We make house calls

(To read El Gringo Feo’s Costa Rica Diary from the beginning, start here.)

Thursday, September 20

After nine days, my ankle still was swollen, sore, and in some respects, more painful. I started to worry that maybe this was worse than a sprain.

Time to see a doctor.

So at about 6 a.m. yesterday, I sent an email to the folks at Uvita Information Center asking for guidance on my medical options. In less than an hour Sonia León sent a detailed response with a series of options, including Dennis Ulate, who she said speaks English and might even be willing “to see you at your place.”

Wow. A house call? That would be cool …

When I called Dr. Ulate, he answered immediately and said I could meet him at his office or he’d come here to PurUvita to see me. He said he could be here within 30 minutes.

Wow again. I asked him to come here.

He rolled up in a 4×4 with muddy tires. A youngish Tico wearing scrubs, jeans and tennis shoes. He hauled his gear out of the truck and followed me up to the kitchen area for the exam.

He did a thorough examination of the foot, including questions about my medical history, the injury, current meds, etc., all of which he input into his laptop, which was hitting the Internet via a tethered connection to his phone. He was personable, professional and his English was flawless. HIs main concern, as was mine, is that there might be a fracture involved here, too. After the examination, though, he was pretty confident it was a grade 3 sprain, the most severe. But based on my ability to walk on it and my responses to questions about pain when he manipulated various parts of the foot, he was leaning toward it being just a sprain.

“If it gets worse over the next few days or doesn’t improve, I want to get an X-ray,” he said.

No problem. Where can I do that?

Well, that’s where it gets a little complicated. There’s apparently not an X-ray machine here in town, and the nearest one would involve a drive on roads that might or might not be affected by the national strike that has been dragging on for a week or so. But there is an alternative:

There’s a veterinary clinic here in town that can do the X-rays and email the results to him. If the foot gets worse or doesn’t start improving, he suggested I swing by there to get X-rayed. I was taken aback at first, but when I thought about it, there’s no reason not to do that. And maybe I’d get to see some dogs in the process.

Then my mind flashed back 30 years, to a situation that was the complete inverse of this. Before Lara and I married, she had an Amazon parrot named Taco who suddenly came up lame and whose head was drooping to one side. Our vet, an incredible woman named George Ranglack (her father always wanted a boy, she explained) snuck Taco into a human hospital in Vestavia Hills to do a CAT scan. The staff there cooperated, with one of them even bringing in her child to “see the bird get a CAT scan.”

Sadly, Taco died before we got the results, which indicated he’d had a series of strokes. Hopefully, I’ll fare better than my avian friend.

Dr. Ulate prescribed some pain meds that would do better than the Ibuprofen I’ve been gobbling (with less negative impact on my stomach) and a gel that I’m applying to the foot three times a day. If the foot isn’t improving in a few days, I’ll swing by the vet clinic for those X-rays.

The cost of all this? About $70 U.S. What a bargain. I can’t imagine even getting a doctor to make a house call back home, yet alone do it for this price. As of this morning, the foot is feeling better, though the swelling persists and I’m not ruling out the fact that the improvement could be psychosomatic. I breathed a deep sigh of relief after the doc had examined it and didn’t think there was a fracture so I’m obviously hoping hard for that to be the case.

Next up, I had to get the prescriptions filled. As I started to dial the cab I hesitated and wondered if my friend Gian was around and able to take me in to la farmacia. I pinged him on What’s App.

“Can you wait about 20 minutes?”

“No problema.”

Gian swung by in a badass turbo diesel Toyota 4×4 he’s renting to facilitate a parental visit and took me to the pharmacy, where a young woman filled the prescriptions, asking me in English if I had questions and explaining dosages, frequency, etc.

I offered to buy lunch to thank Gian for being a de facto cab service, and we drove out to Ballena Bistro, a great little lunch place right off the Costanera Sur a few kilometers south of PurUvita. It used to be called the Goathouse in a previous incarnation. While their site describes it as a “barnlike” building, I didn’t feel like I was eating in a barn. The woodwork is beautiful and it’s a wonderful space. I had ceviche, a falafel burger and a glass of white wine. Great food. Stellar service. As we ate in a small open area, the afternoon rains started to roll in. John and I talked and argued about politics, music, Costa Rica. The more I hang out with Gian the more I like him. There’s no bullshit or pretense there, and after two years living in the area he is expert on the best places to eat and frequent.


