Wednesday, December 8, 2010

Cookie karma: what goes around comes around

Every family has a recipe that has been handed down from mother to daughter and, today, to son, so often it’s considered a family heirloom. In mine, it’s the Christmas honey cutout cookies, a pain-in-the-ass recipe that is believed to have accompanied my great-grandmother from southern Sweden to northern Michigan in the 1880s and that has plagued generations of Swedish-American women in the Upper Midwest ever since.

At first glance, the recipe seems innocent enough (see below). But do not be deceived: the instructions to make dough you can roll are insidious. If there’s not enough flour, the dough is too sticky and you’re left with a gooey mess. If there’s too much flour, the dough won’t stick and the cutouts just crumble. (I’ve baked many wingless angels and footless Santas in my time.) It takes years of experience to master this delicate balance and, more often than not, this phase of the project degenerates into nonstop profanity or even physical violence: an older sister in a fit of frustration once slapped me with a spatula when I offered to help her; we were in our 20s.

Then there’s the endless cutting and decorating.

The job of children in the family is to trim the cookies with colored sugar and sprinkles. At first, this is fun. My children, and occasionally their friends, strive to make each cookie distinctive, a masterpiece unto itself. They take their time, and I wait patiently while they decorate the first tray or two.

But soon I nag, as my own mother did, to “just get it done.” And after a while, they get bored and quit. I can usually cajole them into doing a few more trays, but finally, sick of their whining, I let them go and finish the cookies myself. A tray of all red bells or all green trees. The Horror! They howl in protest, but they don’t come back and help. (They aren’t that stupid!) But even with their assistance, the rolling and cutting goes on for hours and, occasionally, days.

Once the cookies are in the oven, they burn faster than a marshmallow at a barbeque. So they need constant attention. I’ve learned the hard way it’s impossible to decorate and bake at the same time.

I recently found out my maternal aunt and her daughter have never baked Christmas honey cookies. I couldn’t believe my ears! How did they escape this fate? I offered to share this bit of heritage with them, but they gave me an unequivocal “No!” Instead, they offered me a recipe for cranberry pie that supposedly came from my grandmother, although my mother has never heard of it. They tell me it’s both tasty and easy: “I make two at a time,” my cousin assured me, “one to eat and one to freeze.”

After foisting the honey cookie curse on my own daughters, I’ve now suggested we stop making them. But it’s too late. They’ve already decided Christmas isn’t Christmas without the honey cookies.

Occasionally I share the cookies with my Swedish neighbors. It’s a variant unknown to them. One even asked for the recipe. I was happy to oblige. It’s only fitting this diabolical concoction return to continue its legacy of anguish in its land of origin.

Christmas Honey Cookies (single batch)
1 cup sugar, 1 cup honey, 1 cup butter (part margarine). Cream sugar, honey, and butter. Add 1 teaspoon baking soda dissolved in 2 teaspoons hot water. Add ½ teaspoon salt, 1 teaspoon anise extract, and 4½ cups flour to make dough you can roll. Chill dough overnight. Roll dough flat and cut with cookie cutters. Bake at 350° F. until cookies are light tan in color, about 3-4 minutes.

Tuesday, November 9, 2010

A place in this world

(To read this article in Swedish, click here.)

My niece is working for a few months in Mumbai at a legal aid/advocacy organization for women and has sent her first dispatch about her experience. Although she is well-traveled for her age, 24, she finds India both fascinating and challenging:

“Nothing and everything is a surprise. I'm constantly taken aback by things I was told to anticipate and expect – cows in the street, overpopulation, poverty, traffic, but I'm still constantly on my toes. Which is good because otherwise I'd get hit by a car, rickshaw, or cow.”

One observation, in particular, resonated with me. Although she enjoys many things about the country, as a young “western” woman on her own, she is experiencing, firsthand, gender culture clash. About men:

“Friendly gestures are invitations. An arm brush is an invitation. Eye contact is an invitation. Yelling loudly ‘No! Don't talk to me!’ is an invitation. Really, it's hard. I walk around sensitive to the glare of men and constantly on guard for my enemy, 50 percent of the population. My workplace is all female, and I'm a regular in the ladies train compartment. I fear I may forget how to interact with men in a normal and healthy manner. So, friends, when I get back home, don't take it personally. It's a jungle for ladies out here.”

It reminds of an experience I had years ago in Tunisia. I went to a bank to get cash and as I completed the transaction, the male teller said, “I love you.” At first I wasn’t sure I had heard correctly, especially because I had said all of five words during the visit. Obviously, it wasn’t personal – I think my American passport caught his eye – but I had absolutely no idea how to handle that kind of remark! I guess I was supposed to be flattered, but mostly I was dumbfounded. I just mumbled, “Thank you,” and got out of there as quickly as possible.

(A couple years ago, my daughter’s friend was traveling with her family in Tunisia. A man offered the friend’s father two camels or a Ferrari in exchange for the friend. Because your average person in Kvicksund has no pressing need for camels or, for that matter a Ferrari, the friend's father declined.)

