The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 3

First thing the next morning, I walked to the hospital and found Shelagh in the second bed of a four-bed ward.  She was in great spirits and was comfortable.  Opiates will do that for you.  (Morphine sulfate. Write it down. Ask for it by name.)  She was receiving IV antibiotics, which is what is done for open fractures.  Bone infections are nasty things and need to be prevented with large doses of high-powered antibiotics.

The next couple of days were a lot of waiting.  On Call International, the travel assistance company that was part of our travel insurance, made contact with me (one of the many things the Dream’s crew did for me while I was packing, besides process our passports, was to open an account with them).  There was, of course, paperwork to be filled out, with sections for physician attestation.  We both prodded to get it filled out and sent in, but things operate on Island Time and they’d get around to it.

Two days after surgery Shelagh had follow-up x-rays (all was well) and had the cast removed to visualize the wound (it was healing well).  The next day a physiotherapist got her up and moving a bit.  The question of which would be better, crutches or a walker, was not clearly answered at the time (it did get answered the next day: walker).

That was it as far as excitement goes.  Lots of lying about and healing.  The ward had a TV that was playing Lifetime Movie TV 24/7.  Shelagh and the young girl in the bed next to her watched enough of it that, even with no sound, they figured out the formula.  While everybody was attractive, the heroes and the villains were the really good looking ones, the guy with the red hair and a beard must own the company because he’s got a part in all the movies, and there was always a car chase.

As I headed to the hospital on Tuesday, I realized that you know you’ve been ashore for a while when your ship comes back.

Huc accedit per Somnium!
Latin for 'Here comes the Dream!'
And this entire caption comes from lots of time on my hands.

My route from the PMH main entrance to Shelagh’s ward took me past the Labor and Delivery unit.  Walking out of the hospital one day I heard a woman giving birth who wasn’t a student of the Lamaze Method, but clearly studied the Le Mans Method – she was screaming like a Ferrari.

Visiting hours at PMH are old-fashioned and draconian, as are the nursing sisters who enforce them.  Hours for the wards at PMH are noon to 1pm, and 6pm to 8pm.  I got away with excessive visitation on Sunday, and again on Monday morning, but after that I was persona non grata outside those hours.  

I used my down time to visit all the nearby tourist traps (and spent less than $15 for a pocket knife and a Bahamian flag fridge magnet), nap and draft my blog posts.  I couldn’t bring myself to doing anything more than that while my Sweetie was stuck in that ward.  Hell, I felt guilty about all the sun I was getting walking to and from PMH twice a day that she wasn't getting.

Speaking of opiates, they are freely available over-the-counter in the Bahamas.  Just be sure to complete your recreational activities therapeutic course instead of trying to bring leftovers back with you.

Codeine: Morphine's kid sister

Suddenly on Wednesday afternoon, four days post-injury, the doctors started making noises about discharge.  To back up the talk, all the paperwork suddenly got filled out.  By Thursday morning it was clear that discharge was going to happen.  At noon, her physician came in and told her to get dressed since the discharge orders were written.

Since transportation to CONUS (military term for ‘continental US’) was still pending I had to get her to the hotel.  I called John Knowles from RH Curry, the port agents, to ask if he had a recommendation for a reliable taxi.  With Shelagh being non-weight bearing on her left leg and a bit wobbly on her right, having been bedridden for five days, we didn’t want to just chance it with the next guy in line at the taxi stand.  John was kind enough to come to the hospital and give us a lift in his minivan. 

The hotel lent us a wheelchair, which I really appreciated because I wasn’t looking forward to lugging Shelagh around the room, down to dinner and back upstairs again.

We had a conch dinner that I ran and brought back from Imperial’s, a restaurant that is right across the street from the hotel (where else?).  Conch was, after all, one of the two reasons we came ashore.  We managed to take that off our list without further incident.

I got Shelagh tucked in, we watched a bit of Shark Tank on TV, and then she had the best night’s sleep since we left the Dream (which, by the way, has outrageously comfortable beds).

