101. You Knee-d to read this!

Tuesday 10/18- With the green season rains come all sorts of challenges. One of those challenges is mold, mildew & algae that grows in places were you don’t want it to. In a much earlier post we told you about the dusty white mold that grows on surfaces in the house. We struggled with this constantly at our old rental house and constantly had to wipe down cabinets, drawers, walls, you name it. It’s also very common for your fabrics, clothes, towels, etc. to smell musty unless you stay on top of laundry or have a dry-room or similar space. The problem today is the slimy green algae that grows outside on the concrete surfaces (such as the wall Ramie just pressure washed and also in the cuneta's, or concrete drainage ditches that surround our yard. They work as open topped culverts that drain all of the rain runoff from our yard down to the creek and we have them along the entire back and one side of our property. 

Our covered garden greenhouse is right inside the corner where the 2 sections of cuneta come together.

The cuneta is the half pipe you can see running along the left side of this picture.

Today while I was working, Ramie was working out in the garden picking some veggies and taking care of things, when he came into the house and said something like “well, that’s going to hurt for a while”. I turned around and saw that his knee was bleeding. It didn’t look too bad at first, but when we really got close and looked, you could tell it was a very deep gash, and there was a piece of "something" that came out from the inside of the hole. Well, that doesn’t look good. 

I asked Ramie what happened and he said that he was walking around the back of the garden along the green fence to pick some veggies when he stepped into the slimy, wet, algae covered cuneta and his foot slid out from under him at lightening speed because of the cheap flip flops he was wearing. He landed his left knee right on the jagged concrete edge of the cuneta. Ramie said he stood up right away but was afraid to look but realized he should and only saw a little bit of blood, but he said it felt like he broke his knee cap. After "being a man" and walking it off he went on with the rest of what he was doing.

He picked the rest of the veggies, went and planted some things on the lower lot and then realized he should probably come in and wash his knee and have me look at it. Upon even closer inspection we discovered that the piece of "something" went in and out of the hole when he bent his knee and moved around. Well, I suppose he better have a doctor take a look at it. It was right around lunch time when he drove himself into town, and wouldn’t you know it, the doctor’s office was closed for lunch. He then decided to try the other doctor, and sure enough he was closed for lunch too! (That sure is some poor planning by the local urgent-care doctor offices!) So, without seeing a doctor he came back home and tried calling to see when they opened back up. The one closest to our house (not the “antique” doctor office that I went to when I sliced my finger) opened first, so once he was back, Ramie went up there to have him check out the injury.This was a brand new, very modern looking doctor office and the doctor here spoke pretty good English. He took a look at Ramie’s knee, cleaned it up a little bit, and said that this wasn’t a big problem, it was just a cut. Ramie pointed out the piece of tissue that was coming out of the hole and the doctor didn’t seem at all concerned, it was probably just some skin that got stuck in there. He offered to cut it off, but Ramie just didn’t think that seemed like a good idea. The doctor just bandaged it up and told Ramie to take it easy and clean for the next few days and no charge, just be more careful.

Thursday 10/20- Today Geoff & Tracy invited us to go with them to a cute little town with a nice beach and a good restaurant nearby that they like. Even though Ramie was trying to take it easy, we decided to go sit at the beach with them for a little while. Ramie & Geoff walked around on the beach a little bit to look for cool pieces of drift wood, but not nearly as much as Tracy & I. We brought chairs with us and just hung out listening to the waves and chatting. When we were done hanging out at the beach we ate some lunch at the restaurant that they like and headed home.

Ramie mentioned that even though he was taking it easy today, he noticed that his knee was getting stiffer and getting more and more sore. We thought that it might be a good idea to get a second opinion, and had heard some very good things about a different doctor in the area, Dr. Monica, from Tracy as well as other reviews on the local pages. Ramie got her phone number and sent her a text, (it was about 6pm at the time) asking if she could help. She asked him to send a couple of photos and videos of his knee to see what she was dealing with and she spent the next 45 minutes or so messaging back and forth with Ramie about what was going on (we will save you and wont post those pictures or video but Ramie does still have them). She told us that she was not the type of doctor that could help with an issue like this, and that he needed to make an appointment with an orthopedic surgeon at the hospital in San Isidro right away. Well, this certainly didn’t sound good!! She gave us the name and phone number of the doctor that he should see, and advised us to take care of this sooner rather than later. Of course, by now it was late in the evening and too late to call, so we’d just have to wait until morning to schedule an appointment.

