packing…and the emergency room.

October 24, 2012

My journey to the States begins late Sunday night, and I’m starting to pack. I’m taking all three of the suitcases in my luggage set, but for the trip there, I’m hoping to close my medium suitcase in my large suitcase, so that I’ll have a whole extra piece of luggage with which to bring back delicacies from my homeland.

Regarding my trip home, I am currently maintaining two lists in my iPhone. One is titled Things I Will Eat While In Missouri–i.e., things I love but haven’t been able to source here in Riyadh and can’t feasibly be brought back with me. So far, the list includes Springfield cashew chicken with crab rangoons, real mozzarella cheese (the super-soft kind that comes in a ball), Pillsbury Toaster Strudels, Cream of Wheat (although I know this is technically just semolina, which is plentiful here, I haven’t been brave enough to just buy a bag and try to cook it. The red box–and the directions!–are comforting), my mom’s French toast, my dad’s pancakes, artisan pastries from Chantilly’s…and Claussen’s dill pickles.

My other list is Things I Will Bring Back To Saudi Arabia. Thin Mints! (Oh, how I hope I can find them!) Cranberries! Grits! Those pink-and-white frosted animal cookies with rainbow sprinkles! Cheez-Its! Pop-Tarts! Triscuits! Those pastel after-dinner mints that melt in your mouth! Tums! (For both me and my husband.) Swiffer Wetjet refills! (For both me and my mother-in-law.)

However, while I already have a detailed plan for bringing things back to Saudi Arabia, that is not to say that I’m not bringing many things to the tried and true homeland from the new one. I’ll have even more space in my luggage once I give away the presents and treats I’m hauling home.

My suitcase is already chock full of treats. I have an abaya for my mom (in the black bag)–she will need one when she comes back to Riyadh with me! Several Saudi mabkharas for friends and family. House thobes for my little nephews (my brother’s son and my best friend’s son). Sweets from Saadeddin for my cousins. A shmagh and igal for my dad. A big tin of maamoula type of Middle Eastern date cookie (sort of like a more decorative and more delicious version of a Fig Newton, but stuffed with dates–although you can get them stuffed with other fillings, such as pistachios) for my dad’s best friend, who came to Saudi Arabia in the U.S. Army during Desert Storm and came home with a taste for maamoul (and, as far as I know, hadn’t had them since his time in Saudi Arabia until he met my husband…I think one of the first things he mentioned to Saleh was, “Hey, so if you’re from Saudi Arabia, do you know about those cookies with dates in the middle…?”). I also brought home a wooden maamoul mold for his wife, so that she can take a crack at making them herself for him if she wants to.

As excited as I am to go home for a few days and see my family and friends that I love, I’m also nervous about leaving. I’m looking forward to being there, but I’m not looking forward to not being here, if that makes any sense at all. Having spent two years mostly on opposite sides of the world, neither Saleh nor I are quite ready yet for another international separation, however short it may be. A few days ago, as he was helping me organize my things to take home, I just burst into tears, threw myself at him, and sobbed, “I don’t want to leave you!”

Yes, I really wish that Mr. Mostafa were traveling with me. But at least this time apart is quite short. And my mom is coming back with me. It’s a good situation, and I’m grateful.

But I’m also nervous about leaving now because Saleh is under the weather. Last night, as I was composing this post (which was originally intended just to be about my prep for traveling), he woke up from a nap with a stabbing, unbearable pain in his right side. We quickly got dressed, woke up his brother to drive, and Saleh, his brother, his mother, and I all headed for the emergency room to figure out what was up. We suspected it might be kidney stones, as Saleh had had kidney stones while in the States about three years ago, and the symptoms had shown up in almost exactly the same way. Still, since this time the pain was on his right side, visions of appendectomies crowded my head, and I was terrified that his appendix had burst or something like that.

When we arrived at the hospital (Dr. Suleiman al Habib Takhassusi Hospital), we walked into the emergency room entryway, where a nurse met Saleh, saw him clutching his side in pain, and immediately put him in a wheelchair and pushed him back to a bed in the emergency room. Once Saleh was in the bed, his vital signs were immediately taken and the nurse wrote down his symptoms and asked if he had any allergies to medications. Then he said that a doctor would be with us shortly and suggested that I go to the reception desk and check Saleh in and provide our insurance information, if we had it (we did). My brother-in-law and I headed to the reception desk (in case I needed a translator) while my mother-in-law stayed with Saleh.

