Urgences

I wasn’t sure what to expect when I went to the ER this week. More than half of the hospital emergency services in this country are on strike, a movement that’s been building since March. They want more staff, more hospital beds and better conditions. Not so much for themselves as for their patients.

Of which I was one, however reluctantly. My belly-ache hardly seemed worthy of a trip to the ER. But the first available doctor’s appointment was over a month away. It was probably nothing but what if it wasn’t? So off I went.

Here in France profonde as we call it, ‘les Urgences’ are the first and last resort for both the seriously injured and the walking well. We live in an area with few doctors. Hardly surprising, given the proximity of Switzerland where medical professionals earn twice what they do here. We’re too far from the big hubs of Lyon and Paris, where medical care par excellence is readily available. Our local GPs are few and far between; they are over-worked and under-paid. There are no walk-in clinics and basically no options other than the hospital.

Being of a squeamish nature, I avoid such places like the plague (and for fear of the latter). So when I arrived at the hospital, I went first to the general reception desk, hoping that the medical appointment side of the ER might be removed from the one with the helicopter pad. No such luck. Off I went.

I arrived before the set of solid double doors that said ‘Emergency – Push Hard’ and paused. Then I took a breath and pushed. Instead of bloody accident victims and George Clooney running alongside a gurney, I saw a waiting room with people that looked like they might possibly have a pulse. Eyes glazed over with either pain or boredom, possibly both, it was hard to tell. No one spoke. Waiting rooms are silent places in France.

Behind another set of doors was where it was all happening. I took a number and was heartened – 256 and they were currently serving 253! After several minutes I realized that this was the line for paperwork. Another ten minutes went by before I was registered and the real wait began. One of the many signs on the wall informed me that the order in which patients would be helped would not necessarily be in the order of arrival, depending on the nature of their affliction. Fair enough.

I had plenty of time to observe what was going on. The ER was on strike, but that didn’t mean they weren’t taking care of patients. It is more of a symbolic strike, a gesture aimed at raising awareness of the untenable conditions in our hospitals. A bunch of hand-made posters included one that said: “It’s not because we’re on strike that you have to wait so long, it’s because you have to wait so long that we’re on strike!”

After a two-hour wait, I was better informed about the issues surrounding the strike. It’s not just a matter of throwing money at the problem. The system is broken. The health minister Agnès Buzyn wants to fix it with a plan that will take pressure off the emergency services, developing other medical services rather than increasing ER resources. The striking ‘blouses blanches’ (doctors and nurses) aren’t happy with this solution. Clearly it is not the shot in the arm they were hoping for. I feel their pain. But I also believe that a bigger healthcare reform is needed and that the current plan is a step in the right direction.

When I finally saw a doctor, he prescribed two weeks of meds and advised me to follow up with my regular GP when my scheduled appointment finally comes up. I am grateful that this option was there and for the hard-working people who provide urgent care. But I had no business taking up space in an ER whose resources would be better spent helping urgently ill patients.

What’s your experience with the ER?

A l’hôpital

I had to go to the hospital the other day. Rest assured that I am well (she says, knocking on brain).

It was a routine check-up with my ENT. That’s ORL in French, for the barely pronounceable ‘oto-rhino-laryngologue’. Imagine the mental gymnastics I have to go through every time I have anything to do with this particular medical specialist. E=ear which translates to O=oto; N=nose translates to R=rhino (think: rhinoceros); T=throat translates to L=laryngo. Just as we add ‘ologist’ to any specialty in English, in French you just add ‘logue’.

It’s a mouthful in any language.

Our closest hospital is a 30-minute drive in theory, but I have to allow an hour for traffic and for the fact that I inevitably get lost. It’s not that hard to find the actual hospital but it takes at least ten minutes to navigate the parking lot and figure out where the entrance is. The parking lot is built into a hill (well, we do live near the Alps after all) with four tiers of open-air parking spaces. There are many steps and winding paths leading down to a central drive with tiny signs showing how to access different departments. How practical for patients, I always think, many of whom are about to give birth, presumably not 100% mobile or not quite feeling up to a hike.

I almost always go in the wrong door. This usually leads to the Emergency entrance where I panic and run in fear of seeing someone in death throes or alternatively catching some fatal virus. This time I remembered my last visit two years ago and knew that the main entrance was up and down a series of valleys across which I cut like Heidi.

Arriving at this thriving hub of French culture, where the usual welcoming committee of huddled smokers by the door greeted me while holding on to their IV units, I noticed the new innovation of a welcome and orientation desk. There was no one there and anyway I remembered from my last time that I had to check in at the area called ‘Consultations externes’ just to the left of the main lobby. I was delighted to see only two people ahead of me and took a number. Two minutes later my number came up and I approached the person seated at one of the cubicles. “Ce n’est pas ici,” she said, shaking her head with a rather pleased air and directing me to the other side of the building. A different waiting area for a different set of consultants and services.

Off I went, still on time as for once I’d arrived a few minutes early. I successfully avoid the ER for the second time and arrived at the correct reception area. Here there was no number system but a longer lineup of people waiting to be triaged towards an admin cubicle for check in.

