Posted by tags: medical emergency, Finnish Emergency Medicine, Malmin sairaala, Malmi Hospital, Töölön sairaalan, Töölö Hospital, Klinikka 22, Helsinki Finland
Ambulanssi Töölön sairaalan tapaturma-aseman edessä, Helsingissä
[Ambulance in front of Töölö hospital, Helsinki, Finland]
Image: Hehkuviini, 29 January 2009 (Wikipedia commons) [larger view].
As you all might recall, I was going to visit Tallinn, Estonia yesterday. I spent a few hours looking at maps, photographs and reading about other people’s visits, and generally getting very excited about this unexpected adventure.
Alas, I never made it.
Instead, as I was walking to the ferry, I slipped and fell on the ice and broke my right wrist. At first, I was determined to just ignore the pain and go to Estonia anyway. Well .. that was my plan until I actually peeked at my wrist. Not only was it giving me that delicious combination of extraordinary pain and numbness that accompanies a fractured bone, but .. it didn’t look normal. In fact, it was bent into a rather impressive 60-degree (or so) angle. Can a wrist swell to enormous proportions in just a few seconds? I wondered.
Well actually, no, bone fractures do not and cannot swell THAT rapidly. As I later learned in the ER, instead of seeing swelling tissue, the lump that I was looking at was the displaced end of my seriously fractured radius, which had been pushed up alongside my hand, near my thumb — a distance of an inch or more — and it had also been twisted to a 90 degree angle away from its normal position. I was completely unable to move my thumb. As if that wasn’t bad enough, my ulna was also fractured in several places at the wrist, and there is apparently some ligament damage, which impaired my ability to move my last three fingers at all.
So instead of filling my digital camera memory chip with hundreds of images of beautiful Tallinn, I spent the day (from 600 until 2000) being shuttled by taxi from one ER to another. The first ER, in Malmi, acted as a general intake and triage center while the second ER, in Töölö, was a trauma unit where they also had a hand specialist on duty. The Töölö Hospital is where they straightened out and set the bones — snap, crackle, pop — OH! MY! GOD! — and put a temporary cast on my wrist before sending me to a private surgery clinic, Klinikka 22, where the hand surgeon later arrived to finish his work of setting the bones by adding a rather large titanium plate and half a dozen screws to the radius. After giving me some time to recover from the anesthesia and to eat something, they allowed me to go home, although I could have stayed overnight. The doctors also gave me lots of phone numbers and email addresses as well as a reasonable supply of OxyContin, Panacod (paracetamol with codeine), and extra-strength ibuprofen.
I should also mention that doctors don’t typically perform surgeries on Friday afternoons in Finland.
The hospitals did need to have health insurance since I am a foreigner, but luckily, I did, as always, invest in Travel Health Insurance that covers up to $50,000 in medical bills with $0 deductible for the duration of my stay overseas. This insurance cost only $46. (Unfortunately, I have been unemployed long-term and thus have been without any medical and dental insurance for years in America.) My medical expenses were estimated to cost roughly 200 Euros for the first ER visit. I am guessing it will probably cost more for the second ER visit since they did more to my wrist there, although I did not get an estimate for that visit. The surgery was estimated to cost between 5000-6000 Euros. I am not yet sure how much the taxi fares amounted to since my Finnish host paid those on his credit card, although I am guessing it will be roughly 150 Euros total for the four taxi rides.
I have only the highest praise for the many doctors, nurses, and candidate doctors (medical students) and the several taxi drivers whom I came into contact with: They all treated me like gold. The medical people took so much time with me, explaining things so they were sure I understood what they meant, showing me the x-rays (fascinating and utterly disgusting all at the same time) and making sure I was given pain medications as well as muscle relaxants to make things easier on me. They also made sure that my Finnish host was well taken care of when everything became overwhelming for him.
Not only that, but the surgeon wants me to stay in contact with him after I return to the States regarding my progress. [Unexpectedly, the surgeon is a funny, caring and personable man -- I didn't know that they made surgeons like that!] The physical therapist, who also wants to stay in contact with me regarding my progress, gave me a written exercise program to follow, starting today, so I hopefully recover full use of my right hand. I am quite pleased about this since none of the medical doctors I’ve had contact with in NYC has ever shown any interest in maintaining any form of contact with me, except through one or more rather nasty lawyers seeking payment for bills that I had already warned them in advance that I couldn’t possibly afford.
The taxi driver who took me from the clinic to the pharmacy and then home was especially fascinating to talk to. He worked as a sales rep for two big pharmas, Astra and then Roche, for his entire life — and he too is currently unemployed! After learning that I am a molecular biologist who studies evolution in birds, he told me that his surname, Rautiainen, is the Finnish for Dunnock, Prunella modularis, a bird that is a common research species that breeds throughout Finland (pictured below). Despite being debilitated by pain and pain medications, I already have plans to specifically find a good scientific paper or two about Dunnock to write about on my blog, preferably either about their behavioral ecology or behavioral evolution, so I can send the URLs to him. If any of you have PDFs to share from papers that you especially enjoyed about Dunnock, feel free to email them to me or mention the reference in comments so I can follow up.
Dunnock, Prunella modularis.
Image: Sławomir Staszczuk, 30 March 2007 (Wikipedia commons) [larger view].
So last night, after I returned home, I worked on catching up on my licorice consumption (supplemented with BLACK iscream) while being comforted by The Beast and making up for my inexcusable cultural deficit by watching the first season of the Black Adder series. Since the doctors and nurses advised me to wait until Sunday to pursue my planned visit to the Helsinki Science Museum, today is the perfect day to finish watching the Black Adder series.
I do have pictures that I plan to share with you — both before-and-after photos and x-rays (still working on getting one of the x-rays digitized). These images are impressively DISGUSTING as well as being educational, although you might find yourself feeling nauseous after looking at them — the perfect combination for increasing my blog traffic!
There were a few things that surprised me about Finnish emergency medical care as compared to what I’ve received in the USA:
- the Finns do not demand that patients use a wheel chair, even when entering the hospital emergency room with a traumatic injury (like a serious wrist fracture) that typically induces shock.
- there is a strong emphasis on pain relief in Helsinki, so I was given pain medication right away, even before I was admitted and was sent home with an adequate supply of pain relievers — this is completely unheard of in all the NYC ERs I’ve ever been in!
- the doctors did part of their treatment (injecting me with a local anesthetic before they set the bones) in what appeared to be their office space. They also freely discussed how to deal with the injury and when to schedule surgery with me sitting in the room (they spoke in Finnish, but my Finnish host, who actually is British, knows enough Finnish to translate some of their consultations).
- the hospital did not have ALL of the newest x-ray developing equipment, as you’ll find in most hospitals in the USA. (On the other hand, are the saved seconds in film development time really worth the added expense?)
- I was not provided a lead shield to drape over my body during the x-rays (They knew I am not pregnant, so I don’t think this was critical).
- their wonderful speed and efficiency at assessing the problem and providing appropriate pain relief as well as making sure I got to the correct place to receive the proper medical care. (I fractured my wrist at 6am and was home the same evening at 8pm — absolutely unheard of in my NYC emergency room experiences!)
- the Finns’ overall ability to communicate professionally and reassuringly as well as in a kind and personable way — in English — was absolutely impressive.
Throughout everything, my Finnish host was a true champion, even when he was ready to faint after my obviously mangled and crushed wrist was fully exposed. Further, I am Finnish-American — I mention this because I might be biased — so I have always loved Finland in an abstract sort of way. But after my several visits and especially after this experience, I realize that this amazing and humane country might be the home I never had and have always been searching for.
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