Finnish Emergency Medicine: One American's Experience

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Ambulanssi Töölön sairaalan tapaturma-aseman edessä, Helsingissä
[Ambulance in front of Töölö hospital, Helsinki, Finland]

Image: Hehkuviini, 29 January 2009 (Wikipedia commons) [larger view].

As you all might recall, I was going to visit Tallinn, Estonia yesterday. I spent a few hours looking at maps, photographs and reading about other people's visits, and generally getting very excited about this unexpected adventure.

Alas, I never made it.

Instead, as I was walking to the ferry, I slipped and fell on the ice and broke my right wrist. At first, I was determined to just ignore the pain and go to Estonia anyway. Well .. that was my plan until I actually peeked at my wrist. Not only was it giving me that delicious combination of extraordinary pain and numbness that accompanies a fractured bone, but .. it didn't look normal. In fact, it was bent into a rather impressive 60-degree (or so) angle. Can a wrist swell to enormous proportions in just a few seconds? I wondered.

Well actually, no, bone fractures do not and cannot swell THAT rapidly. As I later learned in the ER, instead of seeing swelling tissue, the lump that I was looking at was the displaced end of my seriously fractured radius, which had been pushed up alongside my hand, near my thumb -- a distance of an inch or more -- and it had also been twisted to a 90 degree angle away from its normal position. I was completely unable to move my thumb. As if that wasn't bad enough, my ulna was also fractured in several places at the wrist, and there is apparently some ligament damage, which impaired my ability to move my last three fingers at all.

So instead of filling my digital camera memory chip with hundreds of images of beautiful Tallinn, I spent the day (from 600 until 2000) being shuttled by taxi from one ER to another. The first ER, in Malmi, acted as a general intake and triage center while the second ER, in Töölö, was a trauma unit where they also had a hand specialist on duty. The Töölö Hospital is where they straightened out and set the bones -- snap, crackle, pop -- OH! MY! GOD! -- and put a temporary cast on my wrist before sending me to a private surgery clinic, Klinikka 22, where the hand surgeon later arrived to finish his work of setting the bones by adding a rather large titanium plate and half a dozen screws to the radius. After giving me some time to recover from the anesthesia and to eat something, they allowed me to go home, although I could have stayed overnight. The doctors also gave me lots of phone numbers and email addresses as well as a reasonable supply of OxyContin, Panacod (paracetamol with codeine), and extra-strength ibuprofen.

I should also mention that doctors don't typically perform surgeries on Friday afternoons in Finland.

The hospitals did need to have health insurance since I am a foreigner, but luckily, I did, as always, invest in Travel Health Insurance that covers up to $50,000 in medical bills with $0 deductible for the duration of my stay overseas. This insurance cost only $46. (Unfortunately, I have been unemployed long-term and thus have been without any medical and dental insurance for years in America.) My medical expenses were estimated to cost roughly 200 Euros for the first ER visit. I am guessing it will probably cost more for the second ER visit since they did more to my wrist there, although I did not get an estimate for that visit. The surgery was estimated to cost between 5000-6000 Euros. I am not yet sure how much the taxi fares amounted to since my Finnish host paid those on his credit card, although I am guessing it will be roughly 150 Euros total for the four taxi rides.

I have only the highest praise for the many doctors, nurses, and candidate doctors (medical students) and the several taxi drivers whom I came into contact with: They all treated me like gold. The medical people took so much time with me, explaining things so they were sure I understood what they meant, showing me the x-rays (fascinating and utterly disgusting all at the same time) and making sure I was given pain medications as well as muscle relaxants to make things easier on me. They also made sure that my Finnish host was well taken care of when everything became overwhelming for him.

Not only that, but the surgeon wants me to stay in contact with him after I return to the States regarding my progress. [Unexpectedly, the surgeon is a funny, caring and personable man -- I didn't know that they made surgeons like that!] The physical therapist, who also wants to stay in contact with me regarding my progress, gave me a written exercise program to follow, starting today, so I hopefully recover full use of my right hand. I am quite pleased about this since none of the medical doctors I've had contact with in NYC has ever shown any interest in maintaining any form of contact with me, except through one or more rather nasty lawyers seeking payment for bills that I had already warned them in advance that I couldn't possibly afford.

