Antihéros

You may have heard the name of Professor Didier Raoult in the media of late. He is an avid proponent of hydroxychloroquine as a treatment for COVID-19.

What you probably don’t know about the eminent Dr. Raoult is that he epitomizes the French love of the anti-hero: a renegade who doesn’t pander to authority, a medical doctor, a microbiologist and an eminent researcher who is among the most respected in his field. Raoult is also, most importantly to the French, a free thinker and forthright speaker who says his truth without compromise. That truth has been rather uncomfortable for many people over the past months of pandemic. It has divided the country along with the international scientific community.

The fact that he wears his hair long, collects art and generally comes across as an ageing ‘baba cool’ (the French expression for hippie), only adds to his charm. Along with the fact that he was born in Africa and hails from Marseille, a city known for being loved or hated in equal measure.

I had every reason to dislike him. Already early in the confinement the media were hinting that Raoult’s claims for a cure for COVID-19 were overstated, that there was little evidence to support his approach and that — most dubious of all — President Trump was touting it as a miracle cure. I was sceptical at best about the fellow. He sounded like what I hate most: a jumped-up counter-culture figure with a huge ego.

“I’m against information before knowledge. Our work is to obtain knowledge.”

Then I saw him being interviewed. In French. And my preconceived dislike evaporated. Didier Raoult speaks with surprising humanity and humility, advances arguments that are sound and does it all while expressing equal doses of conviction and reasonable doubt. Here is a thinker, a doer and someone who embraces his role as a clinician. That is, a doctor having direct contact with patients rather than being involved with theoretical or laboratory studies.

This is how he has defended his refusal to conduct a formal clinical trial during a pandemic. I must admit I sympathize with this view. It seems rather harsh to ask people who are diagnosed with a life-threatening viral disease to accept the risk of being randomized on a placebo rather than receiving the drug that could save their lives. Of course such trials are essential to medical science and the very foundation of our approach to safely prescribing drugs. But Raoult’s point is this: you cannot compare chloroquine, a drug that has been through clinical approval and prescribed as a treatment for multiple diseases for many years, to an as-yet unapproved drug that has yet to be found safe in humans.

All of which has led to Professor Raoult (‘professor’ in French trumps ‘doctor’ as a title) being elevated to the level of (anti)hero amongst the French populace. His ideas feed into the strongly held belief that Big Pharma is evil, the government cannot be trusted to tell the truth and that good, old-fashioned remedies will cure most ills.

The fact that recent studies have tended not to support the use of hydroxychloroquine to treat COVID-19 has further divided opinion. Just this week, the government announced it would no longer authorize the prescription of the drug to treat coronavirus. But Raoult’s supporters believe him when he explains that the so-called studies are not randomized trials but observational, that dosing is an issue and that his protocol, used in his hospital, of treating patients in the early stages of the disease (and not when they have already developed a serious case), with hydroxychloroquine, and azithromycin, along with zinc, works.

Here’s an interview (from mid-April). Long, and not great quality but worth a watch if you’re interested. Note: he speaks English like a Frenchman!

Time will tell if he is right. In the meantime, if you were to ask the average French person on the street who they would trust to treat them if they were to catch the virus, you know the answer.

Who would you trust?

Torticolis

Stiff neck. Leave it to the French to give it a fancy name!

How can something so much fun to pronounce be so painful to endure? That is the question I’ve been asking myself since being plagued by a stiff neck for the past week.

‘Torticolis’ is the term for a stiff neck in French. I find the French always prefer a highly technical medical term to describe even minor ills: a sore throat is ‘une angine’, an ear infection ‘une otite’, a chest cold ‘une bronchite’ and stomach flu is ‘une gastroentérite’. Note that all such afflictions are feminine in gender. (But that is worthy of another post.)

I am not sure why my neck would choose to play up now. I’ve never had a healthier lifestyle than in the past few weeks of confinement. My workload is low, so no stress there. I’ve been getting lots of sleep, eating healthy home-cooked food and exercising a reasonable amount each day. The only thing I may be doing a bit more than usual is sitting. And looking at my phone. And, come to think of it, worrying about running out of time to do all of the million things I would like to do in life before possibly dying on a respirator.

So maybe I am a bit stressed.

But, unlike the novel coronavirus, there is nothing all that new in this for me. I am a worrier by nature, constantly fighting down negative thoughts. Overall I do pretty well. Stay upbeat and mostly keep the demons away with a good balance of healthy living and therapeutic alcohol.

But back to the torticolis… (Seriously? doesn’t it sound like a fun type of pasta?) It seems I probably have some sort of cervical osteoarthritis, surely exacerbated by being deaf on one side and turning my head all the time to the right. Also sitting in front of a computer and right-side mousing. I spoke to my doctor about this on a video consult yesterday (the only kind he’s doing during the lockdown), which probably didn’t help my neck as I was staring at a screen again. He suggested the possibility of regenerative medicine, and platelet-rich plasma injections.

It certainly sounds promising and I intend to investigate further. While also trying to improve my posture at work, sit less and spend less time online. In the meantime, thanks a million to my friend Meeka for sharing a wonderful video of stretches to help correct forward head posture, along with much helpful info about COVID-19 on her blog.

Hope you are all staying healthy! Anyone else got a pain in the neck, back or other?

Photo by Aidas Ciziunas on Unsplash

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?