{Click here for Part 4!}

The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 2

After I caught my breath at the hotel I headed out for Princess Margaret Hospital (PMH).  It’s a 20-minute walk from the British Colonial Hilton.  The first half of the walk is through the port-associated tourist traps.  The second half, not so much.  But in the daylight I wasn’t concerned about it.

As I started my walk, I saw the BTC telephone store across the street from the hotel that Adrian told me about (lots of things are apparently across the street from the British Colonial).  There I could get a sim card for my phone since it wasn’t working in the Bahamas and keep everybody in touch.  Or I could get a cheap phone.  Or I could do what I wound up doing: staring at the door of the closed store.  I missed it by about 20 minutes and now would have to wait until Monday morning for it to open (this was Saturday).  Communicating with the boys and my boss would have to be through old school e-mail until then.

When I returned to PMH’s A&E (that’s Accident and Emergency, the term used in the Queen’s English for what is called the ED or ER in ‘murica) I found Shelagh in the same place but with a different wardrobe.  She was wearing a hospital gown, which isn’t any different from those in the US – designed for easy access and to maximize patient humiliation.  The pants she was wearing when she fell couldn’t be taken off normally because of her injury and the splinting, and they had to be cut off.  They were her favorite capris.  She was heartbroken.  She was also saddened because she had a new pair of white sandals that were super comfy for her and the left one was pretty bloodied.  I told her not to worry, I knew how to get blood off of things.  Not only did I work in EMS at places that had white uniform shirts, but I also worked at a blood bank as a phlebotomist back when we had to launder our own white lab coats.  The best trick I learned was that running large volumes of cold water over the stain with some gentle friction works like a charm.  And even the next day when I got around to trying to clean her sandal, it worked.  So there’s your stain removal tip of the day, free of charge.

Just as I caught sight of Shelagh in her bed, I was told to follow as she was being taken to x-ray.  She had already been seen by an orthopedic surgeon and surgery was going to happen right away (yay!), but they needed to see what exactly they were dealing with (really good idea there, doc).  When we got there, I sat in the waiting area just outside the x-ray room she was taken into.  This allowed me to be a knowing but very unwilling audience to what I knew I was about to hear.  I had an ankle sprain about 30 years ago and knew they would manipulate her foot to get clear views of the bottom ends of the leg bones.  It was excruciating for me with a moderate sprain and I knew it would be much, much worse for her.  Listening to her undergoing the necessary torture was shattering.

Her fractures prior to surgery. 
In order to get a good view of the bottom of the tibia and fibula her foot had to be pulled down.

Once the films were obtained and deemed to be of sufficient quality (thank God because she didn’t have to go through that again), she was taken to the OR, or ‘Operating Theatre’ in the vernacular.  I was plopped in the surgery waiting room.  It was spacious, well-appointed and more modern than the rest of the hospital.  I was pleasantly surprised by how soft and comfortable the chairs were.  I was also pleased that I was the only one there.  I wasn’t in the mood for crowds and noise.

After a while a lady who worked in registration came in and said we still needed to do some paperwork, or as they say in American healthcare, we still needed to do some paperwork.  We took care of that and the lady asked if I needed dinner.  I said that I did and she kindly escorted me to the cafeteria.  This was truly kind of her because I was just beginning to notice that there was absolutely no directional signage in the hospital.  The various areas were marked at the entrances to those areas, such as ‘Radiology’ and ‘Accident and Emergency’ but no indications anywhere as to how to get from one to the other.  When we got to the cafeteria, she even walked me through the process, which was also very kind because it was not anything I was going to figure out.  Even in retrospect, I’m not sure how money from my pocket turned into food in my hand.  And then to top off her kindness, she made sure I could get back to the waiting room.  My regret is that I never got the name of this angel.

What I wound up with was stewed lamb chops on a bed of rice with mixed peas and green beans.  The peas and beans were blah, but the lamb was good.  Not gourmet, mind you – this was a hospital, after all – but something I would recommend to anyone having no choice but to eat at the PMH cafeteria.

