Mexicowoods—An Expatriate Life

Surgery Tomorrow

St. Lukes Hospital, Houston.

I spent the last two days slogging through medico-bureaucratic hell. I’ve been x-rayed, prodded, injected with radioactive goop, scolded (high blood pressure), weighed, and scanned. Each doctor wanted new blood and urine samples. Apparently none of them trust the other guy’s lab work. I’ve got tracks on my arms—I look like a drug addict.

The administrators, too, have taken shots at me. My insurance card is worn out. Processing co-pays has rubbed the gilt paint off my credit card. I’ve recited my address and phone numbers a dozen times. All records from prior visits to my doctors were full of errors. Nurses complained that Doctor A hadn’t received a report from Doctor B and threatened to snatch away my precious surgery slot unless I straightened out the mess.

In the USA Medical System, this exercise is called “Pre-Op.”

—§—

I chose surgery as treatment for my prostate cancer. The procedure is called radical prostatectomy—removal of the entire prostate gland. Major surgery, today it’s usually done laparoscopically using robots. Unfortunately, I have too many abdominal surgery priors for this approach. My doctor will do conventional open surgery, picking his way through scar tissue and adhesions to reach the prostate. Remember that frog you dissected in Biology 101A? I’m going to look like that.

Six months ago, I didn’t even know what the prostate gland was for except to cause problems for aging men. Now I’ve learned it’s pretty darn useful, and I’m gonna miss it.

Shortly after prostate surgery, urinary continence can be a problem, so preparation includes learning how to do Kegel exercises. Laura took this photo in the lab where a lovely Nurse named Kara helped me learn proper technique using biofeedback.

Kegel exercises strengthen the muscles of the pelvic floor. Biofeedback involves using sensors and computers to monitor one’s ability to properly flex those muscles. I’ll leave it to your imagination as to how flexing is sensed.

Throughout the training, Kara entertained us with the story of her semi-arranged marriage (she’s from India).

“... my cousin knew this medical student over in the States that she thought was just right for me... Oh! I think that sensor has slipped. Let me just fix that... There. Now it should stay in... so she wrote my mother and suggested she talk to his mother...”

I found the whole encounter kind of homey and almost pleasant, if a little surreal.

—§—

Pre-Op was hugely stressful. Surgery will be much less so since I won’t be present when it happens. It’ll be harder on the surgeon, the anesthesiologist, the nurses, and especially on Laura, than it will be on me.

I’m feeling sadness from the realization that I’ll be changed. Hereafter, my body will function differently. I won’t know if I’ll be cancer-free until a month afterward, when the biopsies are complete. I won’t know how functional I’ll be for up to a year or eighteen months afterward, as the affected structures and nerves slowly heal.

This isn’t my first major medical milestone and with luck, it won’t be my last. The surgery should be completed tomorrow afternoon. Then recovery, a process that’s becoming all too familiar to me, will begin.

Many, many people have shown concern for me and have told me they are keeping me in their prayers. I cannot begin to express how grateful I am for all the support I have received.

Blessings to you all.

Comments:

Blessings to you too John. Hang tight! Bob Mrotek | Homepage | 07.15.09 - 8:32 pm | #

You are in my prayers now and through this night. Steve Cotton | Homepage | 07.15.09 - 8:53 pm | #

Although I've never commented, I'm a regular reader of your blog. Please know that you will be in my prayers. Terri | 07.15.09 - 10:02 pm | #

I don't pray often but appreciate it when others pray for me. Tonight is one of those nights when I will be saying a prayer for your speedy and successful recovery. I consider you a friend and will worry about you as friends do for each other. Stay strong mi amigo. wayne | Homepage | 07.15.09 - 10:29 pm | #

