Gig Harbor, USA, Spring 2009
My 5 year old son runs in to find me, his face all red and streaming with tears. He has swallowed a nickel and it hurts…really bad. First, try to assess whether it will block his breathing or not…he is breathing OK and seems to be getting better by the minute…decide not to call 911, knowing how expensive a trip to the ER can be…call medical insurance as we are getting in the car to see if we can go to the new local hospital 4 miles away…yes, they say, we are covered, but we pay 80% in addition to the $100 deductible. He seems better and I talk to the consulting nurse on the way to the hospital and wonder out loud if I should continue to the new hospital in town or go the extra 20 minutes to our HMO hospital in the city where I know it will be covered. She understands my dilemma, all Americans face it–how to get the care we need without risking our mortgage and food money. It’s a financial gamble to go to the new hospital because it’s outside our HMO…but, if the nickel is stuck vertical and it flips down flat, it could cut off his airway. I decide to get to the ER within 5 minutes and risk the big bill.
We enter the new building (that looks a little more like a luxury hotel or spa than a hospital with the dazzling architecture and décor) and are greeted by two friendly staff members at the desk. As soon as we fill out multiple forms and give them our insurance cards, we are escorted back to a trauma room fully decked out with an array of life-saving equipment. We are seen by the nurse and a doctor within 10 minutes. We are escorted by another staff member to the X-ray facility where the tech takes a couple of X-rays. He shows me where the nickel has ended up on his computer screen. It’s in the intestine, and that is a good thing.
We are escorted back through the shiny new, immaculately clean hospital to the trauma room. As we wait to speak with the doctor, a woman comes in with a computer on a wheeled cart to get all of our information for billing purposes. The doctor comes in and talks to me for about 5 minutes about what happened, explaining that the nickel went down the esophagus instead of the lung. He said the little guy should pass it within a week or two. He said to keep an eye out for it and if we don’t see it within 10 days, come back in for another X-ray.
In about a week we receive a thank you card from the ER staff. Seriously?!?! I can’t believe that this is what medical care has come to. About a month later we get a bill from the hospital for nearly $400. I almost called the hospital to ask if they could take the card back and refund me the cost of postage and the per minute rate for 6 highly trained staff to sign it and someone to send it. That could add up to a few hundred bucks easy. We could have done without the escorts, too!
I’m so glad that my son was OK (he did finally pass the nickel without further fanfare) and grateful to know that if they were prepared to deal with any and all possible scenarios, but a thank you card–that hit ‘completely’ on the ridiculous scale.
Total time at the ER: 45 minutes
Total cost: $500
Grimsby, UK, Summer 2010
My 9 year old son hobbles over to me in the gym of the leisure center crying in pain. He explains through his sobs that his foot flipped under as he was skidding on the mat (doing exactly what he was told to stop doing several minutes earlier). It hurts so bad that he can’t put any weight on it. He is very upset as this is the worst injury he has ever had (lucky him). Get the trampoline coach to take a look at it. After he has him move it slightly and checks for immediate swelling, he says it is probably not broken but we should have it looked at. We get directions and head to the hospital for an X-ray. Be prepared to wait, they cautioned.
We pull into the pay car park in front of the “Diana, Princess of Wales Hospital”. My husband gives my son a piggy back ride into the ER. It is an older building and my first thought from looking around at the cloth covered chairs and far-from-sparkling floor was—don’t touch anything. We check in at the desk and the woman takes only our names, my son’s date of birth and our address. No forms to fill out. No insurance cards to copy. It does not concern her in the least that we don’t have a national health number yet or any other form of insurance. We are told that we will be seen by a trauma nurse for an assessment, then wait for the doctor. She verified that all the wheelchairs were taken. We sit down carefully among the 34 people in the waiting area.
