I’m sitting on the balcony of the Las Cumbres Inn on the outskirts of Escazu looking over the central valley of Costa Rica and its capital of San José. The city is beginning to come to life as the sun sneaks over the mountains and brightens the coffee plantations on the far hills. I could live here. LIVE THERE! I thought you said you were going to stay in the U.S.!!! True enough, but this is a place that has everything I could ask for except a sufficiently large readership. I can get by in Spanish but any literary hopes I would have in Costa Rica would definitely be derived from an agile translator. Humor is a tough thing to take across cultures. Maybe someday.

Today I’m in Costa Rica to visit an oral surgeon. I had a bone-loss problem that evolved from the long term misapplication of orthodontics in my childhood. So I am here to get a couple of dental implants – I always preface “implants” with “dental” so nobody thinks I’m going to end up with new pecs and a ripped six-pack – replacement teeth as it were. But more than that, today I am going to, quite literally, put my money where my mouth is.

Look at it this way. You walk into a car dealer and check out the new Rolls-Royce Ghost. It is a gorgeous vehicle – hand-rubbed finish, custom fitted upholstery, and a polished burled walnut dash – and you find you must own this automobile. You plunk down your $250-large and the sales-weasel leads you into the parking lot, smiles, waves, and tosses you the keys to a new Ford Taurus. Exactly how pissed off would you be? Yeah, that’s about how pissed off I would be. I would be a toss-up as to whether I’d go talk to my shyster attorney before or after I paid a visit to the Rolls dealer with a baseball bat and a screwdriver.

OK, same scenario but instead of the Rolls this time you just dropped $11-grand for a new Hyundai Excel and ended up with the same Ford Taurus. Now you’d bounce across the parking lot doing a happy-dance thinking you scored big-time. You’d jump into the driver’s seat, and motor away with a smile on your face.

So it is with health care. In the U.S., the health care system is commonly rated by the organizations which do such things at about #37 from the top. France consistently tops the list for all you “freedom-fry” eaters. The U.S. placement is reflected by a similarly low rank in life-expectancy. It’s #38. The U.S. ranks behind such health care powerhouses as Dominica(35), Columbia (22), Morocco (29), and San Marino (3). Which would all be fine if the U.S.’s costs were in line with the health benefits received. They’re not. In the U.S. we pay more for health care – total expenditures per capita – than any other place on Earth. We pay for the Rolls and drive away in the Ford. Smiling.

I, obviously, wouldn’t advocate dragging yourself onto an airplane with a fractured femur and flying off for treatment. Some things are better done fast and where you are. However, if your treatment is not an emergency and you are so inclined, there are at least 36 other countries you can go to and get better care than in the States. There is no place you can go and pay more.

I chose Costa Rica. It’s only one above the U.S. on the quality of care list but it’s 50 below on the cost of care list. I can find a top-flight doctor – oral surgeon in my case – who trained in the U.S. and/or Europe, who uses state-of-the-art equipment, in a top facility, using U.S. standard parts for my new bionic bits. I get everything – treatment, airfare, hotel, and meals – for about half of what the treatment alone would cost in the U.S. In my case this translates into bringing back enough change to pay for my recently purchased van.

So how does my theory compare with reality? I’m writing this little Rant before my treatment so, at this point, it’s all just a guess. The remainder of this entry I’ll write after all the slicing, dicing, and drilling. Assuming, of course, that I survive.

It’s now the next day.

OK, ouch, but just a little. The deed is done. I’m assuming that some of you may be a bit squeamish so I’ll leave off the details of ten separate injections, the feel of gums being pulled away from bone, the sound of metal scraping….. I’ve been through all of that before. One thing I’ve never felt before is the torque from a socket wrench screwing something into my jaw. Very interesting. Otherwise it was kind of ho-hum and it didn’t hurt much at all.

The medical care was great. My surgery team was an oral surgeon, a dentist, and a surgical assistant. It was the best medical experience I’ve had from a care and concern standpoint. Before he did anything the surgeon would tell me what he was going to do, ask if that was OK, and to let him know when I was ready. I had a bit of discomfort in the middle of the procedure and the team just stopped, peeled back my drape and patiently waited until the episode passed. All of the team members proceeded with skill and deliberation and in a short period of time I was done and out the door.

Back to my hotel.

