Thursday, 13 April 2017

Adventures in UK Healthcare, Part I

One of Durham's many hills -- with a
good-looking man halfway up it!
This winter, as I looked ahead to a major surgery in March, my primary fears weren’t so much about my health. No: when I woke at night, in the weeks leading up to my abdominal hysterectomy on March 22, it wasn’t to worry over that surgery’s outcome. For one thing, I felt very healthy and strong. I was walking a minimum of 3 miles a day (up and down Durham’s hills!) and taking fairly rigorous yoga classes 5 times a week. For another, my doctor had said that he thought the recent developments in my uterus—a thickened uterine lining, and a fibroid that had grown exponentially over the previous 6 months—were a direct result of taking Tamoxifen daily, as I have done and will continue to do in this decade following my incidence of breast cancer in 2014. My doctor had made me feel pretty secure that these new developments, while ultimately not good for my body (otherwise, why have this surgery at all?) did not signify cancer again. And that was the main thing for me.

August 2014 -- day after my double mastectomy,
in Chicago.
Nor was I very anxious about the surgery itself—though it would involve a 6-inch vertical incision from my navel to my pubic bone and would probably last 4 to 5 hours. This sounds kind of major, I know, but so does a double mastectomy, right? And I’d already had that adventure in 2014, in Chicago, the last year that Dave and I lived there. Based on my recent history, I felt confident that I’d come through my new surgery without complications and would bounce back to normal quite quickly. (Which, by the way and praise Jesus, has turned out to be true.)

This winter and spring, my fears turned instead on how my days in the hospital, after my operation, would be. I had reason to believe that my experience of major surgery in the UK would be quite different from the one I’d had 2.5 years ago in the US.

To begin with, my doctor here seemed to think I’d need to stay in the hospital for 5 or 6 days. I could not imagine what for. In the US, after my double mastectomy, I’d been released within 24 hours. I’d been proud of, and pleased by, this fact. Going home as soon as I could seemed the natural and preferable option – and after all, it’s common practice in the US, because of the extremely high insurance costs for a hospital stay. In the UK, however, doctors feel far less pressure to get patients back out on the street. So this time around, I was looking at close to a week in the hospital recovery ward.

University Hospital of North Durham: my
local hospital here in the UK
Not only that, but it sounded like I would not have much privacy, either, during this insanely long stay. My English friends warned me about it. No one in an NHS hospital, they claimed, ever got a private room, unless they were highly contagious. I should expect to spend my recovery days in large open ward, with 5 or 10 or maybe 20 beds all in one room. To make matters worse, I wouldn’t have much of Dave’s company; he wouldn’t be allowed on the ward except for two separate visiting hours. Here in the Durham hospital, Dave could visit from 2:00 to 3:00 PM and from 6:00 to 7:00 PM. Otherwise, I would be on my own – or as much on my own as a person can be on her own, when sharing a room with 9 or 10 others.

“That’s just how it is here,” one of my English friends said. “As the patient, you’ll be looked after well, but friends and family don’t get much attention. It's just an attitude handed down from the 1950s, when the doctors and nurses knew best and the family had busy lives to be getting on with (down t'pit or similar)[i], and this attitude hasn't really left us.”

Coal miners of County Durham, 1940s
None of these prospects – the long hospital stay, the ward full of beds, the short visiting hours – filled me with joy. In fact, they filled me with dread. (Hence the waking up in the wee hours, those first weeks of March.) Could my English friends have been exaggerating? It was a tempting thought. Based on my previous visits to the Durham hospital, though, I had reason to believe my English friends weren’t shitting me. In many ways, the UK healthcare system is much more hardcore than what I knew in the US. And since they are the people who’ve interacted with this system all of their lives, the citizens of England—I’ve now come to think—are somewhat more hardcore, too.

During some medical errands preparatory to my surgery, I got my first glimpse of these rather more hardcore ways. The MRI that I had here in England was done in the back of a truck. Yes, a truck. A truck which is driven around the North East, from one medical center to another. At about the same time I also had a D & C, a procedure which I’d had once before in the US and for which I had to be admitted to the hospital, given twilight anesthesia, and taken into the operating room. Here in the UK, a doctor performed the D & C on me right there in her exam room, with no anesthesia at all – on an examining table that didn’t even have stirrups. It hurt like a mother, and lent a whole new level to my understanding of the British stiff upper lip. On the other hand, the whole thing was over in maybe 10 minutes -- and gave me a real opportunity to practice my yogic breathing.

Based on these two examples alone, I’d say that the UK healthcare system is absolutely about doing what needs to be done for the patient, but doing it efficiently. With a degree or two less physical comfort – or luxury? – than what we’re accustomed to in the US. The most obvious reason for this, I think, is that US hospitals know the patient is shelling out major bucks for her healthcare -- or her insurance company is. In US medical centers, then, there's an element of wanting the patient to feel more like a customer: like she's getting her money's worth, so to speak. Getting the full-service treatment.

