heart patients

Dia de la Madre

We have come to the hot, dry, dusty season where we are all waiting for the rains to start in June. One can only hope the rains will come soon and be plentiful, as there has been no real rain since last September. The lake level is very low, our gardens are drying up, the hills are brown, and it’s gradually getting hotter here in the summers, exactly the same as pretty near everywhere else.

But nature does send us some positive indications. Every year the cicadas come out of the ground and for a month and a half make a terrific and unmistakable racket; the folklore around here is that the rainy season will start exactly six weeks after the first cicadas make their appearance. The expats around here call them “rainbirds”, actually, and that’s what they sound like when they get going… an introductory and quite loud “chuck-chuck-chuck-chuck-chuck” for a few seconds, followed by an ear-splitting whine. As the season wears on, there are more and more of them out there so it becomes pretty deafening at times, but most people are eager to hear the first ones, as harbingers of lush gardens and emerald hills, and a recovering lake, just a few weeks from now. One gets excited calls from friends….”I just heard one! I just heard one! The first rainbird!”

However, setting thoughts of the dusty streets aside, it’s Mother’s Day here – unlike the States where it floats every year, here it is fixed, May 10. The village is full of balloon and flower-sellers and moms walking around in their best finery carrying armloads of flowers with little kids trailing behind in regional dance costumes, communion dresses, or other special outfits. The schools always have the children prepare some kind of special Mother’s Day party and performance – a folk dance show, music recitals, little plays. Of course all of this gives every kid a chance to be in a costume and Mexicans love any kind costume or mask – any excuse to shape-shift into something historical, folkloric, mythical, religious. Everyone knocked off work early, half the town was closed up by 2 p.m. and now, in the late afternoon, people are are busy barbecuing, stereos at full blast, kids running around, with much merriment as you’d expect. I normally complain mightily about the blaring music right over our walls, but the folks across the street have a big fiesta going for their family and they’ve got Jorge Negrete or Antonio Aguilar or one of those great old singers on their stereo, volume cranked to the max, and I have to admit it’s actually really nice for a warm, beautiful spring evening. You can tell they’re getting more and more sloshed because they’re starting to sing along with the CD quite lustily. I ran into town for some groceries for the weekend; Wal-Mart was giving away free cake and every cart that came out of the store had at least one cake in it, and people were carrying out boxes with new blenders, pot and pan sets, and all sorts of other Mother’s Day gifts and regalia.

Mexican friends have asked me if I miss my mother on this dia festivo and of course the answer has to be terribly nuanced because I don’t want to spoil anyone’s fun. On one level, the truth is “no, I really don’t” but the more accurate response is that sure I miss her, but I miss the Shirley several decades ago, before illness, depression and dementia took their horrible toll. It would have been so much fun to have had her as she was back then, to go house hunting with us in this latest relocation escapade. She would have so enjoyed seeing all these wonderful Mexican houses. And of course in her imagination she would have occupied herself with remodeling and decorating each and every one of them. It is really too bad that she wasn’t well enough to have had a home of her own here; it would have been a fantastic project for her. That missed boat along with a long list of other missed boats just fill me with sadness, I guess, but there’s no going back now; she’s gone, my dad is gone, and we are getting on with our lives.

Meanwhile, as luck would have it, in spite of not having sold our present house as we had hoped, we did find a new one we absolutely love and we seem to have purchased it! So my “leisurely” summer to lie around, relax in the pool and do my nails has now turned into having to pack this place up, move to the new house on or about July 1, get it up and running and start the process of settling in to a new home. The new place needs a fair amount of cosmetic work, which made it affordable – so we have some grungy times to live through with some construction and repairs to be done. But its bones are wonderful – a great “Mexican Contemporary” on a clean, quiet, charming block-long cul-de-sac street with nicer, larger homes, mostly inhabited by wealthier Mexicans and older, long-retired-here expats. After a couple of years there, having fixed up the things we want to fix up, it should be the perfect house for us; with any luck, we won’t have to move again.

