Wednesday, July 30, 2014

I have been holding back on everyone. I did not want to tell this story until I knew the outcome, because I did not want anyone to worry. Don’t worry. All’s well that ends well here, and I can tell this one for laughs now, though it was not funny at all at the time.

Greg did have altitude sickness, but he had another problem as well. He had a black stool, classic evidence of bleeding somewhere in the body. In typical man fashion, he did not mention this problem to me until late on Monday, and so we arranged the doctor visit, which had turned into the day clinic stay. The doctor in Yucay had nixed the trail and recommended an endoscopy, telling us it was absolutely essential to determine the source of the bleeding. He assured us that Greg’s blood tests did not indicate anemia and that everything was under control, but he told us it was necessary to make sure we were okay to continue with our tour. We were scared to have the procedure and scared not to. The endoscopy could not be scheduled in Cusco until Wednesday because Tuesday was the Peruvan Independence Day. We always seem to get into the thick of things. No wonder the evil town had been partying into the night when we arrived. It was all a part of their festivities.

We had purchased a Travelling Nomads insurance policy before we left, the first time we have ever elected to do so. It was a godsend. If they do not pay a penny on our claims, I was still be forever grateful for their assistance. Within an hour of sending them an email, they contacted us with forms that would be necessary if Greg needed to make a quick exit from the country. Then their medical support team called us and asked us to explain everything. When we told her where our tour operator had sent us to the doctor, they quickly replied, “We have worked with that clinic quite a bit, and that is exactly where we would have referred you. You are in good hands.” That reassurance enough made me feel so much better. We decided we would book the procedure but cancel immediately and walk out and come home to the states if we felt as if the care was not adequate.

The head of operations for our tour company, Carla at Enigma Tours, met us with private transport in Yucay and helped us check out of our nice hotel and get to Cusco for the procedure. She stayed with us every step of the way, assisting us in dealing with medical personnel, translations, hand-holding and bag carrying. I am not one to cry much, but I teared up a time or two and Carla would immediately brush her hand across her face and say, “No worries. Everything will be okay.” It is such a blessing and gift to have been so well cared for. Enigma Tours went above and beyond.

We arrived at the clinic in the early morning. It was clean and bright, and they were waiting for us at the door and greeting us by name. The doctor in Yucay had arranged everything, so paperwork was at a minimum. We dropped Greg off, and our driver took the bags, Carla, Genene and me to the hotel two short blocks away. Carla helped us get checked in. We quickly stowed our bags and got a room key and walked back to the clinic. By the time we arrived, they had Greg’s IV line started and were ready to put him in a transport vehicle to another clinic a few blocks away. This concerned me a little because I liked the look of where we were. We had a lady escorting us the entire way. She wore street clothes, not scrubs. I called her our “concierge.”

We arrived at something like a small hospital, with mazes of halls and lots of people. I could see various departments–gynocology, gastro, surgery. We waited for an elevator and when the doors opened, an ashen old man was wheeled out on a gurney, dried blood in a bag beside him. I did not like the look of that, but we kept going forward. After an initial misstep, our concierge led us to the gastro department. We walked down a long hallway, and Peruvians lined the walls on either side. Our concierge led us right to the front of the line. I felt badly about this, but I did not say no. I figure that our American credit card took us to the front of the line, and by God, I was okay with that. Many times I have sat for hours in a waiting room in the United States. I just figured it was our turn to catch a break. We went right into the procedure room and met our doctor, a woman younger than I. She was matter-of-fact and apparently spoke no English. Thank goodness for Greg’s Spanish and for Carla. There was very little in the way of preliminaries. They removed all the instruments and needles from sterilized containers, just like in the USA. There were no worries there. They put Greg onto a bed, turned him on his side, and stuffed a spacer in his mouth with a hole in the middle, into which the endoscopy tube would be fed. He looked like Hannibal Lector in “Silence of the Lambs,” and his ability to talk and translate was immediately gone. They gave him a bit of dope (he said later that it was not nearly enough). The doctor waited no more than two minutes and started jamming that scope down his throat. He was gagging and making the most horrific noises. Spit was roiling out of the side of his mouth. The doctor kept telling him to swallow, not spit, and to relax “tranquile se.” Yeah, doc, you stay calm while someone jams a two-foot tube down your throat! I rubbed Greg on the leg and kept saying, “Be calm. Be calm. It’s okay.” I did not know what else to do. After she finally got the tube into Greg, he got a little calmer and it got pretty interesting. It’s been a long time since I took biology, but it was easy to see his esophogus, stomach, and even part of his small intestine on the TV monitor in living technicolor. I was gratified not to see any blood spurting anywhere. It was just lovely pink guts all around. I tried to get Genene to look, but she was pretty put off by the sound of her dad hacking out his guts and stayed on the floor, wrapped up in a game on her iPod. The concierge had pressed a small deck of cards into her hand, and I found Genene gripping it tightly later. What a sweet gesture. Carla and the concierge were in the room too. I could not believe that Carla would stay right there by our side for all that drama, but she did. She acted like it was just another day at the office, though later she confessed that this was her first time to see such a thing. She was rock solid. By the end of the procedure, I felt a little put off and woozy. I sat right down on the end of the exam table beside Greg and told no one. I was afraid they would throw me out. My niece and nephew are both very talented RNs. I could not do what they do for all the tea in China.