Friday 10/21- As early in the day as he expected the doctor’s office to be open, Ramie called to make an appointment with the orthopedic surgeon. We had been told by Dr. Monica that the doctor spoke English well, but his assistant (who happened to be his mother) didn’t, so Ramie was prepared with as much as he could in Spanish to explain what he needed. He called and was pleasantly surprised that the man who answered the phone spoke good English. He explained what had happened, and told him that he needed an appointment as soon as possible, as it had already been a few days since the injury happened. Unfortunately, the doctor wasn’t working today, and the earliest appointment that they could offer was Monday at 4:00pm. Well, I guess we’d take that one, there isn’t really a whole lot we can do about it! For the time being, Ramie will just have to continue to take it easy and keep it covered. The wound was still weeping and we knew it was deep, but it was only a couple more days so we’d just do what we could to make sure he didn’t make it worse.

Of course, when you’re sick or injured and haven’t seen a doctor yet, what do you do? Go to google to see what your diagnosis might be. Since he couldn’t do much but sit around, he got on google to see what might be wrong with his knee. His prognosis was that this might be a tendon or ligament issue, and that piece of “skin” that the local urgent care doctor wanted to cut off was probably a little bit more important than just that. Good thing he didn’t cut it off!!

Saturday 10/22 and Sunday 10/23- With Ramie’s knee issue, we expected to keep quite a low-profile around the house this weekend. We spent the days relaxing, working on the computers, and all things that didn’t take a lot of movement. Unfortunately, despite taking it easy as much as possible, it seems like his knee continued to get worse. It’s getting more sore & more stiff, and he’s having a hard time sleeping, getting dressed or just getting around, and he can barely bend his knee at all now. It’s also getting swollen, and doesn’t look quite right any more. It’s a good thing we have this doctor appointment on Monday, I think the urgent care doctor really failed us and led Ramie in the wrong direction!

Ya, that left knee just doesn't look good at all!

Monday 10/24- Since today’s doctor’s appointment in San Isidro was in the afternoon, I started the day working for a few hours, as I would on a normal Monday. I did take off a little bit earlier than I usually would so we could do a little bit of shopping before the appointment was scheduled. We had originally planned to go to San Isidro this Thursday for our regular provisioning run, but since we’d be driving there today, we wouldn’t be going back again this week. To make this trip a little bit more productive we planned as much of our regular shopping (minus the farmers market) as we could. I’d just have to make do with the more expensive and less quality veggies that I could find in town for a few more weeks. 

Ramie's exact words were, "well I might as well make my knee more noticeable for the doctor". After doing some shopping & kind of wearing out Ramie’s sore, stiff knee, we headed toward the downtown area where the hospital was located. There isn’t much parking nearby, so we parked at a pay-lot that was nearby and would walk the block to the hospital. When we got to the hospital, things were very confusing and we weren’t exactly sure where to go or what to do, and we couldn’t find anyone that spoke English well enough to really be able to explain it to us. We got to a check-in line where a couple of Ticos told us we had to wait. When we got to the window we explained that we had an appointment with Dr. Hernandez at 4:00. The person behind the window told us that we were in the wrong area and had to go somewhere else. We went to the other place, and spoke to someone at the window there we explained again that we had an appointment at 4:00 with Dr. Hernandez, and this person told us that she couldn’t help us and that we had to wait until the shift change at 4:00 before we could check in. Well, that’s weird, our appointment is AT 4:00! Ok, whatever, so we sat and waited until a different guy came to the window. This one spoke enough English that we could figure out what was going on. We explained for the 3rd time that we had an appointment with Dr. Hernandez at 4:00, and he looked at us kind of confused. He asked if it was the tall Dr. Hernandez or the short Dr. Hernandez, we told him we had no idea as it was our first time meeting him, but we told him that it was for a knee injury.

