Wednesday, February 8, 2012

Adventures In Socialized Medicine

This is an attempted re-write of a post that was finished a week ago that Gmail lost. Like many re-writes, it's not as good as the first version, but it'll have to do.

So, the week before last, I had my first foray into the French healthcare system.

Not by choice, mind you. I'm overdue for some routine stuff that it would be wise to take care of here, and I've considered finding out how much of a new pair of glasses would be covered by social security, and at some point very soon I will need to find a doctor who can vaccinate me against yellow fever and prescribe some kind of malaria prophylaxis before my trip to Senegal in May. But it wasn't any of that. My little adventure that Friday was entirely involuntary.

Basically, what happened is this: I eat a lot of bread. I have a bad habit of holding a piece of bread in my left hand while I cut in half. I have long been aware that this is asking for trouble, but really, you don't usually need a whole lot of force behind your bread slicing. Unless its a French baguette, in which case you can potentially do some serious damage to whatever's behind the bread if the knife goes through easier than you expected. And last Friday, whatever was behind the bread happened to be my finger. And by "serious damage", I mean I think if I had somehow managed to do the same thing but with a chopping motion instead of a slicing one, I might actually have cut said finger off.

It actually didn't hurt that much, nor did it bleed much. I rinsed it off and looked at it for a minute, and tried to think of an alternative to getting stitches, because it really didn't seem that bad. But there was literally a hole in my hand, because the cut was on the joint where the finger joins the hand and the skin had kind of just pulled apart. So it was just sort of hanging open, and although I'm not well versed in the anatomy of what's between the bones and the outside and therefore don't really know exactly what I was looking at, I'm fairly sure I should not have been able to look at it. And I thought, "Crap. I can't put a band-aid on that, can I?"

I wrapped it in a paper towel and went next door to Miguel's room to ask if he knew whether the infirmary at the school could treat us as well as the students, in the hope that a trained nurse with first-aid supplies could work some magic that didn't involve the emergency room. He said yes. I said, "Okay, good, because I just cut my hand open." And because he's an incredibly nice guy, Miguel jumped up and came with me. Technically, the infirmary was not open for the afternoon until 2:30 (this was around 2), but when I told the nurse who came out to the waiting room that I'd cut myself, she decided they could take a look right away, and took me into the back room, where three nurses surrounded me asking lots of questions. I have a hard enough time following one conversation in French, let alone fielding multiple lines of questioning, and I've observed before that French women tend to converse like my sister's high school friends--all at once, and somehow everyone just magically understands everyone else. Anyway, I told them who I was and what happened, and showed them my hand, and all three of them kind of hovered over it saying, "Ohh... that's DEEP." One of them pulled me over to the sink and poured disinfectant all over it, and another one asked if there was anyone who could go with me to the hospital (to which I responded, "Uhhh...."), and then she went out to ask Miguel if he could take me to the hospital, while the other one wrapped my whole hand in an excessive amount of gauze.


Miguel did indeed go with me to the hospital, which was definitely above and beyond considering it wasn't REALLY an emergency, and was awesomely helpful and supportive the entire time. After a stupidly long bus ride and some effort to find the actual emergency department, we entered a very small, very quiet reception area where I showed my passport and the letter with my temporary social security number on it to a girl at the counter. She took my information and made copies of my documents and sent me to another window where I explained what happened to my hand, said I didn't have a doctor here, and declined to give an emergency contact number. (And also where Miguel, much to my entertainment and that of the woman behind the counter, got to explain who he was--my colleague, and my flatmate, but only my flatmate, definitely not my boyfriend.) And then she sent us to a cluster of chairs in the corner to wait, and that was that. No long complicated medical history with irrelevant questions no one knows the answer to. No insurance chaos. Not even any forms to fill out.

After a short wait, I was called into an office where I was asked some more detailed questions about my hand and whether my vaccinations were up to date, and then that guy took us to a different, bigger waiting room to wait for the actual doctor. We joked a bit about how the real reason everything seemed so relaxed was that people were just spaced out amongst a series of different waiting rooms, but seriously, I can't imagine an American city the size of Brest with an emergency room as calm and uncrowded as this one.

