The Doctor Is In

Since coming to Spain in 2001, I’ve been fortunate to enjoy good health, the only problems being those typical of my age – a rise in cholesterol and a rise in blood pressure.  In spite of my overall good health, I’ve had to call for an ambulance three times.  The first was in Barcelona and the second two times were here.  In none of the cases did the problem turn out to be a serious one, and that first time it was in fact something quite mundane and frankly, too embarrassing to go into.

Last spring I went for a mammogram -- the first time in a couple of years.  I didn’t make the appointment for this exam.  I had received a letter in the mail telling me that from the age of 50 to age 69, all women should have a mamografia done every two years and that would I please be punctual and show up wearing clothing that was easy to remove and wear no deodorant or talcum powder.  My appointment was scheduled for Monday 4 April at 18:48.  This free service was brought to me (and all women aged 50-69) by The Program for the Detection of Breast Cancer of the Catalan Health Service, i.e., government-run health care.

On the appointed day I drove to the Hospital de Tortosa Verge de la Cinta in Eve’s car that she generously let me borrow, mine still being at the mechanic’s waiting to have the vroom, vroom problem repaired.  (Although it took months, that surging problem was finally repaired to the tune of 1500 euros.)  I arrived early which I always choose as the alternative to pushing it and possibly arriving late, even though with my Spanish driver’s license, I can probably speed a fair amount with impunity.  The Catalans are generous with their provision of free health care, but if you come late for an appointment and miss your turn, they sometimes make you go through the arrangements for making another one.  Anyway, it isn’t polite to be late.

Tortosa is not my favorite city.  Although the largest river in Spain runs through it, it has very little of any riverside amenities and overall is rather rundown and drab.  But it does have its points, which include a few renaissance and modernist buildings and what was a Moorish castle on an overlooking hill, now a (Spanish) government-run Parador.  The hospital sits on the next hill, and so from there, you have a lovely view of the tiled roofs of Tortosa and La Suda, the castle plus what remains of the old defense walls of the city.  On a clear day, you can see the whole valley across to the mountains of Els Ports.

I passed my health card at the sensor – all that is required to sign-in for appointments with doctors and technicians – and took a seat in the center of the x-ray waiting room, in one of several banks of individual seats.  I was followed in by two women, one who took a seat against the wall and the other who remained standing at the opposite wall.  The span between them was the width of the room, but neither that, nor the signs posted asking people to maintain silence, prevented them from pursuing their conversation at full volume, making it impossible for me to read the book I had brought with me.  “Maribel has died, did you know?” asked the one who was standing.  There was some animated conversation as to who Maribel might be, but when it finally became clear, the seated woman realized that no, she hadn’t known that Maribel had died.  And she was only about 60.  Smiling throughout their conversation (which I thought a bit odd, given the topic), when they had finished, the seated woman’s face fell into a frown.  With the frown came silence.  And soon after I was called in.

There is little or no room for modesty in Spanish medical offices.  You tend not to have a private place to remove your clothes, and sometimes you remain with nothing to cover yourself once you are disrobed.  Other times you are examined half dressed (or half undressed, depending on how you want to look at it) which is even more weird than being naked.  But this wasn’t my first time, and I’m getting used to it.  Or at least I know what to expect.  Besides, I was alone with the technician – a young woman – with the door to the waiting room locked.  So I took off my clothes from the waist up and then proceeded to stand there giving the technician my information, date of last mammogram, change of address, things like that.  The mammogram (there are actually four shots taken) took a very short time (and didn’t hurt), the technician checked to make sure the images were viable, and then told me I could get dressed and go.  They would send me a letter with the results.  I don’t know how long the whole thing took, but my appointment had been for 18:48 and I was outside walking on the street back to my car before 19:00.

This week I went for a gynecological exam/pap smear.  This exam was also in Tortosa but at the clinic below rather than the hospital above, and the clinic is so ugly it doesn’t warrant a photo.  They say you should have a pap smear every three years.  Here the examining room was separate from the doctor’s office, but they didn’t ask me to take off my clothes – just remove my underpants.  I was wearing a dress.  The nurse said just to hike it up.

The exam went the same as these always do, but with the addition of a sonogram at the end.  That was a surprise and I don’t know if they only do that for older women or if it is standard procedure; it wasn’t standard procedure all the other years of my life.

I thought since I was left wearing my dress and bra that the doctor was not going to do the breast exam, but he did.  The nurse wanted me to hike my dress even further up but I found it preferable to remove it.

This appointment had been scheduled for 9:45 am, and I had arrived a few minutes early, taking a book with me because when you go to see a specialist, you never know how long you might have to wait.  By 10 am I was dressed and walking on the street back to my car, albeit that my freshly ironed linen dress had become a crumpled mess from having been scrunched.

Neither this exam nor the mammogram, nor the three calls for the ambulance cost me anything.  I simply don’t understand why so many Americans react with panic when the idea of national health care comes up.  I think it’s super.

Any thoughts?  Leave a comment below!

