Monday, March 22, 2010

Caracas Mammogram

I had to have a mammogram in Caracas recently.

Scared, yes. Scary, no.

I found a lump in my breast in the shower last Friday afternoon. It was small, squishy and painful, so the doctor in me know that the lump was most likely not cancerous.

The woman in me, however, begged to argue that my brother had cancer, my aunt has breast cancer and I lost an uncle to colon cancer at a young age - and that is just on my Mom's side. Cancer is old friends with both sides of my family - so I know I have a better chance than most to have the big "C" bomb dropped on me.

I called my doctor and she got me in for a mammogram right away. I was to meet her at her office in the hospital at 0700. I arrived and went to her office. She had already sent her secretary to the radiology department to pull a number for me.
Yes, pull a number. Like at a meat counter.

Appointments for anything medical are pretty much nonexistant in Venenzuela. You are told to come on a certain day, and it is first come, first serve. Get there early, and pull a number and they will get to you when they can. At least in the U.S. we pretend to have appointments. Sure, you most likely will sit there all day - but have a reason to be pissed off about it.
The doctor met me upstairs in the waiting room and asked if I had on deoderant. "Of course," I said. Well, it seems that the METAL (aluminum) in the deoderants is radiopaque and interferes with the mammograms. Duh. You would think that with a degree in geology AND medicine I could have figured that out on my own.
After a frenzied dash up to the restroom in her office where I had to strip off my blouse and then scrub my armpits in the sink with water and toliet paper, then rush back down to the waiting room for my turn.

Luckily, my number had been pulled for me, so I did not have to wait long. A beautiful woman dressed in the usual Venezlano fashion - low cut blouse showing maximum cleavage, skinny jeans, stiletto platform pumps, and a trim white low cut lab coat - called my name.
"Mah-ree Aw-bear?"
"Si." I replied.
Something in rapid fire venezuelan spanish that I am sure translated meant -" Follow me please."
She was very nice and professional and chatted with me in spanish as she clicked down the halls.
"Buenos dias, como vas?" Clickety click.
"Bien, y tu?" Me
"Chevre, chevre" Clickety click.
We arrived at the exam room and there was a modern looking mammography machine, a chair, and a paper blue vest. I quickly figured out that she was the radiologist technician who would be performing my mammogram itself. I really got a kick out of her outfit then. Just the thing to wear when a woman is in freak mode about her own breasts - why not just display yours to just a millimeter above the areola?
She WAS very professional and I had no qualms about her performing the exam. I am certain she told me that she was the technician but my spanish these days falls into four categories: Delivering babies, grocery shopping, chauffer instructions, and basic greetings. I have not reached the level of being able to understand "Hello, I am your radiologist technician. I will be performing your exam today."
We got through a basic questionaire (I read WAY better than I speak) and then she told me to change. She seemed genuinely surprised and a little amused that I did not have implants. I looked around for a bathroom or closet and a robe, but she pointed to the chair. I took off my blouse and bra and grabbed the blue vest. "No, no," she said and wagged her index finger at me.
I walked up to the machine naked from the waist up. Nothing like making a woman with a breast lump and body image issues walk naked infront of another woman with a push up bra and stilletos. She competently finished all of my radiographs and THEN I was allowed to put on the robe and wait for her to have the films cleared.
She returned five minutes later and told me that the quality of the films were good and I was free to go. I walked out, paid $350 BSF (about $50), and went home to await a call from my doctor.

Friday, March 5, 2010

What little girls are made of.


I write this blog for many reasons - obviously to keep up with our family and friends, but also to preserve a bit of the history I am creating for my daughters. I also want them to never doubt my motives in the decisions I made for them as children. This blog is mostly for Madeline - to read when she is 25 and vaguely remembers her trip to the hospital in Caracas.

My dearest Madeline,

You woke up with a virus night before last — fever, runny nose, cough — nothing out of the ordinary for you having a cold. We gave you some cough and fever medicine and you slept pretty well the rest of the night and into the morning. I kept you home with me and you had a pretty good morning. Your fever would come and go, but you were cheerful, and played most of the morning with your (conveniently) sick neighbor and best bud Ryder who I was watching for his mom as she was at a Chevron function. You and Ryder were having a great time watching TV, coloring, playing Lego's and Pet Shops.

I left you with Julia our housekeeper at about noon to go to the supermarket, and when I got back an hour later, you were again.

It was not your usual cough, it was a dry, hacking cough — like the one Katherine gets with her asthma. Katherine's asthma is much better as she is older, but at your age, every time she got a virus, we were doing breathing treatments into the night. I always thought we were fortunate that you did not seem to have asthma nearly as bad as she did. I gave you some cough medicine, and had to leave to pick up Katherine from school.

While I was at school, you had Julia call me. You were worried and wanted to know when I was coming home. You were coughing a lot on the phone and I was getting worried. When we got home from school at around 4:00, you was laying on the floor of the kitchen, coughing. Every breath led to a dry hacking cough. I grabbed my stethoscope and listened. You did not seem to be moving air very well. I grabbed our inhaler with the spacer and gave you a couple of puffs of albuterol. This has ALWAYS worked in the past for you. I waited about 15 minutes, and your fever spiked. Then you became more lethargic and coughed more.

I scooped you up and went downstairs to our neighbors, the Turners. Tara is a nurse, and her son Hayden is 14 and has had hospitalizations (one recently here in the ICU during a bout with swine flu) due to asthma. She is an expert. She whipped out her nebulizer and meds and we gave you a breathing treatment. I took you back upstairs, and watched you continue to get worse.

