Having Surgery in Germany

 

I am not a stranger to medical situations in Germany. Which means I’m not a stranger to medical situations period and I generally feel comfortable with my necessary levels of medical care. I’ve been to multiple types of doctors now, from the regular dental visits, trips to the general practitioner (Hausartzt) for traditional springtime sinus infection antibiotics and a specialist for my medical condition. “Going to the Doctor in Germany” deserves a post on its own, so this is specifically about my surgical experience, general observations I think apply to everyone and what I’ve learned about “relaxing” without painkillers.

 

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The Perfect Cup of Tea

 

 

 


Background

I have endometriosis (Endometriose auf Deutsch)I’ve probably had it for well over 15 years now but it wasn’t until 6 years ago that I found a practice and doctor who knew how to treat it. At that point, it had gotten pretty serious, was affecting my quality of life and had begun to cause other chronic medical problems. This isn’t the platform I wish to talk about it in detail, but I think it’s important to note that I take the symptoms and life style changes seriously, and I was not interested in starting the process of diagnosis and treatment from the beginning all over again in a foreign country, especially since by the time I moved here I was in a good, healthy place and mostly in maintenance mode. I already knew how bad the disease could get so a top priority was making sure I had access to medical care when needed.

As you can probably guess, I recently needed medical attention once more, which is excellent story and blog material. This past fall my doctor determined it was time to intervene surgically as the medical options we were using were no longer as effective. He assured me the hospital he was associated with in town had a surgical wing and care clinic dedicated to women’s health and that he had worked with all the doctors before. Reassurances aside, I was concerned. I am champion at picturing everything which can go wrong so I started doing this before I’d even left the office. Even though my doctor is fluent in English, that doesn’t mean all doctors are. In fact, in my past experience, it’s been hit or miss, especially among medical support staff.

 

 


Medical Care

First things first: endometriosis is treated by a gynecologist and therefore some of this will make sense to the ladies who are reading and some of the men may be confused. Therefore I’m trying to write “down the middle” to make this accessible to everyone.

At the gynecologist in the states, one signs in at reception, probably pays a co-pay at the same time, waits in the waiting area with lots of other ladies, goes back when called and blood pressure, temperature, weight and other basic medical notes are taken by the nurse. Then the nurse gives the patient a gown and a paper blanket, patient changes, then doctor and nurse come in for the exam.

In Germany, check-in is the same minus the co-pays, but then whether or not vitals are taken seems to differ. I’ve only had mine taken once or twice in the almost three years I’ve been a patient in this practice.

However, patients are not given gowns or even paper blankets. This was confusing the first time I was told to get undressed and I couldn’t find anything for a bit of privacy. In fact, in most doctor’s offices the doctor’s desk is generally in the exam room so in this case, my doctor was doing some paperwork while I stood awkwardly in the corner behind a screen, wondering when my paper decency sheet was going to appear. Which, it never did and in the future, after talking with girlfriends here, I will be bringing one of Z’s button downs with me for some decency.

Once surgery was decided upon with my doctor, the next step is the consult with the specialist at the hospital. Personally I think this is the part of socialized medicine which gets over-hyped and a bad rap. Yes, I did wait for a month and a half for the appointment, but I’ve also had similar waiting times for even just a checkup in the US. I’m not sure where the stories of endless waiting periods and the inability to see a specialist in overloaded social systems comes from, because I haven’t experienced it, nor has anyone with ongoing treatments that I know of experienced it either. To get to the specialist, you need the Überweisung from the Hausarzt (or whomever is referring you on) first, otherwise you might be refused service or you might have to pay in full if you go without. The überweisung looks like a SEPA überweisung you might get at the bank. In the states, when getting specialist referrals, they’re usually done electronically (in my experience) as soon as the appointment is made. Therefore, don’t forget to take this paper with you in Germany.

Note: to see a GYN, Dentist, or a Pediatrician, a referral (Überweisung) is normally not necessary. You also most certainly do not need one if it’s an emergency and you need treatment immediately.

At the surgery consult, I was given a similar battery of tests including ultrasounds, blood draws and an overall exam. I gave a list of symptoms, described what had been done in the past, and it was agreed upon that I should schedule surgery. I was shown to the next room to see the surgery coordinator. I gave her the slip from the doctor explaining what surgery was to be performed, and then she gave me the earliest possible dates. Again, the soonest I could be seen was not right away, it was in fact three months later, but I was not in any life threatening circumstances, symptoms would be manageable for three months, I saw no reason to be upset at waiting.

The date was decided upon and I was given an info sheet which had the surgery date and the pre-surgery checkup date and time (the day before surgery, in the morning).

 

 


Pre Surgery

I really wish I had read that sheet sooner than the week before surgery. The pre-surgery checkup was scheduled at 9:00 and due to last until 16:00. I had told work I would just be an hour late to work that morning, and now I would be potentially out an entire day more than expected. What on earth could take all day for a checkup?

