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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