Mi Noche en la Clínica

I apologize for the delay in putting up new blog posts...the past week has been especially busy with getting ready for midterms, applying for a scholarship, and looking for an apartment for next year (and, to a lesser but much more enjoyable extent, swimming under waterfalls, lying on the beach, and dancing merengue).  And the week before that, I got so sick I ended up going to the hospital.  While that entire day involved far too much vomit and too many needles for my liking, I am feeling much better now and, at the very least, can add "spent the night in a hospital" to the list of aspects of Dominican life that I've experienced.

Consistent with my tendency to only get weird, short-lived, miserable illnesses like swine flu instead of normal ones like colds, until last week I hadn't had a single major stomach issue in the DR.  Then, quite suddenly one night, my stomach started to feel really weird.  Like I'd just eaten a meal so big I wanted to throw up.  As I hadn't just eaten for two hours, this seemed a little strange, but I just went to bed and hoped it'd be gone in the morning.

Nope.  The next day I threw up four times until finally, around two in the afternoon, my host mom said we should probably go to the hospital.  (In the DR, there are no clinics or urgent care centers, just two kinds of hospitals: hospitales, which are public and generally under-supplied and over-crowded, and clínicas, which are private and have much better conditions, as well as doctors who have studied in Europe or the U.S.)  Although I suspected it was just food poisoning, I decided it wouldn't hurt to go and rule out anything more serious, expecting that the process would only take a few hours (ha!).  My host mom called a taxi, and we went to the emergency room at Homs, the best-ranked clínica in Santiago.

Homs looks very much like a hospital in the U.S.: shiny white linoleum floors, pastel painted walls, nurses in scrubs, and doctors in lab coats.  We walked through the waiting room to the check-in counter, where my host mom explained what had been happening to the receptionist.  I showed them a copy of my passport and they sent us to the next room, filled with curtains hiding cots and metal chairs, and a nurse pointed us to the little stall where I should wait.  Overall, the process worked like a slower, slightly less organized version of an American doctor's office, except...

1.  Mercury thermometers.  To take my temperature, the nurse used a mercury thermometer, smacking it against her wrist, then sticking it under my armpit, something I can't remember ever seeing before in real life.  Even better, they gave me one to take home with me in case I started feeling sick again.  Here it is, to the right (since I didn't have my camera in the hospital, I have to stretch a little for pictures for this entry...)

2.  The doctor's questions.  Most of these weren't that strange - What did you eat last night?  Have you taken any medicine today? - but at one point, the doctor asked me, "Have you ever been sick before?"

"You mean with something like this?" I asked.

"With anything."

"You mean serious illness?"

"Any kind."

"Like, in my life?"

The doctor started to get impatient.  "Yes.  What have you been sick with before?"

I was still confused - did she expect me to remember every illness I've ever had?  How were things like the chicken pox at age three at all relevant to this? - so I shot a questioning look at my host mom, who nodded and told me to start listing all of the illness I've had. 

"If it helps, you can say them in English," the doctor offered.

I ended up just listing off a few - chicken pox, colds, the flu - thinking it would take far too long to explain things like "Well...to start with, last summer, one morning my cheek just started swelling up and hurting, and we're not quite sure, but it was probably an infected spit glad one day and, a few weeks before that, there was one day where I randomly felt so weak that all I did was sleep from Saturday night to Monday morning..." and being fairly certain that such illnesses had nothing to do with the bacteria that was almost certainly giving me food poisoning right then.

(Although, afterward, I started to worry that maybe my life is like one very long episode of House, with dozens of seemingly unrelated illness actually all being symptoms of some sort of rare virus or a bad reaction to laundry detergent that has been steadily building that only this doctor, seeing them written all together on a white board, would be able to understand).

3.  Patient privacy regulations.  In the US, I once asked my doctor if she could explain something to my mom over the phone, but she told me that, because I was over 18, she wasn't allowed to talk about my health with my parents on the phone, even if I was there with her and asking her to do it.  For my dad to tell his insurance company about a mistake in coding in a visit I'd had, we had to do a three-way call because the insurance company couldn't talk about it without my presence.

Here, my host mom did everything for me except sign a credit card receipt.  She checked me into the hospital, jumped in and answered half of the doctor's questions before I got the chance to, wandered around asking nurses what my lab results were, told the front desk I was going to stay the night and gave them my check card for the deposit, and talked over treatment options with my doctor when I was asleep.  It was very helpful, and I really appreciated it, especially after the medicine kicked in and made me so tired I could hardly stay awake, but it was certainly much different from the US.  (I am proud to report, however, that even under groggy, sick, weak conditions, I could understand everything the people around me were saying.)

4. Uses of gloves.  At Homs, plastic gloves were all over the place, serving a remarkable number of purposes - storing cotton balls, tying arms about to get blood drawn, acting as a mini garbage bag for band-aid wrappers and used iodine wipes.  I never, however, saw them protecting anyone's hands.  Even when drawing my blood, the nurses used their bare (hopefully clean) hands.

