I usually start these posts with pictures of our apartment and a description of the wonders of our neighborhood. But Rosarito was never meant to be an actual destination. It was just the cheapest location close enough to San Diego to be practical, since the entire purpose of being in the area was to attend our daughter Ruby’s wedding the first week of October.

Our apartment was… an apartment, and our neighborhood was kind of industrial and unattractive. We were blessed with a fonda a few blocks away that made the best tortas we’ve ever had, but that represented the neighborhood’s highlight. Honestly, we never even thought to take pictures.

That was more time and effort than we expected, but we also thought we’d be going back and forth just a few times. As it turns out, we underestimated by a wide margin. In fact, we wound up making the full round trip six times, and sleeping just eight nights in our 30 day Airbnb.

What did we wind up doing in Estados Unidos that kept us out of Mexico for all but eight nights? The Medical-Industrial complex attached itself to me and wouldn’t let go. Truthfully, sometimes it’s hard to tell shark from remora.

Soylent Green Is People!

The actual story about my condition isn’t very interesting. Old person has organ fail, harvesting ensues. Whatever. But before the speculation starts (“I didn’t even know he had a heart”), the organ in question was my gall bladder. A glorified appendix. Although I did learn, while I was in the hospital, that no one seems to have a gall bladder. I would say 80% of the folks in my ward, both patients and visitors, were walking about gall bladder-less. Who knew that every day we walk through a world of ghost gall bladders?

What is arguably of interest, though, is how the Medical-Industrial complex dealt with me, with a little cross-cultural observation thrown in, since this escapade started in Mexico. Let’s dig in, shall we?

We were visiting Dorothy’s parents in Temecula, and as I went to sleep one night, I rolled over and got a sudden sharp pain in my chest. It felt like a muscle pull, so I figured I could ride it out. By the time I figured out it wasn’t a muscle pull I was in so much pain I wasn’t rational, or I’d have awakened Dorothy and had her take me to the ER. Instead, the episode lasted about 35 minutes, and I went to sleep when it passed.

When we woke up in the morning I told Dorothy what had happened (“This is why women live longer than men”), and we set out for urgent care. My blood pressure was fine, blood labs were fine, EKG was fine, but they noticed some inflammation in my lungs. I got a diagnosis of bronchitis, a fistful of meds, and a pat on the back.

I’m pretty sure the bronchitis diagnosis was correct. I’d had a lingering cold in Guanajuato that lasted so long we were taking side bets on when the secondary infection would show up, so bronchitis tracked. But I’ve had bronchitis before, and the chest pain I’d had the night before was nothing like bronchitis. I’ve never had a heart attack, but I imagine one would feel much like what I’d enjoyed the previous evening. However, no lingering effects. No numbness or tingling. No more aphasia than previously. When the pain passed, it was over.

If you’re keeping score, this first episode was September 12th, and the urgent care visit was on the 13th. We’d only planned on visiting in Temecula for a few days, so we headed back to Rosarito after we picked up my new meds. That night I had another episode, again in bed, and thought to check my blood pressure (we’re old, so a blood pressure cuff is part of our travel self-sufficiency kit). I didn’t get it right at the onset, but it was 225/83 about ten minutes in. Pretty alarming. So, off to the ER in Rosarito.

I basically went straight from triage into the ER, where a doctor saw me right away. My blood pressure was still super high, so they gave me a medication, a prescription for high blood pressure medication to fill in the morning, and had me there for observation until my blood pressure dropped and I was stable. I think I was in and out of there in under an hour, and the entire suite of services was under $50. This was retail pricing; we’re not traveling with US-style international medical coverage (I explain how we’re managing health care while we travel here).

So back to our Airbnb, with a quick shoutout to our host. Not only did she tell us which hospital to go to, she called a cab, went with us to the hospital, and waited until we were done, just to make sure her translation services weren’t required. We haven’t had any bad hosts in the last year, and we’ve had some very good ones. But that, that was above and beyond. I’m sorry the rating system tops out at five stars.

Sitting in the apartment, waiting to calm down enough to sleep, and another episode comes on. This time I threw on the blood pressure cuff right away: 265/100-something. When I search to find out how bad that is, Google asks me how I can still type, since most of my organs are about to fail.

Back to the ER, less than an hour after I left. They take me right back in, check my blood pressure, and give me one of the meds I was supposed to start the next morning (different than what they gave me on the first visit). I hang out about 45 minutes until my blood pressure is reliably stable and they send me home again. Without, I feel compelled to note, charging me for the second visit.

The next day I had another minor episode, despite being on the blood pressure meds. It lasted under five minutes, and blood pressure was 156/83. Still bad, but better. I guess. Although it felt like if I was being properly treated I wouldn’t be having any episodes. We thought it best to be on the US side of the medical system, so we returned to Temecula. I swear, I think this is where it went off the rails. I’ll never know for sure, but I honestly believe I’d have been better off under the Mexican health care system.

