Paving the road to nowhere, one word at a time.

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Location: Tijuana, Baja California, Mexico

American born, living in Mexico since 1992.

Wednesday, January 27, 2010

Body, Heal Thyself

Most machinery cannot fix itself when something breaks, like a car or a toaster or a trash compactor or a computer or even a bicycle. Such machines are designed and built to operate under certain power requirements such as electricity or combustion created by fuel and fire or even human movement. The best that some of these machines can do is to diagnose themselves, such as through warning lights or even messages on monitors that alert anyone that cares about a potential problem or imminent failure. Often, there is no warning for such events, nor is there a mode of diagnosis. Most machines are, at some point, entirely dependent on human beings in some capacity.

The human body is also a machine, but unlike other types of machines, it often has the capacity to fix itself. The main warning device employed by the machine that is the human body, is pain. Pain signifies that there is a problem. When one smashes one’s thumb with the inaccurate strike of a hammer, for example, pain dictates that the thumb has been injured and such pain often sends a message to the memory banks of the carbon-based, body-controlling computer that we call a brain. The brain then instructs the arm not to swing a hammer so close to the thumb. If we’re lucky, the arm complies.

The injured thumb almost always heals, by itself, unless you happen to own a very large hammer. Take even a small hammer to your computer keyboard and you’re probably going to have to buy a new one. It certainly isn’t going to fix itself. The luckiest you’ll get is if, by chance, you can repair it yourself. Or else, you’ll have to take it to someone who can. But it won’t fix itself, regardless. Sometimes, the human body is, in fact, self-repairing.

* * * *

When I hobbled into the Perico a couple of weeks ago, cane-dependant, Scott was there and asked me about the leg. I told him that it pretty much constantly hurt and that perhaps the battery of tests ordered by the doctor would reveal why. I told him that I awoke one morning and there it was, pain. I had no reason for it nor any explanation, only vague notions of what it could be. Then Scott asked me about the most painful thing, physically, that I had ever endured.

"Pneumothorax," I told him, not needing to think about it. When I was perhaps twenty or twenty-one, one morning while filing away test data I had the most intense pain, in my chest, that I’ve ever experienced. I didn’t know what it was – a heart attack? I could barely breath. Somehow I transported myself down the street to the company clinic where they x-rayed my chest, and I stayed down on my back on a bed while they developed the film. Within a half-hour, the pain was completely gone, as quickly as it came. I offered no explanation nor was I given one.

It wasn’t until later that I realized that the attendants at that clinic were not very good at reading x-rays.

The second occurrence was much milder and didn’t go away for a couple of days. I didn’t bother going to the doctor until many months later, when it happened again while I suffered from a nasty cold. I went to my regular physician because I suspected it could be pleurisy. Again my regular physician ordered a x-ray, which I brought back for him to read. He came out of the reading room and told me I needed an ambulance. I actually laughed.

I drove myself to the hospital and met a doctor of internal medicine, a short man with curly hair from the East Coast and a very relaxed and witty sense of humor. In the emergency room I explained what I had been through over the last year and he diagnosed me with spontaneous pneumothorax. "It’s rare, but it happens sometimes with tall thin guys. This is your second documented occurrence. On the third documented occurrence we have no choice; we have to operate. It’s painful. We cut and spread your ribcage and take out your lung and irritate the lining, which makes the scar tissue necessary to keep it from collapsing again."

It certainly didn’t sound promising. He continued, "But what we’ve found is that with every occurrence, your lung collapses less and less, because scar tissue is made with each collapse, and as you’ve noticed, each collapse is less and less profound. There’s a good chance, presuming that you can deal with the pain, that we won’t have to operate. If it collapses any more than it is right now, you need to get in here. If it doesn’t, you won’t have this issue in a couple of years."

That doctor was right. That part of this machine of mine took care of itself.

* * * *

I related the second-most intense pain I ever experienced to Scott over yet another beer that afternoon in the Perico. It was when I shattered my heel bone while playing baseball. But again, it was a success story involving a human machine. And again, it was a damned good doctor who allowed that to happen.

