When I emerged it was dark. The street was busy, and I was afraid.
I took off my dark sunglasses, not needing them now, and realised I could not see a thing without their prescription lenses. Putting them back on, I was jolted by a passer-by who shouted something at me. My head still spun, and I clutched at it, wondering how on earth I was to get back to my hotel. To cap it all, it was raining.
I had never felt so alone and afraid in all my 47 years.
I was in some suburb of San Francisco, on a Saturday night, surrounded by strangers, miles from the centre of the city and my hotel and colleagues. I had just spent two hours waiting for a prescription for more migraine medications at the back of the only pharmacy open in the whole city. The pain was so bad, I had held my head in my hands for most of the time, checking periodically to see if my meds were ready.
The migraine had come on during the flight and by the time we descended to land I was in agony. Head in my lap, tears coursing down my face, I really thought my head was going to explode. Something to do with the pressure had made it a hundred times worse than when on land, and whilst it eased a little on landing, it persisted all that night, all the next day, during day one of the conference and all of Saturday too. I had used up all my medication, exceeding the dose in desperation; my employers were paying a small fortune for me to be here, and I felt duty bound to attend as much as I could. However that afternoon I had been sent back to bed, and later the American lead had sent a prescription up to me, to get more pills. She too was a migraine sufferer.
By this time is was 5pm and all the pharmacies had closed for the weekend, and I was given the address of the only one open, which was several miles away in a suburb. The only way to get there was by taxi.
As if the taxi ride was not bad enough – jerky, lots of hand-braking, like something out of Hill Street Blues, the car smelled of rancid sweat and banana skins. I wondered if I would manage not to vomit. When he deposited me in a less than salubrious district, I asked him to stay and wait but he refused and sped off. It was just as well as the pharmacy had not received the emailed script and would not accept the paper one. They had not heard of me. And peering through their toughened security glass at me, shrunken with pain, distorted with nausea and caged behind large dark glasses, they probably thought there was no script.
I telephoned my British colleague – they were in the bar, he didn’t know where the fellow migraine sufferer was but he could text her. It took an hour to make contact with her – she was in the shower – and she re-sent the script. It took another hour for the out of hours pharmacy to receive and process the script. And all the while someone looking like Jackie Onassis in agony was scrunched up on their plastic chair trying not to moan in pain.
Finally my name was called.
They had my pills. All nine of them. That would be 198 dollars.
“No,” I stuttered, “I have a pre payment certificate,” and I showed her it.
“That’s for England,” she said, bored and slightly aggressive.
“Yes, I am from England. I’m English.”
Clearly the pain I had been in for three days was making me stupid. The migraine had infested my brain, and there were no thinking cells left.
“198 dollars,” she repeated, really bored.
I burst into tears. Why do we say “burst?” There was no burst, no sudden explosion, no such energy. I ought to say I disintegrated into tears, my face melting. It was hot and there was no air conditioning. I took off the glasses.
“I don’t have that money. We don’t pay for medications in the UK,” I said, more stupidly.
“You’re not in the UK,” she said, “Now you either pay 198 dollars or you don’t get the meds.”
There was a bit of a burst then, as I sobbed and dribbled a bit, unable to control myself, or the pain in my head. Even taking the glasses off was like sticking red hot pokers into every hair follicle.
Another woman came over. She suggested I take some of the pills – there were nine in the box, and I could just take six…..or however many I needed. And pay for those.
So I did. Handled over my credit card and left the hellhole of a shop after being there for two and a half hours.
And into the night. Wet, dark, noisy, scary.
I had never felt so alone, so far from home, so abandoned. How on earth was I going to find a taxi to get me back to my hotel in the centre of San Francisco?
I stumbled several steps to the corner of the street and almost walked into two police officers. They were at least six feet six tall, and I had to crane my neck to look at them. I grabbed one by the arm, and held on for dear life.
“Please,” I begged, half crying, half laughing with relief, “Please will you help me. My husband is a policeman in the UK.”
You see – still insensible with pain and now wondering if this was just the worst nightmare I had ever had.
They were wonderful. I explained, somewhat incoherently, migraine, conference, hotel, meds, and within sixty seconds they had called a cab and put me in it, given the driver my hotel name and sent their best to my husband.
I reached my hotel three hours after I had left it, and virtually crawled to my room, where I vomited violently and cried my eyes out. It had been one of the most terrifying events of my life.
As a British citizen who has never lived anywhere else, and despite working with the NHS, I realised that I had taken the institution and its benefits totally for granted all my life. My ridiculous response when given the bill for my medication was proof of that. I had known in my head that in many other countries people have to pay for their healthcare, and medications, but I had not actually thought about the implications of that. I had complained when my GP practice had forgotten to issue my repeat prescription, but had never understood what it would be like to genuinely run out of your pills and not be able to get them.
But it’s not just about the access to free care and treatment. I remembered this story when I recently read the excellent account of a doctor who had a cycling accident in Mallorca* and who had also had to rely on his prescription sunglasses at night in a foreign hospital. Against advice, he discharged himself and travelled home to London overland, driven by a strong desire to be with those who knew him best and who could best care for him. He had excellent treatment from the Mallorcan hospital, with better WiFi and possibly nicer accommodation than he would have in the UK, I guess, but he still needed to be on familiar territory.
I suspect the terror of my ordeal was not just due to the cost of the medication, and the inconvenience of driving half an hour out of the centre of San Francisco to access that medication, but it was the unfamiliarity of the terrain. The system was different, and I did not know how to navigate it. All around me the voices were different, the streets were unknown, and I felt vulnerable. I had the money for the pills, and I had the money for the taxi rides, but I was still very frightened. My saving grace was one piece of common ground – the policemen. Being married to one means that I am lucky enough to see the police as regular people doing a job, and was therefore able to trust them and ask for help.
But what of the patient who doesn’t have the money? Or doesn’t know the system? Is from elsewhere, doesn’t speak the language, has no common ground? How terrifying must it be for them when they turn up in our hospitals or pharmacies or clinical centres? People are people the world over, but the way our societies are structured, the complexity of our NHS, can make it all quite alien if you are ill. And even if you are not in a different society, being ill in itself is terrifying, which is one of the reasons the cycling doctor made such a long journey home with 8 broken bones. We need to remember this with every patient.
A GP colleague of mine used the frequently uttered phrase, “vulnerable patients” and I challenged him. Isn’t every patient vulnerable, I asked. It seems that the NHS has categories of vulnerability, and whilst I can see that some patients may have more than one type of vulnerability, my experience in San Francisco made me see that being ill itself is enough of a vulnerability to make accessing help both exceedingly difficult and utterly terrifying for me, let alone someone who is less able to advocate for themselves.
Maybe we all need to stagger around in the dead of night in a strange and slightly menacing American suburb, in dreadful pain, so that we know how it feels to be truly desperate for help? Maybe we all need to remember that if a British person with money in America, or a British doctor on a cycling trip in Mallorca struggled with their patient experience, many of our patients are also going to do so too.
My Saturday night out in San Francisco gave me more than a credit card bill. It made me totally re-evaluate the benefits of the NHS and it gave me added insight into patient psychology. That’s what we call learning the hard way.