Emerging From the Sausage Machine.

Shabby and far from chic, but it works.

I had my second cataract surgery yesterday, in a purpose built state of the art eye clinic – the pride of the CAJA – the Costa Rican version of the British National Health Service.

The other eye had been dealt with at the San Juan de Dios Hospital in the centre of the capital…a maze of structures dating from the nineteenth century, constantly undergoing the construction of new buildings on a restricted site, where departments live hugger mugger, offices stuffed into Victorian cubbyholes while the ‘working’ stuff wallows in comparative luxury in areas dating from the thirties to the present day

We know San Juan de Dios well….with all Leo’s problems the joke among his specialists is that the only departments not treating him are gynaecology and the morgue.

Having finally achieved an appointment for cataract surgery at San Juan de Dios I had jumped through all the hoops – electrocardiagram, blood tests and Covid test – only to arrive at 6.00 am on the morning of the appointment to be told by the secretary that I had not, in fact, done any of them.

Th secretaries are the curse of the CAJA.

As the jefatura – the office – did not open until 9.30 am I messed off home and complained by e mail.

Another appointment…no electrocardiagram but another Covid test – with the same nurse, who wondered why I was there. We agreed that the secretaries were both incompetent and hostile and I returned for the next appointment.

Same gravy.

This time I was prepared. I had the surgeon’s e mail address.

Shortly a young doctor arrived, entered the secretary’s office, and voices were raised. He emerged, red in the face, and informed me that my surgery would go ahead.

Fine, except that I was now last on the list.

From there all went well. Nurses checked blood pressure, checked that that the lesions on my leg were not infected and helped me undress and put on the theatre garments.

Staff, from porters to nurses, talked to me while I was waiting and thus I was relaxed going in to the theatre where the surgeon explained what he was about to do at each stage so I knew what to expect, and before I knew it it was finished, with the surgeon explaining the follow up procedure.

Here the background staff took over, transfered me to a waiting area where they gave me coffee and biscuits, helped me dress and gave me eye drops to use in the following week to complete the process.

I had to return the next day for a check up and, as no secretary was involved, all went well. I was on the list for treatment for the other eye.

A year later came a telephone call from the blue, summoning me to the specialist eye clinic for tests – the next day.

With the new government has come a certain improvement in the standards expected of state institutions and the new health minister – duly loathed by the medical establishment – has set about the old Spanish practices in the CAJA. Good luck to her! I will know that she has won when the secretaries do their jobs rather than expecting the patients to do them themselves.

Operation backlogs are to be tackled….thus, I suppose, the surprise appointment.

I duly toddled off, had the tests, and had the date of operation confirmed. All hunky dory.

Until the day.

I turned up before time, was second in the queue, and awaited the formalities.

Oh dear…the secretary did not have my papers.

I – not she – would have to go to the Admissions office to retrieve them.

The snooty young lady at said office told me that surgical admissions could only be dealt with from 4.00 pm onwards. 4.00 pm being the time of my appointment.

Conveyed this to the secretary whose response was that I had better be at the office on time, then.

Had the state of the eye not been so bad I would have told her where to go and that she would find the papers where the monkey kept its nuts, but, faced with a further wait for treatment, I simmered in silence.

At 4.00 pm there was a queue at the Admissions office, and the sulky lump who had replaced the snooty young lady announced that we would all have to wait while she caught up with her backlog.

Half an hour later she wa still ‘catching up’ when I caught sight of the lady who had sorted out my papers when going for the preliminary tests and asked her if she could help.

She could. She entered the office and blew the sulky lump backwards bow legged, then said she would give me my dossier herself, but I would have to return to the office to get the all important slip of paper authorising the op.

Duly returned to the office where the sulky lump was still ‘catching up’. I would have to wait.

Went in search of the helpful lady – now dishing out documents to the others in the queue – who came back to the office and repeated the blowing backwards bow legged performance until the slip was produced.

I was, by now, last in the queue.

No help to get changed here…..wheeled off in theatre clothing to sit in line with those now ahead of me. The staff involved in their own chatter, ignoring us all.

Finally wheeled to the theatre, where music was blaring, and up on the table. No clamp or headrest…just ‘stay still’. Luckily I had undergone the process previously and had some idea of what was to come as the surgeon’s voice was drowned out by the radio.

Process completed, handed a bag with eye drops and paracetamol and wheeled back to change.

That was that. Coffee? Biscuits ?Time to recover? No chance.

A check up? No one mentioned one but one there must be as on the slip of paper in the bag with the eye drops was a list of dos and don’ts – no cooking, lifting, exercise, etc. – and a reminder that the plastic eye cover applied after the op must be returned at the next appointment.

Given the two experiences, shabby San Juan de Dios beats the shiny sausage machine hands down.