The taxi driver who took me from the clinic to the pharmacy and then home was especially fascinating to talk to. He worked as a sales rep for two big pharmas, Astra and then Roche, for his entire life -- and he too is currently unemployed! After learning that I am a molecular biologist who studies evolution in birds, he told me that his surname, Rautiainen, is the Finnish for Dunnock, Prunella modularis, a bird that is a common research species that breeds throughout Finland (pictured below). Despite being debilitated by pain and pain medications, I already have plans to specifically find a good scientific paper or two about Dunnock to write about on my blog, preferably either about their behavioral ecology or behavioral evolution, so I can send the URLs to him. If any of you have PDFs to share from papers that you especially enjoyed about Dunnock, feel free to email them to me or mention the reference in comments so I can follow up.

Dunnock, Prunella modularis.

Image: SÅawomir Staszczuk, 30 March 2007 (Wikipedia commons) [larger view].

So last night, after I returned home, I worked on catching up on my licorice consumption (supplemented with BLACK iscream) while being comforted by The Beast and making up for my inexcusable cultural deficit by watching the first season of the Black Adder series. Since the doctors and nurses advised me to wait until Sunday to pursue my planned visit to the Helsinki Science Museum, today is the perfect day to finish watching the Black Adder series.

I do have pictures that I plan to share with you -- both before-and-after photos and x-rays (still working on getting one of the x-rays digitized). These images are impressively DISGUSTING as well as being educational, although you might find yourself feeling nauseous after looking at them -- the perfect combination for increasing my blog traffic!

There were a few things that surprised me about Finnish emergency medical care as compared to what I've received in the USA:

  1. the Finns do not demand that patients use a wheel chair, even when entering the hospital emergency room with a traumatic injury (like a serious wrist fracture) that typically induces shock.
  2. there is a strong emphasis on pain relief in Helsinki, so I was given pain medication right away, even before I was admitted and was sent home with an adequate supply of pain relievers -- this is completely unheard of in all the NYC ERs I've ever been in!
  3. the doctors did part of their treatment (injecting me with a local anesthetic before they set the bones) in what appeared to be their office space. They also freely discussed how to deal with the injury and when to schedule surgery with me sitting in the room (they spoke in Finnish, but my Finnish host, who actually is British, knows enough Finnish to translate some of their consultations).
  4. the hospital did not have ALL of the newest x-ray developing equipment, as you'll find in most hospitals in the USA. (On the other hand, are the saved seconds in film development time really worth the added expense?)
  5. I was not provided a lead shield to drape over my body during the x-rays (They knew I am not pregnant, so I don't think this was critical).
  6. their wonderful speed and efficiency at assessing the problem and providing appropriate pain relief as well as making sure I got to the correct place to receive the proper medical care. (I fractured my wrist at 6am and was home the same evening at 8pm -- absolutely unheard of in my NYC emergency room experiences!)
  7. the Finns' overall ability to communicate professionally and reassuringly as well as in a kind and personable way -- in English -- was absolutely impressive.

Throughout everything, my Finnish host was a true champion, even when he was ready to faint after my obviously mangled and crushed wrist was fully exposed. Further, I am Finnish-American -- I mention this because I might be biased -- so I have always loved Finland in an abstract sort of way. But after my several visits and especially after this experience, I realize that this amazing and humane country might be the home I never had and have always been searching for.


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And there's plenty of power outlets (not in the waiting room, but in the emergency room -- ER -- itself) to plug my laptop into. Who would have thought? I am sitting in the ER right now seeking follow-up care on my fractured wrist, which I should have done last week. Basically, they need to remove…
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Please stop breaking your wings.

And do keep in touch with those Finnish health professionals. Finland has first-class health care, so it'd be silly to ignore them or their advice.

Wow... I'm sorry you got yourself hurt and disrupted your visit to a beautiful country, but I'm glad you received such excellent care. I hope everything heals well and properly.

You are such a drama junkie. Most of us are content to post pictures of museums and restaurants...but you have to make it all about you, don't you? ;-)

A request, if you would.

