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— At the hospital, the food cart from the kitchen would arrive on the brightly waxed third floor five times a day. Everything had the look of being maintained by someone's crazy, obsessive aunt, who would not let children sit on her living-room furniture, covered in plastic, for fear of an inadvertent spill. Hospital Angeles took its food service seriously. A crisply uniformed worker would carry the food into the room, flanked by two administrative types carrying clipboards and dressed in blue skirts, navy jackets, and white blouses. The worker who placed the food on my table always had a bright smile, and she lifted the aluminum cover over the plate with a flourish, as if serving someone in a five-star restaurant. There was real silverware and food plated on white china with the hospital logo. "Look," the server would say, pointing to each item, "chicken breasts with garlic, peeled pear with strawberry sauce, rice with corn, yogurt with fresh fruit, and decaffeinated coffee." She made eye contact, looking for signs that I was happy with the fare. Meanwhile, the two administrative types stood by, ready to take notes: "Patient allergic to shellfish. Patient prefers whole-wheat bread to tortillas." At every meal I was informed that I could send the food back if it did not suit me or return it to the kitchen for reheating if it were not warm enough. Sometimes, the chef would call my room and ask if I wanted chicken or tuna, oatmeal or dry cereal. Did I need more coffee? These little food-presentation dramas became something to look forward to each day and helped me keep track of time: breakfast at around 8; midmorning snack (Special K cereal and a side of mango) at 10:30; the biggest, most filling meal of the day at 2:00 p.m. -- a creamy soup; a well-prepared thin slice of steak, maybe two ounces; one-fourth of a baked potato, turned on its flat side so it formed a cone that stood up on the plate, with a design carved on the top to give it the look of a ready-to-eat potato sculpture; two tiny pieces of whole-wheat bread cut to form perfect circles, with a light spread of cottage cheese. Late afternoon, around 5:00 p.m., another snack -- a fruit salad, or five crackers and a glass of skim milk. Then, around 8:30 p.m., the final meal of the day, a snack of mixed fruits and a small bowl of cornflakes with 1 percent milk and a glass of freshly squeezed juice, sometimes a ham-and-cheese or a tuna sandwich with nonfat, artificially sweetened yogurt and strawberries on the side.

Two days before I was to leave the hospital, I had a bitter argument with Dr. Zúñiga, not the first in our five-year doctor-patient relationship. The doctor had sent over a note by way of his secretary outlining how much he would be owed when I was allowed to go home: $4500 U.S. dollars. That was $1500 more than what we'd agreed upon before I was admitted, and, angry, I picked up the phone and called the cardiologist's office. Maria Elena, a buxom, saucy, and a-little-too-familiar receptionist who knew me well, answered. I said, "I just got the bill from your boss, and it is absurd! If he thinks I'm going to pay him $4500 in fees for a week in the hospital, he's crazy. That's more than $600 a day, and for what? All he does is stop by for 20 minutes twice a day. That's more than the hospital is charging me for room, board, nursing care, and medicine. You tell him I am really angry and I want to talk to him right away!" Maria Elena sighed heavily. She had been in the middle of this before and knew better than to take sides. "Okay," she said, "I will tell the doctor to call you. Right now he is with a patient."

Within 15 minutes the phone in room 319 rang. Caller ID showed it was a call from the cardiologist's office. I picked up the phone, ready for a fight. "Yes," I said. "What do you want?" Dr. Zúñiga was on the other end, also itching for a fight. "Look," he said, "that's what I charge. I am expensive. You want the best, you have to pay for it. And if you don't pay me, I won't sign a release allowing you to leave the hospital." Many Americans hospitalized in Mexico, especially those who don't live here but who have encountered some medical misfortune during a visit, have bitterly complained about this aspect of Mexican medicine: if you don't pay your bill, you can't leave. There have been repeated news accounts about gringos held in hospitals under police guard until their hospital bills are paid in full. But I wasn't some tourist unfamiliar with the way things work in Mexico. I decided to call Zúñiga's bluff. "Listen," I told the doctor, "I'll pull this damn IV out of my own arm and walk out of here. Call the police if you want, put me in jail. Go ahead. But you will not screw me over. You told me $3000, and now you want $4500! Forget it."

Dr. Zúñiga quickly adopted a different tone, lowering his voice and speaking more slowly. "All right, all right. Listen, I will come by later this evening and we can talk about this. Calm down. This is very bad for your blood pressure and heart -- these damn fits you have. You create hurricanes in a glass of water! I will be by later, and don't worry. We can work this out." About an hour later, a nurse came to my room with an off-schedule injection. "What is that?" I asked. "Something to calm your nerves," she said.

That evening, around 7:00, Dr. Zúñiga, a short, balding fellow wearing blue jeans, a white shirt with the first three buttons open, and brown shoes styled after cowboy boots came to visit his angry patient. Over the hours since our phone conversation I had strengthened my resolve not to pay the extra $1500. But by the time the doctor arrived, he had already decided to honor his $3000 prehospitalization agreement -- $4000 for a week in the hospital, medicines, bandage changes, and meals included, and $3000 for his professional services. "Look," he lectured. "You are a very difficult patient to treat -- heart problems, diabetes, high blood pressure, blood clots, chronic bronchitis, morbid obesity, and now this damn infection that won't go away. Remember, we are trying to keep you from needing surgery, which would really endanger your life. But you are a complicated patient, and you are a stubborn man with a bad temper. You know that. We are alike that way. Remember, too, that I have called in a surgeon, an infectious-medicine specialist, a hyperbaric doctor to look at you -- and I have to pay their fees, too. But okay, I will accept the $3000." Then Zúñiga looked me squarely in the eye, full of Mexican hyperbole: "You are the kind of patient that makes a doctor nervous. I go home at night worrying about you; sometimes I can't sleep. I worry that something may go wrong, and it could, anytime. You are in very delicate health. Surely the worry you cause me is worth something."

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pampal Sept. 22, 2008 @ 11:49 p.m.

I also am an American living in Mexico and loving it. Agree with the author about the medical care. Since I have no med insurance I receive all my care here and agree that the standard of care is as good as, and even surpasses the care I have received in the US. The doctors here do spend so much more time with me and seem to be more thorough and LISTEN. I have had nothing but great experiences with both dentists and MDs. A nagging bladder infection was cleared up after years of suffering under the care of an Hermosillo urologist. A son in law found relief with a simple cream subscribed by a dermatologist for his bad case of phoriasis (sp?), and this after considerable expensive care in the US. The Cima Hospital in Hermosillo is one of the best and comparable to any US hospital, but at a cost of 25% to 50% of what a US hospital charges. Our friends are shocked that my husband and I get our medical needs taken care of in Mexico!

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