Part 1:

After nine years of a pretty healthy life style in Costa Rica, I decided to join a Medical clinic – Coopeagri just as a precaution. I reasoned that with the approach of my 75^th birthday it only made sense to get a regular physician. In all the time I had lived here I had only a couple of bouts of bronchitis or pneumonia – but nothing else. I credited my strong body and Costa Rica’s healthy food and air.

Immediately upon introduction, I liked Dr. Allen. He spoke nearly fluent English and was straight forward and kind. His Cuban ancestry and training sealed the deal. Always in his presence I felt cared for, which was such a welcome relief from some memories in the US of long ago.

My life was full–completing the gaviones wall and new yard followed by three Intensives.

One morning I photographed the Reina de la Noche flowers in my yard along with the red leaved plants and thought to myself that it was beautiful. Still there was a discordance in the beauty – several opposing energetic crossings among the leaves and petals. I wondered about it….and I even painted it.  I called the painting, “Cross Purposes”

A few months after I joined the Clinic I found myself wondering about a persistent cough. I thought it was likely nothing, but decided that it would be prudent to see Dr. Allen in June, 2017 and hoped I wouldn’t feel too embarrassed when he found nothing.

A Lung Issue…

After he listened to my lungs, he said that he didn’t like the ‘crackly noises’ he heard. He suggested a chest X-ray and when I replied that I would do that next week, he countered with a directive of ‘Now”. I explained that I wasn’t sure how to get to the medical x-ray facility – and he again responded by drawing me a simple map. I was to get the x-ray and then bring it and the Radiologist’s report back to him this afternoon. Several hours later he was prescribing antibiotics for what appeared to be pneumonia opacity in my right lung. After a week of antibiotics, he was still concerned about what he was hearing and I had three more days of antibiotic injections. I seemed better and I felt grateful.

After the pattern that included the cough, X-ray, and antibiotics that didn’t seem to have an immediate affect repeated itself six months later, Dr. Allen became concerned and told me he wanted me to see a Pulmonologist in San Jose.

So – very soon I was off to San Jose on the first of three trips with Billy driving my car over the Cerro del Muerte (Mountain of Death). Don Quixote came to mind when I first glimpsed Dr. Rojas at Clinica Biblica. French braided pony tail, boots and with the most direct manner through clear blue eyes, he asked me and my companions – Billy Vargas and Brenda Roberts which language we would prefer: English, Spanish or German. I selected English. After an exam and a look at my x-rays from San Isidro, he expressed doubt that I had COPD, which had been diagnosed based on the X-rays by the Radiologist. He then set up several lab tests (blood and sputum) to be finished off with a CT scan before we left the city for home, 3-4 hours south. We also set up a follow up appointment for the next week on Wednesday the 2^nd of May– to review the tests hopefully for a diagnosis. We finally got home about 15 hours after we had begun….

The realization that this lung issue was more complex and difficult to diagnose wriggled into our consciousnesses. The next day son, Tim called and said he was coming to be with me for about a week – and would be able to be with me for the upcoming appointment with Dr. Rojas. Of course Billy would again drive us to the city. I resisted initially but felt such a surge of calm once I knew that Tim was coming. I knew there would be evenings relaxing on my front porch with gin and tonics as we talked into the night.

May 2 began just after sunrise with Billy driving my car over the Cerro del Muerte for our early appointment with the Cardiologist, Dr. Aquilar. We stopped at the top to have breakfast at Chespiritos – my most favorite place at 10,000 feet! Fritatas, gallo pinto and arracache with fruit juice. Again the gracious welcome at another doctor’s office. With several women in the office it was almost impossible to figure out which was Dr. Aquilar until she introduced herself. The echo cardiogram was fascinating to watch as she studied and surveyed my heart visually through sound waves. I heard it steadily thumping and swooshing and watched an essential part of myself that I never see.. Upon finishing she announced that other than a mild aortic stenosis this heart is perfect! I felt relief! My lungs had not adversely affected my heart.

