Bonjhola

EP 67: Damien's Surgery Reveals Terrifying Differences in Systemic HealthCare Mentality between the USA and Europe!

• Rebecca West

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Welcome to Bon Jola, a podcast about two women, Amy and Rebecca, who each move from the United States to Europe to become expats. Amy to Spain and Rebecca to France. We're here to share the highs, the lows, and the logistics of this adventure. Encourage you to follow your own, move abroad dreams, and remind you that you're not alone when the going gets tough. Enjoy.

Aimee:

Rebecca? Okay, so, um, I know Damien had his surgery because I texted you that morning and was like, how did it go? What happened? And you said, oh, he didn't ever, or he was awake and talking the whole time. And I'm like, what the hell? And then we started talking about other things and so I like, what the hell, Rebecca, what happened? And how is he doing?

Rebecca:

Circle back. Okay, so we're going back in the time machine by, um, almost no, yeah. Two weeks. Exactly. Today is two weeks to the day from when he had surgery. And to answer your burning question, yeah. He was not put under general anesthesia for rotator cuff surgery,

Aimee:

Oh my God.

Rebecca:

we are pretty sure he was put under general when he had the same surgery in the United States a few years back.

Aimee:

So they treat rotator cuff surgery in France, like they treat colonoscopies in Europe, which is you don't get knocked out, you get to stay awake.

Rebecca:

I haven't had one, a colonoscopy, so I can't compare, but yes.

Aimee:

had one in Europe either, but that's what I've been told, and I'm like, you know, I kind of like that idea because honestly, if somebody is shoving something up my butt, I want to know what's going on. I'm sorry, but if you're gonna perforate, perforate my colon, I wanna be warned. Thank you. I don't wanna wake up afterwards with sepsis.

Rebecca:

No, I am gonna have to be on the other side of that, and if the worst is gonna happen, I would rather be unaware of it until somebody's already come up with a game plan for.

Aimee:

Well actually, um, perforated colons are more common in the US because people are put under and they do not have any feedback from the patient as they are going all up in there. So

Rebecca:

and this is the thing we are talking about.

Aimee:

cultural.

Rebecca:

differences in the healthcare mentality the threads of this are kind of hard to unravel in terms of what decisions have been made within which societies. But we do know that general anesthesia is dangerous. It's not, it's not natural to knock your body out and not let it do its job, in America we like reducing our pain. We

Aimee:

We wanna reduce any kind of discomfort that exists in our body or our mind at any cost. And I think

Rebecca:

for our lives. We want our sofas comfy, our waistlines comfy, and our surgeries comfy. And our birth process comfy.

Aimee:

Convenient, comfy, and convenient. And Look at where it's gotten us.

Rebecca:

I don't know, we have to remind our listeners this is one experience, right? So we have had one experience in the healthcare system and one surgery. So we don't want to assume that this is the only thing that's normal, but he was surprised he didn't enjoy the experience of hearing somebody drill holes into his bones next to his ear. Um, but the surgery went beautifully. He is already without stitches. all the nursing happened in our home, so he never had to go back to a clinic after the actual surgery.

Aimee:

Stop there. I find that exquisite, delightful, amazing, and far more comfortable and convenient than being put out during surgery. I. Like, let me stay awake during surgery if that means that money, instead of going to the anesthesiologist and the drugs pays for a nurse to come to my home to dress my wounds and give me medicine, I will take that. Thank you very much. I.

Rebecca:

Angles. First of all, the patient who is in theory broken in some way, doesn't have to. Get up and move around. Doesn't have to go into a hospital where there's a ton of germs while you're immunocompromised compromised. The

Aimee:

doesn't have to use hospital resources.

Rebecca:

exactly electricity. Uh, check-in staff, like clean janitorial, right? None of that is a cost. there aren't. Hundreds of individual clients transporting themselves from an ecological point, uh, perspective to a hospital. There's one person going to all of these homes. Yeah. It, it was so surprising when we were told that this was how it's going to work.'cause it's so completely the opposite of the United States experience, but it made so much sense as soon as we thought about it.

Aimee:

Yeah, well we haven't had that kind of care in the United States since maybe the sixties,

Rebecca:

And in terms of coming to your home, maybe the 18 hundreds

Aimee:

No doctors used to do house calls for like elders and, and in the infirm, you know, I think in the, even in the fifties and the sixties,

Rebecca:

and all we have now is hospice. It's only when you are at the end of your life that that is a thing.

Aimee:

Well, I, gosh, I'm just like, I feel like we would be such a much better society in terms of anti fragility if we. Stayed awake during things like colonoscopies and dental procedures, and even rotator cuff surgery. Although when you talk about drilling into my bones, it does freak me out.

