Tuesday, June 23, 2009

Give me a break!

After a series of posts regarding the true joy of practicing the medical profession in Greece, I guess it is time for a short break. Of course, my description of the ideal circumstances in which doctors work every single day will continue, but for now, enough is enough. (At this point, I realised I sound a lot like Karen's Not me! posts, so I'll give it up and start being literal). Anyway, a big part of my everyday life is the amazing island of Lesvos, and it's a shame I haven't got a chance to talk about it yet.
As I have written before, Lesvos is the 3rd biggest island of Greece. It is part of the North Aegean district (sometimes referred to as North-Eastern Aegean district) and it is really close to Turkey. Its capital city is Mytilene (that's where I'm living right now), and its population is estimated at 30,000 people.

But because Mytilene definitely deserves a post or two of its own, and I still haven't gotten to photograph all its beauties, today I will write about a place I visited on Sunday - the village Mantamados and its legendary Taxiarhes Monastery.

Now, I am by no means a religious person. However, I sometimes like to visit different places of worship, and get to feel the atmosphere. Most of them are peaceful and relaxing, others are imposing and awe-inspiring.

Mantamados is a small village on the northern part of the island, 37 kms off Mytilene. It is traditional and picturesque. Its cobbled streets and its well-preserved stone houses make you feel like you have travelled back in time. Its inhabitants are either craftsmen, well-known for their pottery skills, or farmers, producing the famous Mantamados yoghurt.

But the area is better known for the Taxiarhes Monastery. A miraculous icon of Taxiarhis, patron Saint of the entire island, is kept there, and people from all over the world travel to the site, to see and worship it.

Before we continue, a quick introduction to Orthodox religion. I am not sure what Catholics do (please be so kind to fill me in on this matter), but the Orthodox draw pictures, known as hagiographies, of Jesus Christ, Holly Mary and their Saints. Every church has its own and, as each temple is dedicated to a Saint, icons of that particular Saint mostly prevail. When the Orthodox go to church, they usually kneel before an icon, pray in front of it, or simply do the cross sign and then kiss it. I fail to describe it properly and it may all sound a bit weird. The main idea is that, through the picture, you communicate with the Saint depicted on it, and ask for his/her forgiveness, help, etc. These icons are considered to be holly items, and in some circumstances, they are even believed to perform miracles.

Of course, I get that you may be skeptical to all this. It's ok, I am too. Every now and then, icons are supposed to "bleed", or "shed tears", "heal" or "appear at unexpected places". Most of these "miracles" end up to be scams. But whether miracles trully take place is not really the point of this post. The point is, all of them are sacred to believers, and thousands of people come to see them for themselves every year. And the icon of Taxiarhis in particular is not only famous, but also unique.

Why? Because, unlike every other Orthodox icon there is, this one is not painted. Instead, it is carved. Normally, the Orthodox religion wouldn't allow that. But due to the fact that the icon is considered to be miraculous, and there is a great story about how it was made, it has been preserved through the years.

Before I tell you that story, I have to point out that Taxiarhis, or Michael, often depicted carrying a sword and wearing metal shoes, is one of the three Angels bearing the message of God (also known as Archangels). The other two are Gabriel, the one that presented in front of Mary to announce that She would give birth to Jesus Christ, and Raphael. All three of them are celebrated on November 8th, when it is a public holiday here in Lesvos. A grand parade is held in the centre of Mytilene, while churches that are dedicated to these 3 Saints celebrate and organise fairs for the pilgrims.

So, our story begins between the 9th and 10th century AC, when Muslim pirates often came to this island, to attack, burn, destroy and slaughter. At that time, the fortress - like Taxiarhes monastery was dedicated to the Archangels and was famous for its greatness and wealth. What a better target for the pirates then, right? So, one night, they used ropes to climb over the walls, surprised the monks during Mass, and slaughtered them all with their swords.

All but one, in fact. Because a 17-year old trainee, young Gabriel, managed to escape through the window and climbed the roof, trying to get away. Unfortunately, after taking all the monastery's property, the pirates saw him, and tried to capture him. After all, they didn't want to leave any witnesses behind, as young Gabriel could alarm the inhabitants of nearby villages of the presence of pirates. The villagers, in turn, could block the pirates' way to the sea and fight them. As you see, it was necessary that nobody was left alive.

