It was the best of times, it was the worst of times. Actually it was neither of those, this is a tale of Caribbean Medicine and two medical facilities, one on a small island and one on a larger island. Both were the kind of experiences we've come to expect in our island hopping adventures. Well you can't really expect these things until you've experienced them, but at least we can give you a hint. Most good stories, well the ones that end in a hospital visit, start off with someone doing something stupid. This is no exception. And I know what you're thinking but no alcohol was involved!
We decided it'd been a while since our little doggies had gone to the beach, and we were out to remedy that. They simply love their beach days and when we get lazy about taking them we start to feel bad about it. Our regular "dog beach" has turned into a little bit of a chore because Kirby has taken to wandering off into the jungle or in the opposite direction, really any place but walking down the beach with the family. The biggest problem is that he's gone nearly deaf so he can't hear us calling him, but he will come back to hand signals if he ever looks our way. Maxwell is a good little boy, sticking right next to us all day, but Kirby has a mind of his own (and maybe some selective hearing) and has earned the nickname him Dora the Explorer.
We found a pretty good beach to contain our little Dora, because to get there you have to go into the water, anywhere from waist to chest deep around a rock outcropping, depending on the tides. On the far end it's another rock outcropping so we know he can't escape. We could climb over the rock point, but it has a steep drop on the opposite side, so that seems more dangerous than just wading through the water, especially carrying dogs. In the water, you have to dodge rocks and are likely to get splashed by waves, but it's only about 30 feet of wading. We'd done it many times before, so this would be no different, right?
Well this particular day the waves were pretty big and strong, and the tide was high. They were steady enough that the water around the rock point was very cloudy, almost like runny oatmeal, definitely not like the clear water we'd grown accustomed wading through. But we'd done this before, what could go wrong? (at this point the astute reader will note that yes, we'd done this many times before, but somehow this time will be different - this time stupidity is involved)
Going around the point on the way out resulted in a pair of brand new sunglasses being donated to the ocean Gods. We also got some bruises, as well as all of us getting drenched head to toe. But it was the return trip and another big wave that left Deb's shin bloody and me with a toe that felt "funny" after stumbling and kicking a large submerged rock I couldn't see. It was a feeling I'd had a couple times before when I'd dislocated toes, like my toes were being crowded. We went home and I asked Deb to pull it to see if she could pop it back in place. It actually didn't look crooked like I'd experienced in the past, but it didn't feel right. That didn't work, and as the pain started to grow minute by minute, we decided it was time to check out the small island hospital in Vieques. It is currently in a building that looks like it was a church or community center of some sort, while the powers that be continue to argue over who's going to rebuild the hospital that was ruined by Hurricane Maria 2+ years ago.
We got there at about 12:45pm and were greeted by a nurse sitting outside having her lunch. We thought she must be hot, wearing long sleeves and long pants in this tropical heat. She took us inside and checked vitals and we figured it all out in Spanish. Then we were seated in a waiting area with two desks at one end, Cajero (Cashier) and Facturación (Billing). We waited while people slowly filed in after lunch, punching in with a time clock. Everyone was wearing warm clothes, one person wore one of those colorful puffy jackets. You'd think they'd all look out of place on a tropical island but we already knew they weren't, after our first step in the front door. The realization immediately set in that we were sorely underdressed for the occasion - wearing tank tops, shorts, and flip-flops - we were freezing!
We waited for a long boring while, at least an hour even though we were the only ones there and nobody ever left. Finally, we were called over to Billing for some basic info. We kept hoping that no real emergency would come in or they'd find our frozen bodies in the morning, leaning on each other in the waiting area chairs. But before long we were called into the back.
Finally, things got interesting. The doctor we met was an older woman, hunched over so badly she reminded me immediately of Igor (Eye-gore!) in Young Frankenstein, and I kid you not, she said, "Walk this way". I on the other hand, could not walk that way with the toe injury that was getting more painful by the hour. I was more like this guy (if necessary, click play below).
We got to her desk where I explained that I thought it was dislocated. She prescribed an X-ray "to make sure", and a nurse led us out the back door of the makeshift hospital. It was great! There was a bench to sit on while we waited and thawed out after all that time in the deep freeze. It wasn't long before a nurse led me to the X-ray trailer, which was even colder than the main building!, in between the Ob-Gyn and Dental trailers, and near the Dialysis trailer. The trailers have us covered, no worries here! ;^)
In a few minutes her X-ray work was done and she asked in Spanglish if I wanted a picture of it "for my records". She said she couldn't send it to me but I could take a picture of the screen with my phone. So I did, and even my inexperienced eye told me it was broken. So it was back inside to see the doc.
At this point, I should say the X-ray image of the foot is a little confusing as the view is from the bottom looking up. The doctor (Doctora, here) started "buddy taping" my toes together, but instead of taping the one next to the little toe, she was taping the one next to the big toe. I told her it was the wrong toe, so she moved over one (still the wrong toe). I said "la proxima" (the next) to get her over to the broken toe. She taped it tightly to it's neighbor and said to keep it taped for a week.
We finally worked our way out to Billing and were told there was nothing else they needed. No payment of any sort, no credit card, not even an insurance card. They did take my ID but that was it. We're still waiting to see if they are going to charge us for the visit.
After a week the pain was still just as strong as ever so I kept taping it and limping around like duck with a leg cramp. It was surprisingly painful for something so small. After two weeks I looked up online what to do about broken toes (WebMD for the win!). They said to buddy tape for 2-4 weeks, not 1 week!, so I kept going. At some point I decided to just tape it when I left the house because smooth flat floors didn't bother it much. Just shy of 4 weeks I quit taping it altogether and things are definitely on the mend. The biggest issue has been that I couldn't walk on beach sand because it painfully bends the toe in bad ways. I'm slowly getting back to that now.