By the time we got back, the doctor was there with Saleh, speaking to him in Arabic, naturally. I was lost, but I sensed a plan was in action. When the doctor left, he explained, “He is going to give me pain medication and then they’re going to figure out what’s wrong.”

The span of time between the doctor leaving and the pain medication arriving was about ten minutes. At one point, frustrated because Saleh was literally shaking in pain, I went over to the nurses’ desk and let them know that he very much needed some pain relief. The nurse at the desk said, “Yes, ma’am, the doctor is right there”–she pointed behind her–“getting his medicine now. He will have medicine very soon.” Sure enough, I saw the doctor prepping two IV bags.

A few minutes later, the nurse came back, inserted an IV in Saleh’s arm, set up two drips of pain medication, and gave him a localized pain relief injection. As all this was happening, another nurse wheeled in an ultrasound machine on a small cart. Once the pain drips were set up, the nurse left, telling us that the doctor would be back shortly.

We waited for about twenty minutes. Slowly but surely, the pain meds kicked in, and Saleh began to relax. Two doctors and the nurse came back to his bed. It was a little crowded around his bed, so my brother-in-law and mother-in-law went to sit in the waiting area for families while I stayed with Saleh. One of the doctors prepped the ultrasound machine while the nurse prepped him for the ultrasound, squeezing gel on several places on his tummy. The doctor began examining his stomach with the ultrasound transducer as the rest of us watched the screen.

And that’s how we found out that Saleh has one kidney stone of a significant size (about half a centimeter), and several smaller stones (the doctor called them “gravel”). The doctor prescribed a pain medication, an antibiotic (since he has a history of kidney stones…and also because I think the Saudi system is really antibiotic-happy to begin with), and lots and lots of water, and gave us a referral to a urologist at the hospital and recommended that we see him to establish further treatment, if necessary. I went to the reception desk and was able to immediately make an appointment (this was around one in the morning) with a urologist–if Saleh hasn’t passed the stones by Saturday, we will go to the appointment to see what else can be done. As I was doing that, my brother-in-law went to the hospital pharmacy to get Saleh’s prescriptions.

And that was it. We were home within two hours. Total cost for the emergency room visit, including medicines (with our insurance): the equivalent of less than $20.

I couldn’t help but contrast this experience with the one we had in the States three years ago. In that case, the symptoms started almost exactly the same way, except on the left side. We went to the emergency room at seven o’clock that evening. Saleh was obviously in excruciating pain, but he could breathe, talk, see, and move all his limbs (which meant he obviously wasn’t having a heart attack or stroke–the only way to get a straight shot to a bed in the emergency room if you walk in), so we had to sit at the reception desk while his insurance information was entered first thing. Then we sat in the packed waiting room for a couple hours, Saleh writhing in pain the whole time. Then he finally got called back to triage, where a nurse took his vital signs and wrote down his symptoms. We sat there for another hour or so.

Finally, he got a bed. Nurses checked in on him occasionally, but they couldn’t do anything for him until he’d seen a doctor. So basically, they’d look behind the curtain, see that he was still in pain, and leave. At one point, I got really angry and stomped out to the nurses’ station and demanded to know when a doctor was going to see him; he was in horrible pain and nothing was being done about it. They assured me that he would see a doctor “soon.”

Yes, after a few more hours, a doctor came, which meant Mr. Mostafa finally got some pain medicine, and he was able to sleep a bit. A nurse came and drew about eight vials of blood. Then another nurse came and wheeled him away, into an elevator, and up to a different floor for a full CT scan, which is how they found out that he had kidney stones.

He was prescribed two medicines, one for pain, and sent home after eight hours in the emergency room. But the pain medicine ended up making him horribly sick; he couldn’t eat or drink anything. So the next day, we were back in the emergency room. He spent 45 minutes throwing up in the waiting room restroom as we waited to get called back to triage. Then, once they took his vital signs, he spent another hour sitting in a plastic chair in the hallway, throwing up into a plastic bedpan one of the nurses had given him. Finally, he got a bed. After some more waiting, he got a medicine switch and some nausea medication. That emergency room visit was five hours.

Total cost for those two visits? The hospital billed Saleh’s insurance company about $15,000 (nope, not a mistype), and that was without his medications. Thank God the insurance was excellent and he didn’t have to pay anything. But what if he had been an uninsured American? God only knows.

