A day in the life of socialized medicine, Part III

Sometimes it's best to start a long story at the very end. In the case of my emergency eye problems in France, it's the part of the story where the French medical system keeps refusing to let me pay for my $3000 surgery.

It was around 1030 last Saturday morning. A little more than twelve hours before, I'd had a scleral buckle sewn on to my right eyeball - it's a piece of silicone sewn on to the outside of the white part of my right eye, in order to stop the further advancement, and help heal, a torn and detaching retina that, if nothing was done soon, would lead to permanent blindness.

Other than the urge to vomit since about 2am, a swollen shut eye, and the vestigial remnants of a searing headache on the side of my head still numb from the local anesthesia, I was ready to get the hell out of Paris' Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts.

The nurse came in, handed me a few papers - my EKG, an appointment slip for a check up in a week - told me I could leave whenever I wanted, then she turned around to walk out the door.

"Um, should I pay when I head out downstairs," I asked.

"Oh no," she said, "the caisse (cashier) is closed. It's Saturday."

Silly me.

She got up to leave. So I tried again, as politely as I could.

"Um, so, should I pay for the surgery when I come back next week for my check-up?", I tried again, not wanting to offend her with my apparent insolence.

"Yes, I guess that would work - if you like."

Getting a French hospital to accept payment for surgery is a lot like getting an American insurance company to reimburse you.

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Now back to the beginning. I landed in France a few weeks ago to do my annual house-sitting for my co-blogger Chris and his wife Joelle. Every August, the French migrate, en masse, to a vacation spot of their choosing, leaving Paris a virtual ghost land. But the city is not without its charms, even empty. It's still Paris. So every August, I dutifully hop on a plane, and move the AMERICAblog headquarters 3,000 miles to the east for a month or so, to relive my junior year abroad some twenty five years ago, until the Planche-Ryan family returns from their annual walkabout.

I landed in Paris and something was bothering me. I'd noticed a rather large, new floater in my right eye. If you have floaters, you know what I mean, if you don't, you're lucky - they're fuzzy, or stringy, or even solid dark things in your eye that float around and occasionally get in the way of your vision. I'd suddenly noticed a rather large new one that was getting in the way of my vision, and I also started to feel something in the bottom right corner of my right eye - not pain or anything, just a slight fuzzy pressure or something. I'd had small-scale retina problems a few years ago, and my sister had a full retinal detachment, so I knew that a sudden increase in floaters was sometimes a sign that all was not well with your eye.

I asked Chris' wife, a Frenchwoman, to ask around for a good retina doctor in town, and she said to go to the Hopital Quinze-Vingts.

The Quinze-Vingts - literally 15-20 - has been around since the year 1260, since Saint Louis, (King Louis IX of France), established the hospital to take care of Paris' blind population. The name Quinze-Vingts comes from the number of beds the original hospital had - 300 - or "quinze-vingts," the word for 300 in older French (15 times 20 = 300), just like "quatre-vingt" (4-20) means 80 in modern French.

Now, I'm not going to lie about it. The hospital has a decidedly 1950s General Hospital look to it. But appearances aside, it's roundly considered one of the best hospitals in France, if not Europe - especially for eye problems.



As many of you are already aware, since I wrote about it two weeks ago, my due diligence call to my insurer back in the states, CareFirst Blue Cross Blue Shield, didn't go so well. I called CareFirst the night before going to the hospital to get my eye checked, thinking that perhaps my plan required such a call (you never know), and more importantly, I wanted to know if they had any doctors they could recommend that were perhaps covered by their plan (it happens sometimes).

Not to revisit my previous blog posts, but in a nutshell, CareFirst's employees don't know their croissant from a hole in the ground.

Blue Cross employee number one: Yes, you are so definitely covered, regardless of what doctor you visit or where you go - get to a doctor now.

