Madrid blog--Different Perspectives on Medicine

House-calls

One of my most pleasant surprises here in Madrid is the discovery of a pediatrician who not only gives you his cell phone number (that he picks up), but who will make house-calls. With four children, one of whom is in his first year of preschool, can I say what a life-saver this is.

Dr. J is probably way over-specialized to be dealing with my children's flus and sniffles (he's also a neonatologist), however, he never makes me feel bad when I call him, even one time when the school secretary sent my daughter home saying she had conjunctivitis and it turned out to be a pimple on her eyelid. I am under no illusions that tending to my progeny's medical needs has much to do with what he studied in medical school, however since the morning portion of his work is related to social-security and making the rounds of day-cares, I feel like a relative prize--something along the lines of Mrs. Pumphrey with her pampered lap dog Tricky Woo from the BBC series "All Creatures Great and Small," about a Yorkshire veterinarian in pre-war England. Or, at least someone who pays full cash fees for quick and easy work. On that note, I need to think of Christmas present to send to the nice Dr. J. to express my gratitude to him.

The Great American Medical Factory

I really like my children's pediatrician in the US, but his office, part of a multi-doctor practice, feels like Grand Central Station. He's a good doctor, very in demand. To make an appointment with him for something like an annual check-up requires a minimum of six weeks advance notice. The children have to be really sick for me to be motivated to take them in because this requires a drive to a medical building with inconvenient parking, followed by a 45 minute wait with a bunch of other snotty-nosed children. You wonder what they're there for, and hope you won't be back in the office one week later with something far worse than the original illness. The American medical visit is truly a triumph of process engineering, with its supporting army of receptionists, medical techs, lab technicians, nurses, back office accounting and insurance professionals, its shiny medical buildings, disposable paper covers for examination tables, in-house testing with immediate results and its various protocols. By the time you go through the whole experience, the doctor is the person with whom you will spend the least amount of time.

I have the television series House, especially the clinic duty segments, to thank for the uncompromising vision of exactly how our doctors must view us: an endless procession of whiny patients with the same uninteresting complaints. Every time, Dr. W patiently explains the same thing to me. "Mrs. Fleury pretend that this is 1907 and I'm here with my little black attache case. There is nothing I can do for your child: it's a virus." I reply: "Yes, but he's had this for more than two weeks and he's not getting better," to which he replies: "He probably caught a second virus." Meanwhile, he's got some urgent communication from the nurse, which, from the little I can gather, involves a diagnostic tour de force along the line of "sarcoidosis with Colonel Mustard in the Billiard Room."

First Madrid experience, in the Office of Dr. "R. G. de L."
Same flus and colds, same forty-five minute wait with snotty-nosed kids, different hours, different decor.

Before I discovered Dr. J., I used to take the children to another doctor, whose name I got out of the health insurance booklet. Dr. "R.G. de L." is the only pediatrician in our neighborhood on our private health insurance plan (everybody else they will re-imburse at 80%). His hours are from 5pm to 9:30pm. His receptionist doesn't even know how to contact him during the day, so if you can't wait until evening, your only option is to go to "Urgencias," the emergency room, which everybody here seems to visit at the drop of the hat, whether it's because they can't see their regular doctor or they don't want to go to various different labs and wait one week for the results of a strep test. In fact, none of my Madrileno friends has ever heard of a strep test. If the child has white pus in the back of their throat, the doctors assume they have a throat infection and give you antibiotics.

Dr. R.G. de L., an older and very dignified person, reminds me of my childhood pediatrician, which is to say he says the same things as Dr. W, but with the the bedside manner of a mortician. "Madam, since this is your child's first year in preschool, you might as well expect for him to have a runny nose all the way through May. The cough is a healthy mechanism because it gets rid of the mucous in the lungs. If he wasn't coughing, he'd get a bacterial infection for sure."