But as the pirates approached Gabriel with the swords drawn, a miracle is believed to have taken place. The roof suddenly transformed into a windy sea, and in the middle rose Taxiarhis, mighty and furious, his sword in hand, ready to attack.

Having seen him, naturally the pirates panicked and fled to the sea, while leaving all their loot behind. The monastery was saved. But wait, there's more to it: The next day, all of the pirates were found dead at the shore, killed with a great stab wound, starting from the forehead and ending at the belly button. And as no man could have been so powerful to inflict such a blow, Taxiarhis was thought to have caused it with his sword.

When Gabriel realised that he was safe, he returned to the monastery to help the other monks. But when he saw all of them dead, a divine inspiration came upon him: He collected their blood, mixed it with clay, and, out of great awe and gratitude, tried to create an icon of the Saint, recreating the shape he saw on the roof. Unfortunately, the clay was not enough to make the Saint's whole body - and that's why his head is disproportionately large, compared to the rest of it.

So that is the story of Taxiarhis, protector of the Monastery and the whole island. And no matter if you believe in all this or not, this place is a must-see if you're ever visiting Lesvos. Because there, in an opening surrounded by olive groves and a pine forest, you may come in touch with your true self and spirituality. And feel like a tiny particle of the universe, but unique and important at the same time too.

After going to the Monastery, we visited another village, Skala Sykamnias, and had lunch at a Greek tavern by the sea. And there, eating grilled sardines, octopus, traditional grilled cheese "ladotyri", drinking the trademark ouzo (well, I opted for wine, but still), while watching the Turkish coast at the horizon, I realised, once again, that I live in a beautiful country. It's not obvious all the time, but it's nice to feel it every now and then.

All in all, it was a great day...

Tuesday, June 16, 2009

The craziness continues...

My last post about the flaws of the Greek healthcare system led to unexpected comments and conclusions: That public healthcare really sucks, and that the American system had better remain unchanged.

Don't get me wrong, I am by no means familiar with the American system (I've heard and read a lot, but didn't experience it myself), so I am not the one to say if it should be changed and how. But, at least as far as my own country is concerned, I am and have always been an avid supporter of public healthcare. Maybe in a future post we'll discuss about how this could work and benefit both patients and hospital employees. It may seem unreal and idealistic, but I think it could be done - if only someone was really willing to change the current horrible situation.

But before we talk about changes, it is important to describe what is really happening right now. So, our journey to The Twilight Zone featuring Greek hospitals continues...

If you think that winning the lottery is impossible, try finding a nurse in the Emergency department.

This is the second time I am writing about nurses, and taking in mind that the first time I was disagreeing with the fact that doctors and nurses are paid the same, while they don't work for the same hours and don't share the same responsibilities, you have every right to be suspicious of me. Maybe, like most doctors, I am suffering from "superiority/God complex", shunning nurses and flattering myself that I am much, much better.

Uh, I don't think so.

Because, let's face it - I am not. After all, I am just a clumsy Medical school graduate, still shaking when stitching (alert: This is NOT pleasant to watch - let alone experience!), almost pooping myself when an emergency comes in and I am alone in the room, even for a few minutes, while having no clue about most of the questions patients ask ("Will I get better?", "Is it too bad to eat half a roast lamb while suffering from gastric ulcer?", "Will the guys from Lost ever get out of this f-ing island for good?" - no sorry, the last one is a question I ask myself all the time, and not the patients!)

So yeah, I am not better, and I know it. The nurses know it. The whole hospital knows it. But it's ok. Because I'm not supposed to know everything right away. But please, dear nurse looking at me with a scornful look, help me. Teach me. Don't scowl at me in front of the (terrified) patient. And most importantly, don't leave me alone when I need you the most.

For some weird reason, becoming a doctor in Greece is much too popular than becoming a nurse. As a result, for every 5 doctors that beg for a job, there is only one nurse, who is always in high demand. And also for some curious reason, there are never enough nurses in the Greek hospitals. So, in order to deal with that, we have come up with the model of "Beaming-up-Nurse 3000", a special-patented nurse that manages to move from one clinic to another in seconds.

Or at least, she is supposed to. Because the nurses working in hospitals, compared to those that are actually needed to meet the needs, are much much less. As a result, the same nurse is supposed to cover the surgical department, while performing patch tests at the dermatology clinic, and measuring glucose levels in diabetic patients. All these cannot possibly be done at the same time.

