When our family planned a three-month summer abroad, we congratulated ourselves on our preparedness: We'd fully checked off our packing lists, purchased public transit tickets in advance, and invested in a last-minute travel insurance policy—just in case. What we hadn't prepared ourselves for was actually having to use that insurance plan. But then on the night of the 4th of July in Cologne, Germany, my six-year-old daughter fell in her sleep from a second-story loft bed and suffered a fractured skull, traumatic brain injury, and broken clavicle.
Experiencing her injury in a foreign country was an education I never dreamed I'd get during our time abroad, and one that showed me just how disparate two nations' hospital systems could be.
I first realized that things would be quite different in Germany when the ambulance reached our apartment and the emergency department doctor himself stepped out of the vehicle. There on the street he performed his initial assessment. Once he determined my daughter had broken her “Schädelbase,” the base of her skull, we knew we were headed for the hospital. Even in the haze of my terror, I actually felt thankful, that someone so qualified was already involved in her care.
Upon arrival at the Uni Klinik (University Clinic), at least a half dozen doctors hovered in the triage room discussing my daughter’s care. In my every experience with American ERs, even with the utmost level of pain or worst injury, I can’t recall seeing more than two actual doctors conferring with the patient at one time—and I’ve definitely never seen them hang around as though they had nowhere else to be. But here, the doctors remained in the room with an air of mellow nonchalance, even after they had answered all of our questions. I actually felt the urge to tell them they could leave if they had more important matters to attend to. And I did wonder if their assemblage said something about the seriousness of my daughter's injury.
Gradually, they departed, except for a young pediatrician, who sat by me in the room as I attempted to wipe encrusted blood from my daughter’s face. The German tendency to eschew small talk was obvious in his silent presence beside me. Any initial awkwardness passed as I relaxed in to the idea that he considered quiet comfort part of his role as a physician.
The surprising amount of doctor involvement continued throughout my daughter’s five days at the Uni Klinik. When my child required an abdominal ultrasound, a doctor performed the procedure and narrated to me exactly what he saw as he did. No mysterious “hmms” or worried looks on a radiology tech’s face, no hours of waiting for a radiologist’s interpretation like I’ve so often experienced in the U.S. Just information on demand, directly from the doctor’s mouth. I could get used this, I thought.
As the days went by, however, another, less agreeable difference revealed itself: the staff’s high expectations of parental involvement in their kid's physical care. In retrospect, I can appreciate the mentality that parents desire and deserve an active role in their child’s healing, but the first time a nurse handed me a medication-filled syringe to put in my daughter’s mouth, I hardly knew what to do with it.
Over the course of our hospital stay, it was assumed that I would bathe my head-injured daughter without assistance from a nurse, return all the dishes from her meals to the hospital kitchen, and even lift her from her hospital bed to a wheelchair to transport her to appointments in other buildings. Having no medical background, I felt completely unprepared for many of the tasks I was called upon to perform.
Still, once I got used to these expectations, I started to appreciate that the German healthcare system feels less institutionalized than it does in the U.S. and a lot more like home care.
The evidence of this was all around—in the lack of state-of-the-art TVs and other technology in every room, or in the way that the walls of the ward were decorated with children’s artwork in all its imperfect glory, rather than framed photos of benefactors. Even the fact that my daughter was never given anything stronger than Ibuprofen reflected this less aggressive treatment environment. While this more relaxed attitude sometimes made me rather uneasy (weren't they supposed to be pumping her full of heavy-hitting painkillers?) it probably had the effect of putting my daughter more at ease.
The home care vibe extended to how nurses treated me as well. Once, when I was so exhausted that I felt faint on the walk from the ER to my daughter’s room, a nurse brought me pillows and a blanket and instructed me to lay down right there in the hallway, before she went on to offer me a cup of coffee. It’s hard to imagine this scenario playing out in an American hospital.
After my daughter’s eventual discharge came the last dreaded phase of any hospitalization cycle: the wait for the bill. In anticipation of whatever fees we had racked up, my husband scrambled to coordinate our travel insurance with our own American health insurance in a headache-inducing series of phone calls and emails. We needn’t have worried. For everything—ambulance transport, five days in the hospital, every image, every test, and even two follow-up appointments—the bill in its entirety, before insurance coverage, totaled $2,500 USD. I can only guess how many hundreds of thousands of dollars the same treatment would have cost in the U.S.
While I never hope to repeat anything like the five days my daughter spent at the Uni Klinik, they were evidence of a truth I often tell my kids about difficult times: “The hard things are the good things.” This “hard thing” forever changed my perspective on the meaning of health care in my own country and abroad.
The German hospital experience opened my eyes to the ways medicine in America could evolve. If only our system could embrace the notion of quality time between doctors and patients. If only we had the courage not to treat every ailment so aggressively. And if only we had the compassionate legislation that would allow for more affordable and accessible healthcare.
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