A Gonzo Journalist Investigates Spanish Health Care — OR –A Fat Old Man Rollerblades

Readers have been clamoring for more information about health care in Spain. A traditional journalist would respond to such requests by doing “research,” and then weaving “facts” and “figures” into an informative narrative. Ha! Stupid traditional journalists!

I want to write about Spanish health care using Hunter S. Thompson’s technique of “Gonzo Journalism.” If you are unfamiliar with Hunter S. Thompson and Gonzo Journalism it probably is because your youth was not misspent.

Thompson popularized Gonzo Journalism with his bestseller, Fear and Loathing in Las Vegas. That book is a first-person narrative (a hallmark of Gonzo Journalism) chronicling the author’s real and fictional experiences, all of which involved his abuse of alcohol, psychedelics and other drugs.

One of the great impediments to my fully embracing Hunter Thompson’s style of journalism is that I wouldn’t know where to buy a tab of acid or a line of cocaine, even if I wanted one. I do not want either of those things, but for the past year I have been unable even to drink alcohol. That malady (the inability to drink) led to first-hand experiences with both American and Spanish healthcare systems. Get yourself an adult beverage and I will explain.

Spain makes great wine and sells it for not much more than the cost of bottled water. I used to drink two glasses per night, sometimes more. Then one day I got a bad headache. “Red wine will do that sometimes,” I thought. I tried different varieties and vintages, but the problem persisted. I could drink one glass and be okay, but the second would trigger a 16-hour migraine.

I tried tequila, the excellent kind made by a handsome movie star which you are supposed to let linger on your tongue (the tequila, not the movie star). The first drink was delicious, but the second triggered a headache. Not being a quitter, I tried bourbon, scotch, vodka, gin, brandy, rum, cognac and beer. No matter the grain or fruit, or the fermentation process, I could have one drink only. And in case you are wondering, there were no loopholes. I could not escape the headache by doubling the first drink’s size.

One day I found that the first drink, even the normal-sized first drink, triggered a migraine. Indeed, eventually just a single sip of beer left me in agony that lasted all night and much of the next day.

I first sought treatment for my unwanted sobriety last May (2021). I saw an American doctor while in the USA visiting family and friends. My Spanish insurance did not provide coverage for treatment in America so I paid $250, in advance, for the consultation.

I had to arrive at the doctor’s office a half hour before my appointment. This because I needed to answer written questions about my personal and family medical history, going back to my birth. I had completed the exact same form before every doctor visit during the preceding ten years.

As a retired lawyer I know the reason for repeating a question even after getting a clear answer. Obviously the doctor wanted to catch me in a lie. This was stupid because each visit began with me getting on a scale. He had all the proof he needed that I lied.

My doctor was busy, but the $250 got me the ear of a physician’s assistant. She listened attentively and asked pertinent questions. She said that it is not unusual for alcohol to trigger migraines, but she marveled at the fact that this started when I was 64 years old.

“What should I do?” I asked.

“Try to avoid alcohol,” she said.

This exchange may remind you of a classic Henny Youngman joke. That joke’s punch line is, “Don’t do that. That will be $50.” Modern doctors have learned a lot since Youngman’s day. They now get paid up front.

Fast forward ten months. I have abstained from all intoxicants. I really don’t much miss the alcohol but I have gotten a couple migraines for no apparent reason. I decide I should again see a doctor.

This time I am insured. Doubly insured, in fact. Because Denise and I have been in Spain more than a year we were allowed to enroll in the national healthcare system, at a cost of €217 per month. But we also kept our private policy with Sanitas, for which we pay €3,326 ($3,600) annually.

I go online and make an appointment to see Dr. Salvador Pertusa Martinez. He works for the national health service in Alicante.

I am able to see Dr. Pertusa in just a couple days. I arrive a few minutes early and wait in a hall outside a door bearing his name. No more than five minutes after the appointed time I am invited into Dr. Pertusa’s office.

He sits behind a desk. On either side of the desk stands a young man, each looking to be about 13 or 14 years old, but each wearing a white coat. Despite their apparent youth I presume they must be old enough to be in medical school. They say nothing but watch me attentively. I wonder if I should offer them candy.

I have never before seen Dr. Pertusa. I have completed no forms. He does not know what surgeries I have had or whether I have a family history of cancer, diabetes or madness. He does not know whether I am allergic to penicillin. I have not been weighed and I do not see a scale. If he asks I will tell him that I weigh 175 pounds.

