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.

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Ah Maun Dree Ma Ain Weird

Because, as one says in Scotland, ‘Whit’s fur ye’ll no go by ye’ so you are obliged, in the best Calvinist tradition, to submit to your fate.

Which in my case has meant various health problems which have rendered me less than that which I was…no longer up and about from dawn to dusk, forced to lie down, tired for what would once have seemed nothing.

Clearly, it is nothing in comparison with Leo. He is reliant on a wheelchair, struggles to breathe at times, and is easily exhausted….but he keeps buggering on and so shall I.

I am just not used to it.

We have taken on a part time worker to fill the gaps…and he has been a treasure. He has green fingers, is a skilled painter and decorator and the dogs love him.

Thus, for the first time today, he and Danilo wash the dogs. All ten of them.

I had my own system…shut the bedroom doors, assemble the shampoo on the balcony, get the hose set up, coax the thugs into place with biscuits and shut the doors to the house. Then the fun began. Trap first dog against the balustrade with the knees, soak dog, shampoo dog, rinse dog, release dog…repeat until complete.

Carlos and Danilo have another method.

The hose is set up under the orange tree in front of the house and the dogs are transported, one by one, to meet their fate.My contribution is, once again, to shut the bedroom doors and stand by at the front door to prevent re entry by wet, shocked, traumatised dogs intent on shaking off the whole experience in the house.

The two big boys, Einstein and Bunter, are no problem. They love being washed and once it is clear that no more water is forthcoming leg it down to the sheep shed to roll in the bedding there….

Podge is caught in a moment of distraction….chewing the centre out of a cushion to make a nest under the baleful eye of Black Tot, who had been keeping that cushion for herself….and is whisked off for summary judgement by hosepipe. Black Tot removes the remains of the cushion into a a safer place under my desk and sits on it. I sweep up.

Two black pointy ears and an indignant face appear at the door. Podge is displeased.

The others follow….no problem with most, except for Scruffy, the little mum, who hides under the sink and has to be pushed out with a broom, and Napoleon, who has to be taken in a rugby tackle as he scoots across the room….but the group outside the front door is growing, damp and despairing. What feels like scores of reproachful eyes are fixed upon me.

Traitor…..abandoner of animals…..Cruella Deville…..

I take refuge in the kitchen area…only to find two cold wet noses pressed against my leg and two wet bodies jumping up. Auntie and little Zuniga have made it into the house!

But the front door is still shut…..

They have used their…or Auntie’s…. initiative and have crossed the garden, descended to the pasture, ducked under the wire and emerged by the swimming pool, upon whose narrow wall they have made their way to the small balcony and thus to the large and into the house! Damp tails wagging…very pleased with themselves.

Perusal of the swimming pool reveals that the big boys have followed them…but only as far as the wall of the pool…..they do not trust themselves on the wall itself and sit, mournful, under the jocote tree, well adorned with the straw from the sheep shed.

Eventually I relent and let in the remainder of the tribe……apart from Podge and Napoleon the rest have managed to adorn themselves with mud and other substances obtained while rolling in the garden post wash……so next time, it is back to the balcony…but it will be someone else’s knees trapping each dog against the balustrade.

And I find that very hard to accept.

Still….the brain is still working, the memory too and, according to privileged observers, the voice is far from stilled…..so the lum is reeking yet!

Should This Woman Be Put Down?

This is my mother at Southampton airport on her way to celebrate her 97th birthday in Spain….the which she did…in style. Thank you, Maggie and Adrian.

She hasn’t changed a great deal since this photograph was taken a few weeks ago…….so does she look to you as though she should be put down?

When she had a hip replacement operation at 95 and a knee replacement at 96 her surgeon certainly did not think so…he told her she would be good for another ten years: but a more junior medic clearly did not agree.

Mother asked for a house call recently as she had a heavy chest cold and did not feel up to going to the surgery in the miserable weather to see whether or not it was an infection of some sort.
There was no problem with obtaining the house call – her G.P.’s surgery is well organised – but there certainly was with the result.