Side note: When the doctor called me back, Miguel initially came with us until I told him he didn't need to wait with me and he went back to the waiting room. That exchange happened in English, just because we're used to talking to each other in English, which prompted the doctor to ask me if I speak French. I said yes, then laughed and added, "Well, a little. Sometimes not very well." He then asked if we were Portuguese, which I thought was an interesting guess. Definitely not one I've gotten before. I said, "Oh, no, I'm American, and my friend is Colombian," at which point I think he was even more confused, but he let it go.

The next thing he asked me was whether the cut on my hand was deep. I said yes. (I was there for stitches, after all...) He said, "Oh. Well, we may have to move you to a different room, then. We're not set up to deal with deep wounds here." (I don't know.) I said, "Well, at the infirmary they told me it was pretty deep..." I didn't really know how deep was deep, so he decided he'd just look at it first and then decide. He asked me a bunch of questions, about what I'd done to my hand and also about medical conditions, allergies, etc.*, and, again, whether I was up to date on tetanus shots. Even with a minor language barrier, the interrogation only took a few minutes, and everything he asked me seemed more or less related to the situation, or at least generally important. (He did not, for example, ask for the date of my last period, or whether I've ever had [insert random unlikely disease here], or whether my mother's second cousin's brother-in-law died of heart disease.) I think I had to give a more unnecessarily thorough medical history to get a driver's license in the U.S., let alone be seen by a doctor.

Anyway, then he asked if the knife had "touché un osse", which I did not immediately understand. I gave him a blank look and said, "Touché quoi?" and he managed to come up with the English word "bone", which both impressed and embarrassed me, because duh. I of all people should recognize that word, especially in an obvious context. I told him I didn't think it was that deep, and he said if it was I'd need an x-ray. Great. Then he made me move my finger around, and tapped various places on my hand to make sure I could feel it, and then he finally unwrapped the gauze.

And he poked around the cut for a minute, and then said he was going to go get his colleague to come take a look at it.

To be fair, he was an intern, so it's really not all that surprising that he wanted a second opinion and his supervisor's okay before he did anything.

He came back a moment later with an overly cheerful orthopedic surgeon, who proceeded to make me explain again how I'd cut myself and then did some more extensive testing for nerve damage. Satisfied, he started talking [over me] to the intern. I didn't catch everything he said, but it went something like, "Blah blah blah, yes, it's superficial, blah blah... See, the vein runs along here, and the nerve along here, and we know they're both okay because she still feels everything and she still has blood in her fingertip, so blah blah blah you need to just make very superficial stitches, very shallow, just stay right above the vein..."

And the intern said, "Yes, that's what I'm going to try to do."

And I looked back and forth between them and said, "I understand enough to be a little afraid."

The surgeon laughed and said, "Oh, no, don't worry, it's really very superficial." Yeah, you're not the one who just heard the doctor say he's going to "try" not to stitch her vein.

He said some other stuff I didn't catch, and then, "But you're going to have a scar."

Well, yeah. There's a hole in my finger. I'm expecting some kind of scar.

So he left, and the intern numbed half my hand** and successfully put three stitches in my finger. It could have used four or five, but it was hard to get to, being between my fingers. Three actually took a while. He also didn't realize how long it was until he'd thought he was done and wiped away the blood, and then he said, "Oh, look, it extends all the way over here... Well, that part's very shallow, we'll just put a special bandage on it and it'll be fine." (And honestly, if all of it had looked like the part he didn't bother to stitch, I wouldn't have gone to the hospital in the first place.)

He sent a nurse in to do the dressing, and she also had to take some time to figure out how to go about doing it. "You know," she said, "if you were going to cut yourself, frankly you could have done it somewhere else. This is not a good place at all."

