One of our friends on the Cape reminded me that Thanksgiving is coming up soon, in fact it’ll be Thanksgiving this coming Thursday, November 28th. I had to think of turkeys, immediately. And of Alice Glenn. I emailed the story of Alice Glenn to our friend (who remembers Alice Glenn?:) who famously said during the debate about the divorce referendum here in Ireland that “women voting for divorce is like turkeys voting for Christmas” – or Thanksgiving in the US. I could see our friend smiling in my mind when she read this…

Thanksgiving also remembers me of a song, in fact it is the longest folk song ever recorded, which also was made into a movie.  The story of “Alice’s Restaurant” (no – not Alice Glenn’s) by Arlo Guthrie (Woody’s son), even older than Ireland’s divorce referendum, originated on Thanksgiving, 1965, at the time of the Vietnam war, when young kids in the US were drafted to fight for freedom and democracy, and many (amongst them, Arlo) found a way out – sometimes in quite unexpected ways. (The original song was recorded in 1967, but Arlo kept singing and recorded another live version in 2005 at the Guthrie Center; you can find the lyrics here.)

The bit I like most is when Arlo tells his listeners that they should join the Alice’s Restaurant movement:

“… and walk out. You know, if
One person, just one person does it they may think he’s really sick and
They won’t take him. And if two people, two people do it, in harmony,
They may think they’re both faggots and they won’t take either of them.
And if three people do it, three, can you imagine, three people walking in
Singin a bar of Alice’s Restaurant and walking out. They may think it’s an
Organization. And can you, can you imagine fifty people a day, I said
Fifty people a day walking in singin a bar of Alice’s Restaurant and
Walking out. And friends they may thinks it’s a movement.
And that’s what it is , the Alice’s Restaurant Anti-Massacre Movement.”

Sometimes you just have to walk out, others will follow, and you might start a movement.

Another friend asked how the Irish and the German health systems compare, generally. Whether I thought that the difference between our experience in Germany and in Ireland originates in cultural differences between the two countries or because of the different levels of funding available. I think it is both: Germans spent more on their health system (10.6% GDP) than the Irish (8.2%). In 2014, 666m euro will be taken out of the health system (some experts say that the total cuts will be closer to 1 billion), and deal a final blow to a system that is already at braking point.

When the CEO’s of the four major hospitals wrote a letter to the director general of the HSE in early November, saying that health cuts are beginning to seriously threaten patient safety (“There is clear evidence that funding reductions coupled with accelerating demand have begun to seriously threaten the quality and safety of patient services.”), the Minister’s response was that he could not comment since the letter was not addressed to him.

People working in Irish hospitals are conditioned by the realities of their work place. Many think that the care and treatment provided to the patients is adequate. As someone who spent close to 4 months in an Irish hospital with Pádraig, I would not blame the people, but the ‘authorities’ who do not guarantee resources, provide control, and implement sanctions where necessary. – Remember the headlines when staff was found not to wash their hands properly? How could it ever have come to that point?

Today, I spoke to the man in charge of the intensive care unit where Pádraig is being looked after at the moment, the ‘Chefarzt’. What struck me was how positive he was about Pádraig’s progress and his very positive outlook. I had stopped him on the corridor (this might ring a bell with friends who are familiar with a similar situation we went through in Ireland), when he was completely unprepared – nonetheless, he showed that he was familiar with Pádraig’s case, he commented on some quite specific questions I asked, and he demonstrated that his doctors have a definite plan for working with Pádraig on improving his situation. It was refreshing, and evidence of a level of attention a patient like Pádraig would, obviously, never get in an acute neuro-surgical ward, such as the one he spent 4 months in, in Beaumont.

The Schön-Klinik in Hamburg is one of Germany’s leading hospitals for neuro-rehab and was, historically, the second hospital in the country where early dedicated and intensive neuro rehab was offered to patients. The Chefarzt in charge of Pádraig is heading up a neurological Intensive Care Unit with 40 beds; there are 49 beds for early neuro-rehab. And listen to this: there are a total of 200 carers/nurses, 45 doctors, 12 consultants, and 72 therapists. – The whole of Ireland has 3(!) beds for early neuro rehab, with a waiting time of one year(!).

