While I described yesterday as not a good day, I will describe today as a day of reality. Reality sometimes means that what you hope for is altered by circumstances beyond your control.
I am going to relay what we went through today because I feel it may help others. When you move to a country like Panama you have expectations based on what you know. If you have no previous experience, then you may buy books on Panama, read magazines such as International Living, or search the Internet.
Depending on the source, you may enter Panama with your eyes open, closed or covered with rose colored glasses. I think the only people that come here and like it for a reasonable number of years have come with their eyes wide open and have reasonable expectations.
In going thorough today’s experiences, I will state that I discussed the possibility of my writing up our experiences for my CC readers. At the conclusion of today the son of the patient said he felt that these experienced needed to be discussed and said do it.
That is to say that I am posting these experiences with the permission of the patient and the patient’s son. Henceforth, I will call the son RG.
My day started at 7:00AM this morning at the Regional Hospital, where I met up with RG. Today, we were to meet with the Surgeon and get specific information to make decisions on a possible release to return to the US, to move to a private hospital in David or Panama City or some other less preferred option. It was also a day to try to prioritize the options and gather the information to make decisions. We also needed meet with the Director of the hospital to get his input.
As I said in a previous post, there have been other people involved in this case. One was the individual with the VFW in Chiriquí. There has also been a missionary couple that is in David and they have put in a lot of personal time and effort. Each has done what they could to the best of their ability.
While I have been involved with several Embassy cases, I seem to always learn something new. I think I have always left each experience saying, “I wished I had known that before”. Today was no exception.
While RG and I were waiting to meet with the surgeon, the missionary couple came up. They decided they should wait in the Directors office and when he came in, they would call RG and me to come to that meeting. RG had already become more knowledgable about his dad’s condition because he had spent time the previous evening when the nurses came to tend to his dad.
He saw that his dad was in no condition to travel by air to the US. He was in tremendous pain when moved, and bathed and since he was unable to walk, he was in adult pampers. This forced RG to evaluate the tremendous complications of getting his dad to Panama City and then to the U.S.
Coupled with this, the surgeon clarified his previous statement about the patient being able to travel to the US. He said that the patient would have to be transported in a horizontal position. Had RG known this in the states, then expectations would have been more realistic and transfer to the US would already have been off the table. How the wrong information got sent to the US, is unknown.
The patient is a US veteran and has Tri-Care. We now decided, since the US transfer appeared to no longer be an option, to see if we could get the patient transferred to a private hospital that would bill Tri-care.
Before leaving The Regional Hospital, we had our meeting with the Director. If all else failed, we needed to understand what it would take to move forward in the Regional Hospital.
Since the Regional Hospital is a social security hospital in Panama, it takes all poorer patients and noninsured patients. Associated with this type of hospital is a huge paper process to get anything done. In this surgical case, before the operation can be done, the required surgical pins and screws have to be obtained. Following that, the surgery would be scheduled.
We were told that process could take up to 45 days. WOW! RG was not sure than in his dad’s frail condition, he had 45 days. We asked if there was anyway to speed up the process. We were told that the operation could occur 3-4 days following having the required surgical pins/screws.
We were told if we paid for the pins/screws up front, then the 45 days can be shortened to around a week. Still a problem to overcome was the understood stated price for the doctor of around $30k.
When the Director learned that the patient had Tri-care, he suggested that we contact Mae Lewis hospital since he said they took Tri-care. I asked him if he could call Mae Lewis for us and get the question answered. He said he would and called. He then learned that Tri-Care had changed its policies since his last Tri-Care patient and it was not as simple as he had thought. He gave me the name of the lady that handled all Tri-care patients in Mae Lewis and said we would needed to talk to her to understand specifics for this case.
In the meantime, I had already emailed the U.S. Embassy and they had replied that Hospital Nacional in Panama City accepted Tri-Care and provided me a contact to talk to. Thank goodness for the iPhone and the ability to have Internet everywhere. I was able to send and receive my emails while we were in the hospital.
After leaving the meeting with the director, RG and I headed for Mae Lewis. At Mae Lewis, we were directed to the office that handled Tri-Care patients. We learned that Tri-Care would cover 75%, however there was a big catch. The patient would have to pay up front and file with Tri-Care themselves. I am not sure I would call that accepting Tri-Care since the hospital would not file the paperwork to be paid.
This was our second let down of the day. This was going to require so much money up front, it would not be an option. The first let down being the realization that a transfer to the US was unrealistic.
I am now in need of more help. Hospital Nacional needs to be called and my Spanish isn’t good enough to do that. Luckily, I have a Panamanian lawyer that knows I volunteer for the U.S. Embassy. He has helped me before in situations like this and I decided to call him to help.