5. Lack of communication with the patient.  At no point after examining me did the doctor come back to explain that she thought I had a stomach bacteria and explain the different things she thought I should do.  After she left, I waited around for awhile, and eventually a nurse stopped by with a box of test tubes and needles (safely individually sealed in little glass-and-plastic containers), set it down on my bed, and started cleaning off my inner elbow.  No "We'd like to test your blood for x," no "Have you had blood drawn before?" just walking in and getting to work.  When my host mom asked, she wasn't even sure what they wanted to test it for.

The i.v. was the same thing.  My host mom understood what was going on and recognized the medicines they were giving me, so she didn't seem to think this was strange, but no one had told me they thought I should get and i.v. or asked if I wanted it or told me how much it would cost or if it was covered by insurance.  I was just lying there, half asleep, when another nurse bustled in with a pouch of a saline solution, hung it on a hook above my head, grabbed my hand, wiped it with alcohol, and drew some more blood out of it before connecting it to the i.v. line.  (Side note: When my host mom asked why they were drawing more blood, she was surprised and said, "Oh?  Someone already did that?" so I we can add lack of communication between nurses to this section, too.)

6. Getting yelled at by a doctor.  Continuing the theme of lack of communication, as the evening went on, someone told my host mom (not me) that the doctor wanted me to stay the night, so I didn't get dehydrated (since I hadn't drunk anything in over 24 hours and, even after taking the anti-nausea medicine they gave me, had thrown up juice).  My host mom thought it was a good idea, especially since it was already quite late.  I was concerned, wondering why I'd have to stay overnight for something as little as food poisoning, so I called my program's director, who reassured me that overnight stays at the hospital are more common in the DR than the US, and especially now, given all the worry about dehydration caused by cholera, doctors are being especially careful about preventing dehydration caused by other things, as well.  Reassured slightly, I agreed, and my host mom told the front desk before heading home to get the things she would need to stay the night with me.

There was some miscommunication, however, and the doctor still needed to talk to my mom about me staying there.  She came into my room to talk to her about ten minutes after my host parents had left, and when I explained they'd gone home to get a few things, she left.  When she came back about twenty minutes later, however, and found that my host parents still hadn't come back, she started yelling at me to call them because she needed to talk to them.  Actually yelling.  At a poor, sick, groggy girl alone in a foreign hospital, about to stay the night for the first time in her life.

Eww.  Just looking at it makes me feel sick.

7. The various theories about why I was sick.  One of the doctor's questions was what I'd eaten the night before.  It had been yucca, avocado, eggs with tomatoes, and a papaya smoothie - a meal so typical that I actually took a pictures of it as the perfect summary of Dominican dinners.

Of all of these things, the doctor did not suspect, as I did, that one of the eggs been bad or maybe not quite cooked enough...or that the avocado or tomatoes or papaya maybe weren't washed quite as thoroughly as usual...or that the eggs had been sitting out on the counter a little too long before I ate them.  The one that stuck out to her as the most likely suspect was yucca, a completely bland, tasteless, inoffensive plant that had been peeled and cooked through in boiling water that I have had about three times a weeks since I got here.  My host mom reassured her that I've eaten yucca many times before without problems.  Later, my host mom told me that the doctor thought it was probably a stomach bacteria, and I got a handful of medicines designed to kill what must be every bacteria, amoeba, and parasite in the country, just to cover my bases.

My host mom, however, didn't seem convinced.  She asked if I thought maybe it was the rice and beans I'd eaten at the preschool I volunteer at on Mondays.  I told her probably not, as I've been eating that for weeks without problems and had been completely fine for three days afterward.  She then thought about what I'd eaten that day again, and decided that it was probably not one food in particular, but just that I'd eaten too much, since I'd had two slices of cornbread in the afternoon and a larger-than-normal dinner.  The first time she mentioned this theory, I politely mentioned that thought it was probably just a bacteria since I was still throwing up things like a sip of water a good twelve hours after everything from dinner had left my system.

Days later, however, she was still musing at least twice a day, "You know, when I think about it, I really think you just ate too much on Wednesday night.  Remember?  You had all that rice for lunch, then that cornbread, and a big dinner.  I think it was just too much."  I started just starting nodding and saying, "Yep, that might have been it."  Even today, she keeps reminding me not to eat too much at night so I don't throw up again.  On the one hand, hearing at that at every meal, I can't help but think of goldfish and their inability to tell when they're full.  On the other hand, it does mean, instead of giving me large, Dominican-sized servings of everything, she's been letting me serve myself, which has been nice.

Designed to kill every amoeba known to man.

8. The pharmacy.  Before we left the hospital, the doctor gave us a list of the medicines I should take and how often I should take them.  To get them, my host mom just called up our neighborhood pharmacy and read off their names and how many pills we needed.  A few minutes later, one of the pharmacy workers brought them right to our door, two of them in little boxes and one of them just as a few sheets of pills with the name stamped on the back, no list of precautions or ingredients or anything.

Prescriptions here are also used for totally different things.  They're required for lab tests of any kind - for example, if you want to get a blood test for AIDS (which I only know because it's required to use the pool at my university, don't worry!), you need to go to the doctor, tell her you want one, get a prescription authorizing it, and go to a lab.  To get any type of medicine, however, you just call up the pharmacy, tell them what you need, and get it delivered to your door.

So there you have it - that's the Dominican private emergency room experience in a nutshell.  Not horrible, but here's to hoping I can get through the next month and a half without needing to visit it again!