Hours later after lunch at an Argentine restaurant we waited for Dr. Rojas in his office on the fifth floor of Clinica Americana. He reviewed what we now knew through the tests, CT scan and echo cardiogram. There were no bad bacteria found in my lung fluid ruling out the supposed pneumonia I had been treated for in April. This explains why I didn’t respond to two weeks of antibiotics. Instead, my lung diagnosis is Interstitial lung disease (ILD) which is a group of lung diseases that affect the interstitium (the tissue and space around the air sacs in the lungs). The membranes in the lungs become thickened with scar tissue and the treatment is to prevent the membranes from getting any thicker. Often the causes are unknown. But this is a progressive disease for which there is no cure. Still, there can be treatment if the specific type of ILD is identified. For this a lung biopsy is needed, which will entail thoracoscopic surgery (surgery between the ribs). Here in Costa Rica there are only 3-4 surgeons who can do this procedure and they are in San Jose. A pathologist can then determine the type of ILD so we can know if it is treatable (through steroids or anti-inflammatory meds). Because my lung function is pretty good at 77%, Dr. Rojas recommends the biopsy and recommended a thoracic surgeon in San Jose. Dr. Guido.

So we didn’t get a final diagnosis and prescription, which is what I hoped for. Instead – we were told that more was needed to find out which of the 80-100 different interstitial lung diseases I had. Overwhelmed with complexities, we needed some time to talk and think. Which is what Tim and I did over the next few days before he returned to Seattle.We had to understand all our options here in Costa Rica.

In Costa Rica there are two medical systems. Caja (which is Nationalized health care) and Private care. I have Caja coverage, which would make my use of the system free or nearly free. The problem is that there may be only one Thoracic surgeon in the Caja who is trained and able to do thoracoscopic surgery – and the delay in treatment may be longer than is advised. So – the next thing to do was to make an appointment with Dr. William Guido, Thoracic surgeon at Hospital Bibllica in San Jose. May 15 was the date and Billy would drive again over the Mountain of Death!

We had no idea what the biopsy and private hospital stay would cost and I had little savings. Tim could arrange to cover the costs but would need to be paid back. An idea surfaced,

What about a painting sale to raise the money needed for Medical costs? After all, I had well over 100 paintings in various stages of completion just waiting in my indoor office cabinet. What if…I got the paintings together (say 75 or 80), finished those that needed finishing and then got them all photographed for sale?, And what if it became a family affair? Tim and Mike could take them back to Seattle in July, and then Jay could design and put together a Medical Painting sale web page with photos of each painting?  And then we would need to get help for Tim to mail out each sold painting.  Could we do it?   By the end of my time with Tim, we were already moving forward on the Medical Expense Painting Sale with local friends helping and two Seattle friends who volunteered to be the Seattle Shipping Service! I set up my indoor studio!  Thank you for the refocus, Tim!

But first we had to do our May 15 appointment with Dr. Guido in San Jose. Once again – a familiar drive over a familiar route over the Cerro Muerte with Billy in the driver’s seat.

Dr. Guido,was young, attentive, fluent in English, and acted as if he had all the time in the world to talk with me, reassure me, and explain to me what would be happening in the biopsy. He went over the costs, line item by line item including the expense of the staples that would be used in the process and promised that he would have the costs for each of the two private hospitals so I could select – CIMA and Biblica. It would be between $9 – 12,000. But the most important thing he said that afternoon was, “Jan, I will never lie to you and I will tell you everything that is going on. And I will not let you down. I’ll be there when you need me before and after your surgery.” I could tell that he meant it. Billy liked him too – because he grew up on a farm in Liberia, a very small town in northern Costa Rica. He was a man ‘of the people’.  We scheduled the surgery for July 25 and felt confident that I would be ready, willing and able.

The visit with Dr Guido helped me refocus on my preparation for the lung biopsy, I decided I needed to exercise more. After all, my Achilles tendonitis was not getting worse, and maybe I could resume taking the dogs on a short morning walk again. I began on Sunday morning and managed to get as far as half of what I used to walk. Seurat and Frida were ecstatic. Two days later I did it again, and went further – pushing myself beyond the pain. The following morning I realized I might have overdone it as I limped through the morning chores. While opening the back door, Seurat suddenly cut in front of me and I started to trip – grabbing the door frame. The jab of searing hot pain along my Achilles let me know that I was in trouble. I rested and iced my ankle off and on the rest of the day and ominously wondered what had happened.

Now, on top of my lung issues I had a foot issue….Oh boy.

Achilles Tendon issue:

I needed to know what had happened and what to do about it. While I was researching Orthopedic surgeons in San Jose, Billy was talking to folks he knew and surprised me with an announcement that he had made an appointment for me with Dr Hernandez for the following Tuesday. In fact, he had already interviewed and approved Dr. Hernandez. Referring to him as Dr. Mario, Billy reported that he was trained in Cuba for Orthopedic and trauma surgery, had twenty years of experience, was highly regarded in the community and was actually about to open a new hospital right in the center of downtown San Isidro. Okay. We’ll stay local.

