What happens when you need surgery…. in Budapest, Hungary?

Hungary-national-cancer-center

The Hospital

After a year of intermittent sinus issues and pounding headaches, Pat finally broke down. “I can’t take it. I’m calling a doctor.” We travel home for our routine medical care, so we never visited a doctor here. Luckily, I had a reference from an American colleague who used to live in Budapest. Pat saw an Ear, Nose and Throat specialist later that same day. As soon as I walked in our apartment that night, I called out,

“Hey, how was your appointment?”
“Not so good, I have polyps completely blocking my sinuses. I need surgery.”
“Oh my gosh. In Hungary? ….  (seconds of silence)  That’s gonna make an awesome blog post!”

That night, the Callahan apartment was uncharacteristically quiet. While Pat wrapped his head around surgery, I mentally pitched an article. Worst case, I could email The Huffington Post. They don’t pay writers, but they love this stuff.

Pat’s doctor suggested he go home and think about what he wanted to do. My employer, in the last round of cost cuts, changed our medical benefits. Employees on foreign assignment, like us, must seek all medical care in the country where they are assigned. Pat accepted that the surgery must take place in Hungary. He called his doctor the next morning, “Let’s schedule it.”

When I mentioned the imminent surgery to our Hungarian friends, every single person gave me the same advice, “Do not, under any circumstances, use the Hungarian public system.” “That’s not a problem”, I assured them, “I have private health insurance.”

Pat plodded through a series of appointments and tests: a CAT scan, anesthesiology screening – including blood work and EKG – follow up visits, and more follow up visits. He picked up results at one hospital to deliver them to another. Three years of living in Central Europe, we realized, was dress rehearsal for this moment.

After clearing all the pre-surgical hurdles, Pat’s doctor asked if he had selected a hospital. “You probably ought to tour four or five. Pat was stunned, “I have no idea how to do this. I’d rather use the hospital you recommend.” She picked the National Cancer Center, a public hospital with “the best operating theater in the city.” “Meet me there tomorrow at 7PM, and we can tour it together.”

As Pat recounted this story over dinner, we both wondered if this was normal. Does a surgeon generally tour the hospital with their patients? Or did she want Pat to see a public hospital while he could still back out?

After the hospital tour, Pat’s anxiety kicked into overdrive. “Julie, the rooms hold six patients – all extremely ill with some form of head and neck cancer. One man sat in a wheelchair in the corridor, popped open a beer and drank it. Patients are smoking outside by the street. The place looks like a 1960s tuberculin sanatorium. And I have to stay there for four days!”

The doctor had taken him through the schedule:

  • Check in and acclimation day (Fun! Like camp!!)
  • Surgery day
  • Two recovery days

Sensing Pat’s concern, she agreed to shorten the hospital stay as much as possible. If we promised to arrive at the hospital by 7AM, we could waive acclimation day. “No problem”, Pat assured her. “We’ll be there.”

Now that we had accepted the public system, my friend , Szabi, promised he would come to the hospital with us. “Julie, I’ll help you. No one will speak English. And besides, I can arrange the tips. Just bring cash and envelopes.” “Szabi, why would I tip anyone?” He looked at my like I was crazy, but then realized I was a rookie, “In order to receive care!”

A web site goes so far as to provide tipping guidelines. To have a baby (thankfully, we are not dealing with this one), the doctor’s tip ranges from 500 to 1000 dollars. In order to bring some semblance of professionalism to the process, patients often place the money into something innocuous, like a box of chocolates. A girlfriend mentioned that her father is a surgeon. “We always have a pile of chocolate boxes in the house.”, she laughed.

And somehow, we started to laugh again, too. A lot. “Make sure you bring everything you need, toilet paper, pajamas, towels – oh, and food. Assume they will provide nothing.”, one friend offered. We joked about foregoing the blog for a book deal and movie rights.

On the day of his surgery, Pat, Szabi, and I arrived by seven and sat in the hallway, which also serves as the waiting room – patients waiting for doctors, families waiting for surgeries to conclude. Everything happened in this corridor which connected patient rooms to examination rooms, a tiny nurses station, and the outside – through a pair of swinging wooden doors.

But before we could begin, we had to pay. Everything. In advance. We trekked through the hospital campus to the payment office where we received an invoice, back to our doctor who signed the invoice, to the cashier who collected our money, back to the payment office which noted the payment in the system, and back to our surgeon who could now proceed. The bill totaled 1500 dollars including the four day hospital stay and all doctor’s fees. Everything.