Blue Cross employee number two: No, you are only covered if your treatment takes place inside an emergency room. If you even step one foot outside the emergency room (possibly to pee, it's not clear) you lose your coverage.

Blue Cross employee number three: Obviously this is an emergency and would be covered.

Blue Cross employee number two then cuts off Blue Cross employee number three on the same call: "I just read you the sentence: Only in an emergency room."

Yes, my insurance is so confusing that Blue Cross itself has no idea what my plan covers, so they just make shit up on the telephone to their customers facing emergency health crises abroad.

Again, you can read about my first French hospital visit in the previous post, but suffice it to say that they found a large tear in my retina and the beginnings of a full-blown retinal detachment, both of which demanded immediate emergency laser surgery to cauterize them and stop them from most certainly, and quickly, making me permanently blind. I also started to notice, I think the night before, a slight black shadow or something in the bottom right corner of my eye - exactly where the doctor would discover the tear and detachment the next morning. (As an aside, the doctor will tell you that the laser surgery doesn't hurt. It does. Which is kind of funny, because who'd have ever imagined that burning the back of your eyeball with a laser coming through the front of your eyeball, for nearly an hour, would actually hurt?)

I was told that it would take 7 to 10 days for the surgery to either work, or not work, and that I should come back in a week to find out. I went back to the hospital, they took a look, and said the surgery didn't take, the detachment was spreading, and I needed more complicated emergency surgery as soon as possible - or else, again, the detachment was going to spread and I was going to soon lose my vision. It's hard to know what exactly made me freak out this time around versus the last, when I was really quite calm about it. But something in that moment made me lose it. Maybe it was being in a foreign hospital, thousands of miles away from home and family. Or speaking about health emergencies in a foreign language I was super-fluent in, generally, but suddenly found myself way over my head discussing parts of the eye in French I'd never even heard of in English. Or maybe it was simply the estimated cost of the procedure, 2000 euros, as compared to the paltry 100 euros I owed for the previous laser surgery. If this round of emergency surgery was going to cost me $3000 bucks in the land of socialized medicine - a place where a normal visit to the hospital emergency room should only cost $32 - then my condition must really be serious.

So, surgery it was.

My doctor, who ended up being a real sweetheart, told me I had to stay in the hospital overnight. Why, I asked? Because it's the way we do things in France, she said - emergency patients spend the night. I laughed. That's funny, I told her, in the states emergency patients are pretty much kicked out the door in a few hours. In any case, she had to check my eye the following the morning to make sure it was all right.

But, she warned me, don't expect a four-star hotel. Then I entered my room.



It was a single room. There was a God, and he was French. (That's my friend Marcus in the corner. He came to hold my hand, and switched off with Joelle's sister Marielle, who stayed for my surgery. Things you don't think about until they happen - but if you're alone in a place and need surgery, who's there for the doctors to talk to if something bad happens while you're asleep on the table?)

As I was a bit stunned by having my own room - knowing how in the states you'd pay an arm and a leg for such royal treatment - the nurse assured me that it's the same cost to you if you get a double or a single, the patient pays the same.

The nurse handed me a dark blue gown and told me to go shower in a special room they had. Apparently all patients have to shower before their surgery, or this kind of surgery. A bit odd, but what the hell. I went in to the shower room and found the soap the nurse asked me to use - it was a variant of iodine. Hoping I'd understand her correctly, and wasn't about to make a fool of myself staining my entire body with bright red iodine, I lathered up, slipped on my horrendously dehumanizing man-gown, and scurried back to my 4 star suite.

A few hours before surgery, the nurse arrived and told me to take a pill. What is it, I asked her? It will help you relax, she told me. I still have no idea what she gave me.

Little did I know that this exchange would be the leitmotif of most of my stay with the French health care system: They talk, you listen. And please don't ask questions. It will get you nowhere.