While I waited for my appointment with Dr. Mario, I limped around my house with a re-located cane while icing my Achilles heel several times a day. Apprehension was seeping into my mind along with Denial.  Perhaps I had just bruised my Achilles tendon?

Again, refocusing on something more positive, the art show came to mind and my close friend Jill came to the rescue. We spent a day going through the huge pile of paintings and sorted them into four categories: (1) Not good enough; (2) Needs some finishing/cropping (3) Ready to sell (4) Private collection – just too precious to part with. Everyone has a superb skill – and Jill’s is her mastery of organization. Added to it, she is an artist – with an eye to match her skills. While I sat mostly on the couch with my left foot elevated over a bag of crushed ice on a pillow – she was like a whirlwind! And we already had a date for the following week, to follow up – right after the appointment with Dr. Mario.

On May 19 Billy helped me into a somewhat hidden office just down the road from the feria. There I met Dr. Mario, a friendly, tall and direct man in his late 40’s with rapid Cuban Spanish that even Billy had some difficulty understanding. He listened to my history and then verified, through a sonogram that I did indeed have a ruptured Achilles tendon. He went on to say that I needed surgery right away. When I asked what would happen if I elected not to do surgery, he replied that I would be walking unsteadily, flat footed and in pain. And that I would be at risk for another fall – and the next time it could be a hip fracture, a shoulder fracture or a head fracture. His words shocked me out of denial and into agreement to  schedule surgery for the following Monday – 6 days away. May 25, 2018. Yikes! Another surgery. I would have just two months to heal and be ready for the Pulmonary biopsy.

The rest of the week was spent in a dizzying array of ‘must do’s’ – that began with arranging with Tim to add the $3200 I would need for the surgery at the brand new hospital, Las Americas that was being built by this energetic and Cuban Orthopedist. Jill jumped in to begin arranging the 24 hour/day care I would have to have for the 4 weeks following the surgery and a call was put out to arrange for needed furniture and equipment. By the end of the week I had a raised toilet seat, a wheel chair, crutches and best of all – a knee scooter! I spent a part of each day practicing…. I would be off my left foot in a solid cast that pointed my toes for 4 weeks after surgery. Unable to walk, drive or move about much, I felt the fear of being trapped in my house as surgery day approached.

May 28: Surgery on my Achilles Tendon

I managed my last drive down to Billy’s on Monday afternoon – using the heel of my left foot for the clutch. Billy then drove me to Las Americas where I had a scheduled blood test with a Cardiologist, another Cuban who called himself Dr. Denis.  He was jovial, kind and affectionately patted my head and cheek for reassurance. The tests were good and I was okayed for surgery. We waited in a room with all the latest technology that operated the bed, the TV and other communications. Just after 4 p.m. Dr. Mario appeared and said we were just about ready to go! Dr. Denis came into my room to tell me he would be assisting and all would be well. Then he patted my head again and smiled.

I woke from surgery seeing the eyes of Dr. Denis over his mask and a thumbs up! After a little wait back in my room, I got to see my new cast – a vivid, almost surreal green and one I swear I would never use in a painting. Oh well – green is for healing!

The 4 weeks of recuperation begin

Looking out onto four weeks of not being able to walk or even allow the cast encased left foot to touch the floor is nothing short of daunting. And into it we charged – me in either a wheelchair, on a knee scooter or in an office chair with wheels….

 

The first day was spent with Jill and Anita working out the kinks in a home care system.  We would depend mainly on Anita but fill in with friend volunteers to give her some breaks.

There were a few issues to resolve or figure out how to deal with:

• one step up to the kitchen and bathroom in m house
• small rooms with not much space to turn around
• two dogs who needed to be let out through the kitchen to run several times a day
• a parrot, Sage – used to being fed from the outdoor aviary that was up four steps from the yard.
• Breakfasts, lunches and dinners
• Managing bathroom challenges including showers

We made decisions about each which resulted in a more or less functioning schedule. It would have been impossible without friends who came for a few hours or sometimes overnight. Other friends loaned vital equipment for recuperation – a commode that was installed into my bedroom next to my bed, in place of a recliner, etc.

Recuperation in the Cast.

Approaching the 28 days of disability while my tendon healed inside the cast, I wondered how I would react. My immediate emotion was fear of being trapped in my house, trapped in a body that could not move without careful thought, planning and necessary equipment. I was also fearful of being so dependent upon others – friends, family and Anita and Billy. I knew and understood the sacrifices others were making for me and knew that I had to receive their kindnesses well. For a fiercely independent woman, this was a new and initially terrifying challenge. And I had to find a way to stay positive.

