A couple of weeks ago I injured my neck, not in any substantial manner, and merely as a result of acting like a kid. But it felt as though I herniated a couple of disks in my neck which pinched a nerve. It was not a problem unless I turned my head in a certain fashion and then I would get pain shooting down into my elbow. It felt similar to sticking your finger in an electrical outlet, something I tended to do (accidently) with some frequency when I was a little kid. However, whereas with an outlet you get these driving pulses that flow up your arm from your finger to your chest, here I felt these electrical pulses travelling down from my neck into my left arm and elbow. Sometimes the shock and pain would travel all the way down into my hand, but frequently it would stop at the elbow. Then, after the initial shock, I would have some lingering pain in the arm and elbow, but no pain to speak of in the neck. Indeed, I would never have associated this with a neck injury had I not previously been familiar with such pain as a result of a couple of herniated disks in my lower back which caused similar pain to shoot down my left leg into my foot.
In any event, after I started experiencing this pain in my arm, I realized I had injured my neck, as well as re-injured my lower back (which caused a renewal of pain in my left leg.) So I tried to stretch out my upper and lower back in hopes of alleviating the pain and the pinched nerves. I initially thought this would clear up in a week or two, but then had to re-assess that initial impression after a week or so, and realized that it may take a full month or more to recover. So I was prepared to grin and bear it.
But Irene was more concerned about my condition than I was because she had a friend who had a pinched nerve in her back who did not receive proper medical care and ignored it (my preferred line of medical treatment), and the problem simply worsened until her friend was driven into traction for a couple of months. However, I thought the analogy was totally inappropriate because I was getting better not worse, I argued; and therefore, I did not need any medical intervention. In order to demonstrate that I was indeed getting much better, I decided to spend the night in our bed. For the previous week, I had been sleeping in Miles’ bed because it is a platform bed with simply a foam rubber mattress and therefore much more firm than our bed. Our bed, being an expensive coil mattress with a foam top, provided to us (top of the line) by the US government, gave my back no rest and simply exacerbated my problems.
So that night, Miles was relegated back to his room, and I joined Irene for two hours of blissful sleep. Then I woke up around midnight with pain up and down my back. I got up and out of bed and decided to try to lie down on the floor to stretch out my back. My lower back appreciated the hard wood floor, but my neck resisted. And as soon as my head touched the ground, I felt this huge bolt of lightning shoot down my arm, through my elbow into my fingers and back up the elbow into my chest. My arm, my chest and my back were wracked with pain which would not let go. I had never felt anything quite like this before: the intensity of the pulse and the lingering grip of pain. It felt as though I was in the hand of God and God was not pleased with me at all. I could imagine only that I was nothing but a lemon in the eyes of God and he wanted some juice. I struggled to my feet and tried to walk it off, without success. I slowly crept downstairs thinking that a change in scenery would help. It didn’t. I found it hot and stifling in the house and thought I needed to go outside for some fresh air. I tried to walk but started to become dizzy and instead fell to the ground. I didn’t think that I had passed out, but I found the next morning a small abrasion on my right elbow which may have been caused by the fall. Since I have no recollection of hitting my elbow, I may have blacked out for a few seconds. But after I fell, I got back up and crawled into a chair where I sat and collected my breath, wits and energy. Slowly the pain in my arm, chest and back subsided. Irene came down to see what was the matter. She kicked Miles out of his bed and I took over that domain, promising to see a doctor the following day.
Now medical care in Indonesia is a dicey proposition (or so they say). The US embassy recommends that if you need any surgery, major medical care or diagnostic tests that you do not receive it in Indonesia, but rather go to Singapore. I am not particularly well informed on the subject, but I understand that part of the problem is that Indonesia will not license foreign doctors, and therefore there is not that much competition within the profession. An additional problem is that the Indonesian universities do not rank on a par with the first world universities and, for the most part, do not promote creative thinking. As a result, Indonesia does not produce a lot of original thinkers/researchers in the sciences. But also, Indonesian culture tends to favor the promotion of people based on their seniority and status, rather than their boldness and achievement, thus creating a bit of an intellectual stagnation. Couple this with the fact that while this country has some fabulously wealthy people, and some hospitals can purchase state of the art equipment, it is not a particularly rich country and the equipment in most hospitals is something less than state of the art. And, even if they have state of the art equipment, they do not necessarily have state of the art technicians to operate the equuipment or interpret the results.
So, if you want state of the art, academic/intellectual rigor, and exacting science, you must go to Singapore.
Irene had previously spoken to the medical unit at the American Embassy and had discussed my back with them, asking for suggestions for the name of a doctor in Singapore I could see. They gave Irene the name of a woman who served as a medical coordinator in Singapore. This woman is not affiliated with the Embassy.