Mother and her friends have a mutual assistance agreement.
If they have a doctor calling one of them, another of their number is with the patient… not that they are expecting anything in the nature of a cross between Carry On Doctor and The News of The World – as they say, chance would be a fine thing at their age – but they think that two heads are better than one when remembering a doctor’s recommendations, so when the young female doctor arrived, mother’s friend Adolpha was in attendance.
Which is how I know what happened.

After the usual pleasantries, the doctor examined mother, looked at her notes and prescribed a diuretic which mother refused: there was some civilised discussion about mother’s blood pressure and then the doctor said that while she was there she would take the opportunity to update mother’s notes.
Just a routine matter, nothing to worry about.

‘In the event that you have to be taken to hospital in an emergency, would you like to indicate now if you would prefer not to be resuscitated?’

Silence in the room for a moment….then

‘If you want to kill me you’ll have to shoot me first.’

I first heard of this from Adolpha, full of rage and fury and was struck by something she said.

‘What did this young madam see; an old woman living on her own feeling miserable with a rotten cold and she has the cheek to even think that her life isn’t worth living.
I wouldn’t mind betting if she’d seen her in the villa in Spain, enjoying her holiday, the thought wouldn’t even have ocurred to her!’

I heard it from mother too. Her initial fury subsided, she was sad and downcast that the question had been posed.

‘I suppose she thinks that I’m on my own…you live the other side of the world…there’s no one here…they can do what they like.’

Then, angry again,
‘If they want to be rid of us let us have a dose of morphine to do it ourselves, not to be tortured to death without food or water!’

She and her friends, all people with their wits about them, hold the local general hospital in fear and loathing.

‘But you had both your ops there and nothing could have gone better…’

‘Yes, it’s all right if you go in for something like that….where they know it’s for a limited time and then you’re out into rehab……but you don’t want to be taken there helpless if you’re old…’

A gentleman living down the road from mother was taken ill and came to himself as he was being loaded into an ambulance. He fought his way out of it, terrified that he was being taken to die.

There is clearly something terribly wrong where such a lack of confidence exists and I don’t see much sign of the hospital concerned doing anything to allay the concerns of the elderly in its zone; especially those living alone who don’t have a family member close by.

Mother may not be able to get about as once she did…her eyesight is not what it was…but she enjoys her food, her music…and the sport on television.
If you want a re run of Krakatoa exloding just ring mother when the Hennessy Gold Cup is on the box….

She has cleared all her clutter – to save me doing it after her death; she has just what she needs and wants to stay independent and she very much resents anyone even asking the resuscitation question.

She doesn’t want to be kept alive if the obvious outcome is life as a vegetable…but she wants a doctor to assess the situation on the facts…not to use a consent to non resuscitation form to bump her off just because she is old.

Some things are too good to keep to yourself….

We are building an extension which does not entail anything like the disruption to daily life experienced with the kitchen makeover, as it is, after all…an extension.
On the end of the house.
Away from me.
Dust is blown away into the garden…..
Nothing has had to be moved out to remain infuriatingly elusive for weeks….

The Men need feeding, true…but they do anyway.

We had planned to build a new house up in the cafetal and had gone so far as to have plans drawn up, install a septic tank and plant trees in readinesss…..and then we thought…
No.
The views are beautiful up there it is true and we would still be sheltered from the strong winds of December by the mountain behind but we’ve grown to love this little house and the garden we’ve made around it and, at our age, what on earth do we want with a whopping Italianate villa on two floors with a tower!

So…the extension.

The Men are at the stage of painting the inner walls and yesterday, having a number of things to do in town, went to buy more paint to match the wall they had started on, taking the paint lid with them as well as the mix number.
The young man in the shop set up his machine…and looked puzzled.

It’s not the same.

He called his boss who confirmed that it was not the same colour. The Men concurred.
My husband suggested that perhaps one of the nozzles was blocked.

No, no, I’ve done everything properly.

But we’ve started painting….

The boss intervened.

I’ll tell you what….I’ll give you double the paint in this colour for the price and then you can paint over what you’ve done and it will be all right.