This takes us to the 15th, with no more episodes and blood pressure mostly in the 110s to 130s, with a few peaks at 147 and 151. On the 16th, although still no episodes of chest pain, my blood pressure was stubbornly high, consistently in the 140s and 150s. So, off to try our luck at a US ER.

Not as smooth an experience as the Rosarito ER, but a similar outcome: a diagnosis of high blood pressure and a different medication. Thank you very kindly, you’re free to go now.

The next day, the 17th, I had two minor episodes, both of which had blood pressure readings in the 160s. Another minor episode on the 18th sent me back to the ER. They ran the same set of blood tests and EKGs they’d run before, and discovered that my liver enzymes had spiked dramatically since my visit two days earlier. And thus we had our culprit: the unassuming gall bladder.

Turns out I, and all of the medical professionals, had assumed that the high blood pressure was causing the chest pain. Rather, gallstones blocking my bile duct were causing the chest pain, and the pain was shooting my blood pressure up. Easy, by-the-books solution: they’d clear out the gallstones and remove the gall bladder to keep them from recurring. It seems that once your gall bladder starts spitting out stones it just can’t stop.

So far, so good. The reason I’m drowning y’all in so much detail, though, is because it’s the foundation on which the next part rests. Because this is where it goes south.

After explaining all this, I’m told they’ll be admitting me to the hospital for the procedures. Which seems sensible only because I don’t know how long this is going to take. I spend my first 24 hours on a gurney in a hallway, because they don’t have room for me anywhere else. Even better, food and water are withheld for that entire 24 hours, because no one can definitively answer the question as to whether it’s OK for me to eat or not. Not even fluids are provided. I can just desiccate in the hallway, if you please.

Extra fun in that first 24 hours: I had blood taken eight times. Despite the fact that I had an IV port hanging off one arm. I finally get an explanation from a nurse: some of the blood needs to be drawn directly (whatever, sure), but mostly it’s because they’re sending phlebotomists to draw blood, who aren’t licensed to access the IV port. Has to be an RN. Every time someone approached me with a needle, I demanded a nurse, so they could use the port. And I still got spiked eight times in that first 24 hours. I had the bruises for weeks.

On Day Two, they finally move me to a group ward. Kind of like a cross between sleepover camp and prison. People just keep showing up or disappearing randomly. But an actual doctor does finally pay a visit. So I ask why, if both upcoming procedures are outpatient (removing the gallstones is endoscopy and removing the gall bladder is laparoscopy), I’m in the hospital at all. I’ve been asymptomatic since checking in, so why don’t I just check out and come back for the outpatient procedures?

Up until this point, the barbarity of the care I’d been provided had seemed site specific. Sure, many hospitals are under the same staffing and space constraints, but my treatment had been specific to those circumstances. If I’d happened to have gone to a hospital without those constraints, in an imaginary world where such a place existed (like Mexico), I wouldn’t have been warehoused in a hallway without food and water.

But the doctor’s response to my seemingly reasonable question cast the whole system in a more sinister light, where my treatment represented something endemic rather than situational. His answer was, sure, I could check out. But it would be Against Medical Advice, meaning that my insurance wouldn’t cover my hospital stay (it turns out that’s not true, but it’s not clear whether that was an intentional falsehood or just the thoughtless repetition of a discredited urban myth). And good luck getting on the schedule for outpatient services. That would be weeks, at best (and don’t forget, I have a wedding to attend on October 6th). So if I actually wanted this thing done and paid for, I should sit tight in the hospital until it happened.

Which I did, because, really, what was my choice? Even so, “until it happened” took five days. I was in the hospital for five days to get two outpatient procedures. And if that wasn’t enough, my gift with purchase was a case of Covid (our first, after all this time), which I gave to both Dorothy and her elderly parents before knowing I had it. We cleared protocol with only a couple of days to spare before Ruby’s wedding.

About That Wedding…

There hasn’t been a lot of pleasure in this story so far (unless you count schadenfreude), so I’m going to take a detour before returning to my previously scheduled screed. We were in San Diego in the first place for my daughter Ruby’s wedding to her partner, Layla. It was very hard to keep our eyes on that ball during all the Sturm und Drang, but that was the actual point of our presence.

And, with apologies to my son and everyone else whose weddings I’ve attended, it was the best wedding I’ve ever attended. Bar none. Ruby and Layla are such a delightful couple, they take so much pleasure in one another’s company, it is impossible to be around them without getting a contact high. Everything about the wedding, which Ruby planned out meticulously over the previous two years (wonder where she gets that from), was perfect.

