Why you should care
Because this woman needed Mexican therapy to truly recover.
Josh Barkan is the author of Mexico: Stories and winner of the Lightship International Short Story Prize.
My wife had a brain aneurysm rupture on November 31, 2015. Mariana, then 45, clasped her neck while eating dinner and started sweating uncontrollably. Her eyes rolled back in a seizure, and I called 911, begging them to hurry because my wife appeared to be dying.
That night, paramedics took her to a small Roanoke hospital, where she suffered another seizure. At first, the ER doctors looked indifferent and then alarmed, with four medics circling her bed. They put a handheld respirator down her throat and rushed her for a CAT scan. My wife quickly was transferred to a bigger hospital but was beginning to lose consciousness. Two hours had passed, and pressure was building in her brain. One doctor decided that a hole needed to be drilled into Mariana’s skull to relieve the pressure. He asked for authorization, and I gave it. “You have to understand, this is a marathon, not a sprint,” he said.
Standard insurance in the U.S. grants 30 one-hour sessions annually of physical and occupational therapy — which, in our case, was a joke.
Over the next month, my wife nearly died five times. The 1.8-millimeter aneurysm ruptured in a difficult place, on the PICA artery. If the wound doesn’t close properly, a second bleed can occur and be fatal. Standard procedures could not coil the wound because of the location. Rather than transfer my wife to yet another hospital to perform a surgery normally done within 48 hours of such a crisis, her doctor wanted to wait. But with a bit of luck, I was able to get her transferred by helicopter to the Neurosciences Critical Care Unit at Johns Hopkins, where the procedure was performed immediately. Then came a 21-day death march, with my wife suffering vasospasms — constrictions of the brain’s arteries. Each time she spasmed a team was assembled, threading a probe from her thigh to her brain, where they released chemicals to try to return blood flow.
We spent six weeks at Hopkins, and then the real marathon began: recovery. And that’s when we became refugees of the U.S. insurance system. Once an American patient is “saved,” it is considered too costly to help with recovery. Healing from a stroke like my wife’s takes determination, optimism and endless repetition of physical, occupational and cognitive therapy. When she came out of Hopkins, Mariana had a feeding tube, couldn’t swallow liquids and was stuck in a wheelchair. Standard insurance in the U.S. grants 30 one-hour sessions annually of physical and occupational therapy — which, in our case, was a joke.
After being by her side every hour for two months, I sent Mariana — who is Mexican — to her sister in Mexico City, where I could afford to give her the treatment she needed. Every week, she went to the Hospital Español, and therapists came to the house. She had eight sessions a week of physical, occupational and cognitive therapy and 24-hour nursing for four months. When I was able to go to Mexico over the summer, I took over from the nurses. After getting excellent care at Hopkins, I worried that sending Mariana to Mexico might mean she would suffer from lower-quality treatment, but I knew it was the only way to get her the needed therapy. The care in Mexico was, if anything, superior — not only because we could pay for so many sessions but because the staff was warm yet strict with my wife. Unafraid of lawsuits, they pushed Mariana hard. The head doctor used methods that worked — inserting needles into neck and arm muscles, for example, and using a metal instrument like a shoehorn to press on muscle spasms. Gradually, Mariana, who has long been a painter, was able to extend her left arm and learned to walk. I strolled with her in the parks of Mexico City to help build her stamina and balance. One day, with a sense of victory, she did a short jog. It took an hour of driving each way just to get to the therapy sessions, but we kept it up through September. Then she returned to the U.S. and blitzed through her annual allotment of therapy, which, if used at the same pace as in Mexico, would have lasted 7.5 weeks.
While president Trump speaks of building a Mexican wall, without Mexico my wife would be paralyzed. She saw psychologists, neurologists and otolaryngologists for seven months in Mexico, where we spent $16,000 for treatment. Until reasonable care can be provided in the U.S. for recovery, we will continue to be medical refugees. And thankfully we can, and will, return to Mexico this summer for more treatment.