Agreement was reached and, other errands accomplished the Men returned in the late afternoon to take coffee and discuss the next day’s programme.

There was the noise of a motorcycle engine and the Alsatian took off…he is not keen on anything disturbing his slumbers and a motorcycle rates at the top of his dislike list.
The engine stopped somewhere up the road and a voice was heard calling.

My husband went out to find the Alsatian sitting at the gates and the motorcyclist standing very still behind his machine. While actually a peaceful animal the dog has a certain way of sitting and looking that reminds one of the immovable object…and it was clear that the motorcyclist did not intend to be the irresistible force.

It was the young man from the shop. Cautiously he held out a small plastic wrapped packet.
It was paint, to add to the mix to get the proper colour. The boss had dismantled the machine and found that, indeed, one of the nozzles was blocked and this was the colour that should have come from it.

Just mix it in and you’ve got the paint you wanted.

My husband thanked him and went to get the money for the extra paint they had been given.

No! The boss said it was our fault….and he sent me out straight away in case you had started to use the paint.

Would the young man take a coffee…a beer?

No…he would not. He had to get back to work….and, once the gates were closed between him and the Alsatian, that is what he did, his motorcycle kicking up dust and stones on the road up the hill.

To me, this is something too good to keep to myself….that a shopkeeper is not only willing to get you out of a mess by giving extra materials…but also sends his shopman out with the pukka gear to get to you before you’ve started with the new stuff…..
Not just service…but thoughtfulness.

It wasn’t the only good thing that happened yesterday…..
There’s a new prosecutor at the Fiscalia….and he’s been getting to grips with his job.

My husband had been summoned to see him by telephone that morning and dropped in on his shopping trip…to find about half the inhabitants of the Three Valleys in the waiting area.

The new prosecutor had unearthed the files on the would be developer and his Mr. Fix-it…The Neighbour.

The people giving us all trouble with our water supply.

The new prosecutor wanted to know why all the complaints had been filed and parked in a cupboard.

From the noises coming from the offices it sounded as though these were not the only files parked out of sight and out of mind…….

From the noises coming from the offices it also seemed that the new Prosecutor was not very happy….

Secretaries came and went at the gallop…people were ushered in and out of offices at speed….my husband’s turn came.

Did he uphold his complaints ?

Yes, he did.

Sign here.

What will happen?

Well, the files won’t be going back into the cupboard….

So, a new judge up at the court and a new prosecutor at the Fiscalia……The Neighbour had better watch his step.

And the best of all…an improvement in my husband’s health.

He has been diagnosed with something enchantingly known as Miller Fisher/ CANOMAD…..which always has me thinking of Noel Coward singing ‘Mad Dogs and Englishmen….which is related to the better known syndrome Guillain-Barre.

What it means for him is that should he catch a ‘flu, his antibodies – instead of going for the intruder – go for the sheathing of his nerves, leaving him progressively paralysed.

And it’s a quick progression.

From a tingling in the hands and lips it can be complete paralysis and coma within  two hours. Treatment has to be fast and has to follow a particular cycle to avoid death or permanent damage to the nervous system.

Well, over the years, over many attacks, the treatment hasn’t always been fast enough and the cycle hasn’t always been respected.

There are many consequences, but one in particular has been that his blood pressure swings alarmingly from high to low and back again…migraines at one extreme, faintness at the other. It doesn’t make life fun.

We’ve always taken precautions against high blood pressure…I don’t use salt, I use as few prepared foods as possible….but it’s the swings which have proved insoluble.

Until recently.

He has been reading  up on blood pressure and discovered that it is controlled by three elements…the kidneys, the nervous system and sodium and potassium ‘pumps’.

Well, the kidneys are fine…but the nervous system is shot to bits…so he reckoned his potassium levels needed to be upped to compensate.

He bought a tub of salt substitute…potassium iodide and potassium chloride (I think)….sprinkled it on his food…and not only is his blood pressure stable but it is that of a young man.

With Mad Dog syndrome he could still drop dead tomorrow…..but in the meantime his quality of life has improved out of all measure!

That is certainly something too good to keep to myself!