At this point, this guy finally seemed to figure out what was going on. It turns out that our Dr. Hernandez works at this public hospital during the day, but at 4:00 moves to a different private hospital a few blocks away, and that we are at the WRONG hospital!! He brought us to the front doors of this hospital, pointed down the road and told us to go 2 or 3 blocks that way, we’d find a different hospital, and inside we would find a receptionist to check in with. We thanked him a bunch and headed toward the direction he pointed. At this point we realized that we had forgotten the insurance paperwork in the car, which was a couple of blocks in the opposite direction, so Ramie started on his hobble to the correct hospital while I quickly headed back to the car, got the paperwork, and then tried to catch up with Ramie on his way to the hospital. He had made it to the check-in counter about the time that I caught up, and had just begun to fill out the paperwork. At this point we were only about 10 minutes late for our appointment, but that didn’t seem to be a problem. While they did have appointment times, it was sort of first-come, first-served, so 1 or 2 patients may have gotten in front of us, but that wasn’t such a big deal. At least we were finally in the right place!!

It only took a few minutes before the doctor called us in and we got this appointment started (Yes, WE. It would probably be a good idea for me to be involved in these appointments since the language barrier can be difficult sometimes, and between the 2 of us we seem to be able to pick up on, understand, and be able to communicate in slightly different ways that make talking to Ticos a team effort). We first started at his desk, the doctor took a VERY brief background- allergies to medications, if he was taking anything currently, and just very, very basic information. Then he asked what happened. Ramie explained the fall, that it had happened nearly a week ago, and that it’s been progressively getting more painful. We were also sure to tell him that he DID have a doctor look at this, but apparently that doctor was not very good, because he told us not to worry and this was just a scrape that would heal up.

At this point, Dr. Hernandez brought us to the back of his office and his exam room. This looked more or less like a doctor office that you’d expect- an exam table, one of those lamps with the goose neck, a sink and a couple of drawers with medical supplies in it. He told Ramie to get up on the exam table & I stood back near the doorway to observe. He unwrapped the knee, asked Ramie to explain again what happened, and then told him to lay back on the table. Ramie insisted he was fine sitting up, the doctor did some more checks and said to Ramie to lay down. Ramie said it was ok, and the doctor really told him, he should just lay down. Ramie reluctantly laid down.

[All of you squeamish people should skip this next section, no pictures but gory details]

At this point the doctor put his hand on Ramie's knee and immediately looked at us and said he has a serious infection. He then squeezed his knee and the wound and I could tell that Ramie was doing everything he could not to scream in pain. The look he had on his face and how tense his entire body got told me that the doctor squeezed hard and it hurt! The doctor must have seen what he wanted to see, then walked over to his drawer of supplies. He grabbed out a syringe and was looking around for something else that he couldn’t find. At that point, he left the room, presumably to go look for whatever he couldn’t find in the drawer.

A few minutes later he came back into the room with a few vials of liquid, and another doctor. He introduced him as Dr. Alex, and then this doctor began to talk to Ramie, asked about what had happened, and got Ramie talking a little bit and to also keep him distracted (Dr. Alex spoke fantastic English too, which is always a good sign). Dr. Alex again confirmed that Ramie had a serious infection in his knee, while this was happening I watched as Dr. Hernandez took a vial of a liquid into a syringe, a surgical cloth, iodine, more tools and a few other things. Dr Hernandez then went over to Ramie, while he was still distracted talking to Dr. Alex, gave him a shot of local anesthetic, and began covering the area with one of those surgical cloths. Ramie was in the process of showing Dr. Alex a picture of what the wound had looked like originally when Dr. Hernandez grabbed the tissue of "something" that came out of the wound, pulled it out further with the clamps, and snipped it off. Ramie immediately dropped his phone and it fell right into Dr. Alex’s hand, which he then handed to me. Dr. Alex tried to continued to try to keep Ramie distracted but whatever he was saying to Ramie fell on deaf ears. Ramie was clutching the table and trying not to move his leg. Dr. Hernandez proceeded to dig deep into his knee to scrape around and try to get out whatever infected tissue was in and around the wound, out. The Dr. also made sure the tendon was pushed back into his knee in the general location it should be. He then got the ultra sound machine out and took a look at the rest of Ramie's knee for anything else that may be obviously wrong. After he was done with that he cleaned Ramie up, (no stitches) bandaged his knee and then talked to Dr. Alex in Spanish about the next steps.