I didn’t post an entry Wednesday because there wasn’t a lot to say. I finished Middlemarch and, perhaps foolishly, started re-reading Malcolm Lowry’s Under the Volcano, a dark, dipsomaniacal modernist tale set in the shadows of Mexico’s twin volcanoes, Popocatépetl and Iztaccihuatl. I remember the first time I saw them, looming over the Valley of Mexico as my friend José and I drove his powder-blue 1971 Dodge Dart to Puebla in the early 1990s. He explained the Aztec legend behind the names. Every time I return to Mexico City I hope for clear days so I can see the Aztec warrior and the princess he loved, capped with snow, stunning in their volcanic repose.

I’ve never been shy about having a few drinks, but I’ve never understood the all-consuming obsession of the raging alcoholic. Lowry did. In a horrifying way. Under the Volcano is set on the Day of the Dead in 1938 Cuernavaca and details the story of a British Consul right after Britain had cut off ties with Mexico and recalled its diplomats because President Cardeñas had seized and nationalized foreign oil concerns on the cusp of World War II. The Consul refuses to return to Britain, remaining in Mexico where he wavers between delirium tremens and mescal-infused lucidity. The story is told from several perspectives, including the Consul’s wife, who recently divorced him, and his half-brother. Lowry’s writing is gorgeous as he dives into the minds of each character during that single day in Mexico. But after a few hundred pages of this brutality, I needed a break. So I started tinkering again with The Book, making decent progress and drafting my way through Chapter 4. I waver between being overwhelmed at how daunting the task is and impressed at how the story is starting to take on a life of its own, writing itself as I go. But I still have a long, long way to go. I’d love to return from Costa Rica with a first draft, regardless of how messy it is, but that might be too ambitious.


Yesterday, I continued reading Under the Volcano but also carved out a few hours to read Thomas Kyd’s The Spanish Tragedie, a late 16th century play with revenge as its central theme. That’s a theme I’m toying with in my book, and as I worked on it the other night I inserted one of my favorite lines from Kyd’s play into my book: “Vindicta mihi!” (Latin for “Vengeance is Mine.”) It’s a line uttered by Hieronymo in The Spanish Tragedie, and it always stuck with me. (This is the same Hieronymo who pops up in T.S. Eliot’s The Waste Land):

These fragments I have shored against my ruins
Why then Ile fit you. Hieronymo’s mad againe

In Kyd, Hieronymo’s searing drive to be avenged and demand that vengeance should be his is an abnegation of the fact that in the Bible, God cautions that only He can mete out vengeance. The Biblical verse (Romans 12:19) is

Dearly beloved, avenge not yourselves, but rather give place unto wrath: for it is written, Vengeance is mine; I will repay, saith the Lord.

When Hieronymo seizes that prerogative as his own, things go horribly wrong and he’s out of sync with God’s law.

After all that acute alcoholism and bloody revenge, I lightened things up last night by listening to a 2014 podcast interview with Karl Ove Knausgaard. It’s the first time I’ve heard him speak in his polite, calculated English inflected with a Norwegian accent. Jeffrey Eugenides had the unenviable task of questioning Knausgaard. What do you ask a guy who has (at that point) written a six-volume autobiographical novel?  It’s pretty much all out there already. It was delightful to hear Knausgaard read the first several sentences from My Struggle: Book 1, though I guess one could arguing I’m returning to the dark place again:

For the heart, life is simple: it beats for as long as it can. Then it stops. Sooner or later, one day, this pounding action will cease of its own accord, and the blood will begin to run toward the body’s lowest point, where it will collect in a small pool, visible from outside as a dark, soft patch on ever whitening skin, as the temperature sinks, the limbs stiffen and the intestines drain. These changes in the first hours occur so slowly and take place with such inexorability that there is something almost ritualistic about them, as though life capitulates according to specific rules, a kind of gentleman’s agreement to which the representatives of death also adhere, inasmuch as they always wait until life has retreated before they launch their invasion of the new landscape. By which point, however, the invasion is irrevocable. The enormous hordes of bacteria that begin to infiltrate the body’s innards cannot be halted. Had they but tried a few hours earlier, they would have met with immediate resistance; however everything around them is quite now, as they delve deeper and deeper into the moist darkness. They advance on the Havers Channels, the Crypts of Lieberkühn, the Isles of Langerhans. They proceed to Bowman’s Capsule in the Renes Clark’s Column in the Spinalis, the black substance in the Mesencephalon. And they arrive at the heart. As yet, it is intact, but deprived of the acting to which end its whole construction has been designed, there is something strangely desolate about it, like a production plant that workers have been forced to flee in haste, or so it appears, the stationary vehicles shining yellow against the darkness of the forest, the huts deserted, a line of fully loaded cable-buckets stretching up the hillside.