Costa Rica Cost Of Living Update: Hernia surgery-$0

On the day of admissions, we reported to an office and filled out paperwork. It lasted no more than 10 minutes. I was not sure if it was fast because that was the actual process or because we couldn’t understand anything.

We were directed to the emergency ward where Rob was instructed to go into a utility closet and change into a pair of scrubs. He walked out wearing an ill-fitting ensamble with numbers stamped across his chest. The pants were too short and the top didn’t even cover his navel. My husband looked less like a surgical patient but more like a gay prison inmate.

“What do you think?” said Rob.

“Don’t expect a phone call from Calvin Klein anytime soon.”

“Mas grande?” Rob asked the man. Rob walked out again, his scrubs barely covering his abdomen but it’s the best they can do. The man made Rob sit in a wheelchair and took him to the hospital ward; a large room, about 20 beds, and no dividing curtains. The screen-less windows at the top of the room were all open. This allowed the breeze—and later the heat—to creep through. Little lizards jumped around the ceiling and darted in and out. It
reminded me of the television series MASH, and I was all but ready to see Hawkeye
and Hot Lips Houlihan saunter through.

Rob got a bed next to a young guy who had a motorcycle accident.  His entire leg was bandaged and propped up on a few pillows. I left to use the communal bathroom; there were no toilet seats or toilet paper. So far, this was not turning out to be the Mayo Clinic.

An hour later, our roly poly doctor walked in—his Winnie the Pooh appointment book under his arm. He introduced us to another doctor who looked exactly like Groucho Marx. He was wearing jeans and a polo shirt—it must have been casual Friday.

“This is your surgeon, he is from Mexico and very good,” he said. Rob was quick to respond.

“La mejor doctor. Nice to meet you.”

“Rob, how do I know this guy even has a medical license,” I said after Groucho walked away. “I want to find his office and ask to look at his diplomas.”

“Don’t you dare,” threatened Rob. “You’re going to piss him off. Whether we like it or not, this guy is doing the surgery, I don’t want him to have a grudge against me.”

“Then I’ll be nonchalant, just look like I’m lost, and check for myself to see if they are on the walls.”


“I’ll knock on his door and ask a question.”

“NO.” Rob insisted. I was sick to my stomach. I couldn’t see a good outcome and
started to cry.

“Please, I’m going to be fine, stop worrying. Listen, it’s all going to be over in a few days. What’s the worst that can happen?”  Rob’s ability to be optimistic in the face of
great odds was incredible.

The morning of the surgery, I walked into the ward but Rob’s bed was not there. I turned to the motorcycle guy, who curiously had a different woman at his side. I asked him if my husband was dead.  Because—as you know—I am such the optimist.

“Que? No…Noooooo,” he said.  He mimicked getting his side cut open.  It was around that time I heard moaning in the hall. A few seconds later, Rob was wheeled back into the room.

“Does it hurt?” I said as I leaned over him, as one would a soldier in the battlefield.

“Holy shit….yes…shit….shit…wow….”

I could see the vulnerability in his eyes. He was in a tremendous amount of pain and needing me more than ever. With these factors in mind, I did what any wife would do in this situation….I started bawling all over him.  Not the pretty cry, which I am prone to do at the end of a sappy movie. Women, you know the one I am talking about. The ugly cry.  The snotty, double shoulder pump cry. The one where your face looks like Ernest Borgnine and your shoulders spastically bounce up and down.

A nurse wearing a cute white cap, the kind of hat nurses used to wear years ago, tried to console me and tell me all the things I needed to do to help. I noticed she was carrying a Dora the Explorer file folder, which in turn caused me to collapse over Rob in a display that can only be compared to someone draping a corpse before the coffin lid was closed. It was quite a scene.

“Honey, calm down, I’m okay. But you really need to get the hell off me, you’re lying across my stitches.”

“I’m look like you’re in pain. I just want to help.”

“Start by calming down and asking if I can have some pain medication.” I got myself together and asked the nurse.  No, she said. He had a shot already, he’ll get another one later. I calmly informed Rob he would not be getting another shot until 8 o’clock at night.

“Are you kidding me? I can hardly move. I can’t even imagine how this is out-patient in the states. How do people get out of the bed to go home?”

“Apparently with a lot of drugs.”

“Well, I guess I’m not going anywhere, I’ll probably be here for the full three days, it hurts like hell. Before the surgery, the anesthesiologist told me I must stay calm when I wake up on the gurney. I didn’t think it would be a problem ‘till I opened my eyes screaming  ‘druga druga druga’. ” I was glad to see my husband still had his sense of humor.

“Thank god I didn’t eat anything,” Rob continued. “I couldn’t even imagine having a bowel movement. Not a chance.”

This was not the only thing keeping Rob from going to the bathroom. It has come to my attention the prevailing fear men have about performing a bowel movement in a public bathroom. Since they get the luxury of standing to urinate, they don’t have to go through the many indignities that women do.  Women have to deal with unseemly toilet seats all the time….men don’t. So when it came to the eventuality of having a bowel movement, Rob came up with a plan. And like many of his plans, he consults his friend Tommy Walnuts from Brooklyn who had the misfortune of landing in Central Booking on a four day weekend for outstanding traffic tickets.

“Man, trust me.  Don’t eat anything. Do you know what Central Booking is like? A cell full of the craziest guys from the neighborhood with only one toilet in the middle of the room. You don’t want to crap around these maniacs. Whatever you do bro, don’t get caught with your pants around your ankles.”

You can always count on Tommy to provide guidance on such pressing matters.

Rob took his advice and stopped eating the day before the surgery. He had only consumed a few glasses of chocolate protein shake and vowed to not have a bowel movement for three days. It was a little alarming that Rob was more concerned about this than the actual surgery.

