Monday Morning Blues....

I was still groggy when Raf’s cousin came, kissed me, told me that she would be releasing me from the hospital, if it weren’t for the fact that I’d refused the X-ray.

“But I’ve already had one,” I told her.

“This is a special one—we have to make sure that nothing is compressing on your spinal cord….”

“Well, no one told me that….”

“That’s OK,” she said. “I told the spinal guy that you weren’t difficult, just really intelligent, and he understood….”

It developed: even being a neurosurgeon is not enough: the spinal column is sufficiently long to allow for sub-sub-specialties. So while she works with the skull base and neck, there’s another guy—unseen—who’s looking at my spine.

Well, sort of looking, because the curious thing is that no one, absolutely no one, has looked at my back. The have CT’ed it, MRI’ed it, X-rayed it but not, in fact, looked at it. And that’s weird, since I could swear that I can feel the place where the fracture is. Granted, I presume the lack of bleeding means that I don’t actually have bones sticking out of me, but shouldn’t some look and see?

At any rate, no one has touched me except to take vitals signs and draw blood. So whatever happened to the laying on of hands? Well, if it’s taking place, it’s taking place internally, since I have remembered the monastery in Chicago where I spent a bit of time, recovering from my mother’s death.

A monastery—ancient buildings, steeped archways, quiet gardens, contemplation—right? In fact, it was none of these things, and I never saw the cells or rooms where the monks hung out. Nor did I have the stamina to wake up at three in the morning—or whenever it was—to hear the monks sing the first office. But in the days of the worst pain, I remembered the monks, remembered the ancient chants, and formed the oddest image an old atheist could concoct.

I was lying face down on the altar, facing the cross. The prior was kneeling at my side, with his hands on each one of the two fractured vertebrae. Around me, in a circle, were the monks—holding each other’s hands, and singing. And so I spent hours of pain-time, feeling the energy of Gregorian chant warming my spine.

Did it work? I have no idea, but I do know that there was no energy for music, and none for serious reading. For I had decided to join the ranks of the elect: to emerge from this enforced period of inactivity having read War and Peace, as well as Anna Karenina….oh, and throw in The Brothers Karamazov. But the energy to listen to music, or absorb serious reading, was too much for me. I lay in bed with my pain, and with six or eight once seen but now-imagined monks.

During this time, I was as likely to be asleep at 3 PM as I was to be awake at 3 AM. And so, in the twisted logic that a pain-ravaged brain can conceive, I decided to eat as much shrimp as I wanted, because do you ever get enough shrimp? Of course not—whatever dish you order comes with just three or four shrimp artfully distributed across the plate. Well, screw that! Because if I was going to be assaulted with this kind of pain, and if at the end of it I might after all stuck in a wheelchair for the rest of my life….

….and so I was—on my one daily journey out—buying a pound and a half of frozen shrimp, at, yes, an obscene price. I would gorge myself on shrimp in the middle of the night, and then stumble back to bed. In the morning, I would take the plastic bag with the shrimp tails out to the trash—like a drunk taking out his nightly bottle.

Through it all was the fear—one false move and it would be over. A cat, rubbing up against my legs at three in the morning, could provoke a fall, and then it would be a wheelchair for life. So I began to leave lights on, in the bathroom and kitchen. That was fine, but what about all those unthought-of, almost instinctive movements? A cat jumping on the table needs to be swatted—but if I were half-turned, moved suddenly, jerked in some unexpected way? Would that be it?

“Well, I guess you’ll have to have surgery,” said an acquaintance at the café one Monday morning, during this time. And I, who had held it together all of this time, simply became unstrung: I began to cry and could not stop, which is, it must be said, inconvenient in a public spot. But the café has seen many tears—not always of sorrow or pain, but of joy as well. And so I am in the arms of David, the Mexican guy who makes the little plaster houses that Lady will paint. And I am telling him that I can’t, I absolutely can’t have surgery and I can’t stand the pain, and that my whole life has been pain.

