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

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.

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!”

Canterbury Rails

It was time yet again to take the rails from Paris to Canterbury, England to visit to my niece. And Eurostar provides easy rails – I don’t even have to go as far as London, but get off the train in the English countryside at Ashford. Then I take a local train to Canterbury.

But this time I almost didn’t make it onto the train! Since my niece works in the organic produce market (The Good Shed), right next to Canterbury West station, and we knew she would be at work when I arrived, we had arranged for me to simply walk over to the market and meet her there. What I didn’t realize is that now, before you board the Eurostar in Paris you have to fill out a form with the address you’re going to visit in England. I didn’t have her address! I only had a phone number because I don’t carry my address book anymore. After all, I have all the phone numbers I need stored on my cell phone, right? Oh dear – would they let me on the train? Fortunately, the British agent in Paris, after some light resistance, let me through after I agreed with him that, yes, if this were the U.S. they would throw me in jail and leave me in solitary confinement for 3 months while they set about to prove I was a terrorist. I do think that the next time I travel to a foreign country I will have the address where I’m staying – that sounds like a good idea actually.

After that, the trip went very smoothly and I successfully walked the 50 yards from Canterbury West Station over to the produce market to meet my niece. I must say it’s an impressive market with all kinds of goodies, including cooked food. I think I had one of the best beef stews ever for lunch the day after I arrived. Who says the British can’t cook? This was terrific country food and at a great price. To be followed by Squirrel curlycues (or something like that) – chocolate and nut swirls that melted in the mouth. I’m a chocoholic, so I was happy.

Most of the time I had to stay in the cottage where my niece lives – on Heel Lane behind the orchards. No public transportation. No car. An hour’s walk from Canterbury – which my niece does almost every day. I’d pulled my lower back just before the trip – for more about that you can read my article:
http://www.bonjourparis.com/story/urgences/

So I took lovely, slow walks in the woods just beyond the orchards. You can discover all kinds of things in the woods, including fish tree bark! It gave me a real break and rest from concentrated Paris. Plus the fantastic food that my niece cooks, or rather creates. I’m in awe. (For more photos of Canterbury, go to http://www.flickr.com/photos/jeanne-feldman/).

You do have to be tough, however. There’s no heat in the cottage except when someone builds a fire in the fireplace. Let’s just say I made friends with the sweater my niece lent me and the super quilt that weighed about 3 lbs I used at night. I survived!

There were several highlights during my stay. One was definitely the taxi drivers. Since I couldn’t walk into Canterbury, I had to call a taxi service. With no exception, all the taxi drivers were fantastic – as we drove into town, we had great conversations. “Are you from California – you have a California accent.” Actually, I did live there before I moved to Paris. (“Yeah, Dude”).

Another highlight was a guided tour of the house that my sister and her husband have bought and will live in once the renovation has finished. This is no joke since it’s been under renovation for about a year and a half already. But we found out why when my niece and I had a guided tour with Chris, one of the artisans who’ve been working on the house. It’s located in another small town near Canterbury called Headcorn (thankfully not Cornhead). The house is several hundred years old – and a few rooms on the ground floor are now the town post office! No problem – once you enter the house, you realize how grand and elegant it is, as the rooms unfold one after the other. Chris gave us at least 30 minutes of his time to lead us through each room – lovingly renovated and restored – it was a true blend of art and craft. (When they move in, I’ve got to figure out how to get invited there a lot).

But the most uplifting highlight came from Patrick, a friend of my niece, who has a food stand at the market. On an upright piano in the hallway of the market, by the toilets, he faultlessly played a Bach cantata, just for us. It was splendid.

Found: Boulangerie Nulle Part

I have just walked out of a bakery with the best rye bread I’ve ever had in Paris. Good bakeries are certainly the norm here, and great ones are scattered all over Paris. But, yes, I have found a fantastic boulangerie (bakery) that is literally “nulle part” or in nowheresville It’s called Au Duc de la Chapelle, and is located in a poor, immigrant neighborhood with social housing all around in the 18th arrondissement.

What makes it special is the current owner/baker, Anis Bouabsa who won the “Meilleur Ouvrier de France” award in 2004 in the bakery division. The literal translation is “Best Worker” but the real meaning for Anis Bouabsa is more like “Best Artisan Baker”. Then four years later in 2008 he won the Meilleur Baguette de Paris award – a lot easier to translate – Best Baguette, man! Winning that award allowed Anis Bouabsa to supply bread to Matignon (i.e. the French White House) for one year. Frankly, putting nowheresville in connection with upper crust Matignon is mind bending. Plus, Anis is the youngest baker to ever to win the Meilleur Ouvrier award.

