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Health Care in London

9/9/2009 By Thomas P. Beresford, MD
I was in London four weeks ago when around 11 p.m., I felt a sharp pain. I feel for a point on my body - a third of the distance from the right hip bone to the belly button. Pressing ever so lightly, the right side of my belly lights up with pain as though on fire. I can not stand.

Using what I call a cell and the British call a mobile, I phone the night manager, who then calls the paramedics. With an IV line and morphine in the ambulance, they take me to St. Mary's Hospital Paddington. "Is that hospital any good," I ask. "Oh yes," he says. "And don't worry, the Accident and Emergency visit is free."

An Irish nurse tends to me, watching my vital signs and the pain. Then comes an emergency service doctor and then a junior followed by a mid-level surgeon - what we call residents. I received chest and abdomen X-rays and then a CT scan of the belly.

I was admitted to a surgical ward in the early hours. "We don't want to operate on your appendix in the middle of the night," my doctors told me. "We want you to see the Specialist Registrar who is the most practiced at laparoscopic (surgery through a tube) work through the belly button."

I meet him the next afternoon. He has the self confidence of his profession. "I am what you might call the 'Chief Resident' in your system." I grin.

"I was one of those myself but in psychiatry," I tell him. Eye to eye, we exchange knowing and assertive glances, one Chief to another.

I go under and wake six hours later on the ward wearing an oxygen mask, a dressing over my belly button and a drain stitched in lower down. As I clear, I begin to try deep breathing to keep my lungs clean. The fire is gone. There is soreness, but I can cough.

The nurse tells me it's too early to walk. I'm on IV fluids and antibiotics with less pain killer but enough to cover. The next day I don't need any. The first night I drift in and out of sleep as my water output returns.

At 3 a.m. another junior surgeon and a student wake me to be sure the repair does not leak. I have no pain, and none when she gently tests the right side of my belly.

The team and the mid-level resident see me the next morning. "You had a nasty appendix," the team tells me. "The tissue was dead and leaking into the abdomen. The surgery usually takes twenty minutes. Yours took ninety. They were surprised you could walk to the anesthesia suite."

The Specialist Registrar stops by in mid-afternoon and says, "I was worried. We've watched you closely and will for a few more days. But the worst is over." Then he grins and says eye-to-eye "You're a tough man." I said, "Thanks."

I went back to the hotel two days later, pain free, walking, able to shower, then to sleep, and easing back into an appetite.

I've been a physician and a professor in American medical schools for nearly 40 years. I've heard all the arguments against universal coverage and all the stale criticisms of the National Health Service. When I tell a friend about the NHS, fresh off my surgery in Britain, she says "I've been paying lots of good money for health insurance for years."

"And what have you got to show for it besides the receipts?" I ask her.

Look what we all could have for far less than it costs to fund insurance companies and malpractice lawyers. Health care for everyone. If Britain can do it, the U.S. certainly can.

Thomas P. Beresford, MD, is a professor of Psychiatry at the Department of Veterans Affairs Medical Center and School of Medicine at the University of Colorado Denver.


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