Peas!

On Tuesday 27 April, I put on shorts for the first time this year, intending to go out, enjoy the sun, and start on my summer tan. Giving myself a look over in the full length mirror, I noticed a good-size lump on the back of my right leg, at the back of my knee joint. When I turned a little to get a better look, I saw an even bigger one on the back of my left knee. I felt them and they were hard -- hard and ugly. You might ask, how could something grow that big without my knowing about it. All I can say is, God only knows. I never noticed the lumps all winter, maybe because I only look in the mirror after I’m dressed. The lumps don’t hurt, and the slight stiffness that I feel in my left knee I figured was just part of aging. It’s not nearly as stiff as what I feel in my lower back most mornings.


But lumps don’t count as part of aging, so I called for a doctor’s appointment and got one for the Friday of that same week. My doctor told me they were not bone cancer (my original worry), only cysts. I have had small cysts on my head several times in the last twenty years – the one I have now is the fourth. The first three I had removed; but for this fourth one, the dermatologist here prescribed two creams to apply each day and after a while it became smaller and has stayed the same now for over two years, so I just leave it alone. When it comes to my body, if it ain’t truly broke, I don’t mess with it.

However, the doctor said the ones on my knees would probably just continue to grow indefinitely so she authorized for me to go see a specialist – a surgeon – in Tortosa. I was given an appointment for the following Tuesday.

I am a great chicken when it comes to illness, pain, and almost any kind of medical procedure, with surgery being at the top of the list for what to avoid at all costs. But I did a good job of not worrying too much. Since Doctor Nadal had assured me that they weren’t bone cancer, I figured this wouldn’t be much worse than the surgeries I’ve had on the small cysts. Grow up Dvora; it isn’t enough to lose sleep over

In my village the health service has a small building where the regular GPs and pediatricians work, where you can go in case of an emergency 24 hours a day, and where the ambulance is stationed. But specialists are housed in larger clinics and the nearest one to us is in Tortosa.

Tortosa is our closest city and the capital of the comarca (like a county) of the Baix Ebre (lower Ebre). It is a small city of about 31,000 people, and sits on the Ebre River. Originally Roman, it was conquered by the Muslims in the 8th century and remained under Muslim rule for over 400 years. The castle overlooking the city (now a government-run Parador) was built by the Muslims in the 10th century on the site of an old Roman acropolis. Tortosa was later conquered by Ramon Berenguer IV, Count of Barcelona, in 1148 as part of the Second Crusade.

The cathedral was started in 1347 and took 250 years to build. They say it was completed in 1597, but in fact, I have never seen it without scaffolding and construction netting. The church of Sant Domènec, built in the 16th century, has sculptures on the facade that were all beheaded by gunshot during the Spanish Civil War. One of the most colorful buildings is the old Escorxador (slaughter house), designed in 1905 in the modernist style. It is made of brickwork and ceramics and is reminiscent of the Mudejar architectural style. The biggest battle of the Civil War – the Battle of the Ebro – took place in this area and Tortosa still shows many scars from that time. Although a comarcal capital, Tortosa has many ruins and derelict buildings in its old town, gives the overall impression of being shabby, and seems to be a somewhat forgotten and abandoned part of Catalunya.

But this wasn’t a sightseeing trip. The Tortosa surgeon said that I had Baker’s cysts, but because there were two of them – twins -- he thought I should be seen by a traumatòleg (an injury surgeon) who would probably do an eco- or sonogram, to check on any underlying problem with the joint. This was not good news as far as I was concerned, and I went down to the window to get the appointment with the traumatòleg. They gave me one for the following Monday.

Now I did start to worry about having surgery, not just on one knee, but on both and not just because of a little fat-filled cyst but something more complicated. Would they do both at the same time? How would I get around? My bathroom is on a half landing, how would I get to it? My bedroom is upstairs. Would I be able to bend over to feed the cats and clean kitty poop from their boxes? Would I be in a wheelchair for the rest of my life? I really should not be turned loose with my own thoughts when an illness or health issue looms.

That Monday, the wait for the traumatòleg was over an hour. These doctors are public health service employees and don’t have a say in how many people get scheduled in. Some people went in and out quickly and others took longer. Frankly, I was happy that she (as it turned out) was giving everyone who came the time and attention they needed. Keep in mind that none of these doctor and specialist appointments were costing me a penny. When my turn came, I explained my problem briefly (in Catalan – all my conversations with medical personnel are in Catalan), she had my record already on her computer screen, and she proceeded to examine me.

The traumatòleg confirmed that these were Baker’s cysts, and that they were probably the result of sitting a lot. She would authorize an ecogram to take a better look but she didn’t think surgery would be necessary. I was so relieved I kissed her. No surgery, no drugs, no creams. I could treat them myself. But I couldn’t quite understand what she was telling me to do twice a day for twenty minutes. Put something against the cysts? Had I heard right? I didn’t even need to go to a pharmacy. I just needed to go to a grocery store and buy two bags of frozen peas!