Even though the treatment wasn't exactly Johns-Hopkins level, I'm glad we got the X-ray (we were surprised we could even get an X-ray on Vieques!) and found out exactly what was going on. Had I not, I think after a couple of weeks I'd have been wondering if I'd damaged something permanently. And in her defense, and that of all Caribbean medicine, the toe was broken (as shown in the X-ray), not dislocated, Dr. Norm.
During this time period, Deb's vision was slowly, and then more rapidly, getting worse and we were both getting concerned! She described it as looking through dirty glasses. We kept cleaning her sunglasses and then buying new ones (also donated one pair to the ocean - see above) because she thought the cheap sunglasses were the problem.
For some background, Deb got cataract surgery a couple of years ago and that was supposed to be a "permanent" fix. Cataract surgery involves removal of your natural lens, which has become cloudy, and replacing it with an artificial lens, clearing the light path and correcting the vision at the same time.
That is supposed to be a permanent fix, but two years later, she was practically going blind! She didn't want to drive, had to have the blinds down in the house because of sun glare, and generally couldn't see well at all. She said as we drove by our favorite restaurants and other haunts that she'd just wave to the building because she couldn't tell if it was anyone we knew.
One day we were talking with local friends and they recommended we go to Fajardo on mainland PR to an Ophthalmologist they knew. So just like that, Deb made an appointment. Now appointments in Puerto Rico, and I think this is almost universal here, are generally given as 9:00 am and 1:00 pm. Everyone gives out those two appointment times. Doctors, dentists, veterinarians, it doesn't matter, all are the same.
Because the ferries are so unreliable, we decided to fly over from Vieques on the 7 am flight, for $40 each, one way. We could then take the $2 ferry back to Vieques when the timing was less critical. We got there easily enough, it's a wonderful 10 minute flight just after dawn, which makes it extra beautiful. Then we got lost trying to exit the rental car parking area but eventually made it out through the in door.
We drove into town and stopped for breakfast at a nice little city diner. There we enjoyed a ridiculously large pancake, scrambled eggs, and ham for $3.50, including coffee. I was pretty pleased with that. Deb was working her Spanish as well as she could without having yet had her full morning dose of coffee, so she ordered black pancakes and cinnamon coffee with milk. It was good though! By the way, she also claims that when you can't see, you can't think. ???
Twenty minutes early, we walked over to the office and up the stairs, to find the place completely packed. Deb asked how many were ahead of us and was told about 15 people. Oh well, live and learn. So we sat and talked and watched all the different people. During this time we decided to use the bathrooms which are in the hallway, serving multiple doctors offices. The ladies' room had no paper and the soap dispenser didn't work, but you could dunk your fingers in the open top to get some soap. When Deb warned a lady about the lack of paper on her way in, she said she carries her own (yay for local knowledge!). The men's room was worse. It was like the worst truckstop bathroom I've ever seen, certainly in the top (bottom?) three. I was literally walking in puddles that did not come from plumbing leaks if you know what I mean. Deb said it's because the bathroom is right next to the Urology office and down the hall from the Ophthalmologist, so they can't hold it and can't see the target!
But we survived it, and Deb was called in and checked out nicely and efficiently. I think we were out by 10:30, did some grocery shopping (craft beer, chocolate, cheese!), and took the ferry back to Vieques. All in all it wasn't too bad, and we had an appointment to return in 3 weeks.
Now Deb is always in the minority when it comes to anything medical. If something occurs in only 10% of people, she's going to be in that 10%. As a very benign example, she's one of the 10% of the population who is left-handed. In this case, 10% of cataract patients get cloudiness in their vision within a couple of years, as cells grow over the back of the new artificial lens.
Turns out it's nothing to worry about so I could finally relax about it all. The solution is a one-minute laser surgery (per eye) where the Ophthalmologist goes in and obliterates the cloudy cells with a laser. So we went back in three weeks, with the same flight, same car rental, same waiting room full of (different) people. This time, we skipped breakfast to get in and out of the office earlier. That only helped a little, but the laser surgery definitely helped a lot! We paid with a credit card and were out once again by mid-morning. Following the procedure, and for several days after, everywhere Deb went she was talking about how bright and sharp everything was, from her phone screen to our window blinds, even our dogs' fur was somehow special now, ha! She waves at real friends again when we drive by their places instead of just waving to some blurry building.
Looking back on the big island medical experience, we were surprised at the crowded waiting room - hoping that a specialist would have real appointment times, but alas no. And of course we were not impressed with the restroom situation. But we were very impressed with the doctor and staff, basically the important parts of the process. All in all, Caribbean medicine has a been a big success for us; both islands' medical facilities have served us well. After all, we're not dead yet!
With Deb's eyes all fixed up, we went to Old San Juan for a couple of days of celebration and exploring, but that's a story for another day.
TODAY'S SPECIAL: "Doctor, My Eyes", because of course it is!, by Jackson Brown.
UPDATE 1/21/20: This "hospital" thing just got very un-funny last week when a beautiful teen girl died in Vieques due to lack of proper equipment and care. The islanders are now protesting and trying to force the PR government and the US government to figure out their issues and rebuild the hospital 2 1/2 years after the hurricane. There is great sadness for this young person, her life cut short by bureaucracy.
UPDATE 6/2/20: To be clear, this poor girl's death had nothing to do with COVID-19 - it was before that mess got going. And still no action on the hospital. Bureaucracy and corruption can truly be deadly folks.