Spinal Fusion: Part 2 “Latvian Healthcare”

Spinal Fusion: Part 2 “Latvian Healthcare”

Latvian Healthcare

Healthcare in the USA

Omaha Women’s Hospital

As a person from the USA, I grew up in a typical family with healthcare provided mostly through my father’s insurance, with deductibles and additional expenses paid out of pocket. Because I was a relatively unhealthy child with ear problems and constant doctor’s visits, I can still remember how angry my dad would get when the bills came and he had to pay. He had a real phobia about the cost of hospitals. Even at 90, when he went in with a heart condition, he kept worrying about how much it was going to cost. Luckily, it was mostly covered by medicare.

Then, as an adult, I had my own insurance through my various teaching jobs that took care of me and my family. And each year, I watched as the coverage became stingier and stingier, deductibles increased, and out-of-pocket copays became the norm. I always felt trapped in my teaching jobs because they didn’t pay that well, but at least I always had healthcare for my family.

Therefore, seeing another healthcare system here in Latvia has been a huge change for me in understanding how a system like this works, and how much different it is to live with a social umbrella.

Latvian Healthcare

My Daily Helper

As a Latvian citizen, I am covered by the state healthcare system. Latvia is one of the poorer European countries, so their healthcare system is by no means lavish, but it is so refreshing to know that if something does happen, I will not go bankrupt trying to take care of myself.

In addition, many private healthcare agencies operate and seem to do quite well. When I had my back injections, I went to a private doctor and paid out of pocket. I was still only paying €90 for each injection which is way less expensive than it would be in the States, but pretty pricey for a procedure over here. I also pay for a private dentist. If you want or need something done without waiting, you have the option to pay a fee out of pocket. But if you can wait, you see your family doctor, they write a note, and then you get a huge discount on the price of whatever you have to have done.

Another good example was that I had to have x-rays and an EKG before my surgery. The x-ray was covered by the doctor’s note, and it cost less than €2. But for the EKG, they tried setting up an appointment after the date of my hospital check-in, and I said, “That isn’t going to work.” So they offered to let me get in right away if I paid the full price, €15. I accepted.

The healthcare workers here are super professional and very efficient. I always feel bad for how little they earn for the hard work they do. We have recently had strikes here in Riga over the government going back on a promise to increase salaries for doctors and nurses. It is an ongoing struggle, but hopefully, they will get what they have due.

I guess one “downside” to the healthcare system here is that doctors are paid well, but not McMansion-Range Rover-boat-summer house-private school well. This causes some of the best professionals to seek employment in other countries where they can earn more money. I think the U.S. is way out of whack when it comes to how much some professionals earn over others... lawyers and doctors come to mind. The whole system is inflated from the cost of education, through the cost of doing business to the out-of-pocket costs for patients. In my opinion.

200 Kilometers

Ventspils Hospital

One of my fears was that I would be used to hospitals in the States, and the care here would not be up to the standards that I have come to expect. I had previously visited two hospitals in Riga, and one of them was in a state of relative disrepair, and it felt unclean. Although, I am certain that the places where they did medical procedures were perfectly sanitary, the lobby and hallways gave me a feeling of unease.

Rita and I spent the night an an AirBnB in Ventspils the night before my check-in. It was a 3 hour trip by bus, so basically it would be like going from Omaha to Grand Island to have surgery (both in terms of distance and the relative sizes of the cities). Then we went to the hospital together. If you don’t speak the language, this is where you really want a Latvian by your side. Basically, I just showed them my doctor’s note saying that I needed this surgery, and then I signed one piece of paper. After just a few minutes, a nurse came to take me upstairs to my room.

Compared to Riga, the hospital in Ventspils immediately felt more modern and much more polished than those in the capital. The floor was new and nice, the administration lobby was clean and very efficient. Everything felt right. This made me feel much better.

I was told that this would be my room the night before as they prepared for the procedure, and then I would be moved to a different room after the operation. As I waited throughout the day, like Scrooge before Christmas, I was visited by medical apparitions. The first was the nurse who wanted all of my paperwork. In Latvia, everything needs to be printed on paper and usually in duplicate. I had lots of papers, but she needed my blood tests which were available online, and I thought they had access, but we had to figure out a way for me to print them. We got it to work, so problem averted.