It took eighteen hours from when it happened until I was actually at a specialist in the United States of America, x-rays in hand. The x-ray technician, upon viewing my film, had asked my why I wasn’t crying. I didn’t know how to answer him. All I could think about was how much worse it was to have a collapsed lung. The foot specialist ordered an ultrasound, which I took the next day. I showed up back at his office with the results.

"Well, let me tell you, in the old days there would be no question," said the young man – perhaps a decade younger than myself – telling me this as he read my images. "The old procedure under any circumstances would be to open up the foot and scrape out all of the bone fragments and mold them together with a special epoxy to make another heel bone. Then we would fuse it back up there where your old one was. In your case, you didn’t blow it out to one side or another; but rather, the fragments are still fairly symmetrical. I’m inclined to put you in a cast and allow the bone fragments to fuse on their own. We’ve found this to be successful in cases like yours."

"Will I walk normally?"

"Yes. You won’t be able to run marathons and no more baseball, but the only effect you’ll notice after a few years is arthritis, and you’ll probably have a few wayward bone fragments working their way out of your foot."

It took six months to get to the point where all I needed was a cane, and then a few weeks after that, I was fine. I lack some mobility, and experience slight arthritis, but that doctor was also right about that part of my machine. Basically, it healed itself in the cast. Stanford University can be proud of him. I am proud of Stanford University.

* * * *

When I awoke with that pain in my leg, and it didn’t go away after a few weeks, and there was no good reason for having it that I could think of, I went to a doctor. I tried to take their tests, but fate did not cooperate. I figured I would take those tests this week, now that I know what I’m up against. Then something else happened.

I awoke the other morning, and like any morning I put both feet on the ground and reached for my robe. Then I noticed something. The pain was gone. I went downstairs and made a cup of coffee and waited for it to return, but it didn’t. And it hasn’t. It’s as if nothing happened at all. I’ll be damned if I can figure it out.

Understanding that I risk the wrath of friends and family members, the tests will remain on hold for a while. Those papers have no expiration date. Besides, what’s a Doppler ultrasound going to find now? Blood tests? Urinalysis? Chest x-ray? Nothing more than the fact that, apparently and inexplicably, my machine has fixed itself. That, and a slight iron deficiency. And a warning that if I don’t quit smoking I run the risk of cancer and heart disease and several other dangerous and harmful effects on my machine.

I walked to the local market noting the chill here in Baja that seems to have settled in for a while. I bought two packages of unfiltered cigarettes so that just in case I get that chest x-ray taken at some point, they’ll have a reason to lecture me. Even the store clerk noticed me walking without a cane. Weeks ago when I first appeared with the cane he had asked me if I had fallen. It made me feel old.

"Feeling better?" he said to me in Spanish.

"Like new," I said. "The human body is a remarkable machine."

I walked back home slowly and completely free of pain, careful to avoid the uneven concrete lest I fall and need that damned cane again.

Saturday, January 23, 2010

Stuck In The Mud

The rain and wind and hail fiercely competed with the thunder and lightning for an order of brutal display, and there would be no winner. I awoke many times Thursday night and into Friday morning, succumbing to the sounds of one barrage after another of nature’s calling cards. When it stopped, after a few minutes, a jet airliner would sneak out of Tijuana’s airport and make that sharp turn southwest over the house. Minutes later, another storm cell would threaten and then close the gap, dumping its deluge in the wake of people flying to somewhere that storm cells couldn’t reach them.

I imagined a dragon snapping at a sparrow.

When I awoke for the last time on Friday morning, Rocio had left for work leaving a slow and steady rain behind. I came downstairs and showered while yet another storm cell dumped even more rain to accompany me through the crack in the bathroom window. I was to be poked and prodded today, storms or no storms. I did not have the luxury of a commercial jet waiting on a runway for safe clearance to take off. I would be making this trip regardless of whether the dragon slept or raged.

