In early 2018, two separate and debilitating medical issues suddenly appeared, each requiring immediate surgery. And each would also involve a lengthy recovery period. Because my life was turned upside down, it became very important to me to understand what was going on. Writing has been my tried and true means to understanding but it has been more difficult this time. One essay became two and then three as I kept discovering more layers of thought. Emotions. And healing.

My first reaction was shock.

Since my arrival in Costa Rica 10 years earlier, I had had no serious medical issues. The titanium cage in my spinal column that repaired my staph infected laminectomy from 1997 had apparently worked well and I had no residual pain or problems. To stay active and healthy, I was mostly careful about what I ate and walked my dogs about three times a week. Everything was Pura Vida.  Until it wasn’t.

The first medical issue began as a puzzling, but seemingly minor cough. When it continued into the early months of 2018, I checked in with my doctor, Dr. Allen here in San Isidro, my city. Affable, with a big smile, my Cuban trained doctor listened intently with his stethoscope and suggested X-rays because he didn’t like what he heard in my right lung. When two rounds of antibiotics for pneumonia didn’t stop the cough, Dr. Allen persuaded me to see a Pulmonologist in San Jose – 3+ hours north over the mountains. There were no Pulmonologists in San Isidro. And that began the further investigation via Dr. Rojas that included various blood tests and CT scans to finally get the diagnosis of ILD – Interstitial Lung Disease.  ILD is a group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs). This progressive disease could not be cured but its progress could be stopped if we knew the specific ILD. The only way to find out which ILD of nearly a hundred different ones required a lung biopsy. A surgery.

The date for the biopsy was set for late July, when two of my sons would come to Costa Rica for a visit and to be able to help care for me post surgery. We decided that the surgery would be in San Jose at Hospital Biblica with a recommended Thoracic surgeon, Dr. Guido. Again there was no Thoracic surgeon in the southern zone where I lived and the wait through the Caja, or National Health Service would be too long. The private care surgical expense would amount to around $9,000 and would initially be covered by son Tim’s credit card. My job would be to figure out how to repay the debt and to prepare myself for the surgery. I breathed a sigh of relief. It was early May and I would have it figured out by the end of July.

And then the next shoe dropped, almost literally.

I rushed to open the back door for my dogs – and Seurat cut in front of me. I tripped and pitched forward, able to catch myself against the door jamb so I didn’t fall completely to the floor. But I felt the searing jab of pain at my left Achilles tendon. Deep gulps of air with my head and arms on the kitchen counter carried me through the agonizing wave of pain. I wondered briefly if there was a chance I had ruptured my tendon. It wasn’t out of the realm of possibilities since I had been coping with a persistent tendonitis for nearly two years and become accustomed to limping. Now it really hurt and I was scared.

I thought about going to the local emergency room available through the National Health system that I was a part of, but my lung vulnerability suggested I stay away from waiting rooms with potential respiratory contagion. I began inquiring about orthopedic surgeons in San Jose although I really didn’t like the idea of more ‘over the mountain’ long trips for appointments, surgery, etc.

A few days later my Tico ‘like a son’ Billy insisted that I see a local orthopedic surgeon. He even took it upon himself to interview Dr. Mario Hernandez before making an appointment for me. Dr. Mario was an orthopedic/trauma surgeon in high local regard among the local Ticos. From Cuba with twenty years of experience, he was in the process of opening a private hospital in town that was so needed. Two days later I was sitting in his office.

Dr. Mario performed an ultrasound test and stated that I needed immediate surgery to repair the ruptured tendon. Though I was still clinging to Denial and a hope that my tendon wasn’t ruptured he convinced me by carefully placing my own thumb into the significant gap between the ends of my left tendon. I felt it. After several talks with Billy and son, Tim via WhatsApp I agreed and accepted Dr. Mario’s assertion that without the surgery I would not walk again normally.

As it turned out, I would not walk again for 3 and a half months. Normal or not.

On the evening of May 28, Billy drove me downtown to Las Americas hospital for the two hour surgery. My left lower leg was encased in a grass green fiberglass cast with my foot extended into a pointed toe position. The directive was to not to let my toes or casted foot touch the floor – and return to see Dr. Mario in a week. I was helped into a borrowed wheel chair and Billy drove me home. It all felt surreal, almost like a dream. I was still in shock.

For the next four weeks I did the best I could without walking. My friend Jill arranged scheduling for help from close friends and Anita, my ‘surrogate Tica daughter’. And I slowly learned how to manage my limited mobility using a borrowed knee scooter or my office chair. Crutches didn’t work for me. My days and nights were spent sitting or lying in bed and my only activities were rather clumsy transitions from bed to scooter to chair. I hated my total dependence on others for all the things I’d done myself as a single person living alone. But now all I could focus on was the slow count down of the four weeks to cast removal time. All I could think about was beginning to walk again.

