My Experience in a Basque Hospital

Initial Issues 

In July I started experiencing abdominal discomfort. I tried, but failed, to make appointments. Unfortunately, it was almost summer. Most clinics were either already closed until September or would be soon. Those who answered their phones said no appointments were available or recommended that I go to Urgencias [the ER]. I felt totally lost. I didn’t feel well, but it didn’t feel like an emergency. I wasn’t sure what to do.

Unfortunately, the pain got worse and I couldn’t live with it any longer. I would need to make a trip to Urgencias. While I speak fluent Spanish, I have never pursued medical care using the language. On my first trip to the ER, I struggled to effectively describe my symptoms. After an exam and a few tests, I was told that they couldn’t find anything wrong. The doctor recommended that I give it more time and make an appointment in September, if things hadn’t improved. 

The discomfort continued to worsen. I would wake-up with pain so intense that I couldn’t fall back asleep. I knew that a return trip to Urgencias was the only available option, especially given that, being August, it was officially “summer” in Euskadi. Prior to my second trip to the ER, I made a note, first in English, of exactly where/how I felt pain. I then translated it. This resulted in a much more extensive [and successful] visit. 

The doctor quickly recognized that it was a gastrointestinal issue and ordered a series of tests. While these didn’t initially show any issues, they eventually revealed the likely cause of the problem: what appeared to be a small piece of metal [unclear how it got there] stuck in my appendix, causing inflammation and pain. I was given a prescription and referred to a specialist.

Side note: we have private insurance, as we don’t pay Spanish Social Security. Our coverage required me to pay for these visits out-of-pocket as “uninsured” and submit for reimbursement. Americans will read this and think “Have you gone bankrupt??” But the answer is absolutely not. While acquiring the payment required more phone calls than I liked, I initially paid 900€ total for two ER visits that included bloodwork, X-Rays, CT scans, and more and eventually received a full reimbursement. [Some folks in the States have a co-pay higher than this!] This experience has provided more evidence in support of my beliefs that taxes should be used for 🏥/🏫/🚄/🌳 and not 💣!

A Possible Solution?

Following the second Urgencias trip, I made the earliest available appointment with a gastroenterologist [late-September]. At the appointment he agreed that I should have a colonoscopy (yay!) to investigate the issue and (🤞🏼) remove the foreign object. I scheduled the procedure for the following week and soon began the prep [eating a bland diet, eliminating wine, drinking lots of water]. I hoped that this saga would soon be over!

I could not drink anything after 6:00 on the morning of the appointment. So, I set an alarm for 5:45 and got-up to drink a can of Aquarius [basically Gatorade] and lots of water, before going back to bed. When Eliott’s alarm went off and he got-up, I stayed in bed, knowing that watching him eat breakfast and drink coffee would only make me angry.

Medical Emergency + Diagnosis

Fortunately I do not remember anything that happened next. E came into the bedroom to find me very confused. My arms were rigid and I was incapable of putting them down. Because I have no medical history, we had no idea what was happening. I insisted that I was fine and that we should go to the appointment as planned.

After a few minutes, E decided that something was, in fact, VERY wrong. He called 112 [the EU equivalent of 911] and used his limited [but vastly improved!] Spanish to explain the situation to the dispatcher. The paramedics arrived within 10 minutes. After a quick examination and conversation, they insisted that I be taken to the ER. They told E that he had three minutes to grab a few things and meet them outside, or the ambulance would leave without him.

Initially I was taken to Basurto, the primary public hospital in Bilbao. The paramedics realized that I was having seizures and kept asking if I was epileptic. Not surprisingly, I was combative and struggling to get free/leave the hospital, even after they’d removed all of my clothes. The seizures persisted for much longer than the hospital staff expected. They sent E to a waiting area while they conducted more tests, including a CAT scan, and placed me in a medically-induced coma to stop the seizures. 

While very rare and typically occurring in MUCH older patients with pre-existing conditions, the medical team determined that the seizures were caused by an extreme sodium deficiency that occurred as a result of the colonoscopy prep. Two factors created a perfect storm that left me in the hospital for five days:

1. Diet: Supermarkets in Bilbao are not the monstrosities that we know Stateside. For most items there may only be two or three options from which to choose. As a result, I struggled to find things that I could eat before the exam. Worried that eating the wrong thing would result in the procedure being rescheduled, I ate very little and drank lots of water [to make my stomach feel full]. 
2. Exercise: When I was scheduled to have the colonoscopy, I was in the final stage of training for a half-marathon. Therefore, despite the dietary restrictions, I was still following my typical workout regimen [and had run 10 miles earlier that week]. 

Path to Recovery

Once they’d finished all of the tests and I was fully-sedated, I was transferred to Cruces, a larger public hospital with an Intensive Care Unit specifically designed for patients emerging from heavy sedation. The medical team said that I wouldn’t wake-up for at least 24 hours and would stay in this ICU for a day or two after that. 

About 36 hours after the first seizure, I started to regain consciousness. While I couldn’t see anything [I wasn’t wearing my glasses], I eventually figured out that whatever I was experiencing wasn’t some strange dream. Unsurprisingly, I was once again combative, this time trying to pull every medical device off/out of me while yelling: “It fucking hurts!!” Before leaving that night, E fed me some yogurt, as I was complaining of hunger, and I soon fell into a deep sleep. 

