Mexican medical care

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.

A Romp Through Andares

Last week it was time for Arnold to go have his new stent checked out at Dr. B’s office – and I also was due for a checkup and a stress test (just to be sure I would survive at least as long as Arnold will now with all his new hardware).  This required us going in to his main office, in the gleaming new Puerta de Hierro medical center in Guadalajara. Both of us got poked and prodded and tied to various machines and after two hours of this, Dr. B. said we were both fine, he’d see us in three months. Then Dr. B’s topic turned to where we were going to have lunch at the splendid Andares mall right next door. Have you tried this place, have you tried that place, this one has fantastic steaks, this one has a very fine wine list – and so it went for fifteen minutes before Dr. B. sent us on our merry way – after offering us cappuccinos to strengthen us for the arduous shopping ahead — and he had to see his next patient. How many cardiologists have espresso machines in their offices? We are getting very spoiled.

I spent most of my childhood in the San Fernando Valley, where many of the first of the “outdoor” malls cropped up. Instead of being under a roof you walked across landscaped courtyards with splashing fountains from store to store. The first one that I recall was Fashion Square in Sherman Oaks. It was always fun for my sister and me to go there with our mother to pick out clothes for school, home décor items, whatever we needed. Andares shopping center is located in a new community of tall glass office and condo towers, taking shape in one of the nicer parts of Guadalajara. It is similar in concept to Fashion Square because like Los Angeles, Guadalajara’s temperate climate allows for the mall’s restaurants and stores to be clustered around open gardens, green all year round. So of course the Valley Girl feels right at home there. We lucked out too, because there was lots on sale, it being August. It made for very good prowling through the men’s department for Arnold (who didn’t buy anything but enjoyed looking).

Anyone who still thinks of Mexico as being a land of mustachioed campesinos sleeping in white cotton pajamas and huaraches beneath a cactus needs to pay this place a visit. It’s anchored at either end, as malls tend to be, by Palacio de Hierro and Liverpool, arguably the two fanciest department stores in Mexico. You can wander in to the gleaming marble atrium of Palacio de Hierro and find pretty much anything your acquisitive little heart requires – after you pass through the sizable cosmetics section, which has counters for just about every international brand you can name from Chanel to Lancome to Bobbi Brown to Clinique, Yves St. Laurent, and many more.  Then for insane luxury purchases, there’s a Tiffany, a Louis Vuitton, a Cartier, Gucci, a Ferragamo, an English gentlemen’s club kind of store for men, – well, you name it, it’s pretty much there. The dozens of  stores in the mall itself are loaded with the latest fashions and crowded with shoppers. Mexico has more and more high-end merchandise for sale, so if you wake up one morning and decide you must purchase your Rolex watch that very day, you no longer need to get on a plane to hunt it down; there are plenty of places – not only Andares – in Guadalajara where you can find the watch of your dreams.

How times have changed. One of my favorite high-end Mexican shops (which has boutiques located in the main Mexican airports, fortunately or unfortunately) is Pineda Covalin, where exquisite items in silk and other fine fabrics are adapted brilliantly into prints from traditional Mexican folk textile designs. Their designers are endlessly creative and find the most wonderful embroidery and other images to transform into silk scarves, shawls and accessories you could wear with perfect elegance into any opera house in the world.

But what has made my Jewish American Princess heart sing of late is that there is now (yippee!!) a Sephora cosmetics store at Andares mall. I know, how superficial, how ridiculous, overpriced makeup when you could buy the same thing at the drugstore. Well, here, you CAN’T buy the same thing at the drugstore; in that respect it is still different from the States. Back in the Ancestral Homeland the scruffiest CVS or Duane Reade has a boatload of modestly priced and fun makeup and beauty accessories (hey, I’m 65, I need all the help I can get), but here, the farmacia pretty much sells medications and a few household items like diapers and toilet paper, and that’s it. Farmacia Guadalajara, the big chain around here, has hardly any cosmetics at all.

Thus I was looking for a few things I missed picking up in New York; I knew that Sephora would likely have them. So I went in with great anticipation as they have just recently opened their first stores in Mexico. To my great delight I found most of what I needed but a few things were not to be found, and the very nice young man who seemed to be the manager said “Yes, I’m so sorry we don’t have that in yet, Señora, but we will. Every week they are shipping us more things and soon we will pretty much have what Sephoras elsewhere in the world have. You must come back soon.”

We had a lovely lunch, along with dozens of stylish, professional Mexicans, executives having business meetings, elegant women having ladies’ lunches, young families with kids turned out in all the latest gear, at a terrific sleek, gray and steel Italian restaurant. We wandered around afterwards and bought a few more things, having had a much-needed (after all the medical stress of the last few weeks) dose of retail therapy. Just knowing it’s all there, an hour away, somehow makes more bearable the infuriating lapses of electricity, the home repair people who say they’re coming and then don’t; the petty thievery of the glass from the lamps outside our gates, the garbage strewn around the calle carelessly after every weekend’s fiestas and other stark reminders of the class differences in our village. A romp through Andares, with all its superficiality and contemporary temptations, sometimes is just what the doctor ordered, especially after an in-office cappuccino. From my Encino-bred punto de vista (point of view), every once in awhile one needs a break from the undeniable fact of Mexico being indeed the “land of contrasts” with a return – however brief – to the familiarity of the good ol’ global monoculture.

Apparently they are coming out with a new Andares app for your cell phone that will tell you everything that’s going on in the mall and gives you contact information and such for all the stores. – sales, special events and such. ¡Muy padre! (very cool). I can’t wait to take my sister there when she comes down to visit next month, so we can both wear something pretty for lunch, and channel our inner Valley Girl heritage, at least for a day.  Meanwhile if you want to see what an upscale Mexican mall looks like, here is a link to Andares’ 360 degree photo panorama. And of course, it’s like this all year. No snow in Guadalajara!

http://www.andares.com/andaresv2/recursos/vista/CentroComercialAndares.html

¡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!