I wish you well, John. Felipe Zapata | Homepage | 07.16.09 - 8:40 am | #

You are in my thoughts and prayers. Don't forget, we are here too. Call when you can or have Laura call if you need something. Billie | Homepage | 07.16.09 - 11:01 am | #

good luck and keep thinking postive purkey | 07.16.09 - 12:23 pm | #

best wishes and a speedy recovery. what a scary thing to do. Sam told me about your post. so i checked it out! no jokes form me this time.....just get better. Kip Kip | 07.16.09 - 12:44 pm | #

John is in recovery and doing very well. His surgeon felt the procedure was a success and is optimistic that the pathology report will show that the cancer has not spread beyond the prostate. Thank you for your support! I have saved your comments here to read to John in his room as I know they will mean a great deal to him. Laura Laura | 07.16.09 - 5:11 pm | #

Laura, Pls tell John I am thinking of him, as is Sharon, and we will say a pray or two for his full recovery. He may not have told you this but I think he saved my life once (for sure) and maybe twice. This must be a Godthing as I only check on him sporadically and tonight was the time. Pls take good care of him....and Sharon sends her hugs and loves and her web site for when he is up to it - www.sharonseale.com... Randy Randy Seale | 07.17.09 - 1:13 am | #

"hang tight"???? what a comment. My son up here in Santa Fe forwarded your pics of the new Rosewood site with the cranes hovering in front of the Parroquia. So now I have your blog address and don't need to be wondering when the surgery will be happening. I do wish you all great good luck. You've got a certain style with the black socks and johnny look. No need to take it to Milan on the runways tho. I'm heading south tomorrow with a stop in Truth or C...New Mexico. Too hot here in Santa Fe and it is the opera season; all those Texas cars we get in thesummer are up here too. LOL Georgia georgia wright | 07.17.09 - 9:43 am | #

Great Good News for us all. Georgia georgia wright | 07.17.09 - 9:45 am | #

Thanks for the update Laura. We have been worried. wayne | Homepage | 07.17.09 - 2:31 pm | #

John & Laura - Of course we are greatly relieved that all went well and trust that the rest of this will as well. We are regular readers - but want to say that John's candor through all this has been thoughtful and considerate as these kinds of issues are often so personal the rest of us learn little. As John wrote a few months ago he knew little to nothing about this matter and now he is greatly aware and involved. So thanks for the information. You two remain in our prayers. John Calypso | Homepage | 07.18.09 - 8:48 am | #

John, I'm a stand for your recovery and continued good health. Really nice piece of journalling. All my best, Tim. Tim | 07.18.09 - 1:05 pm | #

Wishing you a good healing after your surgery. TandJ | 07.23.09 - 9:14 am | #

Getcha Kidney Transplants Here

Management guru Tom Peters’s adage—stick to the knitting—never reached the ears of small-business proprietors in Mexico. My first Spanish teacher interrupted lessons to take real estate inquiries. A lavanderia on Calle Jesús repairs small appliances. At an establishment on the Ancha San Antonio, you can get acupuncture—and while you’re at it, kidney dialysis.

Curiouser still, the sign on the left advertises kidney transplants. Storefront surgery?

I like the graphics: Robbie the Robot with tubes snaking under a masked patient’s smock.

Comments:

noting the mood swings of your blog these days. interesting. nancy | Homepage | 07.10.09 - 7:39 pm | #

I have long believed that medicine, the practice as opposed to the research, is not so complicated as the U.S. medical industry would like us to think. If you can afford the equipment, perhaps the processes of such things as dialysis can be done this way, and far cheaper. Or perhaps not. Felipe Zapata | Homepage | 07.13.09 - 10:23 am | #

John, Linda found the topper on Relox -- a gynecologist and a dentist. Somehow it makes sense if you think in über terms such as specializing in cavities. Saludos, Pablo Paul | 07.14.09 - 6:04 pm | #

Road to Recovery

Just over two weeks have passed since my surgery and I am back in San Miguel de Allende recovering. Never have I been so glad to be home in comfortable surroundings among supportive friends.

During the two nights I spent in the hospital, I turned responsibility for my well-being over to my doctors. For another week I had to remain in a Houston hotel until I was strong enough to travel. During that time, I depended on Laura for my care and feeding.

