A couple more entries to Appendicitis Central.
Andrew Duffin writes:
I NEARLY had a really really bad one on the NHS. They’d realised what was wrong, and were going to leave it overnight “to see how things develop”.
Then I said I was insured, and an hour later I was in the theatre and the job was done.
Reader - it was gangrenous, it would have ruptured overnight, and I might therefore not now be telling you this tale.
Not quite sure how to categorise that one. NHS bad for sure, but does it also get entered in the (so far) non-existent UK private column? It sounds as if it is even more complicated than that as it was an operation carried out by the NHS but paid for privately. Does that still happen? And, more importantly does it count as NHS or private? I am going to say private for the time being.
The other one comes from Akiko who tells me about a friend who had a perfectly good appendectomy in Cambridge in the early 1990s.
So, the scores:
UK (NHS): 2 good, 3 bad
UK (Private): 1 good, 0 bad
Japan: 1 good, 0 bad
France: 2 good, 0 bad
Italy: 1 good, 0 bad
While out on Friday I came across some more appendicitis stories - maybe I’ll turn this into Appendicitis Central after all.
First up, what happened to an American friend of Michael Jennings at the hands of the NHS. Once again, they missed it and by the time they got to it they had to hack quite a lot of his gut away meaning that for quite some time afterwards there were only certain types of food he could eat. That pretty much put him off the idea of socialised medicine.
Secondly, what happened to a friend of Samizdata’s Philip Chaston. This was in some out-of-the-way place in Italy. They couldn’t speak a word of English but, yet, everything went fine.
Finally, what happened to our host, Christian Michel, in France. It was near Christmas, and (I guess) about 40 years ago (Christian was 16 at the time). Nobody wanted to operate but by Christmas Eve they had no choice. The operation itself was unremarkable. But when Christian came round it was midnight mass - all smells, bells and wafers. In his drugged up state it took him a full 30 minutes before he realised that he was in fact still alive.
Anyway, if I am going to take this Appendicitis Central thing seriously I may as well do it badly and completely unscientifically. So, have you, or do you know anyone who has had their appendix out? I am particularly interested to hear from people who had their operations in the US or other exotic locations. I would also be interested to hear from anyone who has a “good” appendectomy on the NHS (there’s got to be one).
The score so far:
UK: 0 good, 2 bad
Japan: 1 good, 0 bad
France: 2 good, 0 bad
Italy: 1 good, 0 bad
Update I knew there had to one (good NHS appendectomy - see comments). Seems rather similar to my own. I also have a pretty large scar (two actually), so it looks like keyhole surgery isn’t being practised everywhere. So, the updated table reads:
UK: 1 good, 2 bad
Japan: 1 good, 0 bad
France: 2 good, 0 bad
Italy: 1 good, 0 bad
...here is a brief summary of what Jackie’s boyfriend, Antoine, told me (or, at least, what I think he told me) last night about what happened when he got appendicitis way back in 1985.
After spending ten hours waiting in Hampstead’s Royal Free Hospital’s casualty department he got to see someone. It then took three doctors (one of whom got it wrong) for him to be diagnosed with appendicitis after which he had to wait another 12 hours for an operation by which time his appendix had burst. He then spent another month in hospital recovering.
Boy, am I glad I got ill in Japan.
I went through my treatment in complete ignorance of Japan’s healthcare system. Since then I’ve done a bit of research. This is what I have been able to glean:
- There is a mixture of public and private provision. They all charge (in the first instance) full whack
- Health insurance is compulsory and must be purchased either from the government or through one’s employer. And it only covers about 70% of the cost. In the Ishikawas‘ case it is only 35%. Their employer pays the other 35%. The insurance costs themselves (according to the Ishikawas) are crippling. This is because it is not proper insurance. It is more of a Pay As You Go system like our beloved state pensions. And like our state pensions they are paying for the older generation.
- It takes twice as long to get discharged in Japan as it does in the West. I can vouch for this. At almost exactly the same age as I am now my father also went down with appendicitis though this time it was in France (we Croziers don’t do anything the easy way). He was out in four days: I was out in eight.
- Japanese doctors have a reputation for haughtiness - you know, not listening to the patient, not telling him what is going on, having a poor bedside manner etc. This was not my experience.
- The system is (apparently) starting to creak. On the one hand, Japan has an aging population which means the bills keep going up. On the other, because it is paying the bills, the government won’t pay for some of the more modern treatments. Remind you of anything?
Last week I discovered that untreated appendicitis does not always lead to a burst appendix, peritonitis and death. Apparently, it sometimes goes away.
This is important because this may have been what happened to me back in April. I think this because the symptoms (stomach cramps, vomiting, fever) were almost identical to those I had in Tokyo, although they came along in a slightly different order. They were even the same down to the stomach cramps being across my stomach rather than being on the right-hand side as they “should” have been.
On both occasions I ended up in an ambulance. Over here, on arrival in hospital, they took a fairly cursory look at me (blood test, if that, I can’t quite remember) reckoned I just had constipation and sent me on my way. Now, no one knows for sure what I had first time around (though it definitely wasn’t constipation), and I do have an axe to grind (if it were up to me I would abolish the NHS tomorrow), but by comparison to what happened in Tokyo the NHS’s performance doesn’t look good.