“Did you bring the protein powder?” he asked.

“Yes, as well as, soap, toilet paper, anti-germ gel, a fan, and your mp3 player.” I stuck around for a few hours and watched some incredibly awful soap operas. The young nurses all gathered to watch one in particular that looked like the Latino version of Grey’s Anatomy. They swooned as the leading man kissed his wife as she lay in a coma. One nurse took a newspaper and fanned her flushed face. I too got a little weepy and went over to give Rob a kiss on the forehead. He, in turn, handed me a jug of urine. A size of which
one might use to irrigate an entire corn field.

“Please don’t tell me that whole thing is filled with pee.”


“I suppose I have to get rid of it?”


“But there is no lid.”

“I know.”

I emptied the contents in the bathroom and when I returned I noticed motorcycle guy had a different woman at his bedside. Rob told me he is married but appears to have an admirable amount of female friends. All this came in handy because everyone helped each other. When I was not there, this harem of women would assist Rob when he needed a nurse or had to get out of bed.

During the day, people came in and out, cleaning the floor or disinfecting the beds. For all that it lacked, it was an incredibly clean place. I watched as the man got on his knees and washed not only the plastic lined mattresses, but also the metal frame beneath it. He took his time and hit every surface of the bed. I was impressed by his dedication to his job. It
became apparent where the allocated budget is spent. It was not on newly painted walls or private rooms, but on things that actually matter. I am always surprised how much I am willing to leave behind, but at the same time, expecting things to be just like the United States. But if this was the United States, we would be paying $20,000 for the surgery. We pay nothing in Costa Rica.

The next morning I returned to find Rob in better spirits. He still couldn’t move much but his color was coming back. It probably helped that he was no longer dealing with a hysterical wife.

“It was crazy last night, the male nurses came in and played dominos for three hours. And throughout the night, female nurses kept coming in and pulling up my gown to look at the scar.”

“That doesn’t sound unreasonable, they have to look at it.”

“No, I mean a group of ten, young female nurses. They come in and check out my stuff. They leave giggling. It’s like bad hospital porn.”

“They are probably training. I doubt they are giggling.  You’re just imaging it.” Five minutes later a group of nurses marched into the room and walked over to Rob. The obvious boss out of the bunch told the girls about the hernia surgery, grabbed Rob’s gown, and lifted it up for the trainees to take a gander. And it was an impressive gander. The head nurse pointed to Rob’s crotch, telling the girls to get closer for a better look. The girls looked wide-eyed, nodded professionally, but as they walked away I could see the ones in the back giggle. Wow…this is bad hospital porn. We will never know if they were laughing with us, at us, or just young giggly girls.

“It’s all so weird. Last night I’m listening to Parris Island by Billy Joel on my headphones and looking at the lizards running in and out through the windows. The words are “and we will all go down together”. I felt like I was in Vietnam.” Rob had grown fond of his motorcycle friend so the lyrics really hit home. “Hey, since you’re here, go get me and my buddy a grape soda.”

Between women looking at his crotch, me running around for him, and the motorcycle guy’s many girlfriends helping him out of bed, this whole hospital stay wasn’t so bad for Rob. No wonder he was in good spirits this morning. By the looks of things, he’s got it pretty good here.

On the third day we were given discharge papers. One of them included a slip for us to return so Rob can get his stitches removed. We were handed a bunch of antibiotics and Tylenol for pain and told to go to the discharge office. There, a nice older man asked us how our visit went. He was happy that things turned out well and gave us a hardy handshake. I was all but tempted to give them a review.

Great all-inclusive. Staff was friendly and helpful. Although no swim up bar, they do have an active night life. Ask for the four day/ three night special. You can’t beat the price.

After 10 days, we returned to the hospital to get the stitches removed. I came across the same mascara lady. Her attention to her make-up application was impressive; her ignoring of us was not. When she finally glanced at the date on our slip, she typed something into her computer and told us to come back in three months.

“Well, that sounds wonderful, but my husband has stitches that need to come out this week.” I said. She shrugged her shoulders. I ended up going to a pharmacy, buying
surgical scissors, bandages, and antiseptic in order to remove them myself. I removed all but one. Unfortunately,  I snipped it too close to the skin and it disappeared into his scar.  We just hoped for the best with that.

What have I learned from this experience? The bad about the care here was also the good.  The open windows that allowed little lizards to come in also allowed a constant breeze of fresh air and the soothing sounds of rain. Unlike in the states, where sick air continuously recirculates throughout the ventilation system, this breeze stifles unwanted bacteria and keeps the place free from unpleasant odors.

Without curtains you had little privacy. However, it also made it easy for other visitors to see if you needed help. They would go get the nurse or help you get out of bed themselves. Everyone helped everyone. This built a sense of community and freed up the nurses to care for other patients.

The many interruptions while Rob tried to sleep also kept the nurses on top of their patients. Rob noticed no one sat in a dirty diaper. They had a high level of care even though they had limited resources.

There was less pain medication, but they did give enough to get by. It made Rob aware of what he could and could not do. Maybe the trend of out-patient surgeries has gone too far. Drugging someone up and sending them home is not always the best solution.

And although you had to bring your our own soap and toilet paper, the surgery didn’t cost anything. I am sure many people in the states would be happy to bring their own supplies if they could get the surgery they needed. And it wouldn’t take much for people to volunteer these items to those who couldn’t afford them.

In the end, I was grateful for many things: grateful to the Costa Rican government for allowing us into their health care system, grateful to the other Ticos who helped care for my husband along with their own ailing relative, grateful for the nurses who giggled at Rob’s crotch, and grateful to Groucho Marx—our skilled surgeon.

This process has taught me not to judge a book by its cover. Even if your surgery is scheduled in a Winnie the Pooh notebook.

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