Abdominal surgery is traumatic, and I often found myself teary and depressed. Withdrawal from narcotic painkillers dampened my spirits. The emotional support Laura provided was critical.

St. Lukes is one of the world’s great hospitals and I was fortunate to have surgery done there. The entire procedure from pre-op to discharge was confidence-inspiring: professionalism, quality control, information management.

Just one example: In the seven years since I was last hospitalized, hospitals have switched to computerized patient charts. Nurses rolled carts bearing laptops into my room. They scanned my bar-coded wrist band, scanned labels on all medications, and entered vital signs right at bedside.

The carts are called COWs, for Computers on Wheels. Nurses hate them. Doctors and patients love them, as do hospital administrators and their lawyers. (I’m being cynical: meticulous procedures and record-keeping reduce wrong site surgeries and other tragedies.)

(A red duplex power outlet on a hallway wall labelled with a sign “Plug COWs Here,” mystified me until a nurse explained what it meant.)

Now that I’m home and past the early recovery stage, my comeback becomes entirely my responsibility. Fortunately, St. Lukes provided me with a handy guide.

The information contained in the booklet is useful, succinct and complete—obviously written by a medical professional. But as so often happens in corporate life, the communications department got hold of it, adding graphics that left me less informed than discouraged. The inanely happy model in the cover photo clearly has not had prostate cancer—at least not recently. Nor, I imagine, has the pamphlet designer who in all probability is a recent UT journalism grad named Tammy-Jean.

But I digress. My responsibilities today include lots of walking, kegel exercises, good nutrition, lots of rest, and maintaining a positive attitude. Finding energy to see friends is tough, but the encouragement they offer more than repays the effort.

I also call my surgeon’s office when I need to.

I’ll return to the gym in September. I’m planning a month of bus travel through Mexico in November. Each day is better than the previous one.

Over my 68 years I have survived four diseases, any one of which would have killed my grandfather: perforated colon, lodged kidney stone, heart attack, and now prostate cancer. In each case, I was saved by surgeons.

We live in an age of miracles.

Comments:

Good to hear your came through surgery OK. Being back home is some of the best medicine for recovery. Missed your blogs, but looking forward to your future travels. good luck billie Billie | 07.31.09 - 12:41 pm | #

Glad to hear you are back home and comfy. I hope we get to see you soon! Sam | 07.31.09 - 1:20 pm | #

I wish you a speedy recovery, John. Felipe Zapata | Homepage | 07.31.09 - 4:26 pm | #

I had been thinking of you and had hoped you were doing well, thanks for posting. Patience is something you are probably going to need a lot of as you take things step by step. I'm glad you have more travel planned, I look forward to reading about it. Nancy Dardarian | Homepage | 07.31.09 - 4:58 pm | #

hi john, i'd been on vacation and hadn't read your blog in a while, so i didn't know you'd had your sugery. i'm very glad to hear that it went so well and that you are recovering nicely. a good attitude is definitely important and something i know you have. best wishes for a continued speedy recovery. i'm sure laura is doing a great job taking care of you. God bless you both, teresa in lake stevens teresa freeburn | 07.31.09 - 6:11 pm | #

I'm looking forward to read about your future travels. Glenn | 08.01.09 - 5:05 pm | #

I had open surgery March 25, 2008. I flew back to Detroit from Baltimore (johns Hopkins) on the 27th or 28th and am doing just fine, although I never bothered with the exercises. Just give yourself a couple months or so and you will be frolicking in the surf just like that guy in the picture! Glad to hear you are doing well, and I wish you the best in your recovery. And if you have sons, remind them to get their PSA tests and digital exams annually. The PSA thing is not fool-proof and actually didn't do me any good, as it was still very low, but my family doctor thought something wasn't quite right and sent me to a urologist (thank goodness). D. Blodgett | 08.01.09 - 10:49 pm | #