My niece also said about a few days in Dubai:

“Although I dressed very modestly, I stood out just for being a woman, and especially for being Western. Surprisingly, I was far more comfortable in Deira than the shinier parts of Dubai. Deira was far more crowded, so there was a lot more anonymity. Elsewhere, I was subject to cars slowing down to drive alongside me as I walked or pulling over on the side of the road and silently watching me pass...I felt stalked and terrorized simply on account of my gender…The drivers were working under the assumption I was a prostitute because I was female, alone, and Western. That breeds a terrible feeling of shame and vulnerability. I ended up blowing a lot of money on cabs.”

I’ve talked with other women about this dilemma. In a show of respect for local culture, you dress modestly, watch your behavior, and try not to draw attention to yourself. But it’s about more than just appearance. It’s also about eye contact, bearing, and, really, every aspect of body language and being that screams self-determination and establishes you as someone’s peer, male or female. These things are impossible to censor without great damage to oneself, which is the chronic dilemma of western women who travel in parts of the world where acceptable behavior for women is much more conscribed. How can you mask or change who you are?

They say you don’t miss what you never had. As a western woman, it’s difficult to tolerate regressive attitudes; but it’s heart-wrenching to know most women in the world are seldom encouraged to dream, believe, or dare.

At least they don’t know what they’re missing…I hope.

Friday, October 29, 2010

Even you are getting older

(Artikeln finns även på svenska. Se nedanför.)

My knee was bothering me so I decided not to join the rest of the family in climbing one of the medieval towers in San Gimignano, Italy. Although it was only June, the afternoon sun was warm so I decided to find a shady place to sit. Across the courtyard I saw one of those “rooms” you often see on public squares in Italy – a three-walled space that faces the courtyard at street level under the first floor of some medieval building. I went in, propped myself against the stone bench that ran along the walls of the room, and waited.

A few minutes later, a couple white-haired seniors carrying aluminum lawn chairs came in and sat down. Soon others joined them; and before long, I was part of a gaggle of elderly Italians whiling away a summer afternoon. At least one had brought a thermos of coffee. Clearly this was a daily ritual, but no one seemed perturbed by a tourist among them. Perhaps that’s par for the course when you live in San Gimignano!

I've seen a similar phenomenon in southern France. We were poking around a city park one afternoon when a group of elderly women and men gathered to play boules. I had heard that people in France do this, but was pleasantly surprised to see that it is true.

Contrast this with a day at an indoor pool in Sweden. I was showering in the locker room when a woman who must have been at least 80-years-old or even 85 stepped into the shower and removed her bathing suit. Loose skin hung in swags down both sides of her back and from her bottom. She wasn’t fat; just old. Two nubile teens shot glances her way and snickered. But I had nothing but admiration for the woman. I only hoped I would be equally spry when I was 80-plus and able to swim in a large public pool crowded with screaming kids, watchful parents, and self-absorbed teens.

In Sweden and my U.S. home state of Minnesota, you rarely see old people in public. Even on a bright summer day in Stockholm or Minneapolis, you rarely see groups of old people just hanging out in a park or other public place. Where do our old people hide, or perhaps more accurately, where do we hide them? Why don’t we see more old people out and about in Sweden and in Minnesota?

In the late 1960s, my family lived down the street from an Italian-American family whose maternal grandparents lived with the family. The grandparents had a small apartment on the second floor of the house and sometimes I would see them puttering in the yard or sitting in the first floor living room. I was amazed to see grandparents living in the same house as the family. It was the first and only time I had seen that while growing up.

I haven’t thought a lot about what kind of life I want in my dotage, but like most people, I don’t want to “be a burden” to my children. But what constitutes a burden, when do you become one, and who decides? Isn’t it time for meaningful social policies that support families in all ways, sizes, shapes, and forms including intergenerational living for those who want it? (See also Dream On…)

When I lived in Minneapolis, I used to pass a building – it may have been a nursing or retirement home – every day on my way to and from work. Inscribed across the front of the building was this pronouncement and daily reminder: Even you are getting older.

Note: This article has been published in Swedish in the Västmanland newspaper VLT:
Var gömmer vi alla vara äldre?

Wednesday, October 27, 2010

Disgraceful – even by Bleak House standards!

In early June, I had some kind of “x-ray” of my kidney and bladder as a follow-up to surgery I had in March. After a lot of back and forth, I was told I would be contacted in September(!) and the urologist would “explain everything” then. (See post Don’t call us, and you can be sure we won’t call you!)

September came and went, and I heard nothing. I figured I had fallen out of the system, but I didn’t care any more.

Today I received a letter in the mail notifying me of an appointment with a urologist on November 11, presumably to discuss the x-ray results from June, SIX MONTHS AGO! (Hell, why not wait until next June and make it a full twelve?)

I am completely disgusted with the urology unit at Bleak House (Västmanland County Hospital, Västerås / Centrallasarettet Västerås), especially since all I ever wanted a phone call and a chance to talk to someone for ten minutes about the x-ray results and my symptoms.

Needless to say, I am NOT going to this appointment.

It's a waste, and much, much, much too late.

Wednesday, September 29, 2010

Attention single women! Does your prospective pass The Toilet Bowl Test?

I bet when you saw the title of this post you were hoping against hope you had found the holy grail of housekeeping: How to get your man to improve his aim or, at least, not drip on the floor. Alas, nothing can help that. But I do offer The Toilet Bowl Test.

When I was single, I heard countless stories from female friends about husbands who don't do housework. I decided then the make or break point in household cooperation was bathroom cleaning. So I created The Toilet Bowl Test. To pass it, the person in question has to clean the toilet without being asked, and without comment or complaint. I vowed to never marry a man who could not pass it.

