Putting the Trauma in Traumatology…

Well. It has been an eventual two weeks here in the Russian Federation. In the big picture, there was a presidential election.  And in my small little world there was (ahem, is) a looming chapter deadline, as well as a new and unexpected administrative requirement.  That requirement is the subject of this post…

A few weeks Mammoth University informed me that my department’s administration is now requiring all foreign exchange colleagues to have a complete medical exam at the university (re: State run and for Russians, theoretically, free) health clinic.  I do believe I have mentioned a time or two in this particular space that I am not especially fond of Medical Professionals regardless of their country of origin or level of Medical education.  I think this has something to do with having a bizarre genetic syndrome, a history of frequent visits (essentially from birth) to such esteemed Professionals, and the general medical model attitude that A.) the body belongs to the doctor B.) the textbook, technology, and lab test are always right.  So. As you might imagine, I was not thrilled about the prospect of a visit or several visits to one or more of the Motherland’s Esteemed Medical Professionals.  Not. Thrilled. At. All. Especially given what I had heard from Russian friends about the general state of disrepair of most State-health clinics and the disillusionment, due to long hours, unstable/hazardous work conditions, and extremely low (like $500/month low) salaries, of the Medical Professionals who run them. Tried to avoid the whole spectacle, but my department’s head administrator was becoming increasingly insistent that I obtain the required lab results and the stamps and the signatures. So off I hobbled, with the Evil Aid, to the health clinic, or Polyklinika as they are called here, knowing good and well that my various defects would certainly raise a few eyebrows and probably a lot of questions. And unfortunately, I was right.

Let me begin by saying that a complete medical exam at a State-run clinic here in the Motherland is absolutely nothing like a complete medical exam in the United States.  You do not see one general practitioner who examines you thoroughly for any signs of trouble or significant changes in your general health, orders your labs, reviews your labs, and if you are doing reasonably well sends you on your way with a prognosis and recommendations.  Or if you are not doing so well or happen to have an out of the ordinary syndrome (ahem) you receive, along with your general prognosis, a slip of paper with a referral to the necessary specialist or specialists.  That is to say, you only go to a specialist if you have a health problem that requires specialization.  Not so in the Motherland.  One sees the GP not for a general health check, but rather to receive a list of specialists (which can be as short as five folk or as long as eight) to see in order to obtain information about the condition of one’s general health.  In theory, the GP asks questions about one’s medical history and thus draws her conclusions about which specialists one should see from that history.  But because the GP’s are the most overworked physicians of them all, they tend to simply handout pre-prepared lists of specialists to anyone who crosses their threshold and announces that she has come for a physical.  There is a logic to this: It allows them to save their time for patients who are actually acutely ill.  Because there is no triage point and no appointment system, everyone simply gets in line for the GP when she opens for business.  The sick and the lame wait behind the healthy and the strong without preferential advancement, sometimes for hours.  And let me tell you, when you are a sitting in such a line (provided there is an actual place to sit; this is not always the case) clutching your tiny paper chart, a relatively healthy individual who simply happens to use a mobility aid, and waiting for a few silly stamps, you start to feel really really badly for the kid behind you, who is coughing and sneezing and who has a fever of 101 F.  Really badly.

But no matter. The system is what it is.  And my situation is what it is.  And as I expected, my trusty stick caused the GP to prick up her ears. “What is with that?” she asked as soon as I sat down at her desk.  I explained quite simply that I had spina bifida.  No need to open the EDS can of worms.  Spina bifida is a fairly common birth defect, which does not discriminate based on geography, and I figured she would understand it quite easily.  And I was right; she did.  And she did what any good doctor would do in her position.  As she was preparing my list of specialists she added an orthopedic surgeon, or “Traumatolog” as they are called in Russian, thinking quite correctly and quite logically that someone with a spinal defect should probably have the general health of her spine examined. Entirely understandable. I accepted my list without protest, said thank you, and trotted off to try to find the Traumatolog, whose office was of course on the third floor.