Dressed and loaded with papers, a medical card, and twenty-six dollars, I guided my cane through the mud and water out to the main boulevard. It was eleven o’clock. The green and white taxis took turns loading and unloading passengers near the old Chinese restaurant next to a bank of pay phones. The rain had stopped. I climbed in and the driver took off, his cab riding on the wet asphalt and eluding the new potholes brought on by temporary torrents seeking the lowest ground that water could find.

* * * *

In nineteen hundred and ninety-three, when all hell broke loose in Tijuana, when they opened the gates of the Rodriguez Dam, the water came barreling down the river and washed out all of the roads except for the two bridges, one near Cinco Y Diez and the other in Centro. Concurrently, mud and boulders the size of small cars came oozing and spilling and tumbling down the hillsides to the south of the river, also bringing the thousands of old worn tires that many had used to keep their yards from washing down the hill. It was three feet deep on the bridge near Cinco Y Diez, effectively cutting the eastern end of the city in half. There was never a bigger mess here.

The number of people who died in that series of storms has never been officially reconciled.

Over the course of the next decade, the entire Tijuana River was transformed into concrete. Bridges were built, several of them, and no more roads would run through the river, but rather over it. Drainage was improved. Asphalt streets that were prone to flooding were replaced with concrete. Tijuana’s east-west freeway was completed, using space on both sides of the Tijuana River, from Centro all of the way out passed the Dam. Another six-lane boulevard was paved, running parallel to the main boulevard, Diaz Ordaz. Bridges were built carrying the north-south traffic harmlessly over both of the east-west boulevards. All of these improvements have had a profound effect on the eastern portion of Tijuana.

When it rains, there are still problems here. Pedestrians are going to get wet, with the simple matter of crossing a street meaning wading through a foot or more of water. We are willing to live with it. This latest series of storms have brought fatalities as well, with a family swept away while attempting to cross swift water in their car, and a young girl drowning while two of her siblings are still missing in a more rural area of Tijuana. Such occurrences are tragic. The loss of any life is tragic. The ability to count such tragic losses is an improvement of what once was either an inability to do so or an unwillingness to account for the loss of life.

* * * *

The Allen W. Lloyd building originally housed a life insurance company, with other offices leased by dentists and doctors and other professionals, and served as a landmark on the border at the San Ysidro port of entry into the United States of America. Over a decade ago I wrote a fictional short story I called Jesus Stone, in which that building had been renamed and the life insurance had been supplanted by medical insurance because more money could be made selling the latter than the former. That part of the story is no longer fictional. The rest of the story remains speculative: The Jesus Stone that brought the friend of the protagonist a lot of money along with a lot of other problems and ultimately his own fatality, caused the protagonist to then gift the money blindly and recover the stone and ultimately throw it off of a long pier, ostensibly back to whatever primordial beginnings from whence it came. May the rest of that story always remain speculative and entirely untrue.

The green and white cab rolled along, eluding any rain and carefully negotiating bodies of standing water. The potholes along the way were new and deep and tricky. The one passenger in front of me that had accompanied us for most of the ride to Centro remarked in disgust about the local government’s inability to fix these problems. We chatted about it. I reminded him how much better it is now than it was over a decade ago, and he agreed. He was a rarity, a born-and-raised Tijuanense. We wished each other luck and I got out on Calle Madero, I decided to walk to what once was the Allen W. Lloyd building.

My cane didn’t help much, other than to draw stares from some of the pedestrians. The storms didn’t appear to have had the dramatic effect on Downtown Tijuana as such storms once had. As I crossed the pedestrian bridge toward the border, I noticed the Tijuana River, much higher than the normal trickle, moving swiftly underneath me. There was a time that the river would have almost risen to the brim, and now it is so controlled as to steadily release water into the Pacific Ocean as though this sort of thing happens often. That a city receiving a few inches of rain annually, with little in the way of original infrastructure to handle anything more, could negotiate several inches within a matter of hours is certainly a testimony to vast improvement.

