We left Cusco Saturday morning w great reluctance. What a wonderful metropolitan city in the mountains of Peru with friendly people, good food, nice architecture and fun shopping. Walking around was a bit of a challenge due to the altitude. Taking it slow helped, so did the disposable bottle of oxygen purchased at the local pharmacy. Lisa seemed to be affected by the altitude more than me.
Loved this young lady. Mature beyond her 17 years. Marisol, from Chinchero.
We were in for an 8 hour bus ride from Cusco, through Juliaca (a true armpit of a city) to Puno and Lake Titicaca. We would travel through the high plains, or altiplano, an area I have been reading about for 18 years since purchasing our first alpacas. We would reach 14,500 feet at one point where we stopped for a "technical stop" or potty break.
By this time it was apparent Lisa was not well and VERY ill. Her cough had worsened quite a bit and she seemed a bit confused, both signs of high altitude sickness. We had the oxygen and sickness pills, along with 2.5 hours of travel before we reached a civilized part of the world and medical attention.... On we went.
I was very worried about Lisa and could do nothing to help her. We had called ahead to have a doctor waiting to meet us at our hotel adjacent to Lake Titicaca, that calmed some of my fears but I was scared and felt very alone. Coupled with the guilt of enjoying the scenery, seeing vicunas and alpacas at the estancias, with their amazing stone corrals, I put on my headphones and cranked up CSNY and the Allman Brothers. I lowered my cap so no one could see my tears. It was the most alone I have ever felt, or so I thought.
We arrived at Lake Titicaca and were met by a doctor who performed a brief exam of Lisa. He confirmed our fears, high pulmonary edema and he also suspected a mild brain edema, her blood oxygen was 70%, he advised she be taken to a local "clinic" as there are no hospitals in the immediate area adjacent to Puno. He warned me that the clinic is "primitive" and I imagined dirt floors and no windows. It was not THAT bad, but it had no heat or hot water. The daily temp range was 30-60 degrees.
They performed a chest x-ray and an EKG. The x-ray showed some fluid and the EKG did not indicate a heart attack, thank God. She was placed on oxygen, given IV fluids and appeared stable. After six months of ABVD chemo therapy a number of years ago Lisa'S veins are like think ropes in her arms. While the nurses were competent it takes an excellent phlebotomist to get an IV started and keep it running for any amount of time. Watching Lisa writhe in pain while they got an IV going was difficult but she is such a trooper and they got one going that remained viable for the duration of her stay. By this time it was 10pm. I left for the local supermarket to get her some food and basic neccessities. Upon return, Lisa was the same and resigned she would be there at least overnight. The nurses, as they always are, were quite competent and friendly. Language was a barrier, but such is life. I left for the hotel hoping I would see Lisa in the morning and that she would show imrovement. Leaving her there was quite demoralizing and again the loneliness crept in.... I could only imagine how she felt. : (
From the time we arrived I was in contact with our travel insurance company, who was incredibly supportive and friendly. We discussed options and began making arrangements to have Lisa air evacuated to Lima at sea level and then on to the United States. These things take time, to get a nurse from the US to Puno, arrange the flights and coordinate and confirm and approve benefits on the weekend, in Puno Peru. I spent the night on the phone, talking to doctors, nurses, case managers and plan administrators begging them to help. They needed information from the attending doctor and the medicsl clinic. It was the weekend and the insisted they were moving as quickly as they could........ I was supposed to be resting but how could I knowing how important it was to get Lisa home safely?