The doc jerked out the tube, and they sat Greg up and gave him a couple of minutes to regain composure. The doctor explained to me that Greg had a small hernia at the spot where his esophogus joins his stomach, and that prevents the valve from closing at that spot, causing reflux. He also had a small ulcer, which had been the source of the bleeding. It was not bleeding any more, and the doctor thought Greg was stable and in good condition. She assured us that we can follow up with our doctor when we get home. The bad news is that she told him to go on a bland diet, told him no booze (boo hoo), and gave him a ton of different medicines to take–Nexium, antiacids, etc. It was a lot to take in. Hindsight is 20/20. Greg had to take blood thinner and baby aspirin for 2 years after getting the heart stent. The aspirin likely contributed to the stomach irritation, while the blood thinner made it more likely to bleed. Greg’s cardiologist told him he could stop taking those medications anyway at the 2 year anniversary, which is about 3 weeks from now. We are going with the local doctor’s advice and stopping it now. I figure we made it close enough to the anniversary, and Greg’s cardiologist has been pleased with the strength and condition of his heart. You take drugs to fix one problem and you end up with another.

Our concierge told us that we would have to return to the original clinic location several blocks away to check out and get our medicines. Our transport ambulance had been called away to the airport, so the concierge hailed a small cab. I had to sit in the floor in the back seat, while Greg, Genene and Carla squeezed into the seats. We were jammed into that taxi like sardines, and I just hung on for dear life. The concierge sat up front with the taxi cab driver and paid the tab. It was actually very efficient, better than waiting hours for an ambulance.

We talked to another doctor back at the bright, cheery clinic, and like in America, his instructions varied some from the doctor who ran the endoscopy. (Isn’t that always the way it goes?) The variances were not too major, so I think we have a good plan. Again, the prescriptions were dispensed on the spot, our credit card was accepted, and we walked the two blocks back to our hotel. We had arrived at the clinic that morning at 10:00 AM and were done by noon. The whole bill, including medicines dispensed, was something in the range of $500. I did a Google search of endoscopy procedures in the USA and saw some figures as high as $8,000. Greg described the whole medical experience as “rough and ready,” and I agree with that assessment. I have to say that overall, I was impressed. Easy for me to say since no one tried to gag me to death.

Carla showed us a good place to have lunch later, made sure we were settled in at the hotel and said her goodbyes. She has a lot of work to do on our behalf and will be back in touch. Train tickets will be hard to come by at this time of year, but we really want to see Machu Picchu.

Greg wanted to rest for a few minutes, naturally. Wouldn’t you?

After a slight break, he said, “I’m really hungry.” That was a great sign in my mind, for Greg had not had much of an appetite since our first night in Yucay. We went to Valentina’s and had a delightful lunch. I had been dying to try the Peruvian delicacy, cuy (guinea pig). The waiter assured me that it was good, and so I took the chance. I must confess that it does not look all that appetizing in the photo, but it was delicious! The skin tasted like a roasted pork. The meat was fatty and succulent. Best of all, the waiter told us it was to be eaten with our hands, Peruvian style. I am all about that. The weight of the procedure was off all our chests, and we wolfed it down.

 

We went back to our room for a siesta and spent the rest of the afternoon resting. I blogged while Greg read or slept. Genene happily played games. We even had a visit from Carlos, who was to have been our guide on the Inca Trail. He and his wife came by with a giant bottle of water, which was much appreciated. He told us that his daughters (12 years old and 8 years old) are out of school tomorrow and asked us if we would like to join him and his girls in a day of family fun around Cusco. He said we could do some light walking, touring, and maybe even take in a movie. We were excited and honored to accept this invitation and are looking forward to it. There are wonderful people all over the world. We had felt really bad about leaving all the porters, the cook and the guide in a lurch. I am sure they do not get paid if they do not go on the trail, and tips are a part of what they work for. At least we will get to give Carlos a job, and I am thinking that it will be fun for all of us. His wife made Genene promise to try to teach her daughters some English, and they took their leave. We will see them in the morning.

In the late afternoon, Greg said, “I’m tired of sitting around. Let’s go out.” Again, a great sign. We walked down to the main plaza and past the cathedral. Carlos had told us of a trendy restaurant, Fallen Angel, located behind the cathedral down a long, narrow street. We found it easily and had a nice meal.

Our table was a large bathtub with a glass top, inside of which were fish swimming.

The walk home was very cold, and Genene felt a little queasy. I chalk all that up to the long, harrowing day, the increase in altitude (Cusco is at 11,200 feet), and the change in diet. She is sleeping contently now after chewing two Peptos, and I think all is well.

Greg’s altitude sickness seems to have quickly abated. He seems essentially normal to me now…or at least what passes for normal in Greg world. He is making bad jokes and sighing each time we pass a bar that serves Cusquena beer. I fear a bland diet will be hard for him to maintain. He loves spicy food and until now has had a cast iron stomach.

What a day!

POSTSCRIPT: I am writing this postscript in current time on Thursday, July 31. I just wanted to leave everyone with assurances that Greg is continuing to do great. We had a great day sightseeing in Cusco today, and he felt good all day. We have our train tickets, and Machu Picchu is in our future. I will tell you more about that later, but I will leave you with a photo of our intriped medical tourist.