P.S. The ‘no cooking’ instruction has somewhat ruffled the domestic dovecot, but the resident Dr. Strabismus (whom God preserve) of Utrecht, otherwise known as Higher Authority, has a solution. I have been presented with a wrap round pair of goggles, which, I am assured, will keep the steam out.

He is getting sandwiches, notwithstanding.


41 thoughts on “Emerging From the Sausage Machine.”

    1. The sight is considerably better, thank goodness. It was getting to be quite a problem.
      It seems to be a feature of hospitals here that the patients do the running about while the staff loll in their offices – somewhat illogical seeing that the patients are, by definition, unwell!

        1. The problem is that while the medical staff are fine, they are badly let down by the clerical staff who do a lot to give the institution a bad name.
          Mr. D is currently reclining on the bottom of the kitchen trolley like a roman emperor awaiting the arrival of grapes and dancing girls.

  1. Bureaucracy is always painful but healthcare bureaucracy is leap years worse. So sorry about that. Perhaps if secretaries were treated better by their bosses, it would engender them to be kinder and more efficient toward patients (who are the point BTW). As for cooking, my slogan has always been “the kitchen is just as far for you as it is for me…so I recommend you hop to it if you’re hungry.” Best wishes for a speedy uncomplicated recovery., Norman would love to visit you in person to make sure you’re improving.

    1. Bring on Norman! I need his ideas of supervision!
      As for the clerical staff, they live the life of Riley…no one dare upset them for fear of union action. However, this might be coming to its end with the new Health Minister…..she thinks her medical personnel deserve better support, let alone the patients! Leo can’t cook – unless we lower everything to wheelchair height – so I laid up several meals in the freezer, but salad and sandwiches also feature largely.

      1. The clerical staff is why I left the first vet that treated Elsa’s epilepsy. They used to send me into orbit no matter how hard I tried being gracious and kind. It makes me crazy!!! And not in a good way.

        Norman is sending his best digital visit your way. 😍

        1. Please thank Norman for me….such a kind chap!
          I have a short fuse at the best of times and this arrogance does not help matters! Costa Ricans don’t like confrontation but straight speaking is permitted, so several secretaries have received my opinion of their services followed by complaints to the internal Contraloria of the establishment when necessary. Younger people are more forthcoming about complaining, wheras the older people remember the days when healthcare was sparse and scanty and hesitate to speak out.

  2. So happy to hear you came through in flying colors, Helen. What a trooper! You have your eye surgery and still come home and feed Leo!

  3. The difference in attitudes may come from new staff rather than those who have been at the old place for years. The secretaries are lucky guns are not involved.
    So glad it is over, so glad you will see better from now on.
    So glad he is enjoying a week of sandwiches….

    1. So that’s why they frisk you at the entrance, to prevent frustrated patients from massacring the clerical staff. I have to say that the tempation is overwhelming.
      At the clinic, the staff are generally younger…but have the same attitude as their elders and there was a clear difference in the attitude of the medical staff at SJD to those at the clinic.
      Sight much better, however….and I’d laid up a supply of meals in the freezer, but clearly not enough for three meals a day for a week, so sandwiches and salads it is. Lucky I smoked all that fish…..

  4. Ye gods! I find my fuse gets shorter as I get older. I suppose I’ve come to realise that I don’t have the luxury of hanging around for bloody manana.
    We (that’s The Man, mostly) have just jumped through hundreds of hoops, back-tracking years, to find building approvals and sign-offs for work done on a house years ago. It didn’t help that said work was done before Councils digitised all their records.
    No, it’s not quite the same as causing delays for medical treatments, but damn! it’s annoying.

    1. You have my entire sympathy! Luckily we escped France before a whole galimaufry of hoops was erected in order to sell a house. Generally, Costa Rica has lowered my blood pressure which used to be at High Do in France…but the CAJA’s secretaries take the biscuit. How is it that they expect people who are by definition ill to scud round hospitals in search of papers the idle so and sos should have collated in the first place.

  5. Had both mine done 10 yrs ago……oh what a difference it makes. Luckily for me I didn’t have to suffer ‘running the gauntlet’ of medical staff of any nature so they were pleasant experiences. The Golfer was a bit miffed though when he read the post op info similar to yours – no housework, no cooking, no anything in fact….and yes my lovely specialist even said ‘none of that either’!

    1. Well ‘that’ wasn’t on the list!
      Lovely to hear from you and glad you had a better experience….the first op went far better once past the secretary and the health service here is very good…once you get past the secretaries!
      I shall probably use the goggles when cooking in future…but not just yet!

