The post I hoped I wouldn't have to write

To begin, an explanation of the title, since I suppose there could be many posts I hoped I wouldn't have to write: unfortunately, I've spent the past couple of days getting a full tour of the Israeli health care system. As you'd probably expect from this description, this post goes in some detail into some mildly unpleasant medical misfortunes, so if you're sensitive to such things, this may not be for you. On with the story.

First, the backstory. I woke up early in the morning of Sunday, April 10th with a slight twinge in my lower back. At first, I thought it was just a muscle strain from the lousy Ikea mattress in my subletted room, but when the pain began to intensify, I knew immediately that it was a kidney stone. I've had them before, so I'd brought strong painkillers with me to Israel in order to deal with the excruciating pain of an attack like the one I was beginning to experience. I quickly swallowed a couple of pills and collapsed back into bed to wait for them to take effect. After an hour or so of writhing in bed waiting for relief, I mercifully fell asleep.

I woke up a few hours later, around 11 am. The pain was gone, but I knew the respite wouldn't last for long. I knew I'd need to go to a medical facility of some sort in order to get checked out-treatment for kidney stones varies based on the size of the stone, plus I only had enough pain medicine for a limited period of time, so I'd need to get a new prescription.

In the US, I'd just go to an emergency room in this situation. In Israel, however, you're not permitted to simply show up at an emergency room unless it's a bona fide emergency. To use an emergency room, you have to go through one of two gatekeeping processes: either a paramedic has to bring you, or you have to call your insurance company and get an authorization to use the emergency room before going. Otherwise, you're on the hook for the bill, which is about as large as an emergency room bill in the United States. This seems like a good idea- it theoretically cuts down on ER wait times by reserving the ER for the most dire needs. In practice, as I discovered, it doesn't work so well. More on this later.

I fortunately felt well enough to not need the services of a paramedic, so calling the insurer it was. I called the hotline and spoke to a representative. When you call for an ER authorization, they don't have to give you one-if it's something minor like a cold, they can actually send a doctor employed by the insurance company to your home to evaluate you and write a prescription if necessary, or they can send you to a clinic run by the insurance company for further testing. A doctor actually works in the call center and makes these determinations on behalf of the representative, interestingly. Suspected kidney stone didn't require much analysis, though-just as it would be in the States, it was off to the emergency room. I was instructed to go to the emergency room at Ichilov Hospital, Tel Aviv's main hospital. A referral would be waiting at the reception desk. Time for my first experience with Israeli emergency care!

Now, a bit of background. Due to a combination of bad luck (the aforementioned kidney stones, a go-kart accident on my 21st birthday of all days) and stupidity (drunkenly smashing a beer bottle and attempting to clean it up with my bare hands during my freshman year of college), I've sampled a fair number of emergency rooms in my young adult life. While some of my ER experiences have been OK, most have been horrifying. My worst ER experience was being mistaken for a heroin addict during a kidney stone attack and being threatened with arrest (Montgomery, Alabama of course), but waiting 8 hours to get three stitches in a finger (Providence, RI) and waiting 5 hours for pain medicine in the midst of a kidney stone attack because some idiot drunkenly decided to eat dry ice at a pre-Halloween party (also Montgomery) were up there. So I went into my Israeli ER experience with a bit of trepidation, but also with a bit of excitement. Maybe the Israeli system would be better than the American system, which is obviously well-known for its dysfunction, and I'd be in and out in a reasonable period of time. If that wasn't the case, then I'd get another ER war story! 

I was in a bit of a haze from the pain medicine, so I decided to take a cab from my apartment to Ichilov. 15 minutes later, around noon, I was standing at the entrance to the massive Ichilov complex. (Note: if you Google Ichilov Hospital, you probably won't find much. The official name is Sourasky Medical Center, but everyone seems to call it Ichilov. Sort of like the National Airport/Reagan Airport controversy in Washington). It was there I made a fateful decision, possibly influenced by pain pills. I assumed that, given the referral system, I'd be in and out quickly. I hadn't eaten anything before going to the hospital, because I was a bit nauseous from the pain pills, so I decided to hold off on eating until after my visit. This turned out to be a mistake. After wandering around for a few minutes, someone eventually pointed me in the right direction-underground! The Ichilov ER is apparently designed to serve as a bomb-proof field hospital in the event of another major Middle East war, so the entire facility is a maze of caverns located under the hospital proper.

The best way to convey my ER experience is probably a bulleted, hour-by-hour list of the unfortunate details.

