3/4/20 – 3/13/20
After a day of stretching my knee on Lake Nahuel Huapi, it was a day’s ride to Bariloche, a Bavarian settlement and tourist mecca on the south side of the lake. We stayed with a man named Coco who had a cozy home overlooking the water. Beyond getting a Cortisone injection and trying to stretch my knee, we didn’t do much. I met an old eccentric named Miguel who built and collected bike frames. His dream was to build a museum for touring cyclists in town. He had made a replica of the first bike to win the Tour de France with alloy rims, one with a dual speed drive drain that moved forward as you pedaled backwards, and another with an old style manual shifter that actually released the rear wheel and allowed it to slide in the dropouts in order to tension the chain while shifting. He had another with wooden wheels. On the walls were pictures of him touring in a leather helmet. Old parts and tools lay all over the floor and every available workbench space.
My knee was still stiff, but it was feeling better, so we decided to move. We only rode twenty five kilometers the first day to Lago Gutierrez. It seemed to be popping excessively when we started, but settled in and mostly felt fine. We found a quiet place to pitch the tent on the gravel shores under the steep granite cones. It was such a short day, we didn’t know what to do. I stood waist deep in the icy waters with my headphones on to ice my knee.
We made dinner and went to bed. I didn’t sleep well. There were rats all over and I could hear them taking interest in our bikes. I would hear them scurrying on top of a bag and jump up to shine the flashlight to see a tail disappear and one of our silvery pedals left spinning. They were still at it at 7:30 when we awoke. The moon was still bright although the sun was rising. The air was warmer than expected and my knee felt decent.
Rodents seemed like they could be a recurring theme in Patagonia. The campsites, formal and informal, see quite a bit of use. People leave food around and there usually are no toilets nearby.
“I can tell an Italian slept here recently.”
“There is a little cake of ground espresso over here. Only an Italian would travel with an espresso maker.”
In El Bolsón, I did my best to lay around and do nothing for the day. At some point I wandered out and found myself deep in conversation with Ariel, our host, about the seemingly impending doom that would soon befall mankind as a result of the novel Corona Virus. This inevitably led to comparing and contrasting the health care systems of Argentina and the United States. I had been intrigued with the previous week’s experience trying to obtain a cortisone shot in my knee back in Bariloche. I wandered to a few facilities with all the trappings of a respectable medical establishment and told them, “Me duele la rodilla.” (It pains me, the knee)
Everyone told me to go around the corner to “Guardia.” I assumed that it was just a coincidence that they were all mentioning the same place and that I was going to get trapped in the infinite loop of asking for directions in Latn America. To be safe, I just kept walking into every single door on the block with all the medical sorts of businesses figuring I would get lucky at some point.
Eventually I turned the corner and saw a sign. “Guardia.” It was the emergency room. That didn’t seem like what I needed, so I skipped it. After a few more doors and no luck I decided to give it a try. There was a short line, but I made it to the receptionist in less than five minutes.
“Eres un residente de Argentina.”
“Hay un cobra de examinación.”
“1200 pesos.” She said it like she was sorry that it was so expensive. It was about twenty dollars and at the current rate of deflation of the peso relative to the greenback would probably be a quarter cheaper if I waited another day. There was no paperwork. I showed her my passport and she asked me to take a seat. Within ten minutes I was on an examination table and a young woman was poking my patella. I had heard that Argentinian doctors were slightly less trigger happy in terms of writing prescriptions or jabbing corticosteroids which are known to deteriorate cartilage into joints on demand than their counterparts in the United States and so I had prepared a detailed log of several weeks of pain, exercise, and explained that Fred had advised me to get a cortisone shot.
Fred was of course a friend of a friend with whom I had once driven across the country on the maiden voyage of a Volkswagen Golf which I had converted to run on recycled vegetable oil. We had spent a week hiking in Moab with the Buffalo. Fred completed most of the canyon traverse in a pair of green Haines briefs, an impressive accomplishment given his fair complexion and the oppressive desert sun. We only met once after that for cocktails in an overpriced pretend hipster speakeasy. At this point he was a respected orthopedic surgeon, although he had his sights on something more meaningful.
