A medical anecdote

DRAFT…

Recently I went on a trip, to Kraków, where during the trip I got to try out the medical system and got to compare this with an experience in the U.S. too.

In Kraków, I went on a traditional raft during the trip and prior to that, in the U.S. I was attempting to understand some long standing pain in my wrists.

One of the things to do in the Polish countryside is to raft with the local Gorals¹ who live in the forest areas, near the Poland/ Slovak border. Involved in herding and forestry, but at one point they got into rafting and a tourist attraction they organize is to go on a large raft made out of six canoes tied together by ropes. The joke is that you have to hold them tightly with your adductors in case the ropes give way. The trip is a lot of fun because the flisak (or raftsman) keeps you engaged with jokes about names of mountains and about friendly rivalries with the bordering Slovakia, of which is separated by the River Dunajec.

This type of raft is propelled mainly by the river, classically intended to help take chopped trees downstream after harvesting. So there isn’t so much rowing as using a long pole to navigate, making sure not to crash into the rocks, reminding me of punting² I remember experiencing in Cambridge UK once.

I went on this raft with my mom as a side quest during a family trip to Kraków. We were moving right along, with 6 other people though at one point, there we saw a long wooden pole floating, lost by another boat, and our raftsman attempted to snatch it but it was just out of his reach and then one of the other passengers near the aft, made an attempt to grab it and he managed to shove that wooden pole into our boat, but also straight at my face . I felt the impact but this wasn’t incredibly painful, just that apparently there was a lot of blood and the people around me were kind of speechless. I felt fine more or less for 10 minutes but then all of a sudden I got a feeling of intense dizziness, and pressure and everything got pretty bright too. Right away I thought wow this must be what a subdural hematoma feels like and this is the end of my story. I palmed my head and folded myself into my lap. A passenger next to me recommended I do some box breathing. And a few minutes after, actually, the dizziness went away. And no fainting either. I didn’t feel great but my mom was also super helpful to cool down my brow with some of the river water to try to keep the swelling down. And as soon as I got off the raft, half hour later, I started GPT-ing, how late can the symptoms of head injuries arrive? Turns out it is possible for them to be delayed. They can include nausea, vomiting, numbness, asymmetric vision, slurring, and seizures. None so far.

So this was the second time I had the chance to try out travel insurance. The first time was in Germany, with a pink eye incident, maybe a story for another time.

Back at home in the U.S., let’s talk about a bill I received before my trip

I have been having issues with my wrists for over ten years, never really getting down to the bottom of it and I figured I’d try to understand what’s going on one more time because it has been a while. I asked my primary doctor, and she referred me to get an X-ray, but I made the mistake of not asking for the cost up front. I felt pretty silly when I got hit with a crazy bill for the wrist X-rays. The full amount was $710 plus another $2,025, and my insurance contributed to some of this, but after looking at https://www.fairhealthconsumer.org/ I learned these charges are outliers. X-rays and interpretations usually cost 10x less than that.

So specifically, the claim had two parts,

1. General HC X-ray Hand 3 Views, 73130 (CPT)
2. HC X-ray Wrist Complete 3+Views, 73110 (CPT) where CPT stands for Current Procedural Terminology.

Each part was further split into two parts, one diagnostic and one to take the actual X-rays.

There was also an interpretation that I took a look at on the app for my provider. Basically it said that nothing abnormal was found.

My thinking was now that sounds like a extreme amount of money for a non-emergency procedure, done calmly by appointment and by referral from my primary doctor.

Per https://www.fairhealthconsumer.org/, the typical cost is $60 based on these ICD codes. I’m lucky that my bills include procedure codes, because I can look them up and see the expected charge for this specific type of X-ray. There was one code for the wrist and one for the hands.

Okay so back to Kraków

Our guide, he helped so much, he found me ice for my face.

We also found a nearby pharmacy with a doctor’s office also directly attached to it. We went inside, they were not really staffed at this time, but one person there offered to take my blood pressure. And she said the closest hospital was in Nowy Targ, a town nearby, we should try. I felt super glad that we were with our guide who at this point in our trip was going to take us to see another castle, as part of our pre-planned trip package, but instead he agreed to take us to the hospital.

At the hospital, the first step in was to take a number and talk to a person at the intake about what happened.

Okay so, Because of the stressful situation and my prior X-ray experience back home, I didn’t want to make the same mistake of receiving healthcare without knowing the cost, so I asked, hey let’s do one procedure at a time. I said that I want to know what to expect and what the costs are for the procedures, before I agree to get each treatment, because I was abroad and I did not have the same insurance situation here.

After reading Marty Makary’s The Price We Pay³, I had information I wanted to act on well. The triage nurse said she doesn’t have these answers and that the person handling the billing left for the day. It was after 5pm, after all.

Since I did have travel insurance, so I checked my policy email and I called the number and I was able to reach them pretty quickly and they said they can cover $15,000 in medical, hospital costs, so that was pretty reassuring, so I decided, okay, lets do the out of pocket. I went through triage, and got an a eye exam, with a light, and then, with closed eyes, had to touch the tip of my nose, with my left and right hands. Then I had to take some steps forward with eyes closed too.

Apparently I aced the tests. Next, I got asked to sit back outside, keeping an eye on my number on the monitor. I saw my number now appeared on the next step with a green circle next to it, noting non urgent, and a expected wait time of 2 hours 59 minutes. Except this went to jump over three hours, when another person came in, with higher urgency.