Which leads me, in some crazy way, to tell him the whole story of my life, and guess what that has been? Yes, pain—starting with the pain of knowing I was gay and having to do something about that, and then all of the anguish with the cello, and then it was time for a major depression, and let’s see…. Well, there were the wasted years as a nurse, and then the crazy years as a teacher, and then I lost my job…and have I told you my whole life has been about pain? Which is what I am in right now, and what I’ve been in for the last two months, and now some guy tells me casually that I’ll probably have surgery and I can’t, I can’t, I absolutely CANNOT bear the thought of surgery.

So now I am shaking and crying and David is holding me, and caressing my head, and shooing Nico—Lady’s husband—away. For he has seen me for months, writing away at whatever I’m writing, but has he ever seen me in full psychiatric crisis? No, and it’s not pretty, because in addition to the crying and the wails, I am also shaking. And why is that?

News flash—it takes a lot of energy to melt down, and had I had anything to eat? Of course not, so my blood sugar had bottomed out, and I was now in hypoglycemia.

Nor was that all of the problem, since I was halfway on the road to a place called Panic Attack, and so my heart was pounding and my breath was shallow and I was sweating and afraid and couldn’t be alone, and that was a problem since David? His job was to pour plaster into molds, not to hold aging writers undergoing panic.

So then it’s Gabriel’s turn, since he has the misfortune of walking in just as I am realizing: I can’t keep David from his molds forever. So now it’s this 18-year old kid, this sweet and earnest kid who is probably gay but definitely not aware of it. Or so it seems, since I have seen him with his arm around a girl—presumably his girlfriend. Though one of the people in the café asked him about all of that, and then was rebuffed very gently, and not given an answer. Anyway, Gabriel is the new David, which gives me a wonderful opportunity to tell him the whole story of my life, and have I mentioned what that’s been all about? Right—pain! Oh, and also loss.

So now I’m feeling seriously horrible, and I realize: I either pull myself together or they are, yes, going to have to call the ambulance and take me to the loony farm. So what to do?

“Listen, Gabriel—get Santana, and ask him to come here.”

Gabriel is relieved, since it is one of the only things I’ve said that has made any sense. And Santana, when he comes, is perfect, because he is not eighteen, but rather my own age, which means that he’s seasoned. And so I explain that I am in hypoglycemia, and he brings me a papaya smoothie, heavily laced with brown sugar and cinnamon. And then he sits with me as I drink it, and talks calmly, and then he brings me a sandwich. And so I have become the invalid of the Café Poético, since they have brought me a little tray table, and put me in the back of the café, where they can monitor me and hide me from people who—astonishingly—are little interested in writers in breakdown. So I get all that down, and start to feel better but not—because why am I shaking so badly? So now Carlos is the new Santana, since Santana has other things to do, like make sandwiches for paying-and-not-breaking-down customers.

Yes, it’s Carlos, whom I’ve known for a couple of years, and who is a pirate, when needed—which is often, since being a poet and a Yoga teacher? Well, somehow the money isn’t rolling in, so the only solution is to get himself up as a pirate, and then to get “offerings” from tourists after having their picture taken with him. But today, Carlos is un-pirated, since he’s just come from Utuado, where he’s doing something related to something, which I would know if I were in my normal state. Which of course I’m not, and so since I am so anxious, I decide to go and plead with the people at CVS to give me Klonopin. And who will go with me, in case I start bawling in the street? Right—Carlos! So the plainclothes pirate and I are going down the street, and I am breathing deeply and pretending not to be anxious, and Carlos is explaining his project, about which I still know nothing.

Well, the pharmacy can’t give me Klonopin for another week, so what to do? We walk back to the café, stopping at my house to pick up some Benadryl! Yes, Benadryl is the new Klonopin, and it does take the edge off the anxiety, but what has happened to my stomach?

Because all the medicines that I am taking for the pain and the muscle relaxation and everything else have held a conference call, and what has the committee decided? Right, the first battle in the war will be my back, but why not head around the front (which is the back) and attack the back (which is my stomach, if that makes any sense). So now I’m under attack from both sides, and the Prilosec that I have taken will do nothing, since it doesn’t. Not at first. Rather, the Prilosec needs to see other Prilosecs over several days before they decide to go to work. So now I am in serious stomach pain.

Well, my grandmother stepped into the room, and though she died in the 70’s, she still comes through with the suggestion: baking soda and water. And so now I am taking baking soda and water every half hour or so, and then I begin to worry. I have to be absorbing all of this stuff, and what will happen to my electrolytes?

