Doctors and hospitals in Germany

Unfortunately, I'm sitting in the doctors office waiting to be seen. I've been waiting for an hour and 53 minutes so far. I miss minute clinics so much right now!

Also unfortunately, I have had a great deal of experience with doctors and hospitals since I've been here the last 21 months: Alex had his adenoids removed and tubes put in his ears, the kids have had their fair share of infections, the family has had 21 diagnosed infections of strep this winter, including one that put David in the hospital for four nights, and I underwent a liver biopsy not too long ago. I've also taken a friend to the emergency room and stayed with him until he got admitted.

So here are my thoughts on doctors and hospitals in Germany:

* Doctors really care about you. They take their time with you even when they're completely overwhelmed with a busy day. My GP even answers her email. That is so convenient for me because the language barrier at the front desk is difficult.

* As a general rule, the front staff really doesn't care about you. I have felt many times like I was a nuisance just because I or the kids got sick and needed an appointment. That hasn't always been true, and I have had some very helpful front staff, but the majority of the front staff have acted more like bouncers than health care people.

* I think that Germans don't care too much about suffering. I don't think they're insensitive, but I do think they're pragmatic about it. It's kind of convenient in a way, because then you pretty much know that if you're being treated, you need it.

* I also think they're very averse to the use of antibiotics. I believe that's why we've had strep so many times this year. They keep giving us 7-day doses that just aren't long enough. If it shows up again, I'll be throwing a fit.

* Surprising to me, they don't automatically provide sheets, blankets and pillows. At the biopsy, I rested on a hospital bed without a sheet, pillow, or blanket. I was on my side for an hour, and luckily had my fluffy scarf to rest my head on. I later recommended to my doctor that he should advise his American patients accordingly, but he said all I would have had to do was to ask for this. In the U.S., our wonderful nurses are always asking if we need anything. Not to mention, all the other patients there had their own blankets and pillows. During David's stay in the hospital, they were provided and he was in a nice room. Maybe it's an out-patient thing.

* There is no discretion or privacy here. Americans are prudes, it's true. Here in Germany, during my routine physical, I had an EKG, and the boy (maybe he was 20) who gave it turned his back briefly while I took off my shirt and bra. No robes or sheets for covers or anything. I've heard it would be a similar experience with a female doctor, which I've opted to pass on since I'm returning to the U.S. in only a few months. Just now, I had an x-ray, and it was the same. This time, they did have a closet for me to disrobe in private.

* Along those same lines, they interrupt all the time no matter what. I was getting a sonogram for my liver, so my shirt was mostly up, and one of the assistants kept coming in until the doctor (who studied in the U.S. and knows that Americans are prudes) finally told her to stop coming in, she would only be 5 more minutes. Interruptions also happened multiple times during my EKG. It's not that they don't respect privacy. They just don't expect it. It isn't rude, but it is a little awkward compared to what I'm used to.

... Update. I waited for two+ hours for the doctor, but it was worth the wait. I went for an x-ray to rule out pneumonia. Thankfully, it was bronchitis and not pneumonia. But I have to say, contrary to what I said above, this doctor put me on strong antibiotics for 10 days, with a 3-day dose of an additional antibiotic, a steroid inhalant, and a couple other things to help me feel better. I am so ready to feel better!! I was sick for 16 days!

Because of my diagnosis, I had David take Lilly to the doctor. RSV! Argh! We need a break!

The biopsy and the diagnosis

I know, this sounds like really bad news, right? Maybe you think I shouldn't advertise my health issues? The problem is, when I was told in January that I probably have an autoimmune liver disease (autoimmune hepatitis), I couldn't find many real-life stories about it online. The usual references were helpful, like WebMD, but they were so textbook. I couldn't find anything very descriptive that would tell me what I was going to experience (or possibly experience) as I went through this. So for the next person who searches, here you go.

In October, my doctor discovered high liver enzymes during a blood draw for a routine physical. She did a sonogram of my liver to see if anything looked abnormal, which it didn't. She said, "We'll do a second blood draw to further investigate. Maybe you have hepatitis." I wish she hadn't said that. The next couple of months while I was waiting for my second appointment and the results, I was very stressed out worrying if somehow I had infected my entire family with some form of viral hepatitis. I was trying to remember if I had received a blood transfusion when I delivered Alex (and how could I remember that, since I almost died?) or if there was some other thing that would have caused it. I was extremely stressed out, fearing that even my poor 2-year-old now had a liver disease.

