Sunday, April 01, 2012

Part 2: French Hospital Lessons

I entered Hôpital Bichat on February 4, 2011 and ended up spending 9 weeks for tests that, in the end, revealed I had cancer. I also had to have a hip replacement operation on March 8 because the cancer had metastasized onto my bones. In fact, the reason I was admitted to the hospital in the first place was that there were holes in my hipbone.

French hospital personnel are now really stressed because of budget cuts, but the quality of care is still very high. And if you asked me how much it cost, I couldn’t tell you. I never saw a bill. Everything was billed directly to my standard health insurance company and to my complementary insurance (my mutuelle). Not bad huh?

I’d like to share four lessons on how to survive a hospital experience in France.

1. Make sure you have a network of friends – the quantity is not as important at the quality of the friendship. As I mentioned, this really helped me “set up” my stay at Bichat, even though I was hospitalized with no forewarning whatsoever. This also helps when your toothbrush falls into the toilet. Oops! Fortunately, just then I had a friend scheduled to visit me who was happy to buy a replacement toothbrush – and boy was I happy too! It was the best toothbrush I ever had.

2. Join associations/groups that express your interest. I’ve got a wonderful network of friends, but they’ve got their own lives to live and I needed more. What saved me was my involvement in my synagogue. I had people visiting me almost every day! It was really a great support emotionally, as I never felt isolated or alone.

3. Relationships in France can change. The two ladies who cleaned my room seemed to really dislike me at first – maybe because I was American? Who knows. But I persisted in being really polite with them and by the time I left, they were really nice to me. Remember that when French person doesn’t know you, they can be brusque and not especially nice. But as they get to know you, this often changes and suddenly they become wonderfully nice. It happens.

4. Use the French medical system, which is fairly open, as a backup if your doctor is a jerk. The young doctor who was in charge of my case was definitely in this category. I noticed that the “older” doctors were wonderful – empathetic, knowledgeable, and they listened to you! The young doctors, called internes, are often totally the opposite. I guess with their lack of experience, they feel that have to strictly go by the “rules and regulations”. And nothing else. Yuck.

After my hip replacement, I needed to get two crutches (béquilles). I had brought one crutch to the hospital (from years ago when I had broken a toe), but it was really necessary to buy two new ones so they would be identical. The interne refused to give me a prescription for two crutches – only one as far a she was concerned. But think about it – who was paying for the crutches? Not the hospital. Nope –my health insurance would cover it, so what difference did it make? Solution? I saw a different doctor who gave me the prescription I needed!

Then I had to surmount another problem. You would think that I would be able to get the crutches in the hospital, given that I was not allowed to go out and about, and I had no family members in Paris to help me. But no – there were no crutches available there. So, how was I to get them? Answer: a member of my synagogue came to the hospital, got the (good) prescription and went out to get the crutches for me. Voilà

Monday, March 19, 2012

A French Hospital Story

As far as I’m concerned, my hospital story started on December 1st, 2010 when my Mom passed away in her rest home in New Jersey. I went back to the US for the funeral the beginning of the December and got back to Paris on Dec 18. The day after, Sunday, I decided to go swimming in the municipal pool as I’d done for years.

It was unusual weather for Paris in winter – there was snow on the ground – and ice. What happened is that I slipped on some ice hidden under crunchy snow right in front of the Chinese restaurant that’s next to my apartment building (i.e. I dropped 180° on my rear end). I knew immediately that something was really wrong– I could hardly walk back to my apartment because my left and lower back hurt so much. And it didn’t get better in the next few days, despite a visit from “SOS Médecins” – a French association that sends doctors to your home when you need a home visit. So, after a few days, I went to the emergency room of Hôpital Bichat, the municipal hospital closest to where I live. It was there that I discovered what had really happened. When I slipped, I had fractured my coccyx. There’s nothing you can do for that except lie down and not walk. Which I did. Plus I discovered home aide (“aide à domicile”). Through the town hall (mairie) of my district (arrondissement) I discovered a wonderful association that sends out women who can help you with cleaning and errands. That really helped me get through this period.

When I went for my follow up appointment at Bichat, the coccyx was fine, but my left hip wasn’t. Actually, it had been pulled and hurting since I was in the US. What was going on? The intern who saw me gave me a referral to a “professeur”, a doctor who was not only Head of the Orthopedic Department at Bichat, but a specialist in hips. (In France, professeur means the absolute top level of doctors.) I went in to see him and in the spirit of his title, he examined me in front of an audience of interns. There wasn’t much he could tell me, so he gave me a prescription for a hip scan and after that, I had to come back.

I had the hip scan on February 3 at an upscale radiology clinic near the Arc de Triomphe in the 8th arrondissement, a far cry from the immigrant ‘hood where I live in the 18th. I could tell that the doctor was worried when he looked at the scan – apparently there were holes in the hipbone. “You need to see Professor Massin tomorrow” he told me. I replied, “If I phone him and demand that, basically his secretary will laugh at me and tell me where to go.” “Ok” he said, “I’ll phone him and make the appointment for you.” And he did!

So, the next day, February 4, I went to Bichat for my appointment with Professeur Massion, carrying a load of scans, x-rays and MRIs. His reaction to the scan? “Madame, the holes in your left hipbone could fracture at any minute, even if you step the wrong way. What you need to do is check into the hospital right now so we can do tests to determine where the holes come from.” “What? Check into the hospital right now – with nothing except my purse and a few x-rays?” Well – he was so serious and worried that I accepted. And so began my Hôpital Bichat adventure.