The result? Huge lines of patients complaining about the long wait, doctors carrying samples to the labs, because there is no one else to take them down there, patients' relatives making the patients' beds and carrying them to the X-ray department themselves, students left alone to deal with life-threatening situations simply because there is no one else at the ER at that moment. It is CRAZY in there!

So no, I don't hate nurses. In fact, I love them dearly. So much, that I would like to have as many of them as possible. Please god, give me nurses. Because a good nurse can always save the day (and my own a$$ as well)...

Tuesday, June 9, 2009

I blame it all on George Clooney

My last post was going to be about Medicine and Med school, but "Greek parents" appeared out of nowhere and monopolised the conversation - after all, it was to be expected. Hopefully, this time there won't be any more surprises. We'll see...

As I wrote last time, I chose to be a doctor pretty much because I was an ER fanatic (and of course I mean the tv show, not the actual Emergency Room!). I was so carried away by the stories, that I ended up believing that real - life doctors would be like this:

Instead, I was terrified to discover that they actually look like this:

So I will some inside info today - dirty things that I didn't know when I applied for Med school. Had I known them, maybe I would have chosen a different profession altogether. Or at least I would have gotten a second job, trying to save money for therapy sessions, right from the start!

This post is not meant to be funny. Some of the things that I will describe are actually tragic. Any similarity to real facts or people is NOT a coincidence. So if you are easily upset and don't want to end up avoiding all hospitals and doctors just because you don't trust them anymore, please don't read any further. Oh, and if you choose to think that these things only happen in Greece because in reality it is a third - world country, feel free to do so. Whatever helps you sleep at night...

1) Taking the Hippocrates oath to heart (as long as my heart is where my wallet is)

The first thing you swear to do as a doctor, is to provide your help without asking for a reward. This is pretty cool, but doctors are people too, and they too need to eat, have a safe place to spend the night, and generally meet their biological needs - so they need to get paid for their work. The real problem arises when having a 197-inch plasma screen is considered a biological need, and the fact that you definitely have to get one forces the patient out of his own place!

In Greece, healthcare is public. This means that hospital care is provided for free, as long as your are insured. Fear not of the mighty term "insured", my friends. In Greece it is very easy to get insurance, and it covers pretty much everything. So basically, hospitals are open for everybody, free of charge.

In theory, at least. Because in the hypothetical case you need an operation, for example, doctors' implications become quite nasty: "There is a great waiting list", and "your operation should take place after 3 months or so and not earlier", and "it is a fairly difficult procedure that needs the utmost care and dedication from the physician", and so on.

If you fail to take a hint, you are likely to be banished to the worst room, with a broken bed or something, while the medical staff weirdly doesn't notice you very much, and your operation somehow takes forever to schedule. Unless you manage to produce some pocket money, say 500 or 1,000 dollars to the physician in charge. Not out in the open, of course. You need to be discreet, put them in an envelope, and carefully slide them into the doctor's pocket.

If you perform this trick, you almost instantly get an upgrade, the staff becomes very tentative of you, and your operation is due for the very next day. All goes well in the end, you recover quickly and go home, satisfied with the excellent medical care you received. It is a win - win situation.

The problem? You spent 1,000 dollars to get medical care that is supposed to be provided for free!

And this, my friends, is the number one pain in the booty in the Greek medical system. "The envelope situation". Money you are not obliged to give, but you give anyway. Money that is not taxed, and just fill the attending doctor's pocket. Money you may not even have - and what happens then, if you are in desperate need of an operation?

Please don't tell me that in the USA a tonsilectomy, for example, would cost far more money than only 1,000 dollars, so we should be happy for not paying as much. The problem is that you cannot have public and free healthcare and then demand "black" money from the patients! It is illegal to do so, and yet, most doctors do it and nobody EVER gets prosecuted! It is a secret that everybody knows, and nobody takes action against. It is a practice that encourages corruption and exploitation of the patients. THIS makes us a third - world country, and not one less metro station, or one less overpriced stadium.

But, to be absolutely fair, this is the opposite opinion...

