did manage to barely whisper, on several occasions, that she really liked her room and was happy to have ended up there, which made us feel good. Having inherited her decorating genes, I know we did make the place look much nicer for her. But now the time had come to clear all that out and make way for the next poor ancianito who will spend his or her last days there; I brought all the stuff home in a couple of carloads and with some help from Rosa’s son-in-law, who has a pickup truck, and that was the end of that.

The next day I stopped by to see Maria, the wonderful lady who really took physical care of Mother, changing her diapers, feeding her chocolate milk with a spoon, pulverizing all her food because she could no longer swallow, turning and bathing her. I wanted to thank her and I gave her a photo of Mom as a beautiful younger woman, which I had promised her. We chatted for awhile and Maria said “You know, Señora, the strangest thing happened….I was down on my hands and knees cleaning in the bathroom after you left the other day, and I missed your mother so much that I was crying, But I felt this soft hand, almost a caress, running down my back to console me, and no one else was in the room…I just KNOW it was her”. I told her that I bet it probably was her, that I have read and heard about such things happening. “Maybe she was trying to tell you that she is okay now, that she is at peace”, I added. Maria thought that was true, that she was with my dad now, and all that. It helps a lot to be religious, I guess. But there might just be something to it, one cannot know from this perspective, maybe it will become evident from the top of the Rainbow Bridge when one arrives there.

In any event, with this chapter over, I am one step closer to my own death as I move up a notch into the slot of “probably-the-next-generation-to-start-dying-off” in my family but I also feel that in a weird way, now that I have indeed discharged my filial obligations to the best of my abilities, I’m about to be reborn somehow. The “Third Age”, tercer edad, the Mexicans call it. If I’m lucky, I’ll have another twenty years or maybe even a bit more, si dios quiere,  so I think my task over the next few weeks and months as I mourn my mother, however that turns out, is to think about what I want to do with the time I have left and then get busy doing it. Listening to a lot of Bach these days, ageless, timeless perfection. Tempus really does fugit.

Q.E.P.D

(Que En Paz Descanse)

Back in the saddle?

Day of the Dead, midnight, Ajijic. Where I left off writing in November....

Day of the Dead, midnight, Ajijic. Where I left off writing in November….

Surely I am not the only blogger out there who has taken a break from writing for awhile.  Once again, life intervened and obliterated my good intentions to write at least SOMETHING over the past couple of months. But, in brief, here are my excuses.

We decided, for financial reasons as much as anything, to move my mother yet again, into a nearby convalescent home, basically, and begin the process of taking apart  her house here (we keep having to take apart houses my parents – or now, just my mother – have lived in, and it’s time-consuming and draining, to be candid). Since she is now pretty much blind and bedridden, keeping her where she was, in her own private home, was not making financial sense any longer.  But this time we found a much more economical and reasonable solution for her, where honestly, we are pretty sure this will be her last stop. They take terrific care of her there, as only doting Mexican ladies can, feeding her wonderful chicken caldo (broth), vegetables and, by doctor’s orders, chocolate milk whenever she wants it, which gives her enormous pleasure after years of obsessive dieting and diabetic diets. She has been so weak and immobilized that now she actually can use the calories – and the enjoyment to keep her spirits up. To whatever extent she is capable of rallying now, she does have occasional moments of more lucidity and we even get to see faint glimpses of her old wicked sense of humor, which is heart-wrenching in a way, but also lightens the load a bit. Much of the time she is just asleep, but in the rare moments when she is candid, it is good to see that for that moment, at least, she’s still “in there” and can manage a faint smile.  She will turn ninety in January, and when I reminded her of this and told her we’ll have a big party in her room at the asilo, she barely could get out a whisper, but she did say “wow, amazing”. And so it goes.

Then I was surprised in November by a couple of medical problems that pretty much required immediate surgery – I tried to figure out alternative therapies or ways around my medical issues, but after all my hesitation and resistance, I finally had to surrender to the reality that I probably couldn’t fix things on my own, and I had to face the situation head-on and deal with it. Mid-December, I had a three-day stay in a private hospital in Guadalajara that was just terrific. Through that experience, I also found wonderful new doctors who can take good care of me going forward, so in that respect, it was fortuitous. Now, I’m on the mend and surveying the wreckage of everything (I seem to have utterly missed Christmas this year, and my birthday December 23!) that was left undone and littering my path before I disappeared from view for awhile. Well, surprise surprise, all that stuff is still right there where I left it lying around while I dealt with more pressing matters – unfinished projects, unanswered e-mails,  and of course my poor lonely blog. It’s all still here, sort like our dog Reina lying patiently at my feet, none of it went anywhere, so I guess I can pick up where I left off.