Pádraig has been doing well, given the circumstances. He opens his eyes more often then before, his breathing, heart beat, and temperature are all closer to normal than during the previous days – and I am sure that he is very much looking forward to the first visits by his friends starting tomorrow!

Going back to Thanksgiving, Alice Glenn, turkeys, and Alice’s Restaurant. If the turkeys decided to walk out first in pairs, then 3 at a time, and eventually in groups of 50 – they could become a movement – and if we all said “enough is enough”, our movement would impact change. Forget about 12 months – 24 (hours), no more!

Today’s German Music Tip
Spliff, Carbonara (1982)
What’s hot
Caring.
What’s cold
Just everyone for themselves.
The German word/phrase/verse of the day
Scusi Segnorina, willst du auch’n Spliff, oder stehst du nur auf Männer mit Schlips?

Leaving Hamburg in the evening leads us across the Kennedy-Brücke. Since last Friday

Drive Time

was the 50th anniversary of JFK’s assassination, we talked a bit about what he meant and how much he moved in his time. Hyannis was and still is his family’s favourite place to spend the summer. Hyannis, of course, is also where Pádraig was operated on and where we spent the first weeks after his accident. i never did, but Pat and her friends actually saw JFK driving down Dorset Street in Dublin – where his car stopped to allow him to give a present to one of Pat’s friends. – Yes, we are getting old.

There are dozens of famous JFK quotes around. From being a ‘Berliner’ to doing work for your country. Here is one that made me think today: “Change is the law of life. And those who look only to the past or present are certain to miss the future.” I promised myself that we will make sure not to miss the future.

The care for Pádraig here continues to impress us. There is a dedication and care, a professionalism and personal touch that is truly amazing – and something to aspire to.

There was a piece on the Irish news over the past days reporting that there is going to be a significant shortage of GPs in Ireland and that young doctors are leaving the country. I wonder whether that made alarm bells go off in the Department of Health? How will the health service function, following a cut of 666m in 2014 which will in reality most likely rise to one billion, according to The Irish Times. Already, the health system is not functioning as well as it should. Many people in it are disillusioned, tired, and overworked. Where in the western world have you ever seen doctors in gowns wearing multiple buttons ‘shouting’ 24-no-more at their patients? People in Ireland not only deserve better, they need it to be better. It should not be acceptable that doctors have to leave the country, and the patients with them, out of sheer desperation.

I set up a Google Calendar for friends visiting Pádraig in Hamburg:
https://www.google.com/calendar/embed?src=ejbikhh20hgf5i87d88fenj9ns%40group.calendar.google.com&ctz=Europe/Dublin
You should be able to see the dates, and edit them – let me know how that works.

Today’s German Music Tip
Rosenstolz, Ich bin ich (2006)
What’s hot
Working on a computer and the internet while being driven to the hospital.
What’s cold
Getting out of the car being so dizzy that my stomach is just waiting for an excuse to bring back breakfast.
The German word/phrase/verse of the day
Ich bin Ich

Have you ever got obsessed with something? Anything? We acquired a new obsession. – When we drive home from the hospital in the evening, we are passing close to a dozen petrol stations. During the past week, we started to check out the price of petrol at each of these stations. It is absolutely incredible to see how petrol prices fluctuate. We have seen prices for E10 petrol between 140 and 149 cents, at the same station, on the one day. These 9 cent means, we figured out, a difference of almost 50 euro per months, on the basis that we drive 300 kmh/day on about 6l of petrol. – We have become obsessed with the price of petrol.

We also have loads of time to talk during these long drives. Today we commented on the fact that sometimes it is hard to see that Pádraig is making progress. Then, days merge into each other and timelines vanish: where we are, how got there, what the future hold. On the way back, at exactly 120 km/h to safe petrol, we got into this mood and while we were talking, we realized that some of the progress Pádraig is making becomes part of this time warp we have been living in for the past months. It was only when we were talking to we realized how much more relaxed Pádraig is now, the sudden, uncontrolled movements have disappeared over time, and he has become much more himself again. Still in a coma, but communicating and reacting in his own way.

