Fun with Ladders and Doctors

I don’t usually talk about health issues on social media, but I recently became (once again) a health care consumer when I fell off a ladder at the mökki about a month ago. You could say I fell off the roof, since I was still at roof height when the ladder slid out from under me, dropping me like a rock flat on my back onto our porch. The fall fractured one of my shoulder blades, and it hurt like hell. Considering the kind of health issues some folks have to endure, it was no big deal. Still, it required a hospital visit and, just to be on the safe side, an ambulance. And did I mention, it hurt like hell.  

To go into a bit more detail, my latest little episode of careless ladder usage required:  

• a forty-minute ambulance ride, during which I got three doses of fentanyl (once again, it did hurt like hell)  
• a CT scan of my head in Malmi Hospital  
• seven X-rays of my back and shoulder in Malmi Hospital  
• blood test in Malmi
• a cross-town ambulance transfer to Töölö Hospital for more specialist examination  
• two more CT scans in Töölö, including a full-body scan to rule out internal injuries  
• another blood test, before being discharged from Töölö around one in the morning 

Luckily, the cracked scapula was the only body part damaged. My pride, from once again falling from a ladder like a klutz, is another matter.  

And the point of me talking about this at all now is the costs. The accident resulted in two medical bills. The ambulance bill was €25 ($28). The bill for everything done at the two hospitals, all the examinations, X-rays, CT scans, came to €32.70 ($36). Total. 

This is the kind of health care system we have here in Finland. I did not have to fill out any forms. I do not have any kind of private health insurance. I do not pay insurance premiums. I did not have to worry whether the doctors or radiologists treating me were “in network”. I did not have to worry that the hospital where the paramedics took me had some prior arrangement with my insurance company, which doesn’t exist anyway, since I don’t have insurance.  

I did have to give my Kela number, equivalent to the Social Security number in the States. This allowed the paramedics to access my medical records already before the ambulance ride. It is also proof that I am part of the Finnish health-care system and entitled to its highly subsidized services.  

Private insurance does exist here, as do private clinics and hospitals, but I’ve never seen the need to use them except when they were provided as part of my employer’s health benefits for routine doctor visits.  

The public system here is fine with me and is typical of European-style universal health care, or “socialized medicine”, or Medicare for All, or whatever you want to call it. Some variation of this kind of public health system is what Democratic candidates for US president have been discussing in recent debates. Universal health care should be a winning issue for the Dems, since it sets them apart from the Republicans, who are doing their level best to dismantle the imperfect, but needed, reforms in the ACA (AKA Obamacare). 

Listening to the debates, it’s clear Democratic proposals for changing US health care are still taking shape, like whether private insurance should be banned (in my opinion, no). But, if you ask me, the Finnish system would be a good model.

Mökkis and ERs

Here in Finland, we are in full autumn mode, meaning the days are certainly shorter and often gray, and plant life has either died or shed its leaves or otherwise gone into some form of suspended animation.

For my family, it also means the end of the mökki (summer cabin) season, the end of frequent trips by my wife and I out to our little sauna-cabin on the water.

While we certainly enjoy being there, paying attention to all the activity – both human and wildlife – on the bay below our log cabin, much of our time there is spent working, since we still have plenty to finish up to make it a place for fun and relaxation. One day, we’ll get there.

Still, this past summer there were fewer of those work projects to do, and perhaps because of that we needed fewer trips to the Emergency Room. In fact, none.

The summer before was different. That summer I gained some first-hand experience of the Finnish medical system.

Now, I’m not naturally inclined to publicly share details of doctor visits. But, with health care once again front-page news in America due to Obamacare insurance premiums going up sharply next year, this seems like a good time to share some personal insights on how it works over here.

Luckily, I haven't normally been in much need of medical care, not in recent years anyway, and for nothing life-threatening. I’ve been very fortunately that way. Knock on wood.

Of course, I can’t take any credit for that, other than by not smoking or overeating and generally trying to stay active. Staying well, as we all know, is not only a matter of choice. No one wants to be sick. It’s not a matter of consumer demand. Hospital visits are not on anyone’s shopping list. Illness and accidents happen to us -- hopefully not often -- and not because we wish for them. 

Anyway, in the summer of 2015, I made three visits to the ER (päivystys, in Finnish), all because of our mökki. Well, rather, because of my own carelessness, at the mökki.

The first incident occurred when my wife and I took a stab (groan) at trimming the broad sweep of reeds that grow off our shore. Most of these reeds can be reached only from the water. So, while my wife paddled our canoe back and forth among the tangle of vegetation, I sat in the front armed with a sharp sickle. A very sharp sickle.

I was doing a respectable amount of damage whacking at the reeds, mowing them down, so to speak, as they swayed in the breeze until – for reasons that remain unclear to me still – my free hand got in the way.

