A Tale of Two Fingers….and One Tendon

November, 2009 – Belmont, California

My Japanese garden machete is from Soko Hardware in San Francisco. Soko is one of those urban hardware stores where in addition to finding screws, toilet plungers, and extension cords, there’s a large selection of white paper lamp shades, pottery in dark blues, greens, and golds; metal teapots, and craft tools: rasps and planes and chisels for woodworking; shears and scissors for flower arranging, and gardening tools, so many gardening tools.

The machete has an 8” blade and a white oak handle of about the same length. The catalog description lists some samurai-sword-esque characteristics — Hitachi Yasuki steel, tempered to Rockwell c64, white steel, and so on. Many of my favorite gardening tools, sadly not used in recent years, are from Soko Hardware: a small two-tine weed puller, a curved, serrated root cutter, a bamboo saw, hedge shears, hoes, among others. And the machete: the perfect intersection of art and tool: is it sharp, heavy for its size, but well balanced.

At our home on South Road in Belmont that November we needed some kindling for a fire. We loved the home for its mid-peninsula location, view of the San Francisco Bay, and raised fireplace — we used any excuse to make a fire. I went into the back yard and around to the side where near the stack of firewood was a pile of fallen branches, smaller logs, and scrap lumber, all candidates to chop up into smaller pieces.

I gathered up some pieces, set them on a stump, held the wood in place with my left hand, and began chopping.

In hindsight it was one of those accidents that in the moment it happened, I thought I had a vision, a premonition of the accident just about to take place, and didn’t understand why it had happened if I knew it was going to happen. I’ve have that same feeling in auto accidents. In any case I chopped the wood once, chopped the wood twice, then on the third chop, instead of the happy crisp sound of wood snapping there was a dull thud as I struck the lower part of my left index finger, making a diagonal slash that immediately started bleeding.

Even in that moment of chopping my finger, I felt in my skin and in my bones the wonderfulness of the tool, its perfect weight and balance, it’s razor sharpness. It didn’t hurt a bit.

I dropped the machete and closed by right hand around my left index finger. I knew from past experiences that in about five minutes I might not feel so good, so I made my way into the kitchen, pushed a chair over by the kitchen sink, sat down, then called to Annie while I continued to apply pressure and elevate my left hand.

I told her what happened, how it might not be bad, and we might not have to go to the hospital. She gave me the look she reserves for lower life forms or errant children. We waited a couple more minutes. Then I removed my hand, ran some water over the finger, and as soon as Annie saw it she started getting the kids ready to spend Sunday night in the emergency room. The gash was wide and deep, and no amount of band-aids, pressure, and elevation, were going to close that thing up.

We went to Sequoia Hospital in San Carlos. We waited a couple of hours; the admitting nurse looked the finger and said there were more pressing cases. In time the finger was examined, cleaned, and stitched up. The doctor said I was lucky: no nerves had been cut. He gave me some special wraps to enclose the finger after hearing my concern about missing some upcoming swimming events.

The doctor also said I’d need to have the stitches out, but about a week later, using my Leatherman, Annie pulled the threads out.

The bill for it all was about $4,000. Blue Shield of California paid most of it — I had only a small co-pay, less than $200. At the time I was not working, or perhaps more accurately, I was not a W-2 employee anyplace. The month before I had been laid off from Playlist.com, but had the option of continuing my insurance under COBRA, which I had chosen.

~

October, 2010 – Saint Clet, Quebec

The cutting wedge on a John Deere 30 Ton Hydraulic Log Splitter, when oriented for vertical splitting, does not descend especially fast. Unlike a guillotine, the splitting wedge, which has a blunt, rectangular edge, descends slowly and steadily. Given this, the likelihood of an accident is remote.

But not impossible.

We were helping our wonderful cousins prepare for the Canadian winter; their home is heated entirely by a sophisticated wood furnace system in their basement, and it requires a lot of wood. The work that afternoon was hot, fast, and dirty: roll a big ass stump onto the base of the splitter, send down the wedge, watch the piece of wood split into two, three, maybe four pieces. If a piece was not split small enough, we’d put that piece back under the splitter, holding it in place until the wedge made contact with the wood. Other times there were knots in the wood so dense, that instead of splitting the wood, the knot was pushed into other parts of the stump, and drove those apart.

Sometime in the late afternoon I set a stump on to the splitter, and the wedge started down. At that moment the stump slipped off, and while working it back into place, the splitting wedge made contact with my left thumb, and pushed it steadily and inexorably into the stump. Luckily, there was no knot underneath, otherwise it could have been really gross. After a moment the stump gave way under my wedge propelled thumb.

