Counting down the days with a bit of trepidation...What do world travelers like us do without a primary care doctor?...This morning's new photos....

This Cattle Egret is sitting atop a tree in the backyard, an usual sight to see.  Most often, they are on the ground near where there is landscaping, grading and excavation in process. They seem to know that such scenarios are excellent opportunities for foraging for bugs and worms.
After a fitful night of listening to science podcasts, at 6 am I literally rolled off the edge of the bed, exhausted and wishing I could lay back down for a few more hours.

My mind was doing a number on me.  I had to get up and try to call the doctor again with no response after yesterday's call.  ER doctors don't usually participate in any aftercare for patients they've seen on an emergency basis.

We no longer have a primary care doctor.  Its simply been too long since we last visited our former doctor in Minnesota which was in September, 2012, a month before we left. 


The egret couched down watching me open the door to take the photo.
I knew he wouldn't participate in any health care questions at this late a date when several months ago, I inquired to the Minnesota clinic with an online request for a relatively innocuous medication refill, never receiving a response.  At that point, I knew he was no longer in our court.  Too much time had passed. We get this. They have "rules." 

Travelers maintaining a home base would have no difficulty contacting their primary care physician for advise.  Although in Hawaii, prescriptions can't be "called in" from an out-of-state physician.

Its a little late to establish a relationship with a doctor in a private office or medical clinic in Kauai.  Besides, none of the testing equipment required for a diagnosis is readily available at any of the local clinics and a trip to the Wilcox Memorial Hospital in Lihue would be required. 


This morning's view from our lanai while it rained off and on.
From what we've discovered most doctors refer patients to the hospital if their condition can't readily be treated with meds.  I suppose this is not unlike many clinics worldwide, let alone in the US.

Finally, this morning at 7 am I reached the ER doctor I'd seen on Friday asking for a different, perhaps more effective antibiotic.  This is often necessary with a variety of infections which don't respond well to a particular drug which seems to be my case at the moment.

Ah, the perils of world traveling without a home base!  We knew this going in.  We also knew that having only major medical insurance (which pays 100% of any hospital stays, doctors, tests and medications rendered while in the hospital) would be a risk. 


I edited this photo to be dark in order to show the two rainbows that developed after the rain.
By purchasing the international policy, we chose the option of major medical only or paying outrageous fees to include doctor visits. However, if we had made a choice to include doctor/outpatient services, the policy still didn't include any necessary medical care as long as we're in the US, as we are now. 

Since Medicare doesn't pay outside the US, we opted out of Medicare's Plan B which pays doctor visits with a copay as much as 20% for which most seniors purchase an additional policy.  This would not be a sensible option for most senior travelers especially those who periodically return to a home base.  They can easily purchase a specific travel policy for their trips, event by event.

This individual trip policy was also not available to us when our lives consist of one continuous "trip."  No such policy exists for us other than the 12 month international policy that we purchased almost three years ago and renew each year.

It was raining when we got this rainbow shot.  If the hill and the trees hadn't been in the way we'd have been able to see the end of the rainbow in the ocean.
When we consider the potential out of pocket costs for tests at a hospital, we cringe but fully accept that potential no matter where we may be. We've dodged a bullet to date but, we knew sooner or later the scenario could change on a dime.

In any case, the ER doctor refused to "call in" a different prescription without my having additional tests.  We understand her dilemma.  As an alternative, I presented her a list of all of the antibiotics we currently have on hand and she suggested Cipro, the "big guns" for infections. 

She emphatically stated that if I'm not better 48 hours after taking Cipro which will be Thursday, we'll be heading to the hospital for more tests. Both Tom and I agree that this is our only option. At that point, it will be only 10 days until we depart on the cruise. 


Its hard not to appreciate the seeming magic of a rainbow.
What do expats do in these cases?  They either purchase insurance available in the country in which they live, purchase international insurance such as ours or in some cases, pay for medical care out of their pocket when medical costs in some "retiree friendly" countries is surprisingly inexpensive. 

From what we've read online to date, a typical doctor's office visit in Australia may be around US $50, as opposed to $100's in the US.  Once we arrive in Australia, we won't hesitate to see a doctor if we deem it necessary at the time.
These berries on this plant reminds me of Christmas.
If this illness had occurred a few months ago I would have followed the doctor's instructions and not given it much of a thought.  The current time constraint is weighing heavily on my mind at the moment.

My sister Julie worriedly reminded me of how many times we've been sick since we left the US, more often me than Tom.  I must admit that at least twice a year I've picked up some type of infection, viral or bacterial.

With a history of inclement health for most of my life (mostly due to heredity and inflammation), my immune system continues to remain vulnerable regardless of how hard I've tried to offset it. It was equally precarious when we lived in Minnesota, still contacting some type of virus, sinus infection or respiratory infection once or twice a year. 


Sunset from the front lanai.
Then again, how many of us don't "catch" something once or twice a year?  Tom would push through such conditions and continue to work as did many of the guys he worked with on the railroad, often infecting one another while  working in close quarters on a train. 

Having a home base has what we now refer to as "luxuries" that come with it; easy access to medical care, cable TV, working cell phones, appliances such as a clothes dryer, quality Internet services, shopping centers and grocery stores with familiar products and services.

We don't share this personal story to elicit sympathy, although bless the hearts of many of our readers for sending their well wishes. We continue to tell our story for the purposes of sharing both the good and the bad of what its like to be traveling the world without a home base. 


And, we appreciate the beauty of flowers blooming in the treetops at a distance from the lanai.
The vulnerability we express here at times even surprises us when in our old lives, we only shared a degree of personal information with our close family members and friends.

How foolish we'd be to hide the realities of our daily lives only sharing the details of the most exciting of locations and adventures.  With that, we'd only be a travel log, extoling the virtues of where we've been and what we've seen, a place for a degree of braggadocio.  The manner in which we share our lives in done so with a much bigger intent; truth and reality.  

We have no doubt that at times, some of our readers may become bored with our truth, reality and mindless drivel. Then again, daily life for most of us is mundane at times, isn't it?

We've come to appreciate the simplest of life's amenities, never taking for granted that which is available to us, including the potential of more medical care in Hawaii.  If we must go, we will.  If we luck out and I'm well again in a few days, it will be time to rejoice and start packing!

Have a superb day!
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Photo from one year ago today, May 12, 2014:

A year ago today, we were three days from leaving Morocco.  We were definitely ready to be on the move.  For details on that day, please click here.

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