I started dating a guy from Sweden. Since he lived there and I lived in the United States, we didn’t spend a lot of time together and communicated through letters and phone calls. (No internet in those days!) One time, he came to visit over Christmas.

We had been busy all week and had not spent much time at home. It was now New Year’s Eve and I had friends coming for dinner. There was a lot to do, including cooking and cleaning. I didn’t have time to do it all.

This posed a problem. He was my guest, and I don’t usually ask guests to help with housework! On the other hand, since we didn’t see each other often, everything in our relationship was accelerated. My dilemma: Do I treat him like a guest to show good manners, or do I treat him like family and ask for help?

I mustered my courage and explained the situation. I gave him a choice of starting dinner or cleaning the bathroom. He chose the bathroom. I showed him the cleaning supplies and, without a word, he set to work.

A few minutes later I checked on him and found him kneeling in front of the toilet wiping its base. I asked if everything was okay. He said “Fine” and continued working – no wise cracks, no smart remarks, no complaining. That’s when I decided “This one’s a keeper!”

Twenty years and two children later, he still cleans the bathrooms.

I once told a friend about The Toilet Bowl Test and bragged about my good fortune. She listened, then smiled, “But does he polish the chrome?”

She does know men!

Wednesday, September 22, 2010

Don’t call us, and you can be sure we won’t call you!

Regular readers of this blog are by now used to my rants against Bleak House (aka Centrallasarettet Västerås / Västmanland County Hospital, Västerås), with which I have a love-hate relationship: I love to hate the place. That’s why I can’t resist sharing the outcome – or lack thereof – my final conversation with the hospital’s urology unit.

As faithful readers may remember, I had an x-ray (or something like it) of my kidney and bladder on June 3. Two weeks and several phone calls later, I finally had contact with the doctor who ordered the test. He gave me a terse, “The x-ray is normal,” and refused to answer any questions about my concerns, promising me, “I’ll explain everything in September.” (See post “Who are you?”) I subsequently called back, requested a new doctor, and asked that the new doctor call me, presumably during the summer.

You, being the observant reader that you are, have undoubtedly noticed the date of this post. And knowing that you are waiting with bated breath for the outcome of this story, I will tell you now: I have not heard a word from the urology department. (Did I just hear you gasp in shock or are you laughing yourself silly?)

Do I even care? Not any more. I simply don’t have the energy. (I have found partial answers to my questions elsewhere.)

Mostly, I am just sad and discouraged about the way patients are left hanging by Bleak House.

(See also posts Bleak House: Service at Västmanland County Hospital and And so it goes.)

Wednesday, September 15, 2010

Power surges and sage tea

A friend recently shared a story about her son. He is twelve years old and had a friend staying overnight. Her son's friend is a couple months older than her son, about an inch taller, and has armpit hair whereas her son doesn’t. Her son, angered that his friend is “ahead” of him developmentally, exclaimed in disgust, “Hormones suck!”

My friend, who heard this from another room, yelled back, “I AGREE!”

She’s 52, and dealing with fickle relatives like Aunt Flo.

I myself have entered the spiritual realm: sweat lodges minus the lodge but heavy on the sweat!

We commiserate on the “change of life” and share ideas about how to cope. Most recently, I’ve been chowing flaxseed and soy, and gulping sage tea. Is it helping? Doubtful.

“Here’s a way to deal with things you're experiencing,” she suggests. “Use different words to describe them!”

Mind over matter? Worth a try.

“Instead of a ‘hot flash’, you’ve just had a ‘power surge.’

“Instead of being ‘old,’ you're a ‘seasoned professional.’

“And, as the French used to say, you're a woman ‘of a certain age.’”

Hmmm...I’m alluring, wise…and about to short-circuit?

Nah, count me in, too.

Hormones suck!

Monday, August 23, 2010

“We are not Dr. God”

Funny...I never thought you were.

Yet last week was the second time in recent years a physician said that to me during a doctor visit. It happens when I start asking questions.

I explained my situation then tried to ask a question. But before I even finished articulating it, the doctor interrupted and started answering based on what he thought I wanted to know. When I tried to refocus the conversation on my particular circumstances, he just continued his spiel with "'We are not Dr. God'" thrown in.

I think his comment reveals an interesting self-perception.

I do not believe physicians are omniscient. But I do expect them to answer my questions. Note: answer my questions, not cure my ailments. If a doctor can explain my symptoms, great! If she can treat or eliminate the problem, even better! But if a physician doesn’t know why my body is acting the way it is, that’s an answer, too. And a straightforward “I don’t know” while perhaps dismaying is at least honest and respectful.

“We are not Dr. God” is a defensive, and demeaning, statement. But maybe it’s our own fault.

In the western world, we groom doctors like thoroughbred horses. In college, premed students are held in awe: “Medicine is hard! You must be smart!” The ego-building and instant prestige continue when proud parents later brag “My daughter, the doctor!” or people add “He’s a doctor!” when parading the specimen at social gatherings. (Sorry, lawyers no longer cut it.)

Never having had to justify their career choice or, since most mere mortals don’t understand medicine, explain their decision-making, it's no surprise that many physicians perceive questions from patients as a challenge to their authority, competence, knowledge, ability – who knows? – and react defensively. Questions break their stride.

