Wish You Were Here: Zagreb Emergency Room

Zagreb Emergency Room

In the Sveti Duh emergency waiting room, the lights are off and the fans are on. This feels appropriate for a late Sunday afternoon.

Most of us don’t want any more light or heat than we’ve already had today. Sunday emergencies should be as informal as natural disasters; should leave us free to pace, or whisper, or sit with our heads in our hands.

Though I’m only 100 metres away from my apartment, it took me a while to find this place. I’d crossed the street, through the clustered smokers, to the subterranean double doors. I knew that’s where the Information desk was.

Inside, the dim hallway was as quiet as a tomb. I didn’t see another soul except for the Information lady who manned her post in an oasis of yellow light, a cell phone held to her ear and a stream of exasperated nods directed at the ceiling. I didn’t get her name during our short exchange, but she looks like a Paula.

I’m at the receiving end of an exasperated glance when I ask Paula if she speaks any English.

“No,” she says, throwing up her hands and walking away. She must get this question a lot. In our limited experience, everyone in Zagreb knows at least a few words of English. Either from annoyance or lack of confidence, they often pretend they don’t. And why should Paula speak English on a Sunday afternoon, when she could be making Zagrebacki ordrezach (veal steaks stuffed with ham and cheese) for her son? So her face brightens when she sees the little piece of paper I hold out.

“Ah.” she nods, in her element now. Infekcija moracknih putevl. Urinary tract infection.

She beckons me to follow her into the hallway, where she points me down and to the right. I’m pretty sure I understand. She wants me to go back, out the way I came, and to the right. To be sure, she pulls up Google translate on her desktop and types out thorough directions to the central emergency room. AKA, that big entrance across from my apartment with the ambulance sitting out front.

In my defense, there was no red or green signage, or the even word Emergency, as I’ve often seen in some form in other countries. Also, I’m pretty sure the ambulance wasn’t there earlier. I know the word for thank you at least, and I leave Paula with several Hvalas on my way out.

Inside the sliding doors I go straight to the counter on my left, and again ask the nurse if she speaks English as I hand her my paper.

“A little,” the college-aged woman says. This time my paper is not self-explanatory. She calls the lead nurse over, a beautiful older woman whose face I would not be surprised to see in a movie. She’s in matter-of-fact, problem-solving mode.

“Have you had…before?” She asks. I could tell her I’ve been prone to UTIs since I was in the cradle, but I think she’s asking how long I’ve had it. That’s what they always ask. “One day,” I say, “Last night.”

“And…do you have pain?” I nod vigorously, aware that my “emergency” isn’t the same kind as others they’re attending. I came prepared to wait hours behind the real emergencies, the people who look like they’re wearing colorfully designed shirts, but are probably wearing pieces of themselves.

Dried blood dots line the window well of the glass pane separating nurse from patient.

“Do you have documents?”

I hand over my passport, and after a glance the younger nurse nods and smiles. There is always a point during an awkward half-translated conversation between strangers when someone decides, “Everything is okay now. I can help you.”

I wait for her to ask if I have insurance, but she doesn’t. “You can sit,” she says.

If it’s never polite to stare, it’s doubly impolite in the Emergency Room. In my periphery, an older man in a wheelchair rocks himself back and forth. A middle-aged woman on my right sits quietly with her hands clasped in her lap. Many of the people here are older. In front of me, one of those confetti-shirted men paces, rubbing at dried blood on his neck. When his back is to me, I see that he’s streaked from his waist to face. Maybe he was working on his car. Maybe he was fixing the sink. How did he spread so much blood around, when you can hear from his conversation with his wife that he’s not in a distracting amount of pain? Maybe it was a fight, but I don’t think so. I think he was alone when he got hurt, and had to do some careful maneuvering before he could reach a towel. His wife watches him, and I can’t decipher her expression.

As I make snap judgments, I think about what I must look like. A youngish woman in no visible pain. I can almost sit still. I’ve been drinking water like there’s no tomorrow, and that always helps. In 5 minutes the nurse beckons me back to the window, and hands me a vial in a styrofoam cup. I nod before she says anything. I know the drill.