Having determined that I was in the right galaxy, the woman directed me to a zombie whose charm began with a ‘Je vous écoute’ (‘I’m listening’, not the nicest greeting but not as rude as it sounds to English ears). Eyes trained on her screen as she typed in my details, she continued a conversation with her colleague at the next workstation, complaining about some ongoing IT issue. I was invisible until she handed me a paper and told me to proceed to waiting room number 4. “And the waiting room is…?” I asked, having no idea where to go next. “Just behind the divider,” she said, as if the question was absurd. “We have several waiting rooms…”

Seeing the number 6 on the wall, I almost turned around and went on a dangerous tour back to the ER when I realized that the large room had several smaller areas, confusingly labelled ‘salle d’attente’ (waiting room), each with its own number. I found mine and squeezed into a seat. The place was packed. 45 minutes later, eyeing the ladies’ room with increasing envy but afraid to leave in case my name was called, a tiny white-coated nurse came and called out the name of the fellow sitting opposite me. Up he jumped, clearly ready to dance in joy and followed her to the door.

As she left, I heard her mumble something vaguely resembling my husband’s name. Not wanting to risk missing my turn, I grabbed my stuff and ran after them. At the door I asked her if she had in fact called my name. Yes, she confirmed, although admitted she hadn’t said it very loudly. I nodded and joked that thankfully I have good hearing for a deaf person.

She laughed. The ice was broken. Away we went.

The ENT, whom I saw after another 15 minutes in yet another waiting area, confirmed who I was and why I was there. Agreed it was good to get my hearing checked again and asked me to sit in his examination chair.

Before I could ask him what was next he had shoved a metal object up my nose. “It’s ORL,” he reminded me when I acted surprised. I couldn’t help but be grateful he was not my gynecologist.

A quick spin around my upper orifices and off I went back to my seat to wait for the soft-spoken nurse to come and perform the hearing test in a sound-proof booth across the hall. I passed with flying colours. While my left ear is completely deaf due to a surgery for an acoustic neuroma several years ago, my right ear is still going gangbusters.

How I hate hospitals. I say that with all the humility and gratitude of someone who has had the opportunity to take advantage of their services and to come out alive and well. All without having to mortgage my life away to pay for it.

I left with a spring in my step, along with a prescription for an MRI to check that all is well (more on that nightmare later), having paid a grand total of 40 euros. Which princely sum will be entirely reimbursed once I send in the paperwork.

Still. French hospitals. The less I have to do with them, the happier I am.

What’s your best or worst hospital experience?

Octobre Rose

I’ve always hated pink.

Not just the colour, but what it represents. Pink for girls, blue for boys. Berk, as they say in my adopted land. Yuck.

But I’ll make an exception for pink this month. It’s ‘October Rose’ in France, Pink October. And breast cancer prevention is worthy of even the most vile of shade of rose bon-bon, candy pink or my most-hated fuchsia.

I guess I hate breast cancer even more.

My mother died of breast cancer in 1989. That will make it 30 years ago next March. I was pregnant with her first grandchild at the time. Her grandson, Elliott, born the following September, helped me get through that first year.

There is something especially cruel about breast cancer. Cancer du sein. It attacks the very heart of motherhood. That maternal breast that nourished us as babes in arms is eaten up by cells that grow haywire, out of control, that harden and metastasize. In my mom’s case, it went into her liver.

That was after the chemo. First came the trauma of a mastectomy, then the nauseating treatments and hair loss. But she rode out that first wave. Came to Paris for our wedding in 1986. By then her hair had grown back. A few years later so did the cancer.

While research has made great strides in understanding the genetics of the disease, and therapy has become more targeted, detection and prevention of breast cancer have not advanced much. Aside from those with a genetic predisposition to the disease, particularly that ticking time bomb of BRCA mutations, the only ‘prevention’ widely used is early detection by mammogram.

Essentially this means that, beyond living a healthy lifestyle, eating well and not drinking too much, our only option is irradiating our breasts to find out if we have a tiny tumour in the making. I have been getting biannual mammograms since the age of 35, which adds up to a lot of radiation over time. Now there is considerable controversy over whether that is, in fact, a good idea.

Some countries, like Switzerland, have opted out of routine mammograms. It seems they consider the risks, between radiation exposure and over-diagnosis, outweigh the benefits. Yet what choice does someone with a family history of breast cancer have? You are damned if you don’t and, possibly, damned if you do.

Not to mention how unpleasant it is to have that particular part of your anatomy squeezed flat between two pieces of glass, pinching the skin of your arm pit while the technician orders you not to breathe or risk having to do it all over again, doubling the dose of radiation. I remain convinced that if men had to submit to a similar procedure for testicular cancer, they would have found a better way long ago.

Still, it is better than the alternative. And I can only imagine how grateful one would feel when such a test picks up a cancer very early on.

That was the case for Caitlin Kelly, a fellow Canadian and a journalist who shares her recent personal experience with breast cancer on her blog, Broadside. Happily, her prognosis is excellent. This week’s post also includes a link to Caitlin’s story, published in the New York Times, about the importance of touch in medical care. Check it out: https://broadsideblog.wordpress.com/2018/10/08/exposing-oneself-to-millions/

So, pink it is for this month at least. Let’s hope that increased awareness will save lives and that research will get us a better way to detect and prevent this terrible disease.

