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Tuesday, December 6, 2011

Emergency Hospitalization!

What is it like when the worst happens and your all alone in a foreign country?

Imagine this scenario; you're away from family, long-time friends and associates. You don't speak the language of your new country fluently just yet and then a medical emergency strikes. How do you cope? What happens in such a situation here in Uruguay?

This post is a narrative about a true, life threatening medical emergency requiring hospitalization. It did not happen to me. This is not my account of what happened but rather that of a Single woman who wishes to remain anonymous so we'll call her "Missy' for the purposes of this post.

"Missy" is a fairly new expat to this country. She's been here a little over 3 years. She was hospitalized for a sudden and surprising case of acute Pancreatic infection. She had no such prior history of this. She didn't know what she had or why she was in such pain until it was discovered during the hospital stay.What happened to her, happened at the beginning of this year in January, 2011. She is now finished with the ordeal and is fine.

I thought that most of my readers but especially other expats and those considering moving here would like to know what happens in such a medical emergency. I asked Missy some questions and her answers are in the narrative she wrote for this post.

Missy, do you have medical insurance? Do you have an ambulance rider attached to your insurance or in other words how did you get to the hospital? Since women tend to ignore aches and pains, what made you realize something was really wrong and when? Did you go to the hospital right away or did you go somewhere else first? What tests and procedures were done to you to determine what condition you had?

You can find out her answers to those questions and more in her following narrative. Please note that she tells what happened to her in her own words. I have added nothing except having bolded a few words and italicized a few others to emphasize some points I thought were unique.

Missy tell us what happened!