First I want to say that as an expat in France it’s good to have a network of friends and people from groups you belong to. This made my stay in Hôpital Bichat bearable, starting with lists of things to bring me in the hospital. A friend of mine had extra keys, which she handed over to other friends as time went on. The “guardien” (building supervisor) also has a copy of my keys. And I’m real good at making lists. We also developed the “cell phone sur place” technique where someone would enter my apartment and then call me on their cell phone so I could guide them to find stuff I needed. It worked. In the end I had everything I needed, which is pretty miraculous considering how I unexpectedly checked into the hospital after a doctor’s appointment with no preparation whatsoever.

I quickly discovered that the theme of staying in a hospital in France is “interruption”. When you least expect it, a nurse or nurse’s aid enters your room and takes center stage. It doesn’t matter what you’re doing – they just take over and do what they have to do.

The first thing they needed to do was to find out why there were holes in my bones, especially my left hip. This meant tests – lots of tests. Just a sample are: pet scan (really funny in French as this can be translated word for word as a “fart” scan), ultra sounds of the pelvis and skull, x-ray of the vertebrae, eye exam, colonoscopy, MRI of the pelvis, examination of the bone marrow in the left hip, mammogram and it goes on. Leave it to say that 3 weeks after I entered the hospital, they came up with a general diagnosis: cancer. But where did it originate? Don’t know? Ok – do more tests.

Then there was the question of what to do about my left hip which was fragile from the holes. Their solution: I needed to have a hip replacement operation before starting cancer treatments. This would eliminate the possibility of starting the treatments and then breaking my hip which would mean stopping the treatments to have an operation. Not good. I agreed with them that having the replacement before chemo was to way to go. So, on March 8 I was moved from the Rheumatology Department to the Orthopedic Department for the hip replacement operation. It was done by a young doctor (i.e. he looked about 25 years old), so I was a bit hesitant at first. But I would have had to wait too long for Professor Massin, head of the Orthopedic Department, who checked me into the hospital in the first place. And the young doctor worked closely with Professor Massin. So I agreed. And in the end, he did a really good job.

About three weeks later I got the final diagnosis: the cancer came from a small tumor on my left kidney that had metastasized onto my bones. As a matter of fact, the tumor was so small they hadn’t even seen it the first time they looked at the x-ray. What gave them the answer was an analysis of the cancer lesions on the hipbone that had been removed – it turned out they were kidney cells. Voilà.

It was then that I met Doctor Rodier who was to be my oncologist. Since Hôpital Bichat did not have a cancer department, Dr. Rodier was the link to cancer treatment at Hôpital Beaujon just outside Paris in the suburb of Clichy. I liked him immediately and agreed to follow his treatment there.

Monday, February 20, 2012

I Lost My Keys!

Quite some time ago, a friend of mine gave me a necklace/cord with an attachment for my cell phone. I never used it because my phone didn’t fit onto the “hook” at the end of the cord (I have to admit I’ve been lazy about replacing my phone – I assume it’s simply too outdated to fit the latest hook). So, the necklace/cord sat in my drawer taking up space since I inherited an important quality from my parents: “You never know what’s going to happen in this world, so save everything even if it takes up too much space.”

Finally, I had an inspiration: “Why, not put your keys on it and wear them around your neck instead of having them float in your pocket or belt pack and possibly fall out?.” I have to explain that I haven’t been using my purse lately when I walk around the ‘hood which is why I either put stuff in my pockets or use my belt pack. I figured it would be a lot more secure to wear my keys around my neck.

Last Saturday I went for one of my walks around the ‘hood – it was sunny for the first time in weeks. “Wow – a blue sky!” It was a great walk, and as I got to my front door I felt very satisfied. But not for long. As I reached for my keys, I found – NOTHING. Not even the necklace/cord.. What a disaster (quelle catastophe)! I couldn’t even get into the building, let alone my apartment. One good thing is that I had remembered to bring my cell phone with me. So I took a chance and called the gardien or building supervisor to whom I had given a set of keys to my apartment when I moved in. However, it was a chance, because he doesn’t work on Saturday afternoons – would he even pick up the phone? To my great relief – he did. And was willing to come to the office and give me my keys. And once I was in my apartment, I found my duplicate set of keys, so all was well. Well, not quite. It really bugged me how I could have missed the necklace dropping with a set of keys that should have clunked on the sidewalk. What was going on?

At this point, I decided to pray to St Anthony, the patron saint of lost objects. Okay, okay, I’m Jewish. But I don’t think St Anthony really cares about that. He certainly has helped me in the past to find things I had lost or misplaced. Whatever works, right? (Now – that’s a Jewish attitude.) The next day, Sunday, I decided to retrace my steps to see if maybe I could find the keys curled up in their necklace/cord on the sidewalk, or whatever. Of course I didn’t find anything. BUT – just before entering my apartment building, I saw a sign (a real one), printed, that basically said (in French): “I found a set of keys on this street on Saturday”, followed by a cell phone number. Wow – could those be my keys? So I copied the number and phoned, only to fall upon an answering machine with a male voice saying, “Leave a message.” Which I did. And phoned several time more, finally connecting with a real human being.

“I live at 34 rue de Torcy and I’ll be there in 15 minutes. I’ll call you when I get there”
“I live there too! I’ll wait for your call.”

It turns out that he and his wife live in my very own building (!) and when I went up to their apartment – there were my keys!

“Thank you, Saint Anthony!”