The Battle with the Bureaucracy Begins

American economist Thomas Sowell once wrote “You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing.”

Yeah, boy howdy, was he ever right!  You’ve dealt with them yourself and you know what he’s talking about.  Now imagine trying to deal with them in a language which you speak very poorly.

You’d think that after living in Mexico for five years, I’d have quite a few Spanish words in my vocabulary.  And really, I do.  Unfortunately almost all of them deal with food, directions, and hygiene issues.  In other words, I can ask about good places and things to eat, how to get there, and where to find the bathroom in any home or public facility.  Oh, and most of the time, I can figure out how much something costs.  But after that, it’s all pretty much downhill for me.

So you can imagine my horror at not only being told that I had a more than 95% chance of cancer in my left breast, but that I was going to have to deal with the huge bureaucracy that is IMSS (kind of the Mexican equivalent of Medicare).  Neither of the two private doctors I had seen, Dra. Claudia nor Dr. Banuelos, have any connection with IMSS, so I was on my own.

The only thing that Dra. Claudia could do was call a friend of hers who works in an administrative position at our local IMSS clinic and ask him to help me get in to see the doctor there as soon as possible.  And so he did.  I talked to Jorge on the afternoon of 5 December, immediately after leaving Dra. Claudia’s office and he told me to return a little before 8AM the next morning and he’d get me in to see the doctor, who, Jorge said, spoke “a little” English.

My friend Jonnie and I arrived bright and early at the clinic and got in to see the doctor (yes, “the” doctor….the only one there that we ever saw working there) after a wait of only an hour or so.  Not bad!  Maybe this is all gonna work out okay, I thought.

Well, not for the first time in my life, I thought wrong.  Totally ignoring the mammogram pictures, ultrasound film, and radiologist’s report that I was literally waving in his face, the doctor only wanted to know how old I am, how much I weigh, how tall I am, and whether I have high blood pressure.  I could answer the first question with authority, having had my 65th birthday just a few weeks before.  As to weight and height, I just had to guess because, of course, I needed to give the information in kilos and meters.  And although there was one of those doctors’ weighing and measuring scales right behind me, he never stirred from behind his desk.

So, as I say, I guessed.  I know that 100 kilos is 220 pounds and I figured I was in the 200 pound region (not having weighed myself since I moved here five years ago), so I just said “100 kilos.”  Seemed a little high, but I was too flustered to do even the very simple math in my head to figure out what 200 pounds would be.  As to height, I know I’m about 5’6″, and I know that two meters is about 6′, so I guessed again and said something like “1.7 meters.”  Close enough.  And, “si,” I responded, I had high blood pressure.

During all this, the doctor had pretty much refused to make eye contact with me or with the large, bright red and white envelope with all my information inside.  He just barked out questions and sighed heavily in disgust when I had to pause in order to think of the Spanish response.  But finally he asked me a REAL medical question….although not quite the one I was expecting; you know, something like “What’s your illness?” or “What can I do for you today?”.

No, folks, what he asked me was “So, you want medicine for your blood pressure?”.  WTF!  It was like asking a guy standing there with his bloody arm stump from an industrial accident if he wanted a bandage for the shaving cut on his chin!  The point, Doctor, you are missing it!!

No, Doctor, I responded, what I want is whatever I need from you to get up to the IMSS Hospital in Guadalajara to see an oncologist. “Well,” he said, “there’s not a point in the world of sending you up there without blood tests.  I’d be in all kinds of trouble if I did that!  That’s the procedure.  Blood tests and then maybe I give you a reference to a specialist up there at our new hospital in Tlajomulco.”

So there it was, folks, the first “that’s the procedure” message.  The first of many, many, many more to come.   And that’s how my battle with the bureaucrats began.  I was just too naive to pick up on it right then.  The opening shot had been fired and yet I thought it was just a pesky bee buzzing past my ear.  But, as I mentioned, I have thought wrongly before, and, yeah, boy howdy, I sure did it again!

What’s going to follow in the next few posts are the low- and highlights of my journey from the Jocotepec IMSS clinic through my surgery some seven-and-a-half weeks later.  It’s a story that I’m sure many of you can relate to personally, and a how-not-to guide for other gringos in Mexico who rely on IMSS for major medical issues.

There are some heroes and wonderful people involved….but this first doctor is not one of  them.

Stay tuned!