  • 12 pm. Check in at the reception desk. They don't have the referral that was promised. They say they'll deal with it while I receive care, and they hand me my medical file and a receipt with a 3 digit number.
  • 12:05 pm. Enter the waiting area. The 3-digit number on my receipt is way bigger than the 3-digit number on the overhead displays, and there are a lot of people here. Shit.
  • 12:30 pm. My number is called! This wasn't so bad. The triage nurse speaks good English, and is very helpful. She tells me that all I'll need is a blood and urine test, and then they'll get me in a bed and seen by a doctor.
  • 12:35 pm. What do you mean there's only one nurse taking blood for the entire emergency room?
  • 1:30 pm. Finally, I get my blood drawn. Never been so happy to have someone stab me with a needle. She leaves the needle in my arm for use as an IV needle in the event I need an IV. Those Israelis, so resourceful!
  • 1:45 pm. Waiting for a bed. All the beds are full, and so's the seating area for those waiting for a bed. I get to stand in front of the nurses' station and watch them eat lunch. Just in time for my nausea to wear off and for me to get hungry.
  • 1:50. Finally in a bed!
  • 2 pm. The doctor shows up. He makes his presence known by opening the curtain surrounding my bed and promptly banging his head on the IV pole. I suppose it shouldn't be a surprise that he introduces himself as an intern.
  • 2:05 pm. He agrees it's probably a kidney stone, but he wants to order a CT scan, just for confirmation. But he needs to check with the attending first, because, in his words, the attending likes to yell at him for ordering the wrong tests! Off he goes, banging his head on the IV pole again.
  • 2:15 pm. The attending's in a good mood and agrees to order the CT. The intern tells me that it'll be a few minutes, but someone will bring you for your scan soon. He walks away, banging his head on the IV pole one last time as he departs.
  • 2:45 pm. No CT.
  • 3:15 pm. No CT.
  • 3:30 pm. A nurse comes to take me for CT! Only, it turns out this is a lie-he just needs my bed. There are still no seats in the waiting area, so deposits me in front of the nurses' station again. 
  • 3:45 pm. I haven't eaten anything all day and I'm starting to get a little lightheaded. I tell the nurses this. They tell me I can't eat because I may be having surgery. I tell them that I don't think that's the case, and ask them to check with the doctor. They tell me they can't. I ask them if they know my name and why I'm in the ER. They don't.
  • 3:50 pm. Escorted back to a bed to lie down.
  • 4:05 pm. Finally taken to CT! It's there that I realize the problem-there's only one of each type of radiology machine for the emergency room (so 1 x-ray, 1 CT, 1 ultrasound, etc). Maybe if I'd put more quarters in the little blue JNF boxes as a kid,  Ichilov would have been able to buy more radiology equipment.
  • 4:30 pm. Back in the ER. Only now there's someone in the bed I'd just left. I check with the nurse-my bed is now in the hallway. Now I wait for the results.
  • 5 pm-no results. My phone dies.
  • 6 pm-no results. The nurses are now pretending that they don't speak English so that they don't have to speak to me.
  • 7 pm-no results. I'm reading Amos Oz's A Tale of Love and Darkness on my Kindle. It's a classic of Israeli literature. Only it doesn't seem right for the moment-I don't want to read this profoundly affectionate autobiographical work that parallels the author's coming of age with the Israeli state's coming of age. I don't feel profoundly affectionate towards the Israeli state. 
  • 7:15 pm. Flip through my Kindle. I see that I have Max Blumenthal's Goliath (aka: "The 'I Hate Israel' Handbook") on there. Seems more compatible with my mood. I switch to that.
  • 8 pm. Tempted to just leave, but the IV needle is still in my arm. I go to the nurses' station and ask them to take it out. They can't do that. I ask them to let me eat. They can't do that. I ask them to ask the doctor if I can eat. They can't do that. I ask them to tell me my doctor's name. They can't do that. Decide that the only way to get results is to annoy the shit out of the nurses. Begin leaning on the desk at the nurses' station.
  • 8:15 pm. Results! Surprise of the century: I have a kidney stone. They're going to write a prescription for painkillers and send me home.
  • 8:30 pm. I have the prescription. It's for a painkiller I've never taken before. I ask them if they can give me the painkiller I've taken before with minimal side effects, and they can't do that. They send me to a nurse to get the IV needle taken out.
  • 8:35 pm. The nurse is flirting with her colleague. She interrupts her important flirting long enough to yank the needle out of my arm before handing me a gauze pad and walking away. I ask for a band-aid. She rolls her eyes.
  • 8:45 pm. I'm at the reception desk again. They present me with a bill for $5,000 US. But I thought the authorization was on its way! They go back and look for it-they forgot to put it in my file when it arrived shortly after I checked in at the ER. They present me with a bill for $0.
  • 8:50 pm. Eating a mediocre cheese sandwich at the cafe next door. It's the best thing I've ever tasted.
  • 9:15 pm. I'm back in my apartment. Check the painkiller they prescribed me at the hospital on WebMD. I can't take it because it causes a potentially fatal reaction when mixed with another medication I take. Ahhhhhhhhhhhhhhhhhhhhhhhhhhh.

The next morning, I sought out and found a private hospital that works with American medical tourists and American health insurance. One encounter with the Israeli health system was enough for a lifetime.