At this point, I’m at home and it’s after five, and Raf will soon be home. And there he is, and there I am, eating dinner and watching television later. And I go to bed, stomach still aching, and thinking, hoping, praying, pleading with the gods please, please, PLEASE let me sleep.

And of course, I don’t.    

Deliverance

It wasn’t a code blue, I realized—though it seemed that way, because why else should there be so many doctors, nurses, respiratory therapists all hanging around? But then I realized—this was a normal hospital, with adequate staffing. And then I began to ponder: had something akin to the Stockholm Syndrome occurred? After six hours of lying on a gurney and seeing no one, I had completely forgotten what an emergency room should look like. I had come to expect to be ignored and forgotten.

Did it help that Raf’s cousin had called the ER to speak to the attending in charge? Undoubtedly—and the attending strolled by and chatted with Raf as I did the triage. Then, and curiously, she completely ignored me. Was I miffed? Yes—until I began to marvel that the care was almost choreographed: first the administrative process of admission, then the financial business of the deductible, and then the chest X-ray, the EKG, the routine blood work, and finally the interview with the admitting doctor. By this time, it was getting late, and though Raf had taken Blanca out for dinner, it was clear that everybody needed to get home.

“Is it definite that I’m going to be admitted?” I asked the doctor.

“Absolutely,” he said.

“Go home,” I told Raf and Blanca, since what sense did it make to wait for the two or three hours for a bed to become available? Besides, I had done something completely uncharacteristic: I had lied, and told them I was taking 1 mg of Klonopin three times a day.

Klonopin is related to Valium, and although my psychiatrist had prescribed half a milligram only as needed, I rarely took it. But in the week after the fall, I had taken it once or twice a day: like Valium, it also relaxes the muscles. And so, as the nurse was writing down the (extensive) list of medicine, it occurred to me: short of LSD and mescaline, there was nothing I couldn’t get.

Drug holiday!

Even better, the admitting doctor had been incredulous when I told him I was treating the pain with Tylenol and Ibuprofen.

“I think we can do better than that,” he said.

And so, three times a day, two Percocets and 1 mg of Klonopin appeared in the little white paper cup. Half an hour later, I would experience the strange effect of being pulled down into the deepest rungs of sleep—it was like a slow-motion anesthesia, and it was hugely soothing. For the first time in seemingly weeks, I slept, and slept well, and slept without pain.

The next day, I was awakened by a woman bringing me a tray of breakfast, which she put on the table in front of the window, and then said: “don’t eat this.”

Say what?

It was a classic example of hospital idiocy, I decided. The woman’s job was to deliver the tray, but it was also her job to instruct me not to eat it. And in fact, she had committed the ultimate mistake of those who deliver trays: she had left it out of reach. Not a problem if—as I was—the patient could stand and walk. But every day, thousands of trays are delivered in hospitals, and how many patients are left, hungry and unable to eat? No matter—I waited for what came next….

It turned out that I had to have a CT scan, and that the test—for some reason—was best done fasting. And so I went down to the lab, escorted by two amiable chaps who had tossed a coin: who would have to speak English to me? The answer, of course, was neither, and we chatted in Spanish.

I had been told by my internist that an MRI was just as good, and considerably less annoying, than a CT scan. In fact, even though the lab technician gave me earplugs, I was completely unprepared for the menacing, unpredictable series of roars, whirling, clicks and unnerving silences. At times, it seemed that I had been cornered by a snarling, mechanical beast, which roared in my ears just prior to devouring me, and then retreated, silently and maliciously eyeing me, as it plotted its next pounce.

I did what I had been doing for almost a month: I counted my breaths. But then, curiously, I began to be fascinated with the sounds; was there a pattern to them? And if so, could I discern it? And so for twenty minutes, I was bombarded with cacophony—I, a musician, acutely sensitive to sound, to the point that people eating popcorn with their mouths open will make me want to flee the theater.

What, I wondered, in God’s name had we been doing in those years when I worked on psychiatry wards? Because it was routine: young schizophrenics were sent down to get CT scans of their brains. And if I—neurotic, perhaps, but connected with reality—had experienced the CT scan as distinctly unnerving (to the point of Satanic), what in the world was the experience for a truly psychotic person? How could they not think that something or someone was implanting thoughts in their brains?

