Talbert Pipes Life in France Adventures Let's Get Physical Somewhere around here is our doctor's appointment Let's get Physical Before I go into our adventure, I want to take a minute to say a few words about French health care. Back in the 90's, the Clintons attempted to nudge health care in the US towards a national system and were met with outcries of horror so fierce (especially from wealthy doctors and campaign contributors) that the whole idea went the way of Carter's attempt to go metric in the 70's. I think this was a real shame, as I feel that health care, like military defense, is something that cannot and should not be expected to run as a profit-based business. Getting and keeping health care in the US can be a nightmare, especially for those who are not lucky enough to be employed by large businesses capable of providing employee coverage. Anyone with any maladies at all is immediately dumped as a bad risk - logical in a profit-based system but terribly inhumane on those needing care. In France, the burden of health care is split between the state and private "gap fillers". The state provides retirement, unemployment, and a large chunk of one's personal health care coverage while individual companies provide the "gap" insurance to reach 100% coverage. Since we've only been here a few months and have been lucky enough to need no serious medical care so far, I cannot comment on the good or bad of the system here. Opponents of national health care in the US would often make a big case about long waiting lists, lines in the emergency ward, inefficiency, etc. We have seen nothing like this here, however. Our one experience thus far was as pleasant as a doctor visit can be - Emily was badly bitten on the hand by an abused dog whose owner had essentially dumped the animal, and she had to be driven to a nearby doctor to clean and examine the wound. In the US, a doctor's office visit goes as follows: Arrive on time, sign in on a clipboard in the waiting room, and sit down to read a magazine. Your appointment is at 3 and you are there at 3. You wait 20-40 minutes, and typically get called back into the actual examining rooms just as you find a magazine article that is really interesting. You walk down a hall past storage areas smelling of disinfectant and closed doors emitting muffled screams, and are led into a very cold room with a tiled floor and a metal table and nothing to read. You are told to undress and wait, and the doctor will be in to visit you shortly. You undress and are given a paper towel to wear (which fastens across your buttocks with a thin metal chain just removed from the icebox), and then you sit freezing on the cold table for another 15-30 minutes until the doctor wanders in, looking tanned and mellow and totally unconcerned with your wait. Overall, it's a cold and very impersonal experience dominated by demands for your insurance papers or credit cards at every turn. In France, we arrived and were met at the door by the doctor himself, who was concerned and friendly. We did have a short wait, but since it was Saturday and he was the doctor on duty for the local area, we were surprised not to have to wait much longer. The next surprise was the examining room itself - it was warm and carpeted and had the office desk in the same area as the examination table, and also had a working fireplace with a pile of logs and comfortable chairs... overall, a cozy parlor totally lacking in the "bug on a cold microscope slide"-feeling of a US examining room. This, however, has nothing to do with the story which Emily will get on with now. As part of our entry into the French health care system, we were required to get a physical. Now, at home in the US this is something any doctor can do and generally your regular GP will handle it if required. Here however, for whatever reason we were required to go to a special doctor in Nantes - there was a real reason as she was the physician in charge of immigrant health examinations, but no one told us this beforehand. In fact, all we had to go on was a street address to find an office (or a house? or an apartment?) in a city the size of Atlanta which we had never visited before and which was, inestimably, French... meaning "totally alien and confusing" in this case. We did what all good Americans would do - we got a map, we found the address, we wrote out an elaborate plan of attack which would take us, turn by turn, straight to the specified locale, we marked it on the map, we went over it beforehand and had it memorized, etc. We loaded up the car with a travel guide for Nantes, maps, toll change, and cookies and water bottles in case of delays and/or starvation (we're learning!). This was our first experience on a big French highway and it was great. Basically you just put the pedal to the floor and go. It gave us a beautiful view of the countryside as we zipped along as fast as our little Clio could pedal. Big trucks here are limited to 90kph and actually drive at their limited speed so it was a different experience from the US, where the big trucks are usually the ones going faster than everyone else and blasting past you at 85mph. People observe the left lane passing rules too - a shock. Americans sometimes seem totally unaware of the concept that you are supposed to move to the right if you are in the left lane and a faster car is approaching behind you. Here, you must be always alert to keep from being run over by someone trying to get their Mercedes to 150! As we drove along, we kept a close eye on the map and were relieved to find that the exit signs and towns matched the map accurately. We were also pleased to find that Nantes was not as far away as we'd expected -- we're still having trouble gauging distance here. We began to enter the outskirts of Nantes long before we expected to, and briefly entertained the notion that we could be on time for our appointments . Unfortunately, it was at that point that things began (predictably) to go haywire. Part of the problem with not