Rebecca:

Do. I mean, it could be worse. My mom in the States, she just had a cancer removed from the top of her head.

Aimee:

Mm-hmm.

Rebecca:

They had to, it was, it was a big deal. They had to drill into her bones and that was a surgery that she did have to be awake for some reason for. So she had her skull being drilled into under non-general.

Aimee:

Wow. That gives me like Mayan past life flashbacks. That's wild. Was it the Mayans? Who was it? There was, I mean, there was a a, a, a culture in the Americas thousands of years ago that did do surgery on the skull where they would cut into to relieve pressure after a head wound. Um, like they had that level of technology back then and that level of understanding, and then it was lost for a while and then it came back. Um, yeah. That's intense.

Rebecca:

But like I said, everything went great. Um, did I tell you last time about like payment and stuff? Did we talk about like the

Aimee:

No, no. I like, we know, we know nothing. We know nothing. All, all we knew was that the surgery was scheduled, it was gonna cost, like, you know what the price of a week of coffees in Paris and,

Rebecca:

Yeah. So for example.

Aimee:

to go in.

Rebecca:

The, well, no, I, I don't wanna start at the end, do I? All right. Yeah. For example, those four nurse visits were mostly covered by car vial, the, the social healthcare system. So as I think I've mentioned before here, there is socialized healthcare and it doesn't cover. Everything. I don't exactly understand what the rules are for what's not covered, but there's always a bit of a residual amount. And most French people have a mutual, which is that top up insurance. So when you go into the hospital, they say, do you have your cart vital? And hopefully the answer is yes'cause it's really easy if they literally like swipe it like a credit card. That's the system. Now the system is set up to directly pay the bills with very little administrative burden. There's no, as far as I can tell, there's no coding and, and all of these middlemen that seem to be in our system. Um, then they ask if you have a mutual, and in our case, we say, no, we're gonna pay cash for whatever's remaining. In the case of these four. Human shows up at our house, nurse visits. Damien paid a total of 21 Euro.

Aimee:

Holy shit.

Rebecca:

Yeah, that's not even a week of coffees in the United States.

Aimee:

No, in Seattle that is, oh, actually wait. And then you have tax and tip. So, um, that is two and a half lattes in the Seattle metro area.

Rebecca:

Isn't that insane? Um, we got a huge pile of pharmaceuticals and bandages. I can't remember exactly what it was, which means it must have been less than 50 euro. It

Aimee:

Mm-hmm.

Rebecca:

and that covered, that included, um, golly. So there was an anti-inflammatory, there was a kind of a Tylenol level drug. There was a antidiarrheal and a stool softener because they actually prescribe for you the drugs that deal with the side effects that are likely from the drugs they're prescribing.

Aimee:

Right.

Rebecca:

And there was, um, I dunno, two or four kind of morphine level drugs in case you needed it. All of that, less than whatever it was like.

Aimee:

And, what was the patient experience with European painkillers versus what he would've gotten in the states?

Rebecca:

I can answer that a couple ways. What do you, can you rephrase that question?

Aimee:

Sure. So, you know, Damien's had the surgery before in the states, presumably. He also received painkillers as part of recovery. And had, you know, varying degrees of pain and management of that pain throughout the healing process. There are, I'm assuming different drugs, different strengths, different kinds of pain management medication here in Europe because opioids. Um, and what was like, what is his experience healing here in terms of the amount of pain He's. He's undergoing in the efficacy of the pain management medication here in Europe versus what he had in the us.

Rebecca:

I would say they've been surprisingly similar. I feel like we got fewer overall drugs in terms of the number of drugs we brought home. There was very clear instruction like, don't use those high level drugs unless you've already tried the other things and you're still in that kind of pain. But they did say, particularly if you're not sleeping through the night, use the drugs because they're trying to give you guidance on how to heal. Um, I would say that at a top level, it feels very similar to what we experienced in the United States, but it wasn't. I don't know. There's just, it didn't feel like they took the purpose of drugs as seriously. They're just like, yeah, take it if you need it. In the United States, there's also, I don't, I don't know if this is true in the United States, but I've lived there a long time and picked up a lot of drugs over my decades. There was very clear labeling on those high level drugs. It says, if you don't use these, please return them to the pharmacy.

Aimee:

Nice.

Rebecca:

really easy, not punitive, not nanny state feeling. There's, there's not this feeling of dictation about what you should be doing. There's kind of an assumption that you're a grownup. Maybe that's what I'm trying to express, like here is clear instruction so that you can take care of yourself and we assume you're going to do that. It's the same thing with like if you see a big hole in the sidewalk and then you fall into it. They're gonna be like, why'd you fall in the hole? Look where you're going. Not who can I sue? Like, it's sort of related to that

Aimee:

Yep.