After doing my own slip-on-ice last year, $HERSELF posted the X-rays of my "spiral fracture of the distal tibia" to WikiMedia. There's a shortage, it seems, of good images like mine (and yours) on the Net for educational purposes, and my busted leg has unexpectedly become a high-volume download! ($HERSELF is annoyed. Her own excellent photography is lagging a stupid black-and-white bone shot.)

As a ski patroller, I unfortunately see a lot of fractures in the distal radius and ulna. Not like yours, I suspect, but it's really good to have those images available. So, if you would, please ... ?

Best wishes for a speedy and complete recovery.

By D. C. Sessions (not verified) on 07 Mar 2009 #permalink

Sorry you missed your trip to Talinn, Grrl, and best wishes for a speedy and complete recovery.

Unexpectedly, the surgeon is a funny, caring and personable man -- I didn't know that they made surgeons like that!

I have at least a dozen surgeon friends and close colleagues, and all are caring, intelligent, hard-working, funny, and endearing individuals. They are the finest kind, IMHO.

Ouch! You and Ice don't seem to get along too well. May I suggest visits to Florida or Bermuda?

On a slightly more serious note, you might want to consider finding a friend trained in Ju-Jitsu or a similar martial art to teach you how to fall without such injuries.

Do us all (especially yourself) a favor, Grrl - as soon as the temperature drops below 35 degrees F, go put on a fully padded Michelin Man suit - and don't take it off until (late) spring!

Take good (better!) care of yourself, y'hear?

PS: Good move on buying that travel insurance...

By Pierce R. Butler (not verified) on 07 Mar 2009 #permalink

As you brother in broken wrist-itude (i'll tell you the story some day), i feel for you, sister. The good news is that the pain usually subsides rapidly after the first couple of days. Sounds like your host has been a real hero (although i gotta admit, if i were the host, i'd be staring at the wrist and once you were adequately narcotized, i'd be saying "cool!")

Thanks for sharing your story. Good luck with the healing, Grrlscientist! I'm thinking of you.

jeez, you really do have something, some aura, some misunderstanding with the universe, that makes it necessary to break wing bones at least once a year...

i hope you grow out of it, much as it makes for entertaining blogging (grin)... get better.

please. :)

I can only say good luck. It is always fascinating to read about ER medical treatment. I wish you a speedy full recovery. Do that physiotherapy!

Condolences on the injury and congrats on the excellent care.
I can answer you on the value of the digital x-rays. As an ER doc, (US-based), it's truly awesome to have the archiving and portability of the digital images. You need a chest x-ray? I can compare it to the one you had last year in clinic. You have a weird fracture at 2AM? I can call the specialist and they can pull the image up at home and tell me what to do with it. The uses go on and on.

There's a lot of what you wrote that made me jealous of their ER system, though...

Ouch! Fortunately, you are in good hands.

By afarensis, FCD (not verified) on 07 Mar 2009 #permalink


I hope you feel better soon, and that you at least made your host feel guilty enough to kiss it and make it better. ;)

1-1/2 years ago I got thrown from a horse in Iceland and broke 5 ribs in my back. The very first thing the first medical responder did was give me a shot of morphine. The pain relief I was given in my five days in their hospital was unbelievably good. After being transferred to my local hospital in Minnesota, it was totally different. Suddenly I knew what 5 broken ribs REALLY feels like. I was hooked up to one of those self-dosing gizmos which I could never get the hang of. I alternated between brutal pain and active nausea until my family doctor arrived on the scene and got me a pain med regime that worked as well as that in Iceland.

If I ever get hurt like that again, I hope I am in Iceland. I cannot say enough about their health care.

By lectric lady (not verified) on 07 Mar 2009 #permalink

niklas -- i wrote that entire essay with my nose -- which is rather inconvenient when my allergies flare up! this is the reason it took so long to write, by the way ..

It is great when trips go as planned and we get to visit, and photograph, all the essential tourist destinations. Often the most memorable experiences and best stories come from the accidental and the unexpected. You got a glimpse behind the scenes and it sounds like your trips is much more memorable because of it. Just sucks that you had to break an arm as part of the package!

It looks like you found a better health care system than The Best Health Care System In The World (TM). It's good you had the insurance; I'll have to remember that if I have the opportunity to travel abroad.