Another really cool thing about medicine over here is that everything is online, and available almost immediately. I went in for blood tests (€5), and by the next morning, I got an email with my secret code so I could see the tests immediately from my home computer. They also send prescriptions this way, so I can text my doctor and tell her that I am out of medicine, and she automatically writes me a new script. It is absolutely amazingly convenient. I have no idea why something like this isn’t adopted in the U.S.

The second apparition was Dr. Osītis himself who explained the procedure again and answered some questions for me. Then there was Oskars, the chief anesthesiologist who spoke very good English and walked me through my tests and how the procedure would go. He was very kind and reminded me of my uncle.

I had a stint put into my arm, and I was given a couple of pills to help my stomach and to help me sleep. I fasted that night and slept pretty well considering how nervous I was.

The next day they brought me breakfast, then the chief nurse came, and I had to take off all my clothes. No gown. She hooked me all up, put me on a stretcher and covered me with a sheet. Then they wheeled me down the hall to the prep. room. No backing out now!

Surgery

I have had many surgeries, and I really like that feeling of a complete and total loss of consciousness. I sometimes seek this feeling from a good night’s sleep. Undisturbed by dreams or visions, they inject you with the sedative, and then you drift off almost immediately waking up hours later with absolutely no concept of time or place.

I was told I would have to spend the first night in ICU, but apparently the surgery went so well, that I woke up in my room very easily. I had some immediate pain, but a nurse was there to give me an injection and then I slept in a bit of a fog that first day.

The doctor showed me some photos on his phone of what he had done. I saw three giant screws in my spine, and I wondered how on God’s green earth that was ever going to feel right. I was very relieved to hear how confident he was in the procedure, and that he did see (and repair) compression in the nerve root. It made me feel as if I had surely made the right decision.

Recovery

I was told that I would be in the hospital for a week, which seemed like an impossibility. I think the longest I ever spent in a hospital was two days. But even in the States, this surgery warrants an average of a 5-day hospital stay.

I prepared by having all my electronic devices at my disposal. I knew I wasn’t going to be able to do any real work, so I just needed a way to stave off the boredom. I started a new book on my iPad, I played lots of Civilization VI on my laptop, and I listened to many podcasts on my iPhone. I found that gaming was a good way to both avoid boredom and to take my mind off the pain. They say that computer games release endorphins and activate our pleasure centers, and I could almost feel this happening while lying in the hospital bed trying to think about anything else other than the creeping pain as the drugs would wear off.

The weird part is that most of the pain has been in my left leg. I have read that this is due to the nerve root repairing itself after years of compression. The actual lumbar part of my back doesn’t hurt very much at all. As I lay in bed with nothing to do, I could really track these weird pains in my foot, ankle, shin, etc. Pain is a lot worse when you have no distractions.

The Worst Parts

For me, the worst part about the hospital was the constant IV fluids. I was on a battery of antibiotics and analgesics (as they explained) and 3 times a day, they would hook me up. The first few days, I would just lull off to sleep as I got the fluids injected into my bloodstream, but it seemed to take longer and longer each time. And as the first stint got older, it started to hurt and I had to have a new one. I was trying to count how many injections and needles I had in me during this time.

I also had to have this anti-thrombosis (blood clotting) medicine injected directly into my stomach. When Rita told me this is what the nurse was going to do later in the evening, I just lay there in terror. When I was growing up, we were always warned that if we got rabies, we would have to have something like 12 painful shots with a giant needle directly into the stomach. So this is what I was thinking about all day. It turned out to be a small injection, a little pinch, some itching, but not nearly as bad as I had thought. But they repeated this procedure every day, and it got a bit tiresome. I guess I should be happy that I didn’t have a blood clot (knock wood).

Sleeping was very difficult. I had imagined that this whole surgery and recovery would give me ample time to reset my sleep schedule and actually get a nice long sleep. But ever since the surgery, I have only slept in short stints. Two hours, then I get up to go to the bathroom. Another hour, and then there is pain. A nap in the morning, but never a full eight hour sleep. I ended up watching the entire 6 hour impeachment debate and vote all the way until 4 a.m. our time, and even that didn’t knock me out.

I ended up staying a total of 9 days because I had to arrange a ride from Riga, and we had to reschedule. By the end, I was really restless. I wanted some real food. I wanted to get outside. I wanted to be anywhere but in that room. For a few nights, I was the only patient in that ward of the hospital. I would walk around, and feel this sense of total isolation. The nurses were there, but they weren’t very chatty, especially since I don’t speak much Latvian, and they didn’t speak much English.