In the UK, meanwhile, that just isn't much of a concern. If you're a tax-paying resident of this nation, you'll get your healthcare: you know this. (And you will get it for free.) But no one on the medical staff is necessarily out to impress you. As far as I can tell, and rightly so under these circumstances, they don't see that as part of their job.

Speaking of which, let’s just think for a minute about hospital d├ęcor. It may sound like a trivial aspect, but the variance between the amount of money spent on hospital facilities in the US and in the UK is so striking – so vast – it seems a reflection of somewhat different priorities, too.

One tiny corner of the hospital lobby
in Chicago.
My hospital in the US, in Chicago, was a thing of undeniable beauty. You entered a marble-floored lobby with a 3-story-tall ceiling and a waterfall – a real waterfall – crashing down all 3 stories into a marble-lined pool. Ornate arrangements of fresh-cut flowers rose up from every reception desk corner, and as you walked beneath gleaming skylights toward the twin escalators, you passed A) an ebony player grand piano, and B) a huge free-standing fireplace with leather armchairs drawn up around it.

In the US hospital where I was treated, the waiting room for a patient’s loved ones was similarly well equipped : more leather arm chairs, more fresh flowers. Plenty of electric outlets for people’s laptops, and a free Wifi connection. Large video monitors, placed in the waiting room walls, allowed people there to keep track of their loved one’s progress; during my mastectomy, Dave could see when I was in pre op; in surgery; in post op. When my operation was over, the surgeon came to that waiting room to tell Dave about how it went. And then – oh glory of glories – Dave could walk up the hall and be with me, just as soon as I’d woken up.  

My hospital here in the UK is significantly less glamorous. Inside its walls, there’s not a flower in sight. No high ceilings, no marble floors. To say nothing of waterfalls or grand pianos. In the exam rooms, the sinks are often just that – little sinks, stuck onto walls, with the plumbing beneath fully exposed. Throughout the building, the hospital windows can be opened wide – and usually are, no matter the season[ii]. The color scheme is all mauves and pale turquoises that remind me of the 1980s, and chairs are in short supply. What chairs you do find are hard plastic, and the waiting rooms themselves are miniscule, Spartan – because no one there really wants the patient’s family and friends to spend their time waiting around.

In February, when we went up to the hospital for my pre-surgery consultation, Dave asked a staff member about this. Where would he wait while I was being operated on?

The nurse practitioner running our consultation seemed a little nonplussed. “We don’t really have a room for that,” she said. “If you want to be near the hospital, though, there’s a coffee shop down the street.”

Dave has stuck right by my side
through all the health adventures
of the past several years.
(Here we are in summer 2014.)
So then it was our turn to look taken aback. “But how will I know when Patricia’s out of surgery?” Dave asked.

“Well, there’s a phone number you can call, after a certain number of hours.”

“A phone number,” Dave repeated. “Okay.” When the nurse practitioner just barely nodded, he said, “How do I get this phone number?”

The woman sighed. Maybe she’d had a long day. Maybe she had cause to think that Dave and I were ridiculously spoiled. “Listen,” she said, “we don’t cater to you like you may have been used to, in the States.”

Having come out on the other side of this experience, I can say that this woman – I see her now, in her tidy blue dress, her little cap of brilliant red hair – was by far the least pleasant person with whom I interacted during my whole hospital stay. I can also say that, in her claim about the UK health system not “catering” to us, she was both right and not right.

Part of my new scar!
April 2017.
In a similar manner, my time of recovery in a UK hospital was both like and not like what I’d feared.  I had a memorable 5 days. Uncomfortable, yes, in some ways. But almost delightful, in others. In my next blog post, 2 weeks from now, I’ll write about those 5 days.  

For now, though, what can I say except that I had a major surgery, 3 weeks ago, and am now almost fully recovered? The surgeons at the Durham hospital removed my cervix, and my ovaries and fallopian tubes; they removed my uterus and the 1.5-pound (yes, holy lord) fibroid. After that, they did some “washings” of my abdominal area to test for abnormal cells. All the pathology came back normal, thank God, and that six-inch long vertical cut in my belly is starting to heal up quite nicely.

I am grateful for the good care I received. I am awed that, like every tax-paying resident of the UK, I received all this healthcare for free.[iii]

A little post-yoga-class
excitement! Today.
And I’m amazed by the body’s recuperative powers. Today I did my first one-hour yoga class since my surgery! It made me so happy, I was almost in tears by the end. It’s so good to know that, even after the trauma it’s recently been through, my body is still here for me.

[i] Meaning “down into the coal pit.” County Durham was a major coal-mining area of the UK in the previous century.
[ii] Hospitals in the US, like most US hotels, have windows that are sealed tightly shut.
[iii] For more on this topic, see my previous blog post, “A Tale of Two Healthcare Systems.”


  1. This is good to here your perspective before and after. Thanks for sharing !!
    Love ,

  2. Replies
    1. Hello, Waldino! Technically, it was a fibroid, not a cyst, but I totally agree: It was giant. Very pleased to have it OUT of me.

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