You crawled up into my lap and said, "Mommy, I don't feel good." I called our doctor here who is on retainer with Chevron. We are fortunate as she is half Canadian half Venezuelan and grew up bilingual. I explained to her what was happening, and how this was very abnormal for you. She told me to take you to her clinic and she would meet me there. I realized I had sent the driver back to Daddy at the office, and they were looking for pediatric masks for our nebulizer. I had no car! I called everyone I could think of for a vehicle — but it was prime time for traffic and picking up spouses from work and no one had a car handy. I called Daddy, and he said they would head straight home. Fortunately, traffic was not too bad for them, but it was a LONG 45 minutes for me. We got to the doctor's clinic — and she saw us in the hallway waiting. She took one look at you, and suggested we go to the ER which is in the same complex as her office.

I had no idea what to expect. I was pleasantly surprised by an ER which could easily have been in a small rural community in the US. It was clean, neat, but just not fancy. The staff were patient with us, and thank goodness my spanish is coming along and medical terms are basically the same in any Romance based language. They started you immediately (no crowds, no waiting) on inhaled steroids, and by the second huge breathing treatment we could see you were getting better. Your coughing finally stopped after about 45 minutes of nebulizers. They had to draw blood and start an IV. You was not happy about it, but Maddie, you are so brave, it still brings tears to my eyes. They gave you IV steroids as well. You were feeling much better when you went for your XRAY. You were the cutest, bravest little slip of a girl you have ever seen in front of that big machine. I interpreted for you to take deep breaths and hold them, and you were a perfect patient.

Your blood work was consistent with a viral syndrome, and although your XRAY was not normal — there was no pneumonia. Dr. Vega let me take you home to continue steroids and breathing treatments at home. You has rested very well overnight and hardly coughed at all (thanks to the IV steroids) and I am sure by Monday you will be back at school.

You are feeling much better today. We watched Black Beauty, played the Wii, read stories, did the computer Starfall reading program and did all of the homework your teacher sent home for you. I am so glad you are feeling better, and I although I hated you being so sick, I loved spending time with you.

Mommy

Thursday, March 4, 2010

The Cost of Success



I am what is known as a planner.

To the amusement of my friends, I am the one who plans vacations a year in advance, buys clothes 2 sizes too big for my kids, and has a to do list ready if my husband died suddenly in an accident. Like many of our friends, we are also planning to help pay for our children's education (college and beyond).

Being an uber-planner, it is not enough for me to simply say, "I am going to pay for my kids college" - I needed a realistic goal to meet. How much does college cost? How much should Chris and I prepare for. Katherine is heading off in 9 years, and in a planners mind, that is day after tomorrow.

Chris and I started the research by discussing what it cost for us to go to college. His tuition was paid for by his parents (mostly) and I covered all of my own expenses. My tuition was less than $1000 a semester, and by eating lots of top ramen, living at home or with my brother, walking or riding a bike every where, and a myriad of jobs, I was able to make ends meet.

Not knowing where to turn to get an accurate picture of expected costs for my children, I consulted the internet. I googled "college cost calculator" and got an education. It seems that expected college costs for Katherine and Madeline will be around $400,000 total.

Seriously. About $200,000 a piece. That is for an instate tuition at a public university. This covers room, board, books, fees, tuition and transportation costs. It also accounts for the expected college inflation rates of 6% a year. Private university costs are much higher, with tuition the average of double the public university rates.

So the debate begins. My husband and I are both products of public universities. We both went to graduate school (me public, he private) and paid for it ourselves. We plan on keeping our residency in Texas - regardless of where we live in the world, and realistically expect our children to choose one of the many excellent public universities in Texas for their educations.

What exactly do we expect to get for $400,000? Chris and I have very clear goals when it comes to our children's educations — they need to be able to support themselves. Period. I really do not care what they choose to do in life, as long as they are reasonably happy, and can pay their own bills.

We also have had many discussions on what majors they are going to be "able" to pick. You might think we are crazy - but hear me out. As stated above, we expect our children to graduate from college with and education AND a skills that will allow them to be fully functioning adults. There are certain majors that do not typically lend themselves to immediate employment, and we are steering them away from those. We have also told them they could minor in anything they wanted.

Chris and I don't want to work forever. We are happily sacrificing and saving for their future, but there are limits to what we can offer them. We also want to be able help them out with buying a home, or starting a business, or graduate school, or the inevitable "rainy day." If they chose a private, out-of-state University - and we paid for the whole thing, there would be nothing left for the future.

What! Are we crazy - trying to micromanage our children's lives? We are lucky to live in a state that has so many diverse opportunities in higher level learning - Some colleges are large, some are small, some are known for education, architecture, engineering, business, etc.. and we believe they should be able to find a university that meets their goals. We also believe that buy paying for their educations, we are investing in their futures, and we expect them to choose careers that will provide for their needs.


We certainly have many friends and acquaintances who had to opportunity to attend excellent private universities throughout the world, but we wonder if it is truly worth the cost? Is an education degree from Baylor really better than one from Texas A and M? You are still a teacher, most likely in a public school in Texas, making the same amount of money — just Baylor's degree was four times as much. I do not want to offend anyone here, but I would like to hear opinions on this topic.

Below is the link to the college cost calculator:

http://www.careercornerstone.org/pdf/universities/tuition07.pdf