Marcus, who's been here I think 11 years now, or more, says it all goes back to the French education system. In American schools, universities especially, you're taught to question. In Europe, you're taught to shut up and take notes. I exaggerate, but only just. The French medical system is ranked, in some surveys, as the best in the world. And when you're the best, no one asks you questions. Apparently.

Even my surgery. I only just, today, found out what they actually did to me last week. My doctor called. I had been Googling "scleral buckle." Well, let me step back for a second and recount a conversation I had with three people: Joe, a friend of mine from Italy who I hadn't seen in years, and my friend Matt. Each of the conversations went exactly like this:

"So what are they doing to you?," friend asks.

"The doctor is putting a scleral buckle on my eye," I say.

Sound of friend typing.

"There's a video," friend suddenly says.

Silence.

"Oh." Silence again. "You really don't want to see this video."

I noticed that there seemed to be a few different techniques. I also noticed there seemed to be some major cutting of tissue in the eye (I'd though I'd been told the surgery was non-invasive, i.e., not going inside the eye). So I finally asked doc about it today and yes, there was some cutting of the eye. And I found out that I got an individual buckle, not a wraparound the eye kind of buckle, for those in the know.

Another example. Right before surgery, my allergies started to bother me, bad. We think it was some perfume the hospital puts in their floor-disinfecting solution.

John to nurse: Madame, I'm having an allergy attack. It's starting to make my throat close up. Since I'm about to go into surgery and be put asleep, that's probably not a god thing. Can you ask the doctor if I can take one of my allergy pills?

Nurse to John: Allergies? Allergies to what?

John: Well, lots of things, like flowers, for instance.

Nurse: Monsieur, there are no flowers in this room.

And that was the end of that.

As my allergic reaction grew worse, and I more agitated, we asked a second nurse if he could ask if it was safe for me to pop a pill. He asked what I was allergic to. The conversation went downhill from there.

My doctor says that she thinks the difference between the French and American system is that the French trust their doctors, so they don't ask questions. Perhaps. But I told her I think that Americans trust their doctors too, but we insist on being a part of the process. We want to know the facts, every step of the way.

I'm running out of wind here. And only just got over last night's migraine headache brought on by yesterday's check up of my eye. But overall, I got excellent treatment at a ridiculously low cost. The doctors were absurdly nice. To the point of absurdity. My doctor/surgeon gave me her cell phone number in case I had questions. Yes, the nurses are a bit Nurse Ratched (or for you young-ins, think the Joker in the latest Batman movie when he's blowing up the hospital). Like the nurse who refused to believe that my my eye was in searing pain in middle of the night after surgery, and didn't believe that my stomach was flipping from nausea, until she finally did believe it, and directed another nurse to walk me down to the emergency room, as she now thought perhaps something was wrong with me.

Yes, they tried to walk me.

I made it halfway down the hall, at 2 am mind you, with one eye, and even that eye had my glasses at the tip of my nose because of my bandage on the other eye, so I could only see about 10% of the good eye's entire field of possible vision, with a full-blown bout of nausea, walking my IV tube beside me, before I told the nurse I couldn't do it. They said they'd get some orderlies to come up and bring me down to the ER. I guess they ultimately forgot.

So yeah, all was not roses during my hospital stay. But it was pretty damn good. Pretty damn personal. (Adorable Doctor Julien, the guy who treated me the first time I went to the hospital's emergency room - aka Dr. This Won't Hurt - stopped by my bed, as I was waiting to go into surgery, simply to say hi and wish me well.) And it's also pretty damn cheap.

And best of all, I can see.

And the entire experience has still only cost me about 100 bucks out of pocket because the hospital just hasn't gotten around to asking me to pay yet. When I went back for my check up this week, they still didn't want me to pay for the laser surgery or the scleral buckle. I did pay, however, 28 euros for the check up. Maybe they'll get around to asking me for the $3000 I owe them when I come back for my check up next month (yes, next month - it's still not clear when my doctors will permit me back into a plane again - mom is exploring transatlantic boats, seriously). I'll let you know.