Was “The Universe" warning me off?
Or was it just a spot of moss on stairs?
This Substack is about life in Việt Nam from the viewpoint of a 10-year expat who spent his first 60 years in a low-context culture.
As regular readers know, after four years of applying for a visa, this is the week H and I finally get fly to the US to visit family and friends.
I’ve been an internal decision maker all my life — I go with what I know and my gut to make decisions on everything from what to order in a restaurant to whether or not to uproot my life, move 13,000 km across the world, and start a new life where I know no one. I’ll listen to others’ opinions, but they hold virtually no sway in my decisions.
That changed a couple weeks ago when I sent an email to a few IRL long-time friends and a couple I’ve only encountered on-line, all of whose opinions I value, most of whom are in the US who pay attention (really pay attention) to current events. The email asked their thoughts on whether or not we should postpone the trip because of the current xenophobic cabal currently in charge there. The overall opinion was that, since H has a valid visa and she’s not Latina, we’d be okay if we stayed away from any demonstrations.
We were starting to pack (mentally) and getting more excited by the day.
Then the universe (or was it a spot of moss?) stepped in and said,
Not so fast!
I made it a whole two weeks without writing about my knee. Then, about four hours after last week’s post published and eight days before H’s and my departure, La and I walked to Sunday breakfast a couple hundred meters from the house. Just a short jaunt, right. What could possibly go wrong?
Descending moss-patched stairs, that’s what — the same stairs I’ve navigated more than a few dozen times prior.
I had just finished cautioning La to be careful, when I caught a mossy spot and took flight. The landing was ugly, and short of landing on the back of my head, it couldn’t have been much worse. I landed on my right foot and my (bad) leg came down fully-flexed. I’m sure I saw my calf hit the back of my thigh. Not normally a BFD, except when you have a knee replacement, then it is.
When your knee is titanium and poly, your soft tissue is gonna give WAY before the artificial stuff. So my patellar tenon took it all, but I didn’t know that for two more days.
I thought I’d busted a few stitches maybe a vein. There was about a 4 cm tear at the top of the scar where they keep having to open my knee — why couldn’t they’ve installed the zipper I requested? — and that’s where the blood came out.
I took off my t-shirt, bunched it up, and used it to apply pressure to the wound while La called an ambulance — you can see the nurse wrapping me for transport above — and headed to Dalat’s public hospital. While waiting for the ambulance, La brought me a clean t-shirt and cash. I’ve written before at length about the “quality” of care at Vietnam’s public hospitals. This visit and the one the next day verified everything I’ve said before and more.
Here’s the bullet points version:
Day 1 — Sunday, 22 June
The ambulance personnel were professional and effective; triage and transport.
The ER staff was efficient and overworked.
Before taking x-rays, the doctor said I didn’t need x-rays because the leg wasn’t broken. Not sure how he “knew” this.
I INSISTED on x-rays because of my knee replacement.
After about five minutes back-and-forth, with me telling him at least twice that he’s an ER doc, NOT a fuking orthopedic surgeon and I know more about knee implants than he does, he finally ordered x-rays. Fortunately, they showed no damage to the implant.1
This was the last of the good news for some time to come.
He also ordered an ultrasound to find the source of the bleeding.
They took me into surgery.
Spinal injection to temporarily (gods, I hope so!) paralyze me from the navel, down.
Repaired the open vein — not yet independently verified
Closed with stitches and bandaged me up.
The whole time, La’s sister and her husband helped transport me throughout the hospital because there is no hospital staff to do so. If you don’t have friends or family to help you navigate the hallways and bring you food, you’re gonna be hurting. I’m not sure what you’d do.
They wanted me to stay in the hospital for observation. After discussing it a bit and once I had feeling in my legs again, they let me go home in the ambulance with my promise to stay in bed for a few days with a knee splint to keep me from bending my knee. Each one-way ambulance trip cost 300,000VND (US$12).
Day 2 — Monday, 23 June
Late afternoon, while the splint was undone to allow me to scratch my itchy leg, I accidentally bent my knee a bit too far and what looked like thin blood started running down my leg. I put pressure on it and the ambulance returned.
This was actually a good thing, as it turned out.
After reiterating the need to keep the knee STRAIGHT, the same doc as yesterday said he’d left the 4 cm opening at the top of my knee open because there was fluid inside that needed to come out. He couldn’t tell me how the opening at the TOP of my knee was supposed to do that because… gravity.
Again, he tried to get me to stay in the hospital for a few nights — in a room designed for four beds, but in which they can and do fit up to six — with everyone watching YouTube or listening to VN music without headphones, so good luck sleeping.
I realized he was making it up as he went, so we called the ambulance and got the hell out of there.
By the time we got home, La had arranged for another ambulance to take us six-plus hours to Saigon and FV Hospital in the morning where they have real orthopedists and doctors with a clue.