The first thing I noticed when I finally to ascend to the third floor and locate the office of the Traumatolog was that the line to see her, compared to the line to see the GP, was quite short.  There were only three people in front of me. Progress.  The second thing I noticed was this:

This nifty light is positioned just outside the Traumatolog’s office.  The red lettering reads “Enter!”  When the doctor inside finishes with one patient and is ready for the next, she flips a switch, which causes the bulb to flash, “Enter! Enter! Enter! Enter!” in a Soviet vintage staccato fashion, informing the next person in line that it is his turn to see the Good Doctor.  Pretty soon, it was my turn. “Enter! Enter! Enter! Enter!”

I hobbled in to the exam room and the Good Doctor and her nurse sidekick stared at me with wide eyes.  In the Motherland, specialists and their nurses sit together in the exam room, where they conduct your exam, collectively.  I presented my chart, which attests to my American-ness but to little else, since the GP hadn’t recorded anything about my health, other than my blood pressure.  She had simply noted which specialists I needed to see, with the Traumatolog topping the list.  The Good Doctor stared at me angrily.  So angrily in fact that if she had been a cartoon character, smoke would have been coming out of her ears:

“Young lady! I am a doctor-specialist! You are here for a general physical. I DO NOT SEE GENERAL PHYSICAL PATIENTS!”

All shouted loudly enough to create vibrations.

“Yes. I see that that is what you are,” I said. “But as you can see from my paperwork,” (when in the Motherland ALWAYS refer to your paperwork) I stated matter-of-factly. “The general physician has written both your name and your office number on the list of specialists I am required to see.”

Grunt. “Well, what’s wrong with you?”

“I have spina bifida.”

Grunt.

Nurse, to me: “Get undressed down to your waist.”

I remove my sweater.

Nurse: “No you fool. All the way undressed! Take off your bra.”

I comply.

Good Doctor: “Stand over there! On top of those feet!”

I walk, unaided, the half-meter from the exam table, where my top and undergarment are now strewn, over to the sticker on the floor in the shape of two tiny feet.

Good Doctor: “Alright. Stop right there. Now! Explain! I don’t understand. If you can walk WHY ARE YOU WALKING WITH A CRUTCH?”

Because clearly being able to walk a half meter demonstrates the ability to walk solidly for a whole meter, ten whole meters, a kilometer, in icy and snowy conditions. In a country with shaky infrastructure. Right? Don’t you see the logic? Isn’t it perfectly clear??

“Well,”I said, as calmly as I could muster. “I am simply following the recommendations of my American doctor. I can’t walk unaided for all that long…”

Softer grunt. “Well does it hurt to walk?” Steamy anger briefly melts into a something softer, something I would almost call compassion.

“Yes. It does.”

Hmmm….”Well! Turn and face the window!”  It is then that I notice that the window is entirely bare. No curtain. No blinds. I am no standing shirtless, in front of a naked window, which overlooks a yard filled with workers from Central Asia.  In other words, I am, against my will, performing a striptease. For free.

“Turn around! Bend over! Come up slowly! You have scoliosis!!!  Do you have your x-rays with you?”

Me: “No. And if it’s all the same to you, since I just had a lumbar series at home, I don’t really want to repeat it. May I get dressed now?”

Grunt. “Yes.”

As I struggled to cover myself as quickly as possible I heard her stamping and signing my chart.  The thud of the bureaucrat’s stamp means that you now have what you need, and you are free to go. Which is exactly what I did.  Without another word.

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2 thoughts on “Putting the Trauma in Traumatology…

  1. Good grief: the vice grip of the medical model indeed.
    I can only aspire to one day have the sort of kickarrrrs resilience you have, grrrrr.

  2. Ah shucks Che, that’s so nice of you. But listen: It is really you and Katja that I must credit. Your blogs have made me laugh (most important), given me courage, and helped me make it through some of the toughest days. Seriously.

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