The good news is that we are about to start a new year, which gives me an excuse to say about this last one that – well, I’ve seen better. As I have gotten older I seem to feel that way at the end of every year, and last year I had a REAL excuse for giving 2011 a bad review because we did go through my dad’s death. I mean, that would have seemed a much better reason to wish the year was over and hope that next year would be better. This year we had a horrific crime wave here in Ajijic that terrified all of us but now when we look at it from the perspective of the murder of all those children in Connecticut, the random murder of people, especially young people, doesn’t seem any weirder here than back in the Ancestral Homeland. Whether you get snatched from the street in a kidnapping or mowed down at your school, your friendly local mall or at the movies, what’s the difference? The final outcome is the same, I guess, for you and the people who love you.

So we stay – cynically perhaps? here in our paradise, which, after all, by now is home, and hope for the best. Undoubtedly the weather here is better than anywhere else we can think of and if for no other reason – and inertia – here we shall most likely stay, year after year, enjoying the sunshine and flowers. Sometimes we talk about a different house, but as a practical matter it isn’t something we can tackle right now. Perhaps mañana.

My mother is still alive, doing as well as can be expected in her pretty and, as such spaces go, large and bright room at the rest home. Arnold, Wendy and I brought in a few decorative items and linens of hers from the storage unit when Wendy was here a couple of months ago, so on the days when she can see – some days being better than others – she knows that some of her own things and art are in there; we made it as nice as we could given that her real world has shrunken down to a hospital bed with occasional moves to a wheelchair for bathing and such. She has sliding glass doors out to an eternally green garden, and I hope that she makes it long enough for us to have her crack a few more jokes before she takes off.

¡Viva México!

On top of the stresses of my mother’s ever-so-agonizingly-slow decline, the ongoing territory battles of the cuatro gatos, the occasional armed robbery and murder here to keep us on our toes, we have had to deal with the outcome of Arnold’s PET scan, done just before we went off to Puerto Vallarta. Sure enough, as Arnold’s Mexican cardiologist, the wonderful Dr. B., suspected, the PET scan showed some additional problems in his heart, and he wanted to get in there to do an angiogram – and probably put in at least one “estent” (stent) as soon as possible.

So our choices were – A) Go back to New York, where Arnold is in the hospital’s system and Medicare plus his insurance would pay for the whole thing. He mused, “We could go back to New York, I could go into the hospital overnight and then be out and guess what – we’d be in New York! We could shop and play and eat and see some performances and yippee! If we’re going to be spending all that money anyway.” B) Have it done in Guadalajara, where we would have to pay for everything ourselves, but one would come back from the procedure to one’s own home and bed – and garden terraza (terrace), with vodka and tonic at hand rather quickly – in a matter of an hour or so after being released from the hospital; no hotel rooms, flights or going through customs required. I did a rough calculation and figured that it was pretty likely to be a wash, or close to it, with New York hotel prices, airline tickets, food, and such. So it was really up to Arnold, where he wanted to have this done.

He really liked the idea of going back to New York; everyone in the hospital speaks English, and they have even more fancy technology there (or so we thought) than they do here, should something go wrong. I wasn’t sure I agreed; my wifely instincts were telling me we shouldn’t mess around with this, getting on what amounted to four plane flights, the stress of traveling and then staying in a hotel, and the general hassle of it. What if something happened to him on a plane? And there was the nagging question as to why the wonderful specialized American cardiac center had utterly missed this possibly fatal blockage in the first place. In the process of putting his pacemaker in they had done god knows how many echocardiograms and x-rays during the time he was in there. But it was his decision, so I said  “Of course, whatever you want to do” even though my gut said we should hie ourselves off to the catheterization lab in Guadalajara like NOW.  Dr. B., who deals with Americans all the time, said “I get it about wanting to have Medicare cover it, but don’t delay on this too much longer” which for a Mexican is pretty much a five-alarm bell, at least in my view.

Still, Arnold, undaunted, persisted in wanting to go back to the Ancestral Homeland. He got on the phone and contacted my cousin’s highly regarded cardiologist in New York City. Well, not exactly the doctor himself, but his office, whose Patient Care Coordinator told an eager Arnold rather briskly that unfortunately the first available appointment was mid-October and this was mid-July. Welcome to the U.S. medical care system. So, good news, you can have it done in the U.S. and Medicare and your insurance will pay for all of it. Bad news, if you wait five more months with a couple of badly clogged arteries you could be dead.