In January when I got the results, the doctor told me that my ANA were high, (1280 when they were supposed to be 80 at the most), and that viral hepatitis was ruled out, and I had an autoimmune disease that is attacking my liver. That was, ironically, a relief. She told me I would have to go to the gastroenterologist.

A couple of weeks later at the gastroenterologist, he told me that I would need to have a biopsy to clearly determine what stage of damage my liver was in and to determine the treatment. He did a sonogram of my liver to check the blood flow, and it all looked good. He also told me that viral hepatitis had not yet been ruled out, so he needed to do more blood work. Great. Enter the stress about my family again.

They wanted to schedule the biopsy right away, but I had to travel for work for a week and to visit my sister while she was in Europe. I had the biopsy on Tuesday, two days ago, and on that day, the doctor confirmed that viral hepatitis was definitively ruled out. However, he wanted to take more blood samples, to my surprise, but I didn't ask why and just acquiesced. I will find out when I return, I'm sure. Once again, knowing that it wasn't viral was a great stress relief.

At the biopsy, the doctor did a sonogram to determine the entry point. He used his fingernails to dig an "X" into my skin (haven't they ever heard of markers?!). Then he numbed it with a local anesthetic. It was all mostly painless. They fit a small tube into your skin first, then use some kind of a tool to grab a piece of your liver. The doctor told me that one in ten times, he needs to take a second sample. Ripping off a piece of your liver is, as it sounds, very, very painful. However, it is also mostly instantaneous. Naturally, he needed a second sample from me, so it was very, very painful twice. It feels like one would expect it to feel: a shockingly sharp pain followed by a stabbing pain that becomes fairly tolerable after about a half hour. It was hard to breathe at first, which was an unpleasant surprise. I got through it.

The other pain that was a surprise to me was the strong pain in my right shoulder, which he explained was a result of snipping the nerve running down my side. It feels very much like the pain I had in both shoulders after my first c-section that results from air collecting in your shoulders, in case anyone knows what that is like. He led me to believe that not everyone gets shoulder pain during a liver biopsy.

All in all, I would say that, while it was very painful, the pain of a liver biopsy is nothing to be afraid of. If you are reading this because you're going to have one soon, try not to worry too much because it will be okay.

They monitor you for a couple of hours afterwards, and I lay on my side for an hour before the doctor told me I could move to my back. They have you do that to help control internal bleeding. He did a sonogram to see if there was any blood, which there wasn't, took some more blood as I had mentioned, and scheduled a follow-up for two weeks from now. He told me that I can't work out for three days, and that I can't lift heavy weights for three days.

As I said, this was two days ago. I am at the morning of the second day. Yesterday, I had David take the kids to school but went into work. I actually thought working would be easier than being at home with the little kids. (I was probably right.) Today I took the kids to school. I was going to drive the twins, but I really don't like driving here, so I walked. That might have been a little bit too much. I still have pain where my liver is. I have a small bruise at the entry site, and you can barely see the cut where he used the scalpel. It's not too bad this second day. Walking up the steps to work yesterday was somewhat difficult, but I took it slowly and did just fine.

... I am a week out from the liver biopsy, and I feel just fine. I think I am all healed, and I am not stressed about the results. I read that 85% of patients respond to the treatment, which is usually a long-term dose, if not a lifetime dose, of steroids. The 15% who don't respond to the treatment will need a liver transplant, but that's too many steps ahead of where I am today for me to be worried about that.

I have a list of questions for my doctor during my follow-up. Mainly they center around managing the symptoms associated with being on a steroid long-term. Weight gain is really not something I need right now. And I looked at pictures of people with "moon face", and it makes me very sad to know that I'm probably heading there. But I'm trying really hard not to get ahead of myself. I haven't even gotten my treatment, yet. Three more days. It has been a long and stressful two weeks.

I look forward to getting answers on Tuesday.

... Answers. I can't believe it. They were all good answers. I was mentally preparing for something very bad. My liver is completely healthy and free of any disease. My ANA levels came down a step. They're still high, so I'm going to go back in 3 months for another check and then, if they're still high, a referral to a rheumatologist. It's not autoimmune hepatitis, and even though I didn't actually get an answer today, that is good news by itself. It has been a very long 5 months going through this. Although it isn't exactly a diagnosis, at least it isn't that.

