Health & Efficiency
02 November 2017 | or 'The Naked Truth'
Well, here we are back in Spain, where the weather is distinctly warmer than it was when we left Toul.
So much warmer, in fact, that I have even been disporting myself in shorts and T shirt, a dress code that has brought the appalling changes wrought upon my upper body into the public domain. I appreciate that this may be difficult for those of you with first-hand knowledge of my magnificent physique to appreciate, but my upper body musculature has atrophied to the point where my previous Adonis-like figure is unrecognisable. My once broad shoulders now take on the aspect of an anorexic sparrow while my former barrel of a chest is now more aptly described in terms of a couple of raw chicken wings stapled onto a piece of tripe. My arms, far from their former status of manly, protective fortresses into which maidens dreamt of swooning, have shriveled into vestigial appendages hanging uselessly by my sides. Overall, I now look like the bastard, stunted, mutant offspring of Gollum and Skippy the Bush Kangaroo.
"Oh No!" I hear you cry in sympathetic horror, "What can possibly have caused such an abominable fall from grace?"
Well I'll tell you. It's lack of use. And what has caused this lack of use? I'll tell you that as well. It's sub acromial impingement syndrome, that's what. And it hurts like Hell. And limits the available range of movement in my right shoulder to a gnat's cock and a thou in any direction. As a result a lot of activities have had to go by-the-by. Playing the saxophone? - can't pick it up, let alone play the bloody thing. Riding a bicycle? - If there's any traffic around I'm limited to left hand turns on the bike - I can't signal right. Dress myself? Hah! I can't even thread my belt through its loops. I'm walking around with my jeans hanging off my arse like some puny adolescent trying to gain street cred by pathetically aping gangsta chic.
Medical opinion seems to be that this problem is caused by bony growths in the joint that need to be ground away under local anaesthetic with the medical equivalent of an angle grinder. Orthopaedic surgery is expanding from its traditional role of warm carpentry and now encompasses warm metalwork and ceramic tiling.
"Man up" the less sensitive amongst you will exclaim. "What about your left arm - why don't you just use that, you big girl's blouse?"
Well I've got an answer to that. Incompetent bloody French phlebotomists. The sort of incompetent bloody French Phlebotomist who, when supposed to take a blood sample from a vein in the left elbow, sticks the bloody needle right through said vein and out the other side.
Right into the bicep tendon.
Bruising it badly and causing tendinitis.
So that's both arms knackered then.
All of which attention-seeking and needy, sympathy-soliciting whinging brings us to the point of this entry, such as it is. Medical care and the long-term cruiser.
Illness and injury are never a barrel of laughs, but at least for those with a more conventional lifestyle, the process is relatively well understood and easy to put into motion. You go to your GP and explain the problem. (S)he then either treats you, surreptitiously adds the cryptic note 'TF Bundy' on your file (*), or refers you on to an NHS specialist who will see you at his or her clinic, hopefully some time before judgement day. Unless you are filthy rich or insured, that is, in which case you get to see the same specialist next Tuesday, at which point the specialist's secretary will surgically remove the contents of your bank account before you get halfway across the deep-pile carpet.
No such simplicity for the cruising sailor. The choices are so many, so variable and so nuanced that in order to make the right decision you would need an algorithm more complicated than Google's, Amazon's and Facebook's combined.
Some choices, of course, are relatively straightforward. All the algorithms will start with the question "Is it immediately life-threatening?" If the answer to this is "Of course it is you bloody idiot - I can't breathe and there's blood pouring copiously out of my every orifice!" then you call an ambulance, go straight to the best hospital in the vicinity, get done whatever needs to be done, and deal with the financial fallout later.
If it's not immediately life threatening but is nevertheless pretty bloody urgent then the first thing you do is look to see if you've got insurance cover or an EHIC if you're in the EU (Use it while you can, folks).
However, if your problem is not life-threatening or urgent but still debilitating and bloody painful, such as - Oh I don't know, sub acromial impingement syndrome to pick an example purely at random - then you're spoiled for choice.
To wit, you can:
1. Pay between 2500 and 3000 euros and have the op done next week in a Spanish hospital. (Competence of surgeon and general hygiene and nursing standards of hospital to be ascertained beforehand).
2. Get yourself back home and get the job done on your home health service. This is by far the cheapest option but it does involve writing off at least a year's cruising while you sit around waiting for appointments and theatre dates, which get cancelled and rescheduled at the last minute because some idiot's crashed a car into a bus queue or the beds are all full of well but frail pensioners who can't get the place they need in a care home because their local council has been effectively bankrupted by a mixture of central government politicking, rapacious development consortia and its own incompetence and hubris.
3. Get yourself back home and go private. By the time you factor in the travel costs and the cattery bills this is probably the most expensive option but it does avoid the problems of (2) while still ensuring you a familiar and Anglophone environment. It's going to take a lot longer than (1) though. (**)
This is where the financially prudent among you will smugly proffer the opinion that we bring this upon ourselves and that all these difficulties would have been avoided had we bothered to take out travel health insurance.
I counter this with the following tightly reasoned argument:
Would they Bollocks.
Let me expand my argument.
a) It is virtually impossible to get health insurance that meets the requirements of the cruising sailor. Most only cover shortish trips abroad, certainly not a year or more. Combine that with trying to get cover for a more mature demographic, usually with pre-existing medical conditions and you're on a hiding to nothing.
b) Related to (a), Almost without exception, travel insurance policies cover emergency treatment and repatriation only. With a condition such as I have, they just tell you to get yourself back home and line up behind that queue of pensioners. They don't cover non-urgent conditions.
c) Most insurance policies are so tightly worded that if something is at all likely to happen to you then the odds are you're not going to be covered for it. Conversely, as the odds of your being infected with the Ebola virus as a result of having been unexpectedly ravished by a lust-crazed hippo whilst taking a midnight skinny dip in the Zambezi are so infinitesimal, they'll happily commit to cover for that. Although they might quibble somewhat if you'd had a few drinks beforehand and might be regarded as having led it on a bit.
For the last eleven years' of cruising our policy has been not to take out health insurance. Instead, we have put the premium money into a savings account and used that account to pay any medical bills that have arisen. This has covered several medical interventions including a hernia repair and thus far we're still in profit. However, as we are getting older and we're driving more, we feel the risk of bankruptcy-inducing serious illness or accident is increasing. Intensive care can easily run to over a grand a day. So this year we took out insurance to cover such an eventuality - for peace of mind if nothing else.
Anno Domini, eh? Still, it's not so bad when you consider the alternative.
Mind you - the condition did have one saving grace. See the next installment on ABBA tribute bands
(*) A medical acronym, no longer used now that patients have access to their notes. It stands for Totally Fucked But Unfortunately Not Dead Yet.
(**) As far as the op's concerned, my money's on option (1)