Staff at the Urayasu Ichikawa Community Hospital. The bloke on the centre-right saved my life
In Tokyo, on arrival at hospital (in the early hours of Sunday morning) I was given a blood test and an X-Ray. The doctor reckoned (in excellent English) that if I was lucky it was colitis but it was probably appendicitis. He couldn’t operate there so he sent me to a second hospital. The second doctor, looked at me with ultra-sound, showing me the display. I couldn’t see a sausage. He could see a dead-cert appendicitis. He explained that although they could do operations at the second hospital they couldn’t do emergency operations. I would have to move yet again.
By this time, I was getting rather used to travel by Japanese ambulance. They seemed to have pretty much the same equipment as in London even down to that annoying clothes peg thing they attach to your finger to take your pulse. The only difference was that it was a bit more pristine. Oh, and for some reason, despite it being the middle of the night and the roads being empty, they had the siren on the whole time.
At the third hospital, they gave me another blood test, another X-Ray and a CT scan. I wasn’t quite sure why they were doing this when the second doctor had been so adamant but the answer came back the same. The doctor, Dr Kitasato, explained what he was going to do to me and gave me some sign-your-life-away forms for signature. By this stage I had spent about 7 hours in the company of Japan’s health services which seemed rather leisurely to me.
And then, a general anaesthetic, of which I remember not a thing.
I came round in what they called “High Care” (= high-dependency care?) after which I drifted in and out of sleep. I can’t remember all that much about it other than being given periodic doses of “pain-control medicine”. I must have slept a lot because I was very surprised when they wished me a good morning on the Monday.
I was taken to a normal ward later that day.
So, what was the care like? Obviously, it is difficult for me to say, I am not a health professional and the only comment I have had so far from a health care professional is that the scars were in an unusual place. So, I can only judge on superficialities. Not that I think that superficialities are unimportant - I think they can tell you rather a lot about the general health of an organisation.
The building itself was about 25 years old. It had the sort of wear and tear you would expect over that time but everything seemed to be reasonably well-maintained although the automatic talking urine sample collector had clearly seen better days.
Unlike the NHS signs were on sign boards and notices were on notice boards. I mean, really, every time I wander into an NHS building there are hastily cobbled together notices strewn all over the place. You don’t get that in Tescos.
Oh, and it had spare beds.
People of Britain: this is what spare beds look like
The nurses were fantastic. Well-turned out, charming, efficient, responsive, (dare I say it) pretty. Every time they managed to hurt me (not difficult, given the two tubes going into and three tubes coming out of me) they would always offer a strong apology. Totally unnecessary, of course, but it all added up.
The routine rarely wavered. The cleaner, the checks, the dressing changes, the ghastly brown tea and the meals always turned up at the same time every day.
Mind you, I may have been getting some special treatment. As one nurse explained to me: “Mr Patrick, we are really into you.” Yup, I had become the David Beckham of the Fifth Floor.
The meals themselves were pretty unexciting but then Japanese food on the whole is pretty unexciting. But there was more food than I could eat and the meals were always served nice and hot.
I got the impression that the doctors had a plan and that I was expected to follow it. Therefore, I did get to my feet on the Monday, the drip did disappear on the Wednesday and the stitches were removed on the Sunday. I reckon they probably kept me in about a day longer than strictly necessary.
It was not quite faultless though my only serious criticism was with the filthy drip stand.
Oh, and the bill? Well, if my insurers get any change out of £4,000 they’ll be doing well.
Update 11/01/06 A warm welcome to Grand Rounds readers
A few years ago I was sitting on the platform at Chippenham railway station minding my own business when a petite Japanese woman approached me to ask where the second-class carriages would pull up. I explained as best I could that the likelihood was that she was in the right place but with our trains almost anything could happen.
She sat down on the next bench which was an invitation even I couldn’t ignore to try out my recently-acquired Japanese language skills. I said: “Nihonjin desu ka” which means “Are you Japanese?” She reacted by leaping about three foot in the air. I guess she wasn’t expecting to be spoken to in her native language. When she recovered from the shock we got talking. Akiko Ishikawa and I have been in contact ever since.
To say I was glad of our friendship when I fell ill is (my) understatement of the year. Although, I tried to keep a stiff upper lip about things eventually even I could see I was going to need help. Akiko then phoned for the ambulance, acted as translator between me and the ambulancemen and nurses, bought all sorts of supplies, lent me her phone so I could phone home, “persuaded” the nurses that a shampoo and blow dry are in fact right up there with dressing wounds and taking blood pressure readings, got her husband to clear out my hotel room, booked me a new hotel when I was discharged, (quite rightly) bullied me into looking after myself and did a hundred other things many of which I can only guess at. I am not sure if I should mention this or not but she even (in the first instance) paid the (not insubstantial) bill.
And every time I said “thank you”, which was a lot, she just replied: “It is my pleasure.” (Bet it wasn’t.)
I do not know (as in, I really don’t know) what I would have done without her and Kazuhiro.
So, Mr and Mrs Ishikawa, I thank you again. I just wish I had the words that could express how desperately grateful I really am.
Tokyo: as I saw it
The plan was simple enough: go to Tokyo, take a shufti, come back. Unfortunately, at about the same time as I had been planning to take a leaf out of the Michael Jennings Book of Gratuitous Offence I was instead lying on a hospital trolley listening to a doctor explaining to me how he was going to whip out my appendix.
Not that I was worried. I was in far too much pain for that. Nor should I have been. Let’s face it, when it comes to slicing open bellies the Japanese are the universally-acknowledged experts.