This afternoon, Pádraig had a visit from his German family and his room got a bit crowded. A male nurse came in, looked at us in horror and asked what we were all doing in there. They had, in their generosity, allowed three people in at a time – now we were five. I assume he was right, but there is enough room , we were not in the way, and we all had traveled a long way to see Pádraig. So we left for a break, and when we came back we found Pádraig positioned in his bed by a true artist. What the nurse had done was done with such care and attention to detail, it was hard to believe. We made friends again:), and thanked him for taking such good care of Pádraig. He said that this was the reason he had chosen his profession, he wanted to care for people. He had brushed Pádraig’s teeth with a soft tooth brush, and his cheeks and tongue with a special suction swab. His lips and face were covered in soothing cream.

Today’s German Music Tip
Die Ärzte, Rebell (1998)
The German word/phrase/verse of the day
Straßenunterhaltung (“Street Maintenance” or “Street Entertainment” – take your pick:) – seen on a Hamburg City Council truck.

In 1986, when a lot of you weren’t even born, I moved to Ireland. It was a dream come true. I had listened to Clannad in Dortmund’s bunker (a folk bar in a WWII bunker) in 1976. They arrived 3 hours late because they had been stopped on the Autobahn by German police looking for terrorists – they had, after all, very long hair. In 1997, I walked up the west coast with a friend and we both thought that to live here would be heaven. When Pat and I moved to Dublin, it was like a dream come true, the beginning of a new life, and a new family. I never thought that we would have to leave one day.

First frost on the roofs in Tating

This morning, we got a phone call from the hospital. The doctor who rang us made the mistake not to introduce what he had to say by “no need to worry, everything is alright” – so we had a few anxious moments until he told us that he was ringing to ask us for permission to take out some of the cerebrospinal fluid from Pádraig in an attempt to reduce pressure from Pádraig’s brain. Apparently, it’s a routine procedure, there is a bit more involved than drawing blood, but not much, he said. The only risks would be infection and possible bleeding, but they were minimal and would be kept well under control. We would see in a day or two if the procedure would have any positive effect on Pádraig’s level of awakeness. We consented, of course, and the procedure was carried out this morning. We’ll have to wait and see whether it’ll make a difference.

When we went to visit Pádraig later in the day, he was still on the ventilator, with a bit of a fever. The doctors explained that they were looking for bacteria that caused the fever. We said that  both in Beaumont and in the US, doctors had been trying this unsuccessfully, and that the slight occasional fever might not be caused by bacteria or an infection at all. We also agreed with them to start a special treatment for his lungs with the physios on Monday, to clear the phlegm out of his lungs on a regular basis.

There will be a steady flow of visitors from tomorrow. I am sure, Pádraig will be delighted to have his friends around again. He must be missing you, your voices, your stories, your presence.

Finance Minister Michael Noonan said in January of this year that young emigrants are not driven away by unemployment. Instead, he said, emigration in most young people’s cases is being driven by “a desire to see another part of the world and live there” (as reported by TheJournal in January 2013). Sarah Stack, on 27 September 2012, reported in the Irish Independent that, according to official figures published by the Central Statistics Office (CSO), 87,000 people emigrated from Ireland in 2012, a new record.

I don’t know whether Michael Noonan is right or not, but I know that at least Pádraig did not get the treatment he needed when he needed it. Being told that he would have to wait for the best part of a year for a bed that he needed straight away basically forced him out of the country. He was emigrated. It was not a life-style choice. I don’t know anyone who loves Ireland as Pádraig does.