[OK all of you squeamish people, it’s safe to start reading again]

After Dr. Hernandez was done doing this minor surgery right there in the exam room, Dr. Alex, who spoke English better than Dr. Hernandez, explained that the joint (not the wound, but the joint itself) was very infected. Ramie would be required to stay over night for IV antibiotics to get this infection under control, otherwise it could become very dangerous. Oral antibiotics would be too slow to get it under control, and it was better to do this fast. At first we thought he was joking, but it quickly became clear that he was not. Ramie gently got down from the exam table and Dr. Hernandez followed us out of the office. We had to stop first where he proceeded to talk to him mom (his assistant) about what it cost and then he left. We paid her for the office visit, then Dr. Alex took over and brought us to a different check in desk and waiting area. He told the staff that we needed a room and we waited in the waiting area for about a half hour before they brought us to one.

During this time we got to thinking about things that needed to be taken care of. First and foremost, Breeze was at home by herself. Geoff & Tracy to the rescue!! I quickly called Tracy and explained what was going on and that we would have to stay at the hospital overnight (potentially longer depending on how the antibiotics took care of the situation.). Could they “break into our house” and take care of Breeze for us? We explained what we thought the best way to break in would be, and where to find the extra keys, and they quickly got to it to take care of our doggy (it’s a very good thing that Breeze really likes them!!).

The next thing that needed to be taken care of was the car. It was parked 5 or 6 blocks away in this crazy busy city (with confusing roads and lots of one-ways) in a parking lot that closes at 7pm. We asked Dr Alex what we could do with the car overnight and he said that we should move it to some street parking near the hospital, and once a space in the hospital parking lot (consisting of about 12 parking spaces) clears out, we would move it to one of those spaces. At this point, it’s getting dark, I don’t know the area or the route, and I have only drove once since being in Costa Rica. This was going to be a bit of a dilemma. Ramie said that he would just walk down there and move the car, but we didn’t know how long it would take to get the room and he probably shouldn’t be walking that far anyway, so we decided to just wait until we got to the room. When we were finally brought to a room, we figured it wouldn't be too long before the doctor came in, so we didn’t do it then either. 

Waiting for the doctor
Gotta stay positive, right!?!

It took nearly another hour after we were brought to the room before Dr. Alex came back. It turns out that he was the ER doctor on duty tonight and he would be the one in charge of Ramie’s care. He got the nurses to come in & hooked Ramie up to his first 2 bags of different antibiotic IV's, and then he was stuck to the bed & I was stuck figuring out what to do with the car. Once Ramie was settled, I left the room to go ask one of the staff members if there was someone that could come with me to at least give me driving directions from the parking lot to the hospital. The parking lot would be closing soon and as I was leaving the room, Dr. Alex was coming out of another room nearby. I had asked him if he knew of anyone that could help me, and he said that he was just finishing up with his shift and his wife was here to pick him up, but before he left, he would walk with me to the car and bring it up to the hospital for me. 

Wait, WHAT?!?! The ER doc just offered to help me move the car?! That would NEVER happen anywhere else.

We left the hospital and sure enough his wife was waiting outside in their car, he told her we’d just be a few minutes and he’d be back. We had about a 10-minute walk to the car, he told me a little bit about his background and where he had lived in CR before he ended up as a doctor in San Isidro. When we got to the car, he was surprised that our “car” was actually a SUV. He confessed that he has only really driven small cars before but would happily drive it up to the hospital for us. I offered that if he was uncomfortable driving, that I would, if he could just give me directions, but he assured me that it was fine and he could drive. I’m pretty sure that he could tell I was nervous! It turns out he was really glad to get to drive the big vehicle because he could “show off” to his wife that he could drive a big car too. He easily handled the big car through the winding one-way streets and tons of pedestrians. When we got up to the hospital parking lot there was an open space, he pulled the car in, and I was in the clear for having to drive tonight! Valet Parking by the ER doc at no extra charge 😉

I thanked him profusely before he jumped in his wife’s car and told me he’d see us again tomorrow morning. I then went back up to the room and told Ramie all about what happened. Ok, now that the dog & the car situations had been sorted out, it was time to try to get us settled in for the night. There were a few stores nearby and I was on a mission to find us some toothbrushes, toothpaste, and maybe a clean t-shirt to change into, since we both felt disgusting after being in our same clothes all day. (At least Ramie got to change into a gown). By the time I made it back out to the street all of the little shops nearby were closed and there was nothing but a grocery store open. (Seriously, 2 hours earlier it was a hustling bustling place full of shopping, tourist shops where I could have found an I Love CR shirt, and all of that stuff). Oh well, I was able to get the toothbrushes & toothpaste so at least my mouth would feel clean!