His office isn't in a medical building at all, but in an elegant nineteenth century residential apartment building. As for the inside of the office, it looks like something out of a period movie from 60 years ago with reproduction antique furniture and books whose publication date probably coincided with the Spanish Civil war. Exactly nothing in the place is child-friendly, from the bay windows with low handles that my 2 yr old wanted to open and pitch himself out of, to the antique looking type-writer on the floor with loads of intriguing electrical wires. Ironically the only concession to juvenile furniture---plastic Ikea kid stools, posed the biggest problem. My 2 yr old proceeded to steal them from other children. Then he discovered that it was more fun to throw them on the floor and watch their legs and tops pop off. This was before he started to climb on the adult chairs and try and pull down the oil paintings (conveniently within the enterprising child's reach) and reach for handfuls of the random pamphlets with information about aloe vera hand creams, "sexo con seso" ("sex without stupidity?") for adolescents, even though I've never seen a child older than 9 at the office, and Parkinson's disease (in a pediatrician's office?) Needless to say I spent the whole time trying to control my little American savage, cowed by the disapproving regard of the other parents and, later, Dr. R.G. de L.

The one time I did bring all 4 children to his office, it was total chaos. The children brought balloons and proceed to run around tossing them to each other, screaming and fighting. My children not only stand out because of their unruly behavior, but also because of their number. With the exception of immigrants, the average Madrileno my generation seems to have one, at most, two children. I couldn't tell if it was with pity or disapproval that Dr. R.G. de L. told me, after our first vist "Usted tiene muchos hijos" "You have lots of children." At that point, I was so exhausted and worn down, I couldn't think of anything better to say than "Pues alguien tiene que tenerlos" "Well, somebody's got to have them..."

Chocolate con Churros--The Neighbors Strike Back

Some of you may have become acquainted with our neighbors in my previous blog entry. Since that time, they have not been idle. In addition to a hostile visit from the forty-something single woman who lives with her mother in the apartment below us, the building association (representing the owners of the exactly 12 units in this place) sent us a certified nastygram citing "numerous complaints" about the noisiness of our children and telling us that noise is forbidden in the building before 9am. Almost none of these people, in the almost four months that we have lived here, has ever bothered to introduce themselves to us, but they apparently organize enough amongst themselves to dispatch certified communications via the post office.

None of this bothers my French husband in the least. He, himself, has vivid childhood memories of ongoing noise complaints (regarding his brother and himself) from the curmudgeonly old lady who lived in the apartment below his family. One day, in a scene reminiscent of Tatie Danielle, his mother tried to shut the door on her, but the sturdy old hag stuck her foot out, at which point his father had to physically push her out.

I wonder if there isn't something particularly Anglo-Saxon, reinforced by the American high school experience, about the tendency to spend so much time worrying about whether people (whom we may not even like ourselves) like us?

In a nod to Stephen Colbert, my phrase of the day, came across it in a Canard Enchaine article about a French socialist political convention, is "petits meurtres entre amis," which I roughly translate as "little assassinations among friends." This phrase conveys, for me, two sentiments: a dismissive tone regarding a petty domestic spat and the slightly more sophisticated and cynical perspective that the greater the degree of intimacy among people, the greater the likelihood they'll be at each others throats--especially when the stakes are low.

You can't control whether people like you, but you can force them to respect you.

On that note, I exacted my own petty revenge on the neighbors. I complained to the landlady that the owners renovating the third floor apartment were giving the building keys to very unsavory sub-contractors--that these people entered the building at all hours of the day with no supervision, and that they were coming up to our floor acting like they were casing it out for future robberies (all true). The upshot is that they changed the keys to the building, thereby inconveniencing everybody. Because of the key situation, I found myself in the ironic position of letting the judgmental neighbors' adolescent children in the building at one thirty in the morning, when their parents were out of town. They were standing outside the door as we were returning from a party. We let them in and chatted briefly on the elevator, and, really, their children were quite nice.