Thankfully Sunday morning arrived, I had not slept, eaten or showered since Saturday morning but received a text from Lisa. That was the best news I had received in a long time (I think since they told us "Lisa's cancer is in remission). I called a cab and headed over to see her and meet with the doctor. (I will write more about cab rides and other experiences on Peru later) While she was improving, she could not yet travel and the air ambulance arrangements were stalled for many reasons; the attending doctor seemed to keep changing her condition when updating the insurance company, the insurance company had challenges due to the weekend and my insistance on being included in any travel arrangements was out of the norm. We were scheduled to leave Monday afternoon and it was appearring I would be expected to leave Lisa and trust things would be handled. This was not going to happen. Lisa and I did not agree on this topic, but there was no time to argue. The end game was to get her stabilized and to sea level. We have the rest of our lives to argue..... : )
Sunday crawled along and sped by. We needed a plan. I am a planner by profession and a fixer by gender. Peruvians seem to think time is not an enemy but when faced with potentially losing the most precious person in your life, you need a plan. Lisa and I both insisted she would be on the flight on Monday, unless an air ambulance could arrive prior. The insurance company had made it clear to me that any air evac efforts would be for Lisa and her nurse, not me. If we missed the flight Monday afternoon and she was air evac'd I would have to make last minute travel arrangements. There is one flight a day from Juliaca to Lima and they were sold out for one week in advance. The flights from Lima to the US would be a bit easier, but I would fly standby at great expense.... But money is not an issue when dealing w life or death of my precious wife.
There was a surgeon in the tour group, Dr. Cristal Cunningham. An amazingly unique person we had befriended on the first day. A deep and gentle soul. I called her and enlisted her assistance w the insurance company and the attending doctor at the clinic. Including her Sunday afternoon made all the difference in the world and in hindsight was critical to the eventual result. Having a medical advocate changed many peoples perspectives. And she helped validate each step of the plan. Lisa was improving but growing impatient and scared that she would be left alone, despite my statements to the contrary. We attempted to arrange permission for oxygen on the plane, this required 48 hours advance approval by the airline and $100 paid in cash in Bolivia, the tour group could help w the payment but not the time. The air evac was still over 24 hours away and while this was still an option it caused other ripples that we would not prefer. The only viable solution was to get Lisa on the plane on Monday afternoon with me and the group. She would have to clear a medical evaluation by the doctor and appear healthy at the airport to board the plane, as the airline could deem her unfit to fly. Additionally, if she became ill on the flight the airline could divert the flight and offload Lisa so they could continue. Dr. Cunningham assured me we could get her to pass the evaluation but suggested we arrange to have oxygen in a private transport between Puno and Juliaca, a 1.5 hour drive. She began to work on the doctor, insisting Lisa was improving, she really was. I began working w the tour group to arrange oxygen and private transport. Time was running out, it was now Sunday evening and everyone in Puno was not working, except us. We found two oxygen bottles, empty. No way to fill until Monday morning. We would have to trust they could be filled prior to our leaving. The doctor and Cristal reached agreement on the criteria Lisa must meet to be deemed safe to travel. These were levels she was already at and unless she digressed overnight she should be okay and discharged. Private transport was secured late Sunday through a local tour group manager who had just returned from Arequipa. Off to the supermarket to get Lisa some dinner and then back to the hotel to sleep, yeah right. Shopping in the market was quite the experience as well, worthy of a blog entry at a later date.
Monday morning arrived at breakneck snails speed.... The insurance company informed me that not following their plan of air evac would "leave us on our own" and require us to pay any and all expenses and submit for repayment when returning to the US. I had nothing to do but agree. Arguing was fruitless. Besides, all I cared about was getting Lisa to Lima, money did not matter at that moment. I received a text message from Lisa early Monday, she was hysterical, scared and needed to get out of the clinic as soon as possible. Her physical condition had improved but mentally she was begiinning to lose it, with good reason. No hot water, no heat, no care after hours, no changing of the bedding, no cleaning of the bathroom, no cleaning of the floors since she had been admiited. After a mild breakdown, I composed myself, called my new friend Pacho the cab driver and rushed to be with her, hopefully relieve her anxiety and get her the heck out of there.....
