Obamacare and open heart surgery from Guanajuato to Seattle

In the hospital in Leon, Mexico, following a surprise diagnoses of Endocarditis. (Photo courtesy Dale Terasaki)
In the hospital in Leon, Mexico, following a surprise diagnoses of Endocarditis.

“Endocarditis,” Dr. Gutierrez declares in Spanish. “And you need surgery soon…”

His voice grows faint and time seems to slow down. What began as a mild flu-like illness has culminated into this moment of shock in a Mexican hospital room.

As a University of Washington medical student, my brain instinctively starts diagramming the disease: an oral bacterium entered a vein, became a vegetation on my now perforated valve, and caused regurgitation of blood flow. But this isn’t just arrows and notes on a page. It’s happening to me. Right now in my life.

My wife Kate and I were living in the charming colonial silver-mining city of Guanajuato in central Mexico. Kate’s great, great grandfather was the town’s bank manager a century ago, but the Mexican Revolution uprooted their family to Los Angeles. So it seemed an enjoyable and profoundly personal site for us to improve our Spanish while I finished up my degree in public health.

Our instructors at Adelita Language School frequently hosted barbecues on Fridays, where we shared food and drinks around the parilla. But the first Friday of December was the day Guanajuato’s silver charm began to tarnish. I stumbled back home after an evening of ribs and mescal, confessing to Kate, “Maybe I’m coming down with something.”

What an understatement! Eventually after noticing a new heart murmur, I found my way to the local cardiologist, Dr. Gutierrez.

Echocardiogram results taken in Guanajuato showing vegetation on my heart valve.
Echocardiogram results taken in Guanajuato showing vegetation on my heart valve.

He performed an echocardiogram and gave me my jarring diagnosis. That was December 31. Being admitted to the hospital was not how I anticipated closing out my public health year.

Medical news like this was stressful enough, but Kate and I also had some serious financial concerns pending. We had opted not to purchase medical insurance for our time in Mexico, because on-demand medical care in the region is usually pretty inexpensive and straight-forward.

Unless, by chance, you need open heart surgery.

We decide to return to Seattle, where friends and family abound and where the surgical jargon would be (slightly) less foreign to us. Kate arranged a flight and a car-ride straight to the emergency department at UW Medical Center.

Financial disaster is looming. The average charge for the procedure I need is over $100,000, not including physician payments. Taking out a loan that size, on top of my already ballooning educational debt, would pretty much spell doom.

Then, like a miracle, I get insurance!

Due to enormous luck — and recent implementation of the Affordable Care Act — childless graduate students like me are now eligible for Medicaid (at least in states like Washington that signed on for the Medicaid expansion).

While we were still in Mexico, Kate’s mom got a hold of the Washington Health Benefit Exchange, and got our application in a couple hours before the December 31st deadline for coverage starting on January 1st. I’m almost immediately covered for the surgery I need to save my life.

The public health student in me still insists that, in a country as wealthy as the U.S., covering people through a patchwork of employer-based and individual plans, federal and state programs, as well as charity and uncompensated care seems ridiculous. A universal, public system would bankrupt fewer people (businesses too), and it could establish health care as a right instead of just a commodity.

But I’m grateful that this time, for me, the current system worked.

Kate and I arrive in Seattle on January 2nd, I have my operation on January 7th, and we walk out of the hospital on January 12th. Fortunately, my repaired heart valve works well and doesn’t require any lifelong medications. I spend the next several weeks limiting arm movements, self-infusing antibiotics into a PICC line, and walking on treadmills for cardiac rehabilitation.

Offsetting these hassles, the fervor of the 12th Man begins to animate the city. I lose my voice as Richard Sherman shows what happens when you “try” him with a sorry receiver like Crabtree. I hear triumphant, honking drivers inch through an I-90 tunnel shortly after the Superbowl against… who again? I rub shoulders with 700,000 fans flooding downtown on my way to rehab. Truly, the Seahawks’ success feels physical to me.

On March 3rd, after doctors cleared me for travel and said that my initial infection could have just as easily occurred in Seattle, Kate and I arrive back in Guanajuato. We find our apartment and belongings just as we had hastily left them. We feel a sense of closure reconnecting with friends and familiar places.

We stop by the clinic to see Dr. Gutierrez, strictly for greeting this time. But he presses his stethoscope to my chest anyway and confirms, “Sounds brand new.”

Back in Guanajuato and feeling much better, thank you.
Back in Guanajuato and feeling much better, thank you.

Kate and I have discovered how the two of us react in a trying situation (resiliently). And we’ll never forget just how generous and supportive our family and friends can be (incredibly). Though briefly frightening, our time in Guanajuato will still be a cherished memory for years to come.

A lesson for travelers might be that no amount of planning can predict certain events. That insurance is important. That traveling with a capable partner can be a life saver.

One more thing: you might get a nod on national television.

During the State of the Union Address this year, President Obama called out an audience member, reporting that, “on January 1st, she got covered. On January 3rd, she felt a sharp pain. On January 6th, she had emergency surgery. Just one week earlier… surgery would’ve meant bankruptcy.”

Perhaps the international aspect of my story would not have fit so neatly into a SOTU caliber anecdote. But I will never forget how an issue that had been a political abstraction suddenly became so personal.

3 Comments

  1. Just curious. Who do you suppose paid for the &100,000 plus medical problem? The taxpayers, perhaps? Don’t know who else pays for O’Bamacare. Anyone?

  2. @Marlene, who do you think pays for unpaid-for medical bills? And how many people need such an unusual emergency surgery compared to all the people who have the opportunity to improve their health through having access to health care for their chronic diseases and therefore not needing more expensive care. Furthermore isn’t it great that we have a public health practitioner who understands the health needs of the nation and world and hopefully lower the costs of health care overall?

  3. Just curious, Beck – do you have a clue how bankruptcy works? Where does that medical bills bankruptcy debt go? Who pays for that? Why, eventually the same taxpayers you are concerned about paying for Dale’s medical care through the ACA.
    In other words – if Dale had gone bankrupt due to medical bills, “the taxpayers” would ultimately pay for that. Instead, we just up front paid for his medical care. Might have been cheaper that way, and certainly less hassle and grief.
    Do you have a clue that commercial (for-profit) insurance is essentially gambling against yourself? If you don’t get sick, you lost your money. If you do get sick, you got lucky, because you didn’t lose all that money you spent on insurance premiums. But insurance companies always win – like casinos, they are not in business to lose money.
    We are the only “modern” (so-called) western industrial nation that doesn’t have some form of national health care system that provides essential coverage for all citizens. Are we so incompetent as a nation – or so incredibly selfish as individuals – that we can’t manage to do what all those other nations have done successfully?

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