I approached the steps noting the beautiful new construction and lovely glass doors and, once inside, a security officer eagerly helped direct visitors to their appropriate destinations. On the second floor, I approached the receptionist who took my information and paperwork and medical card and asked me if I had eaten any breakfast. No, as a matter of coincidence. She smiled and handed me a plastic cup with a screw-on top and told me to go "pee-pee". I found the men’s restroom and filled it halfway, proud that I could comply. Once back in the office area, my name was called and the sample taken and tagged, and another nurse now attending to me asked if I had had anything to drink this morning.

"No alcohol," I responded, proud of my damned sobriety.

"Only water, right?"

"Coffee," I said. "And a small cup of Fresca."

"Oh, no! You can only have water. I’m afraid you’ll have to come back."

"But the doctor never said anything about not…"

"You can’t have any sugar in your system at all for at least twelve hours prior to the blood and urine test," she said. She handed me back my paperwork and I told her that I would return for the tests next week. Then I asked about the other tests, the Doppler ultrasound in particular.

"It’s on the other side of the building, you’ll have to go there and ask them about that."

I left that side of the building, stepping outside where it was now sprinkling. The doctor never said anything about breakfast of coffee or soda or anything other than no alcohol for forty-eight hours. I reached the other side of the building; more steps and more glass doors. Once inside, I found that I could take some chest x-rays that had been ordered, but that the Doppler ultrasound would have to be done somewhere in the United States of America. Call this certain doctor in Tijuana and he would schedule my appointment. Where was this place in the United States of America? Only the doctor would tell me, once I called him.

My body was nothing more than a machine stuck in the Tijuana mud.

The modern interior, indoor fountains, and beautiful furnishings betrayed the system in Baja. That old expression about painting lipstick on a pig (but it’s still a pig) came immediately to mind. Everything would have to be done yet again next week. I left, and the rain followed me. I would take a bus downtown and have a beer. The skies opened up on the way to the bus and I stood huddled underneath the eave of a building along with several others, waiting until the cell passed, until the hard drops turned into something more manageable. The bus then shielded us from whatever fell after that.

* * * *

"Remember what it used to be like?" I asked Jody as we sipped a beer in the freezing cold Nuevo Perico.

"Yes. Of course, first thing in the morning, the mud is still there until they shovel it up and take it away."

"That will never change. It’s the same out where I live. The mud will always be there," I said.

I bought him another beer. The Perico is the coldest bar in Tijuana. This works well in the summer but not so well in January. Friday afternoon there were not enough jackets to keep anyone warm. I stood for a while.

"How’s the leg?"

"Actually, it hurts less now. Or maybe I’m getting used to the pain. Or else I’m tired of worrying about it. It doesn’t bother me much to use this cane," I said.

Jody finished his beer and left, and I wasn’t too far behind. The Dandy has heat, worth the extra fifty cents a bottle, and my cane seemed to find all of the right spots on the sidewalk all of the way down Calle Sexta. Even that six-toed cat they let have the run of the place was content to curl up and keep warm on a nearby chair. I sipped my beer and read the paper and wondered why sometimes the more things change the more they stay the same.

Tuesday, January 19, 2010

The Last Sunny Day For A While

I can’t remember the last time I actually ventured out the front door before Saturday. I would watch the sun cast shadows across the cobblestone through the front window, briefly, before the pain would begin again. Then I would have to find a chair. Sitting is better than standing and lying down is better than is any other option. I can’t stay in bed all day and the couch is out of the question because the television is intolerable. Sitting is the compromise, then. Writing and reading articles on the internet are preferred activities to distract me from the dull throbbing pain in my right leg.

It started well over a month ago with a couple of day’s worth of chest pain, high up and not seemingly related to the heart or the thorax. I figured I was smoking a bit too much, and I cut back on the non-filtered delicados I have come to enjoy here in Baja. After two days, the chest pain subsided only to be immediately replaced by a right leg that felt as though I had so completely overextended it as to cause me to reach for a cane once used for another injury more than a decade earlier. This is what happens.

Three weeks after that, I told Rocio to make an appointment with the doctor, that something was wrong.