Today’s German Music Tip
Marius Müller-Westernhagen, Wieder hier (1998) (Westernhagen is the ‘raw’ version of Lindenberg, although this song is almost too sweet for him.)
What’s hot
Pat driving the red Kia Ferrari to Hamburg, and back
Me sitting in the passenger seat looking at the scenery
Kilometres we have driven to-date (since Wed., 13 Nov): 2,356
What’s cold
Surprise calls from the hospital
Isolation, isolation
Having dinner at 10pm
The German word/phrase/verse of the day
Ich bin wieder hier
in meinem Revier
war nie wirklich weg
hab mich nur versteckt
ich rieche den Dreck
ich atme tief ein
und dann bin ich mir sicher
wieder zu hause zu sein
(Westernhagen, Wieder hier)

Wolfgang Niedecken’s song tells one of these father-son stories: It’s been a while (Verdammt lange her, or in the dialect of Cologne: Verdamp lang her), he sings, since we really talked, and that what we said got actually through to the other. I am sure many people have felt like this. We always (but wrongly) think that we’ve got all the time of the world to have this important talk with those close to us, when we’d say all those important, maybe somewhat ‘deep’ things we always wanted to say but never did. German’s are actually really good at looking deep into the inside, and talk about it nonstop (… I am writing this blog, after all:), whereas the Irish communicate more indirectly and the ‘big’ things when they happen can easily be missed if you don’t pay attention. Think Philadelphia here I come.

Today, I did not drive. I cannot believe it! My whole body actually feels like as if it had been transformed into this shape that perfectly blends in with the driver’s seat of the Kia Pactera, our perfect wheels hitting the German Autobahns at a carefully balanced 120km/h. So if I sit at a desk, like today, my body just cannot cope anymore with all the empty space surrounding it. (You need to have been in a Pactera to appreciate this. I had never heard of this car until about two weeks ago. Look it up and you know what I mean.)

I did not drive because Pat went straight from the airport to the hospital when she arrived this afternoon. She is getting the Nordostseebahn from Hamburg to Heide where I will collect her in about an hour. The just 30 minute-drive will be a poor compensation to the usual close-to-four-hours we usually get – sometimes, a little is better than nothing:)

Ihre Meinung ist uns wichtig!

Pat just sent a message from the train saying that Pádraig is out of isolation! No more blue gowns and face masks! It’ll be a whole new visiting experience for all, and it’ll be much easier for Pádraig to actually recognize who is visiting him! And this is not all: he is also off the antibiotics! One day I’m not there and all these good things start to happen… Pat told me that one of Pádraig’s good friends called today and talked to him over the mobile (God bless Meteor for free roaming). She said it looked like as if there was a great conversation going on – and we are all sure that there will be, once he’ll have got rid of the tracheostomy that prevents any ‘sound production’.

A good day.

So here is the first, and my favorite verse of the song I mentioned earlier, in Kölsch (the dialect of Cologne, for those advanced German speakers amongst you), in German (for those interested in it), and in English (as a backup).

Verdamp lang her, dat ich fast alles ähnz nohm.
Verdamp lang her, dat ich ahn jet jejläuv
un dann dä Schock, wie et anders op mich zokohm,
merkwürdich, wo su manche Haas langläuf.
Nit resigniert, nur reichlich desillusioniert.
E bessje jet hann ich kapiert.

Verdammt lange her, daß ich fast alles ernst nahm.
Verdammt lange her, daß ich an etwas geglaubt.
Und dann der Schock, wie es anders auf mich zukam.
Merkwürdig, wo so mancher Hase langläuft.
Nicht resigniert, nur reichlich desillusioniert
– ein bißchen etwas habe ich kapiert.

It’s been a while, that I took almost everything serious. It’s been a while, that I believed. And then the shock, when things turn out quite differently – strange how roads turn sometimes. Not yet resigned, but pretty much disillusioned – I understand just a bit by now.
(The full translation of the lyrics can be found here.)

Below is a link to a wonderful live performance – I had forgotten what we looked like when we were Pádraig’s age:)

Today’s German Music Tip
BAP, Verdamp lang her (1981). (A really amazing life performance by Wolfgang Niedecken and his band, BAP. I lived in Cologne when they got big. It was an amazing time. – Another favourite from the same band with some unbeatable lyrics: Frau ich freu mich.)
What’s hot
Un-Isolation
Sitting at a desk (and not behind a Pactera’s steering wheel)
Kilometres we have driven to-date (since Wed., 13 Nov): 1,707 – not much of a change since yesterday!
What’s cold
Antibiotics
The German word/phrase of the day
Ihre Meinung ist uns wichtig (“Your opinion is important to us.” On a postbox in the hospital’s waiting room.)

