Health Care, Part 2: The Fickle Finger of Fate

On a rainy Sunday in late March, I open the refrigerator door and a jar of applesauce falls out and breaks on the tile floor. “Drat.” I clean it up, dump the broken glass into the garbage, and continue on about my cleaning of the kitchen and our tower apartment. An hour later—applesauce forgotten, I open the garbage can to empty a dustpan full of dog hair, dirt and dust swept from the floor. The garbage bag is nearly full, so I put my hand on top of the garbage to smush it down… and slice my right index finger open behind the second knuckle on the broken applesauce jar.

“Drat!” My hand under cold running water, I call Susan to help. The finger keeps bleeding. We wrap it in a clean paper towel, and I sit at the table while Susan runs downstairs to get Rosie for a second opinion. Rosie and Susan agree that it might need a stitch or two, and so the kids pack up some toys and snacks for the waiting room, and we head off to Rangueil, about forty minutes away on the outskirts of Toulouse, to the emergency room. The hospital itself is easy to find—atop a hill above a large city park and recreation area—but the emergency room is mysteriously hidden, with the parking some distance away once we find it. Through a maze of dim and empty hallways—me with my finger still wrapped in the paper towel, feeling a little queasy, and James and Izzy disgusted that they have to sacrifice a day off from school for a trip to the hospital waiting room—we wind our way to the E.R., where we stand in line in a room about the size of a small living room, surrounded by a half-dozen gurneys on which lie clearly sicker folk than I.

I feel a little ridiculous. The ambulance drivers glance curiously at us, and the desk clerk ignores us for a long time. It’s a Sunday, remember. A number of senior citizens seem to be sleeping on their stretchers, a girl hobbles in with a Sunday sports injury, the medics wheel in a young man who appears to have been in an auto accident. We send the kids into the adjacent waiting room, and stand behind the red line, Susan to act as my interpreter.

After about five minutes, the clerk summons us to the desk, where Susan explains my injury and our status as Americans abroad. I unwrap my finger and bleed a little on the ER floor. He explains that we will have to pay for the visit, and that the consult will cost at least €100. “Fine, fine,” we say. We’re here; we might as well have someone look at it, though I do have half a mind to forget it and go home. The desk clerk makes copies of my insurance card and passport, and gives Susan a form to complete, after which we are directed to wait. One of the kids needs to go to the potty, so Susan takes both of them off to find a restroom and the snack bar we passed on the way in. A half-hour later, a nurse or aide comes and takes me into a consulting room, where I explain again what happened. She is very nice, but she doesn’t speak much English, and, of course, my French is terrible. She tells me to wait and returns in a few minutes with another nurse, who speaks English well. They look at my finger on an examining table, soon joined by a young man who tells me that he is a medical student in his fourth year. His English is good, and he and the nurse clean the wound carefully, look into it, and wrap it lightly in gauze. A supervising doctor will be in soon, they say. Other patients are brought into the room—a young man with a gash on his head, a woman in athletic shorts with a hurt ankle. Each is treated by a rotating group of nurses and medical students and residents. I’ve been at the hospital for about two hours now, and I haven’t seen Susan and the kids for an hour. I wonder at how they are getting on. I’m still thinking that eventually someone will just put a stitch or two into my finger, give me a bill and send me on my way. I feel like a dope for not being able to speak French. A woman doctor returns with the medical student, unwraps my finger and opens the wound a little to look inside. She frowns, shows something to the student, and then tells me—in English—that the tendon might be damaged. A surgeon will need to see it. My medical student escorts me to be x-rayed to make sure there’s no glass in the wound. I add another hundred Euros to the bill in my head. I am returned to my table in the examining room where I sit and try to understand the French conversation between the guy with the gash in his head and the young woman who is stitching it up. Fifteen minutes later, the med student, the woman resident and a nurse return with the surgeon, a nice officious man of about forty-five, who takes a quick look at my finger and tells me that they will need to cut it open and fix the tendon.

There’s no consultation with me—the patient—no questions, no second opinions, no hesitations. This is what needs to be done, and I shall take his word for it and follow directions. They ask me when and what I last ate. A Diet Pepsi in the waiting room, nothing else since breakfast, pancakes. It’s now about three o’clock. Have I ever had surgery before? Tonsillectomy when I was twelve—the only night in my life I’ve spent in a hospital—and colonoscopy (as an outpatient) last summer. Have I any allergies? Any problems with anesthesia? Is there someone here with me?

Susan and the kids come in. Izzy and James are crying, worried now, and Susan’s eyes are wide and amazed, which is basically how I feel. For goodness sake, it’s just a little cut on my finger from a broken jar of applesauce!

