As the bulls approach, I glance back over my shoulder to see a galloping dark gray bull swinging his wide horns out in front of the pack. I run. The runner behind me screams. Something pushes into my butt cheek. I glance back. The lead bull dips his head. Jump! I leap into the air as the bull’s horn hits me on the ass. I fly upward, twisting as the bull passes below me. The sidewalk rushes up. I reach my hand down and break my fall. My hips smack the cobbles, then my shoulder. My head lands softly. I didn’t know it, but these few seconds in Pamplona, Spain, in July would define my life for the next three months.
PART I: SPAIN
The horn came close but luckily didn’t perforate my anus. (I know this because the doctors checked several uncomfortable times.) Red Cross medics rushed me to the hospital, where they injected me with morphine, put me on IV antibiotics, did minor surgery to clean the wound, and stuck a tube in it attached to a drain capsule about the size and shape of half a roll of quarters.
After 36 hours in the hospital, the surgeon chose to release me at my request. This made the news because I told Reuters I planned to run again later in the week. (In fact, it trended on Twitter and Facebook.) My surgeon told me, “I don’t want you to run. You are seriously hurt, but you are a grown man, you have to decide for yourself.”
It wasn’t my first rodeo. A bull named Brevito had gored me twice in the thigh in 2014 resulting in a long hospital stay. In both cases I found the Spanish healthcare system to be superb, probably the best country in which to be gored by a bull.
After my release from the hospital, I ran again on July 10. As the herd approached, a hefty fellow runner smashed into my back, yanking my shoulder. My core muscles collapsed. I felt a spike of pain dig into my pelvis near my hip. Still, I ran alongside the pack of Fuente Ymbro bulls for ten yards, their eyes watching me curiously.
Complications from the goring and contusions took me on a healthcare odyssey that would send me from that well-run Spanish hospital to rural Panama to Chicago. People often criticize the US healthcare system and compare it unfavorably to European countries where the government is usually more involved in care and provides more benefits. From my perspective—as someone who needed a lot of medical treatment for a long time thanks to those bulls—there’s no competition. The closer the US can get to Spain, the better.
Enku Kebede-Francis, a Tufts professor and the author of Global Health Disparities: Closing The Gap Through Good Governance, finds it difficult to compare healthcare in Spain and the US. “The United States is like 50 nations in one when it comes to healthcare,” she told me over email. She feels Spain’s healthcare is “comparable to Hawaii, which has the US’s best healthcare system.”
“Spain spends less money per patient and they get better results than the United States,” she said, “because they practice preventative services and most medical workers are like public servants.”
After the run, two weird lumps formed on either side of my pelvis. All horn wounds infect because the bulls dig their horns in bull crap, turning them into poisonous spears. I took antibiotics but still the infection exhausted me. I spent a lot of time crashed out in my room in my friend's Pamplona apartment. The drain capsule nestled in my butt crack was hard to clean. It sat in the crook of my anus, every time I took a crap, the shit had to push the drain out of the way and smear around it, inevitably getting into the open wound. I took a shower afterward every time but still failed to clean it sufficiently. Doctors removed it after five days. The procedure was surprisingly painless but disgusting enough to make my nurse to start to tear up.
When I tried to get out of bed I screamed as daggers of pain stabbed into my hips and pelvis, even though I took 600 milligrams of Ibuprofen. My friend Kevin gave me a dab of topical marijuana cream and that really worked, but there was no way to replenish the supply.
PART II: PANAMA
Twelve days after the goring, I headed to Panama where my wife works as volunteer for an aid group, an 18-hour voyage by plane and bus. My wife and I hadn’t seen each other in months so we immediately checked into a hotel and had somewhat violent sex. My pelvis and groin burned afterward.
We left for her mountain village and went to bed. When I woke from the pain, I turned to my wife and told her, “I’m scared.”
She took me to the local hospital, which looked nice but proved rougher than the Spanish ones. The nurse dug an IV needle in my arm until I yelled, “No mas!” When she finally got it in, it bled and leaked fluid all over me and the bed. They didn’t have the pain meds I needed, so my wife went across town to a drug store.
Kebede-Francis said my experience was a typical one—infrastructure spending in developing countries is often uneven. “When they build new facilities, they have to aim high and long-term. This is true even in places like Florida,” she told me. “You’ll find state-of-the-art buildings offering limited services and no specialties.”
We went home and within a few hours the pain in my crotch worsened. Anger got the better of me and I decided all I needed to do were some squats. My groin tightened with each angry dip. Then I decided to stretch my back. I arched my body, yanked my torso to get a deep stretch, and a pop jolted my lower back. My nerves came alive with electric twitches near my tailbone.
Within an hour I couldn’t walk.
We took a cab to a private hospital in the city of David, stop number three on my healthcare world tour. That’s when the money started flowing. Everything in the private healthcare system in Panama involves payment up front. Except for seeing the doctors—you pay them right after they look at you. Each one was $20 USD, with specialists costing $100. The bills stack up fast.
We paid $500 upfront for the X-rays of my hips and pelvis, which came back negative. I couldn’t afford the MRI. By the time we got out of there I had coughed up over a grand.
In the hotel that night, the pain got so bad I went back to the hospital where they injected me intravenously with morphine. I only remember waking up in my hotel room the next morning. We decided to go to the public hospital, also in David.
