Report from Quito

A birthday/convalescence bouquet from our kid. Coffee cup for scale.

Around our sixth or seventh month in Quito – we’ve been here 10 months to date – our neighborhood no longer seemed quite so alien. The unrelenting traffic, endlessly barking dogs and unattractive storefronts had become like so much wallpaper: something I don’t tend to notice. This was a change that made Quito feel more like home, or at least like the place where we stay and go about daily life with a minimum of outsize wonder, stress, or dis-ease.

Unlike the place we left, my city of 40 years: Minneapolis. I moved there at age 25, made friends, got jobs, got fired, bought a house, got married twice and divorced once, had a baby, had a heart attack, raised and educated our son. It’s ground zero of the new civil war, from all accounts far worse than the state-run media will ever let on. 

It’s hard not to think constantly about what’s going on in what I still consider my home. Especially how the families of young people murdered by the secret police can manage to put one foot in front of the other. But for those of us who aren’t able to do much about what’s happening – and I imagine even for people who still live there – attention must be paid, if possible, to other things. 

Enlarged prostates, for example.

Turns out size does matter when it comes to prostates, and a prostate that is six to seven times its normal size is excessive, even for my hearty hubs Bill, a man of 74 who has already survived bladder cancer.

We learned about this from Dr. Erazo, a suave, deep-voiced urologist we consulted at our neighborhood home-away-from-home, Axxis Hospital. Following tests including measurement of how rapidly (or not) the pee comes out and an ultrasound confirming the prostate’s attempted annexation of the bladder, Erazo recommended removal of the oversized organ, which he would effect with a laser. 

Our private health insurance determined, upon reviewing records from Bill’s Minneapolis urologist, that this was a pre-existing condition and they would not cover the surgery. We might have enrolled in Ecuador’s public health system, IESS, but it would have taken months before the surgery could be scheduled. Everything we’ve heard about IESS is bad. 

We might also have gone to the U.S. for the surgery. But where? In besieged Minneapolis, where Bill’s previous treatment had taken place? In the state where our son lives? Or one flight away from Quito in Florida or Georgia? No matter where we went, we’d have to schedule appointments, pay for flights, pay for housing and food, and then pay the Medicare copays. 

It took many emails, but we finally received estimates from Dr. Erazo for the prostate removal surgery, including his fee and hospital costs for three different facilities – we were to choose one. We chose paying retail in Ecuador at the Centro Quirurgico Quito Tenis, a short walk down the hill from our apartment. 

We reported to the Centro at 10 a.m. on a Thursday. It was, like every medical facility we’ve seen in Ecuador so far, private and spotless. Bill was checked in, weighed and led to a room just big enough for a bed, nightstand and chair. The room’s tiny bathroom would have been unnavigable for anyone “broad in the beam,” my mother’s expression for people with big asses. 

A young MD, Mateo Rojas, spoke with us in excellent English and said he would be just outside Bill’s door – as in about six feet from the head of his bed, with a wall between – for the next 24 hours. 

Dr. Erazo was running late and the surgery began nearly three hours after it had been scheduled; we did not see him before the procedure began. I waited and knitted, and at last Erazo came into the room. He held a one-cup plastic storage container with a blue lid; in it was what looked to be three-quarters of a cup of prostate tissue. It appeared pink and spongy, and I asked first if I could photograph it and second if I could keep it. Yes and no: it was headed to pathology. (Photo by request only.)

The first hours post-op are weird everywhere. Bill was loopy, then ate, then barfed, then slept for minutes at a time when people weren’t coming in to check on him. It was, in short, just as you’d expect at North Memorial in Robbinsdale or anywhere else in the U.S. Likely a bit better than some North American facilities. 

By the next morning he was in pretty good shape, and Dr. Erazo rolled in around noon to offer some general pre-discharge advice on getting through until Monday, when we were to come to his office for a follow-up and to have the catheter removed. 

The discharge process – something you take for granted until it doesn’t happen – was haphazard, but we managed to get back to our apartment with tubes still attached, six heavy bags of saline solution, and four prescription meds. Three long days later, the tubes came out. 

Bill is forbidden from riding his bike for a month. He finished the first four meds and is on two other meds, which make him sound like Joe Biden. Other than that, he feels pretty good, tired and relieved. 

We have yet to receive the pathology report or an invoice. We’ll report back.