“Well, now I know what people abducted by aliens go through,” I told the technician. He laughed and sent me off to lie in the hall: my two companions would appear in moments to take me to X-ray….

X-ray? Why X-ray? I had had, after all, X-rays of my spine: that’s what had led to the doctor’s visit, and the MRI, and then all the way to the gurney I was currently lying on. So, why repeat the X-rays: I protested and ultimately refused. No one was particularly pleased with me, but I stood my ground.

And I returned to my room, got my breakfast, and then the angel in white appeared with the balm and blessing of Percocet and Klonopin, and I was just about to plunge down deep, deep into the ocean of unconsciousness, when it occurred to me: administratively speaking, how could I be here?

I had, after checked into one hospital, never officially checked out, and then checked into a second hospital? What would Triple-S think? How could I be in two places at once? Were they paying double? And then I thought: did it matter? I was here, safe, no longer in pain. People appeared, gave me drugs, hung IV bags, administered Heparin (I presumed, since it was into my belly, not intramuscular), and took charge. And I couldn’t have been more pleased: I relinquished control as a snake sheds its skin.

Was the ordeal over?    

  

Another, and Better Trip

There was a mildly Bonnie-and-Clyde feel to it, since we were fleeing Centro Mérdico (sorry, that was a typo, but it’s so apt it stays! And may become permanent!) and I worried: would they send out the security guys? Or maybe the National Guard? I didn’t mean so little to them that they’d just let me go like that, did I?

Happily, we’ll never know, since as we were walking down the sidewalk, Blanca—Raf’s cousin and second wife of the neurosurgeon cousin’s father—was coming up the street. The problem was that there were two railings between us: one at waist high, the other at knee level. So desperate were we to get out of the place that we crawled through the railings, to Blanca’s protest and—very much—my back’s as well.

So we were out of there, passing the sign announcing cremations starting at 199$. This, of course, is just one of the many gallows’ humor that Centro Médico attracts. Nico, Lady’s husband, declined to eat at the cafeteria, located in the basement—but location had nothing to do with it. Or rather, it did, since….

“…It’s right next door to the morgue!”

So I began thinking of all the ancillary business that might pop up advertising at Centro Médico: malpractice lawyers were an obvious, of course. Ambulance services, designer-made coffins. (“The corpse looked stunning as she reclined in a ermine lined coffin studded with diamonds….)

On the more prosaic level, what happens to all that medical equipment that is so vital one week, and so utterly useless the next? How many urinals are wasting their time in bathroom cabinets, when they could be far more gainfully employed reprocessed and reused? I saw myself, sitting in the summer sun outside the emergency room, surrounded by attractively priced and professionally sanitized bedpans, urinals, commodes—maybe even a titanium hip or knee replacement or two. (I mean, why bury that stuff?) The business would expand, go global, and I would be the face of the empire!

Of course, there was money to be made, too, in the personalized bedpan or urinal. Look, if you have to be taking a dump on a bedpan, wouldn’t you at least want to be spreading all over a photo of George W. Bush? Clearly, the possibilities were endless….

It was now dusk, and we were heading into the mountains outside San Juan. The harsh daylight of noon had softened, and the hills appeared almost glowing as we moved toward them. My world had been a bedroom, a bathroom, and—I now remember—one daily trip out to eat breakfast in the morning, and scavenge food for the rest of the day. The problem was that the grocery store was two blocks away, the importance of which I learned on one of the worst days after the fall.

I had eaten, and someone strengthened, had determined to go get bread and peanut butter: it had gotten me through my childhood, it could serve me now. But I could not walk ten feet without stopping, grabbing onto a building, closing my eyes, cursing silently, and then counting my breath until the pain subsided. Still, I was out, I was close to the store—if I could just get there, get the food, and get home, all would be well.

The store is small, crowded, and has the distinct and interesting feature—unique in modern retailing—of the disappearing cashier. Because while you are chatting with your neighbor—poof, Alfredaida (the cashier, whose father was Alfredo and whose mother was Betzaida, and that’s sweet, isn’t it?)—anyway, the cashier suddenly isn’t there.