**I was at a New Year's eve party in Atlantida when I started to feel "not quite right". I had eaten a lot and had quite a bit of alcohol, and I don't drink very often. I felt as though I needed to either throw up, have a bowel movement or pass gas. I was finally able to have a BM and eventually I started to feel normal again. I went home that night but didn't go to sleep because the feeling persisted. It was a sort of pressure, and when I took Pepcid A/C it tended to go away. I felt uncomfortable off and on Saturday and Sunday, and by Monday afternoon, it had developed into an excruciating pain in my abdomen. I couldn't take it any longer so I called a friend, who came right over. By then I could hardly walk. She took me to the Medica Uruguaya clinic (this is my health provider) in her truck. They put me on a gurney and tried different IV's but couldn't get the pain to subside. They recommended I go to the hospital and called a taxi for me. Ambulance service is included in my monthly premium, but I've been told there is only one ambulance, and if it isn't available, you take a taxi, which is paid for.
All the way to the hospital, which is on Avenida Italia and 8 de Octobre, about an hour ride, I lay with my head in my friend's lap. When we got to the emergency room, it was quite crowded. My friend went to the desk and told them I was in terrible pain (her Spanish is excellent!) and I was moved to the head of the line. They took me in, put me on a gurney and gave me morphine. They took blood, and when the pain finally eased, took me to have a CT scan of my abdomen. These two tests confirmed that I was having an attack of acute pancreatitus. I had never heard of this and didn't know how serious it was.
I sent my friend home, as another friend was on the way who would spend the night with me. I was taken to Intensive Care and hooked up to four IV's. It was January 3, and one of the worst episodes of my life had begun. I would not be allowed to eat or drink for the next three weeks! This was horrible. I had no energy, I couldn't get out of bed, I had to wear a diaper because of constant diarrhea. I think I was on pain meds because I don't remember what I said to people or who came and went. And I had a catheter. They did give me a sponge bath every morning which felt really good. I had to wear an oxygen mask for a period of time as well.
I shared a room with another woman, and this was difficult because they let family visit any time and stay overnight as well. There would often be five or six people in the room at the same time, and the television was often blaring until 1:00 am or later. My doctor moved me the first time because I couldn't get any rest. I was moved a couple more times, once out of Intensive Care and once more because someone else needed my room.
The rooms were fine, each patient had access to a TV with cable which had a few English stations,  but you had to pay for it. Most of the nurses were nice, There were several  that were really kind and thoughtful, but there were a few who were arrogant and brusque. Some spoke English, but not most. There was an en suite bathroom with a shower, and the rooms were cleaned twice a day. There was no call bell, so when you needed help, you had to clap your hands until someone heard you and showed up. I thought this was strange, especially when I was later moved to a room that had a call bell when I was doing much better and hardly needed it! The rooms had big windows and a fan which contributed greatly to comfort
Two weeks after I arrived I had a procedure to remove two cysts that had developed. My surgeon attempted to drain them by puncturing them, but was not successful, so he put in a drain in each of my sides. I was awake during this procedure and even though he used a local anesthetic it hurt like hell. I was no longer going to be able to sleep any way but on my back because of these two drains.
Three days after this I went into surgery to remove my gall bladder and the section of my pancreas which had died. The cause of my illness was gall stones which had formed and blocked the duct leading to the pancreas. This caused the pancreas to begin to die, which was why I was in such pain. It can be compared to kidney stones, which I have heard are very painful. You can't live without your pancreas, and I found out later I lost nearly half. I also found out later that people can die from acute pancreatitus, about 30% don't survive. No one told me this while I was recovering, because they didn't want to scare me or stress me out. Just as well I think. With my gall bladder gone, this wouldn't occur again.
I had blood taken every week, and I was tested for diabetes often. It often hurt, because I have small veins and they were clumsy. I had lots of bruises and was often in tears. I was often in tears anyway, just because I was so miserable and I didn't want to be in the hospital. When I was recovering I begged the doctor to let me go home but he couldn't and I cried a lot because I wanted to go home.
I had CT scans and ultrasounds regularly. Medica Uruguaya is a big hospital and all the tests and procedures are done on site. They would just wheel me in my hospital bed to the appropriate room, or bring the equipment to me. Everything was covered with my insurance, and I am so glad I had it, as I was there almost eight weeks initially, 25 days in Intensive Care.  
Eventually I was allowed ice water, and what a blessing that was. I had been craving liquid and was so envious of all of my roommates who could have whatever they wanted. It also made me sad because they got to go home and I didn't!  I had no appetite, so not having food didn't bother me in the same way. When I finally got food, it was so disgusting I couldn't eat it anyway! It was the same thing every day, pureed squash I think. When I recovered enough to eat solid food, it wasn't so bad. I had rice, soup, chicken, potatoes, ham, pasta. I just couldn't have fruit, or anything with sugar. But I was allowed tea and ice cream with artificial sweetener. There was absolutely no spice on the food, it was completely bland.
Breakfast was served at 8:00 am and consisted of a piece of bread or crackers and a cup of tea or coffee. Later supplemented with sugar free jam.  Lunch was at noon (see above), then another cup of tea and piece of bread at 4:00 pm, and dinner (see above) at 8:00 pm. Before breakfast our sheets were changed and we were given whatever meds we were prescribed.
My doctor finally let me go home on February 25against his better judgement. He thought it was too soon, and I still had both drains in place. I think he got tired of listening to me cry, ha ha. I had to follow a diet with no fat, no sugar, no fried food, no alcohol, no fruit, no spicy food. I was glad to get home, but I had no energy for the simplest things, all I could do was sit in a chair and watch TV. I had no appetite, even for my favorite foods. I had lost about 16 pounds. A nurse from the clinic in Atlantida was sent to my house each day to clean and change the drain sites (included in my treatment). I couldn't ride my bike or even walk very far. Being in bed for so long had weakened my muscles. I had to take a nap daily and couldn't lift anything.
On March 8, I was feeling very weak, dizzy and just not well. I called the clinic and they sent an English speaking female doctor to my house. She took one look at me and said I must go to the hospital immediately. I called a taxi, and she told them to take me to emergency, no charge. When I got there I was given a blood test and put in a chair to wait for ages. They finally told me I had low potassium and I was admitted to the hospital. It was too late to see my doctor that night, but I saw him in the morning. He said I needed to stay for "a few days". I ended up staying 18 days! I never knew why my potassium was so low, but I know that's not a good thing. I was eating vegetables, and I think I wasn't supposed to. I was resigned to my fate, though, and didn't cry this time. I felt much better quite soon, so this wasn't the hideous experience the last time was. I could get in and out of bed, take a shower, walk the halls, eat regular food, etc. so it wasn't so bad. I realized though that the doctor had been right; I had gone home too soon, and this was my punishment! They were able to remove one of my drains, so that was a bonus. I wouldn't lose the other one for almost two more months, however.
I went home for the second time on March 26, and I haven't had a relapse so far. I had a few followup appointments and scans afterward, but haven't seen a doctor since beginning of May, seven months. The doctor followup visits are free, but I had to pay for additional blood tests and scans, which weren't expensive. I am eating normally now, and have gained back the weight I lost. I feel fine and am back to normal activities. I am taking no medication.
There is no doubt in my mind my surgeon saved my life. He was excellent and even spoke English. He was very patient with me and came to see me every day, even though I got upset at him often. When he went on vacation, he had another doctor visit me, who also spoke English. I received good care at Medica Uruguaya but it was certainly no frills. You had to bring your own towels, soap, shampoo, toilet paper, tissue, for example. My long hair was ruined while I was there when they tried to wash it in a small bowl and didn't get the soap out. I had to have it cut off when I got out because it was snarled and damaged beyond repair. It's growing again now and is in good health.
I don't have any family here, and that might have made my stay more pleasant. I did have lots of visits from good friends, which helped a lot and gave me something to look forward to. The early days passed verrrrry slooooly! It got better as I got better, and I had books and my laptop brought in that helped pass the time. I didn't take any pictures, it never occurred to me. I am grateful to be alive. I thought I would never be back to normal, it seemed to take forever, little steps at a time. Patience was never one of my virtues. I just turned 62, and have always had such good health which I took for granted. This came out of the blue and hit me very hard. It was so unexpected and so shocking. I'm so very glad it's over.**