Or maybe they’re just nerdy introverts with lousy communication skills.

(Does it matter that I’m female? The doctors who said this to me were male. Would a female physician say this to a female patient, or a female physician to a male patient, or a male physician to a male patient?)

I’m aware there’s a fine line between too little and too much information, and I can imagine many doctors consider talking with patients a no-win situation: If I don’t say much, the patient will complain about being uninformed. If I say too much, the patient will accuse me of information overload or being too technical. That’s why doctors need to listen to patients and hear what they’re saying, and respond accordingly. Health care is a two-way street: It's a dialog, not a monolog.

A physician friend claims the most important skill of a good doctor is an ability to work with people. (What good is knowledge if it doesn’t translate into effective care?) I agree.

Don’t talk at me, talk with me.

See related posts Doctors never make mistakes and Name game.

Friday, August 6, 2010

Is your inner critic talking to you?

I was reading a newsletter today where the author touched on people’s inner critic – you know, that little voice in your head that tells you you’re not good enough, smart enough, hard-working enough,
__fill-in-the-blank__ enough. The author relayed the story of a friend who said if a real person talked to her the way she talks to herself, she’d have ditched the friend a long time ago.

No kidding!

This tickled my fancy because I, too, am my own worst enemy. And I wonder why.

It reminds me of the Groucho Marx joke about not wanting to join a club that would have him as a member. Or better yet, in a story in Nasty Book, a book for tweens, about a boy whose imaginary friend runs away because the friend can't stand him.

Now that’s pathetic.

Why is it so hard to be your own best friend?

Theories abound: You grew up in a critical family. You did poorly in school. You weren’t popular with the in-crowd. Your boss and your colleagues hate you. You don’t have even imaginary friends. We internalize all that negativity, and it’s downhill from there.

Or maybe it’s false modesty. After all, if you really believed that critical voice, you wouldn’t be as successful as you are or try to master new challenges. You’d just give up before even trying. But everyone does something. It’s mainly in the learning phase or before we’ve mastered a skill that the little voice screams loudest.

Perhaps it’s a female thing. I think woman are more prone to this than men. Just the other day I was discussing something with my husband who said, “I don’t know why you’re so negative about yourself.” The fact that someone may not be worthy of or deserve what they hope for hadn’t even crossed his mind. For him, if you’re skilled or qualified for what you want, there’s no reason you won’t get it. (I know even he has his inner demons. But it’s sweet that he refused to acknowledge mine.)

I wanted to comment on this because I think it’s interesting. But I couldn’t really think of anything helpful or pithy to say. No insight or lesson to share. So I thought I wouldn’t write anything.

But that’s not what I wanted to do. I then thought people would think what I wrote was stupid. But "inner critic" is a phenomenon we all recognize, so why not comment on it? Because it’s boring unless I have something compelling to say. But do all blog posts have to be enlightening? Does each one have to be a gem?

Will I look foolish or idiotic if one is not? Do I dare put something out there that’s less than perfect? What if this post is too trite? What if I fail? What if I look dumb? Maybe this is a really bad idea.

Shut up already!

Thursday, July 22, 2010

“Who are you?”

On June 3, I had an x-ray at Bleak House (i.e. Västmanland County Hospital/Centrallasarettet) of my kidney and bladder as a follow-up to surgery performed in March.

(Are you, faithful reader, as sick of reading about Bleak House as I am of writing about it? It’s a dirty job, but someone has to do it.)

I ask the nurse who does the x-ray when I will know the results. (I have some problems and really want to know what the x-ray shows.) She says if I don’t hear within a week that I should call.

A week later I call Radiology about the results. “X-ray results?!” the person answering the phone asks with astonishment. “That takes five weeks!” I explain that I was asked to call after a week. “Who told you that?” she asks. She then suggests that I call Urology since they ordered the x-ray.

It’s now almost mid-June and I’m going on vacation soon. I call Urology and explain that I will be going on vacation the following week and ask if I can find out the results before I leave. “The doctor just got the results yesterday!” says the nurse with exasperation. (Who do I think I am asking for such a quick response!)

A few days later the urologist calls me on my cell phone. I’m at a conference and cannot take the call. I ask if he can call the following day. No call. I call Urology again and ask if the doctor can call before Friday since that’s when I’m leaving town.

The urologist calls back. I explain that I want to know the results of the x-ray. He seems puzzled: “Who are you? What is your identification number?” He then asks, “Who ordered the x-ray?”

“Are you ______?” I ask. Yes. “You did,” I reply. By now it is clear he is stressed and doesn’t want to talk to me.

“The x-ray is normal,” he says suddenly.

I try to explain some concerns I have and to learn more about the x-ray. “I’ll explain it all in September,” he states, trying to end the call. (It's summer in Sweden. Nothing happens before September, even a report by phone about an x-ray done on June 3.)

How can he “explain it all” when he doesn’t even know what the problem is?

When I return from vacation in July, I call Urology. (“Urology. Nurse.” Is the curt greeting of the woman who answers the phone. I guess nurses who work there don’t have names.) I request a new doctor.

Consider it a vote of no confidence. I expect the doctor to know who he's talking to when he returns my call (a second time!) about the results of a test he ordered.

Friday, April 23, 2010

Women! Have you asked your friends yet if you have cancer?