having a good sense for distance here is that we have no idea how long it will take to get somewhere. We are learning rapidly that the maps often don't match what's on the ground (hence the comment in the previous paragraph) and this trip proved to be no exception. We missed the exit that we'd planned to take by overshooting it quite decisively, and we're still puzzled about where the exit was, since none of the road signs we passed had anything on them that seemed even vaguely related to the areas on the map. We decided after a hasty consultation with the map that we did NOT want to go towards Le Mans and managed to exit onto the highway loop that went around Nantes, ending up entering Nantes from the southeast instead of the northwest. That was fine, because it actually put us closer to our goal than we would have been coming from the northwest, but we were rattled, and the real challenge was about to start: finding a place to park in downtown Nantes in the middle of the afternoon. We got into the general area of the address we had and started looking for a parking space along with about 300 other drivers who had more experience lunging for openings in bumper-to-bumper traffic. Our map began to seriously let us down at this point because the street names often aren't given for the tiny one-block-long streets you tend to find at the heart of cities that weren't orginally meant for cars. We crept along, looking for street names, which in France are posted (if they're posted at all) on the sides of buildings at the intersections instead of overhead, leading to some very odd-looking head motions from driver and passenger as we dodged around monuments, over tram tracks, and between cars and pedestrians. On our first attempt to find the main drag we ended up on a side street that suddenly (and unknown to the map) dead-ended, forcing us to turn right into a street that didn't appear to be used by cars during business hours. We rumbled over the cobblestones at a tortoise's pace, herding pedestrians before us who seemed to be wholly unconcerned that we outweighed them by a considerable margin. We finally found our way back to a street more than one car wide and went back to try again for the parking areas along the main road. This time we got onto the right street but were immediately stuck like glue in traffic. Everyone was oozing along and any open parking spot was immediately filled, regardless of the relative size of space to vehicle. After about ten minutes of oozing and checking the clock every thirty seconds, we did a James Bond U-turn and found a parking place in the lot for the Nantes train station. This was only good for an hour, but it seemed to be the best solution we would find for the moment. "We have to be able to do better walking," we thought. So off we went on foot through a lovely park, hunting for a way across the tram tracks that ran along the back of the park. On the way we passed opposite the Castle of the Dukes of Brittany (see pictures), which was begun in the 1300s and is a very impressive building, but we didn't have time to gawk. We found an underpass under the tram tracks with some extraordinary graffiti that looked like the sort of place you don't go near after dark -- or maybe even during the day -- in most major US cities and dashed through it toward our goal. Several minutes and blocks later, we reached what the map said was the street we were looking for. Surprise, it's an open plaza where people wait for trams, with no buildings! Did we think this would be any different from our other attempts to find things in France? Across the tram tracks we found a dentistry building and thought "Aha! We're getting warm!" A few more minutes of zagging about brought us to the Nantes hospital, and finally, with the help of the gate guard, to the radiology area where we were supposed to report in. And we were only ten minutes late! After a few minutes to check in and get more paper, Trev and I looked at each other in complete incomprehension of what we were doing there. We came to the conclusion that the only thing we knew for sure was that one of us was going to have to go move the car in a few minutes, since by then most of our hour had been eaten. We had just about enough time to get back to the car before our nickel (or in this case, our 1.30 euros) would be up. As French Speaker Designate, I was chosen to move the car, so off I went with our map, leaving Trev in the hall in the hospital to see if anyone was going to eventually talk to him. Parking in Nantes is like that in any other mid-to-large-sized city in the world: hellish. I was fantastically lucky, because I passed by a space just as someone was leaving! Someone else beat me to it but their car wouldn't fit, and they sped off in a cloud of burned rubber annoyance, leaving me to shoehorn the Clio into the space. To my complete surprise, I didn't even bump the surrounding cars in the process. Finding the non-time-limited parking space meant that we'd be able to do some sightseeing as we'd hoped instead of having to rush immediately back to make sure our car didn't get towed. That task successfully completed, I made the (much shorter) walk back to the hospital to determine my fate. Trev was waiting in the hall with a large brown envelope and the news that someone wanted to take a picture of my lungs. This is apparently standard procedure in French medicine. I had been reading Tom Clancy's "Rainbow Six" for several days and was more knowledgeable than I really wanted to be about Ebola as a potential agent of terrorism, so I wondered momentarily what they expected to see on the X-rays. The doctor fretted about my hair, which insisted on being in the picture, and ultimately taped my braid to the side of my head (without asking me first, I might add, as I cursed his name getting the stuff out). Fortunately the film came back perfectly normal, and they sent us upstairs somewhere with our big brown envelopes, once again into the system without any clue as to where we were