“Man, some days I just want to have me a little hot dog stand in front of a liquor store. Not just a stand though, more like an ice cream truck, but with hot dogs. That way I could sit inside and serve food in my underwear and nobody would know.”
I admired Fred’s thinking.
The woman examining me seemed satisfied with all of this and said I could see a doctor in the morning who would give me an injection.
“Dr. Puchi,” she explained, would make the call as to whether I would get Hyaluronic Acid or Cortisone. She said the acid was very expensive.
I laughed a little. She looked offended.
“En Los Estado Unidos, una enfermera no te escupirá por eso.” (In the US a nurse wouldn’t spit on you for that)
The next morning I arrived at the main hospital and told the receptionist I was there to see Dr. Puchi. The appointment was an additional twenty dollars. I was in his office within a few minutes and he was jabbing at my patella with a sharpie.
“No hay problema con el meniscus.”
“Si, Fred me dijo que necesito Cortisone por los tendones.” He seemed to respect this and told me to come back in the evening. He gave me his phone number and said to send him a message because he would probably forget.
I arrived at 7:30 that night. Dr. Puchi came in just after me and we went back into his office. He had a small paper bag from the pharmacy with butterscotch candies and a small vial of a milky white liquid.
“Cortisona!” he said with a smile, and offered me one of the candies. He said that he had just finished a surgery and was going to take his son to soccer. He seemed to be in a hurry. He pulled out a fresh needle, close to an inch and a half in length. I looked at the thin layer of flesh over the bones of my knee joint and wondered where it was supposed to fit. There was a bottle of alcohol and some cotton balls on his desk.
“Make sure they clean it with alcohol and Betadine and that it is a generally clean environment,” Ned had told me.
I didn’t see any Betadine.
“Two out of three ain’t bad.” I imagined him adding.
He gave me a few quick jabs on each side and below the knee cap. The actual pain was not as bad as the thought of somebody who seemed to be rushed, and substandard sterilization chemicals, jabbing a needle into my knee.
“Cuanto cuesta,” I asked.
“3,000 pesos.” ($50)
I told him I would see the receptionist on the way out.
“No,” he waved his finger at me, “me pagas.”
I gave him the wad of cash. It made the whole thing feel a bit like a back alley heroine deal, but my knee was stiffening up just like the article I had read said it would and so I was satisfied that I would soon experience a moderately painful cortisone flair. It was my understanding that even a low brow smack dealer would supply a Band-Aid after a jab, this was not the case. I hobbled down the road to meet Soph for pizza and afterward struggled to climb onto a city bus.
I relayed this experience to Ariel. He mirrored the emergency room receptionist’s apologies that I had to pay anything.
“No es justo.”
I laughed and told him that in the US the whole ordeal would have taken two weeks and five grand without insurance. This prompted several thoughtful questions. Trying to explain and justify the intricacies of the US private health care system to somebody who only knows one in which you arrive at the hospital, receive care, and then go home without paying anything but a modest visitation bill is an interesting experience. It reminded me of a dinner party we once hosted in Utah at which a newly made friend was trying to explain the basis of her religious beliefs.
“Well, he found these special stones and had a hat that basically had magic powers which allowed him to read the word of God written on the stones….” I thought I was keeping a straight face, but I must have had an eyebrow raised. “You know, when I say that out loud I realize that it sounds ridiculous,” she sighed.
I was struggling to explain co-pays and deductibles and how when two people get into an auto accident, one person’s insurance company has to sue the other’s but that there are likely limits to coverage by the company representing the at fault party and so if damages went beyond this limit then your company would have to cover this or you might even have to sue the individual; which would likely bankrupt them. I had a realization that speaking in Spanish now came more natural to me than explaining free market health care economics.
“Sabes que? Cuando yo lo digo eso, yo se parece ridiculoso.” (You know, when I say that out loud I realize that it sounds ridiculous.)
Like what we're doing here? Throw us some bread. It keeps tires on the bikes and food in our bellies! Better yet, share us on social media or send a link to a friend with a message that says something like "Hey, I consider you a person of refined taste and culture and think that you would enjoy this."