Rocio is the warrior I once was, crossing the border before sunrise every day to report to work and then coming back home in the dark. I did that for fifteen years. Like many employers in the United States of America so close to the border with Mexico, the health insurance offers the employee a choice of coverage in Mexico. Rocio took this option because she is more comfortable with the doctors here. I am bound by that option now whether I like it or not.

* * * *

My first experience with a doctor in Mexico was actually with an obstetrician. Six months into what has now become a permanent sojourn into Baja, my daughter was born in a small clinic in Las Brisas, not more than a few miles from here. In about a month, that daughter will be seventeen years old. It seems ridiculous how much time has passed since that afternoon. It doesn’t seem so long ago.

The tiny clinic, not unlike other tiny clinics in Baja, had a small reception area with a few old chairs and it also served as a waiting area. The receptionist also worked as a nurse in case the clinic became too crowded for one nurse to handle. It wasn’t clean, it wasn’t dirty; it was merely adequate, right down to the lighting. It was a simpler and much more rustic version of any doctor’s office in the United States of America.

Once we chose the clinic, I recall paying half of the six hundred dollars that the entire procedure would cost. This would include monthly visits, but not tests and the ultrasound. We didn’t want to have my daughter born in Mexico merely because it was inexpensive, but it worked out wonderfully well that way. We wanted to have Anna born in Mexico because she is Mexican, so that she would feel rooted in the culture we chose to bring her up in. One day, green card in hand, she may have a decision to make concerning where she wants to live – and she can make that decision freely while keeping in mind the flavor of freedom she has grown accustomed to here in Mexico.

My experiences in childbirth from my first marriage were different; both children were delivered by Caesarian section. I lied about having attended the class for the first one, and sat next to my ex-wife who was awake during the procedure. I delightfully remember her guts laying exposed beside her torso, a memory that serves me well when any of dozens of awful recollections from that marriage might creep up from time to time. The second Caesarian section was filled with technical and personnel problems from the beginning – the assisting doctor was a half-hour late, they lost suction right after the second incision, and so on. Afterward, both doctors commended me for maintaining my composure and keeping my ex-wife calm. My only thought was this: What else was I there for?

In that clinic in Baja, as I gowned and scrubbed up next to the doctor, I remember wondering how many deliveries he ever made by Caesarian section.

A half-hour prior to that evening in February of 1993 I was in a supermarket near the clinic and it was raining harder than I have ever seen. Water was coming through the light fixtures, as if the roof served no purpose at all. Back in the clinic, as I finished scrubbing, I could still hear the water pounding the roof and I worried as much about getting my wife and my new daughter home as I did about anything else. We entered the birthing room and the nurse took sight of me and blushed. I didn’t speak much Spanish but I did understand the doctor telling her that it was common and often expected that Americans be with their wives during the birth. The nurse would have none of it, she left while Rocio crushed my hand during transition, and only re-entered after Anna was born, quickly taking my daughter into another room to clean her up and take her vitals.

The rain never let up, and a few hours later with a healthy baby and a healthy wife, I was ready to get them out of there and take them home, up the hill and away from the flooding. The doctor would not even remotely entertain the notion, that it was customary for the mother and infant to remain at the clinic for twenty-four hours. We argued. One point that came up? I still owed the clinic one hundred dollars, which I was not scheduled to pay for two weeks. We argued some more. Finally, a younger doctor just beginning his shift intervened on my behalf, and we avoided the worse flooding in Tijuana in over fifty years, safe and up the hill, watching the catastrophe unfold over the next few days on the local news television programming.

* * * *

My second experience with a doctor in Mexico was more benign - it was a simple matter of having a common cold. I was in the doghouse of the owner where I worked for reasons that now escape me, and when I called in, my boss recommended I get a note from a doctor or there would be hell to pay. That office was also rudimentary, featuring a ceramic tile floor and sparse furnishings on the second story of a small cinderblock building next to a restaurant and a hardware store. The doctor barely examined me, and fifteen dollars later I had a prescription for antibiotics and a note in Spanish excusing me from work until I felt better.