Rebecca:

level of adulting. So

Aimee:

Yep.

Rebecca:

obviously I'm trying to interpret a lot, but the facts are, the drugs were pretty similar. I do feel like we got a few fewer of them, and other than that, they are all different drugs, which is a little weird because there's a, there's a comfort that goes with knowing your drugs. Like Tylenol and codeine. I know if I take that, what happens because it's the drugs I grew up with. Whatever his high level drug was, I don't remember at all. We just don't know how he'll respond to it. And so it made him less likely to take'em.

Aimee:

Mm.

Rebecca:

And we also have to remember that my, my husband has a really weird ability. To heal and doesn't, and he has a really high pain tolerance, so your results will vary as compared to Damien, who is like this healthy horse of a man.

Aimee:

Right, right. Now, when you say there were few left with fewer drugs, do you mean fewer numbers of different kinds of drugs or fewer quantity of the drugs that you were prescribed?

Rebecca:

Fewer quantity of the drugs we were prescribed. It actually felt like more drugs because we, they said, just pick these up to go with these. And it's kinda like cocktails, and I don't remember that being as true in the United States, but literally fewer high level drug pills at all.

Aimee:

Yep. Awesome.

Rebecca:

Yeah,

Aimee:

Wow. So he's two weeks out and you, you know, you've kind of talked him up as being a little bionic, so how is he doing with, like, how is he recovering? Is he back to doing pushups or?

Rebecca:

he wants to, he's already don't, don't tell my mother. She'll be mad at me. He's already cooking. I try to rescue, rescue him when I hear things happening in the kitchen. Um, he

Aimee:

And he is like, but I got this idea and I need to try it.

Rebecca:

well, he's just, he's stir crazy. He's an active human and every part of him is functioning except for this one stupid shoulder. So he's just trying to do a lot of things. One hand did, um. But no, he's healing up fantastically. The funniest and cutest thing is as we walk around, we'll go out to dinner, people will see him in his brace'cause his arm is completely strapped to his body. And we will get advice from French people. So this one, this one experience we had, he said, oh yeah, I had exactly that same surgery as when I was paying the bill inside. Tell your husband that the keynote is very important. The keno, um, kinesthesiology, the pt. And I was like, okay, I will. You know, and we've had interactions like that many, many times. They do seem to take the physical therapy more seriously than we do too. It's about getting healthy. That's like all the arrows point at, we're trying to help you be well.

Aimee:

Right, and I, the major reason why people don't do PT in the US is because it's inconvenient and it takes time.

Rebecca:

And it's expensive because you don't know what's covered. And even if it is covered, you've got all your deductibles. We are disincentivized in the United States to take care of ourselves. When you have a good socialized healthcare system, the whole system is incentivized to make sure you're not. Spending money in stupid ways and keeping your population sick is expensive. So if your, if your system is for profit, keeping them sick is a good business decision. If your system isn't keeping your people healthy is a good economic decision. The math is so simple.

Aimee:

Yes, exactly.

Rebecca:

And this is the thing that keeps me going through my Visa renewal, which I should also update you on because I want this.

Aimee:

yeah. It makes me wanna scream, cry, and vomit all at the same time, because I'm not gonna have it yet or maybe ever.

Rebecca:

I know and it's the one thing. It is, I think truly the one thing that makes me not wanna go back to the states, almost all of the rest of the stuff that's going on politically I care about, but it doesn't at this age and at my income bracket and stuff, a lot of it doesn't affect affect me directly right now, but the healthcare stuff does

Aimee:

Yeah,

Rebecca:

and it will.

Aimee:

more.

Rebecca:

More. Yeah. Every year that passes it will affect me more.

Aimee:

Yeah, yeah, yeah. I am, I have actually, you know, with, as, as of this recording, it is still, uh, it is the end of April, 2025. And so it's been a fun month in the stock market for those of you who are following along. And I've been really grateful that I am, you know, 20, 25 years away from retiring because. I'm not worried. I'm like, you know, I'm, I'm kind of treating it as stocks are on sale right now. I should probably invest more at this point in time because when we look historically, like things always bounce back within five years.

Rebecca:

So if you have time, it's okay to take a breath, but for people who don't, this crisis is real for them.

Aimee:

it absolutely. And terrifying. Yeah.