...It's a month later now. I'm waiting for my doctor to get done with vacation so we can figure this out. One thing I know, God is good. All the time.

And now I can finally publish this post. It was pretty easy to read, but kind of hard to live through. I'm glad that all of this is in the past.

Garmisch

Ready for the pool! The highlight of their trip.

We love Garmisch. We visited it for the third time as a family (fourth for me and David) over Spring break.

We didn't have the best weather ever, but it was nice enough to enjoy some incredibly beautiful scenery and to visit one of the most famous castles of all time (thanks in part to Walt Disney).

We love Edelweiss Lodge and Resort, too. I admit, it is nice to go there and comfortably speak English. But their customer service is incredible. The kids love the pool. We love the hot tub. And the location. Most of all, the location.

Last night, our last night at Edelweiss, probably ever (wiping away a tear), there was a fire, or threat of a fire, and we were evacuated at around midnight. The staff did an excellent job communicating and trying to make people comfortable while waiting in the drizzle. We waited in the car, and David acquired a comfy blanket for the kids to cuddle up with. David estimates that we were outside for at least an hour and a half. In my opinion, the staff did everything the right way, and so did the fire fighters, and it couldn't have been helped. Even still, Edelweiss offered its guests free breakfast this morning (which we naturally accepted!). That was a nice gesture, but given the obvious fact that it seemed out of their control, I didn't even think it was necessary.

So our first day there, David walked to the China King, and we enjoyed a night in after quite a long drive from Bratislava. The next day, we took it easy, and as promised, took the kids to the pool (for TWO hours!) after a trip to the grocery store (mainly for drinks--we were so dehydrated!). We are in the room again from Zuggy's Base Camp in the lodge--it's average American bowling alley food, but it was actually nice for a change.

Yesterday, we went to Neuschwanstein Castle, and it was lovely. I had reserved the tickets well in advance, and it was no problem whatsoever. I hauled Lilly on my back on the way up. I'm a bit out of shape for that right now, but it was still enjoyable for me (and Lilly, I think, in spite of her initial objections!). We enjoyed our castle tour, and took a horse and buggy ride back down, which the kids really enjoyed. (Except for Lilly. She was completely dead to the world with exhaustion!) After the drive back to Garmisch, we had a nice Italian dinner at a great restaurant named Celenteno. The risotto was wonderful! Then, of course, we took the kids to the pool again (for ALMOST two hours! and no, I don't think we waited an hour after eating!).

It was a great vacation. The kids enjoyed it. I enjoyed it. David enjoyed at least part of it. He also did all of the driving after my initial 8 hour stretch. That was nice!

We're home now. I admit, I'm looking forward to our next trip in two weeks! To the tulips!

 A rare photo of all of us. A kind woman offered to take our picture, and then explained, "I had four, too."
Thank you, kind lady!

The castle. Couldn't take pictures inside, but it is worth the trip.

Just outside of Garmisch.

What I will not miss about living here

Driving and parking. You've heard me complain already, I know. But my overall conclusion about driving and parking (a minivan, especially) in Germany is that it's difficult and stressful. What's stressful, and I try not to let this affect me because I'm doing my best anyway, is when you don't know where you're going and people are acting pushy and impatient, which they seem to notoriously do here. The lack of street lighting at intersections doesn't help any at night-time, either. And who's the genius who thought it would be prudent to make a person going straight yield to somebody coming from the right, unless there's a sign, which is either placed before or after the road in question, excepting that rule? That's one of the dumbest things I've ever heard of!

Oh and in case you're wondering, there is no turning on red in Germany. And you should know that you should avoid the free roadside WCs like the plague. I'm telling you, think of the most DISGUSTING gas station restroom you've ever been in in your entire life. Now multiply that by ten and you MIGHT be getting the picture. Gross. That being said, the autohofs usually have clean restrooms where you have to pay 50 cents to 1€. It is worth it, believe me!

Upon entering new city limits, there's a sign announcing which city you've entered. That sign also serves as a speed limit sign, so if you see a yellow city sign, it means automatically that the speed limit is 50 kph (unless otherwise noted). Not seeing a number to announce the speed limit was hard to get used to at first. There's also no flexibility on the speed limit here. I got a €43.50 ticket in Frankfurt for going 36 in a 30. I've heard that they will not fine you if you're going 3 km/h over. That's the leeway. That's kind of difficult with the minivan because my speedometer isn't set on kph, and the kph are tiny and really hard to see.