Next to us was a woman in crutches and we she said, haha, that she could walk back home faster than they would call her back in. So sitting around there for maybe twenty minutes half hour, it felt like a dead end. So I was basically, I felt bad also, that our guide, wow what an amazing person, he stayed with us, all this time. I went to the front again and went to say okay, since you guys put me on green non-urgent status, low priority and since I did understand the next step they wanted to put me through was a tomography so I thought okay let’s drive back to Kraków and we can eat then I’ll find another hospital for the tomography. So after our guide drove us back, I was thankful that he stayed with the us in hospital, but when asking him if he wanted to grab food, he said actually he has to walk his dog. Wow such a kind person.

So after grabbing a bite to eat with my mom, I went back to the hotel, okok - I gathered my stuff also an extra water so yea, it is now like 23:00, I took myself to a nearby hospital, one I found on my phone during the drive back, which was just a 10 minute ride share from the hotel, cool. But oops, I go there and oh no, it looks pretty closed I walk around the whole city, block, nothing. Anybody home? I look on google maps again, oops, first review, one star, person saying, they are not a 24 hour facility as said on google map. Oops. Okay I find another hospital, and I go there instead, open door, try to anyway, closed, damn, but wait, another entrance cool, open, guy at door say fill out form, okay I fill, so a few minutes in, doctor attending opens door to a room and asks me if I need help, okay I go inside, fill out a different form.

For out of pocket - so kind of the cool thing I really appreciated, they were super accommodating, I explained my situation about my head injury and about the last hospital putting me on green status, and then the attending said that they don’t really do that kind of thing here, but, he said, well they can do the tomography though. So the nurse said that, even, without my asking, it will be a flat cost of 750 PLN, so there was no one else there and I was like, ok here is my Capital One, credit card, and she gives me the machine, I tapped my card but it is refused haha oh no, I see on my phone it says went through though umm, we try one more time, because I notice on capital one, not a decline but a charge and instantaneous refund. I said I would call my card company. They said it was probably the merchant’s fault. And yea card was working just fine up until then and the capital one representative said yea, you no longer need to declare your travel, so yea it wasn’t being treated as a fraud charge. Okay I go outside for on ATM of like looking after midnight the ATM search sucks unfortunately, both for my Google Map search and oh my ATM finder on my bank app, because sea I see the ATM yea haha behind a closed gate for a locked restaurant. I just keep walking to the next one on my map, but before getting to it I luck out find an ATM not on map and I am able to do a cash withdrawal.

I go back to the hospital, I pay in cash, and tomography MRI looking machine although they put a lead guard on my body so maybe CAT scan. Nurse says, they will send it out to specialist. So I should wait A few hours. Haha okay I ask can I go to my hotel? At this point it was about 2AM.

She said the specialist could take one hour or five. Okay yay sounds like I can get some sleep? She said I should call them at 5AM, or if not ready, results yet, I should try At 6AM. Ok, I decide to walk home well to hotel, because only a mile away, walking back, ok cool, ok and the walk back was so relaxing, so fresh. And at home, well, at the hotel, it was pretty late now. I knew I needed to set my phone to wake me up at like 5 am and it was maybe just two three hours away. I attempted to sleep, and 807 maybe some snooze then, woke up, I called the office, and the nurse recognized me, and said, okay I should call back in like half on hour. Haha I thought wow, that’s not even what they give pilots for their forty five minutes of sleep on a plane anyway, so I set another alarm, for half hour later, and basically when back I called the nurse said pretty excitedly, that I my results come in actually, 5 minutes after the last time I called. And that anyway, I should come in to get them because I should check out as the patient.

Okay, so I took one more Uber, and the driver said something cool really on the goodbye. He didn’t say, bye, good day, he said “have a successful day”, (“udanego dnia”) so yea when I got in, the same nurse was there, wow, so she was there from at least when I come in, until of least the morning, which was maybe 6AM when I - got in. And yea every one was in a really good mood, and indeed it was a beautiful morning, but haha; I was wondering, how do we all have such amazing moods if basically no one really slept.

But anyways, I read my radiology report, It was basically perfect. Final radiology diagnosis, injury on the Dunajec. And headed back to try to get some more shut eye before having to check out of the hotel. I met my driver on the way back, and without thinking, I sat up front shotgun with him, because his car only had two doors. I afterwards noticed that he did have seats in the back but you have to push the front seat forwards to get back there. But haha he said it was okay and that ended up being a nice icebreaker to talk anyway. We were reminiscing how the morning is so great, because the rest of Kraków is still sound a sleep, and he said he likes it because he likes to run in the morning especially when it is very peaceful and empty. I asked how he likes it and he mentioned he likes longer ultra marathon runs and one time he even did one month of marathons, so one marathon per day. He sounded like a really kind person too, because he said at one point he had trouble with his knee and he could not run so intensely and he used that as an opportunity to pair run with blind runners.

Later in the trip, I saw family in Warsaw afterward. A cousin who is a surgeon mentioned that my brow bone had done its job protecting the eye, so that was definitely a fun aha moment about our biology.

So what’s next

Next, I should gather my claim information and add it to my travel insurance. I should update this anecdote then later, with that experience.

References

1. https://en.wikipedia.org/wiki/Gorals
2. https://en.wikipedia.org/wiki/Punt_(boat)
3. https://www.fairhealthconsumer.org/
4. Marty Makary’s The Price We Pay