On day 28 I was elated. Billy wheeled me in to Dr. Mario’s office. As the cast was removed, the mood in the office suddenly shifted from upbeat teasing to tense concern.

There was an infection.  Uh oh.

Now, in addition to the healing tendon, the surrounding incision site would have to be treated and healed, from the tendon to the skin surface. From the inside out. I had no idea how long it would take for this wound to heal. But I was about to find out.

Dr. Mario was up to the task and began a 3-½ month process of two to three times/week cleaning, treating and bandaging. Billy always accompanied me – for support and translating Dr. Mario’s rapid Cuban Spanish. And so it progressed, office visit by office visit. Although I was told that my advanced age of 75 further slowed the process, there were usually incremental evidences of healing each time the bandage was removed. And always I hoped to hear Dr. Mario say, “Excelente!”

In order for a wound to heal after infection, it has to be cleaned completely and all dead skin or tissue removed. So the healing process at the beginning was painful as Dr. Mario scrubbed it and cut out dead tissue. Because of the infection, no anesthetic could be provided and I clung tightly to Billy’s hand while Dr. Mario scrubbed. We saw him every day during the first week and there was one time when the doctor had to stop treating me and turn to Billy, who was about to faint. But by week three, they were seeing some progress. I wasn’t ever able to see my wound because of its location though Billy offered photo glimpses through his cell phone. Slowly, slowly the deep wound was filling in with granulation tissue. It would be over another month until stitches could be applied. And much longer still to complete healing.

During the three plus months of wound healing, I was again told not to put my bandaged foot onto the floor and to rest often with my foot elevated on pillows to reduce swelling. The borrowed knee scooter that had been my companion while I wore the cast continued to be my mode of transportation around the house once. Because of the layout of my Tico house, with its small rooms and a one step up to the kitchen and bathroom, I needed help around the clock for food preparation and so much more.  I could get by on my own for a few hours if I was lying in my bed with my foot elevated. Various friends stepped in to take shifts with me while Anita took over most nights and several days. She helped me shower in the only bathroom I could manage­­–in Frank’s house across from my front porch.

We had a well rehearsed routine. After I backed the knee scooter into the bathroom, she helped me undress and move to a seated position in the plastic chair in the shower. Then she secured the top of a plastic bag over my bandaged foot with two strips of masking tape and then waited for me to minimally manage my shower and shampoo. She also helped me get dressed since it was difficult for me to pull up pants or underwear while standing on one foot. Hopping was not an option. Someone suggested getting dressed while lying down. My reply…have you tried to do that?  A bedside commode helped me during the night and if I needed Anita for anything I would call her cell phone and hear her immediate response from Frank’s house, “Voy”. (I am coming).

It was a very difficult and emotional time.

Mostly I tried to fill the time with distraction: reading, watching television, resting and talking with visitors. There were some times when I painted, foot elevated next to my painting. And there were times when I wrote, mostly about my experience.

But it was awhile before I could understand that there was much more going on inside my mind and heart while my wound healed.

My mind was mostly occupied with issues on the surface of life during this time and my focus on when I would walk again. I found myself stuck in a reactive mode to whatever was needed in a particular moment. Because I was still the person in charge at my house, Often I became preoccupied with worry. I couldn’t get into the kitchen but I needed to make arrangements for someone to bring groceries. I couldn’t feed my dogs but I still needed to make sure they were fed. Anita still took her directions from me because there was no one else in charge. And so my mind continued in a worry loop. Was my foot swelling again? Should I rest more? Should I try to rest less? Should I call to make sure ____ was coming today? Have the dogs been fed? What time is Billy coming up for the appointment in town? Are we nearly out of dog food?  I wonder if ______?

I desperately needed reassurance that it was all going to be okay and that I would be walking by the end of July in time for my lung surgery. But there was simply no one around who could know for sure. The healing was on its own time schedule and none of my friends or Tico neighbors could offer advice from an all knowing position.  The best I could do was move through the shock of my demise, follow directions from doctors and just keep going.

Once again I remembered the oft repeated Tico phrase. “Poco a poco”   Little by little. And I danced on the edge of hope that I could manage any bumps in the road ahead. I knew there would be more lessons to learn in this journey through healing.

“If you desire healing,
let yourself fall ill
let yourself fall ill.”
― Rumi

Read More:  Recovery: More than Healing the Wound Part 2 – Letting Go