Day 3 — Tuesday, 24 June
The ambulance picked the three of us (I am NOT leaving a 13-year-old girl who is great at finding loopholes in the rules alone with only her feeble grandparents to “watch and take care of her”) and H’s uncle up at 8 a.m. and headed to Saigon. H is close to her uncle and he would stay with her when La was with me at the hospital.
We arrived in Saigon just after 2 p.m. and saw Dr. Phat within 30 minutes. Right after we left Dalat, I sent him the x-rays and told his very helpful secretary about my previous two days’ experiences.
Since I’d eaten something at 1, he scheduled my surgery for 7 p.m.
When I asked, “Why not just wait ’til tomorrow morning?”, he said that it couldn’t wait. Ut-oh.
They collected a 55 million VND (US$2096) pre-payment and checked me into a room to await surgery.
Once I woke up, Dr. Phat told me that I’d torn up my patellar tendon pretty badly and that he’d sewn it back together.
He added that I would need to stay in the hospital at least a week because he is very concerned about infection and IV antibiotics are stronger than those in pill form. He will re-evaluate after six days and let me know whether I can go home or if I have to stay longer.2
Days 4 thru 6 — Wednesday, June 25 thru Friday, June 26
If there’s one thing that’s the same in every hospital I’ve ever been in, it’s that the staff will NOT let you sleep the night through until at least the third and sometimes fourth night. They wake you up hourly or bi-hourly for:
Blood pressure readings
“It’s time to take medicine.”
“Do you need anything?” — my (not) favorite
Change the IV bottle — it wakes me because the f-ing machine BEEPS when it needs changing. Haven’t they got one with a Bluetooth connection that’ll tell the nurses’ station and let the patient sleep?
La and H went home Thursday morning, so I’m here alone. H was very bored, so La wanted to send her home with her uncle, but I insisted she go, too. Refer to my previous point about loopholes. My daughter’s wellbeing wins out over my comfort, every time.
This bottle is how docs who know what tf they’re doing drain excess fluid from a wound. If you squeeze it before connecting, it creates a vacuum to draw the fluid out.
The days were all pretty much the same. BORING. Three tolerable meals delivered from the menu selection offered the day prior; frequent comings/goings of nursing and cleaning and support staff; daily bed linen change; lots of looking out the window3; a selection of IV pain meds ranging from the VN version of Tylenol to tramw doc adol to morphine. Fortunately, I have my backup laptop with me, so I can stay busy if I want.4 Writing this, por ejemplo.
Dr Phat checks in twice a day; first with kids I’m assuming are his residents; second, solo. He updates me on blood tests and other things while checking the wound. I need to remember to ask him about the vein repair.
Physical therapy comes twice a day; in the morning with a Continuous Passive Motion (CPM) machine to exercise my leg muscles; in the afternoon with a machine that flows ice water through a jacket that covers from my ankle to my thigh. We walk a couple laps around the hallway prior to the first.
According to the nurses, the IV antibiotics they’re giving me are so strong that they “break” the veins and a new IV line has to be inserted daily. So far, they’ve stuck me 12 times to get 5 successful IVs. Successful here as apparently defined as it lasts at least 18 hours.
If I need a nurse, I don’t have to press the call button, I just have to start to try to nap. They show up within five minutes, every time. It just happened again.
Day 7 — The day I’m writing this, Saturday, June 27
I’m pretty sure this will go down as one of the worst weeks for me in the last 50 years, mainly because H and I can’t go to the US as planned.
The FV IV F-Troop really showed their colors today:
Today’s final tally is 7 attempts before 1 successful IV started. I’m a flippin’ human pin cushion.
It could be worse, I could be at a Vietnamese public hospital…
Trip Cancellation Efforts
I’d forgotten how many different elements we had for this planned trip, many of which required a reservation that must now cancelled. Some things, like airfare, were non-refundable, so I asked Dr. Phat to write something detailing why I can’t fly in the hope that it would be sufficient to get me a full refund.
Since he says I can’t fly commercially until 1 August at the earliest, he did so.
Starlux Airlines — awaiting promised full refund
Vietnam Airlines — they’re taking their cancellation fee. Assholes!
Cancelled with no penalty
H’s medical insurance for the trip
Various hotel and car rentals
Space Needle & Chihuly Garden and Glass tickets
So… was it The Universe or just a patch of moss? If the former, I’m pretty good at listening, so maybe tone it down a bit next time? If the latter, now I’m pissed off.
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I sent the x-rays to my ortho surgeon at Cedars-Sinai and he said the knee looked fine. Note that x-rays don’t show soft tissue.
Today is my only my fourth day in hospital and I really want to get out of here!
Friday morning I watched a swarm of dragonflies outside my sixth floor window feeding on something. Mosquitos, I hope.
Sorry D. W., your book draft is on my main laptop which is at home.