After 45 minutes we are seen by the triage nurse. The triage room was a tiny, with 3 chairs, a few basic examination tools and a computer desk at one end for the nurse on the rolling chair. She checked out his foot and asked if she could give him a dose of pain medication, and by the way was he allergic to anything. I asked what the medication was and her answer was something I’d never heard of. “Is it like ibuprofen or acetometaphine?”, I asked. She looked at me like I was talking in a foreign language. It has both ibuprofen and insert some other drug that I didn’t recognize here, she said. I wanted him to stop hurting, but no mother on earth wants someone to give their kid a medicine they have never heard of. She made it sound totally normal, so I said sure. She said they would get him in to see the doctor, but it would likely be a 2 hour wait. Back into the queue (pronounced “cue”, it’s when you are in line for something) we went.
It was another 2 hours before we were seen by the doctor. He came out in jeans and a shirt to get us himself and took us to the examination room. No scrubs. No massive ID badge. I gave my son a piggy back ride from room to room for the rest of our visit. (This was fine with me because it prevented him from touching too many surfaces.) As long as didn’t bump his foot on anything, he was OK. There was an examination table, a few chairs, some basic equipment on the walls and a set of cupboards, but far from the sparkly chlorine-clean of US medical facilities. Near the door was a cast cart that had clearly been recently used, as there was plaster still splattered on the equipment and floor. There was no clean sheet or rolling paper over the examination table, just a pillow, a bunched up sheet and foam sticking through the cracks in the side. Sit on the edge, I said, and don’t touch anything.
The doctor came in and asked what happened. He touched my son’s foot in a few places and said we were going for an X-ray. He quickly filled out a piece of paper and sent us down the hall and to the right. I hefted my son on my back and headed down the hallway. At the end of the hall it was all dark to the left, so trust me, I was only going right anyway. We got to the X-ray waiting room. There were only three people ahead of us in the queue and most of the lights were on at this end of the hall. Don’t bother ringing the bell, another patient told us, it doesn’t make any difference. The wait was only another 15 minutes or so. The X-ray procedure was nearly the same as in the US, but I was a little concerned when they didn’t cover my son’s body to take the X-ray. I had to stand behind the shield, but the tech didn’t cover him up, so I asked if he would. It wasn’t much radiation, he explained, just about twice what you get in a normal day as background radiation. That’s supposed to be comforting? So in a split second he’ll get what is normally spread over 48 hours? Why he couldn’t just take the crotch shield off the hook on the wall and cover him up? Maybe I was just over-reacting, I decided, there’s nothing like a hurt child to make a mother freak out…when in Rome and all that jazz. Then, we did our own little imitation of a spider (our arms were starting to droop in front at this point) all the way back to the big waiting room.
After about 20 minutes, the doctor came out and was talking to the people seated in the row in front of us (it was a bit like the waiting areas in airports). When he was finished talking with them he leaned over and said to me, “he’s fine” as he waved his hand from one side to the other. Great, it’s not broken! I turned to my son to give him the thumbs up and thought, oh, they’ll probably just give him some crutches and a wrap of some sort. When I looked up, the doctor was halfway down the hall. That was it. No paperwork. No crutches. No ace bandage. No follow up instructions. But he can’t walk on it, I thought as I prepared for the piggy back ride out to the car. I felt a bit like a spoiled child hearing ‘no’ for the first time, and then was even a little shocked at my own reaction. I am an American, aren’t I? I reassure myself that it will be fine. It’s not broken and we’ll take him to a doctor the next day if we need to. I also remind myself that it was all free, well, except for the parking.
Total time at the ER: 3 ½ hours
Total cost: 3 pounds (approx. $4.50) for parking
Thank goodness he really was fine and after a few days of hobbling, he was back to bouncing on trampolines. (I thought I could take him to our local medical facility the next day if it didn’t improve quickly, but I later learned that I was mistaken about that. There are signs for “Surgery” on buildings all over the place, so I thought they had advanced medical facilities sprinkled throughout the countryside. I was wrong yet again, “Surgery” is the name for a medical practice here, and they don’t deal with injuries, you have to go to hospital for that. And yes, I did leave the “the” out on purpose. You go to hospital, not “the” hospital, in England. I have found no rational explanation for this, but I’m working on it.)
I can’t even begin to compare the two systems, I can only share my thankfully limited experience. But I will say that despite the cosmetic differences that brought out the germ-o-phobe in me, and the general lack of hand-holding, it was certainly nice to know that the later incident didn’t deplete our summer fun budget this year.