He said to meet him at his office in 20 minutes and he would try to help. Let me tell you, I have not met many people like him that are willing to help like he has helped me. I can’t thank him enough for his help today.
The first thing he did was to call the contact in Hospital Nacional in Panama City that the Embassy had gotten for me. What he relayed to us was fairly consistent with what we had learned at Mae Lewis. Tri-Care would cover 75%. However there were a couple more complications. The surgeon in David would have to correspond with the director in Hospital Nacional to identify if a transfer was feasible, if a bed was available, and if a surgical schedule could be arranged.
Add to that, the patient would have to contract for and pay for ambulance transportation to Panama City. If you have experience in Panama, then it is easy to see that these new logistics could easily cause a delay of weeks, and the possibility that the hospital might not be able to accept the patient. The economic problem of how much the patient would have to pay, might be beyond what is possible for him to pay.
This is let down three for the day. Ok, the only thing left was to see if we can turn the Regional Hospital into a possibility. Currently the main obstacle is the doctor’s fee. My lawyer called the surgeon. There was a lengthy discussion, all of which I didn’t understand.
Some that I did understand, but won’t comment on. My lawyer made it plain that this patient had NO money to pay the fee that was being asked. He also made it clear that all other options were running out and if an arrangement couldn’t be worked out, then there was a great likelihood that the patient would remain the Regional Hospital and would die there.
Somehow, he was able to get a commitment from the surgeon that if the patient purchased the required pins/screws and things needed for the surgery, he would do the surgery for free. This has turned out to be our only option.
This doesn’t mean that everything is solved. The son is going to have to return to the U.S. tomorrow. He has other obligations and tomorrow was supposed to be the day he escorted his dad to the U.S.
Since everything isn’t locked down, the process of getting money transferred to Panama and tied to this specific patient for the purchase of the surgical supplies still has to be worked out. These supplies are going to run around $7,500 to $8,500. This is going to require work between the son, me and the missionaries over the next week to 10 days. No one wants to see the money transferred here and have it disappear and have another surprise.
Today’s story isn’t complete yet. At around 6PM we were ready to return to the Regional Hospital for the son to say what might be his final farewell and to inform his dad of the plan.
When we arrived at the fourth floor, we found the wing blocked off. I have never seen anything like this. Never one to let a little blockade prevent me from doing something, I moved around the area and went to the nurses desk. I noticed another strange thing that I hadn’t ever seen before and I had been to the patient’s room three times today and many times on previous days.
This time all staff, nurses and other employees, are wearing masks and gowns. At the desk, I was informed that it was past visiting hours and we couldn’t go to the room. I told them that I was working with the Embassy, they recognized me, and that this would be the sons last opportunity to say goodby to his dad.
The staff huddled and said we could go to the room, but we had to put on surgical gowns, masks, and gloves. They went to get them. It was strange because I saw other family members in other patient’s rooms without all of the protective wear.
Both RG and I are feeling a little concerned, because this is beyond strange. We put on the gowns, gloves and masks. We were told to keep our visit less than five minutes and when we left the ward to wash our hands with the surgical soap that is in containers on every floor. This precaution was a warning to me that this wing had recently has some new airborne infection.
I am now not to sure my being type A and not taking no for an answer is a good thing. We go to the room and RG gives his dad some items he had requested. He told him that his flight was in the morning and I and the missionaries would be following through to complete the plan and that the plan was to have the surgery done in the Regional Hospital.
While RG was talking to his dad, I talked to a family member of another patient in an adjacent room. I asked her if she knew why the gowns, etc and why she didn’t have one. She was not completely sure what had happened, but said they were only providing protective wear to the hospital staff.
I took a photo of RG and his dad and you can see what we were issued for the visit. When we went to leave, we stopped at the nurses station. They brought out a special container for us to put the used protective wear. I had flashbacks from a few science fiction movies I have seen.
I washed my hands upon leaving the floor. As we were walking down the stairs to the first floor, we ran into the missionaries who were going up to check on RG’s dad. We informed them that it was blocked off and they would not be permitted to visit.
We left and I dropped RG off at his hotel and came home and took a long shower washing every square inch of my body multiple times. I put all of my clothes in the washer and even washed my new CROCs. I will be paranoid for a week just thinking about today.
I don’t plan on returning to the hospital for a couple days and probably will not return to the fourth floor until I talk to someone in the directors office to make sure it is safe to visit.
Today was far from perfect, but I feel we did all that was possible to do. How is this going to turn out? I don’t know. There is much more to do. There are still a few unknowns.
I have learned I have to take each day at a time and if I do my best, I have to be satisfied. It is impossible for me to be involved in these cases and not wind up questioning myself as to what I could have done better.
This closes today’s report.