I was met by the doctor, he pronounced her fit to travel, like he had a choice. First hurdle cleared. We received a call that the oxygen was secured. Second hurdle cleared. Private transport arranged. Another hurdle. Let's go!
Well wait a minute...... It seems the insurance company did not want to pay the doctor and the clinic after telling me that I would be responsible for expenses moving forward. I now had to pay both to get Lisa out. Holy crap! I had been thinking of money but not the whole bill. Did I have enough cash on hand or did I need to find a bank in Puno, get a cash advance and get back to pay the bills (doctor and clinic) before we needed to leave for Juliaca? The doctor presented a reasonable bill that I quickly paid before he changed his mind. His total fee was surely for less than one hour of a US doctors time. God was working with us this morning. I met him twice on Saturday, three times Sunday and once on Monday. Another hurdled cleared. He told me the clinic bill total. I was agreeable, perhaps too agreeable and began to count out 20's before walking downstairs to pay the bill. Yep, I had it. No problema. I rode the elevator down 5 floors and was presented a bill for 50% more than I was told 5 minutes prior. Holy shit. Now there WAS a problem, I needed to find some cash, fast. Dr. Cunningham to the rescue. She loaned me enough money to pay the bill and back downstairs I went with the exact amount, or so I thought. The doctor had ordered a lovenox shot, to prevent Lisa from having a DVT, during my scraping up the cash and I needed another $15 freakin dollars. Dr. Cunnignham to the rescue again. Okay, lets get the heck out of here before they add something else. We hopped into the private transport, driver, tour guide, Lisa, where the heck is Dr. Cunningham? El bano, really? Right now?! She shows up and off we go. Another hurdle cleared.
The drive from Puno to Juliaca is like the road between Oatman and Kingman Arizona. Small, twisty, bumpy and with crazy drivers. Inside the town of Juliaca to get to the airport it gets worse. In Juliaca there are hundreds of taxis, little sedans, and thousands of people walking on small streets tightly lined with buildings. I was in a comfortable tour bus. There is no way Lise was comfortable in a small old van. It felt like we were smuggling someone out of the country, I was beginning to believe it would happen! We lost sight of the transport twice in Juliaca and I freaked out. Had they been in an accident? Had Lisa crashed? Did they get lost? The tour guide was in phone contact and they were fine.....
We finally arrived at the airport and headed to check in. Lisa waited in the van to remain on oxygen as long as possible. She needed to walk through security, wait to board and get on the plane without appearring too ill to travel. It seemed to take forever to get to the point we were ready for her. Okay, let's go. Through security into departure lounge. 20 minutes until we board... Crap! Arriving flight is delayed and transport with oxygen is on other side of security, no going back. Check of oxygen level 95% still good.... There is the plane, okay lets go. All we need is a pressurized cabin and we are at 8500 feet, a mild improvement from 13,000 feet. Juliaca airport does not use the jetways but stairs. Poor Lisa had to walk up 25 steps, yes I counted them, and appear healthy when greeted at the top. She did it! We were seated, the cabin pressurized and off into the wild blue yonder we went. I could now let all the emotion out and wept like a baby for about half the flight, all the while smiling like the man in love I am.
After a completely uneventful flight, we arrived safely in Lima late Monday afternoon. As promised, Lisa was feeling better almost immediately. What wonderful news! Walking down the same sidewalk where a week earler we had agreed that we were in for an adventure but had no idea what lie ahead.........
There are many side stories to this long winded diatribe that I hope to share later. Lisa's version will vary slightly. I am sure pleased to be sitting next to her on the flight home. I love her more every day. Her strength and courage are enviable, but if you are reading this you already know that about her. She inspires me daily to be a better person.
I will also post pictures over the next few days. I took two pics of Lake Titicaca from the hotel room. Lisa will post some of hers from and of the clinic. The pics seem fairly inconsequential right now, maybe later.
Brad
I believe prayers make a difference. So does hard work.
Dr. Cristal Cunningham
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