Tuesday, July 20, 2010

Pre-Op

I have entered fully into the Dutch health care system with the latest attack from what has turned out to be gallstones. It took about two and a half months to finally get testing done and a final diagnosis. I had my first spell in April which I wrote about previously. I had another one which began on July 9th. That was a Friday and to escape the oppressive heat we sought one of the two spots in town which have air conditioning - the grocery store and McDonald's. Since it was too hot to cook, we chose the latter. Not a good choice in retrospect, but hindsight is the only thing I have which is 20/20. Later that night I was not feeling well with a kind of indigestion-y sort of feeling which bloomed into pain the next morning. I recognized the sensation and after a few hours Jon and I decided to head for the hospital. We knew this thing needed a diagnosis and not just the best guess of the doctor which is what we received last time. Fortunately as I was getting ready to go, Jon emailed our colleagues about our situation. We heard back immediately from our friend that we could not go to the hospital. (What we cant go to the hospital?!?!) If we did we would be turned away unless I was having a heart attack or something of that seriousness. I would have to go to the huisarts first. That is the family doctor. Since it was now Saturday morning, I could not go to my regular doctor and therefore went to what seemed to be an emergency clinic for Saturdays. It was a doctor's office in the Fire Station/Police Station/ EMT building. We called for an appointment and were told to come right in. We did find that we had to pay before we would be seen and unlike just about every other place in town, including McDonalds, there was no debit card machine. Fortunately between the two of us we managed to come up with the 84E necessary to be seen by the doctor. This is about ten times the rate we pay our regular doctor for a visit. We waited a bit, then I got prodded a bit and questioned a bit and he came up with the diagnosis of a stomach problem and he gave me an antacid. It did hurt in my stomach area, but it also hurt on the right side and in my back. So we went home, lighter in the pocket and still in pain. I took the antacids, but they didn't help. Sunday the pain eased some in the afternoon, but it refused to go away. I tried to eat a few bites on Saturday but it wouldn't stay down. So I fasted and waited for Monday and we headed back to our regular huisarts. We didn't get our regular doctor since he was on vacation and it turned out to be a very good thing, because we haven't been very pleased with our regular doctor and this guy turned out to be just who we needed. He did a more thorough exam, including checking me for appendicitis. He ordered blood work and an ultrasound. He suspected gallstones, but he ordered a thorough ultrasound which covered most of my digestive organs. I went home to wait. The ultrasound was in two days. That afternoon I got a call from the doctor telling me that he had gotten the blood results back and I had an infection. He said we needed to come by his office and get a letter, so we could be admitted to the emergency room of the hospital. Cant get in without one. So we headed to Ede, a town nearby. We went to reception and then waited a while. I had a screening by a nurse, I presume, where they asked me some questions. Then we waited some more. After a bit I was admitted. They put in an IV port, but gave me no saline, though I was so dehydrated my urine was nearly brown. The nurse commented on it, but no fluids were given.They did another EKG and took more blood for testing. We sat and waited. Finally a doctor of some sort, or maybe a resident came in and talked to me and then relayed what I said to a surgeon. She returned and relayed that the surgeon also thought I had gallstones and then they sent us home with an appointment to return tomorrow to talk to a surgeon. When we asked about getting an ultrasound that evening we were told it wasn't sufficient cause to have one done after hours. They still did not know the source of the infection, but I was given no antibiotics. So I was admitted, spent a couple of hours, but received no actual care. Since there was the possibility of an ultrasound the next day, I could not drink anything that evening and my appointment wasn't until 11:00 so now that I was able to hold a little liquid down, I was not allowed to do so. The dehydration continued. The next morning we wandered our way through the hospital finding out where we needed to go and finally saw a surgeon, though he had no idea why I was there. Since I had an appointment for the next day for an ultrasound, he could not get me one that day. So we headed home. A short period where I could eat a little and drink what I could before fasting both again, for the next morning. I arrived for the ultrasound and was told by the technician to strip completely naked. Now I had heard about this part of the Dutch medical system so I was prepared. I understand the need for a certain amount of access for medical personnel, but this was strip naked, no gown, no sheet, nothing for an ultrasound of my belly. Just sprawl yourself out there in the middle of the room on the table. Since I protested she allowed me to keep everything on from the waist down. I protested further and was finally allowed to keep my bra on as well. Believe it or not, it didn't inhibit the ultrasound at all. It was extensive and thorough and strangely painful. I thought she was trying to press the ultrasound thingy all the way to my backbone, but was glad to endure it for a final diagnosis. When all was finished the technician told me the huisarts will get the results in four working days. I was thinking that is more time passing before we know anything and I am still in pain. So the visit the day before that we thought was a waste of time, turned out to be an unexpected gift from the Lord. Since we knew where the surgical examination rooms were, we walked down there to see if it was possible to get an appointment with a surgeon to look at our results. We were allowed to do this since a surgeon had also requested the ultrasound. They let us wait and within a few minutes a surgeon had looked at my file, seen the gallstones, and ordered the operation to remove the stones. He made a note "as soon as possible". We are sent down to arrange for a pre-op exam by the anesthesiology department to see if I am healthy enough for surgery. While there we wondered about going around the corner to see if we could get a date for the surgery. Nope. That has to come by mail. So we waited. Eleven days after we started this journey we finally hear that we have an operating date. It was for August 13th. More than three weeks more to wait. In the meantime I had to be very careful about what I ate so I could "keep my gallbladder calm." It felt like a ticking time bomb in my belly.
Since Jon and I were in the States when the whole national healthcare bill debate and vote occurred my mind has been often on the healthcare system of the United States. As a family we have had no health insurance and had a baby during that time. We have had great insurance and insurance that was just okay. We also had no insurance for three years while we were on the mission field the first time. I have to say that I was not happy to see the healthcare bill pass in the US. I think our system had some holes and people fell through them, but the answer was really a very simple one. Let people without insurance buy into the medicaid (governmental) health plan (This is the system that covers the poor and the elderly already in our country) if they wanted to at an affordable price. Problem solved. The one thing that is used as a mantra by those who wanted to push healthcare reform in the US was the idea that everyone needed to have access to healthcare. The truth is everyone had access to healthcare. I know. We lived it and when we had no insurance we used resources which the church and other charitable organizations have set up to help fill the gaps in day to day healthcare for folks. Everyone, always, had access to emergency healthcare, regardless of insurance or not, foreigner or not, illegal immigrant or someone with premium insurance. The one thing that struck me most about my experience during this health issue is my lack of access to healthcare. If I had been in the States I would have gone to the hospital on Saturday. Had an ultrasound that day and probably had the surgery that day or the next at the latest. I would have been well on my way to recovery long before I even had a diagnosis here and my extra pain and suffering would have been avoided.

1 comment:

Karin F. said...

pls do not judge healthcare by what you've had to endure. Canada has had "free" universal healthcare for at least 50 yrs.
We have access to family drs, after-hours clinics as well as the hospital emerg. We are not inundated with red tape; we do not need a drs referral unless it's to see a specialist.
I was aghast when I read about your ordeal! It almost seems like Holland is putting medical procedures back into the Dark Ages.