Rebecca:

Yeah. So, yeah, so couple of weeks. He will start. Kinesthesiology, uh, physical therapy and he should be back to fight and form. I think he has to wear the brace for six weeks total, but at week, like three years, something he can stop strapping his arm to him, uh, to himself and yeah, pretty normal. I mean, truly, that's the thing that's been most remarkable about this. It has been a very wonderful apples to apples comparison of exactly the same surgery he experienced in the United States. It's been nice to see how much of it is the same. It's not lower quality in any regard. In some ways, it's better. I can't think of anything that has been worse, aside from just the fact that we just don't know how to navigate it and we don't know what to expect. So there's some nervousness there. Everything they promised. They being the people that said you should be an expat. It's true So now I'm trying to stay an expat. Damien, I think he got his announcement that his visa has been renewed today, so he is done and I am not.

Aimee:

alright. And where are you at in that process?

Rebecca:

All right. Well, so last we spoke, I think I had told you I needed that free mobile invoice. I needed some kind of utility bill that had my name and my address in

Aimee:

Right, and the phone company was like, yeah, I can't give you that.

Rebecca:

Well, to give credit to free mobile, and I'll tell you the journey in a second. They did it. In fact, they did it in time. Unfortunately, I didn't catch the email in the three hour remaining window, which is, I'm not, I'm not beating myself up with this, but I. Maybe if I had seen the email at the right moment and the lawyer had also seen the email at the right moment, it could have all happened, but it didn't. But that is not free Mobile's fault. So what I had to do was. Call free mobile. And I think I told you they weren't allowed to speak in English. Did I tell you

Aimee:

Yes, yes.

Rebecca:

Yes. So I had to speak in French and they told, well, the second person, first person lied to me, so that's on them. But the second person said, you have to write a letter, send it to this address, and they will take care of it. And I was like, there is no way That's true. Now the problem is I don't have a printer. We've talked about this problem before on the podcast and the timeline. I'm like, how am I supposed to get this printed, signed, and mailed quickly? So my lawyer told me that there's this system where you can send a certified letter in France digitally. I'm like, that's cool. You can send a certified letter in France digitally. So I'm like. Interesting. And, uh, if anybody, I don't remember the name of it, if anybody needs that, shoot me a message. I will make sure to get you that information. So I did it. The way it works is you pay for the certified letter, which was about five euro, five, six bucks, and then you're subscribed to a monthly thing for 40 euro a month, and you can send up to five certified letters a month. So if you're needing to do this. It's a remarkable system. Like if I own a business here or something like that. Now I don't have to do this very often, so clearly I don't wanna pay$40 a month, 40 euro a month, but I'm like, this is important. I can cancel it any time, even if this whole thing costs me one month's worth and the fee cool. So I do it. I didn't get, however, a notice that said it had sent, I got charged my credit card. There was no notice it had sent. So I said to the lawyer. I don't have any proof this sent. Can you please, please, please, please, please also print this thing.'cause I did sign it digitally and mail it and my kind lawyer said, yes, I'm out of town, but my assistant will do it. He did it. Good thing because the system didn't work, it didn't send. The next day I got an email from the certified letter people saying We're so, so sorry for reasons beyond our control. Certified mail. Isn't sending today. I, who knows why? I don't know.

Aimee:

Oh my God.

Rebecca:

We're, we'll be delighted to refund you. And I'm like, you think? And um, I actually had to follow up with them for the refund, but it went really smoothly.

Aimee:

Good.

Rebecca:

the system is a good one, but it didn't work. Which is sort of the story of life in France, uh, in Europe. So. But like I said, they sent the letter and lo and behold, three hours before my deadline, I did get an, I did get it. It showed up in the system. I just didn't check it in those last wee hours. I had been checking it the whole rest of the day. I went into client meetings. It didn't happen, and so now I have to resubmit. But it turns out, did I tell you what the fallout would be? Because I did find out. So I was so nervous. I'm like, what's gonna happen? Are they gonna send me back to the United States? Am I gonna have to go back to the United States and apply for a whole new visa? Like I didn't, while my mind goes to the darkest places, I legitimately didn't know what would happen if we missed the deadline. And one thing I have noticed about way too many people who are providing professional services is they don't do a good job of telling clients. Things that will lower their blood pressure right now, they might be doing that on purpose. Maybe they don't want the client to take it too easy. We want to incentivize our clients to meet deadlines. I get that. However, I was really freaking out and it turns out, as far as I understand from what they told me, it's just going to be an HUN 180 euro reapplication fee.

Aimee:

Oh,

Rebecca:

I'm like, take my money. That's it. I was picturing myself deported.

Aimee:

you don't even have to resubmit everything.