The Meilleur Ouvrier de France competition was created in 1924 to reward artisan workers who worked with their hands in fields that required an apprenticeship. It started out by giving 144 awards. Held every 3 or 4 years, by the late 90s it had 3,500 contestants in 180 professions. Within the bakery division in 2008, there were 84 competing, 15 of whom qualified for the final competition where the contestants had to create an artistic cake based on a theme from the cinema. The day of the finals, Anis astounded the judges with his “pièce de resistance”: Charlie Chaplin sitting on a bench! It had taken over 600 hours to make, but obviously the effect was worth it.

I’ve known about the bakery for some years because I had found it on one of my wonderings around the ‘hood. Originally, it was founded by Thierry Meunier, another Best Artisan Baker of France winner. I especially enjoyed the Triple Alliance (whole grain bread) and Pain de Seigle (rye bread). Especially the rye bread – a sourdough, dark ryebread, kind of the color of pumpernickel, but much more tasty in my point of view.

Anis Bouabsa met Thierry Meunier while preparing for the Best Worker contest, and apparently Thierry was so impressed by Anis’s creativity and energy that Thierry decided to pass along his bakery to Anis right then and there.

I find it intriguing that most Parisian bakers print a mission statement on their baguette sacks. This is a rough translation of Anis’s:

“There are many good bakers and that’s great. But what gives Anis that extra bit of ‘soul’ that made him become the youngest Best Artisan Baker of France?

Quite simply, it’s his thirst to learn and desire to always do better. ‘It was in me’ he always said when speaking of his unique way of connecting with what he was working with and to create, in his own way, the best mixtures of different flours.

Organic bread brings together different flours and numerous specialties springing from a generous creativity, or absolutely simple, crunchy baguettes, (plus pastries) which are all available at the first-class shop Au Duc de la Chapelle open Monday to Friday, from 5:30 am to 8 pm in the evening!”

And they say the French don’t work! This guy does. When you enter the bakery, he’s usually there either baking away in the back or even dealing with customers out front.

Anis has said in an interview that “What I create are like my children. I love to discover breads from different countries, stimulate the taste buds of my clients, mix rye flour and wheat flours... I create my own products and I love to do that.”

I can attest that he does wonders with rye bread. Besides the original Pain de Seigle, there is now a Pain de Seigle Céréales (rye flour mixed with other whole grain flours) that is splendid. Plus the baguette that Nicolas Sarkosy got to eat for a year!

I highly recommend this bakery – it’s worth a trip to Nulle Part if you like great bread. Open Monday to Friday, the nearest Metro is Porte de la Chapelle. Once you find the Rue Raymond Queneau, walk down the street and Au Duc de la Chapelle is just past the Boucherie Halel (the Muslim equivalent of a Kosher butcher) at 32 rue Tristan Tzara (the continuation of Rue Raymond Queneau). Voilà!

Admin Admin: Here we go again

Some say the French administration is a bit heavy. I’ll ditto that. The rather stressed ID portrait above is one point of an administrative journey that actually began back in 2008. It concerns my health insurance which is handled by an association rather than the government because I am a “travailleur independent” or free-lance worker. Quite frankly, I wish the French government Social Security still handled my health insurance. The association (RAM) has made one error after another.

We now have a “carte vitale,” kind of like a credit card with a chip that is scanned by the doctor or medical practitioner and sent electronically to the reimbursement center. Then you get reimbursed in about one week. The problem is that they decided to change the original card to one with an ID photo on it. I still have the “change your card” form from back in 2008. But – one problem – the RAM made a mistake with my first name. I use the name Jeanne in France, but my legal first name is Ruth. My second name is Joan = Jeanne in French. Voilà. The RAM had me down as Jeanne Feldman which is fine for my friends and my blog, but not ok for official documents. After receiving the form in 2008, I sent them a letter to that effect, along with a copy of my passport. Nada. Never heard from them again. Which was no big deal since I still had the old card which worked fine. Until I was dumb enough to believe a letter they sent me saying that the “carte” had to be validated once a year to remain usable. When I did that by inserting it into a kiosk at the Social Security, the damn machine invalidated my card! So I had to apply for the new one. I did this the end of last February (2010).