Greek doctors are the worst paid doctors in Europe. Not only is it painfully difficult to find a job here (I described the situation with the waiting lists and the fact that you may need to wait for 10 years from the moment you graduate, until you start your residency in an earlier post), but the salary is a joke. We get paid 2,000 dollars per month - approximately 25,000 dollars per year. Our salary is the same as the nurses', school teachers', and even civil cervants' working in the tax department. By no means do I mean that we are better than all these people. It's just that our work hours are incredibly more.

While I am on call, 5 different shifts of nurses come and go. That means that I work as much as 5 different nurses, (starting on Monday morning, for example, and going home on Tuesday afternoon) and somehow I am paid the same as each one of them! And I don't even need to stress the fact that our time of studies is not the same, and our accountability in case something goes wrong is anything but similar.

What's more disturbing, is that the government fails to pay us even this small salary in time. All through 2008, doctors in Greece went on strike, because the extra money they legally deserved for being on-call and working overtime wasn't given. According to European Union laws, it is now obligatory to work only 4 days overtime per month. This is what you are paid for. Unfortunately, there are not enough doctors in the hospital to meet the patients' needs, and if each one of us worked overtime only 4 days per month, the emergency department would be empty and unstaffed!

So what are the idiotic doctors forced to do? Work 10 days per month overtime (or else patients would need a bounty hunter to search for a doctor at weekends, for example), and get paid for 4! What kind of country does that to its citizens? Isn't slavery supposed to have been abolished centuries ago?

This horrible situation is the excuse many doctors give for getting the notorious "envelope money". But this excuse is a lame one, in my opinion. I agree that we are underpaid, and in many cases, non-paid. I agree that the government treats us like fools. I agree that we have worked our @sses off and don't deserve this situation.

But exploiting patients is not the answer. We took an oath, remember? An oath to help them, as much as possible, no matter what. We are the victims in this, but victimising patients too is not the solution. We should fight for more. We should ask for more. But we are turning to the wrong people to ask for money.

That's it for now. Hit me with your comments and tranquilizers, people! And imagine this - we are still on #1! A long way to go...

Monday, June 8, 2009

The vampire country

As many of you now, I am now living on the island of Mytilene, working (?) as a general practitioner. It is an exciting experience, and I will come back with photos of the beautiful island and my everyday life as soon as possible. But today's post is about how I ended up on this island of Northern Aegean Sea, just a few miles west of Turkey.

But before we start, here is a picture of Mytilene's port. There are many more amazing photos to show you, so be patient until my next posts.

And here is Mytilene on the map of Greece. For the record, I had been living on Crete before, which is the biggest island of Greece, located on its southernmost end.

I wouldn't be here, if I hadn't chosen to become a doctor. And I wouldn't have chosen to become a doctor, if I weren't completely nuts. And naive. And with no sense of self - preservation whatsoever.

When I was little, I used to watch ER on tv. I couldn't get enough of the brave, self sacrifising doctors, who managed to save lives and look extra cute at the same time! No matter the time, or the extreme circumstances, they fought to do good. The adrenaline was intoxicating, and the sense of accomplishment was hypnotizing.

Unfortunately for me, I relied too much on tv, and didn't have any doctors in my family to wake me up and introduce me to reality. So, while I was studying Ancient History, Ancient Greek, Latin and Literature, (and not having a clue in Math, Biology, Physics and Chemistry that are essential for Med School), I applied for the latter. It was more of a joke, actually. I was going to become a Literature teacher, like my parents, and didn't stand a single chance to be accepted. Well, wrong...
So, I entered Med school, wanting to learn new and exciting things, in order to help people and take away as much pain and suffering as possible. And then, I had to wake up.

Before I continue, it is important to explain a bit about universities in Greece. In my country, it is obligatory to attend school for 9 years (starting at the age of 6). You can then choose to go to a technical school and learn a craft, or continue to high school for another 3 years. At the age of 18, you take exams. These exams are the same for every Greek student. The subjects are the same, the questions are identical, and they all start at the same date and time. So basically, you compete with every other Greek student all over the country simultaneously. Once you get your grades, you are free to apply to any school you like. The school will accept a given number of candidates, depending on their grades only, from highest to lowest.

Example: If you apply for Med school and your University of choice admits 50 students per year, you have to be in the top 50 students that applied for the same position at the same time to be accepted. Even if you have done extraordinarily, you won't get accepted if 50 students did better than you. On the contrary, you may have had a few misses, but if everyone else did as well, it won't matter. As long as you are in the top 50 / 100 / 150, depending on the number of students the school accepts, you are ok. So having good grades alone doesn't matter. The whole idea is the competition - where others stand and where you stand. And it is a matter of supply and demand. Getting into a much wanted school is a whole lot more difficult than getting to one few people apply to.