I recently copied the patient ombudsman’s office (Patientnämden) for Västmanland County on a letter of complaint to “Bleak House” (Västerås Centrallasarettet) about lack of access to gynecological services in Västmanland. (I recently had a complicated hysterectomy that I believe would not have been as problematic if I had received appropriate help much earlier.)

On Monday, I got a call from the ombudsman’s office to say they had received their copy of the letter. As we were talking, I mentioned that, in my letter, I had not raised the point that no one ever suggested or did a biopsy of my uterine myoma (reason for the hysterectomy) when it was first detected and that if it had been malignant I’d probably be dead now. (Since I had conflated the symptoms of the myomas – there were several now – with those of menopause, there had been a long delay before the problem was addressed.) I realize malignant myomas are very rare, but if you don’t check, how do you know?

The staff person assured me that women often talk amongst themselves about menopause and that I would have discussed my symptoms with family and friends and that I would have gone for a check-up. (She also said I would have had pain but I’m not sure this is true.)


My friends are supposed to diagnose my cancer?

What next?

A Ouija board? A divining rod?

First, women do not necessarily discuss menopause amongst themselves. For me, it’s a private matter I’ve discussed with very few people, including family. (Are men assumed to discuss prostate problems amongst themselves?) Second, as a foreigner living in another country, the circle of friends with whom I discuss intimate problems is very small. Third, the symptoms for both malignant and non-malignant myomas, as far as I know, may be the same so why would my behavior have been any different?

I answered that I probably would have assumed my symptoms were related to menopause and done nothing. (And there’s no reason to think my friends would have come to a different conclusion.) I may be dumber than most women, but that’s probably what I would have done.

In fact, it’s what I did.

Friday, April 16, 2010

A seamlessly smooth system? Not!

“You are not our problem, and lest you forget, we have ways of reminding you.” This is the clear and ever-present message to patients subject to referral between clinics within the Västmanland health care system (Västmanlands landsting) and the Västmanland County Hospital in Västerås (aka Bleak House).

That will be SEK 50, please
I recently had surgery at the hospital and needed to have my stitches, or in my case, staples, removed. I was told my local health care clinic could do it if I wanted to save myself a trip to the hospital. Why not? I thought.

On the scheduled day at the scheduled time, I went to the clinic and presented the staple removal request form I had received from the hospital. “SEK 50,” said the receptionist. What? I have to pay to have my staples removed?

I’ve always thought the purpose of co-payments is to discourage overuse of service. I hardly consider removal of surgical staples a matter of choice. Indeed, I thought it was part of the entire “surgical package,” whose cost is covered by county health care services.

I later learned if the hospital had removed the staples there would have been no charge.

Perhaps my clinic, since it was not responsible for putting in the staples, thought it had no responsibility to remove them, hence the co-payment. But SEK 50 was most certainly not the real cost of the task, and I’ll wager the clinic gets reimbursed by the hospital or county anyway. (I wonder if the clinic deducted the SEK 50 it had already charged me from its bill to the hospital/county? A little double-dipping never hurt anyone, I guess.)

So why charge me?

I guess it was just my clinic’s way of making me feel welcome, and reminding me not to waste its time on things that are not its responsibility.

We’re so busy!
But the urology clinic at Bleak House was not as subtle. Due to a complication during surgery, a tube had been inserted between my kidney and my bladder. It was to be removed three weeks after surgery. The gynecological surgeon told me I would by notified by mail of appointment time in urology for removal of the tube.

I waited two weeks. Nothing. By chance, I happened to speak with the surgeon who asked if I had received a urology appointment yet. Nope. Two days later, a letter arrived with an appointment for the following week. The date of the letter was the same day I had talked with the surgeon.

I should have suspected trouble when I saw that the appointment time on the letter was hand-written – a printed time of 11:00 am had been scratched out and 10:30 am handwritten next to it.

I arrived at 10:30 and signed in. After 45 minutes, I tracked someone down and said I had been waiting 45 minutes. She confirmed that I had a 10:30 appointment (duh!) and said there would be a wait. After another half hour – it was now 11:45 – someone heard me complaining on my cell phone to a friend and debating the pros and cons of leaving.

Two nurses approached me. They told me they were overbooked. (At least the airlines offer monetary compensation!) I insisted on knowing how long it would be before they could help me. They wouldn’t commit. Finally someone said “5 minutes.” I was skeptical, but about five minutes later one of the nurses fetched me. It was 12.00.

Suddenly she was all professional, but I wasn’t buying. She offered no apology so I asked for one. She muttered something, after which I let loose about how "patients are people and not hunks of meat!" I explained the staff should have let me know there was a delay, told me what was happening, and apologized for the wait. So then gave a more sincere apology and I said, “That’s all I wanted.” (I still would have been angry, but less so.)

She said there was a delay because they were fully booked with their own patients, but had been asked to take patients from other units too (i.e. me). The implication was that I had been squeezed in, but not by choice. (How long had they had the referral?)

They removed the tube. I was in and out in 20 minutes.

Apparently my local clinic considered it a burden to remove my staples and felt it necessary to “nickel and dime” me as a result. And apparently gynecology and urology disagreed as to whose responsibility it was to remove the tube.

These are internal fights that I as a patient should know nothing about. Yet here I am writing about them because they have directly affected me.

A seamlessly smooth system? Not.