  6. Reminds me of the medical songs of the great philosopher Johnny Nash – ‘I can pee clearly now, the drain has gone…’

    There’s a certain breed I think prone to finding itself minor positions of maximum disruption. It’s been my experience that receptionists at all GPs are of the type, interrogating, barking, preening and self-satisfied. Come the Revolution I shall have them all placed in a vast circular queue with the sound of constantly ringing unanswered telephones playing constantly, Noriega Nunciature style. In England now in hospital environments the type is supplemented by mindless technology, where arrivals are directed to filthy touch-screens and must, with whatever limb is not actually hanging loose by an artery, enter name, date of birth, father’s inside leg measurement – only to be advised that they are too early, too late, or have been cancelled. When I die and go to Hell I am going to offer to work for H.M. Devil for free, to design a special Hell for all such people.

    You have my heartfelt admiration for undergoing eye surgery, in the matter I am Squeamish Maximus and would rather, if given the choice, instead face a charging bull elephant (or GP receptionist or hospital doorkeep).

    1. I have to say that my mother’s G. P. surgery staff were tops…..but this was post Blair’s donation of riches beyond the dreams of avarice and pre Covid offering the avarice without the need to even pretend to work.
      Speaking as one who woke up during surgery aged three, unable to speak or move, and whose rare post war pineapple was stolen by the ward nurses I have an immoveable prejudice when it comes to the medical and nursing professions…..but the clerical staff beats that into a cocked hat. Arrogant and idle I heartily subscribe to your forecast of their fate come the Revolution.

    2. “Minor positions of maximum disruption.” The motto of the Secretarial school for the admin staff of almost every medical professional! Can I add anally retentive to their job description?

    1. I was fit to spit tacks! And all down to incompetence……things can happen, go wrong, we all know, but idle staff who could not give a hoot for the people who pay their salaries is something else.

  7. Do hope that both operations have been a success and that your eyes are doing fine. I read your blog hiding behind the sofa because it’s something I face in the not too distant future and it’s not something I’m looking forward to. Sorry to hear how much additional stress was put on you just by staff incompetence. Not what you need!

    1. First one fine and this one seeming as if it is going to be, thank goodness. I agree, stress when going for any op is distinctly undesirable especially when they will reject one for having high blood pressure on the day. High blood pressure did not go anywhere near to describe my state! Apopletic and steam from the ears would be closer to the reality. Don’t worry about the op itself….it really is next to painless. Just don’t move!

  8. Sorry to hear that you’ve had such a frustrating time, but hope it has all been a success. Very impressed you can write about it, in your usual inimitable style, in such good humour. You probably know that irritating/jobsworth/incompetent admin staff are (probably) universal. I often think that the NHS – which I have had a lot of first-hand experience of recently – would be better if they just let the nurses and some of the junior doctors get on with it. Still, I’m sure our new Health Minister has everything in hand…

    1. As long as they mind the commas….
      The nurse who had to do my Covid test twice reckoned that there are people genetically programmed to become support staff in health services…..idle, incompetent and rude from birth.
      Sorry to hear that you have been, in that phrase much used by an even older generation than mine ‘under the doctor’. Hope all is going well.

  9. What an ordeal. But glad you managed the maze and amazing incompetence.
    (Got some real chuckles out of the comment section. “genetically programed”! That explains it – we see it here, too. “Frisking you at the entrance”
    Hysterical except we all seem to be seeing this.
    It must have been a dream: my vague memories of things working smoothly, well, and considerately.

    1. The comment section is the best part of the blog!
      Oh for the early days of the NHS when every hospital stank of carbolic soap and the hundred or so of you all called for the same time shuffled your backsides along wooden benches – highly polished by same backsides – until seen by the bod holding the session. Somehow, before computers, the staff always had your papers….and they certainly would not have had you roaming the hospital – making it untidy – in search of obscure offices.

  10. Delighted that at least you made it and the eyesight has improved. Long may it last. We have just had a terrible trip to the UK, which, if I had your writing skills I could write a book about!!
    Hope you are both well, take care Diane

    1. I am so sorry you had a nightmare trip….travel all seems to have fallen apart after Covid, let alone all the other variables which make up a trip.
      Look after yourselves….I hope the coming winter will not be as grim as it is predicted to be.

  11. Good heavens, thank goodness you weren’t in cardiac arrest or haemorrhaging, although I suspect your blood pressure must have been rather elevated.

    I do hope you have made a full recovery and are now back in the kitchen enjoying the steam.

  12. After reading of your dramas and staunch perseverance, I will never complain about hospital wait times in Australia again. We are truly blessed in comparison. Notwithstanding the fact that every Secretary of all medical specialists are trained in how to be a beastly dragon to patients. It is confounding given they are in the ‘caring’ profession. So glad to hear that your recovery is going well.

    1. The CAJA is a super institution when left to its medical staff. The problems come when dealing with admin staff, whose number date from the days of expanding jobs in the public services to gain votes – a number highly resistant to a diminution in its ranks despite the introduction of computer records. Personally I’d sack the lot and let the patients loose on their own records….couldn’t be more of a muddle.

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