“I think I broke my wrist,” Nina said.
My wife was on her way back to our rented house from a nearby bodega on our second evening in San Miguel de Allende, Mexico.
“I tripped and fell on the sidewalk on the way to the store.”
“On the way to the store?” I was incredulous. “Why didn’t you come right back?”
“I don’t know. I probably should have.”
Had I hit the deck on SMA’s notoriously treacherous streets, I would have turned right around, complaining bitterly about my klutziness and overall incompetence at life. My heroic wife, however, kept right on going to the tienda a couple of blocks further on. She bought some essentials—milk, bread, fruit, and eggs, looped the bag over her still-functional arm, and trudged home through intense pain, wisely staring at her feet the whole way.
I grabbed my cane and hobbled on my aching knee to the gate at the end of our fifty-foot long entryway. I pulled the heavy wooden monster open and relieved Nina of the grocery bag. Oh great. Now she’s only got one usable arm and I’ve only got one usable leg. The sum of both of us almost equals one viable human.
At first, we thought Nina’s wrist might just be sprained. We jury-rigged a brace by using a ten-inch comb wrapped with a couple of stretchy hair bands, hoping this would keep the wrist stabilized—and lost ourselves in a fog of wishful thinking. The next day, because neither one of us was in any condition to make it to the supermarket, a couple of friends kindly did a more extensive shopping for us. One of them is a retired ER nurse who looked at Nina’s misshapen wrist and said, with the tone of voice normally reserved for errant four–year olds, “Your wrist is broken. Get to the emergency room as soon as you can.” So much for our ignorant optimism.
Now here’s a statement you’ve likely never read nor heard: We had an amazing experience at the local ER. We waited all of ten minutes to be seen by a doctor. After a round of questions by this very chill MD, an assistant appeared and whisked Nina off for an X-ray. Seconds later (or so it seemed), she returned, followed minutes later by the delivery of her hot-off-the-presses images.
The ER doc slipped the images into a light box and pointed out where her ulna (the skinnier of the two bones that run from the elbow to the wrist) was clearly detached from its former osteo-sister.
“Let me see if I can get the orthopedic surgeon on the phone.”
What? Like, right now?
Incredibly, the doctor pulled out his iPhone, snapped a couple of photos of the X-rays, and texted them to the orthopod. WTF? This would never happen in the good old USA.
He called Dr. R. and spoke with him muy rápido in Spanish. Because Nina is hearing impaired, the ER doc handed the landline receiver to me when they’d finished their brief consultation.
“We can do the non-invasive procedure, put the wrist in a cast for eight weeks,” Dr. R. began. “The problem is that her wrist has multiple fractures. If we put a cast she might not have full use of her wrist and hand. Maybe fingers.”
“That doesn’t sound great, doctor.”
“No, it’s not. So the other option is surgery. We make an incision in the forearm near the wrist and repair the fractures using pins to hold the bones in place until they heal. She would not need the cast. We just use a brace for six to eight weeks. Much better outcome, but it is surgery so you have to decide what’s best.”
“When can you do the surgery?”
“We can do it tomorrow if you decide today. She would need to stay at the hospital for pre-op tests.”
“Tomorrow?” I said. “Tomorrow would be amazing except…we have to be at the immigration office to renew our temporary residency.” We’d arranged an appointment with an immigration lawyer with only a few days to spare before time would run out on completing the renewal. Which would be no bueno. “When’s the next time you could schedule it?”
“We can do Tuesday but we don’t want to wait more than that because then the bones start to heal and surgery is muy complicado.”
“Okay, I understand. Can we talk it over and get back to you?”
“Está bien. You can get my cellphone number from the front desk.”
A doctor is willing to give us his cell number? Am I on Candid Camera?
We were out of the hospital in ninety minutes, including a trip to the farmacia next door to pick up some pain meds. Total cost for the emergency room, X-rays, and meds: 2600 pesos, or about $125.
Nina is a classical guitarist. Taking her chances on the bones healing perfectly inside a cast wasn’t a reasonable option, although that’s what I’d done with a broken forefinger decades ago. I was lucky that fracture didn’t forestall my career as a professional bass player. Now, given the circumstances, we decided surgery was the right thing to do.