It seems like half an eternity since we landed here just last Monday, exactly one week ago. So much has happened. Yet, we are still in awe almost every day about the care, the enthusiasm, the professionalism, and the kindness Pádraig is being treated with in the Schön-Klinik in Hamburg-Eilbek. They are working in a system that gives them the time to care, that allows them access to the resources they need to do so, and that really fires up their enthusiasm for what they do to really help their patients.

Pat went in a bit earlier, outside the official visiting hours, to say good-bye to Pádraig for a few days as she is returning to Dublin (back soon). When Maria and I went in, we met the Oberärztin (senior doctor) in the corridor for the first time since we had our

Trust me I’m a Doctor

introductory chat last week. I asked her whether she and her team had found the opportunity to form a more grounded opinion about his condition. With a broad happy smile on her face she told Maria and myself, that yes – they had examined the amount of cerebrospinal fluid, had done an EEG, and carried out a new CT. She felt the results were quite promising and she described a number of actions they were going to perform over the next week or so to try and wake Pádraig up. She also said that Pádraig had reacted to her asking him to open his eyes and squeeze her hand, and he had done so over two consecutive days, and on two different occasions on one of these days. The nursing staff had made the same experience, and she was going to check with the therapists later on. This senior doctor seems to have a plan and is not prepared to waste any time – she is determined to take small but decisive steps in the one direction to support Pádraig’s recovery.

Later, she joined us in Pádraig’s iso-roome when the physios were there (they come in twice a day most days) and she chatted away to Maria, asking how she was getting on. She then came back to me whispering so that Pádraig couldn’t hear her and said that as he was grinding his teeth quite a bit she had been talking to a dentist who was organizing a teeth protector for Pádraig as the wanted to avoid him doing damage to his teeth. – Imagine!

Maria will be going back to Dublin tomorrow. She is great company and Pádraig will be missing her, no doubt. ‘Frau Dr Schäler’, his newly registered older sister, will come for a visit this coming week-end.

We told the physicians here that there are three beds in the whole of Ireland for patients like Pádraig. We said that, in Ireland, he would have had to wait until July of next year for one of these beds, waiting in a 6-bed acute neuro surgical high dependency unit. We watched the disbelieve in their faces when they heard this. And I am wondering why there is not an uproar rising in the country, shattering the walls of the Department of Health, a Department headed by a minister who is himself a doctor, a minister who publicly states that all necessary services are being provided. I am wondering how rehab consultants in the NRH are tolerating this intolerable situation.

A week is a long time in politics, but it is an even longer time in healthcare, especially when you are in desperate and urgent need of help – a year’s waiting time is intolerable and effectively a denial of treatment to those who most need it.

What’s hot
German music tip: Ina Deter, Neue Männer braucht das Land (1982) [The girls in my Wohngemeinschaft didn’t stop singing this for months! Love the pink guitar!]
The water – and you don’t even have to leave on the immersion!
Kilometres we have driven to-date (since Wed., 13 Nov): 1,342
What’s cold
The weather
Sitting in a small car in the cold trying to find a good internet signal.
Forms from various German administrative offices.

In the Star Trek universe, the Borg force other species into their collective and connect them to “the hive mind”; the act is called ‘assimilation’ and entails violence, abductions, and injections of microscopic machines called nanoprobes. The Borg’s ultimate goal is “achieving perfection” (Wikipedia). I looked up this wikipedia article, because today, we woke up to the RTE news telling the nation that antibiotic resistant microbes represent the biggest threat to global health, according to a report published in the medical journal The Lancet. The report was written by a group of 26 leading experts and suggests that “the global health-care delivery system must be re-engineered to counter the threat of antibiotic resistance”.