It wasn’t a huge cut actually. It was mostly a clean slice down the side of one finger, but it did bleed profusely, and there was a flap of skin dangling from the finger.

My wife hurriedly paddled us back to the dock. It was clear that some stitches were needed to keep the flap of skin in place, so a trip to the doctor was in order. While I held my finger tightly in a cocoon of paper towels, my wife drove me back to Helsinki to the Malmi hospital. The hospital in Porvoo would have been almost as close, but the one in Malmi is closest to our home, and thus the one we're supposed to use for non-routine health issues. And at least we knew how to find that one.

The ER wasn’t very busy. After a bit more than half an hour or so in the waiting room, I saw a doctor (female) and nurse (male) who cleaned the wound and stitched the flap of skin back in place. They were both young and, I have to say, insanely good-looking. That has not always been my experience in Finnish hospitals. Checking my records in the health system database, they could see I probably hadn’t had a recent tetanus shot, so they gave me one of those just to be sure. 

My wife and I were back at the cabin before sauna time, though there would be no sauna that night due to doctor’s orders. Obviously. 

My previous experience with Finnish emergency rooms has mostly involved broken bones. Not mine, but my kids. ERs in Helsinki are busy places during the annual ski holidays in February, when school kids are off for a week of what is hoped to be prime skiing, sledding, and skating weather. And, unfortunately, these are the times that all three of my kids have broken arms or hands while enjoying the slippery white snuff that makes winter bearable.

Myself, the only bones I’ve ever broken have been an occasional toe and once a couple of ribs that I cracked when I fell off a ladder while putting shingles on the roof of our outhouse (a classic mökki mishap, that one!).

I didn’t see a doctor for those injuries, because, seriously, what can you actually do for a broken toe, or even a cracked rib? There’s not much point bothering with a doctor in such cases.

In the case of my second ER visit in the summer of 2015, there was.  This incident also involved a ladder at the mökki. I was working there alone, trying to finish up painting the sides of the cabin in late September while the decent weather still held. Attempting to reach a tricky spot under the eaves, I set up the ladder at a ridiculous angle and, with brush in hand, quickly climbed up it.

A minute or two later -- I don’t know how long for sure -- I woke up on the ground. I had a sense of having laid there on the gravel for some time, almost relaxing, maybe sleeping, yet conscious of the radio on the porch broadcasting news from NPR.

Nothing like that had ever happened to me before. I realized I must have hit my head on the porch steps. My side hurt like hell. After slowly sitting up, I felt extremely groggy, like my head was full of cotton.

I phoned my wife, who was at work. She was in a meeting and couldn’t answer the call, so I sent her some WhatsApp messages, which I found difficult enough to tap out on my phone. Some minutes later, I looked at what I had written and had no memory of doing so. I felt mystified by how such messages could have gotten on my phone.

But my wife did get the messages, and was concerned enough to set out for the mökki to take me, once again, to the ER in Malmi.

This time the ER was busier, and it was a different doctor who checked out my head before sending me down the hall to have my ribs X-rayed. Nothing broken. Apparently, all I had suffered was a mild concussion. It took altogether about two hours.

One of my sons, however, was worried by the fact that the doctor hadn’t ordered a CT scan. Eventually, he convinced me to go back a couple of days after my initial visit and see if I should get a scan. It’s true I still had a headache and had been noticing a persistent ringing in my ears.

This third trip to the Malmi hospital was on a quiet Saturday morning. It didn’t take long to see a doctor (again a different one), who agreed that the persistent headache and ear-ringing might call for a CT scan. There results were reassuring, no brain swelling, no cracked skull. Before lunchtime, we were heading back to mökki to continue painting, this time a bit more carefully, to be sure.

A few weeks after these hospital visits, the bills started coming in. The first one was €32.10, the next one €32.10, and the last €32.10. That’s the flat “office fee" everyone pays for a trip to the ER. The sum total of my medical expenses that summer came to less than €100 (about 115 dollars). That’s for three trips to the ER, the suturing of a finger, an X-ray, a tetanus shot, and a CT scan.

What does this mean for my insurance premiums, deductibles, co-pays, etc.? Nothing. I do not have insurance. I do not need insurance, not with the kind of “single-payer” universal health care that we have here in Finland.

To many Americans, this is “socialized” medicine, a concept they are so very afraid of and opposed to. For the life of me, I can’t see why that is. Well, actually, yes, I can. They have been persuaded, you might even say brainwashed, to be hostile to it, just on principle, without really knowing what it’s about, without understanding it.

And, sadly, that is one reason I think reforming health care in the US, of which Obamacare might eventually prove to be only an ill-fated half-measure, will continue being the touchy and tumultuous political nuisance it is today. 

The sickle that did the deed.
(And this motif is not in any way a commentary on Obamacare. Quite the opposite.)