Tuesday afternoon in the pre-op area of the hospital, I sat with Nina as she donned the ubiquitous open-in-the-rear smock and reclined on the starchy-white bed. Why she needed to put that thing on for wrist surgery is beyond me. My Spanish is a little better than hers so I was able to more or less interpret what the non-English-speaking nurses said. After an hour or so, Dr. R., a surprisingly young and handsome fellow, bustled in to talk Nina through the procedure. When he’d answered all of our questions, I waylaid him before he could escape from the cubicle.
“Doc, may I ask you a question about my knee?”
“Sí, what’s going on?”
“Well, I’ve been in terrible pain for about six months. I have problems with my lumbar spine. I was told I needed fusion surgery, but they won’t give it to me because they say I’m too fat.”
Dr. R. frowned. I loved him for that.
“The knee doc thought my pain was solely related to the spinal issues, but I don’t think that’s true. My knee hurts way worse than my lower back.”
“You had an X-ray?”
“Sí. It showed no structural issues, just a bit of arthritis. They said I shouldn’t be having a lot of pain just from that. They thought it must be neurological.”
“Sounds like you need an MRI.”
“Yes, exactly. Gracias. I want to find out what’s wrong and see what treatments might be possible. I can’t live my life with this pain.”
“Okay. When Nina comes to my office next week for a post-op visit, I give you an order for an MRI.”
“That would be amazing. Muchísimas gracias.” I felt a wisp of relief about my knee for the first time ever. So far, I hadn’t been able to communicate the intensity of my pain to anyone at Northwestern Memorial Hospital in Chicago, where their orthopedic surgery department is supposed to be top-notch. Getting an MRI appointment there would take at least eight weeks if I was ever able to convince anyone to order one. I had the feeling I was going to be able to make this happen much more quickly here.
Another half an hour went by, then the orderlies wheeled Nina off to the OR. I cooled my heels in the lobby while the good doctor worked his orthopedic magic.
When she was out of surgery, I met Nina in what I later would come to think of as the Recovery Grotto, a dark, cold, cave-like room devoid of everything except her bed and a folding chair. There was no IV, no beeping machines, nothing. I half-expected to find woolly mammoth paintings on the walls.
Nina was emerging from the anesthesia, mumbling random bits of sentences in between bouts of snoozing. We were left alone in this odd room for an inordinately long time until, finally, a nurse came in to ask if Nina wanted some food. It had been nearly eighteen hours since she’d had anything to eat or drink. The nurse rattled off a few choices, of which I only caught the words “turkey sandwich.” I gave her the go-ahead for that. All Nina really wanted was water.
A short time later, a woman in civvies entered the cavern. She introduced herself as Dr. R’s assistant.
“I’m here to collect payment for the surgery. It is 60,000 pesos.” That’s a little less than $3000.
“Uh, okay,” I said. How bizarre. The patient isn’t clear of anesthesia yet and here comes the collection agency.
“Can you grab my debit card?” Nina piped up. She couldn’t handle anything requiring even a modicum of dexterity because her arm was totally numb from the nerve block she’d been given before the surgery. It would stay numb and useless other than as a potential weapon for the next twelve hours.
The assistant ran Nina’s card through her handheld credit card terminal and gave me a reciept. Strange but efficient, I guess.
At her follow-up visit, Nina told Dr. R. she was having a lot of pain in her wrist and around her elbow. He undid the wrapping we’d been changing every day (ugh, that was an unpleasant task) and told us the surgical wound was healing well. Nina showed him the Eurasia-sized black, purple, and blue bruise engulfing her elbow and upper arm.
“This is hurting a lot,” Nina said.
“Oh, that’s a normal reaction to the surgery. I give you a prescription for something that will break the bruise up in a few days.”
Before we left, Dr. R. handed me an order for the knee MRI, as promised. I was able to secure an appointment for two days later, on a Saturday afternoon.
When I arrived for the exam, a young, mustachioed tech who spoke excellent English ushered me into the MRI sanctuary. It was a chilly, hushed room, identical in every respect to the MRI suite at Northwestern, down to the psychedelic sky painting on the translucent ceiling. A huge, glossy sandwich sign I’d seen in the lobby advertised the availability of this machine, which probably cost two gazillion pesos. They are proud of their new gizmo, rightfully so. This is a very small hospital in a very small city. I felt lucky to be in the machine’s regal presence.
Because I just needed images of my knee, the tech inserted me only halfway into the maw of the MRI tube. Gracias a Murray, the god of MRIs. If you’ve ever endured one of these procedures, you know exactly what I’m talking about. If you haven’t had the pleasure, well, bully for you.