I’m only slightly ashamed to admit that I teared up during the reading of the vows. They were beautiful, heartfelt, genuine, and full of their true playful, loving spirits. We feel… I was going to say “lucky,” or “grateful.” But I think I’ll stick with “we feel.” I’m never unsurprised when it happens.

Here’s a sizzle reel of the wedding, if you’re into that kind of thing.

Don’t Worry, Be Angry…

OK. We were on fire about the medical industry. Let’s not forget why we’re here.

What stood out to me about all this was the difference between the treatment I received in Mexico vs. the US. It’s not a direct comparison, as I only got as far as the high blood pressure diagnosis in Mexico, although I’m certain if I’d stayed in that system they’d have found the gallstones. After all, my first trip to a US ER also ended with a high blood pressure diagnosis.

The Mexican system seems to be driven to maximize efficiency. My first experience with the Mexican healthcare system was for kidney stones in Oaxaca, but there was a part of that story I didn’t share at the time. The doctor had prescribed me 15 pills of one of the medications, but when I got to the pharmacy they were only available in pre-packs of ten each. So they gave me two packs, a total of 20 pills. Five more than I’d been prescribed.

The horror! No one in the healthcare system in the US would tolerate such sloppiness. To say nothing of our broader social expectations that no one should get one more thing than they’re entitled to. We spend more on the mechanisms to make sure that no one who hasn’t earned it gets safety net coverage than we would if we just approved everyone who applied. We’re just dicks.

The US system, unlike Mexico’s, is absolutely, completely, heroically indifferent to efficiency. Frankly, it seems bipolar. On the one hand, the system’s underlying values seem to be accuracy and certainty, which feels like a response to tort risk. We over prescribe, over order, and over treat, to make sure there’s no potential liability. Unnecessary tests and procedures are a major component of our overall healthcare spending (over $200 billion/year by some accounts).

On the other hand, we also under prescribe, under order, and under treat. How often have you had a health complaint effectively ignored by a provider or, at best, under explored? The answer to that depends quite a bit on who you are. White and male? Probably doesn’t happen much. Not white and male? Share your stories in the Comments.

Maybe it’s the difference between being in the hospital (over treating) and seeing your personal doctor (under treating). Maybe the incentives built into our system are in conflict with one another, and sometimes lurch one way, sometimes another. Maybe the US system is just broken in random ways.

So what happens when you value efficiency over certainty? You get pre-packs of meds and over-delivery. There’s no one in a Mexican pharmacy counting pills, filling bottles, checking insurance, printing invoices… They’re just grabbing boxes off the shelves and ringing them up. Could be turkey franks. Getting a prescription filled is near instantaneous, and involves fewer steps and highly paid professionals, so costs stay low. What’s the price of all this efficiency? Occasionally someone gets a few more pills than they’re entitled to. It’s a pretty good trade. One we’d never make in the US.

So why, with that excellent experience under my belt, did we decide to return to the US for medical care? FUD, I suppose. Fear, Uncertainty, and Doubt. Fear of the unknown: walk-in care was inexpensive in Mexico, but how much would hardcore surgical services cost out of pocket? I knew hospitalization was a $90 copay in the US and outpatient services were $320, so our financial risk was capped. Maybe a surgery that would be $20,000 retail in the US would only be $3,000 in Mexico, but that’s still way more than our plan’s copays.

Uncertainty about communication: One of the ER nurses in Rosarito was blessed with excellent English, and translated between the doctor and I. It made the visit manageable. But would that level of translation services be available at every step of the process? Even my visit with the urologist in Oaxaca was largely mediated by Google Translate. That’s a tough way to have to make important decisions.

And finally, doubt about the quality of care. This one stings, because it’s just prejudice. Tijuana is a well-known destination for US medical tourism, specifically because the quality of care and cost advantages are so compelling. Ultimately, this is the concern that brought us back to the US (the fear and uncertainty were manageable). It just feels weak. And having enjoyed five days of the best the US system has to offer, it also feels stupid.

Don’t get me wrong. The quality of the execution of the services provided to me in the US was stellar. My gall bladder is completely gone (I’m told), removed as delicately as current technology permits. But the entire infrastructure surrounding the provision of those services seems intentionally designed to inflict maximum pain and suffering. I know it wasn’t intentional in the sense that every provider I interacted with would have been delighted to have worked within a kinder context. But intentional in the sense that every decision made about the US healthcare system (funding, staffing, payments, business structures, incentives) drives inevitably to the brutality of the system we have. It’s not necessary. It’s the result of choices. We could make different choices and have a different system.

Or we could continue to insist that ours is the best of all possible healthcare systems (despite being first in cost and 75th in outcomes worldwide – looking up the ladder at you, Turkmenistan) and never explore alternative models. Some of which are as close as our southern border.