The waiting room, as I mentioned earlier, was all mine.  But it was also oppressive because of one thing: CNN.  There was a TV on the wall that had CNN on, at a volume that wasn’t too loud, but was difficult to ignore.  And it wasn’t a case of my having anything against CNN (I have long since loathed all the US news networks), it’s just that they had on nothing but a long line of talking heads going on and on and on and on about a top secret document that they had never seen, and for that matter, may not even actually exist.  But boy, could those people make up complete BS and state it authoritatively, sometimes even forcefully, in order to fill up the entire evening with things that weren’t news.

Around 2 hours after Shelagh went into the pre-op area, the PACU Sister (nurse) came into the room.  She said, “Mr. Erskine?” and I leapt to my feet since she was going to tell me that it was over and everything was OK.  Well, I didn’t leap because rapidly exiting those comfy chairs was the same as leaping from a La-Z-Boy…it just doesn’t happen, regardless of one’s athleticism.  So I stood up as quickly as possible and she told me that Shelagh had just gone into the theatre because she got bumped a couple of times for emergencies.

{sigh😒}

The hell of it is that I can’t even pretend to be upset about this because researching and improving the triage of injured patients has been part of my job for the better part of the past two decades.  I’m going to have to figure out a “Hey! That’s my Sweetie!” exception.  (Cam, let’s talk about this.)

I did take advantage of the Sister’s presence to ask if there was a remote anywhere for the TV.  She dug through some desks and found it.  Hallelujah!  I went up just one channel, landed on the BBC and they were reporting actual news.  They spoke of the Olympics, the confusing multilateral civil war in Syria, wearable technology, storms battering Sri Lanka and SE India, the growing shortage of Egyptian penguin milk and any number of things that, if not relevant to me, were at least important to someone.  

For the next couple of hours I alternately played games on my phone, dozed in the comfy chairs, got terrified by how low my battery charge was dropping while in a foreign hospital and a 20 minute walk from my chargers in the hotel, playing some more games anyway, and watching the BBC’s report on the issues revolving around why British nurses trained at the Royal Victoria Hospital don’t get Abbott and Costello’s ‘Who’s on First’ sketch.

(OK, that last one is actually a reference to an incident that occurred once while Shelagh and I were driving through West Virginia.  Ask either one of us and we’ll be happy to share this one with you.)

Finally, the Sister came in and told me she was out and doing fine.  The surgery was a success.  I wound up speaking with the anesthesiologist, who told me all went well from his perspective, both induction and emergence, as well as an orthopedic surgery resident who said that the fracture itself wasn’t severe but still required some screws and plating.

I got to go in to PACU to see her a little bit later and she looked as well as somebody emerging from anesthesia can look - pale, pasty, shivering, not pretty and pretty shocking if you've never seen it before.  She smiled when she saw me and we spoke briefly.  She was in no pain, had a cast and she could wiggle her toes.

After ORIF (open reduction, internal fixation), showing plate, screws, skin staples and cast.

The Sister took me back out to the waiting room, told me which one of the wards could find her in in the morning and then asked how I was getting back to the hotel.  “I’ll walk.  It’s only 20 minutes from here,” I said.  The look of consternation that overtook her face told me immediately that that was the wrong answer. 😳  It was approaching 11pm and those not touristy areas were not a place for tourists after dark.

Just then Dr. Kumar, an anesthesiologist (not the one I spoke with) walked through on his way home.  The Sister asked him if he could give me a ride, which he was more than happy to do.  A few minutes later I was back in my room.  It was 11 o’clock and we had packed a lot of adventure into the preceding 13 hours.

{Click here for Part 3!}

The Bahamian Medical System: A View from the Ward - or - Shelagh’s Big Break: Part 1

In the summer of 2015, Shelagh and I went on a Disney cruise at the request of our then 4-year old granddaughter.  We sailed on the Disney Dream and had a blast.  Afterwards, Shelagh requested another Disney cruise as a present for her 70th birthday.  Being a faithful, loving husband I arranged to make that happen, along with one day each at the Epcot and Magic Kingdom.