The Best Parts

You will notice my complaints are trivial and rather normal for any hospital stay. What I loved about Ventspils was how caring and professional the staff was. Every step of the way, I felt like I was in good hands, and everything was being done in my best interest.

By the second day of recovery, I had all the tubes removed, and a physiotherapist came to visit to show me how to log roll, stand, and walk again. This was the hardest thing that I have ever had to do in my life. I was looking forward to standing up. I felt strong while I lay in bed, thinking about being up and around. But when it actually came time to push myself off the bed… wow. I almost passed out from a combination of pain and fatigue. However, she was there to help, and she could see I was struggling. I insisted on doing a bit of walking, and it was hard, but it felt necessary.

Then I had an afternoon pain injection, and the doctor came in and had me repeat the process of standing stressing that I could not bend forward or side to side at all for two months. I stood up for him, and it was much easier. There was still some discomfort, but I didn’t feel as if I would pass out. Again, he stressed how confident he was that I would make a full recovery and everything was going well. Then he said he was leaving the country, and I wouldn’t see him again before I left.

After a day or so, I was already strong enough to stand up on my own and walk around. The nurses were always happy to seem me shuffling down the hallways getting my hourly exercise. And by about the fourth day, I managed to go all the way down to the lobby to have my first cup of coffee from the LAVAZZA coffee machine. The machine also made hot chocolate and Irish chocolate (no alcohol). All of these warm drinks sustained me on long, lonely nights.

Then, when it came time to check out, they brought me the bill for the entire hospital stay. €121. Nine days in the hospital under constant care, and I was paying just over €100 out of pocket. It felt really unbelievable.

Translated from Latvian, the final operation was decompressing the spondylolisthesis, fusing the L5 and S1 vertebrae using the TLIF technique. There is also what is referred as a “Human Tech implant”, so I guess I am even more of a cyborg than I was before.

Final Thoughts

Rita and her colleague, Guntis picked me up from Ventspils, and drove me back to Riga. I am now home, recovering. The drive back from Ventspils was terribly painful. My doctor said I am not to sit for two months except for that car ride and the toilet. So now I spend my time standing and walking around, and then lying down and reading. I hope that my body is recovering the way it is supposed to.

As a constant worrier, I keep wondering if I have moved wrong and broken something or if everything is still the way it is supposed to be.

When you cannot bend, you find out that there are a lot of things in life that take bending. There is that moment I drop something and my instinct is to reach down and pick it up, but I am helpless! I cannot start fires in the stoves, and I cannot do little chores like taking out the garbage.

Guntis and Me in the VW

I was chatting with one of my former students who said she is experiencing similar symptoms and may need the same kind of surgery. I guess if I had advice for younger people out there it is: Take Care of Your Back! I can think of so many stupid things I did that likely put stress and strain on all of my joints as I was growing up that are now taking a toll. Lifting up the back of my car, carrying huge amounts of weight over long distances, filling my backpack with rocks, etc. And I am sure my constant struggles with weight and riding the line of obesity haven’t helped either.

As to the United States and the future of healthcare, I would love to see Medicare for All  or some other system in place that would combat the fear and loathing that go along with getting care. However, the system is so bloated. As you can see from many of my photos, this room at the Latvian hospital is very simple. There was no $50,000 machine constantly taking my vital signs. The bed itself probably cost 1/100th of a typical American hospital bed. The care was great, but the amenities were not plush. There was no fountain or statue outside, no waterfall in the lobby, no oil paintings hanging under chandeliers tethered from vaulted ceilings. Hospitals in the states sometimes seem to be in some aesthetic competition to see who can raise the most money to make these incredible manicured campuses with all the latest goodies (postmodern cathedrals?). But it comes down to care, and that involves the equipment that actually gets you better, and mostly the people who are trained to use that equipment. And just like the bloated SUVs that infest U.S. highways, I am afraid this same bloat has made us soft, and once you get used to a certain level of comfort, it is very hard to give that up to save a few trillion dollars here and there. Gravy trains are really hard to get off of.

Hospital Food Gallery (And some other random photos)

One way to pass the time in my lonely room was to take photos of the dishes I was served 3 times daily. I didn’t get them all, but this is a pretty good look at it. I guess this was interesting to me because I have always been a picky eater, and one of my fears as a child was having to eat the food in the hospital. Other than not having much of an appetite most of the time, the food was actually not bad.

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