Construction is everywhere year-round! The rumors of being able to drive fast on the Autobahn are only true from about 10 at night until 5 in the morning. If you're driving any distance in Germany, learn the word "Stau" in a hurry. You'll soon become all too familiar with the traffic jams. Another good word to learn is "rettungsgasse", which means something to the effect of "emergency lane". I admit that the way they pull over to make a path for emergency vehicles makes better sense than in the U.S. In Germany, the right two lanes pull to the right shoulder, and the left lane pulls to the left shoulder. I will also say that Germans generally know how to merge into one lane using a zipper fairly well. They should, they get enough practice with all the construction! You'll occasionally have someone not willing to follow the unspoken rule of doing it like a zipper, but I would be almost willing to bet that 7 out of 10 of those people are Americans. 

I have to say that I'm surprised I've never hit a motorcycle or a bicyclist here. I probably shouldn't say that too early! But, in my opinion, they take some serious risks by coming up unexpectedly on either my right side or left side (one never knows!).

Just a warning, if you're behind a bus and think you might pass it, if the driver turns on the turn signal, don't think of passing it. Most bus drivers seem to think that they have the right of way, and that all other vehicles on the road are unimportant and therefore must drive defensively to avoid a collision if the buses are around. If you basically accept that, you'll be okay.

I think that's all I have about driving. Let's just put it this way: unless you're driving in NYC or LA, driving in the U.S. is much easier than driving in Germany. 

This house. This isn't all particular to Germany, but it has really affected my quality of life here. We are a family of six, and the washer and dryer each have a 2.5 hour cycle, which means that the washer and dryer are ALWAYS running. I'll be glad to get back to our more efficient machines at home. Also, our small refrigerator doesn't maintain a steady temperature, so we have to choose between not having cold items or having frozen items. I can't stand my milk warming up and curdling, so we often end up with frozen lettuce and carrots that burst from freezing. How aggravating. Not to mention, the fridge is small. At least there is a deep freezer in the basement. This kitchen also has a white kitchen floor. I used to think I wanted black and white kitchen tile with red accents. So I guess having white tile here was a blessing in disguise since now I won't make that mistake in my own house! 

Then there is the furnace that doesn't stay on. I can't tell you how many times this winter we've had no heat and I've had to take cold showers. The landlord is finally going to fix it while we're away for spring break next month (I hope). The last thing about this house is that the hot water coming out of the kitchen sink has no pressure because somebody hooked up the dishwasher incorrectly. Slightly annoying, yet liveable.

Rude people. I'm SLOWLY coming to the conclusion that the rudeness is mostly focused in Wiesbaden. Man, it is hard for me to get past. I'm looking forward to the friendly U.S. again, especially hometown U.S.A. Friendly faces will be nice.

7:04 bus stop. Ugh. And Alex's hour long ride to school. I know it might improve only by a half hour better in Waynesboro, but it will certainly be nice not to have to be ready so early. 

Medical claims. At work this past Friday, I spent the entire day submitting medical claims. Literally, the only other thing I did all day was eat lunch at my desk and look at a job announcement that my resume had been referred for. I submitted 20 claims in total, including claims for drugs. The last time I submitted claims was January 24th. It is time-consuming and frustrating, and this process ultimately ends up costing the government a LOT of money, considering they paid my salary for a day and got literally no productive work from me. Every civilian who works in a foreign area uses a similar process. They should really put an ORSA on that problem. I wonder which would be more costly, to put civilians on the same system the soldiers use, or this? I suspect it hasn't truly been calculated. But I am certainly looking forward to not having to deal with insurance this way. I have to watch them like a hawk. Oh, and I do, believe me. I do.

All that being said, the closer we get to going home, the more I think (sadly), "is this the last time I'll do this"? (Like today, riding the bus into town with Livvy to do some shopping.)

Overall, life is still so SO sweet.

Vienna

It was an easy 1-hour drive from Bratislava to Vienna, which David handled since I was pretty sick of driving.

For the last two weeks, I had been trying to arrange a tour for David through Airbnb experiences, but I wasn't having any luck. The tours were either too expensive or they had really mixed reviews with some 3- or fewer stars amidst the 5-star reviews. The night before our day-trip to Vienna, I lucked into a 2.5-hour tour with a man who had consistent 5-star reviews. Someone must have cancelled on him because he had not been available at all the previous two weeks. For €25, I was more than happy to sign David up.

