Brief Update

For all of you who follow the happenings of our retirement here in Panama, this will serve as a brief update.

When I last left you, Larry had been cleared of the pseudomona aeruginosa bacteria and released from the hospital. The infection had taken its toll on the surgical site, however, and no amount of cleansing and rebandaging--which required trips to David every other day for several weeks--showed any sign of its healing. It was just too deep, with exposed bone. The type of surgery required was not practiced by any of our existing retinue of doctors, but, luckily for us, a new doc had joined the staff fresh from an orthopedic residency in San Antonio, Texas. Enter Dr. Juan Carlos Pretto, a young, exuberant practitioner who confidently declared that he could remove skin and muscle from Larry's calf and sew it over the wound on the right side of his foot just below the ankle. Several of the doctors doubted it would work, and Dr. Pretto gave it a 60% chance. But he convinced us that he knew what he was doing and that it was the only alternative to avoid the risk of reinfection and to provide an environment for healing.

So Larry went back in the hospital for a few days and then had a long recovery at home, plus numerous trips back and forth to David for follow-up. Eventually, it looked as though the "flap," as Dr. Pretto called it, had taken, and x-rays revealed that the bones in the foot and ankle had substantially healed. Then another problem arose. The skin was not regrowing on the calf from which the flap had been taken. For a month we washed it with castille soap and rebandanged it three times a day, but a visit to Dr. Pretto last week showed no sign of new skin. So Larry was back in the operating room last Saturday for a skin graft. The leg is now to stay wrapped for ten days, after which will be the big reveal. The big wound and flap, which Dr. Pretto is very happy with, also has not completely closed. So we struggle on, after four surgeries and more than 45 days total in the hospital.

It goes without saying that all this has eaten up the majority of my time, but I did get away with my friend Charly for three days at a nice resort in Boca Chica, about two hours away on the Pacific coast. The package was a donation from the Seagull Cove Lodge to Bid 4 Boquete last December which I had bought and was about to expire. Doc and Larry stayed here so as not to miss any football or golf on television.

Chyna and Kitty Kitty are featured in the 2012 calendar Amigos de Animales de Boquete produces as a money raiser. They are the calendar girls for the month of September 2012 (see photo above). I bought in to it over a year ago with the idea of all four animals (Trudy, Chyna, Felipe, and Kitty Kitty) being preserved for posterity, but alas.

I'm also co-chair of Bid 4 Boquete again and therefore have been very busy with that. We've upped our goal and added some new activities, so there have been meetings upon meetings, all scheduled between trips to the hospital in David.

We're in the thick of the worst two months of the rainy season, and one of the bridges to our section of town is out. The other bridge, on a long loop into town, is marginal, having never been replaced but only shorn up since the big Palo Alto flood. So we're a little nervous about the possibility of being cut off from the world.

It's just one adventure after another.

Mishap, Cruise, and Wedding

As most of you know via e-mails, Larry fell two months ago from a high tee at the Valle Escondido golf course and shattered his right foot and ankle, requiring orthopedic surgery, two surgeons, several days in the hospital, and an anticipated months-long recovery. He was officiating a tournament at the time--not even playing--and was doing a good deed: recovering a ball for a player already shooting nine on a par three in an effort to move the game along. Although he had some pins and plates, he had very little pain and was adjusting well to a wheelchair, walker, and crutches, the orthopedic surgeon felt that he was far enough along in his recovery that I could take my scheduled and paid-for transatlantic cruise. So off I went, after stuffing the freezer with food and arranging for many people to check on him and take him to his scheduled doctor's appointments and sessions in a hyperbaric chamber to speed healing.

In the meantime, and shortly before I left on my trip, Derek wrote to advise that he and Wah Wah were getting married on June 7th while her parents are in the States from their home in Sydney, Australia. So, in addition to preparing for my cruise and driving back and forth to David with Larry for doctors' appointments and sessions in a hyperbaric chamber, I set about making reservations on Solomons Island, off the Maryland coast near Baltimore, where the wedding was to take place.

Also shortly before I left on my cruise, Trudy went into a sudden decline, requiring additional trips to David to a new highly-touted Brazilian veterinarian of the female gender. Following blood tests and an x-ray, she (Trudy) was diagnosed with an enlarged heart and impending congestive heart failure, was put on a battery of medications, some long term and some short, and was sent home with instructions to live as tranquil a life as reasonably possible (not that her life ever has been much more than tranquil).

I never knew so much would be happening, of course, when I agreed to accompany friends Penny Barrett and Betty Gray on the transatlantic cruise followed by short stays in Majorca and Barcelona. But it was a splendid getaway, and I did my best not to think too much about home. This was aided considerably by the Internet and television not working for nine or ten days of the fourteen day cruise. We were "at sea" both literally and figuratively, incommunicado except for printed news bulletins issued periodically by the crew. It was three days after Osama's demise before we learned of it, for example, and we knew nothing of the flooding of the Mississippi until we arrived in Majorca. There was nothing to do but relax, eat, read, eat, swim, eat, sun, eat, play games, eat, . . . .