On March 15 I received a letter that my request had been received and that I would (eventually) receive the form to apply for the new card. Then again, nada. Around mid-April I started phoning the RAM, “Where is the form?” “Oh oh oh – we’ll apply for it again.” Still no form. Called again. It finally arrived on May 6 – with the wrong first name! I finally went in person to the RAM on a Friday to see what could be done. Would I have to wait another 2 months just to receive another form? And then wait another 6 weeks to actually receive the carte? I spoke with a lady who told me she could speed up the process if I could provide an ID photo. I didn’t have one. Hadn’t even thought of it! Oh well – could I come back Monday with the photo? OK.

On Monday – the task was clear. Get the ID photo ASAP and then go to the RAM to straighten this all out. I had noticed a photo machine in the Metro near where I live. Why not just go there? Of course I also had a backup plan which is essential in France. If Plan A didn’t work, I’d go to the photo shop 2 Metro stops away where they could take my photo in the shop (Plan B). I arrived at the Metro station and went into the machine. Oh boy, it needed exact change and all I had was a 20€ bill. I went to the ticket window to get change. “Sorry, the machine is out of order. Is there another one?” “Yes, in the Monoprix down the street.” So I went there, found the machine and tried to get change for my bill. Not one cashier would give me change!

OK – time for Plan B. I arrived at the photo shop - closed on Mondays! Then I realized there was another Monoprix near the photo shop (Plan C). I went there, found the machine and got in line to ask for change. It was at that moment I had my “flash” (cool – not hot). “Buy something – then they have to give you change!” So I did. I got out of line for 2 seconds to find sugar free candy that I actually like and is cheap so I’d get lots of change. Bingo! I then took 4 ID photos in the machine and went directly from there to the RAM where I left the form, copies of other official IDs and the photo which I even offered to cut with my own scissors. I do think this really impressed the RAM lady who was actually very nice to me. And I received the card in less than “un bon mois” (i.e. 6 weeks). I’m also now contemplating whether or not I should go back to my local Monoprix, buy something really cheap and then pay with a 50€ bill. I’m thinking, I’m thinking.

GrosBill - Out!

When you google GrosBill, the blurb says “GrosBill sells the most recent and innovative ‘high tech’ electronic and house hold appliances at discount prices online and in 7 stores” (my translation from French). Yeah – except if your innovative high tech electronic product doesn’t work so you take it back to the store. This is what happened to me – it’s so bad, I’ve simply got to out those “bad guys”.

Last year, on Thursday Dec 17, I bought an external hard disk at the GrosBill Paris store. I needed to backup files on my new Macintosh computer, and the man who helped me set up my Macbook Pro had highly recommended GrosBill. I of course told the guy behind the counter that the hard disk was for a Mac, not a PC, and bought it, paying 90 euros for the pleasure, including a special guarantee.

Once I arrived home, I connected the disk– and nothing happened. So the next day, Friday, I went back to GrosBill which, by the way, is really far out of my way and takes forever to get there! Imagine my surprise when, even with the guarantee, the guy behind the counter refused to take back the disk. He told me that it was my responsibility to format the disk for a Mac. Basically he said that “somewhere in the computer system you need to find ‘hard disk’ so you can reformat it for a Mac”. Right.

I made the mistake of taking him at his word and returned home. I looked at the system preferences and - nothing. I opened the disk utility and yet again – nothing. The following Monday, again I wasted my time going back to the store, this time to return the disk. It got even worse. Another customer service guy refused to believe me and insisted that he test the disk. “On a Mac?” I asked. Of course not! And on their PC the disk icon appeared. Then he admitted to me it wasn’t possible to reformat the disk (which is interesting since on the box it said you had to reformat it for a Mac).

At this point, I decided to return the disk for a store credit. I also asked the customer service guy where I could send an email about all this, and he gave me an email address. As soon as I got home, I sent an email with the whole story, in French, including, at the end, that I was so exasperated with their nastiness that I would “out” them.

I soon received an automatic response saying “The questions we deal with at this email address only concern problems of bank payments. If your question concerns an order or how Grosbill functions, you will receive no response from this address.” The guy had given me a wrong address – on purpose I’m sure! Par for the course.

Later, to my surprise, I did get an email response. This is what it said: “Hello. Only the store manager can decide what to do for you. You have been given a credit. We cannot do anything else for you. You may, if you wish, inform your network or a consumers association. Sincerely, GrosBill Customer Service.”

OK – they said they didn’t mind my informing my “network”. I can also add that there is a kind of “happy end” to this story. I figured that I needed to use the credit, and finally I found something for the same price – a cordless headphone. Ordinarily I wouldn’t spend 90 E on a headphone, but what the heck. I wanted one. And when Anvil’s heavy metal rock sound burst into the middle of my head, I did feel that I had turned it around. Somewhat.

My advice to anyone living in France is - avoid GrosBill. Like the plague.