It’s been awhile since my last post, and in that time I’ve had a good dose of experience with the Puerto Rican health care system. Suffice it to say, it’s not as third-world as you might think, though you definitely need to pack your patience and manage your expectations.
Having been here nearly a year already, it was time for my annual check – up. Several of my coworkers recommended a place that “took appointments.” While this is something we tend to take for granted, it’s not the standard practice down here. At most places, you show up, hope not many others opted to see that doctor that day, and wait. Charlie’s vet doesn’t take appointments. One coworker told me a story of needing to see a specialist. She showed up at 9 am to wait her turn – and wasn’t seen until 12:45. A.M. Yep, 12:45 in the morning. I made her repeat the story three times to make sure the timing wasn’t lost in the translation. But her English is among the best in the office. Nearly a 16 hour wait. I couldn’t take it.
Let me give you a frame of reference of what I was used to in Texas. My doctor’s office was less than two miles from my house. I’d show up 10-15 minutes before my appointment and be seen within 15 minutes of that time. In under an hour, I’d get the full workup: take my vitals, talk about my weight, do the womanly exam, draw blood, renew prescriptions, discuss any other issues on my mind, and out the door. A one-stop shop. In about a week, they’d call and tell me all my tests were normal; see you next year.
So I made my appointment for 11 am. I thought that was a bit late, since my Texas doctor always tried to schedule it for the morning knowing you should fast before getting your blood drawn. Turns out, not so much a one-stop shop here in Puerto Rico. My doctor (who’d just returned after seven years in Las Colinas, Texas) was a general practitioner who merely listened to my heart, checked my throat, eyes and ears, and wrote me a prescription for blood work. Thankfully, they had a lab on site, and since I hadn’t eaten, I could at least still get that accomplished. I had to make another appointment for two weeks down the road for what I’ll call the “woman’s physical.”
Two weeks later, I show up 30 minutes before my appointment, as instructed. I’ve now learned these instructions are for the natives. Those of us who routinely arrive for appointments ahead of schedule have no need to adhere to the 30 minute recommendation. I assume this is because if you tell a Puerto Rican to arrive 30 minutes early, odds are better they’ll be on time.
I expected to be seen immediately, as I was the first appointment of the day. However, it’s hard to be seen at 9 am when the doctor doesn’t show up for work until 9:45. I’d been waiting for an hour and 15 minutes and was about to blow a gasket when they called my name. Keep in mind, this is the “good” place that keeps a schedule. The exam went off without a hitch, except for the fact that I had to schedule a follow up for two weeks later to learn the results of my tests. Apparently, follow up phone calls don’t generate any revenue. (Oh, and add the gynecologist to the list of people who have a warned me about Puerto Rican men.)
During this time, I’d developed an odd lump just below my ear on the left side of my neck. I’ve been having some real ear problems down here, apparently something not uncommon in the tropics. But after a couple of weeks of it coming and going, I decided to see an ENT to get it checked out. I had to have a coworker call and schedule the appointment, as I was quickly learning that the administrative support at doctors’ offices couldn’t (or wouldn’t) speak English. I made an “appointment” for between 1 and 2:30 in the afternoon. As it happened, I could also get the mammogram done in the same building. I’d planned to show up at one, be finished at the ENT no later than three, and then get downstairs to have the mammogram done before they closed at 4:30 (no appointments taken at the mammogram place.)
That was a boatload of wishful thinking. I finally got out of the ENT’s just before 4 pm. (Determined to be a swollen lymph node, it’s since subsided completely.) I went downstairs to see about a mammogram, only to find the office completely wedged. I had no idea how this worked. If they didn’t get to you by closing time do you just get kicked out and have to wait all over again? Do they stay until the last person is done? I had no idea if that could mean 12:45 am, and after already waiting three hours for a 10 minute conversation, I was in no mood to find out. I went back on Friday afternoon, just before yet another Puerto Rican holiday weekend, and was in and out in under an hour. And now I know when to go.
Which brings me to Saturday morning. Friday, my eye was a bit sore and purple. I didn’t know what the problem could be, thought maybe Charlie had kicked me in his sleep. I wasn’t too concerned about it, until I woke up Saturday and literally couldn’t open my eye. It was completely swollen shut. Luckily, there’s an emergency room two blocks away that my boss had recently been to and spoke highly of. I’m leaving for a week in Panama early Monday morning, so waiting the weekend to see if it got better wasn’t an option.
At 7:45 am I was the only person in the waiting room. I checked in and the nurse was calling me to the back before I could even complete the paper work (all in Spanish, mind you. The run of the mill forms I can translate, emergency room disclosures are still beyond my literacy rate. For all I knew, I was agreeing to let them remove my liver - an organ that quite honestly, I probably need more than some of the others.) Awesome, I thought. Maybe I can make my 10:30 nail appointment.
Again, a whole lot of wishful thinking. In to see the nurse, back to the waiting room. In to see the doctor, back to the waiting room. In to see the nurse for a blood draw and IV antibiotics, off to another waiting area. By 9:45 my IV was finished and I was ready to go. Only to find out that when the doctor said, “I’ll call you when the blood work is done” she didn’t mean call me on the phone. She meant call me from the waiting area. They left the needle for the IV in my hand this entire time (which kind of weirds me out) it case the results of the blood work indicated I needed to be pumped full of something else.
Five and a half hours later, I was back on the street with a prescription for an antibiotic. Not exactly the way one wants to spend a Saturday morning. But I was VERY happy I got up and went early, the place was jam packed when I went to leave. My eye started getting better soon after starting the IV; I no longer look like a deformed Cyclops. I didn’t do much this weekend, though. Not a fan of the looks I’ve been getting, because frankly, it looks like I finally met a Puerto Rican and he turned out to be not so nice. I’d had the foresight to bring my Kindle with me to the ER. I’m learning that if I can manage my expectations and prepare accordingly, I can probably get through these mundane have-to-do’s in the chil-axed pace of a Latin American culture without having a cardiac event.
Which brings me to a slight side bar. A few weeks ago my Dad said something when we were on the phone and I was complaining about the car in front of me that had stopped and blocked the entire road while he chatted with a passer-by, leaning against the driver’s side window sipping a Coke. He said I could probably learn a thing or two from the Puerto Ricans. I may have mentioned this before, but viewed through my North American glasses, this kind of behavior - holding everyone up while you tend to your own desires - seems quite narcissistic. In fact, I really think it’s more to do with how relaxed the culture is. Nobody’s in that big of a rush, what does it matter if I hold things up a bit? And it’s tolerated, because next time it might be you doing the holding up.
My sister was here a couple of weeks ago, and during our couple of nights out we had some conversations with the natives. I wonder what it would be like to be perfectly content just pouring lattes or running a craps table for a living. More concerned about living your life and having fun with family and friends than what the next move or promotion might be. I bet it’s pretty nice. Unfortunately, I believe this ship has sailed for me. I’m just not wired that way. Doesn’t mean I can’t pick up a tip or two along the way, though!
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