Larry had some setbacks while I was gone, however, and our neighbor/housekeeper Dalys and gardener Edwin stepped in to supervise foot soaks and medications. Nevertheless, shortly after I returned we realized that the foot had become infected. He was rehospitalized for a week on intravenous antibiotics, after which he returned home and I set off for Maryland.

The wedding was lovely, a small group of immediate family and a beautiful ceremony. The newlyweds will be relocating to Richmond, Virginia, where Derek has accepted a faculty position at Virginia Commonwealth University. Wah Wah hopes to get employment with the med school there in the future, but in the meantime will continue with her stem cell research at the not-too-terribly-far-away University of Maryland college of medicine in Baltimore.

When I returned from the wedding, Larry's foot was again infected. On the advice of a local physician, Dr. Chen, who had been administering intravenous antibiotics at his office in the morning and at our home at night, we went to David the day after I returned from the wedding to meet with a critical care specialist, Dr. Julio Osorio. Dr. Chen had done a bacterial culture, and Dr. Osorio picked up the results shortly before meeting with us. He took us first out of a crowded waiting room and advised that Larry had an extremely dangerous pseudomona aeruginosa infection. He admitted him to the hospital forthwith, assembled a team of specialists, and announced within a very short time that x-rays revealed the infection to be concentrated in the "hardware" in his foot, necessitating immediate surgery to remove the pins and plates. It was scheduled for the next day.

Meanwhile, back at the house, Trudy had worsened considerably--was not eating, could barely walk, and appeared to be blind or going blind. I made arrangements for a local vet to come to the house to put her down shortly before driving to David to check on the progress of the surgery, leaving Edwin to bury her in the garden. Bad, bad day.

Following surgery, Larry was put on an intravenous combination antibiotic regime round-the-clock. After several days, another culture revealed the bacteria, which we had been told was antibiotic resistant, to still be present. Another combination of antibiotics was agreed upon by the medical team, but a third culture taken after another week revealed that not only was the bacteria still present but had gone into the bones. Everyone was disheartened and extremely worried, fearing that he faced possible amputation. After consulting with an oncological plastic surgeon in Panama City, Dr. Osorio, in consultation again with the entire team now consisting of five doctors, decided to try two more antibiotics accompanied by local daily cleaning with a chlorine-based formula. This began last Monday.

Larry learned only last night that the latest culture shows no signs of the bacteria. The doctors want to do one more culture before releasing him, however, at which time he will be on oral antibiotics for at least two months. The relief I experienced was overwhelming, and I got my first good night's sleep in three weeks. As to the break itself, x-rays indicate that it had substantially healed prior to the second surgery when all the hardware save one essential pin was removed. That remains to be seen and is, of course, a secondary consideration at this point. Also, he still faces a skin graft or plastic surgery to completely close the wound. Talk about a continuing saga--and I just gave you the highlights.

So that's why I haven't written in so long!

Time to catch up

I've been neglectful of this blog lately. I've stayed pretty busy in January and February, but, too, there's be very little newsworthy too report. Mostly it's been downtime since the auction, the holidays, and Derek's visit; just getting back too normal.

I meet my friends Charly and Deb every other week or so to discuss books, but the three of us took the big step of joining a recently-formed book club. Deb had been agitating about starting one for some time, but I didn't want any more organizational responsibility--the garden club and Bid 4 Boquete are sufficiently exhausting--and I feared that our reading choices likely were too sophisticated for most casual readers. I was contacted by another friend, however, begging me to be part of a new book group and I decided to try it out. It looked good, so I begged the group to allow Deb and Charly to participate. So far so good, but the ultimate success remains to be seen. We've already lost one member who was out of her depth, and have acquired another member in her place. Doc was keen to join, but the women decided that a man would alter the group dynamics for the worse. Besides, we're trying to keep it to under 10 members.

I took a two-day road trip last week with some garden club members to Costa Rica to visit The Wilson Botanical Gardens at the Las Cruces Biological Station near San Vito. We hired a local man who runs a school transport van, as school is recessed during January and February, coffee-picking time. We exited the country at Rio Sereno, a remote immigration outpost not far from San Vito, rather than via Paso Canoas, the principal immigration station between Panama and Costa Rica. We sailed through in about 40 minutes (rather than the usual two or three hours reportedly required at Pasa Canoas) and made it to the gardens in time for lunch. We stayed on site and did a short botanical tour that afternoon, a slightly longer one that night under a full moon, and a long guided tour the next morning before setting on on our return. It was a lovely place, and I'm now armed with new gardening ideas and a long list of new plants to ferret out.

