Last week my blogging consœur Victoria Ferauge—a fellow longtime American resident of France—published a post on her fine blog of an experience she recently had with the emergency room of a French hospital, and in which she made some comparisons between the French and American health care systems. As it happens, I also had an experience with the ER recently, my first ever in France (and only the second in my life, the last in the mid 1980s). Exactly three weeks ago, during the season’s first major snowfall in Paris, I was walking home in the early evening carrying groceries, slipped on the very slippery sidewalk, and fell, and with my foot twisting around in the process. I was in great pain, it was dark, and there was no one around. Fortunately a couple of good Samaritans did see me and came to help. My apartment building was within sight and my wife was fortunately home, so she came with a neighbor to meet me. As I couldn’t walk—I had badly messed up my ankle—, the snow was falling heavily, and I clearly needed to get to a hospital, she called the SAMU. Within fifteen minutes or so an ambulance van of the sapeurs-pompiers (fire brigade) arrived and took me to the ER of a nearby hospital. While in the van a fireman asked for an ID card so he could fill out a form. At the ER the firemen waited with me until a member of the hospital staff came to take charge. They were nice, helpful, and, not surprisingly, professional.
I thought I’d be in the ER for several hours but was tended to fairly quickly, even though the place was full. The X-ray of the ankle showed a fracture, so it had to be put in a cast. The doctor (from the Congo-Kinshasa; hospitals in France would have significant personnel shortages were it not for immigrant staff) wrote prescriptions for paracetamol (which is sold over the counter but if one has a prescription it’s covered by insurance), five weeks worth of anticoagulant injections to be administered daily, and crutches (cannes anglaises). He also gave me the number of a private clinic around the corner from my place and told me to schedule an appointment with an orthopedic specialist there ASAP. I was then told I could go home. There was no discharge process and no one asked for insurance information. The fireman no doubt gave the hospital a copy of the form that had been filled out in the van, but all that contained was my name, address, and DoB. My wife, who doesn’t drive, was fortunately able to get friends who live nearby to traverse the snow-covered streets and and pick me up. I was in and out of the hospital in two-and-a-half hours.
As the temperature remained below freezing for several days I couldn’t venture outside on the icy sidewalks, so the appointment with the orthopedist at the clinic didn’t happen until eight days after the accident. He said more X-rays would have to be taken to determine the seriousness of the injury. The new X-rays indeed showed the injury to be worse than that what the original had indicated, thus necessitating an urgent surgical intervention. So the operation took place and I spent two not particularly pleasant nights in the clinic (it was only the second overnight hospital stay of my life, the previous one 38½ years ago, following an operation on the very same ankle, injured while playing basketball). I was discharged a week ago today and with a new cast on. As this was a private clinic there was paperwork and for which my Carte Vitale and carte de mutuelle were needed. Had I not had these—i.e. if I weren’t covered by the Sécu (which everyone legally living in France is) and didn’t have a mutuelle (which 90+% of the population does)—, I would have received a sizable bill from the clinic. But I won’t be receiving any such bill. I did have to write checks to the orthopedist and anesthesiologist for a total of €180 but some or most of this will be reimbursed by the Sécu and mutuelle after I submit the feuille de soins (my doctors are in private practice—though are conventionné, i.e. registered with the Sécu—and basically set their own fees). As for the prescriptions, the only one so far for which money has had to be forked over was the crutches (€29). The registered nurse who comes daily to administer the anticoagulant shots and take twice-weekly blood tests—a team of three infirmières à domicile, who work out of a neighborhood paramedical clinic that does house calls—is also conventionné, though I’ll have a write a check of around €100 for the service when the process is finished (though that should be mostly or entirely reimbursed by my mutuelle).
So now I find myself at home and with a cast on my lower right leg for another five weeks to go, and with instructions from the doctor not to put any pressure on the leg (i.e. absolutely not to walk on the cast, even lightly). Which, in effect, means that I cannot go outside until I see the doctor again in mid-March. I suppose I could try but I doubt I’d get very far walking on two crutches outside (getting down the four flights of stairs in my building would be tough enough and my wife wouldn’t allow it anyway). I have a prescription to rent a wheelchair—which can be done from selected pharmacies—in case I really need to go out, but haven’t yet done so. So I get around the apartment on the crutches but that’s it. In terms of work, I have an arrêt de travail—which would enable me to receive 100% sick pay—but as I teach university-level courses I didn’t want to invoke it. So I have arranged to teach my classes via Skype, which is working okay so far. It’s not perfect and there are occasional technical glitches but it’s the only solution I have. Thank God for technology.
Being housebound, semi-crippled, and unable to do much of anything apart from sit at my computer, read, or watch TV—I can manage in the kitchen but can’t do any real cooking, and can’t carry anything that won’t go in a backpack—is a bummer but I’m not feeling sorry for myself. Far worse things have happened to many people in the course of human history, including friends of mine and close family members. And it’s only for a few weeks. I think about the good fortune I have had in this happening to me close to home and as a citizen of a rich country with national health insurance. I’ve been thinking about such an injury happening to, e.g., a poor person in a poor country, to a Syrian refugee in a freezing camp in Jordan, or to someone in America without health insurance (and even with insurance, of the deductibles and other fees into the four figures, maybe even more; an American friend here joked that the ambulance in the US would have probably asked for my credit card rather than ID). But, above all, I think of the good fortune I have in having my wife and daughter (age 19). I don’t know what I would do without my family right now. My condition imposes burdens on them but they’re responding with good cheer. I would really be up the creek if I lived alone and didn’t have family nearby. I would dread the prospect of living alone at my age whatever the case, but a debilitating injury or medical condition adds an additional dimension to such a prospect. So, yes, I think my fortune is pretty good.
On comparing the French and American health care systems, my mother (age 82) wrote an account of an experience she had some four years ago when she came to visit me, and that was published as a guest post on the blog of a health policy specialist at Duke University.