 

Turns out, it was only 4 hours, BUT STILL. I had to do:

  1. another exam (with 4 different doctors)
  2. a lung test (I think this was forgotten, because I didn’t actually do it though I was scheduled to)
  3. blood testing
  4. pregnancy test
  5. vitals
  6. consult with the head of the women’s clinic
  7. consult with the head of anaesthesia

This honestly felt like a waste of time. The lung test, I’ve heard, seems especially dumb but is normally required to make sure your body can handle the ventilator while under general anaesthesia. I have been given general multiple times now and never had anyone care about my lungs (or if they did, it wasn’t overly apparent).

Most of what I was doing on this day was sitting and waiting. I had brought along all the exams from last semester to grade so at least I was “productive.” What really annoyed me though was I had had my US medical records shipped over two weeks prior, but no one had looked at them yet. Which meant the first time they were seeing them was during my exam.

While reading through the records, they realized my prior surgery and treatments were more complicated than they had originally thought, and were now debating if they could continue with tomorrow’s surgery as planned. I was pretty surprised at this lack of preparation, especially since I had already made all my plans around being out of work for a few days and being laid up at home. I called Z to explain the ridiculousness of this situation, with lots of arm flailing and pacing on my part to release some energy. They were even considering scheduling two further surgeries, complete with overnight stays, because of how serious they thought the disease progression was. When I calmed down and stopped my dramatics out in the hallway, I looked at it from a cultural point of view, that this is another example of German low-tolerance for risk and only doing things as thorough, efficient and perfect as possible.

This could have gone smoother in my opinion but in the end, surgery was deemed OK as planned and I was told I would have my operation at 10am, but to not be surprised if I was told to stay overnight.

 

 


Surgery Day

The day of I was starving. I was also nervous and cold (this was the end of January). We arrived at the appointed time (8:30) and took a seat in the waiting area. When 9:30 rolled around I was pretty sure we were going to be delayed. I asked the receptionist how far behind schedule everything was and she seemed surprised “we’re right on time, you’re not scheduled until 11” which was a surprising thing to hear since my sheet and what I was told said 10. She showed me her schedule though and sure enough, I was scheduled for 11. So this was also annoying, but we waited another half hour before being called back for prep.

Prep in the US was changing into a gown, getting into the large comfy and sometimes warmed bed with warmed blankets, more vitals checked, IV placed, and general overall getting as relaxed as you can to ease the nerves.

Here, the bed was a joke, it was a tiny and uncomfortable exam table with a ratty old blanket and no pillow. The cubicle itself was tiny but at least had a chair for Z to sit in and a locker to store personal things (which had no key). The dressing gown was ok, no footwear though. No vitals were taken, no IV placed, no one coming to see if everything was ok until it was time to be wheeled back. Am I being critical of the facilities? Yes, none of this seemed liked “state of the art medical equipment” however upon looking back, do we actually need the warmed bed, the large amount of medical supplies (which ends up as waste), the warmed blankets? I want the warmed blankets, but the rest of it, yeah it’s not necessary. It all happened quite quickly too, the nurse came in to make sure I had changed and then two of them wheeled me right out.

There was a complete lack of privacy in this “ward.” In fact while in the waiting room we could see directly into it, and the room served as both recovery and prep so we could hear the moans of people waking up in pain, which is not soothing nor relaxing. I didn’t like the feeling of being watched while being wheeled back. At the door to the operating theater I was parked and told to wait. 10 minutes go by while I lay there and no one tells me what’s going on. There’s a student pacing up and down next to me but he seems too nervous to talk so I don’t want to disturb him. Finally the nurse comes back and tells me to walk into the operating room with her. I am confused by this because 1) I’m still wearing my own socks, which do not have slip guard and clearly could cause me to slip (not that I’m worried about slipping, but it is odd to me in a hospital) and 2) my gown doesn’t have a back, and this is a pretty full hallway but alrighty then, we’re walking.

I’m greeted by a table I do not want to get on, at all. It is humiliating. I understand that in the medical world bodies are bodies, no one cares, blah blah blah, but I care and the table was high up with two leg stirrups even higher and it just looked uncomfortable and indecent. My last surgery there was definitely no contraption like this until I was put under, I’m pretty sure, but the nurses helped me up and “in” to the overly dramatic gynecology table. The poor student who was pacing is now even more uncomfortable and is doing everything he can to not look at me while trying to put the blood pressure cuff on and help keep my gown from falling open in the awkward position. His unease put me at ease (maybe that’s evil of me) so it was pretty easy to actually relax while freezing and having a draft where no one wants draft.

The IV is put in and I’m out.

 

 


Recovery & Pain Relief

Spoiler alert: there are no pain meds ahead. I had brought my concerns around this topic up the day before but they seemed confused as to why I would need pain meds stronger than fennel tea to drink and “relaxing” at home in bed. I even had them read this article to try to express my need strong desire panic preference for having more than just what’s given while surgery is performed. Like the author of that piece, I too enjoy Ibuprofen like candy (liqui-gels only, no need to wait the extra 30 minutes for pills to kick in) and I had asked all the doctors and the surgeon about getting some sweet, sweet chemical relief.