David loved the tour, and said it was a true five-star experience. That's about all I know about that. I think he took 4 pictures the whole time. Bah!

While we were walking to his meeting-point with the tour guide, I walked into a church, and was absolutely stunned by how ornate it was. After all these stunning churches I've seen, this one still surprised me! It was quite unimposing on the outside, and I just wasn't expecting it. But really, take a look at the picture below.

Thankfully I went into that church. Other than that, the only thing I really saw of Vienna was a playground and the outside of the theatre, where I sat with the kids while they ate ice cream, and I enjoyed my own very delicious eiskaffee. At least I entertained myself by taking a selfie of me holding Vienna fingers in Vienna. I don't even really like them that much, but I brought some to Vienna! And by the way, we stopped at a snap dog vendor, and there were NO Vienna sausages available there. Thank goodness! I would lose respect for that city if that were really a thing!

Vienna is probably the most beautiful city I've visited since I've been in Germany. I would really like to go back some day and see it properly. At the very least, I really enjoyed the outsides of the buildings, and all the statues and monuments around the city. And the weather couldn't have been better. What a great day trip for us!

Vienna was stunning mainly because of the architecture.

This could be my favorite window ever.

Wow. It was small, but it took my breath away.

"What are you looking at?!" I've liked pigeons ever since my friend Riley was little. (For SOME reason!)

Yes, we ate McD's in Vienna. Try not to judge me. The kids just love it so much.

Griffin thought this butt statue was HILARIOUS.

I didn't take many pictures at the playground, mainly because I was running around like a crazy woman trying to keep an eye on four very excited kids. And THIS one doesn't realize she is only two and "can't" do stuff like the big kids!

Bratislava (what did we forget this time?!)

For spring break, we are on a vacation that takes us to Bratislava, Vienna, and Garmisch.

We reserved an Airbnb in what appeared to be a very good location with a very big apartment. And it was both. Livvy had her own room and really seemed to enjoy it.

We left the house at about 3:15 a.m., which was only about 15 minutes later than I had wanted to. I drove the eight hours, and we made really good time. One funny thing is that, a few weeks ago, I found a CD in my work folder labeled in my writing "Singing Songs". I must have made that CD more than 15 years ago. It still worked to keep me entertained while driving! (Poor David and kids!)

We arrived in Bratislava shortly after 11:00 a.m. We were able to check in right away, and we all took a short nap, and then went out to see some sights and grab a bite to eat. I feel bad when I travel because I always starve and dehydrate the kids.

The first thing we saw was Michael's Gate. It was pretty. We didn't go up it, but we walked around the square and then found somewhere to eat. After dinner, the boys were, I fear, on their absolute worst behavior. I think it was because of the really long drive. They had been too cooped up for too long. So after dinner, we went back to the apartment and everybody vegged out, and we went to sleep early, which was good considering how little sleep I'd had the night before. At least the very hungry children loved their dinner. I ordered halusky since it is the typical Slovak dish, and it was okay, but not my favorite. David had some beef with a special horseradish sauce, and it was delicious. It was a nice meal with a friendly waiter. David also tried some slivovitz, which is a plum brandy typical in Slovakia. Surprisingly tasty!

The next morning, I left before anyone woke up and went to see the sights that were on my list. I had to abandon the kids, and I'm so glad I did. I walked around that very small city for about 2.5 hours, and really enjoyed myself taking my time and lots of photos. It was a good morning, even though it was a little drizzly here and there throughout my walk. It was fun, and I had time to be efficient and fast. So nice!

When I got back, we all got ready and drove to Vienna. That was an adventure for the next post! But for once, I can finally say that we forgot nothing! What a pleasant surprise!

Interesting cityscape. The UFO looking structure is a lookout and restaurant.

Micheal's Gate, from the 13th century

The start of my solitary walk. Michael's Gate was deserted.

The witch puppet had exquisite detail.

The Blue Church of Bratislava. Amazing from all sides.

Bratislava is an interesting mix of modern and old.

A memorial to a revolution during WWII.

Cutest post office box ever. Bratislava may have the most character of any city I've visited thus far. That's hard to say, though.

The halusky, which was not my favorite.

My favorite graffiti. Alice in Wonderland, I think?