Thursday, April 15, 2010

Hospital hygiene – it's in the details

It started with a chair.

But unlike the movie Juno, that’s where the gynecological similarities between this and that story end.

I had been admitted to Centrallasarettet (Västerås County Hospital) for a hysterectomy. A small armchair stood in the corner of the room. It was not an unattractive chair and it added a little warmth to the room. The evening before my operation I sat on it and noticed the back was broken. This is a little dangerous, I thought. If someone leans back too far they could get hurt; now I know why the chair is propped in the corner.

A day or two after the operation, my husband came to visit. He pulled the chair forward and it flopped back. Look out, I called, the chair is broken. Another time, a nurse came into the room and the chair was looking floppy. She nonchalantly propped it back into the corner. No one took it upon themselves to have it removed before someone got hurt.

(When you're stuck in a hospital bed for a week, there’s not much to do except observe - like the picture of a sweet child on the wall of a room in a ward for women facing reproductive issues such as difficult pregnancies, miscarriages, hysterectomies, and gynecological cancer. Bad choice.)

Due to challenging surgery and a complication, there were two drains and a catheter protruding from me the first couple days. Each time a nurse came into the room to check me, she’d (all my nurses were female) pick up the drains, which had fallen on the floor, saying “These shouldn’t be on the floor.” Inevitably, since hospital beds are narrow and, at first, I wasn’t even aware I had drains in me, they’d fall on the floor again and another nurse would come in and say “These shouldn’t be on the floor.” (I couldn't pick them up myself.) One nurse did pause and look to see if there was a way to fasten the drains to the bed but nothing came of it.

Soon the drains were removed, but I still had the catheter. As I began to get up and move around, I noticed dried spots of urine on the floor, where the drains had lain, and where nurses emptied the catheter. The spots were sticky-looking and dirty because each day a custodian came in and dry-mopped the floor, thereby smearing the semi-dry urine.

I felt ready for a shower. I went into the bathroom, which was shared by four patients, two per room, and their visitors. I noticed a sign above the toilet and large bottles of anti-bacterial disinfectant next to the sink. The sign said that patients, for their own safety, should clean the toilet, I assume the seat, before using. I took a quick look in the bowl. Not disgusting, but not the cleanest toilet I had ever seen. (After abdominal surgery, patients’ bodily functions are not quite what they should be.) It stayed like that for days.

As my own body recovered and I started using the toilet. At least once I slopped excess disinfectant on the sink and the floor as I was wiping the seat. I thought about the effect of this on the worldwide overuse of anti-bacterial agents, but never mind.

One afternoon there was a problem with my catheter. As I lay in bed and the staff attended me, they put used tubing and instruments on my bedside table. When they were done, they took everything away, but no one wiped down the table, which was also used for food and medication. When they had left, I got up and did a little cleaning. Thank goodness for that disinfectant in the bathroom!

At meal time, staff would bang on a pot lid - like farmers summoning pigs to the trough or, more kindly, troop leaders rounding up kids at scout camp - to let patients know the food cart had arrived. There was also a coffee cart in the corridor where patients could get a light snack and something to drink during the day. When I was able to walk, I got up for coffee. The floor in front of the cart was splattered with coffee and juice.

One day as I sat in the patient lounge, I smelled something - it was the custodian’s mop as she casually made her way down the corridor.

I’m sure the chair is still there.

Thursday, February 18, 2010


I had to call Bleak House - I mean Västmanland County Hospital - today to schedule a gynecological exam.

The first thing I noticed was telephone time: 7:00 am - 3:00 pm, Monday through Friday. While I realize some women may appreciate an opportunity to make an appointment before running out the door to work, if the trade-off is to call at 7:00 am or 3:00 pm, I opt for the latter. I think I can safely say the first thought of the morning of most women I know is not "I want to call the gynecologist." (Note: abortion services are another number!)

Second, this is the number to make an appointment for an appointment. When you call, you get a recording that asks you to leave your name and number and a promise that someone will call you "around" a designated time. (My callback was 10-15 minutes late.) If you call too late in the morning, all the callback times are booked and you have to start over the next day. This arrangement is a slight improvement over the old system when you were allowed to call only one or possibly two hours a day and you had to sit on the phone in a telephone queue, often for half an hour or more, waiting your turn. But the fundamental question is: When they decided to make the appointment system more "user-friendly," was this really the best scheme they could come up with?

When the clinic does call you back, you can request an appointment. But first you must justify your need. When I explained my problem, I was asked if it was urgent or if it could wait. If it was an urgent problem, I could get an appointment within a few days. If it was a non-urgent problem, I would have to wait about 2½ weeks. Urgent? Non-urgent? Huh?

I don't know about you, but I don't usually plan my medical problems weeks in advance. When I call to schedule an appointment, it means I'm ready to see a doctor now. If I could wait three weeks, I wouldn't be calling this day; I'd be calling three weeks from now! When I call, it means I've done my waiting for the problem or pain to go away. I'm ready to see someone today (or as soon as possible). That's why I'm calling!     

Tuesday, February 9, 2010

And so it goes

The orthopedist was supposed to call me today at 11.55 to talk about the results of an MRI on my knee that was performed two months ago. By 12.25, he still had not called. I emailed the department (it's virtually impossible to reach them by phone) and asked if he was going to call today.