Anyway, it is difficult to get into university (and it costs a lot of money, since all kids pay for private education in the afternoon along with public education that is offered for free at schools in the mornings). But once you get there, a different era begins. The era of enjoying yourself and simply doing nothing. Because university education is public in Greece - that means you don't pay a thing for your studies. There are no teaching fees and no book fees. Also, there is no limit to the years you can study. You can fail in the same course zillions of times, and it's ok. You can be 35 and still studying after 20 years - nobody tells you anything, and of course nobody throws you out of school. But what makes student life amazing, is the concept of "Greek parents".

You may have heard about this rare species, watched it on National Geographic documentaries, or laughed at it watching "My Big Fat Greek Wedding" on tv. Oh, "Greek parents" are strange creatures indeed, and they deserve a little analyzing. Their whole existence is based on the concept that children don't grow up. The years may pass by, but their babies remain babies. Like vampires or something, time does not touch them.

So, no matter if they are 10, 20 or 40, you still have to fuss about them eating their dinner, dressing in a certain way, and playing / going out / getting married to people you like and approve of. And of course, they never ever go away. In the most extreme circumstances, they may move to a house that is right next to their parents'. But even then, having a spare key and being able to come and go to your children's house as you please is a given.

Having this kind of parents may be a pain in the gluteus maximus, if you get my drift. It is suffocating and infuriating. But it has its benefits as well. One of which is the fact that Greek parents are adamant about their children going to university. To achieve this goal, no expense is too great and no effort is too big. And once their offspring get this much-wanted place, the proud parents continue to provide for them. And they never stop giving, unless their "kid" graduates and finds a job.

So, this attitude is the reason why the image of students selling lemonade as a part-time job in the summer seemed more strange to me, than Paris Hilton actually settling down. Greek parents don't ever get that. To them, a kid having to earn his pocket money by working would be insulting. It would mean that they themselves cannot provide for him. Don't get me wrong, I get the whole "being independent" and "learning how hard it is to earn your own money" idea. I actually applaud the concept. If more kids did that here, we would have less brats that couldn't stop being dependent on their parents. But that doesn't happen here often.

Still, not earning your own pocket money at 15 is not dramatic. But depending on your parents to pay for your cigarettes at 30 is pathetic. Because, as I told you earlier, parents don't stop giving until their "kid" graduates and finds a job. And let's face it - finding a job isn't easy nowadays. And the recent economic crisis is not the only reason for that. It is all a fault of the species of Greek parents, actually. Being so persistent about their kids going to university, they created a country where every kid has a university degree. The result? There are far too many unemployed doctors and lawyers here, while it is painfully difficult to find a plumber or an electrician!

And here comes the last and most important characteristic of Greek parents: Pride. They are immensely proud of their children. To them, they represent all that is good and right in this world. And, having worked so hard to get them to university, they refuse to see them getting a job that is "beneath them". So no, it is not ok to find any job in order to earn a living. You have to find a job that you "deserve". Until then, "you have your family to turn to"!

So, in this vampire country I live, kids don't ever grow up. They live with their parents instead, bargaining for more pocket money at 35, having their mother wash their underwear and cook their favourite dinner. Waiting for the "right" job to come, hoping to get their own place some time - as long as it is close to their parents' house, of course. In the end, getting married to "appropriate" people and giving birth to "extraordinary" children. And this vicious circle continues...

I started this post wanting to tell you about how and why I got into university. I talked about all Greek students instead. As much as this got out of hand, I think this is even better. And while it may seem I detest my country, I actually love it very much. Because only if you really love something or someone, you can accept it with all its flaws and weaknesses.

And to be fair, the species of Greek parents is an amazing species by all means. It is one that never ever lets you down, and always looks out for you - no matter what. It is a species that always makes you a priority, and sacrifises itself for you without a second thought. It is a species we all love and respect. Do you want proof for that?

In Greece, kids selling lemonade is an unknown concept. But old parents staying in nursery homes is an unknown concept as well... :)

PS: I would love to hear your comments and also your own experiences from your own country / community / family.