To be completely frank about it, one of the biggest pluses will be getting away from the things that have driven us crazy about our present neighborhood. We have adjusted to it, but not all that happily, to be honest: the incessant barking of the roof dogs at night, rockets (which terrify pets), roosters at all hours (charming at first but there are zillions of them and contrary to popular belief, they DON’T only crow at dawn!) ear-splitting loud parties on the weekends, car alarms going off, constant noise from the highway, garbage in the street in front of our house after every weekends’ fiestas. This almost incessant racket will be greatly diminished, if an issue at all, in the  part of town we’re moving into.

When we first become expats, we didn’t want to live isolated in a gated upper-class fraccionamiento (subdivision) or in an expat community. As a newbie, many people want to live down among the people and all that. Well, we’ve done it for seven years now and while our working-class neighborhood has its charms – and it really does; there are parts of it we will definitely miss  – as aging Americans in a completely foreign culture, we are more willing to admit that we’re over it; at this stage of our lives we need something different for ourselves. You realize that you can love the country you’re in, and we have no plans to go back to the States, but after seven years here, we will be happy to be in a slightly classier (read cleaner, quieter) part of town. And the new house is a bit bigger and better suited to our needs now than this one is.

So that’s where we are. Since Arnold had his second stent put in a couple of weeks ago, we are both feeling “you know, life is short, we don’t have any kids to leave our estate to, let’s enjoy what we have and if moving into a different house is part of the plan, well, let’s just do it!” He’s fine, but his new identity as a permanent, “till death do us part” cardiac patient has been unsettling. His cardiologist is sure he has a long life ahead now that his plumbing is repaired, but the symptoms, especially back in Santa Fe at 7,000 feet, had him rattled (Conclusion: guess we aren’t moving back THERE). So my job will be to manage the house move as well as I can without letting either of us get too stressed about it. Fortunately we’re in Mexico where you can hire a couple of strong young people to move furniture and boxes around for you all the live-long-day and it is a fraction of what it would have cost in the Ancestral Homeland.

It’s fun to have something to be really excited about after all this sadness and loss; I am counting the weeks till we move on July 1. I definitely could use one of those glittering New York New Year’s Eve balls to drop the night of June 30 with the roar of a huge crowd counting down the seconds till the next phase of our lives really will begin.

¡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!

Day of the Sacred Heart

Dia Del Sagrado Corazón

After we got back from New York and Arnold’s pacemaker adventure, he dutifully reported to his cardiologist here, who had everything checked out. The marcapasos (pacemaker) is doing just fine, but mysteriously, Arnold’s heart is still not working as efficiently as it should. The doctor said “We need to find out what’s going on” as he suspects a blockage or blockages in his coronary plumbing somewhere. So off he went this week to the regional nuclear medicine center,  PET Guadalajara, to have a PET scan done. With those images, the doctor can tell us where we need to go from here.

Arnold is of course sick of the whole thing and is not happy at all about his new identity as a cardiac patient. Nor am I, but as we keep saying, we don’t really want to consider the alternative. Whatever they figure out, it may well involve more surgery and probably a trip back to the States, where Medicare thankfully will cover much of the expense. So for the moment, we are putting things on hold until we know what he will be facing. More uncertainty, alas.

Since all of the local websites have pretty much shut down any talk of crime (some of them being sponsored by local real estate agencies, of course), many people are happy that things appear to be calmer now after the horrible spate of random kidnappings and murders we had last month. People are slowly creeping out of their houses and resuming their habitual routines. The streets are no longer deserted; there are fiestas resuming on the weekends and expat community leaders are urging everyone to start patronizing local restaurants and businesses again. There is much musing about the best ways to help our Mexican neighbors recover from the recent crime wave by sending some pesos their way, from “Get out and eat at the restaurants” to “Donate to the funds we have set up for victims’ families”. Whether it really IS any safer out there now, who can tell?  Most of the expats around here don’t read Spanish well enough to check the Guadalajara metropolitan dailies; but sadly, even a superficial glance at those will tell you that there is more than enough crime to go around. But if it’s true – as they say – that after the elections things may calm down, perhaps it won’t be all that much worse than what you’d read about in Detroit, or Chicago, or insert-name-of-crime-ridden OTHER city of seven or eight million people. Who knows? But undeniably, the rival gangs are still kidnapping and extorting and robbing and murdering out there.