The following morning, I called this woman. I explained that I had injured my neck and wanted to get an MRI of my neck and consult with a doctor. I also explained that I was concerned because the previous night I had this episode which felt like I had a small heart attack as a result of the pain. Unfortunately, I did not choose my words carefully because the utterance of those two words: heart and attack, causes people to act very differently. If you ever want to jump to the head of the line at the emergency room of a hospital, all you have to do is breathlessly murmur those two words. Want out of jury duty? Try a variant: heart condition, leading to a heart attack. You will be stricken for cause. Be careful (hati hati) those two words are very powerful, but once uttered their power is detonated like a bomb, and just like a bomb, once it goes off, there is no putting back the pieces. I tried to backpedal, “no, I do not think it was a heart attack” and “I really want to see someone about my back”. But it was decided, just to be on the safe side, I would see the cardiologist first, today, ASAP. The medical coordinator would call me back with the time of my appointment.
After I hung up I called Irene to report, and then started to balk at the thought of racing off to Singapore. Irene suggested I call a friend of ours, who has lived in Jakarta for 15 years and used to work as a nurse. She re-iterated that if I have a back problem which may require surgery, I should definitely go to Singapore, but she also indicated that if I had a heart attack, I can determine that from a simple blood test here in Jakarta. As a result, I decided to call the medical coordinator back and tell her not to bother finding a cardiologist. Of course throughout this time I am experiencing shooting pains down my arm and am now thinking I may have done more than simply herniated a disk in my neck. When I speak to the medical coordinator, I am told she has already made an appointment for me with the cardiologist and I should drop everything and get the next flight out to Singapore.
I drop everything. I miss the next flight out to Singapore and the one after that because I am stuck in Jakarta traffic. Eventually I get to the airport and get a flight that will arrive one hour after my appointment. My medical coordinator tells me not to worry the doctor will stay here until I arrive.
To make a long story short(er). I eventually get to the cardiologist who, before he has seen me or spoken to me, has ordered up a battery of tests for me. He takes a quick history as they conduct a cardio echo test, which establishes that I did not have a heart attack. “I am not a good diagnostician” he comments. “But I never said I had a heart attack” I protest. He then sends me down for a battery of other tests, including a CT with contrast, and an MRI for my back. Several thousand dollars later. (Oh, did we tell you we do not accept BlueCross BlueShield and you must pay now?) I am to come back the next morning when my cardiologist and the neurosurgeon (surgeon??) will discuss the test results.
After an uneventful night in a Singapore hotel with the aid of some pain killers thanks to my cardiologist and 4 hours of HBO, I am ready the next morning to meet my fate. So here’s the verdict:
My cardiologist tells me that I have an excellent heart. No damage, no sign of cholesteral, good clear circulation. My aorta is a little larger than usual, but not that unusual for my size. I should not have any worries about my heart for years to come. He gives me some beautiful photos of my heart as a parting gift.
The neurosurgeon tells me a different story. He asks me first whether I played a lot of sports as a kid. I tell him no, I just worked in a lot of manual labor jobs. I don’t tell him how I started out pulling weeds and digging clams at eleven, and then later raking up clams by the bushel bag, then slinging pots and pans and stacking fish, nor do I mention all of the ditches I have dug in my lifetime. I don’t think he is particularly interested. My back he tells me is old and malformed. It is no longer the straight highway for my nerve canal. It is an old country road full of twists and turns. Those nice square building blocks of vertebrae are chipped and worn like the ruins of Prabanan. I have bulging disks in my lower and upper spine. It is not so bad I need surgery, but it will cause me periodic pain and only get worse over time. What can I do, I ask. Not much, he tells me, when I am pain free, exercise. When you have pain, don’t exercise until the pain goes away.
So the conclusion: I have a big heart but not the backbone to support it. I may have had a spine when I was younger. But now . . . And so I flew back to Jakarta, none the better but a little bit wiser. It was because of my back bone or lack thereof that I panicked the other night. I did not stand up for what I truly knew and believed, but instead succumbed to my worst fears and nightmares. As a result, I needlessly spent several thousand dollars on diagnostic medical tests that told me nothing I did not already know in my heart. And now the cost of those tests tears at my heart when I think of how that money could have been better spent.
Singapore and Jakarta are a world apart. Singapore is the modern miracle. A gleaming new city with decent mass transportation systems, good clean and abundant housing, a well educated and professionally employed populace, little poverty, little pollution, almost non existent public corruption. The schools are excellent. The people work hard but have their needs taken care of. Jakarta has no safe and clean mass transportation. It is riddled with slums and unsafe and unsanitary housing. You cannot drink the water. You cannot breath the air. You had best not walk along the canals. It suffers mightily from public corruption. Education is compulsory only up to age 13 and the education you receive up to that point is heavily based in rote learning. The money I spent confirming what my heart already knew could have been used to make a substantial difference in the individual lives of many Jakartans who earn less than three thousand dollars a year. Or it could have made a systemic difference to a small village in Sulawesi which lacks toilets, or class rooms, or sanitary water. Instead it went to support the city of abundance, and nothing has changed.