At first I worried that it was the rapture, and began to wonder why it was she, and impeccable me, who had been seized? Is scanning an entry drug for rapture? But no, she reappeared and now can enter “grocery—2.99” into the register for the item she has just gone to find on the shelves (stopping, of course, to kiss her neighbor and give a detailed account of a recent excursion to Plaza, as well as kissing / caressing three babies….) Anyway, she now knows the price, and everything goes on.

The amazing thing is that nobody—absolutely nobody—complains about this. Can you imagine that scenario in Manhattan? Anyway, all goes well because everybody is in the middle of some anecdote or two—and what’s the worry about a missing cashier or two?

Why this long digression?

So that you will understand why I—my back howling in pain—suddenly realized: I would rather starve than deal with the store. And so, I continued the ten step / pause / curse /breath process back to the apartment. But first, I got to the Always 99 Cents Store, which had nothing healthy to eat, with the marginal exception of a tube of oatmeal cookies and a Hershey’s candy bar. Unwisely, I bought them both.

Unwisely because I am a creature of habit—since the next day? Of course, I did the same thing, and I also did the same thing with the wrappers, which I had dropped on the floor.

I was in bed for two weeks before I could move—barring my one trip out per day—to go hail a cab and go to the emergency room. And so, if I was recovering at all, I was recovering in a pigsty. Why didn’t I ask Raf, or a friend, to come clean it all up? I was ashamed, and did I need the lectures about eating junk food?

So there we were: I had gone from a completely disordered space to an ordered but careless (meaning not caring) space, and now to a view of the mountains. It was that moment in The Wizard of Oz when the Technicolor steps in.

It was also that moment when—at last—I could stop caring for myself (badly) and allow others to care for me.

And so we got to the hospital—but where was the emergency room? We searched everywhere for a sign.

Nor were we surprised when there was none, because Puerto Rico has a curious attitude towards signs. First of all, since everyone knows where everything is, why go to the bother of putting up a sign? And if you don’t? Well, you stop the first person you see sitting outside a gas station drinking beer (another local custom, since when go to the bar when you can get beer cheaper at the gas station? So now, many gas stations have carps or tents and picnic tables and even outdoor speakers barking salsa—great promotion, right?)

OK, digression over….

So there we were arriving at the main door of the hospital, and being told that the emergency room was down below, and the only thing below seemed to be the parking lot—which had no attendant, but did have plenty, plenty—and my back can tell you---PLENTY of …

…speed bumps!

Right, so there was no emergency room in the parking lot. What did we do? Well, we went back to the main entrance received a variant of the original answer, and did the whole thing all over. Finally, we went into a nondescript driveway and asked a security guard where the emergency room was.

We had arrived!

We went in, were admitted immediately, and walked into the emergency just after, I was sure….

..a code blue               

Madness, Escaped

I had just gotten to sleep, sometime around 8 in the morning, after a night spent plotting strategy. At nine, Lady called, telling me that she’d pick me up ten o’clock. So I had an hour to get ready. The first thing, of course, was to coax Mr. Fernández out of bed.

It has to be said: the wrong person in this couple has been ordered to do two month’s bed rest. Because Mr. Fernández would happily go into the bedroom, draw up the covers, and emerge—bearlike and grumpy—to bed feed. In fact, there is heated debate among those who know: who gets more sleep, Raf or the cats? Probably the cats, because little things like work tend to interfere….

So I was ragged, weary, and very much in pain—at which point Mr. Fernández began the, “have you seen my….” Do I remember whether it was his shoes, or his jeans? Of course not, because even if I know perfectly well that whatever-it-is is wherever-it-is, the response will be, “no I looked there, and it’s not there.” So I now simply say, “nope.” Mr. Fernández, with a voice dripping suspicion, then inquires, “then where are they?”

In fact, I was in full swing myself, since the one piece of legal identification I possess—my passport—had gone missing. OK—I knew exactly where it was: in a shirt pocket. The problem was that for two months, I hadn’t done any laundry, since the very idea of lifting a laundry hamper was completely unthinkable. Fortunately, Raf’s aunt husband had died, and his aunt had sensibly unburdened herself of her husband’s clothes by giving them to her sister, Raf’s mother. Why? Because Raf’s mother can’t bear to see things not put to use. So my mother-in-law had called one afternoon and ordered me to collect the clothes, and I had been happily going through a dead man’s wardrobe for two months now.