Dr. Pertusa asks, in Spanish, why I am there. I haltingly begin to say, “Si bebo alcohol me duele la cabeza.” He interrupts with, “Would you prefer to speak English?”

I ask Dr. Pertusa how he knew that Spanish was not my native language. He laughs because that question is the most ridiculous thing he has heard all day.

I explain how at age 64 I started having migraines, usually after drinking alcohol. He asks a few questions, each of them obviously relevant to the possible cause of this particular ailment. He asks me to sit on a table. I move to the table and am followed by the doctor and his two Doogie Howsers. I reach into my jacket pocket but am disappointed to find that I am out of hard candy.

After a very brief examination Dr. Pertusa tells me that probably I am fine, but he wants an MRI “to rule out the remote possibility of a troubling pathology.” I have never been to medical school but I know this Doctor-speak is susceptible to two interpretations. It can mean, “You might have a brain tumor.” But it also might mean, “I want to cover my ass.” Actually, when I think about it, both statements mean the same thing.

Dr. Pertusa says that he will refer me to a neurologist. He gives me a letter which I am to give to one of the ladies at the front desk. A front desk lady takes the letter and leaves for a few minutes. She returns and says the neurologist’s office will call when they have an opening, probably in a few months.

You may have deduced that one using the public health system can see a family practitioner on relatively short notice, but there may be a long delay before seeing a specialist. Denise had the same experience.

For some time Denise has had pain in her feet. She saw Dr. Pertusa for the problem and he referred her to an orthopedic surgeon. It would be several months before she could see that public health specialist. Denise therefore called an orthopedist included in our Sanitas plan. She was able to see that surgeon almost immediately. He conducted a battery of tests that same day, and her elective surgery was scheduled for just three weeks later.

“Ah,” you may be thinking. “That is all well and good but we did not start reading this article out of concern for your sobriety. We want to hear about the fat old man that takes up rollerblading! He must have been a complete moron!”

Those of you who are less unkind will be thinking, “How could an otherwise intelligent fat old man do something that stupid?” The answer to this question begins where a previous essay left off, with the rebuilding of our swimming pool.

Large trucks involved in the pool remodel damaged the driveway. As long as we needed to resurface the drive, we reasoned, we might just as well refashion the shape so that it is more to our liking.

We were extremely happy with the results. In the space of a few days our driveway went from the image on the left, to the one on the right.

As I looked at the new driveway I instantly thought of roller rinks. I had never in my life roller-skated, but I have seen images of people cavorting at roller rinks. They always look like they are having a great time, sliding along in defiance of gravity, swaying to pop music, laughing at nothing but the joy of their own rhythmic movements.

Right out my front door there was a brand new flat and perfectly smooth surface. That surface cooed seductively: “Come to me Dan, you sweet graceful gazelle, come to me with rollerblades and show the world how you can effortlessly float through space and time like a beautiful fall leaf in a slow-moving stream. Your friends, Dan, your friends will be in awe of your sublime athleticism and your wife Dan, your beautiful wife will look at you with new eyes and she will swoon and the two of you will fall into each other’s arms and make passionate love on aromatic and exquisitely soft rose petal beds.”

Maybe a concrete surface has never tried to seduce YOU with run-on sentences. If not, you are in no position to judge ME. But if so, then you fully understand why I immediately made a special trip to a sporting goods store and bought rollerblades.

This is where I am supposed to tell you about my rollerblading accident. Suffice to say that just minutes after strapping on the skates I began to suspect that the concrete surface had been mistaken. Within ten minutes I was pretty sure it had lied, and in a half hour I knew that it wanted to kill me. That was when I lost my footing and somehow, and to this day I still cannot figure out the precise mechanism, fell onto my own left foot.

I was not instantly angry at the concrete surface, that cement siren, but only because for me the earth, and all the stars and planets, and all the moons circling those planets, had ceased to exist. There was nothing in the entire universe except the pain in my left ankle. I think I bent into a fetal position but I can’t be sure because even my own body seemed to have disappeared into the singularity of my agony.

At least that is the way it seemed at the time. Apparently my body retained a mouth because Denise came running from behind the house believing that an entire girls softball team was being tortured by some mad Spanish sadist.