It’s really disappointing to be told no, it’s stressing to be told no when you think you are really going to need something to get you through a tough situation, and you should just accept it because you Americans overdose on everything all the time anyway. I don’t think of myself as an over-user of anything (that’s a lie, I consume my cat’s weight in Reese’s products every year) and was honestly offended to be lumped in with “the Americans” like that was a negative label by itself. However, like I had already learned, German bluntness does not have a negative or blaming notion behind it, it is just blunt, with no emotion attached.

So while in recovery, as I was groggily trying to pull myself together, they let Z join me right away and the surgeon said some things which sounded like all went well, the damage wasn’t totally fixable but they were able to repair some “active” issues and I would be released that day. I was also given another überweisung, to bring back with me when I saw my gynecologist in ten days for a checkup. Then we were left alone. The pain started coming around 30 minutes later and I decided that since I wouldn’t be floating home on a cloud of narcotics, I wanted out of there immediately so I could be in my fluffy bed once the pain really hit. I also had 6 flights of stairs ahead of me to climb.

Z helped me sit up and test out how that felt, and decided that was pretty good so since after laparoscopic surgery one needs to prove they can use the restroom before leaving, he helps me shuffle on my sweatpants and then shuffle over to the door, all of this taking probably 5-10 minutes while I’m still wobbly. As we leave my little cubicle we see the nurses in the next cubicle chatting and sitting, taking a break. Z says “can I help her use the restroom? Is it ok for her to walk?” They seemed completely nonplussed and said “sure whatever she wants, you can leave whenever you want to.” We took that to be a mistranslation, they didn’t actually mean “you can leave the hospital whenever you want to” because no one had checked on me, after the surgeon left, or given me discharge instructions and it had only been about 45 minutes since I had been in recovery.

But after the bathroom I really wanted to go home and it turned out that yes, we could actually just walk out whenever. Again with the walking, no wheelchair in sight, no one caring if we got to the car ok. Z packed up my stuff, held me by the elbow and steered me into the elevator to get to the parking garage, where I was promptly sick in the nearest trash can.

The climb up the stairs is a bit hazy, I remember having to take a break at floor 4 or something and really hating life, but we made it and Z put me in bed (which TheCats took as an immediate invitation to join and somehow they knew my body was sensitive, so they tried to lay directly on me to pass on their healing presence via osmosis). That first day and night were rough, especially due to the gas used during surgery, but I’d say the second day was even rougher, and I took my American strength Ibuprofen religiously while useing my heating pad I’d purchased a few days earlier in preparation. Z kept the green tea coming and I loaded up the Netflix series I had been saving up.

The next few days Z was my nurse and Netflix buddy. I actually really enjoyed this time together, uninterrupted and just quiet with no pressing sense of somewhere to be. I was also incredibly hungry. My last surgery was more major than this one and I did not eat hardly anything during my two week recovery, it was difficult to even drink. But this week I had an excellent and very healthy appetite. Here I will concede this is probably because the pain medication during surgery was not as strong or was formulated differently, I wasn’t taking anything afterwards and my systems were back to normal pretty quickly. I have great friends who came over two days afterwards with Tex Mex and Mexican themed foods and kept us company that evening so we weren’t total social hermits.

 

 


So How’d It Turn Out?

In the end then, this wasn’t bad. By mid March I was playing tennis and today I feel fine picking up heavy things again. I keep waiting for a bill to arrive but so far nothing. I’m not expecting one either since this surgery was deemed medically necessary, but I still have a nagging urge to check the mailbox, waiting for some astronomical bill to arrive. I’ve even checked my online health insurance provider’s billing site but the surgery hasn’t even appeared there yet. If I get a bill, or if I find out how much my medical services cost I’ll post it here.

And about pain relief: I still think Germany’s opinion of pain medication is a bit strict. I think if someone needs pain relief they should receive it and without judgement. Even buying Ibuprofen here at the Apotheke is an unpleasant process sometimes since I’ve found the pharmacists to be a bit judgemental and hesitant to provide it. Plus it’s super expensive. But, for a surgery such as I’ve had, I’ll rethink my initial reaction of reaching for medicines before noticing my pain and making a decision as to how bad it is.

This is a tough call though, because before I was in treatment I had spent years in pain, sometimes severe enough for me to miss out on living life a lot of the time. I would hate to think that if I had lived here during that time, I wouldn’t have had access to pain relief which made some days just bearable, at a minimum.

The medical care was good, I found the bedside mannerisms lacking. This was not shocking, I completely expected a lack of pleasantries. I was shocked at the seemingly carelessness of the hospital staff regarding safety and protocol (I was never actually asked for ID the day of surgery) but Germany in general is also not nearly as protectionist as the US is in some ways. Personal responsibility has a different meaning here and if you fall while walking out of the hospital, that is a shame and they will come and help you up and treat you again if necessary, but you are certainly not winning any lawsuits since the hospital didn’t actually make you fall. What an interesting concept.

If I needed medical care again when we eventually move back stateside, I would strongly consider coming back to Germany to get it, even if I was no longer in the health care system, as I believe that strongly in the standard of care I received plus I think it’s delivered more efficiently, effectively, inexpensively and probably all around more holistically than what we do in the states.

I will though, bring my own barrel of liqui-gel Ibuprofen.

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