D. Blodgett--thank you for your encouraging words. John | Homepage | 08.02.09 - 10:33 am | #

Never can someone who hasn't gone through it understand all the emotions, pain and adjustments. Thanks so much for sharing your story with all. Who knows whose life you could be saving? I've been out of touch while I was in Vancouver - back home and glad to hear you are also. My best to you and to Laura. Being a care giver is being an unsung hero. Babs | 08.04.09 - 11:14 am | #

So glad to hear you are well on the road to recovery. Thank Laura again for us for providing updates here. They were appreciated. So where is that bus going to take you? Perhaps towards the Yucatan Peninsula?? wayne | Homepage | 08.07.09 - 10:35 am | #

After going through this article I have decided to bookmark this site found this really interesting & thanks a lot for keeping the blog Lively with such interesting blogs. ___________________ Julie

We have COW's in the birth center where I work, only we now must call them WOW's (Workstation On Wheels). An emotional, very pregnant patient, waddling in the halls in early labor, overheard an RN remark,"Has anyone seen my COW?" The patient burst into tears! Anonymous | 08.18.09 - 4:15 pm | #

Hospital Los Angeles

From time to time, Felipe writes in one or another of his blogs about the quality of health care in Mexico. I’ll gladly add my voice to his. (If you’re not one of Felipe’s readers, you should be.)

Today I’m writing from Laura’s room in Hospital los Angeles in Querétaro. She’s here for a surgical procedure that will require her to spend the night. I’m here as support staff and worrier-in-chief. I’m writing this post while she’s in the operating room as an alternative to fretting about how she’s doing.

This place is unlike hospitals in the USA. First of all, it’s almost luxuriously overstaffed. Today, two nurses attended Laura while installing an IV line. (Is install the right word?) One performed the procedure while the other distracted her with small talk. When nurse #1 had difficulty with Laura’s tiny veins, she called in a third nurse (apparently the resident expert in such matters) to complete the task.

Hospital staffers are not overworked. They have ample time to give personalized attention with warmth and empathy. Six years ago, I spent a week in Hospital los Angeles recovering from a heart attack. Nurses made frequent and unhurried visits to see how I was doing. A hospital stay in Mexico can almost be pleasant.

A nutritionist visited three times a day to see what I wanted to eat. No resuscitated frozen turkey and jello for me: I asked for and got a grilled torta de pechuga de pollo with frijoles and a big side of jalapeños. Mexican nutritionists know that capsaicin is good for the heart.

Every day, two giggling nurses aides gave me a bath in my bed. They rolled up towels and placed them around me to form a dam, and then poured buckets of soapy warm water over me: something I’d like to try at home.

Laura’s room is set up for family. Besides a standard-issue hospital bed, adjustable tray, call buttons, TV remotes, water bottles and such, her double-sized room contains a convertible sofa, an end table, a side chair and a recliner chair. Hospitals know about treating the entire family unit, not just the patient. Laura has facilities for two people to spend the night with her, and the hospital will make provision for even more if desired.

She was wheeled down to surgery shortly after she arrived. No interminable waits for a gurney to become available. No constant security checks to see if all her ID numbers matched: the people here knew who she was. No phone calls to an HMO administrator to see if her procedure was pre-approved.

After she left, I thought I’d refuel while I had the chance. I went to the cafeteria for breakfast: cooked-to-order huevos Mexicanos, frijoles, warm tortillas, a big fresh-squeezed orange juice and a pot of coffee. They don’t serve pre-packaged food at Hospital los Angeles.

Doctors are sensitive to the worry and stress suffered by loved ones. One of Laura’s doctors called me repeatedly to update me on her progress—reassurances I badly needed.

At this moment, she has emerged from the off-limits-to-me operating room. She’s sleeping peacefully, and I’m on duty.

A final note: At Hospital los Angeles, open wifi hot spots are available in all patient rooms and public areas. That is why you are able to receive this post in real time. Free broadband—the acme of enlightened hospital management. Take note, St. Lukes in Houston.