I want to thank "Missy" so o much, for taking the time to write about her painful ordeal and allowing me to post it! I wanted to be sure her story got told. 

"Missy" you are one brave lady and you have survived one of the worst situations imaginable. I know you will enter this coming new year of 2012 not only as a much stronger person for having survived all that you have but with a renewed appreciation and zest for life. May you enjoy life here in Uruguay for a long time! Good health to you! 

PS. I realize that I didn't include any pictures of the Medica Uruguaya hospital or the clinic. Missy was not in the position to take any photos during her stay. I have not had a chance this month to go down to Montevideo to take any of my own. However, I believe her story is riveting enough to have been posted sans pictures.

PSS.  There are many large hospitals in Uruguay and several in Montevideo. Missy went to Medica Uruguaya because her insurance coverage is with that hospital as is mine. However, the best hospital, a private one is reportedly the "British hospital" for care and being upscale. Click on the link for a list of hospitals and for information about them.  


Hawk's Organic Farm And Orchard said...

brave story, thank you. sounds like decent health care, caring friends, painful experience. Health care is obviously pretty good but different.thank you wally for this blog... billy

Wally said...

Billy- as much as I would like to take credit- Denise has been the blogger during the past year, while I am away...

TV said...

Wow. What an experience! I have worked in healthcare for over 33 years and some of that sounds so crazy. I usually think that 5 or 10 days in the hospital is a long time!
Also, towels, soap, shampoo, toilet paper, tissue as frills? Wow again.
The bottom line though is she got the "fix" she needed and hopefully she is doing fine now after recovery. Good to know that you can get the medical care that really counts in Uruguay.
Thanks for the incredible story of courage!

~Em said...

Please tell "Missy" that I appreciated the telling of her experience. Interesting to note the similarities and differences of medical procedure and nursing care. So glad to hear that she is doing well.

Giorgio/Doriana said...