I got in touch with Cousin Michelle, the world-famous Disney travel agent, to make the arrangements.  Working with Michelle made everything frightfully easy…I don’t think our phone call lasted more than 30 minutes and we arranged everything I wanted: the right stateroom, the right hotel on the Monorail with a room overlooking the park so we could see the fireworks without having to brave the crowds on the way back.  It was perfect.  When Michelle asked if I wanted trip insurance I fortunately said, “Yes.”  And that’s what this post is about: the need for that insurance.

A really cool part of our Disney experience was that when we packed our bags, we put Disney’s tags on our luggage and when we dropped them at the airport, we wouldn’t have to handle them again until we arrived back in RVA.  In this scenario, Disney picks them up at the airport and delivers them to your stateroom.  And when you disembark, you pack, leave the bags outside your stateroom and then pick them up at your home airport.  Pretty neat, in a “I have people to do that for me” sort of way.

We got aboard, unpacked, pigged out at lunch (as one can do on a cruise), went through the mandatory evacuation drill then headed up on deck as we set sail.  We departed Port Canaveral at the same time as the Carnival Sunrise.  The sun was shining and the warm sea breeze blew in our faces with its welcome saltiness.  Brown pelicans were diving for fish all around us and dolphins frolicked just ahead of our bow.  It was wonderful.  We did other cruise-ish things, but I’ll spare you those details.

The next morning, the day of Shelagh’s 70^th birthday, we were pigging out at breakfast (as one can do on a cruise) as the ship docked in Nassau.  We’ve been to the Bahamas a couple of times and set our sights on just two things for our day excursion, both within walking distance of the port: conch fritters and the Queen’s Staircase.

The Queen’s Staircase is 66 steps, carved out of the limestone by slaves.  They were built in the 1790s and later named in honor of Queen Victoria.  The steps were used to access Fort Fincastle.  Fort Fincastle, also built in the 1790s to guard Nassau and its port, offers a wonderful view from its walls.  Or so they say.

We climbed the Staircase and paid for admission to the Fort.  Shelagh and I wandered around the grounds before going to the top.  As I was entering the main building, I heard behind me the distinctive and all too familiar sound of Shelagh succumbing to gravity.

The first time I was present when Shelagh had a skirmish with Newtonian physics and lost was on our honeymoon in Scotland, coincidentally enough, at a castle.  She failed to negotiate the last of some steps she was descending.  I was just a bit too far behind her to do anything about it and watched helplessly as she landed on all fours.  She was OK, but she made an “Ooof!” sound that was unique to her.

The familiar ooof sound she made at Fincastle was followed by a very atypical loud groaning.  I wheeled around and went back out to see her on the ground and writhing in quite a bit of pain.  She had missed a single step down.  As I approached her, doing a scene survey, I caught sight of her injury.

Now, I’ve always known that Shelagh is just the loveliest creature, lovely all the way down to her bones.  That day I got visual confirmation of this: she had a compound fracture of her left ankle.  It’s a good thing I’m a paramedic because that thing was pretty gross.

The staff at Fort Fincastle called New Providence EMS.  While waiting for the squad to arrive, Shelagh was well composed once she figured out that squirming made it worse.  There were many well-meaning bystanders who wanted to help in typically not really helpful ways but I was able to fend them off by identifying myself as a paramedic and Shelagh as a nurse.  They were happy to leave us to ourselves when they got a load of the ankle.

New Providence EMS bandaged and splinted her ankle and took us to Princess Margaret Hospital (PMH), whose ambulance entrance is probably less than 300 yards from where Shelagh fell.  

Princess Margaret Hospital

The squad took her to the trauma room and sent me out front to get her registered.  As she sent me to registration the attending paramedic, Miss Carey, said she would make sure the patient representative knew about us.  That was of little comfort.  I am normally a fairly laid back, roll-with-the-punches guy but here I am, waiting to register my wife in a foreign emergency department for treatment of an injury that could cause her to lose her foot while our ride is going to leave in about 5 hours with all our stuff.  My anxiety levels went through the roof.  I could get back to the Dream in about 10 minutes on foot to tell them about our plight and to sort things out, but I wasn’t about to leave Shelagh alone in this environment.