When the nurses came in the next morning, I asked for my glasses. Although I’d been wearing my full-strength versions when the seizures started, they’d been sent home with E when I was admitted. After all, I wouldn’t need them! He did leave a pair behind the following day, but they were my reading glasses. Wearing them did little good and remaining confused kept me feisty.

Despite the time difference and my inability to see, I eventually succeeded in FaceTiming my parents on Sunday morning. [It was 10:00 in Bilbao and 3:00 in Iowa.] This would begin a stretch of me talking to them [and my brother] multiple times each day at ridiculous hours, at first to help me grasp what had happened, and later to cure my boredom or update them on my condition. 

While I still couldn’t do much, I was allowed to sit in a chair and eat actual food. Thank goodness, as I hadn’t eaten in 3+ days and was ravenous. [It may be due to my extreme hunger. However, I may forever remember that first lunch as one of the best meals of my life!]

While I desperately wanted to return to normalcy, rather than remaining bedridden and isolated, I remained in the ICU for another day. Fortunately, there were La Liga matches that afternoon, including Athletic Club vs. Sevilla, available to stream. E also brought my correct glasses, so I could see the matches [and everyone that I FaceTimed] and play the NYT Games.

After being transferred to a standard room, I remained hospitalized for two more days. Beyond the seizures, the initial CAT scan revealed blood vessel abnormalities in my brain, known as arteriovenous malformation. While these did not cause the seizures, the neurologist recommended more tests once I’d emerged from sedation to ensure that further treatment wasn’t required. 

Despite feeling very weak, I was allowed to take my first shower in almost five days. The water wasn’t very warm and still having plenty of bandages and IVs attached to my arm made it a challenge (as was brushing my hair for the first time). But, de puta madre, it felt so good to be clean!

If Someone you Care About is Unexpectedly Hospitalized: What to Bring

Given that neither of us had ever been hospitalized before, E wasn’t sure what he should bring to the hospital once I emerged from sedation. Fortunately, he had brought a few items, and what he didn’t, he was able to buy from nearby shops. [I was transferred on a Monday, when shops here are actually open.]

Should you ever find yourself in a similar situation with a friend or family member, it can be overwhelming to think of all the questions that you have for their care team, along with packing all of the correct items for their hospital stay. So, I thought I’d provide a list that folks could refer to.

Life Going Forward

The Cerebral Arteriogram confirmed that, while quite large, the arteriovenous malformations are not currently bleeding and do not require surgery . [This would actually be much more dangerous than simply monitoring them.]

The medical team also didn’t recommend much in terms of treatment or lifestyle change. [I can’t smoke or power-lift, as both increase the risk of bleeding as a result of high blood pressure. Luckily, I do neither.] While I will need to take anti-epilepsy medication for a year and cannot drive, I can travel, run, and  otherwise live my life as normal. [I could even run this weekend’s half-marathon, more on that to come.]

Our “Cuadrilla” 

Friend groups in Euskadi are called cuadrilla. Cuadra means block in Spanish and cuadrillas are generally composed of a group of individuals who grew-up together and remain friends for life. This is the case even when members move far away or possess wildly different political opinions. 

Cuadrillas are considered almost impossible to penetrate, which makes it difficult to make friends. Many Ex-Pats blame cuadrillas for their feeling isolated. However, we have been adopted into a non-traditional Cuadrilla, composed largely of retirees who live in our neighborhood [but grew-up elsewhere] and became friends later in life. Before this crisis, we spent most evenings with these neighbors at Bar Ereaga. They have also invited us out on several occasions to watch Athletic Club matches and provided plenty of suggestions of places to visit in Bizkaia.

Our Cuadrilla immediately leaned-in to assist when difficulties arose. When I expressed concern about medical appointments in Spanish, Erugne, one of the members whom we’d grown closest to and speaks some English, offered to accompany me to any appointment that I wanted. [She’s also an ophthalmologist who wrote E a prescription for eyedrops when his allergies got bad and provided recommendations for my ordering new glasses after the clinic in DC messed them up.] 

When E returned home the night that I was admitted to the hospital, he texted another member, Miren, to let her know what had occurred. Erugne called him right away. She and Miren were out of town for the weekend, but she had already spoken to Gerrardo [El Capitan], who also speaks decent English. Without E even asking, Erugne and Gerrardo had made plans for him to meet E outside of our apartment building the next morning to drive him to the hospital and help him speak to the doctors.

After I woke-up, I texted Gerrardo and Miren to thank them for all of their help. They then texted and called me every day to check-in and visited me in the hospital. [Gerrardo even brought me a copy of the New York Times and some candies.] We also learned that one of the other Cuadrilla members was previously a neurologist at Cruces and that all of our neighbors were asking him to check on my status with his former colleagues daily during my hospitalization.

When we returned to the block after my release, we were hugged and kissed by everyone immediately, including the owner/bartenders of Ereaga. Miren continued to call me daily to see how I was progressing, while Erugne has answered every question that I have asked about further navigating the health system in Bizkaia. 

Going through a medical emergency in another country isn’t easy, but our neighbors made sure that we had family to lean on during a difficult time. Before this, our adoption into the Cuadrilla had enriched our experience in Bilbao and contributed significantly to our desire to renew our residency later this year. Afterwards, we are even more grateful to have found such a wonderful group who have made Bilbao the home that we hope to stay in for at least another year.