Don't know if they had read the email, but ten minutes later - 40 minutes after the designated time - he called (with no apology). I said I had not had a chance to talk to anyone about the MRI, which had been done two months ago. Didn't I call and leave a message, he asked? Yes, I said, you left a message on my cell phone, which I didn't find until two days later. You asked me to call if I had questions. Well, I do! We talked, and I pried out of him some ideas about what could be wrong with my knee and some thoughts about what to do next.

In Sweden, you do your job. His job was to report my test results, not to assist with or solve my problem. It seems obvious, but I guess it's necessary to articulate that actually assisting a patient is part of a physician's job description.

Job description: physician. Blah, blah, blah. Must also attempt to solve patient's problem by talking to patient live and identifying action steps for treatment. Disdain for people automatic disqualification for this job.

The orthopedist did his job: he reported the test results. But did he attempt to help the patient?

Monday, February 8, 2010

Västmanland County Hospital update: Good news and bad news

On Saturday, I relayed the plight of a man waiting for chemotherapy at the Västmanland County Hospital. The newspaper vlt reports today that after it contacted the oncology clinic last week for Saturday's article, the clinic has since contacted the man and scheduled him for chemotherapy starting today.

The paper also contacted a county commissioner for comment on the man's long wait for treatment, but the commissioner referred the paper to the clinic head. The commissioner added that she had tried contacting the clinic head, division head, and county heath care director herself but had still not had contact with anyone. The commissioner also said, "But we're working to shorten the processes for transferring a patient from one clinic to another."

The good news, of course, is that the man is now going to be treated. The bad news is that it took intervention by the newspaper to make it happen. Regarding the commissioner's comment about making the transfer process more efficient, I say: don't hold your breath. They've been making promises like this for years.

(As Marti points out, you have to be healthy to be sick. Getting care requires a lot of persistence and energy!)

Saturday, February 6, 2010

Bleak House redux: Don’t get cancer in Västmanland!

I am sad today to relay the situation of a man awaiting treatment for colon cancer at the Västmanland County Hospital. The article appeared in today’s edition (February 6, 2010) of vlt, the regional newspaper for Västmanland.

In October 2009, the man visited his primary physician. It was determined he had blood in his stool. The doctor referred him to the Västmanland County Hospital for a colonoscopy. (Note: until recently, you could only get a colonoscopy in Sweden if you had symptoms of illness. It is used as a diagnostic not preventive test.). He was informed by mail there is a 4-6 month wait for a rectal exam. Because he was in so much pain, he contacted his primary doctor again to intervene on his behalf. Six weeks later he got a colonoscopy. He received a diagnosis of cancer on December 17.

He was then referred for chest and abdominal x-rays. On January 5, he received a stratum(?)/layer(?) x-ray. Six days later, he met a surgeon who confirmed he had a malignant tumor in his colon and that the cancer had metastasized into his liver. That same day he received chemotherapy through a vein in his neck and the surgeon hand-delivered a referral to the oncology clinic. “Everyone knew it was urgent,” the man says.

Since then, he has heard nothing from the hospital. What he does know about his cancer he has researched on the internet. Although he’s in great pain, he has received nothing for it. He takes only aspirin, which doesn’t help. When he calls the oncology unit, he is told there is a long wait for treatment and he has to just wait his turn.

The head of the oncology clinic was also interviewed in the article. She says the man will receive treatment as soon as he is admitted to the clinic. She says the waiting time, which is currently many weeks, is unusually long right now because the clinic is reorganizing its journal system. It has even had to offer night and weekend patient hours. The clinic prioritizes patients who have acute pain, she says.

“But cancer is never an active (sic) disease," she continues. "Medically speaking, it is not acute. It actually doesn’t matter if patients have to wait a few weeks or a month.” She also notes that the surgical unit, which performed the colonoscopy, should have helped the man with pain management when he was diagnosed with cancer. Only when he officially becomes a patient of the oncology clinic does the oncology clinic take care of him.

I've often worried what would happen if I got seriously ill and had to get treatment at the Västmanland County Hospital. Unfortunately, now I know.

Wednesday, February 3, 2010

Bleak House: Service at Västmanland County Hospital

In his novel Bleak House, Charles Dickens scathes the slow pace and high cost of Britain’s legal system. He may as well have been writing about administrative procedures at the Västmanland County Hospital in Västerås or Västmanland County health care in general where the message is clear: Patients, please don’t bother us. You just create problems for “the system.”

My knee gave out in June, nine months ago. I’m still waiting for a diagnosis and treatment of the problem.

Patient/appointment log to date:

June 2009
On vacation. Sudden sharp pain in knee. Wait several weeks to see if pain goes away.

August 2009
Still in pain. Try to schedule doctor appointment, but doctor on vacation. Clinic accepting only “urgent cases” since doctors on vacation, clinic understaffed. Call week or two later: get appointment for August 31.

(In Stockholm, the city closes one of two major children’s hospitals every year for month of July. All patients referred to children's hospital that is open. It was a nightmare the day I visited the hospital's emergency room a few years ago – waiting room packed, eight-hour wait, snack bar closed, toilets backed up so staff closed bathroom. All this with an ailing child and baby in tow. Real “third world.” But I digress.)

August 31, 2009
Doctor examines knee. Refers me for x-ray. Couple days later, x-ray at walk-in x-ray clinic in Västerås.