Forty minutes later, I was at the lobby desk, dutifully handing over my credit card. The MRI cost $212, a ridiculous bargain. They told me the results would be available in three days. This healthcare system is insanely great.
The following Thursday, Nina and I shared a two-fer appointment, another unheard-of thing back home. Dr. R. inspected her surgical wound and removed one of the two creepy pins protruding from the side of her wrist. Those things looked like Allen wrenches designed by the Spanish Inquisition. I knew Nina was itching to get rid of them.
Then the doc brought up my MRI images on his iMac. (I knew this caballero was cool.)
“Well, you see all this white areas? They are filled with fluid, which makes your knee swollen. That’s what is causing probably most of your pain.”
“When I read the radiologist’s report, I thought it said that both the meniscus and the ACL have tears. That’s not part of the problem also?” I said. I wanted the doctor to know I’d done my homework.
“Yes, those tissues have some damage. But there’s not good outcomes from trying to repair. And if we remove let’s say the meniscus, it will speed up the need for knee replacement surgery.”
I was shocked. “Doc, I had no idea I was getting close to needing surgery. Are there any other treatments?”
“Well, I’ve had very good result with this medication called Synvisc. It’s a gel kind of like Botox. Here, I’ll put a little on your hand.”
Dr. R. grabbed a blue cylinder about two inches long by a quarter of an inch in diameter. I held out my hand and he squeezed a dot of the stuff onto my palm. It felt like Silly Putty in liquid form, gooey and just slightly less disgusting than Nina’s wrist spikes.
“What does it do?”
“Is not a cure. It will push out the fluid from inside your knee and reduce the inflammation. If it works for you, you could get many months of relief, until the gel eventually breaks down.”
“And then what?”
“You can repeat the injection as many times as you want if it helps. It could delay knee replacement maybe for several years.”
“What about a cortisone shot?” I felt I had to ask.
“Well, yes, we could do that. But pain relief is maybe fifty-fifty and cortisone can make knee replacement more likely sooner.”
All this new info gave me pause.
“Then I guess we should go ahead with the gooey stuff.”
“Synvisc,” Dr. R. said with a brief laugh. “I don’t have any of the medication here today so we can do the injection next week if you want.”
“On Nina’s next visit?” I asked.
“Exacto. Let’s meet same day next week, okay?”
“Claro que sí.”
At the appointed time the following week, Dr. R. removed Nina’s stitches and addressed a few of her questions about pain and numbness. The formerly huge bruise around her elbow had shrunk to the relative size of a Caribbean island.
“What about this second pin?” Nina wanted to know.
“It’s not very loose yet so I think we should leave it in for now.”
That wasn’t the answer she was hoping for.
“Okay, now your injection,” the doctor said to me.
“Ready.” I said. I wasn’t at all ready but I wanted to get the show, as they say, on the road. Enough of this pain bullshit.
Dr. R. brought over a scary-large syringe that put me in mind of the hypodermic needle scene from Sleeper where Woody Allen’s character faints. Rather than have me sit on an examination table, he knelt on the floor, which struck me as far too casual for an esteemed orthopedic surgeon.
“Are you sure you want to kneel there? That’s a hard floor.”
“Oh yes, no hay problema. This will just take a minute.”
So saying, he unwrapped the syringe and wiped the soft area between the bones of my knee with alcohol.
“One, two, three,” he said, as he stuck me with the nasty-looking thing. It smarted pretty good. The doctor pushed the plunger with gusto; I could feel the gel shoving things out of the way, as if it was trying to squeeze one more valise into an overstuffed trunk. Dr. R. removed the canister, leaving what I can only describe as a “port” protruding from my flesh. It looked somewhat like the IV-thingies phlebotemists use when they’re drawing blood.
Dr. R was holding two additional canisters of Synvisc.
“You’re going to use those too?” I asked, wondering where two more gallons of that stuff was going to go.
“Yes, don’t worry. It will be over in a few seconds.”
Easy for you to say, mister. I was beginning to re-think my opinion of this so-called doctor. Before I could get very far with that train of thought, he withdrew the mother ship of a port, applied some pressure with a cotton ball to stanch the small gusher of blood, and deftly covered the wound with a band aid. Meanwhile, my pre-frontal cortex was desperately trying to come up with a knee/needle pun that I knew was out there somewhere. I failed to find anything.
“Okay, bueno. In one to two weeks, you should start to feel much less pain.”
“I hope you’re right, doc. Vamos a ver.”
“Exacto. We’ll see.”