The nurses have told Susan that it’s unlikely that I’ll be released until morning and that she should go home. I put on a brave face for the kids, laugh and say, “I’ll be fine! It’s nothing. They’ll take good care of me here, and I’ll be fine. Nothing to worry about. They just need to fix my finger,” I tell the kids. “I’ll be home tomorrow, no problem.”

I kiss each of the three goodbye and send them on their way, despite Susan’s worries. “I feel like I’m abandoning you here,” she says. I ask her to write our telephone number on my hand, since all my clothes and belongings have, by this time, been taken away. There’s nothing else to be done. The kids need to get home. The surgeon will be waiting in the O.R. I’m alone with almost no language skills in a French hospital, about to go under the knife! I can’t believe it.

Suffice to say that it was, indeed, all fine. I was wheeled through the endless dim hallways in the weekend-empty hospital to the orthopedics wing, where the anesthesiologist and O.R. nurses—one of whom spoke English—asked me all the same questions again and prepped me for the surgery. They all sympathized about the stupidity of the injury—accidents happen to everyone. Clearly, they thought, any of them might have forgotten the broken jar and tried to smush the garbage down as I had.

It was decided that I would not have a general anesthesia because of the Diet Pepsi, but they gave me something to relax me and then numbed my right arm from the shoulder down. We chatted about why I was in France, my job as a writer—and the necessity of being able to move the index finger to type—and the book on which I was working. Eventually I zoned out, and the surgeon arrived and set to work on the lump of lead behind the drape that was my arm and injured finger. I tried not to think about the cutting, tried not to listen, and eventually heard, “Voila!” from the surgeon.

Soon thereafter, he left me to the care of the nurses, who sent me on to the recovery room, and then, after I was more awake, on to a room, where a kind and funny English-speaking fellow took down all my details and called Susan on his cell phone, using the inked number on my palm. I assured her and the kids that I was just fine and told Susan to just come in the morning after she’d dropped the kids at school.

So I’ve experienced French health care from the inside now. The hospital—like any city hospital—was a little frayed at the edges, but clean and relatively efficient. The quality of the staff was excellent. Every nurse and aide I met—from the gurney-pusher to the food-service staff to the O.R. nurses to the night nurses and nurses’ aides—were intelligent, kind and friendly. Everyone went out of his or her way to find a way to communicate with me. I genuinely felt safe in their hands in what might have been a terrifying situation.

I never saw a doctor after the surgeon’s Voila! in the O.R. It’s clear that doctors have a kind of authority in France that is different from their authority in the U.S. Maybe it’s a kind of trust for their expertise, or maybe it’s just a more traditional patriarchal attitude toward medical authority. Part of me wonders if this is partially the result of having the element of expense and payment removed from the equation? Do we Americans demand more options, more information, and more control in a situation such as mine because we suspect that the doctor might be padding his paycheck with an unnecessary surgery? Do the French, on the other hand, assume more readily that the medical professional is their employee, paid with their tax dollars to attend to their well-being with nothing to gain from giving different care? It’s an interesting question, and one for which I have no answer.

In the morning, I was released with a prescription for pain-killers and a wound-care kit, and extensive instructions for the visiting nurses. Visiting nurses? we asked. What a concept. These wonderful women came to the chateau every other day for two weeks to clean my wound and change the bandage. I had an appointment for follow-up with the doctor, but as it quickly became clear that United Healthcare—my U.S. insurance company, who had sworn they would cover all emergency care abroad after the deductible—were going to make it as difficult as possible for me to collect on my claim, we decided that I could wait until I returned to the States. The hospital bill came to €1600, about $2000 at the current exchange rate, the prescriptions to about $80, and the visiting nurses to about $100. Had we been French, of course, all of this would have been covered. As it is, United Healthcare “might” reimburse me for about a third of the cost three or four months from now, and we are surely going to have to spend a lot of time fighting them for it. The bill itself, for instance, must be translated from French into English by “expert translators” at our insurance company, an expense that we will, no doubt, have to foot ourselves.

And my finger? It works fine. It bends most of the way at both knuckles, though it seems a little stiff. It occasionally gets sore after I’ve been working with my right hand (hammering, gardening, etc.). And, as one of the nurses pointed out, I’ve also got an excellent mark-of-Zorro scar.

Accidents happen: anyone can cut a finger on a broken jar of applesauce on any rainy Sunday morning. In the U.S., the emergency surgery to repair it will likely depend, in part, on your ability to pay. After all, do you really need to bend your index finger if you’re not a concert pianist? In the old comedy sketch on Rowen and Martin‘s Laugh-In, the “fickle finger of fate” was awarded to government boondoggles or famous people for dubious achievements. This year, I win the literal fickle finger of fate, but the winner of the prize should be those U.S. politicians determined to let insurance companies control the debate over whether that index-finger surgery is really necessary regardless of your ability to pay.

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