As you may recall from past blog posts, I, and every expat I know, live in perpetual dread of encounters with Panamanian bureaucracy. Unfortunately, both of our driver's licenses came up for renewal this month. Troublesome at the best of times, renewal promised to be downright daunting this time as a result of our having gotten new passports with new passport numbers since the original licenses were issued. All official documents of foreigners are tied to the passport number--the national i.d. card (carnet or cedula), motor vehicle registration, and driver's license--so when the passport number changes all bureaucracy (hell) breaks loose. I had already had my vehicle title changed to reflect the new passport number, but I nonetheless set out with trepidation for Migracion (Immigration) in David to ascertain what tortures had been devised. The reports were many and various, and I thought it best to leave Larry at home until I found out what was in store and how best to navigate it. He's inclined to go absolutely wild in Panamanian government offices, and for good reason. Personnel there are very clever about changing the rules from day to day and from employee to employee.

I set out at 8:15 on a Monday morning about three weeks ago and arrived in David (normally a 30 to 45 minute trip) at 10:00 due to interminable delays related to the road widening. As usual, it was approximately 110 degrees in David, the traffic downtown was frighteningly chaotic, and there was no parking anywhere near the Migracion office. Once I made it inside and fought my way to the front desk and explained what I needed, I was directed to a small side room with a sign saying "Visas." When I got there, I was taken back out to the front desk, where I surrendered both my old and new passports and my Panamanian cedula. Some computer work was done, and my new passport was stamped "Registrado." I was sent back to the Visa room, where I was directed back to the front, to the cashier, to pay $25. Returning with the receipt, I was told to fill out a form asking for all sorts of personal information unrelated to either my passport or driver's license. I was told that the form would be sent to Panama City and that I should return in two weeks before going to the driver's license office.

Two weeks later I returned to find the Migracion office closed for no ostensible or noticed reason. I elected to go straight to Sertracen (the private company contracted to issue driver licenses) far outside of town at the Chiriqui Mall, armed with all my documents of identification and two fat files of vehicle information and everything else that might, even unreasonably, be pertinent. There was a long line, of course. (Panamanians don't mind waiting in line; in fact, they consider it a social occasion.) Once having reached the front desk, I was asked for my passports, my cedula, and my current license and was told to take a seat. No mention of anything from Migracion or vehicle registration being needed. Some time and a couple of chapters in a novel later, I was recalled to the desk and told that everything was in order but that, unfortunately, I was not in the new "digital" system. They made copies of everything and filled out a form to be sent to Panama City for processing and said they would telephone or e-mail when everything was ready, in two weeks to a month. Right.

As it happens, my license tag also was expiring in February and, although I get the new tag in Boquete, one first must get a Revisado (inspection of sorts), which one can only get in David. The inspection facility we use is on the road to Boquete, on the edge of David, so I stopped off on the way home to accomplish that task. It's usually a simple and straightforward process (unless the computer system is down); you give them proof of insurance and vehicle registration (all brought up to date months earlier at great expense of time and money), they take a photo of the car, you pay them some nominal amount and you're on your way. Upon entering my info in the computer, however, the receptionist reported that I had an unpaid traffic fine which would have to be satisfied first. Having never gotten a ticket, I was bewildered and frustrated. No matter. I had to return to the Chiriqui Mall to the Transito office to straighten it out. Some twenty minutes later, plus another 20 minutes of standing in line, I was advised that I had incurred a parking violation (location unspecified) in June of 2009 (well before my last revisado in February 2010) and that I owed a $10 fine. Utterly defeated, I handed over $10, got a receipt, returned for my revisado, struggled through road construction back to Boquete, arrived about 4:30, and promptly consumed three gin and tonics. I consoled myself with the thought that at least I had had the foresight not to take Larry along on this reconnaissance mission. One or both of us doubtless would have ended up in jail: him for assaulting a bureaucrat and/or me for assaulting him. I was decidedly not consoled by the realization that, not only would I have to return, but I would have to go through the whole sorry mess with Larry to get his license renewed. And it would have to be soon.

Two days later, on Wednesday, Larry and I set out to accomplish just this. I explained to him what would transpire in Migracion and what would transpire at Sertracen, as our cases were identical, but that I knew exactly what steps to take so it shouldn't take nearly so long. Upon finally arriving at Migracion (road stoppages and parking problems again), I made straight for the Visa room and told them what I needed. The woman there looked at me like I had two heads and pointed back out to the front desk. There, I handed over the appropriate documents, the woman did the computer work, stamped his new passport, and told us we were ready to go. I asked about the form I had filled out for transmittal to Panama City. She knew of no such form. What about payment, I asked? I was advised 
that there was no charge for registering a new passport. I told her I had paid two days previously. The person who helped me then must have been new and didn't know what he was doing, she said, noting that she is the office supervisor. We left, thoroughly confused, and haltingly made our way through traffic to the Chiriqui Mall and Sertracen. There, everything was as it had been for me two days earlier. We both return sometime within the next month, allegedly, to get our new licenses. I'll believe it when I see them.

Larry's license plate isn't due to be renewed until next fall. I showed him on the way out of town where to go to get his Revisado and told him he would be on his own. I hope to hell that he, too, has a mysterious unpaid traffic infraction. I believe in equal opportunity for suffering. It is for that reason that I have burdened all of you with this tale of woe.