So the passport was in some shirt pocket or other, because I had taken it down to CVS to prove that, yes, I was Marc and they could give me Klonopin. Great—but which shirt pocket? So I was in full swivet, or perhaps a greatly magnified snit, and did it help when Mr. Fernández asked if I would make coffee?

The phone rang: Lady was downstairs. So we left, uncaffeinated, and scanned the street for Lady. It had occurred to me: going to the Emergency Room was essentially the same as going to Wisconsin, and so I looked for a suitcase. And I found one, too, but it was black, and unfortunately, the cat who had been sleeping on it for the last half a year was orange. So the effect—while somewhat reminiscent of Hallow’een—even I couldn’t bear. So we were bearing my knapsack, stuffed with all the electronics and chargers I own, pillows, a blanket, and two sweaters. In short, it looked like moving day on Fortaleza Street.

Lady—except on rare occasions—operates under the principle that she does not drive, she is driven. Therefore, I had no idea of what car or driver might be picking us up: I found Lady in the passenger seat of Jack’s car.

Lady gasped when she saw me, put her hand to her mouth, and said, “oh, no.”

I gave her a smile, and then looked out the window, since I could not bear to see the look of horror on her face. We were quiet for a while, and then Lady, to break the silence, announced that she had put the up the Christmas tree the night before, and that one of the cats had taken it down, rather less carefully, in the middle of the night. So that lead to a discussion of Christmas trees, and then later—and don’t ask me how—a discussion of the business practices of the martial arts school of a mutual friend.

‘This is what life is,’ I thought, ‘or what it used to be. Here I am, faced with the possibility of paralysis, and here Jack is, worried about an extra ten dollars that the school has lifted from his bank account.’

“I think something is licking the back of my neck,’ mused Mr. Fernández speculatively.

“Jack’s dog is right behind you.”

We were on the same bumpy road I had been down the day before, and arrived at the lab. I asked for two copies of the report, and gave one to Raf. Why? Because I wanted an extra one, since I knew that Centro Médico would keep the original.

I’m happy to announce that Centro Médico completely exceeded my expectations in one vital function: pastoral care. In fact, the very first person we saw was a volunteer, who was talking non-stop to the people waiting in line ahead of us about the power of Jesus. We heard about the miracles, we heard that he hears every prayer, that nothing is impossible for those who believe in Jesus. The relatives of the patient being seen in triage were nodding mutely, I was looking away, and thinking of unfair it is that we can close our eyes, but not our ears.

Finally, it was my turn.

“I love Jesus,” the man said to me, in English. Before I had a chance to snarl, the door opened and I went in to triage.

The first problem was that my blood pressure was sky high, but that may have for the best, since the nurse decided to order a gurney for me. So I did the admission (they fell for my voter card, thankfully), and then, there we were, in the “yellow” zone.

There was nothing yellow about it: I was lying on a gurney in hallway with 26 other people lying on gurneys, each accompanied by one and only one person. So we were to wait, and did we? Yes, but after the first two hours, waiting began to look less like an acute thing than a chronic condition. I dispatched Mr. Fernández to interview the relative of the gurney-mate across the hall.

“She’s been here since yesterday, at 7 AM,” he reported.

We went into action. I called my brother John in New York: a lawyer, he responded with logical, practical suggestions. The problem? We were in a place where logic had long since fled, and there was only torpid lunacy. So the hours dragged. I decided to call my doctor, who was distressed to learn that nothing was being done.

“Just stay there—it may take a few days, but you need the best medical care available.”

At this point, I had figured out that “yellow zone” meant that I was expendable, and forgettable. Why? Because obviously “red zone” meant cardiac arrest, massive trauma, conditions that required immediate response. But little Marc? There was nothing wrong with me, barring a sky-high blood pressure and a broken back.

The phone rang: it was a friend, a self-made man who, appalled by the political mess on the island, had decided to run for governor. So I was talking to him, or rather, Raf was talking to him, because all of a sudden, I couldn’t cope. I had had no sleep, I was in pain, and I could no longer pull the strings that would move the crowds of marionettes to give me care. I was in the hospital, and I needed help, and I could not help myself.