Shortly after I got back with our supplies, The nurse came in to take Ramie's order for dinner, (he asked if I could get dinner too, but I opted not to) we waited about 45 minutes and that finally arrived and he quickly snarfed it down. We were both wore out from the long day and decided that we’d try to settle in and get some sleep for the night (yes, I had an uncomfortable little couch that I could sleep on, at least it wasn’t a chair!!!) As I laid down, I saw a sticker on Ramie’s bed that said “Maternity” and realized that maybe this is a room typically set up for a new mom & dad, and that’s why it has a place for a non-patient to sleep. I don’t think most hospital rooms here are set up to have an overnight guest! Just as I was dozing off, the nurse shift change came in waking us up to check Ramie's vitals, now I couldn’t fall back asleep again. I think part of the reason I couldn’t sleep is because the room was soooo cold!! When we got to the room the AC was set at 17* C (62* F). I tried to turn it up to 22* which is about 72* but the warmest it would go was 19* (66* F). MAN, this is a LOT colder than anything we’re used to anymore! Especially only being in shorts and a T-shirt. I’m glad I had the blanket that they gave me, but it sure was chilly in here!!

By the time morning came, I was exhausted and sore. After we had been awake for a while, the morning nurses finally came in to check on Ramie. They took his breakfast order and then left again. Dr Alex came in sometime after that and ordered 2 more bags of IV antibiotics. He said that things were starting to look better but he wanted us to wait around for a while longer to see how it continued to go.

Ramie ordered the typical Costa Rican Breakfast

The next 2 bags of antibiotics seemed to go in quicker than the first 2 did last night, and after those were gone the nurse came back in to tell Ramie he could shower if he wanted to, then she would change the bandage. When the bandage came off we could tell that it did look better today than it did yesterday, so the signs were pointing in a positive direction.

The swelling is starting to go down! Also yes that red dot on his knee is where the injury was. Not a large wound but enough to cause a major problem

After the bandage was changed they gave him one more bag of IV antibiotics and the nurse told us that once this one was done Dr. Alex would come in one more time and we’d be released. What a relief! 

It took a while before Dr. Alex came back, and when he did, he apologized for taking so long. Apparently he had to fix up someone that came in this morning after a run-in with a table saw. After hearing about that, we were glad that our situation wasn’t nearly so bad! He gave us a prescription for 10 days of oral antibiotics, told him to ice and elevate his knee and take it easy. He also told us to schedule a follow-up with Dr. Hernandez in a week. That’s it, it was about noon on Tuesday and we were finally ready to go home.

On the way home we stopped to pick Breeze up from Geoff & Tracy and promised to get them a set of keys made so they don’t have to break in again if we ever need their help. We are so thankful for great friends like them that we know we can count on! Then, on home for Ramie to put his feet up for the week and hopefully not go stir crazy! 

Someone was playing in the rain and also kinda mad we left her

So, one of the wort parts of this whole story was this: On Sunday I had a thought that we should pack an overnight bag just in case something like this would happen. I talked myself out of it and told myself that I was worrying too much and just needed to calm down. Morals of the story- if I have a gut feeling about something I should probably go with it AND always have a go-bag ready when going to the doctor an hour away, just in case something unexpected was to happen. I’m just glad that we had a phone charger in the truck and a USB outlet in the hospital room, because over the course of our stay we both spent a lot of time on our phones. They did have a TV but it would have been all in Spanish.

Oh, and you’re probably all wondering how much this unexpected overnight stay cost us. Well, I would say that you will be shocked by the answer. The total cost of the initial office exam, the overnight in the hospital, the prescriptions, the supplies, and everything else cost $742. Yeah, that’s it… $742 cash (or credit card). We had to pay for the initial doctor appointment first, as soon as we were finished. Then we had to pay for the first night hospital stay before they even put us into a room. And then we had to pay the remainder of the bill for the antibiotics and supplies, etc. when we checked out.

While we do have private insurance down here, it works much differently. You have to pay for everything up front and then you submit the receipts and documentation that the doctor has to fill out to get reimbursed. So now we get to work through the next part of the system- getting the reimbursement. Fingers crossed that this process goes smoothly!

Pura Vida