An encounter with old age, opioids and Berniecare

SAN ANTONIO, Texas—Two weeks ago today, we came here for Stew to have spinal surgery. Our sojourn has delivered unexpected encounters too with the uncertainties that lie ahead as we both age; a brush with the notorious opioid oxycodone; reminders of what it would be like to live back in the U.S., and the wonders of single-payer government health insurance. It’s been quite a mental, and spiritual, seesaw.

Rather than the hassle of  a 12-hour drive, particularly on the return trip with Stew still recovering, we opted to fly from Querétaro to Houston and on to San Antonio. We ran into a five-hour delay in Houston that made the arrangement a toss-up in length of travel and comfort, but more expensive. 

In San Antonio, we have been blessed with the generosity of our friend Ron, who let us stay at his loft and use his car here, and who called periodically to inquire about Stew’s condition. His sister Anita, who lives in San Antonio, also checked on us. Such friends help smooth out the bumps in life’s road.

Stew’s surgery was to correct chronic back pain that had recently spread down his right leg, all caused by a pinched nerve and other problems with his lumbar vertebrae. It was not one of those “minimally invasive” interventions in which the surgeon peeks through a three-inch incision to correct whatever, and the patient is up and about a couple of hours later. In Stew’s case, the three-and-a-half hour surgery involved a vertical cut, about seven inches long and seven stitches, that I get to look at when I clean and redress it daily.

The surgeon was a tall and burly man in his forties, with arms thick as tree trunks, who was born in Nigeria and was self-assured but not much for small talk. He soothed our apprehensions—somewhat—by explaining a couple of days before that it was a complex but hardly rare operation.

His specialty in fact is lower-back surgery and he said he had performed hundreds of these types of surgeries. Still, a comment I once heard from an Australian doctor we used to know in San Miguel, to the effect that “no operation is routine,” rattled my calm.

The surgery took place last Monday at the Baptist Orthopedic Hospital, a three-year-old temple of modern medicine, about 15 miles from downtown San Antonio, and opulently furnished and equipped. My apologies for the comparison, but Baptist makes the new MAC Hospital in San Miguel, where Stew also had been hospitalized a month before for a different problem, look like a Holiday Inn next to a Ritz-Carlton.

Screws and posts were part of the reconstruction of Stew’s spine.

As Liza Minnelli and Joel Grey told us in the musical “Cabaret,” money does indeed “make the world go around” and hospital chains in the U.S. clearly just have a hell of a lot more of it than those in Mexico.

There were also qualitative differences. Baptist was a highly-specialized operation with doctors that worked on nothing else but upper or lower spine, hands, feet, knees, shoulders, hips.

No such division of labor exists in San Miguel, where orthopedic surgeons will deal with, or attempt to, various parts of the ol’ skeleton, sometimes with mixed results.

A surgeon in Querétaro, widely revered by expats in San Miguel, botched a surgery on Stew’s right hand that had to be redone a few years later in San Antonio. The same doctor had offered a “special package price” to operate on Stew’s other wrist, and his upper and lower back.

There was no way Stew was going to have back surgery in San Miguel.

I’m of a mind that some Mexican doctors may be a bit too eager to latch on to American or Canadian patients with charge cards and deep credit limits. And with little or no risk of ruinous malpractice suits—the longest of long shots in Mexico’s terminally rheumatoid judicial system—doctors might be more inclined to oversell their expertise.

The hyper efficiency of U.S. medicine, though, may have a downside: somewhat impersonal, almost mechanical, patient care. Not counting the time that Stew laid face-down on the operating table, out to lunch under the anesthetics, we must have interacted with the surgeon a total of no more than 20 minutes. A series of nurses passing by the room, attending to this or that, remained similarly anonymous.

During his three days at MAC hospital Stew instead complained about a constant parade of gabby nurses and doctors—an internist, two gastroenterologists, the emergency room doctor who first treated Stew, a urologist, plus nurses of all types. At times it felt like a conga line of solicitous relatives who wouldn’t leave him in peace. Too much “face time” maybe. Perhaps it was the difference of a smaller hospital, or just Mexicans being generally warmer and more paternal.

During his convalescence Stew got a frightening introduction to the world opioids which coincided with the publication of an investigative series in the Washington Post about the opioid addiction epidemic in the U.S.

To deal with post-operative pain the doctor prescribed oxycodone, a powerful pain killer in the opioid family that produced in Stew a number of nasty side effects, among them nausea, dizziness, disorientation, night sweats and hallucinations, that were as difficult to endure as the pain itself.

Late Friday afternoon, following the operation, I had to take him to the emergency room at Baptist. 

The ER doctors gave him a shot of morphine and suggested he take Tylenol. Through a nurse assistant, the surgeon also had prescribed Tramadol, less potent and dangerous than oxycodone. Stew still feels some pain, but none of the scary effects of the oxycodone.

Praise Geezus.

It was baffling to me how a drug with such nasty side effects could be pleasurable much less become addictive. But apparently, people with horrible pain may have no other alternative, and the drug’s effects vary from person to person. In some, perhaps most, people, it lessens the pain without any ancillary problems.

It’s even harder to fathom how 76 billion (that’s billions with “b“) opioid-related pills were sold in the U.S. between 2006 and 2012 without much public alarm. Perhaps mega-profits and greed gummed up the ethical gears of the medical-industrial complex.

During this episode’s ups and downs, the Medicare system has worked flawlessly. Stew registered during his first visit with the surgeon, and from there on all services have been provided, including at-home physical therapy, with no questions asked except for the signing of consent forms for various procedures.

Imagine if Bernie Sanders got his wish of Medicare for everyone. Imagine a tooth fairy too.

For me, this was also an unsettling preview of old age’s illnesses and infirmities, particularly as I watched Stew laboriously shuffle around using a walker during the first few days after the operation, and I had to take care of him. It was not an easy experience.

I’ve heard it said that 70 is the threshold of the road to old age. This may have been proof of that for Stew, 72, and Al, 71.

What goes on forward for us is anyone’s guess. My impulse is to keep traveling and doing things with renewed vigor, until whenever, rather that park the car at the curb.

One question is whether we would like to stay in Mexico until that whenever, or decamp to the U.S. But where? After 14 years in Mexico, the U.S. seems utterly foreign yet familiar.

San Antonio’s sky-high prices for everything definitely seem foreign, and so does the youth of people everywhere who give the city an energy—a vibe—definitely lacking from the nursing home feel of San Miguel, especially among expats.

For now, I’m not taking anything for granted.

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