So Raf was talking to the candidate / friend, And I was then dealing with John, who was halfway to ordering me to be medevacked. Completely frustrated, I lost it with John.

“Look, I know I should do this, that, and the other thing—I know, I know, and you would do it and everything would be fine but I don’t have the strength and I don’t have the energy and if I try to do all that I’m just the demanding gringo and…”

…and I break down sobbing in the hallway of Centro Médico!

OK—pulled myself together. Raf comes back with the news that my friend has a friend who is a doctor in the emergency room of a local hospital. Should I go there, or should I wait for three days for a specialist?

In the meantime, the one doctor I have seen (barring the two student eye doctors) has taken the office marked “green zone.” (That’s how I figured there must be a red zone…) And about him were two curious facts: he was the oldest person I had ever seen, and he seemed to have no patients. That did not prevent him, however, from sitting at his desk, shuffling papers, and occasionally glancing at the empty chair. Was he seeing patients there? Remembering them from days past, or perhaps from the Crimean War, where he palled about with Florence Nightingale? Periodically, he would shuffle to his feet, go out into the hallway, look confused, and then return to his desk.

‘He’s a ghost doctor,’ I thought, and wondered if it was worth it to coax him back to the living. No, I decided, he’d probably try to bleed me with leeches,

All of this is interrupted by the sight of an older gentleman in a Roman collar, who is going from bed to bed, praying over the patient, and then—apparently—giving Last Rites. Was he? Well, I’ve never had them, but he was pressing oil or unguent or something on each person’s forehead. And that was enough for me—we sent him away, even more rudely than we had sent the first.

“We should have told him,” I told Raf, “that I had had Last Rites six hours ago, before I even had triage, and that really, lying on a gurney in Centro Médico offers comparatively few opportunities for sin. Although I suppose lack of charity…”

So then it’s time to call my doctor, and float the idea of a regular doctor in a regular ER, versus an imagined specialist in a lunatic ER. But first, I have dragged myself to the nurse’s station, and wheedled and pleaded for information. Nor was the situation entirely bad—I was only ninth in line to be seen by the ER doctor. The bad news? Absolutely all of the neurosurgeons were at a convention at a resort on the other side of the island.

So there I was, explaining to the doctor all of this, and telling her that it was getting late, it was a Saturday afternoon, which has the curious tendency to become Saturday night, and what happens then? Well, the island starts drinking, the boys get unruly, and they start to shoot each other. Then, they get into their cars and crash each other. So, if I wasn’t getting attention now….

“Marc,” she told me, “you need to stay there. Your back is very, very unstable. One fall, or even one sharp movement, and you could have serious and permanent damage.”

I decided to get it out in the open.

“I presume you’re talking about…”

We both said the word at the same time:

“Paralysis.”

I knew this, of course. But now it was out in the open, and now it suddenly became all the more urgent to see a specialist. I decided to play the ace up my sleeve.

Remember the copy of the MRI report that I had asked for? I had figured out the strategy at 3 o’clock in the morning. Raf’s cousin is a neurosurgeon in a city some twenty miles from San Juan: could she help? The only problem is that we didn’t have her number. So then, we were calling the widow of another cousin, who was calling the husband Raf’s cousin, the neurosurgeon.

“That’s the only way to get ahold of her,” Raf reported. “You have to go through her husband…”

Finally, the husband was located, the situation explained, and the call made to the cousin / neurosurgeon. I sent Raf off to read the results of the MRI.

“She said it’s a lot worse than she thought….”

“OK—next step?”

“She’s calling people she knows at Centro Médico, and she’ll get back to us…”

She did.

“Marc, we have to get you out of there, and down to my hospital, where we can take care of you.”

She had, after all, worked at Centro Médico, before she escaped the madness of the place. And so we set off. I told the first person I saw that I was leaving AMA—against medical advice.

“You can’t do that—you have to sign some papers. Wait just a…”

“No,” I said, “I have been waiting for six hours with a dangerously high blood pressure and a broken back. A neurosurgeon has agreed to treat me in Caguas. I don’t have time to wait for a paper to sign.”

And I left!