September 10, 2009
Doctor calls with x-ray results: nothing. Refers me to orthopedic clinic at central county hospital. Almost all specialists in county based at county hospital so must go there. Couple weeks later, notice in mail: have been assigned time with orthopedist on October 6.

October 6, 2009
Orthopedist finds nothing. Recommends MRI. (Knee is killing me. Walk with limp. Difficulty going up and down stairs. Cannot do routine tasks like mowing the grass.) Orthopedist gives me form to fill-in and mail so orthopedic department when know when I’ve had MRI. (Apparently hospital’s departments don’t talk to each other. Patient’s job to keep them in touch.) Told probably several weeks wait for MRI. Ask if I can get one at walk-in clinic. Not possible. Once patient is in hospital system, all services performed by hospital even if faster somewhere else. (Cost to the county, which is the payer, is the same no matter who performs service. Hospital just doesn’t want to lose the fee even if patient must wait months for service.)

Several weeks later, notice in mail: MRI scheduled for December 11 (two months since visit to orthopedist). Mail form to orthopedic department about MRI.

December 11, 2009
MRI of knee.

January 11, 2010
Letter in mail: orthopedist will call with test results on January 27!

January 27, 2010
Orthopedic clinic calls. Orthopedist home with sick kid. Doctor will not call today. When I can expect a call? When his child is better or he returns to work.

January 31, 2010 (Sunday)
Find message on cell phone. Orthopedist called January 29 (Friday) and left detailed message on cell phone. (Do like personal touch and respect for privacy by leaving medical test results as cell phone message!) Asks me to call if questions, but leaves no number.

February 1, 2010
Find contact information for the orthopedic clinic: telephone hours 07.15-15.00, Monday-Thursday. Call around noon, get recording: day’s quota of telephone times has been filled; try again later. Message doesn’t say when. Call again around 13.30. Same message. (Blog readers may recognize this problem from my quest last year to schedule a mammogram. Search “mammogram” on this blog.)

Find website for department and email address. Send message must speak with orthopedist about test results. Ask clinic to suggest several times when we can talk and I’ll confirm one. Also ask for direct telephone number so I can speak with department staff and by-pass telephone queue.

February 2, 2010
Email reply: orthopedist will call on February 16 at 15.30. “We hope this works well for you.”

No, it doesn't. Angry! Two months since MRI and still haven’t spoken with anyone about results. Send message: no can do; try again.

February 3, 2010
New message: orthopedist can talk with me on February 9 at 11.55, not sooner. (Heaven forbid he should just pick up the phone and try calling me!) Message also reaffirms only way to reach department is general number or email.

I confirm phone appointment for February 9.

How does Bleak House end? Several of the litigants in the lawsuit around which the novel revolves die before the case is settled. It’s clear this is also the hope of health care administrators and practitioners in Västmanland: Patients, please go away (or just die, for Christ's sake)! We’re too busy for sick people.

Wednesday, January 20, 2010

Tacos, anyone?

About two years ago, two teenage boys from Italy stayed with us for about five days as part of a student exchange through my daughter’s school.

This week, we’re hosting two teenage boys from Portugal as part of the same project.

With the Italians, I made tacos for dinner one night: easy-to-cook and conveniently serve a group. Although the poor Italians were stunned and hardly ate a thing, I thought I’d try it again anyway with the Portuguese boys.

But alas, when we told them we were having tacos for dinner, they asked what “tacos” are. When we pointed to pictures of meat-filled wraps on the tortilla package and cornmeal shells on the taco box, there were no signs of recognition. Nonetheless, we took them through the ritual of stuffing a tortilla, and restrained our amusement as they first tried to cut the wraps with a knife and fork (which caused the wraps to flop open, bringing our guests back to square one) then follow our example of picking them up and eating them rolled (but neglected to hold the bottom closed whereby all the filling slid out onto the plate). They ate one each but declined seconds.

What astonishes me is that even in Sweden, tacos and tortillas are, today, common, everyday food. Any Swede under 60 can handle a taco. So is Sweden preternatural in its culinary tastes? Or is Continental Europe gastronomically chauvinistic?

Teenagers who’ve never seen a taco? Who’d have thought!

Friday, January 8, 2010

Time to raise Jan Forsberg's salary!

I read recently that Jan Forsberg’s salary has increased something like 60% over the last five years. (Jan Forsberg is the CEO of SJ - svenska järnverket - Sweden’s rail transport company.) Yet trains in our area, Mälardalen, run as poorly as ever.

As I thought about this paradox, I realized we’ve been looking at the problem of CEO salaries and company performance all wrong.

It’s common wisdom that poorly paid workers, or people who feel underpaid, care less about their work than those who believe their financial compensation is commensurate with their efforts.

It appears that Forsberg feels undervalued. The trains in our area are chronically late, when they show up at all. And the least bit of cold weather brings the system to near collapse. As I see it, poor train service is indicative of Forsberg’s job dissatisfaction and that SJ is not paying him enough.

The trick is to get Forsberg to care about his work. This means his salary should not be linked to performance (i.e. the better the trains run, the more he earns). He should instead be paid what he thinks he's worth to motivate him and to keep him happy.

We must get Forsberg to care about his job. That’s why whenever there’s a problem with train service, I say it’s time to raise Forsberg’s salary! Only when he truly feels valued will we see better train service in Sweden.