“Panama has an interesting, developing, mostly public healthcare system,” James Johnson, a professor at Central Michigan University and the author of Comparative Health Systems: A Global Perspective, told me. “They recently built a ‘medical city’ which is dedicated to providing world class health care. It’s an incredible complex. It’s located in Panama City. But the regional hospitals in Panama are a completely different story.”
I saw what that story looked like firsthand at the regional ER. Dozens of worried people milled in front of the doors to a massive high-rise concrete structure. We waited two hours to get inside. As they did my paperwork, a woman died directly behind me. They put me in a long hall with a bunch of people who looked like they were dying. Then people started to die. At one point a body bag containing a young boy wheeled to a stop in front of me, his mother weeping over the body. I sat in the wheelchair for ten hours in that hall before I complained and they wheeled me around the corner to a room so full of gravely ill people on stretchers that touched each other. After several hours a man stormed in, swore at everyone, picked up his dying mother in his arms, and walked out. We left not long after that.
Kebede-Francis wasn’t surprised with my experience at the regional hospital. “The care in Panama City is comparable to care in Illinois,” she said. It was a different story out in David. She added that you might experience crowded conditions in American hospitals—in a Manhattan ER on a Friday or Saturday night, for instance. “But you’ll receive good and fast care,” she noted. I definitely didn’t get that in David.
Johnson told me that understaffed and underfunded regional hospitals are the biggest healthcare problem in Panama today. “There is a large shortage of doctors and nurses in Panama,” he said. “It’s not like in Spain or the USA where we just bring in doctors from other countries. In Panama they have licensing laws that prevent (foreign) doctors from moving to Panama and working.”
We took a cab to a different private hospital where the MRI cost only $500, and were told that my liver, spleen, and lymph nodes were enlarged. They wanted to keep me and potentially operate. But fears of a botched third-world surgery sent me back to my wife’s house, where I sat for two days on antibiotics before we flew home to the US.
PART III: America
That’s where I familiarized myself with the American healthcare system’s cruelty, which anyone who doesn't have insurance is all too aware of. My regular doctor sent me to a private hospital, but they only let me stay one night. They did some tests and then kicked me out.
“If you were insured they would have been more willing to help you,” Johnson told me.
“It’s like that Dickens quote, ‘It’s the best of times, it’s the worst of times,’” he said of the US system. “You can go to Johns Hopkins and get the best possible care in the world. You can also go to a hospital on a Native American Reservation in New Mexico and get worse care than you got in that regional hospital in Panama. Our healthcare system is like Frankenstein, you take an arm, a leg, a heart, and you stitch it all together and you think it’s going to be a functioning human being? Well, actually it turns out to be a monster and that’s what we have in the United States, a malfunctioning monster of a healthcare system.”
After leaving the hospital I went to my parents’ house and fell right back into fever and pain for two days. Then I visited another general practitioner, who prescribed antibiotics and some powerful narcotic pain and inflammation medicine.
“What’s wrong with me?”I asked him.
“Well, I don’t know,” he said. “You got some kinda bruisy teary thing in there.”
I crossed the damn world for that diagnosis? I didn’t return to see him, giving up on healthcare in general at that point. I stopped going to see doctors and, miraculously, I slowly started to improve. I began to walk with a walker. After a week I could get up the stairs with it.
I convinced my wife to go back to Panama so she didn’t screw up her volunteer status, and the day she left I went back to work driving for a rideshare company because I felt completely worthless and miserable and I hoped working would help. I used the walker to get in the car.
The next morning, I felt better and walked into a physical therapy place. My therapist, a man named Ian, seemed to give a shit, the first time a medical professional has made me feel that way since I’ve been home. He prescribed good, old-fashioned therapy: stretches, exercises, heat, cold. We followed that plan for several weeks, with me continuing to work. One night I got some horrible back spasms but refused to go to the hospital. What would they do except throw me out?
Through several weeks of ups and downs, Ian continued to guide my therapy. At last I recovered physically and was back on my feet. His manager enrolled me in a financial assistance plan. The US healthcare system has huge, obvious problems, but there are people in it who just want to help.
The Trump administration has repeatedly made moves that damage the Affordable Care Act. If the president and congressional Republicans successfully scrap the ACA, it seems likely that millions more people will go without insurance because they can’t afford it, just as I did. (Because I earned very little over the past year, I have since qualified for Medicaid.)
After all I’ve seen of the world’s healthcare systems, I believe that if the US expanded Medicaid to cover working poor and middle-class Americans, a project begun by Barack Obama with the ACA, and allow the rich to buy insurance and use private healthcare, a lot like what Spain does, things would improve.
Instead, the people in charge seem hell-bent on taking us in the opposite direction. “The ACA needed the next president to pick it up and improve it,” Johnson told me. “If every president comes in and tosses the healthcare plan for something new, it will never work. Healthcare is too big and complex. Spain, Japan, Germany, those would be great examples of systems we could move toward. But Donald Trump is just not up to the job. He is ill-informed and just doesn’t know what he’s doing.”
The good news is that my pain has faded over time. Ian and I figured out in the end that it was the result some sort of injury in my lower spine from the bull goring me and tossing me to the ground. I still don’t have a clear answer, which is actually not that abnormal for odd injuries like mine. But today I’m fully recovered, feeling good, and looking forward to my next run with the bulls in Spain this coming July.
Bill Hillmann is the author of Mozos: A Decade Running with the Bulls of Spain.