I’ve never been attended more quickly in Urgent Care. Not in Luxembourg, certainly not in the US. In the US, when my insurance was private, it still took at least an hour to be seen in urgent care. It doesn’t take a doctor to analyze a urine sample, and these nurses are some of the only people I’ve met who know this, and whose institution knows it too. I’ll be equally astounded later at the price they name for the whole thing.

As I bring the vial back to them, I’m prepared to wait again. This stage usually calls for more waiting. Instead, the head nurse points me to the younger nurse, who’s already left the nurse’s box to wait for me. She finishes a chat with her friend, a diminutive woman in scrubs, and then leads me away.

“Ambulance #9,” the head nurse calls after us. My heart jolts before my head calms it down.

The nurse drops me off in a hallway lined with chairs, and disappears behind a closed door. I wait for maybe twenty minutes, in which time two other patients are ushered into Ambulance #9, and ushered back out in a few minutes.

When it’s my turn, I walk into a clean, modern examination room that smells like smoke.  Or am I the one who smells like smoke? I don’t smoke anymore, but everyone else here does. During the week, I walk out of my home base coffee shop smelling like I’ve just spent three hours in deep conversation with my dearly departed Aunt Muggie, who had a lit cigarette in every room of the house.

The doctor is a thoughtful, serious man who asks me questions in halting English. He motions me onto the examination table, and to my astonishment, he proceeds to ultrasound my kidneys. Grimly I wonder about the price. At my last visit to a free clinic in the States for women and children without insurance, I answered honestly about my savings and was prepared to pay whatever the clinic thought was reasonable. As luck would have it, they ordered a totally unnecessary mammogram, but forgot to ask me to pay for the clinic visit. I gave forty dollars to a blank-faced receptionist on the way out, and was billed $276 for the mammogram (I’m susceptible to fear-mongering when it comes to my boobs.)

After the ultrasound is finished, the doctor asks a few more questions and then prints out a scrip, which he explains until he’s satisfied I understand. When I walk out the door, I’ve been in there for about ten minutes.

I wait to pay at the front, where a new nurse rummages through her own purse to give me proper change. The bill? $23. At first she forgot to include the ultrasound, in which case it would have been $10.

The more I travel, the lower the US healthcare system sinks in my opinion. Nowhere have I had to make appointments further in advance, encountered more callousness bordering on rudeness, waited longer for urgent care, or paid more. Even when I had company insurance, my copays were more than what I pay without insurance in other countries for an equal standard of care.

In South Africa, you can make a morning-of appointment in a private clinic, and pay a flat $40 for a visit with a down-to-earth, friendly and thorough doctor. The lab fees are extra of course, but our doctors always asked us before ordering tests, always explained why they wanted to order them. In Luxembourg, you had to wait a while for a non-emergency appointment, and you definitely waited a while in the office. Everything is crowded. But the price? Nada. You pay at the desk, and then get reimbursed for everything by CNS, Casse National de Sante. The National Health Fund.

I am woefully ignorant of what these foreign systems are like for the doctors and healthcare providers themselves. I’m aware that the lower prices reflect in part the poorer economies of the countries, except in the case of Luxembourg. Perhaps they also reflect the lack of a law suit culture. Nowhere outside the US have I seen the law suit invoked more frequently and magically as a solution to endemic problems. In the states, you have a universal right to a law suit. In the other countries I’ve visited, you have a universal right to be healthy, a universal right to be seen.

I leave the quiet emergency room denizens and return to the sunshine, scrip in hand. Because Croatia is not a 24-hour culture (I say culture rather than city because even our 25-year-old landlord’s son is conscientious about buying his groceries at the locally owned stores rather than at the megastores whose employees work terrible hours for crap pay), I will either have to go to the town center to fill the scrip at the one 24-hour pharmacy, or wait until the next morning.

All things considered, this inconvenience is minuscule compared to the kindness I’ve received at the hands of strangers, yet again. If you’re reading this, I wish you the same matter-of-fact helpfulness from strangers in all of your emergency room moments.


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