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    Universal Procedures are Not so Universal

    By Rod Moser, PA, PhD


    I did not intend on getting HAPE – High-Altitude Pulmonary Edema.  As a matter of fact, it sort of caught me by surprise since it happened in the middle of the night, after I came back to the lower-elevation valley.  I thought I had done quite well walking around the Alps at over 3000 meters, but apparently I was wrong. I didn’t even have much shortness of breath, but walking over ten miles for two days at that elevation sure made this old guy tired.

    I never thought I would experience European medicine first hand, but I was pleased that I was in a larger city (Salzburg) when the medical event started to rear its ugly head. After a few hours of convincing  my wife that I was not having “just a nosebleed,” my first step was to find a good hospital emergency room.  We did not know if 911 worked in Austria, so we called the operator and asked them to send an ambulance.

    About 20 minutes later (a conservative guess) the ambulance finally came. Neither one of the paramedics spoke English, nor did I speak German. We arrived at the ER in another 20 minutes with me sitting in a back seat, not on a gurney with an IV and oxygen mask. My wife and friends had to take a taxi.

    When I was finally ushered into the examination room, the first difference that I noticed was that the doctor did not use gloves when she started an IV. Some blood got on the floor, but she did not seem to care. It bothered me, of course, so when she left the room, I cleaned it up. Her examination was cursory and only included listening to my lungs and heart.  I shouldn’t complain about this of course, since I was once seen in a local emergency room, and the ER doctor never touched me once…no examination at all.

    The facility used EMRs – Electronic Medical Records. It seemed to be identical to the program that we used in the States, but in German. She ordered lab, x-rays, and an electrocardiogram.  As soon at the attending physician came in and my doctor-in-training discussed the case, she gave me an IV of a drug routinely used for pulmonary edema and high blood pressure.  I understood the generic name and purpose.

    A nurse or tech then came in to do my electrocardiogram. The lead attachments were different. We use disposable pads that help electrical conduction, but their leads are already sticky (more or less). Assuming the patient does not have a hairy chest (like me), it should work. I gave her permission to shave a few swatches, but she just held the lead on with her hand. My last ECG in the U.S., the technician tried to shave my entire chest. Not wanting to deal with the itchy agony of the hair growing back, I respectfully refused.

    Some greasy stuff was smeared over my right ear. I was not sure why. After a few minutes, I touched it. This was a mistake, since both my ear and my finger started to become numb. This was a topical anesthetic used before they took a blood sample from my ear (not something we do in the U.S.). At some point, I forgot and touched my own eyelid and lip. They were getting a bit numb, too.

    While waiting to be sent to x-ray, I decided to wash my hands (habit), use the hand sanitizer, and get any residual anesthetic off my hands. By this time, my IV had run out, so I shut off the valve since no one was around. It began to leak blood around the needle again. I could not find any gauze, so again, I cleaned up my own blood spill.

    I was then sent to the ENT to scope my throat.  Because it was raining outside, they wheeled me through a large, dank basement filled with forklifts, janitorial staff, and supply rooms. Several times, we had to move out of the way of motorized vehicles. When I got to the ENT waiting room, I was not sure I was in the correct place since the signs seemed to imply a pulmonary clinic. The waiting room was crowded, so I was left in a wheelchair. A woman with a nasty disposition came by and shouted something in German that I did not understand. A helpful patient said that she wanted the wheelchair for another patient, so I gave it up. I sat next to a little girl holding her ear, so I guessed the pulmonary clinic also sees ENT patients.

    The ENT was very nice (all three of my doctors were women). Her maiden name was Moser, so she treated me well. She did not use gloves when she grabbed hold of my tongue with a piece of gauze, and her tongue depressor was not wooden, like the U.S., but stainless steel. She had a whole drawer full of them. They were not sterile, but I trusted that they were autoclaved between patients and were clean.

    The general facility of this university hospital was modern and clean, but patients were not left in examination rooms to wait. They were put in wheelchairs and placed back in the waiting room in various immodest stages of undress. No one was wearing any hospital-supplied gowns; just some of their street clothes.

    After I was examined, I was told to go back to the main ER again. The only problem was that I had no idea where it was since I traveled via basement. It wasn’t raining very much at this point, so I just went outside and followed the signs back to the ambulance entrance. All of the ER doors were locked and secured, so I just took the chance and pushed the “doorbell”. An assistant eventually came out, took my papers, and went back inside. Not knowing exactly what to do, I just sat back down in the waiting room again. About a half-hour later, they came out to get me.

    Concerned that I would be admitted and required to undergo a bronchoscopy to find the source of the blood, I was pleased to be discharged with just a prescription. The ER doctor spoke English well enough for me to understand, so I left with a stack of papers and reports (all in German).  Thank goodness one of our staff physicians back home speaks medical German and was able to give me an interpretation. The ER doctor recommended some additional tests, like a bronchoscopy, CT scan, and an echocardiogram when I got home to the U.S.

    I have to say that the language barriers were less of an issue than the difference is medical styles, but all in all, I felt that my care was appropriate and professional.

    Photo: iStockphoto

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