I was wearing leather gloves, and did not immediately remove them as my cousin drove me to the nearest hospital. The split was on the side of the thumb near the end, right at the nail. There was a bit of ground beef look to the mashed up tissue. When the hospital admitting clerk learned I was an American, recently from California, she asked me first for a credit card, then second if I had ever met Ellen DeGenerese; she was disappointed I had not.

A young doctor came in, examined the thumb, cleaned it, then stitched it up. Just to be safe he gave me a tetanus shot. Total bill was 635 Canadian dollars.

~

April 2011 – YMCA, Montreal and Burlington, Vermont

From the outside a squash court does not look like a dangerous place. And in my experience, it rarely had been. Playing doubles squash while in college, I had walked in to the follow through of an excellent forehand shot by my friend Greg. No one wore safety goggles back then. His racquet hit right on the bone of my eyebrow, leaving slight diagonal scar, not unlike the one I gouged twenty-five years later on my index finger. Otherwise once or twice during a match, you might be hit in the back by the ball, the pain depending on the type of ball being used. In those days I recall a hard green ball being sometimes used; this pain was local, but deep. Otherwise we played with rubber black balls of varying hardness, but once the ball was warmed up, when it hit your back it flattened and spread, the pain not so deep, but broader.

That spring we had decided to move to France, but remained in Montreal while working on the visa process. We had joined the YMCA, their facilities were excellent — they even had some squash courts, and Annie and I would play once in a while. The problem was that while she is a very good athlete, Annie had not played before, so the games were not so challenging. Sometimes I played left handed. One morning I had the excellent idea of letting her get within one point of winning, then seeing if I could catch up.

I once heard a story from a football coach about the time his achilles tendon snapped. He claimed he heard a pop sound just as it happened. That never made sense to me; why would something go pop?

At match point for her win, Annie served, and I made ready to cut loose a devastating kill shot to begin my rally to victory.

When my tendon cut loose, I swear there was the softest of popping sounds.

There was a slight sensation in my right ankle, and more than the pain, I was confused about why I could hardly move my right foot.

We spent the afternoon calling around, but no Montreal doctors would see a U.S. citizen. Finally I did see a sports therapist, Renee, Dutch but somehow working at Action Sport Physio; she said as best she could tell, I had ruptured the tendon, and that I should see an orthopedic surgeon as soon as possible. They loaned me a pair of crutches, saying to return them as soon as I got some of my own.

The next day, a Friday, as we walked into the emergency room at the Fletcher Allen Hospital, the first thing the attendant (who looked like the actor Stephen Root) asked me was if I needed a wheel chair (I didn’t — the crutches were fine), then asked me for my name. When he found my name in the database, I had two immediate thoughts: the first was why my name was even in the database, not remembering if I had ever been to the hospital, and if I had, did it have anything to do with that blind date my freshman year, a date I was never sure how it ended, except that there was no second date. My second thought was that whoever was responsible for the hospital’s IT system had done an excellent job of migrating old records, twenty-five years old, into a new system.

The day before, after talking to Annie, I had decided we should drive down to Burlington, Vermont. I knew the town from my university years, and once back in the U.S, I could use my health insurance to cover the costs of whatever was needed. Or so I thought.

That morning we met with a physician’s assistant, and she made an appointment for us that afternoon with the orthopedic surgeon. The orthopedic surgeon confirmed the rupture, explained that is was a standard procedure to re-attach the tendon, and he could schedule a surgery appointment for that Monday, two days later; otherwise his next appointment was two weeks later. We went back to Montreal that night and returned Sunday afternoon; Catherine, Annie, and I checked into a hotel in Burlington.

I was up at 5:00am the next morning for a pre-surgery shower with a special anti-bacterial soap, and by 6:00am I was in the surgery ready room with about eight other patients, each of us in our own sort of bay with a pit crew. In as much as something like this can be fun, in an odd sort of way it was. The anesthesiologist gave me a pre-operation shot, then sat next to me during the entire procedure — I was face down, drugged, but awake, while the surgeon and team worked on my tendon. The degree of control by the anesthesiologist was stunning: he used a combination of drugs and some sort inflatable bike tube thing, wrapped around my waist, to control the pain. One part of my body was numb, but an inch higher and I could feel everything. As the surgery finished, he deflated the bike tube, and said in about three seconds I’d start to feel my legs, and he was exactly right.

That night we were all back in Montreal, bringing with us a rather large amount of pain killers the hospital had given me. I ended up taking maybe six or seven tablets only; it’s not that I’m especially tough, it’s just that the pain wasn’t so bad.

The team at Fletcher Allen were great.

The total cost was about $12,000, of which my insurance company paid about $4,000,

~

France and Switzerland, since 2011

For our first five years in France we carried private insurance. We had no employer to provide coverage, and under our visa type for those years we were not eligible to participate in the French national health care system. That changed when we got our ten year visas.

