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Ouch that hurt!

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Most of the time I’ve come to appreciate the low-cost, bare-bones Czech medical approach. I’ve gotten excellent care during pregnancy, including an emergency appendectomy, and my three children have been treated for their share of childhood illnesses with minimal antibiotics by competent doctors. However, there have been a few instances, particularly with the pediatric care, when the most traditional Czech approach has seemed a little too straight-forward. Or, to be quite honest, too painful for my liking. In each of these cases, unfortunately, I wasn’t the one experiencing the pain, it was my child.

I have more than once found myself caught in the dilemma of deciding whether I should trust an approach or a way of doing things that’s different from what I’m comfortable with (and going to cause my child some pain), versus the alternative of raising a fuss and requesting, or trying to come up with, a different solution.

For the most part, Czechs have been trained to trust their doctors. Czech doctors use this trust to their benefit and don’t expect to answer patients’ questions or provide unnecessary explanations for what they deem necessary procedures. Of course, the situation isn’t that black and white. I’ve found many Czech doctors, our pediatrician included, who are willing to answer my questions. Yet, doctors here are not compensated for their time, as they are under a privatized healthcare system, and the volume of patients that filters in-and-out on a daily basis doesn’t lend itself to personalized attention. I’ll never forget the day I walked into a pediatrician’s office when our doctor was on holiday to be greeted by a gruff, “Co Vam je?” Basically, “What’s wrong with you?” Radek said the greeting was customary and not as rude as I had interpreted it, but he agreed that that particular doctor wasn’t sending a very customer-friendly message, even if she was competent.

When we talk with our Czech friends, the general consensus is that the quality of Czech medical care is excellent, in terms of well-trained, skilled physicians and medical personnel. Yet the external appearance of hospital facilities and medical equipment often seem antiquated, at least at first glance. My friend recently shared a story of the bed her daughter was placed in after she had surgery on her eardrum. Although the child was already 7, the bed still had crib-like bars for a baby, so when she wanted to pee, she had to call the nurse to get out. I also recall walking into a children’s dentist office in Prague for our first check-up and watching the doctor pull Anna Lee’s wiggly tooth with something that didn’t look too different from Radek’s workmen’s pliers. In both cases the children weren’t affected by the equipment used and the care seemed adequate.

Recently, however, our newborn Samuel was diagnosed with a blocked tear duct in his right eye. The problem was first noticed by our pediatrician during her initial home visit, and she demonstrated how to administer antibiotic drops and massage the duct daily. When at seven weeks Samuel still had a gunky eye, she referred me to the eye specialists at the Bulovka hospital. They would check his eye by running some dye through the blocked tear duct, she told me, and if necessary they would perform a cleansing procedure. From the information I’d gathered from reading my baby books, most blocked tear ducts eventually open by themselves before a baby’s first birthday. In rare cases, my books said, a doctor might have to surgically open the ducts by sticking a thin wire through the duct. The surgery is done under anesthesia.

Although I should have already known that Czech doctors don’t spend a lot of time explaining their procedures to patients, I went to the hospital thinking that I would gather more information and then decide for myself if the “procedure” the doctor had mentioned was something I wanted to have done for Samuel. I assumed as his parent, I’d have the choice. However, when I went to the hospital, nothing was as I had imagined. We gave our referral and Samuel’s insurance card to a grumpy nurse. There was a long line of parents with infants, all of whom looked a bit older than Samuel, sitting in a narrow hall. No one explained what would happen, so I sat down to wait. After a few minutes of watching, I realized that a different nurse was calling parents by their last name with their infants into an office. After two or three minutes the parents would leave and the infant would stay. In a few more minutes, we’d hear a baby’s blood-curdling howl and then the nurse would appear and shout Maminko! (Mommy). The mother would go back into the office and reappear holding a screaming baby with a tissue over one or both of the baby’s eyes.