But while Singapore is a beautiful manageable and well managed city, I still prefer Jakarta. It is a city with heart. The people here will break their backs working like dogs, digging ditches, pulling hand carts through the street, sweeping the debris and detritus every morning. Later on I will post photographs of the work being done by Jakartans in building a new elevated highway in the city. For the most part all of the prep work is being done all by hand. You see scores of men digging up the street and sidewalks with pick axes. They fell huge trees along the side of the road and then dig out and pull up a huge root ball five or six feet in diameter, all by hand. The root ball must weigh half a ton. They push it up out of the hole to the side of the street later to be disposed of. You may see three guys working in a hole 6 feet deep by 3 by 4 feet square handing up bags of dirt to someone at street level. This is back breaking work, for which they are paid about twenty-five hundred dollars per year.
Yet, Indonesians will still bend over backwards to help another person, if they can. Our housekeeper, who is paid well but not much, saves all of our aluminum cans and takes them to a man in her neighborhood who will sell them to a scrap metal dealer. She does not profit from this endeavor. She does not need to do this, but she does it because she knows he has a family to support. She saves all of our old newspapers and takes them to another of her neighbors, who will use them to clean and wrap fish which she sells on the street. A few months ago, our housekeeper told me that she was going to the open air market. I offered to go with her, but she told me no, she did not want me to come, which I thought was rather unusual. I later learned that she had gone to the market to sell a small gold necklace her husband had given her for their 10th wedding anniversary over ten years ago. It was her one piece of jewelry of any value. She was selling it, after discussing it with her husband, in order to get some extra cash to give to her brother’s oldest child. He was newly married and soon to be a father. He had lost his job and could not find new employment. He wanted to buy a small handcart from which to sell noodles on the street. Our housekeeper had sold her necklace so he could buy the handcart.
I have had some dealings with an attorney here in Jakarta who has called on me for some consultations regarding legal issues in America. Each time I have met with her, we first must discuss life in general, then she will tell me a little about her family, and I will tell her a little about my family. Then she will tell me the problem or issue, but not really get to the point until she has introduced all of the players involved, their families and backgrounds. It takes time. A fifteen or twenty minute meeting can take two or three hours.
Singapore, the modern city has big machines to do all the backbreaking work you see the people of Jakarta sweat over every day. What would take years to accomplish in Jakarta can be done in a matter of months in Singapore. But the people of Singapore also act like a machine. They are programmed for efficiency and maximum profits. My Singapore doctors were not particularly interested in an oral history of my aches and pains. I guess they felt that they did not need it when they could get a snap shot of my back or heart. After all, is not a picture worth a thousand words? Particularly when it is computer enhanced? The doctors in Singapore were like the ones you see working in the States. They must see twenty or more patients during the course of a day. It is a mill designed for maximum efficiency and profit. It is also a very pleasant mill. I was assigned a young lady who shepherded me from room to room and who was extremely nice and cordial. She made me feel very special, like a shopper at Tiffany’s. But it was all very efficient.
Walking the city streets in Singapore you see a lot more serious expressions, dark pinstriped business suits, and determined, harried, individuals. People cross the street at a cross walk, when the light tells you can cross. The streets are clean, straight, and well marked. There is no reason for you to jaywalk in this City. But if you did, watch out, for they still employ caning as a form of punishment in Singapore. And violators of the law are handled quite strictly, without leniency.
Whereas in Jakarta the streets are maddening and chaotic. The streets twist and turn and come to deadends, or suddenly become one way, opposite to the direction you had been traveling. Cross walks are non existent. Traffic lights more rare than the Sumatran Tiger. The city streets are teeming with poor people strumming guitars for a few rupiah, or protesting for or against some righteous cause, or engaging in some street theater with a monkey on a chain. Rarely will you see someone, other than a foreigner, dressed in a dark business suit. Business attire for men is, for the most part, a button down batik shirt. When you want to conduct business and must engage someone in conversation about business, first you must talk about everything except the topic at hand. Personal questions are never improper. In fact, often you cannot conduct business until you first meet the person face to face and come to know that person on a more familiar basis. But be careful before you go to the bank on what they promised, for they might not have the backbone to back up what they promise, even if they believe in their heart that they will at the time they tell you so. I guess I can relate.
Okay, since no blog is any good without some pictures. Here are some real beauties. They cost me a pretty penny, so I can’t let them go to waste. One caveat: I was led to believe these were pictures of my heart, but upon second examination I cannot say if they are or are not. The color pictures of the heart may be mine, or they may be used only for illustrative effect while the true pictures are the black and whites to the sides. I simply do not know, my doctor didn’t have the time to fully explain it to me.
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