I hope you get better and I sympathize with you. Also, you better get most of your repairs done in Finland. Because when you come back, I don't want to imagine the cost.

Because when you come back, I don't want to imagine the cost.

For comparison, my trip last year to ER with a broken leg netted:
1) A set of X-rays that I couldn't get for later use;
2) A splint made of better material but less skill than the cardboard jobs that we do for free in ski patrol;
3) Your basic oxycodone prescription (no the drugs, just the scrip that I had to find an all-night pharmacy to fill myself.)

Her price was about 200 Euros for the ER visit; when you added up the ER plus the charges from the doc, nurse, X-ray tech, etc. mine came to about $3000.

If I had it to do again, I would have skipped ER. My colleagues in ski patrol do better work for free.

By D. C. Sessions (not verified) on 07 Mar 2009 #permalink

D.C. Sessions: I can't find that spiral fracture pic you mentioned. Wikipedia's spiral fracture page is very minimal right now, and could use a picture. Could you add it?

By Wikipedian (not verified) on 08 Mar 2009 #permalink

D.C. Sessions: I can't find that spiral fracture pic you mentioned. Wikipedia's spiral fracture page is very minimal right now, and could use a picture.

Here goes my secret identity!


I have some others, from various stages in the overall healing process.

By D. C. Sessions (not verified) on 08 Mar 2009 #permalink

Devorah! So sorry to hear about the arm! Hang in there and keep your spirits up.

Your friend,


By John Del Rio (not verified) on 08 Mar 2009 #permalink

I hope your wrist heals quickly and that it doesn't slow you down too much.

The dunnock is an interesting bird that reminds me of a mouse with feathers. You might find its breeding behaviour interesting to blog about as it goes in for monogamy, polgamy and polyandry.

By Richard Simons (not verified) on 08 Mar 2009 #permalink

I just wish you could have had your prior injuries evaluated too since the USA medical system is based on greed, selfish insurance companies, and well-bribed Republican Congressmen and judges. If you have some time today (your last day, I know), would you stop by the hospital for a look-see at the situation with your two other bone injuries? If someone can give you a diagnosis, maybe the crap NYC charity doctors will be less wiling to tell you everything is fine from the prior events. Sending you home with no more than a sling after the upper-arm fracture was a perfect example of malpractice in my legal opinion. You can actually get pretty good charity care in Houston at Ben Taub, where you have the added benefit of working on your Spanish in the open wards.

By biosparite (not verified) on 08 Mar 2009 #permalink

How unfortunate! My deep sympathies, ma'am.
But you do have a wonderous personality; it is shining through even in this situation. Have a speedy recovery.

Ah, I intended to mention:

The medical people took so much time with me, explaining things so they were sure I understood what they meant,[...]

That is what we mean by informed consent of the patient. The doctors I have met can be harried, hurried, snappish, but they have always had the patience to make sure I understood what the diagnosed problem was and that we found a treatment that I could agree to.

Hi! A little late but I just heard . . . hope the pain goes away and you heal quickly. You obviously have a special affinity for Finland -- I think there's a name for that sort of identity-- it's wonderful! Hope you heal in a hurry!! With warm regards, Murray

By Murray Hansen (not verified) on 11 Mar 2009 #permalink

I'm only just catching up with your recent blog posts at the moment due to the fact that my computer at home can't access the internet at the moment, meaning I have to come all the way to Newcastle-under-Lyme library to use the free internet access there.
I was hoping to read up on what a fun time you'd been having in Finland, instead I end up reading this and wincing.
What is it with you and slipping/tripping over? I'm surprised doctors haven't yet asked you to walk everywhere wearing a big padded suit to soften the next inevitable impact!

Anyway I hope those are nice powerful numbing painkillers they've given you so that you can enjoy the rest of your trip.

That sounds unbelievably painful. I'm glad you haven't posted pictures yet because (being an unutterable wimp) I struggled enough to read the *words* without fainting. I'm glad they took care of you well!

I hope you do get to visit Tallinn, it's a beautiful city. Turku in Finland has also (in my opinion) a stronger personality than Helsinki, if you haven't already been there - and probably equally good doctors ;)

Visiting via the 'inspiring travel' blog carnival :)