Jungle Extraction

Once we have made the decision to go to hospital it all becomes a race. We bundle everything into our bags, wolf down a coffee and say a hurried goodbye to a worried Josh, Meg and Marlowe who we are now abandoning alone in the middle of nowhere.

Felipe our hotel manager is full of exciting options: a helicopter airlift out of La Leona perhaps or a private jet charter from that little disused jungle airstrip over in Carate? We are carried along by this for a while – (Menna thinks I’m about to haemorrhage and wants a speedy extraction) but we lose enthusiasm when we understand that this will run to several thousands of dollars which we cannot claim back. There is always the internal flight from Puerto Jiminez to San Jose this afternoon, offers Felipe, a little deflated, I could fly ahead while the rest of the family follows by car. We work out timings and see that although the drive to San Jose will take nearly twelve hours, if we set off now we can arrive about the same time the flight does anyway. It will cost considerably less and we will all be together.

Felipe is disappointed but like a trooper he guns up the quad bike, hitches on the baggage trailer, and drives us back along the beach to Carate at full throttle. It is a hot and exhilarating ride and I forget for a while that I am supposed to be ill, taking selfies and spotting hawks along the way. We then clamber into our car, finding it hot and humid with a strange smell after five days parked in the jungle rain.

We drive three hours back to civilisation, jolting our way through the Osa peninsula over mud-drifts and trenches, fallen branches, rocks and rivers. We make it to Puerto Jiminez by midday and pick up a paved, though heavily potholed road. We then settle into an eight hour drive up to the capital, made much longer by the weekend traffic clogging up the roads into the city.

As long as I am upright I am able to breathe fine. I do much of the driving in a tripped-out half-awake state, while Menna taps up a network of medical contacts, gets recommendations for doctors, digs out insurance details (for several horrific hours we can’t find any record of my policy at all. Did the transaction not go through?). She evaluates hospitals, chats with specialists, books accommodation, checks my stats.

Menna is amazing in a crisis, I think to myself as I sing along to eighties hits on the radio, occasionally spitting blood out the window. The kids are unusually quiet and well-behaved throughout the long journey.

When we walk into Emergencias there is a nurse waiting for me and I am able to sink into the torpor and passivity that hospitals are designed to create. The check-in is like arriving at a hotel chain, they copy passport details, fill out forms, give me a smiling welcome and then take a large dollar deposit on my credit card. Then I get a blood pressure cuff on my arm, thermometer in my mouth, COVID swabs up my nose, cannula into my wrist. Blood goes out, pills go in, radiation goes through. X-Rays and CT Scans show a cloudy view of my inner landscape. Doctors mutter and confer and tell me half the story. Menna asks probing medical questions and they open up fully to her.

This is a well-rehearsed drill that I am familiar with, and as I am poked and punctured, I am able to lazily rate this hospital against various other ones I have stayed in over the years. NHS hospital have a certain flavour: they are bustling, full, usually slightly tattered but with an underlying sense of heart that I always find touching. They have cream walls with scuff marks, overworked stern nurses, those ancient iron wheelchairs, eclectic art, hidden interior gardens, children’s wards with peeling underwater murals.

I once stayed some weeks in an Italian hospital after a road accident, and it had a unique sense of Latin verve – constant bubbling volume, flamboyant and inefficient doctors, crowds of relatives chatting and eating pasta round the bed where grandpa lay dying, barely suppressed chaos everywhere.

The CIMA hospital in San Jose, on the other hand, is silent, clean, new, empty. Its spotless white and grey palette doesn’t seem to reflect the diverse and colourful country of Costa Rica. Everyone here speaks quietly and deferentially and you can’t see any of their features behind the layers of PPE. It feels like a hospital in a sci-fi film.

Eventually I am moved into a room on the top floor, overlooking the mountains. I am given a fetching set of yellow pyjamas. The doctors agree that my lung is full of blood, but they don’t know why, so I stay overnight and go into theatre the next morning for a bronchoscopy: a probe with a fibre optic camera is sent down my throat, deep into my lungs to investigate further.

It turns out that I have ruptured a blood vessel deep in my left lung and it is leaking like a burst pipe. The diagnosis is haemoptysis caused by extreme coughing. The surgeon removes the clots and hoses it all down to stop the bleeding, he squirts in some antibiotics to prevent infection, all while I slumber peacefully on the operating table.

I wake up a few hours later in my room, feeling surprisingly good. I have not eaten for 24 hours and when a nurse brings me a steak and ice cream I nearly burst into tears. It must be the cocktail of anaesthetics and sedatives still washing around my system I tell myself. My room is peaceful, the view is good, I am well rested, I can breathe again. Menna and the kids pop up for a visit, we do some homeschooling but then they disappear again on a mission to the skatepark. I settle back into bed and find a superhero movie on TV.

I ask the doctors if they will let me stay a couple more nights.

A most malicious cough!

Oliver Twist. Charles Dickens.

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