The Las Cumbres Inn bills itself as a surgical retreat. They offer a very nice inn staffed by exceptional people. Their rates include all your meals which are tailored to the kind of surgery you are retreating from. For dental patients like me that meant that they would whip up all the protein shakes and fruit smoothies I could slurp down for the few days I needed before I could start crunching pretzels again. They have a lovely garden, a quiet pool area, and a stunning view across San José. You get all this for the price of one of those dubious interstate highway motels you wouldn’t stay at even if it were 11PM and the sign said “Next Exit 100 Miles” (“161 Km” for everyone else). This place is a find even if you weren’t recovering from something. If you’re interested they’re on the web at www.surgery-retreat.com.

Dental isn’t their only specialty though. They are also very popular with those recovering from what is widely known as “plastic” surgery. Unfortunately, my timing being what it is, no one was recovering from any surgery that actually involved plastic so my residual teenage prurient curiosities went unfulfilled. However the visit was not a total loss.

In the movies those segments of the stories involving plastic surgery tend to overlook the recovery phase. You see the patient wrapped in bandages looking like something from “The Mummy of Los Angeles” in one scene. Nothing but her sparkling eyes show through the gauze. In the next scene the patient is looking, oddly enough, like a beautiful movie-starlet. No recovery required. This little lie is probably one of plastic surgery’s greatest selling points. Now don’t get me wrong, everybody I met here was very friendly and, since we were all more or less in the same boat, understanding of everybody else’s pain and suffering. But the lie persisted. One morning as I was eating breakfast one woman – who had just gone through a face lift and looked like she had been worked over by Vinnie and the Boys out behind Luigi’s – came into the dining room. Another of the patients said something like “Oh, don’t you look great today. The swelling is so much less.” To which she replied “Gee thanks, but you still look like shit.” Honesty in such situations is almost never appreciated and the number of unwarranted compliments suddenly dropped to near zero.

My first visit to the dining room was something of a shock as most of the patients had had their treatments the week before I arrived. It’s kind of tough to explain in words so I’ll try and paint you a little picture. Remember back in the olden days when it was politically correct to portray Native Americans in the movies as vile, blood-thirsty savages? There would be a scene in the Westerns where the plucky hero, or family of settlers, or the Seventh Cavalry would be captured by Injuns and staked out in the Mojave Desert to bake in the sun all day and then be devoured by ants. Rescue would always come in the end but for most of the patients at Las Cumbres it looked like the rescue happened just before sunset. A few looked like the ants got there first. They pay for this. I got used to this surreal situation pretty quickly and soon the sight of flakes of dead skin snowing onto the breakfast buffet hardly bothered me at all. I know all my new friends will heal and look great but it’s interesting what they leave out in the movies.

The “chemical peel” recoverers are not allowed to even think about sunshine and are basically trapped in their rooms away from all sources of natural light. At sunset they come slinking out like so many zombies looking to feed on the living. One night the suggestion was made to go out for dessert. The cabin-fevered vampires latched onto this suggestion like a drowning man grabs for straws. Thus began The Night of the Living Dead Go for Ice Cream. Seven of us – two zombies, four dentals, and a pre-op face-lift – pile into two cabs and zoom off into the night. After about twenty minutes we pull into a shopping center that looked as if it had been beamed into Central America direct from southern California. We screech to a halt in front of a gelato shop that was lit up like a NASA night launch. All conversation stopped as our group oozed out of the shadows and hammered a large dent into what the Costa Ricans present thought of as “reality”. Customers fled for the door fearing contagion and, I believe from the appearance of little red lights on cell phones, several started videoing our odd little collection. I have not yet checked YouTube. It turned out to be a great party with much laughing, talking and eating – all of which were forbidden by my recuperation instructions. There were also a number of photographs taken and, assuming I can afford the blackmail requests, hope to get my hands on them. 

The rest of the week I continued ignoring my doctor’s instructions. I went for a long walk – exertion in any form was taboo – and managed to get completely lost. It was great getting out into the countryside and talking with the locals about how I could get unlost. I always followed their instructions to the letter but, with my Spanish being what it is, was never quite sure what those letters were. After a few hours I managed to circle back to the hotel thoroughly exerted. I mixed up a bit of a cocktail using the local rot-gut known as Guaro – alcohol is not allowed. Took a hot shower – ixnay on the eat-hay, and enjoyed a thick soup with cruchy croutons – which, as you might imagine, my doctor did not consider in my best interest. 

My recovery is proceeding quickly and well but finishing up on my dental implants has become a good-news/bad-news situation. The bad news is that my treatment, as originally expected, will require another trip to Costa Rica in about six months. The good news is that my treatment, as originally expected, will require another trip to Costa Rica. After just a few days here, and more than ever, I really think I could live here. So much for best laid plans.