It was recommended that I fill my prescription right downstairs, because apparently the doctor also owned the pharmacy underneath his practice.

I took that note to work the next day and nothing was said. While Rocio and Anna visit the doctor here in Baja regularly, the last time I had been to a doctor in Mexico was perhaps fifteen years ago. I didn’t look forward to last Saturday. I was sure that I would find the same dusty plastic plants, old, worn, and dirty chairs left over from some newly remodeled business office from twenty years ago, and diplomas hanging on the wall touting achievements from places I’d never heard of.

* * * *

I showered and dressed not thinking twice about my dirty old tennis shoes and dusty cap, grabbed my cane, and Anna accompanied me because she knew where the doctor’s office was. We left early at Anna’s urging because apparently there would be many forms to fill out. With Anna handling the money, we took a route cab to Zona Rio and then a metered taxi to an office right across the street from Tijuana’s General Hospital. The office was immaculate. The chairs – and there were plenty of chairs – were practically new. The entire office, including the large contoured counter, was as modern as was anything, anywhere. Anna presented them with my insurance card (I didn’t even know I had an insurance card), and I signed a small digital screen. There was no paperwork to fill out.

Rocio came directly from work and met Anna and me as we waited briefly and then a nurse called me into a room and took my vitals. My blood pressure? "Good, very good," she said, rattling off numbers that made no sense to me. I returned to my seat in the lobby and Rocio asked me my weight. I couldn’t tell her, since it was taken in kilograms and I paid no attention. I was then instructed to wait in exam room three, and took Rocio with me in case I needed a finer translation than I was capable of relating.

The hallways were spotless, and the small exam rooms were immaculate and fully stocked. In a minute, the doctor arrived and I explained what was wrong. There was ten minutes of questions, and he listened attentively. We chatted briefly about things unrelated. He noticed my black cap, which sported the fleur-de-lis embroidered in gold with silver and black trim.

"Saints?" the doctor inquired.

"They’re playing right now," I said in Spanish.

He then recounted a recent trip to New Orleans, a trip that he very much enjoyed. That doctor put me more at ease about everything than any doctor I’ve ever visited, save for one specialist I had when I shattered my heel bone over a decade ago, a young Stanford graduate that I credit very much for my ability to still walk normally. At least, before this latest thing, whatever it was. I was made to de-pants and wear a silly paper gown, and the doctor immediately came back in and examined my leg, comparing the injured one to the non-injured one.

"The good news is that there is no obvious signs of a stroke," the doctor said. I was relieved.

He ordered a lot of tests, including a Doppler ultrasound, whatever that is. "These tests will find any blockage in your circulatory system, if such blockage exists," he said. "Go Monday. No drinking or smoking forty-eight hours prior to the testing."

Rocio cringed. She knows me all too well.

* * * *

We sat at the bus stop outside of the doctor’s office and I lit a cigarette. It was two-thirty, which was the exact time of my appointment. I was finished with that doctor and I knew the next one would be a specialist of some sort. At some point. I had no designs on getting those tests done on Monday. Rocio knew it. I exhaled smoke onto a beam of sunlight reflecting off of the windows of the hospital across the street. Eventually, we piled onto the bus to downtown Tijuana.

"I haven’t had a drink in over a month," I told Rocio. "I’m going downtown and watch the Saints game and the game after that. I’m going to have a few beers and talk to the friends I haven’t seen in several weeks. Then I’m going to get some tacos de chile rellenos and bring them home. This is the last sunny day for a while, and I’m going to enjoy it."

Rocio slipped me twenty dollars.

By the time I managed to navigate Centro de Tijuana on a cane, avoiding the cracks and holes in the old sidewalks, I walked into the Perico tired but happy. Scott and Jody were both there and the Saints were in full control of their game. The world was right again, at least for that afternoon and into that evening. The beer tasted friendly and helpful, like good medicine. The pain in my leg didn’t matter for a while.

The Doppler ultrasound will still be there, even on a rainy day such as this.