We’ve been lucky: except for one major incident, everything else had been the usual: children’s colds, a check-up for sports, a needed in vaccination. We paid everything out of pocket: a doctor visit cost 23€, a specialist visit a little more. Most of medications have been over the counter, and are not expensive.

In January of 2016 I got hit by shingles around my right eye. It was a nasty, painful experience. By the time it was also over I had made three or four visits to a specialist, and taken some drugs, and more interesting, was on a regime of what seemed like several hundred eye drops per day over the course of several months. These drugs were more expensive than anything we had previously bought in France: generally more than 50€ but never more than 200€; in total I spent maybe 400€. According to a pharmacist in the family, had I been in the United States, those drugs would have cost five times as much.

~

Readers may wish to quibble with several portions of this narrative, mainly the incidents in Canada and France.

  • The hospital doctors’ bills may not have been the entire actual cost.
  • Related – the medical services were subsidized by the government, made possible due to higher taxes on those citizens.
  • It was my thumb, not finger that got smashed. Therefore the title of this article is misleading. Thumbs, like tomatoes, are misunderstood.

My views are these, in order, are: probably, true, and yes, they are.

~

In all cases the treatment outcomes were good: I got fixed up or generally better.

Financially only one was problematic: the case of the torn tendon. My insurance company refused to pay any more than they did (and even getting them to pay what they did took many months and an excessive amount of paperwork); among the numerous reasons for not paying more were that the accident occurred in Canada, that where I got treatment (Vermont) was a long way from my residence (we were residents of Maryland), differences in customary charges for procedures, the CEO had a boat payment due, and so on. This is not a new story.

~

I never thought about health care until I had to. Why would anyone? As you age, or something happens, be it a diagnosis or job loss, you then start to learn, real fast. For me, interest in the topic was originally not out of necessity, but more accidental. I read Michael Crichton’s Five Patients when I was a teenager, then later, maybe the writings to Atul Gawande in The New Yorker, of the economist Paul Krugman, and Bob Somerby who is critical of the press’s coverage of health care.

And then there is life itself. Two friends, both women, had chronic illnesses starting in their mid-twenties. They functioned well enough, but treatments were some combination of debilitating, slightly effective, and in both cases drawn out over many years. In addition, the gift of aging gives you the chance to make new friends: an internist, an orthopedic surgeon, a proctologist.

And then we moved around and had to get coverage, so I got a little interested in the topic.

According to the data here, life expectancy in the United States ranks at twenty-seven, although when you look at the actual numbers there’s not a dramatic difference when compared to the higher ranking nations. Where there is a dramatic difference is in the cost. To take two random countries: the 2016 average per capita expenditure on health care in France was $4600; in the United States it was $9892 — we’re paying twice as much but we ain’t living twice as long.

Please note a key distinction here: there is how much the health care costs, and then there is the separate issue of how it is paid for. In France it’s a government system, with the option to buy complimentary private insurance. In Switzerland, where I now work, each person is responsible for their own insurance; your employer might have an arrangement with several companies to receive a small discount, but it’s all private.

A government solution works. A private solution works.

Being ill or injured is bad enough; living in a first world country and not being able to do something about it is an atrocity — an atrocity that is distributed across towns and states, and so gradual to happen that it’s only long after the fact that we see what has happened.

The French don’t have to drive to Spain, Italy, Switzerland, Luxembourg, Germany, or Belgium, because they can’t afford the drugs they need. But if they did, at least they have more options than Americans!

The French don’t die because they cannot afford health care.

The French aren’t driven into bankruptcy because of medical bills.

Here’s my favorite: no one dies because of coverage denial due to a pre-existing health condition. Neither in France nor in Switzerland, were we ever asked if we had any pre-existing conditions. The only questions ever asked are sex and age.

Are the health care systems in these other countries perfect? No; they are flawed just like all systems are. But some are better than others.

Does the United States offer excellent health care? Yes. But there is something very wrong. Charles Simic, writing in The New York Review of Books, said it best:

Unlike us [Americans], other countries have the peculiar notion that profit has no place in any situation in which the basic decencies that human beings owe to one another ought to be the first consideration, and for that reason regulate the cost of life saving drugs and operations. In other words, they are less greedy than we are and far more humane.1NYRB blog: ...continue

~

The two friends I mentioned earlier, they generally got better. Between the two of them they’ve given birth to six wonderful children.

As for me, I’ve been looking at some cool, new Swiss Army knives, but Annie’s not having any of it. She said with no one around to drive me to the hospital, I’d better save my money for something else.

References   [ + ]

1. NYRB blog: http://www.nybooks.com/daily/2013/04/02/new-american-sadism/.

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