Rebecca:

Um, you kind of do, but yeah, so I do, I have to get all of my fresh, three months of bank statements. I had to get a new e photo, which is an electronic system that they have for, uh, photos for your visas and driver's license and stuff here. Which you can get in the kiosks, in the metros, like it's a whole easy system. So I have to resubmit three months of bank statements. My e photo, you have to sign this Republican contract, which basically says I promised to behave myself while allowed to be here in France and ba obey the rules of France. Um, like a light version of what you would say if you were trying to become a citizen, like yes, this is my

Aimee:

right.

Rebecca:

Um. And then maybe one other document that I can't remember right now. So pretty straightforward and now I'm just waiting'cause they have all my stuff again.

Aimee:

But now you, they have all your stuff and it's submitted and you're not, you're just waiting for the approval to come in, which is fantastic.

Rebecca:

Yes. And same on the cart. Vital. That one I'm not as confident on. I resubmitted my proof of lodging stuff my landlord isn't. Um. Think super helpful with this. So we've had three landlords in the time we've been here. The first one was so, so easy to work with and I think it's in part because he is Chinese living in France. So I suspect, yeah.

Aimee:

And if he was born and raised in France, then he's got family members who have lived through it. And so he knows stories.

Rebecca:

Yeah, and I never met him personally, so I'm not sure what generation he is, but I know that he was renting out his apartment'cause he was going back to China to get married. So clearly he is crossing two cultures.

Aimee:

Yeah. Yep.

Rebecca:

Our second person was between visas, so it didn't matter. This one, it's partly weird because her parents own. The place, place and then all the utility bills are in her name. The visa people want all of these things to align. So not only are none of the bills in my name, they're nodding all even and the landlord's name. So they wanted a deed and my landlord was like, no, I'm not comfortable with that and there's nothing I can do. So I did what I could and we'll see what happens.

Aimee:

And you're moving again when?

Rebecca:

We leave this address at the end of June, so April, may, June, so two and a half. Just under two and a half months.

Aimee:

Yep.

Rebecca:

Then, yeah, this is actually a problem. We have a really nice guardian here. That's the person who takes care of the buildings. We're hoping to ask her. She speaks no English. We're hoping to ask her in French if. For us to hold onto it, we're gonna ask the landlord the same thing. Um, but we won't really have a permanent address again until we come back in September.

Aimee:

Oh, September. Wow.

Rebecca:

Yeah. So do we, we can't change the addresses with these systems until we have a new address. If we go ahead and figure out where we're gonna be living in September now, do we give that address? To all these places now, like as I, as I said a couple episodes ago, my biggest advice to anybody following in my footsteps is choose one address and stick with it.'cause I have, we have complicated our lives so much by these choices.

Aimee:

Yeah. We submitted for our Visa application when we were in that process and we were, um, preparing to submit from the United States. We used the address of our Airbnb. You know, two months before we had even arrived in Spain. So if you have an address, I recommend and you can get all that paperwork together, totally do it before you're there because

Rebecca:

But it depends on the landlord too. Like if they get mail in our name, they obviously need to not throw it away. And you know, Airbnbs. Sometimes they're turning people over so much they don't even check the mail or it's,

Aimee:

Yeah, that's true. I mean, it depends on who the person is, right? But if you submit all of that paperwork like two or three weeks before you're there, it's not gonna show up before you do.

Rebecca:

and even if it does, you can say, Hey, I never got it. I need it resent. And it's just another example of the molasses slow experience of being an expat. What's the next step? What are the 17 steps that are actually part of that next step? And you can't really think past that step because you just don't have the mental, I don't have the mental capacity for it.

Aimee:

Yeah. Yeah. So, you know, when you think about everything that we've spoken about today, the, the high of private nurses coming to your home to help you recover from surgery that was insanely cheap and the low of this whole snafu with Visa re applications. What sort of advice or takeaway would you offer our listeners?

Rebecca:

I guess it's the same advice I would offer myself. Keep your eye on what you're trying to achieve. If the North Star you're aiming at is strong enough. It'll get you through every single step. I wouldn't have the fortitude to keep doing all of this if I didn't know why I was doing all of this. It's not easy. So figure out whether you're remodeling your home, speaking as an interior designer, or moving to another country or getting married or whatever it is. What is the outcome you want and let that guide. Every decision and let that help you pick yourself up off the floor when you're having your tantrum and meltdown and keep going.

Aimee:

Beautiful. That's excellent life advice

Rebecca:

Yeah, I should take it.

Aimee:

and I think with that I wanna bid our listeners and Asta Lugo.

Rebecca:

Look at us staying on time. A la prochaine.

We hope you enjoyed this episode of Banla. If you did, the best thing you can do is share it with another person, brave enough to move abroad. See you next time.