Our Caja Experience Part 2

Not the actual machine at Clinica San Lucas (sorry, could not resist!)

Tamara was pretty happy to leave the Caja hospital after halfway through her third day there. The doctor wrote up the orders for the tests and we were on our way after a short check-out procedure. Contrary to my usual procrastinating tendencies we went right away to a nearby clinic to schedule the exams. First up was a CAT scan, then the colonoscopy within a couple of days. Unfortunately, the gastroscopy couldn't be scheduled sooner than 8 days away, so we had some down time. The CAT scan was done at the only place in Pérez Zeledón that has the machine, Clinica San Lucas. I won't go into all the gory details, but the typical preparation for all the tests was fasting and usually a purgative besides. Believe me, she was pretty worn out by the time we finished all the tests.

The alert reader at this point may have noticed that in Part 1, I mentioned that she needed four tests, not three, the fourth being the Intravenous Pyelogram to check her kidneys and all systems derived thereof. I heard the doctor say four, but I didn't notice until later that he'd only written orders for three tests. I assumed I'd misunderstood, but I hadn't, he'd forgotten to write up an order for the Pyelogram. This bit us later, because when we got all the test results (now about 12 days since leaving the hospital the first time) and tried to check in again with the help of our family doctor, he found the fourth test on the chart and sent us out to get it. The final test took about 4 days to get done due to the amount of preparation (starvation!). In fact, we had to do it twice as Tamara's bowel was not clear enough to get a clear shot of her kidneys, so she had to fast an additional day!

IV Pyelogram Example, not Tamara's

Finally, all tests in hand, we waited for the all-clear from our doctor, arrived just after 7 AM, and got her checked in after an hour or so. She was in the same room with seven other ladies waiting for a doctor to show up. This visit proved to be a short one. The reason? They were now adding another hurdle, namely, she would have to take a 4 AM trip up to San José in 3 days by ambulance to see their Oncologist. This, despite all the exams having shown nothing abnormal besides the tumor we already knew about. At this point we started giving up on the Caja route as we felt we could see writing forming on an imaginary wall. A day later we canceled the trip to San José

You see, the Caja is not the place to go for what they would consider "elective" surgery. It's not life-threatening, or you're not going blind, or something like that, then they are going to keep throwing up roadblocks and delays. That's fine. I can understand that unwritten policy given their financial condition. We'd given it the old college try but in the end decided that going private was the best option even if it was going to require drawing down some savings. 

In order not to go into extra innings, I'll just summarize briefly what we did next. Tamara was admitted to Clinica Labrador on a Saturday afternoon. One last fast for Tamara. It's a small clinic, four private rooms, quiet and modern (even Wi-Fi for the folks in the waiting room!). She had the area's best surgeon, assisted by our own doctor and other staff (in total 7 doctors were involved in her treatment). The surgery took an hour and we spent the night in her private room with a fold-out Futon for me. She took a long time to come out of the anesthesia but by morning she was alert and getting some strength back. We checked out by 2 PM and Tamara is already almost back to normal. Cost? Everything, initial exam, tests, surgery, etc. was almost exactly $5,000. I checked costs in the Portland, OR area for the lowest cost providers  and this would all have been north of $20K up there. 

Unfortunately, this isn't the end of the story. We just got the biopsy results today and the tumor was cancerous. However, it was completely encapsulated and there is no sign at all of metastasis. Nevertheless, we are going to consult an Oncologist in San José for whatever next steps may be necessary. The good news is that we were wise not to wait on the Caja and had the tumor removed promptly.

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