Fortunately, my two great passions – painting and writing provided the path.

The writing was already in process as I was slowly working on Notes in the Night. Though I couldn’t immediately jump back into Chapter 9, I found it really steadying to begin writing about the Transition I was moving through. I had no idea how or even if these words would find their way into my writings, but there was a therapeutic effect when I turned my focus away from my physical body into the creation of word flows through a paragraph. Even though the subject was my personal predicament – there was a relaxing resonance in simply writing. I was processing the event while enjoying the lovely an difficult roll of words and word choices and rhythm…. The writing was giving me a cushion of respite from my physical limitations and impatience.

Painting would become my other creative antidote. The idea was to use my indoor studio table. But would I be able to paint there – without students?  For 35 years I had painted mostly in a teaching mode – focused on the lessons I could help explain with my brush as well as my words. This was entirely different!  Could I do it?

During one of those first 10 days, I found out. Anita wheeled/pushed my office chair away from my computer across the living room and into my studio – and I selected a half done painting of an iguana. With a few iguana photos from my photo box as reference, ‘I knew I had to finish the background in order to see if the painting could be rescued from the ‘To finish’ pile. It was a tentative beginning – but it was significant. I had painted without a student present and I had also enjoyed the process – allowing the intuitive nudges of my mind, through my eyes to suggest the next stroke. It was the break through that I needed.

Slowly I moved into a schedule of sorts that left some time for me to venture into creative breaks – painting or writing.

 

 

 

 

 

 

Creativity as an antidote for frustration and despair

 As I began finishing the paintings I got excited about the process.  Always in my workshops and Intensives, I wind up with no time to really finish what I started – and I’m often too tired after the event to even think about finishing.  Now I was doing it.

The 28 days moved along, painting by painting and word by word.

Challenges Along the Way

Perhaps the most obvious challenge I found along the recovery path with my casted left lower leg was physical. I had to accept the limitations that came with relying completely on one leg. As bipeds, we hardly think about the fact that we use both our legs in most things we do: walking, jumping, moving instantaneously to reposition ourselves and even things like turning over in the bed at night. The use of our two legs leaves our hands free for all the things we find to do. So it was immediately apparent that getting about on one leg would be challenging.

I don’t know what I would have done without the knee scooter! With my left leg bent at the knee, I could keep the casted lower leg and foot off the ground and move about on four small wheels and my right leg. I managed though at first still needed help transitioning from the scooter to any chair, toilet seat or bed. After two weeks I could master most all of them but still needed help getting into and out of the shower. Anita became an expert at this.

We discovered early on that the only bathroom I could use was in Frank’s house. The shower there had enough room for a plastic lawn chair placed below the shower head and room still for the knee scooter, that would get me into and out of the chair. It was still tricky and required that I back the scooter into the bathroom past the sink and toilet and then had Anita help me lift the two rear wheels over the raised 6 inch tiled shower edge so I could then shift my weight from my right leg to the left and step over the edge…Whew – then – into the chair. And that wasn’t the end of the shower ordeal. After all clothes were off and the cast covered in plastic and taped closed, I had to turn on the hot and cold shower knobs that worked in opposing directions for on and off.   It was pure Tico style with no plumbing consistency. In addition, I was doing it behind my back from a seated position that I couldn’t change. I had a choice. I could first turn on the hot water which would spurt an initial blast of cold – and then wait to add the right amount of cold to it. Or I could begin with the cold. For me, the promise of warm was better than the blast of cold though I risked a few scalded seconds. Eventually – ahhhhhh.

The Cast Comes Off  – June 25

Finally, the 28 days or 4 weeks time was up and I was eager for the appointment in town with Dr. Mario. Everything upbeat to his office as Billy and I did the few errands that I needed – groceries, getting cash from the ATM machine, etc. Finally, at four, we waited for Dr. Mario at his office. In short order I was helped and partially lifted onto the examination table, face down while Dr. Mario went about cutting off my 28 day cast that bore some of the ravages in cracks and chips even though we tried our best to keep it clean, covered in the shower and never touching the floor.

There was some bad news. A significant infection of a couple of inches long had taken over and opened a part of the stiched wound over the tendon. This was a definite set back. As Billy watched, the doctor proceeded to clean the open wound and apply antibiotic ointment. It was quite painful and I held tight to Billy’s hand. Suddenly it was too much for Billy, who required some attention to prevent him from fainting.