After what seemed like an eternity in the waiting room but was probably only 20 minutes, my name was called.  Miss Sherman, the patient rep, took me back to her office.  I explained what our situation was and she said they handled this sort of thing all the time.  She called the RH Curry Company, port agents for Disney Cruise Lines in Nassau, and told Adrian Albury, the agent on duty, about us.  Adrian showed up shortly and we went out into the parking lot for further discussions.  He explained how these things normally work and put me in touch with Corey Konczal, Disney’s Medical Operations Manager.  Corey said before deciding a course of action we’d have to wait and see if the doctor thought it was severe enough to admit her.  I told him she was definitely getting admitted and described how much bone was exposed and the disturbingly odd angle at which her foot and leg came together.  He no longer needed to hear from a physician…compound fractures need immediate surgery.  He spoke briefly with Adrian again, who said something to the effect of, “OK. I’ll take care of it.”

Suddenly, the magic of Disney sprang into action and came to my rescue.

Adrian took me back to the ship.  As we boarded, he explained to the crew that Shelagh and I were debarking for a medical emergency and they took it from there.  Since we weren’t just day-trippers in Nassau anymore, we were going to need passport clearance and landing cards, so I gave our passports to a crew member for processing.  I was then taken to our stateroom by a lovely Serbian lady named Mirjana who helped me pack all our stuff.  We worked quickly but had a nice conversation and I learned she had just received her Bachelor’s degree in nursing and would be taking her licensing exam in a few weeks.  We left the stateroom and went to the ship’s Guest Services area where there was a short wait for Malisa (from Thailand) to bring me the stamped and validated passports and the landing cards.  I was taken back down to the gangway where Adrian was still waiting for me.

Adrian then started making hotel arrangements for me.  As he was doing that, I had a chance to chat briefly with a Nepali crew member named Rabin.  I asked where in Nepal he was from and his face lit up when I said I had been to his hometown of Kathmandu.  It turns out that he did a brief stint in the army as a Gurkha.  My short chat with him reinforced my belief that while the Gurkhas are generally considered the fiercest warriors on the planet ("If a man says he is not afraid of dying, he is either lying or he is a Gurkha."), they are the nicest, funniest savage killers you’ll ever meet.

Adrian booked me in to the hotel and took me to the Bahamian Customs Office.  As we were going in, a taxi driver asked Adrian if a cab was needed and Adrian said yes and that we’d be right out.  He was right.  Because I was with him, all we had to do was go in, they put customs stickers on our suitcases and my backpack and we waltzed out.  Elapsed time in Customs was less than two minutes.  As we exited the building, Adrian pointed to the taxi driver and said, “Go with him. You can trust him, he’s old school.”  Even though my encounter with Adrian was brief I understood that this was the highest-order compliment.

The hotel room booked for me was at the British Colonial Hilton.  It is, to say the least, swanky.  How swanky?  Put it this way: A James Bond movie was filmed there.  Twice.  The British Colonial appeared in both Thunderball and Never Say Never Again.

The British Colonial Hilton's lobby

The British Colonial Hilton's private beach from the 5th floor balcony

Adrian said the hotel was in a good neighborhood and right across the street from the US embassy.  When I got to my room I looked out the window and saw…McDonalds.  Not what I was expecting, but not totally inaccurate, either.

McEmbassy

I sat down briefly to gather my thoughts before I returned to PMH.  What had just transpired was an absolute whirlwind of activity.  It was rapid fire, but well-rehearsed.  To make things right for me, certain activities had to happen in a particular order and with all due haste.  All these things happened, on my behalf, in less than 3 hours, relieving me of half of my problems…and I was just along for the ride.  From my perspective it was nothing short of a miracle, nothing less than the Magic of Disney.  I have an overwhelming amount of gratitude for the people who helped me, not just those who are named above, but also all the others who I didn’t see who were acting on my behalf.  Thank you all!

{Click here for Part 2!}