Walking from station to station, I couldn’t help but admire the cluster of 100 year old, golden plaster buildings; quite charming, no doubt, in their day. It seemed more like a New England girls’ school than a hospital complex. Absent were all the things I associate with disease; bustling doctors, bright florescent lights and a never ending stream of PA announcements.

We sat once again in the corridor until Pat was led to a semi-private room. (“Oh thank goodness.”)  Just before noon, a man came in, directed Pat to remove every stitch of clothing and lay on the gurney, covered him up, and whisked him off to surgery. With no modesty curtains, Pat did all this as the other patient sharing the room and his family sat in the corner chatting.

Pat disappeared down the elevator. I walked outside to find patients strolling around the block with friends and men in pajamas at the grocery store picking up provisions. Some pushed their IV stands, all shuffled about in their slippers. It felt like lunch break on a movie set created to reenact a World War 2 hospital scene. I explained the ambiance to an American friend, “It’s not so much a hospital. It’s more like a two star hotel with nurses.”

Back in the hospital, with toilet paper and snacks tucked away, I returned to the corridor to wait. Nurses huddled next to patients talking softly, doctors conducted examinations, one patient blended lunch into a smoothie with one of those battery operated, hand held gadgets. A pair of men in their bathrobes, roommates, walked outside for a smoke while one man sat alone, read his bible, crossed himself and prayed.

Groggy and just coming out of anesthesia, Pat was pushed into his room. His roommate’s family left so he could climb back into bed (still completely naked) and regain his senses. As they closed the door, they turned back and offered, through a series of nouns and gestures, to bring us back something from the store. “No, thank you. Köszönöm.”, I replied.

Nurses came and went, checking Pat’s blood pressure, adjusting his bed height, and giving me a thumbs up that he was OK. His doctor dropped by between afternoon surgeries. She told me he had bled more than she liked, so she had kept him downstairs near the operating theater for an extended time so she could watch over him. Relieved that he was improving, she requested blood to be drawn, “To double check his red blood cell count. Just to be sure.”

At some point during the wait and recovery, I stopped laughing. I reconsidered my blog – frankly embarrassed and humbled. Doctors and nurses working for dismal salaries spent a day doing everything they could to ensure we felt comfortable and cared for. The sole nurse who spoke English was called to answer our questions. Late that evening, more than 12 hours after her arrival, Pat’s doctor checked on him before leaving for the night. It is a system which works, as most systems do, though the brains and sweat of individuals.

This blog post morphed from a slapstick adventure poking fun at the ridiculous Hungarians and their pathetic medical system to one where I realize at times, in spite of my best efforts to the contrary, I am an ugly American. When Pat finally woke up, he said, “Hey Julie, guess what, the operating theater really was state of the art.”

Since the surgery, Pat has regained a sense of taste and smell more powerful than it has been in years. One day, walking home from the store, he said, “Wow, all the women wear the same perfume. It must be what’s in style right now.” “Really, Pat?”, I answered, “I don’t smell a thing.”

That first day in the hospital, once Pat was settled into his room, Szabi and I went outside to figure out the tips. “Julie, there is no need to tip. This is not that kind of place. This is a very good hospital – the nurses would feel insulted by a tip. Just bring in a box of treats or something before you leave.”

The day after Pat’s surgery, Friday, I decided to stop down the hill from the hospital at a bakery to pick up pastries for the weekday staff. I motioned that I wanted a box of items. “How many?”, the woman asked. I held up the Hungarian equivalent of a twenty dollar bill. The woman went into the kitchen and returned with a box – not a bakery box, but the type that might hold bananas or beer; a big, brown, corrugated cardboard box.

“Please”, I asked her, “Select what you like to eat.” She moved from one end of the glass display to the other grabbing two of one item and three of another. She handed back a nearly full box, took my money, and left me to lug it up to the hospital.

I went to see Pat on my way to the nurse’s station. He was up and reading, fully dressed in his street clothes. “Do you need me to run to the grocery store.”, I asked. “No, thanks. I already went. I picked up yogurt and fruit and water. It’s all in my refrigerator.” I held up the box of bakery items, offering something to Pat and his roommate. “Check out what 20 dollars buys from the bakery.” We both laughed. A goodhearted laugh. This, we realized, is our life in Hungary.



Categories: How To

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