Poor Arnold then called Dr. B. and said with a bit of trepidation, “Okay, okay, I get it that I can’t wait till October. Let’s just do it here and get it over with; tell me what I need to do”. “Stop by the office and we’ll make a plan”. So we go, and Arnold regales the doctor with his disappointment in the folks in New York, who wouldn’t make the institutional waters of the great and famous cardiac center part for his stent procedure. The good doctor listens patiently while Arnold vents about the whole situation. While Arnold talks about it all, Dr. B. intently studies his arm, saying “let me see your hand; make a fist, open it, close it, now turn your hand over”.  He then pronounced, just as Arnold put the finishing touches on his lament about Nueva York; “Great, we can go in through the wrist”. “What?” we both asked; “not through the femoral artery in the groin, with the eight hours of a sandbag on you and you cannot move an inch?” “No, he said, we don’t do it that way any more; nowadays we go in through the wrist. Much better, you can get up and move around, go to the bathroom, even go home in a few hours although we generally keep patients in overnight just to observe them. ”

Then he said, “How about day after tomorrow? I’d do it tomorrow but I have appointments with patients.” Be at the hospital at 8 a.m. and I’ll schedule it for 8:30. What? You are worried about getting to the middle of downtown Guadalajara on a weekday morning, a good hour away from where you live? No problem, we will send a car and a driver for you and your wife.”

The nice driver called us at 7 a.m. to say he was stuck in traffic himself coming from the city, but “no hay problema”, he had already texted the hospital and they were expecting us despite the delay. When we walked into the hospital’s reception area, a lovely gentleman in a while lab coat, Dr. B. SENIOR (our Dr. B.’s father, also a cardiologist, who works with him, it turns out) whisked Arnold away immediately to the catheterization lab. He told me to go in to his hospital room and wait, after I had filled out a bunch of paperwork. His room was basic, nothing fancy, a bed, a private bathroom, a TV, a couch for a family member to sleep on, and a bashed but very comfy old recliner. “Disculpe”, the doctor said, “this is a very old hospital and there are newer and prettier ones around, but this is the one where all the cardiologists work because this one is where all the best equipment is”.

An hour and a half later the younger Dr. B. called me and said “Come downstairs, I want to show you the images of his angiogram. I’m very happy you both decided to do this here and I’ll show you why in a minute.” I went downstairs into the lab and there Arnold was with a bunch of tubes coming out of him and a big pressure bandage on his wrist; he was wide awake and very happy it was over with. I noticed that they had rushed him in there so fast that they had left his wedding ring and watch on. There were six big computer screens over the table above his feet; Dr. B. said “I want you to look at this” and showed me “before and after” – what turned out to be a 98% blockage in the left anterior descending artery.  This is a really serious one; turned out he was a sitting duck for a massive heart attack. He explained, “The PET scan showed us there was a problem there, but sometimes we just can’t tell how bad it is until we actually get into the catheterization and can really see what is going on. He is very, very lucky – now he will be fine. We can do miracles repairing peoples’ hearts these days but believe me, it is so much easier BEFORE the person has the heart attack than it is afterwards.”

They moved him to his room, he promptly turned on the Olympics on the TV; I stayed with him for several hours and then decided to head home on the bus. Dr. B. saw him later that evening and said “You can go home tomorrow – how will you get back?” Arnold said “well, I’ll probably just  take a taxi to the bus station and take the bus back.” “Wait, Dr. B. said, I have patients to see in my office in Ajjic tomorrow. I’ll pick you up here at 9 a.m. and run you back there, and your wife can pick you up at my office there around 10:30.” Talk about customer service!

So the next morning, I picked him up at Dr. B.’s office here in the village, and brought him home. The four kitties and Reina greeted him, and later we both went out to the terraza  for our regular evening cocktail and chat. The next day he took off the teensy weensy spot bandaids he had on each wrist – one where the catheter went in and the other where the IV port was. And that was that.

Meanwhile Mexico just won its first Olympic gold medal in soccer and the neighborhood is going nuts, shooting off rockets and one can only imagine how crazy things are in town. Arnold is fine, recovering his equilibrium, paying bills at his desk, after having had the wits scared out of him by this series of events.  I think this means that at least for the moment, life is going to go on.

¡Viva México!

The massive wound left by Arnold’s stent procedure, through the wrist!