Bandaged, Dr. Mario directed me to flex my foot and I was surprised that I was able. I was directed to put my foot on the floor at home, without putting weight on it – and to flex my foot as often as I could. I returned home to flex.

That night two friends who were healers contacted me, along with my son Jonathan and all asked permission to do some energy work with me the following morning. Long distance. I agreed and gave permission. All day I continued to use the knee scooter to get about but sat in each chair with my foot on the floor. While resting, I flexed and flexed until I could do it fairly easily without pain.The next day I continued flexing and waited for my afternoon appointment. Billy arrived on time and we headed in to see Dr. Mario.

All i can say is….Never underestimate long distance healers, Cuban doctors and an old woman!

After yesterday’s visit to get the cast removed and the discovery of a significant infection in the wound over my healed Achilles tendon, I was prepared with my list of questions for the visit to Dr. Mario.  Billy carried the two boots we had (one short one borrowed from a friend and one that I purchased that was quite tall but with an adjustable inclined foot rest to accommodate my foot that had been locked in a pointed toe position for the past 28 days after the surgery.)  We were ready. I sat in the wheelchair.

Doctor Mario breezed by and into his office with an armful of ointments and creams and the artificial skin he was thinking he’d use on the wound.  He asked if I had practiced flexing and unflexing my foot and I showed him – yes, and no pain.  He looked pleased.  Billy then told him I had questions and he turned to listen, replying to each in his usual manner with few words.

• Do I need an oral antibiotic to help with the infection?  Ans.  No.
• Could I have some pain relief before he cleans my wound this time?  Ans.  It won’t be needed.
• Is now a good time for me to call a physical therapist?  Ans. No.
• How will the artificial skin help the infection healing?  And with that he motioned me to get up on the examining table – on my stomach so he could treat the wound.  Billy pushed the wheelchair close and Dr. Mario put a step stool in front of me to use to get up. I stopped because it would mean I’d have to use my healing and bandaged foot, which I’d been warned not to put any weight on.  Clearly he meant for me to use that foot since I certainly could not hop that high. So that was it.  I stepped up. My first step. And it did not hurt.

I couldn’t see what he was doing, but Billy explained that he was delighted about the healing that had occurred over 24 hours.  I didn’t tell him that three long distance healers had helped and I silently thanked each of you (you know who you are). After applying an antibiotic gel and some unspecified cream, he bandaged me up and by the time I was sitting up waiting for the next news, he was already fitting the smaller boot to my foot and fastening the velcro.

Finished,  he stepped back and encouraged me to walk during the day but to rest with the boot off and to sleep without it. I took three steps in the boot to get back to the wheelchair and he had already gone out into the waiting room saying he would see Billy and me in two days in order to change the dressing.

I think I was in a surprised shock most of the drive home. At home, Anita and Billy brought out a walker for me to use to walk slowly into the house…

Gone were all the preparations I had made after copious research online – about boots, inclines, preparing to put weight on my foot, etc. etc.  And all that was left was me – an old woman struggling to catch up with the long distance healers and the Cuban doctor!

And Seurat is still the nurse in charge at home….Such a blue healer!

And then – more changes. More transitions

But we were not out of the woods. Upon the next Dr’s visit I found out that the infection had resumed and was worse.  For the next week I saw Dr Mario daily as he treated the infection vigorously.  He was clearly disappointed.  I was put on oral antibiotics and saw him daily – which included painful scrubbings, treating with antibiotic spray and packing the open wound with a special gauze dressing that would help drain the wound.  Then it would be bandaged again for 24 hours.  It was the worst and most painful week ever.  And added into the mix – Seurat suddenly collapsed and was unable to walk.  A good friend Randy took him to the vet and we started him on prednisone along with meals 4 times a day, which I administered in my office. Time would tell whether this was an inner ear issue that would resolve or a neurological decline in my 15 year old best pal.  This was my most difficult week all around.  Seurat showed me the way.  Though he struggled to get around on wobbly legs and a tilted head, he kept trying.

Then it got better

Healing continued with Dr. visits every 3-4 days for the next month. I knew and appreciated the help from various friends who were connected in the healing arts…   At one point, Dr. Mario confessed that he could hardly believe how well and fast I was healing! I just smiled. Finally, I had to just ‘let go’ of any idea when my wound would be healed enough for me to begin wearing the boot and learning to walk again. I had to be in the place of just not knowing…

Moving into July, my focus was entirely focused onto July 25 –  the scheduled pulmonary biopsy which would happen on the morning that sons Mike and Tim arrived in San Jose for their long scheduled visit. They would be my care team after surgery….

Stay tuned for Part II