(Long post) Had my first experience going to the ED at hospital in the middle of nowhere - in Bahia, Brazil. Have a known kidney stone (ok it's been there for a while I just ignored it - hematuria since August that I blamed on rhabdo while training for marathon, groin pain attributed to psoas so was going for massage and was doing stretches. Finally a couple weeks before my trip to Brazil I had horrible urgency and finally went to urology and found I had a 3mm stone in distal ureter. Duh! So massage does NOT work for kidney stones! Pain wasn't really an issue just always felt like I had to urinate. Still ran the marathon and managed to PR (3:35). Usually book a surf trip after running the marathon as my reward and is a good way to recuperate. Decided might as well still go on my surf trip since the stone has been there for months, what could go wrong? Brought some various meds including pain meds, zofran, flomax just in case. Say what you will about flomax but when you are desperate you will take whatever you think might help even if a slim chance of helping.
Woke up yesterday at 3am with horrible flank pain, took every med I had and things only got worse. Probably vomited up half of the meds. By 6:30am I was desperate and started calling/texting people I knew to help get to the hospital. In the end, the husband of the manager of the hotel came and took me to the hospital. Walk in to the "ED" and hear in Portuguese that there is no doctor. I assume in my pacing and writhing that I'm hearing this wrong. Hospital is very tiny, only a few beds, mold on the ceiling, not looking very promising. They make some phone calls and get a dermatologist on the phone who spoke with me briefly on phone and ordered some toradol and scopolamine. The "nurse" tries to get a vein despite me having good veins and has trouble and then says the nurse just arrived so she will have her try. So have no idea who was sticking me but would have let her try all day if I had to. Got the meds and felt better but pain came right back. Marcia from the surf camp shows up to stay with me and helps translate. So grateful for her coming to stay with me! Not sure what I would have done without her! She gets a local doctor on phone who calls in some orders. They put an IV in this time and give me fluids and more meds and it takes a while but feel better again. They ask for a urine sample for Ua/micro and cash upfront (about $2). Am given a website with code to review the results when ready - why isn't this a thing in the US??? But I still have not seen a doctor while in the hospital. Was explained to me the local doctors used to all work there but the government decided to hire its own doctors. And on cue an older gentleman with wild grey hair, wearing jeans and a white coat walks by and says "do you like tomatoes and rice?" I'm so confused. I understood the question in Portuguese but not sure how to answer. I'm not hungry if he's offering and otherwise the question is too bizarre. He assumes I don't understand and talks to Marcia and she translates with a strange look on her face. She translates that if I eat a lot of tomatoes and rice I will keep getting this pain. I assume he thinks my left sided colicky pain is diverticulitis?? Luckily he is not my doctor. She then proceeds to explain this is one of the government doctors that works there but he is trained in psychiatry. Thankfully I arrived before he came in for his shift!! It is explained to me that I have an appointment to have an ultrasound and then to see a local doctor (who had ordered everything by phone). After the fluids are done the IV is removed. I'm petrified the pain will return but go with the flow. I get to the private clinic (cash upfront for visit and Ultrasound: $80) and go fairly quickly to ultrasound suite which is surprisingly nice. There is a patient screen in front of me so I can watch the ultrasound. There is a radiologist doing the ultrasound which blows my mind. He knows I'm a doctor so explains things as we go along, no hydro (which surprises me), he gets close to the bladder and I think I see a stone but I think how he could he possibly find the stone. He traces the ureter again and it goes to the stone at the UVJ. Measures at 6mm which makes me wince a bit. He prints out the images and passes them off and then back to the waiting room to see the doctor. See the doctor in the clinic and she writes me for pain meds in case pain gets bad again. Recommends flomax but says is difficult to find in Brazil but is happy to hear I brought my own. And also writes a script for IV setup with fluids which I can collect at pharmacy. If pain gets bad again, they can send a nurse to me to the put the IV in and give fluids and meds so I don't have to go back to the hospital. What a great approach! Overall a positive experience but if I had an emergent issue - no doctor in the hospital is quite frightening! Was told by locals they would drive an hour away to bigger hospital when possible. Spent another $40 at the pharmacy for a ton of meds I hopefully won't need but since I'm here for another few weeks gives me a little piece of mind. $120 is quite a bargain for everything compared to the thousands that would all be in the US. My outpatient stuff from home (CT, UA and 2 urology appts -the total bills, preinsurance was almost 10k). Insurance companies should pay us a bonus to get care outside of US.
Took a couple doses of pain meds last night but this morning am feeling good. No pain today. Didn't eat much yesterday so I woke up starving and ate a huge breakfast. Skipped surfing today so I could continue hydrating. Hopefully back to surfing on Monday!
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