Even though I watched the process three or four times, when the nurse called, “Průchovi!” I didn’t anticipate that we would soon follow suit. The doctor asked me which eye was bothering Samuel and how I had treated it. Then he told me to step outside for a minute and they would have a look. Not until the door clicked shut and I heard the subsequent ear-piercing scream did I realize that the situation had slipped out of my control. I sat down, trying not to cry, thinking that if I had just asked a question or made the doctor pause a minute I might have realized what was going to happen. But caught up in the natural in-out flow of patients, I hadn’t dared miss a beat. A few (long) minutes later the door opened, and I was called into the office where the nurse was holding a howling Samuel and pressing a bloody tissue to his eye. I could see a tray with bloody gauze and a few metal instruments. Every negative thought I had was racing through my mind. I took Samuel in my arms and started to cry.

The doctor looked at me and my melodrama without blinking. Without changing his expression or demeanor, he simply told me that Samuel’s eye canal was blocked, and now he had cleaned it. It may bleed from his nose for a day, he said. I was instructed to apply pressure for a few more minutes to the eye and then to give Samuel antibiotic drops for a week and return at 8 am the following Friday. The conversation was blunt and to the point. I had so many questions, but all I could muster in Czech was my irrational fear, which I blurted out, “Is it possible that he won’t be able to see?” The doctor looked at me quizzically and shook his head. The nurse told me to stop crying. The baby was screaming because he’d been strapped down, she said. It’s over now.

The routine procedure might have been over for them, but the nightmare of doubt was just beginning for me. I couldn’t believe I hadn’t realized that the doctor was going to perform the procedure straightaway. I also couldn’t believe that the procedure had gone all right if Samuel’s eye was still bleeding. Since no one had explained the procedure, I didn’t even know exactly what had been done. No blood came from Samuel’s nose, but on and off for the next day his eye bled. I called our doctor and though she said that a bit of bleeding was normal, she suggested that I call the eye doctor if I was concerned. Talking to a friend whose son had the procedure done didn’t do much to assuage my fears either. She told me that her son had stopped crying as soon as the procedure had finished, there had been no blood, and it had been instantly obvious that the duct had been cleared. I called the hospital to ask if I should bring him back. The nurse told me if it was bleeding a lot I should bring him, but a little bit was okay. I couldn’t figure out how much was a lot, but it wasn’t gushing out, just oozing, so I decided that the hassle of getting all the children to the hospital on the other side of town probably wasn’t worth it, unless the blood continued.

On the second day after the procedure Samuel’s eye stopped bleeding, but continued tearing up, just as before. I asked Radek to go to the doctor with me for the follow-up appointment because if the procedure had to be repeated, I didn’t think I could handle the stress of going alone again. I also wanted him there because he’s more assertive than I am in most situations, so I thought he might have been able to step in better than I had. But Radek encouraged me to be strong and said that he believed I could handle the situation without him. He felt certain that the doctor had done what was best for Samuel.

With anger boiling under the surface, I went to the follow-up appointment ready to fight. When our name was called I went in and explained that I didn’t think the procedure had worked because his eye was still tearing. We’ll just take a look, the doctor said, and before I could protest I was out of the room again. With my fingers crossed, I hoped for the best. The door opened a minute later and I didn’t hear any screaming. The doctor was holding a nose-to-mouth suction hose which he explained they’d used to clean Samuel’s nose. Your baby has mucus blocked up and it’s coming from his eyes, the doctor told me. You’ll need to suction his nose regularly, but his tear duct is fine. Relief washed over me and I suddenly felt a bit silly for having doubted the doctor’s expertise and the effectiveness of the Czech method.

Although I wouldn’t want to have to put Samuel through the same procedure again, in retrospect, the Czech method doesn’t seem as horrible as it did the first moment when I saw Samuel’s bloody eye. I believe a large part of my anxiety was created by the atmosphere of the hospital, which was a pretty typical Czech hospital. After years of living in the Czech Republic, I should be used to this approach by now. But, particularly when it comes to my children, I doubt I ever will.

As our children grow, they’re going to be ill or have accidents and need medical attention. I’m grateful that I’m learning that just because it’s not typical to question doctors in the Czech Republic doesn’t mean that I can’t or shouldn’t have questions. In most cases, the questions I’ve raised have been answered with honesty and have helped me better make a decision regarding our children’s healthcare or have helped me better understand why a method that seems foreign and painful could be the appropriate treatment for a given situation.

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