Hi Denise,
I am happy for your friend is getting better. I have a question.
I am reading that there are public and private hospitals in Uruguay. Can you tell me how it works for Uruguayan people? Which kind of healthcare the middle class have. The concept here in USA is that everything that is government is not good. If you want to have better service you have to pay and choose between private businesses. I am an Italian and in Italy we have mainly only government hospitals and doctors and the system is working fine. Some hospitals provide better service than others and we have big differences in quality of services provided between north and south of Italy. We also have few private clinic but with no high technology operating rooms and we have private doctors where we can go and get a good service but at the high price. But very important is that if you are travelling and you need a doctor or an emergency visit to the hospital you have access to all hospitals for free. It is free also all over Europa for EU citizen. In Uruguay if you need to go to the hospital for an emergency, like car accident and the nearest hospital is not public but private how it works? If you pay as you sad your insurance and you cannot reach your hospital on time what you are going to do?
I read articles about which are the best hospitals in Uruguay and I am wondering what the Uruguayan think about this. Because they write that the best are the private hospitals. Sometime is just marketing to get the foreigners to buy insurance from them. I will be happy to hear from you what your opinion is.
Giorgio/Doriana-Florida USA

Anonymous said...

THis is for Giorgio and I hope it helps.

In Uruguay its a crime to negate healthcare even if you have no insurance. What happens its for example, if you have a car accident in front of a private Hospital, they HAVE to give you attention first. IF you have a private or even a Public insurance then they take care of the "bill" of the hospital that took care of you first.

Public health care in Uruguay its good BUT its not at all fancy. What I mean its that you will have good care but the facilities are not fancy at all. To have free health care you have to proove you are "poor". If you are working, chances are you are entitled to a private health care plan, and are able to choose between differents HMOs. BUt if your montly salary exceeds X amount of mony, there's NO Subsidy and YOU have to go and pay a private insurance yourself. MEaning, you are NOT entitled to free public health care, since your income its good enough for you to pay it yourself.

When I was back in Uruguay, I had a middle income job so half my PRIVATE HMO was provided by the Social Security, the other half was discounted from my paychek.

I have been away living in Mexico for four years now and chances are some times have changed by now... Btw, here in mexico if you have a car accident in front of a Private Hospital, they LET you THERE dying on the street if you don't have the insurance.... just saying.

There are several top notch tecniques done in Public Hospitals in Uruguay. My grandma who had a good HMO (La EspaƱola) needed to have a procedure done on her uterus, her doctor over the private HMO told her to go to the PUBLIC hospital where he also worked, because there he could make a new Swedish technique (expensive) that the private HMO covered. The new technique was not invasive and had a better time of ricovery, and lower risk.

Since my grandma its on social security and her montly checks are really low, she could prove she was "poor" enough to get the card. I visited here while she was on the public hospital.

Facilities are clean, attention its good, but it reeks of "public". You will encounter yourself sharing a room with people that is not quite what you are used to interact with. (I don't mean to be clasist but reality is like that). Bottom line, you can have good attention at a public hospital, but you can't expect to be trated as if you are in the Hilton Hotel.

Thanks Denise for keeping the blog, I love reading about my country trought your point of view, makes me feel closer while away :)


Seamus said...

(Sigh) I could rant for hours about health care but I'll be nice.

It just strikes me that people who don't appreciate 'no frills' medical care have never been in the situation of being without health care. You see things a bit differently then.

And that works on many levels. When I had trouble and was on assistance, I was amazed to find I got much, much better health care than when I was paying for it. Not because welfare was paying so much for my care, but because when they saw they couldn't make a bundle off me, the doctors stopped looking at me as a profit center and started looking at me as someone who just needed to be healed.

And the doctors offices stopped sending me bills for 160% of cost so when the insurance company discounted their bill by 50% and I paid my 20% of the non discounted bill, the doctors had me paying the insurance company's discount. I was really paying closer to 50% rather than the 20% I was supposed to pay.

Denise, you might tell Missy to get with someone else who had their gall bladder removed 5-15 years ago to help her with any adjustments. I had pancreatitis and my gall bladder removed about a decade ago. One does completely recover fairly quickly, but there can be very significant changes to the rythm of one's digestive system which can be puzzling and problematic at first.