The unspoken question always hanging above our heads, like one of those cloud comic book balloons, is whether our little expat colony persists in living in a dreamworld convincing itself that they will continue to leave us alone. But in fact, thus far – unless someone got themselves mixed up in the drug scene somehow – they have. Or, as has happened to an unfortunate few, you are in the wrong place at the wrong time. But then I always come back to the crazies that slaughter people in beauty parlors or malls or wherever back in the States. In this day and age, how you meet your maker seems to be increasingly random – and now I am beginning to suspect that with the economies of much of the world collapsing or going through, at the very least, very tough times, it’s going to get shakier and more unpredictable everywhere. People are getting killed all over the place. I could change my tune tomorrow if there is a resurgence of random violence in our village, but right now I’m thinking that one might as well stay in a place where you have flowers and hummingbirds to distract you all year round, your house is your own, not some crooked bank’s, and the coldest it gets makes you put on socks and a sweater.

You don’t have to be reading the morning news to be a nervous wreck, however. Cartels and American psychopaths aside, Arnold is also balancing on the edge of a knife blade just because of what is going on inside his own body – no murderous thug need apply to give him sleepless nights. So we are putting our fretting about being massacred in a balacera (gun battle) aside long enough to try to figure out what we are going to do about Arnold’s heart situation and – to the extent that anyone can relax knowing that they may be facing heart surgery – to enjoy the arrival of the rainy season. Everything is turning lush and green, almost overnight, as it does every year. We were sitting on our terrace the other day, watching not only dozens of hummingbirds racing around, but the big yellow-and-white Great Kiskadees (they call them Kiris here) with the wonderful black racing stripes on their heads, some gorgeous orange, yellow and black orioles, and a couple of brilliant red Vermillion Flycatchers swooping around our fountain.

Then suddenly we heard the remnants of a procession passing by the house in the street outside our garden walls, accompanied by the strangest and most compelling sort of pre-hispanic or medieval melody you can imagine; I thought it sounded like a flute but I’m still not sure. I’d never heard anything quite like it. They’ve been setting off cohetes (rockets) all over town, too, scaring pets and rattling everyone’s nerves even more than they have been rattled by recent events. But cohetes are a big part of the culture here, so their return wasn’t entirely unwelcome; a tenacious tradition reasserting itself in spite of it being a dangerous time. The unearthly music floated around the neighborhood for quite awhile, and whoever was playing it was either in a trance or practicing very hard to get it right, because it was repeated over and over again, almost like a meditation.  The street had been decorated with red and white crepe paper, too. “It’s got to be some sort of religious holiday, doesn’t it?” Arnold said. “Yeah, but which one is it?” I wondered.

Then it dawned on both of us, when we remembered the June date, and that the red stood for blood, the white for purity, that it was Dia del Sagrado Corazón, Day of the Sacred Heart.  It is a actually a very serious holiday for these folks, marked by somber prayers and processions, acts of consecration, the recital of novenas and so forth. It is probably going to turn out, when we see the doctor, that it will have been a pretty serious holiday for us, too. Prayers for us, for those who pray, may well be in order, in fact.

One sees a variety of images of hearts – both sacred and profane – everywhere in Mexican art, from the pierced and bleeding hearts (symbolizing the travails of the Mexican people) of the great muralists to the most naïve and delightful folk art.  Even Arnold’s cardiologist, whose black-and-white office is as sleek and modern a place as you can possibly imagine, in an equally sleek and modern glass tower in Guadalajara, has a wonderful handmade metal tree on the credenza behind his desk – hung with dozens of enchanting, translucent red glass hearts. So while he is telling you that you need to have your chest cut open and your heart patched up, you can enjoy this wonderful piece of folk art. Mexico has come a long way since the day when, instead, they would have cut your heart out and offered it up to the gods as a sacrifice.

And so, still waiting for the results of Arnold’s twenty-first century PET scan, we have passed this year’s Día del Sagrado Corazón. We will see the cardiologist, and his delightful metal tree, in this office this afternoon.