going or what tests awaited us when we arrived. Having visited both Forsyth Hospital in Winston-Salem and Wesley Long in Greensboro, I figured we wouldn't have too much trouble finding our way around this much smaller hospital. We were told "7th floor north" and "O.M.I." (Office des Migrations Internationales, in case you're interested) by the lady downstairs; the first problem came when we found the elevators. ((Insert Trever comment here - No, the first problem was not the elevators. The first problem was the map we were given. The lady said, "Here is a map to the OMI office" and we jumped for joy. A real map! Unfortunately, on inspection it was unlike any map I have ever seen in the US, where you'd have a nice drawing of the hallway layout with pertinent rooms or areas marked along the way. This "map" looked like nothing other than a computer software programming flowchart. There was this little chain of arrows floating in nowhere that went out at a right angle, then turned, then turned again, and arrowed their happy way to meet a little box of French. No landmarks. No doors. No compass. No directions at all, just arrows....)) The ones that were marked "NORD" also said "staff only." Talk about putting two Americans in a logically inconsistent situation! We finally decided to take that elevator and if anyone got mad we'd just ask them how we were supposed to get there. On the seventh floor we looked at the listing for what was on that floor and found no mention of O.M.I. Doubts assailed us. We started down the north corridor hoping there might be a sign somewhere, but nothing revealed itself as the office we wanted. I began to have visions of wandering lost in the halls of the hospital for days, murmuring to ourselves and hoping for a water fountain (most of our adventures seem to have this sort of feeling in common, I've noticed). An open door that said "Office" revealed a lady in a white coat from whom I begged directions, and who gave me a slightly peculiar look at my strained tone of voice but directed us farther down the endless hall. It occurred to me later that I had probably been given directions by the chief of surgeons or something equally ridiculous. Anyway, we did find the O.M.I. office about two-thirds of the way down the darkened hallway (lighting is apparently not a big priority even in hospitals here). It was helpfully labeled with a handwritten sign on what looked like half a manila folder taped to the doorframe. No wonder it wasn't on the big list out in the lobby! I briefly wondered if the people in the radiation department had called ahead: "Okay, we're sending them up to you now, get the desks set up and don't forget to put your lab coats on, look serious...." It would have been funny if hospitals -- especially this one -- didn't give me such a case of the creeps. Momentary attitude examination and editorial: the hospital didn't initially give me the greatest sense of confidence in the French healthcare system. It was somewhat run down and things looked like they needed a coat of paint. I asked myself abruptly whether having a beautifully decorated facility necessarily indicated the level of care one would receive, and the answer, obviously, is that it shouldn't. The marble flooring doesn't care for the patients, the doctors and nurses do, and while it's possible to argue all kinds of ways about how attitude affects health or how pride in one's workplace might encourage better work, in my opinion I'd rather that the money was spent for a new dialysis machine than on fancy carpet. Or better still, on research to make the dialysis machine obsolete.... Off that soap box! Off, I say! So we found the office, and what ensued was a standard physical given by two doctors who asked us to breathe noisily, read the eye chart, whether we'd had any serious diseases or any surgeries, and all the other ordinary stuff that's part of a physical. I found out that the French dictionary on our handheld was pretty amazing, as it told me the word for "adenoids," something I didn't have the slightest expectation of finding. We got handed a figurative clean bill of health and a literal piece of paper (no official visit is complete without at least one piece of paper per person) to give to our mairie to send back to Nantes. Does this seems slightly circular? Never mind. Inevitably, we got lost on the way out as well, but fortunately we ran into one of the doctors we'd just seen upstairs. She pointed us to an exit, and we escaped into the street. Freed, we pondered our course of action and decided to wander around the city -- since we'd worked so hard to get there, it seemed a shame to waste the visit! You can see where we went by looking at the page of photographs. We didn't get to see much inside the Chateau but even the outside was amazing to stare at. I guess if you lived there and went by it every day you might think "ho hum" but it's going to be a while for me before the astonishment of knowing that the building I'm looking at has been standing for seven or eight hundred years wears off. Wandering around was a nice, relaxing end for a rather frantic day, but we still had to get _out_ of Nantes. Thanks to Trev's map reading, we left the way we'd planned to arrive with only a couple of extra turns. Once on the highway we thought we could relax, but the day had one last surprise in store for us: we got dumped into a traffic circle about ten kilometers outside Nantes and chose the "wrong" route for home. I say "wrong" because it wasn't terribly out of our way, it was just less direct and not what we'd intended to do. Lesson learned? Don't watch for highway numbers on the signs in France! Instead, figure out the main cities on the highway you want to follow and watch for signs pointing you toward those cities. We got home just fine and were thrown to the floor by the cats, who wanted to know why we weren't feeding them right now, so at least one thing about the day was extremely normal. Maybe we'll try Nantes again one of these days.....whew!