I’ll raise a (small) glass of rosé to that!

Has breast cancer touched your life?

Du poil de la bête

I’ve often heard it said in French, ‘Il reprend du poil de la bête’. This means to feel better after having been ill.

It never occurred to me to equate it with the hair of the dog. The idea of taking ‘a hair of the dog that bit you’ in the form of an alcoholic beverage to cure a hangover is the so very English expression. Quelle surprise!

Yet it seems they have the same etymology. At one time it was thought that applying a hair of the animal that bit you to a wound would literally hasten a cure.

My Frenchie is almost back to his old self following last week’s operation to remove an obstruction from his large intestine. Snorting, burping, farting and giving in to occasional moments of pure bulldog folly. Makes me remember why I fell in love with the breed in the first place….

Higgins took a hair of the dog and actually came very close to a second incident when he managed to crack open the small hard plastic bit of a vet-approved rope toy. Verdict: he is not to be left alone with any toys, period. As the vet pointed out, rightly so, there is no safe toy in the jaws of a determined dog. So we’ll reserve these objects of his affection for play time.

Speaking of hair, we are in shedding season. Between two cats and two dogs, you need a powerful vacuum cleaner to keep the floors from wearing shag rugs.

The above photo is the amount of hair removed from one of our cats following a recent trip to the toilettage. Finding a professional cat groomer wasn’t easy but it turns out there is a crazy lady ‘toiletteuse pour chat’ only half an hour away. My two kitties had never been groomed before but the experience of removing knots not to mention handfuls of hair seems to have given them a new lease on life. And my vacuum cleaner too.

So that just leaves me. After my series of blood tests and checkups and hair-raising encounters with loud machines, it seems it’s all systems go. As my Beau-père likes to joke, ‘on va mourir en bonne santé’. It’s reassuring to know we will die in good health.

A thought for those who are not so fortunate, however. Having been there before, it is easy to forget the suffering – physical and mental – of all those who are not well, be it with serious illness or chronic pain. Keeping one’s sense of humour is vital, but that’s a lot easier when you have the greatest gift of all.

Here’s to your good health. Santé!

Piqûre de rappel

Dave/Flickr, CC BY-SA

Somehow I manage to get through the year without a trip to the doctor’s office. Then it’s time for a booster shot. And suddenly it seems I have a check-up or an appointment of some kind for several weeks running.

Keeping a body in good health is like a car, especially us older models: you keep it fueled, check the air, go lightly on the brakes, but every now and then you have to do the maintenance. Seems I’m in for a full oil change at the moment.

Maybe because he doesn’t see me so often, my GP tends to pull out the big guns whenever I go in with a minor complaint. This time it was nagging lower back pain that had started in the summer. He was off for a month’s holidays when it started, so by the time I got an appointment, it was almost better. Still, better safe than sorry. I got sent for blood work, urine analysis, x-ray and – okay, why not save time and get it now? – an MRI.

I also got a few prescriptions for minor ailments, and when I go back with my results next week, I’ll probably get a flu shot. Seems this year’s bug is looking like a humdinger, and although the medical community agrees the vaccine is a bit of a crap shoot, as they can only guess at its actual makeup, worst case is you only get 35% sick. I’ll take it.

The anti-vaxxer movement is starting to gain momentum France. I remember questioning the need for my kids to get so many shots when I first arrived. But immunization is obligatory here, and if you want your children to attend school you have to go with it. After a bit of fact-checking, I decided to put my faith with science.

Now France’s new government is boosting the number of ‘obligatory’ children’s vaccines to 11: polio, tetanus, diphtheria, whooping cough, measles, mumps, rubella, hepatitis b, influenza, meningitis and pneumococcal disease. Most of these were recommended anyway but the difference is that now they will be mandatory, and therefore, I assume, reimbursed. I get that people are concerned, and if I had young children would probably question the need for them too.

But the return of diseases like measles that were virtually eradicated in France is a legitimate public health concern for both young and old. Even though we oldsters survived many of them — in my case, measles, mumps and chicken pox. But hey, I also grew up a cloud of cigarette smoke.

This week I had an appointment for the dreaded MRI. You have to go to the hospital for this, and as I arrive I can’t help but notice that they always have a funeral parlour just across the street. Isn’t that a little pessimistic? Not to mention insensitive?

I’ve had MRI’s before, and figured this time would be a picnic as it was only for my lower back. Surely, given the fact that I always tick ‘claustrophobic’ on the questionnaire, they’d let me have my head sticking out of the tunnel? No such luck. The nurse pointed out that my head was almost at the end, and handed me a headset to block out the noise of the machine. The screech of obnoxious commercial radio combined with the strange magnetic noises of the imaging created a cacophony that made the whole experience even more unpleasant. But after a few brief moments of panic, the 15 minutes only felt like 30.

So far so good, although I’ll only get all the results back in a few days.

Hopefully now I’ll be good for another year.

Will you be getting a flu shot? Or avoiding the doctor like the plague?