But she figured it out, and I retrieved Miguel from the waiting room and took my stack of papers (a list of dressing supplies and instructions to change it every two days, a completely unnecessary prescription for paracetamol, and the order to have the stitches taken out after fifteen days) back out to the front desk to get them stamped. The woman who'd checked me in stamped each of them without looking at it and dismissed me with a smile. "Do I have to pay anything?" I asked. Nope. They would send me a bill if there was anything to pay. (And when I told my friends later that night what had happened, another girl who's been to a French emergency room before said she thinks that's probably unlikely to happen. "They take the Hippocratic oath very seriously here," she said.)

The whole thing, from the time I cut myself to the time we arrived back at home, took about four hours. And since we didn't actually leave for the hospital until almost 2:45, which means we couldn't have gotten there until after 3, and we still had to take the bus back after all was said and done, total time spent at the hospital couldn't have been more than about two and a half hours, tops. I don't think that's bad at all considering that with an injury that minor, I could have waited longer than that just to be seen at a lot of American hospitals. (Hell, I've waited that long at my doctor's office before, with an appointment.) When was the last time you saw an American emergency room that wasn't crowded with crying babies and mentally ill drug addicts and people who just have the flu and could have gone to a regular doctor except that they don't have health insurance? Here, there were only a handful of patients around, and everything was calm and quiet. The staff weren't rushed or stressed out, and everyone was very nice to me and took the time to chat as well as the time to explain everything that was happening, despite the occasional language barrier issues. Even though everyone who saw me asked me to explain my hand, they didn't make me repeat anything else over and over again, nor were they constantly looking at my chart for information. And when was the last time you saw any medical professional in the U.S. and didn't have to fill out five pages of detailed questions about your medical history first? I can't remember one.*** All in all, aside from the fact that I'd hurt myself in the first place and was spending my Friday afternoon in the E.R., the whole experience was remarkably easy and stress-free. I've had worse experiences with regular doctors in the U.S--and I've always had health insurance.

Also, because I just need to reiterate this, all I had to do was show my ID and my social security number, and after that there was no mention of payment or insurance until I brought it up, and even then, I didn't have to pay for any of it. Not even with a temporary social security number, which I'd been under the impression meant I would have to pay for treatment up front and then get forms to be reimbursed for some of it later. It's just... taken care of. We complain about/mock all of the bureaucracy involved in doing anything in France, but this is an instance where dealing with that at the beginning really does make everything simple and streamlined later on. Everything is centralized, and it's all more or less the same for everyone. They put my number into the computer, took care of my hand, and sent me home. It was that simple. It didn't even matter that I hold a foreign passport and don't have a carte vitale yet; I'm in the system, so it's fine. The end. And even if I had had to pay, it wouldn't have been a big deal, because it would have cost a fraction of what the same stuff would have cost in the U.S.

The closest equivalent experience I have to this is my college health center, which is subsidized by the school so that most services are free or really cheap for students, and which usually wasn't very crowded because it's specifically for people on campus. Sort of a microcosmic comparison, and still not entirely the same. But it's all I've got.

Try explaining how health care and health insurance work in the U.S. to kids who grew up in a country that's had socialized medicine since the end of WWII. Try explaining why people in the U.S. are so opposed to changing the system. They'll look at you like you might as well be speaking Hebrew. It's unfathomable to them.

I had the first of two of those conversations so far about four days before this happened. I told them I don't understand it, either.

* That was fun. First, I told him I'd had my wisdom teeth out by pointing to my jaw, because I couldn't remember how to say "wisdom teeth" even though it's a direct translation. Then I realized I had no clue what was the French name of my one important medication allergy. #goodthingstoknow, especially since it's an unusual allergy to an extremely common medication. He seemed to understand when I gave him the name I know, though, so presumably it's pretty close.
** Having lidocaine injected into my hand hurt about fifty times more than actually cutting myself had. I almost wished he hadn't bothered and had just got on with it.
*** The most reasonable experience I can think of was the swine flu vaccination clinic I went to, which I think did manage to limit itself mostly to the relevant issues... but then again, it was a free shot, so there were no health insurance companies to deal with.

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