Eventually the pain subsided enough that I became aware of Denise’s presence. A short eternity later I was able to crawl on hands and knees until I was in our house and on our sofa. Denise iced the injured limb. Three days later the swelling was substantially reduced but I still could not put any weight on the bad foot. It was time to see Dr. Pertusa.

This time Dr. Pertusa had only one Doogie. He (Pertusa) examined my foot while silently judging me. He didn’t overtly criticize me or make a snarky comment about a fat old man trying to rollerblade, but I knew he was judging me. “Does this hurt?” he asked as he pushed on my ankle. This pithy question is Doctor-speak for “I bet this hurts, doesn’t it, you stupid bastard!”

Dr. Pertusa wrote a brief report which he gave to me. He said I should take it directly to the emergency room at San Juan Hospital, which is part of the government health system, where I would get an x-ray.

Denise drove me to the ER entrance. Using crutches, I walked in and presented the letter to a woman behind a counter. She gave me a numbered ticket, not unlike one you might get at your supermarket deli. She pointed to a waiting area.

I had only just turned from the counter when a man in blue scrubs asked whether I would like a wheelchair. “Si,” I said, one bare foot dangling in the air.

Blue Scrubs wheeled me into a waiting area, which was just a crowded hallway between reception and more hallways. He pointed to my deli ticket and then to an overhead computer screen. The screen would let me know when it was my turn to be treated.

The hospital was not a cheery place. The paint was dull and lifeless. When I was being wheeled from one place to another I saw so few windows that I once wondered whether I had somehow gotten below ground level.

After maybe 30 minutes my number was called. Blue Scrubs instantly appeared and wheeled me past a row of people apparently getting some kind of infusion, perhaps dialysis. We went around some corners and then stopped at a hallway desk. A lady looked at Dr. Pertusa’s report, tapped on a keyboard, and then allowed Blue Scrubs to wheel me back to the original waiting area.

A half hour later Blue Scrubs again appeared at my side. I looked up and saw my number on the overhead screen. Blue Scrubs and I journeyed to an x-ray machine staffed by a no-nonsense man sporting a well-trimmed no-nonsense beard. He snapped a few pictures and told Blue Scrubs that we should return to the waiting area.

I sat in the crowded hallway not 100% sure whether I should wait or just go home. I got up and hopped over to someone who spoke a little English (most of the people I encountered at the hospital spoke at least some English). I learned that my x-ray images had been sent to Dr. Pertusa. I should wait until the doctor responded with directions to the hospital staff.

About a half hour later Blue Scrubs appeared and took me back to the x-ray room. No-Nonsense Man had been replaced by two young women. Even before I could offer to buy them a drink they told me to remove my pants. “Look,” I said, “you are both very attractive and I am flattered, but (pointing to my wedding ring) I am married.”

The young women were not amused and did not have time for my American bullshit. They told me to put my pantless self on a table and lay on my stomach with my broken ankle raised in the air. “Okay,” I said as I rolled over, “but I want you to know that this is not my best side.”

They wrapped my injured leg as I lay on the table. I heard some giggling and wondered whether there were holes in my underwear. I thought a moment and distinctly remembered putting on my best underpants. There must, I decided, be another cause for their amusement. It was then that I most regretted my decision, decades earlier, to stop doing squats, lunges and other lower body exercises.

Blue Scrubs wheeled me out the hospital door about two hours after I had entered. I have an appointment to return in just a few weeks. I will do so because I have no complaints about the public health system’s treatment of my traumatic injury.

Throughout the experience no health care worker discussed money. They wanted only the number assigned by the national health service. But what would this emergency care have cost had I not been insured?

I do not know the answer, but my good friend Larry Loeppke offers some insight into the question. He suffered from pneumonia a few years earlier when he was visiting Spain. There was a trip to the emergency room that involved x-rays and blood tests. His total bill: €180, or a little over $200 ($50 less than I paid in the US for a 15 minute consultation with a physician’s assistant).

I have not yet seen a neurologist. Perhaps in a couple weeks, when the cast is off my foot, I will see one using our private insurance.

Hopefully the neurologist will offer a cure and I will be able (if I want) to practice Gonzo Journalism with the same debauched abandon as Hunter S. Thompson. Don’t get me wrong. As I write this, my left foot resting on a pillow, I do not mind being sober. But I would prefer being sober in a house sheltering a bottle of excellent barrel-aged tequila, the kind made by a handsome movie star, knowing that my abstemious lifestyle is voluntary, and need not last forever.