And this is why I get so irritated when I hear people argue that “everyone in America has access to healthcare. If you go to the emergency room, they have to treat you.” Well, technically, yes. Emergency rooms in America are legally obligated to treat anyone who walks through their doors. But that is not access to healthcare. Relying on the emergency room for healthcare is not an efficient system. For one thing, when you walk into the emergency room for treatment and can’t pay, it drives up the cost for everyone else. For another thing, when scores of people rely on emergency room as their “access” to healthcare, emergency rooms are crammed, and wait times are ridiculous. When you let your ingrown toenail fester to the point where you can’t walk on your foot and then have to go to the emergency room, one, your treatment is more costly because you didn’t (or couldn’t) get the care you needed earlier, and secondly, when my husband shows up at the emergency room projectile vomiting continuously, he has to wait for a bed–and thus, treatment–for hours because you got there hours earlier and now have an emergency room bed for yourself and your ingrown toenail.

This isn’t to say there aren’t crammed emergency rooms with ridiculous wait times in Saudi Arabia. From what I’ve heard, there certainly are, although I haven’t experienced them for myself. But this situation is one much more likely to be encountered in a public hospital–where all Saudi citizens are treated for free. I hear so much nonsense about what America’s healthcare system will become if it is reformed, but all those fire-and-brimstone predictions are already happening in the States, except they come with a $15,000 bill. At least here in Saudi Arabia, if we didn’t have insurance, I could have taken Saleh to a public hospital and let him puke in the hallway for free. And even if I had taken him to an emergency room in a private hospital without insurance, the bill would have amounted to around $500, maybe $1,000, at the most.

From what I’ve observed, healthcare is accessible for Saudis, and it isn’t for most Americans. I have no doubt that when compared to Saudi Arabia, America has better, more innovative treatments available. America is a place of medical innovation, absolutely–companies are motivated to develop those innovations because in America, they can be sold at the highest possible price. And thus, many of those treatments are only available for those who can afford them.

I’ve mentioned in an earlier post that the last time the World Health Organization ranked healthcare systems, the United States came in 37th, while Saudi Arabia was ranked 26th. Saudi Arabia didn’t beat the U.S. because it has the most innovative cancer centers or the most brain surgeons. It doesn’t have either of those things; America beats Saudi Arabia by far there. What it does have, though, is a system in place so that all of its citizens can have access to healthcare–including emergency rooms when necessary. And America trails Saudi Arabia by far there.

I don’t want to make it sound like Saudi Arabia has it all figured out in terms of healthcare. It doesn’t. But what I do know is that I’ve seen my husband go through the exact same medical problem twice now–once in the States, and once in the Kingdom, and if he has to go through it again, I hope we’re in the Kingdom when it happens. I’m grateful that I’m getting a chance to experience healthcare in another country, because for me, it has really shed light on how broken the system in my home country really is. Even countries that Americans are trained to avoid like the plague (my mom: “I’m going to Italy!” Her friends: “Ooooh, how exciting!” My mom: “I’m going to Saudi Arabia!” Her friends: “Ooooh, are you scared?”) have certain elements of the healthcare system figured out much better than America does. Before I had ever thought of living in Saudi Arabia, I remember thinking, as Saleh writhed in pain in a waiting room chair, “There is no way that this is the best healthcare in the world.” I wish that someday, the powers that be all around the world would be able to put aside their differences (and their greed) in order to learn from one another when it comes to healthcare and its administration. Both Americans and Saudis would be better off for it.

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  • ellen557

    Agree with everything here! The public system in Australia can be shocking too. The wait times are horrendous, health professionals less than helpful… yuck. I was unfortunate to get sick in Indonesia once while we were on holidays there and ended up needing to go to the ER, I panicked, expecting it would be like Aus. Nope – a bed met me at the door, pain meds given once I told them how I was feeling, urine test done within 15 minutes, results given within the hour. All of this cost about $25 which we paid in cash. I also got a massive prescription lol, only filled one of them but seriously, the same trip in Australia would’ve just been hell for what it ended up to be.

  • Sandra

    Great post! And yes, having lived in several countries myself, I cannot agree more with your statement…if only countries put aside their differences, greed and pride, there would be so much to be learn from each others!

  • Anna

    Hi,
    I have been looking for mammoul moulds everywhere in Riyadh.
    Please can you tell me where I can find them, and where you purchased your one.

    Thanks so much.

    • Nicole

      hi, anna! you can find maamoul molds at any abou riyalin (2-riyal shop) in riyadh! just look in the baking tools section. you’ll usually find at least a couple different kinds in any given shop–some wood, some plastic, lots of different shapes. good luck! :)