Before you start wondering what I had for dinner tonight – here is the connection to our current situation: Pádraig’s isolation and us wearing those funny gowns all seemed to make a lot more sense all of a sudden. What didn’t make sense anymore was the reply by Beaumont Hospital to the request from the Schön-Klinik’s accepting consultant to test Pádraig for four types of multi resistant bacteria prior to his arrival in the German clinic, in order to speed up his admittance, and in order to avoid the need to isolate him upon arrival. Beaumont said they could test Pádraig for two of the four multi resistant bacteria mentioned by the German consultant, they could not test for the third, and they had never heard of the fourth. The German consultant was not surprised to hear this, he said, as many of his EU colleagues were “still underestimating the problem”. He decided that Pádraig was to be isolated upon arrival for his own safety, and that of the hospital’s staff.

Today, Pádraig was a bit more lively: heart beat up, higher frequency of breaths. We think that a ‘soothing’ medicine they had given him on Friday when they changed his tracheostomy might have had a slightly stronger effect than they had anticipated; this has worn off by now. Nurses told us again that they see him communicating and responding well to requests – I think Pádraig might not feel he has much of an option when a German nurse asks him “Open your eyes, Herr Schäler!”:). We also heard that the results coming back from the microbiologists have been negative so far – so if all goes well we won’t have to wear the gowns and masks we got so used to anymore from tomorrow, fingers crossed. He is still getting an antibiotic, and it seems to work: his temperature is normal.

The Borg are the main threat to civilization in many Star Trek movies and became a symbol in popular culture for any juggernaut against which “resistance is futile” (Wikipedia). We got the impression that many people working in Beaumont got “assimilated” by the Borg, they believe that the reality that surrounds them is, if not “perfect”, quite ok and certainly ‘normal’. Well, it is not: good, ok, or normal. ‘Good enough’ is not acceptable in the health service where people’s lives are at stake. – And yes, I am thinking of organizing a German-Irish ‘exchange’ to help people break away from the Borg.

Finally – some of you have left comments on this blog. Thank you so much! (They were all very kind so far:) Others have emailed and texted to say they tried to leave a comment but didn’t manage to do so. PLEASE try again – and if you don’t see your comment displayed on the website immediately, don’t worry, it will appear as soon as I release it: comments on the blog have to be approved to avoid spam.

What’s hot
German music tip: Peter Fox, Haus am See (2008)
Kilometres we have driven to-date (since Wed., 13 Nov): 1,037
What’s cold
Endless road works on the famous autobahns
Speed cameras

As every morning, we were listening to the RTE News this morning and heard that Beaumont Hospital asked all visitors to ‘stay away’ to prevent the spread of the vomiting bug Norovirus, against the” backdrop of an increased incidence of the winter vomiting bug in the community”. Restrictions had started last weekend when Pádraig was getting ready to leave for Germany – and his friends and family wanted to say ‘good-bye’. Many of his friends cancelled their visits, his GP was stopped on the corridor on her way to see Pádraig and was told to leave. While everybody agrees that patients need to be protected from dangerous bugs, you wonder who poses the greater threat: visitors, who are just seeing their one family member or friend, or staff, who are moving from patient to patient, and from ward to ward – at times, as we have heard, without observing even basic hygiene procedures like cleaning their hands.

Anyway – today Pádraig was as relaxed as he had not been for a very long time. We were used to heard rates of 120 and fast breathing – when we came in to see him this afternoon, Pádraig was the incarnation of relaxation: heart rate down to just above 70, breathing not much more than 10 breaths/min. We asked his second favorite nurse (!) whether something was wrong, or whether he had been given medication. Nothing was wrong, and no drugs had been administered – we were told. A doctor had seen him and they had checked him out, but all was well. The nurse told us that she had been feeling Pádraig’s presence and that she thought he was communicating with her. We think he might be in the process of finding back to himself through rest and relaxation. We can’t wait to see him tomorrow.

For us – we are still learning how to find our way around. Working on getting a decent internet connection in the middle of the German countryside is as challenging as getting it in Leitrim. There is an endless number of forms to be filled in for the hospital, the insurance, the city council, social welfare, … . And, we are trying to find the optimum speed for the close to 300km return drive to Hamburg – not too slow (saving time), but not too fast either (saving petrol).

One thing is for sure: we will not stay away from Pádraig – and we are hearing with delight that there are family and friends from Ireland planning to visit him over the coming weeks. Hopefully, he will be out of the isolation room by then and it’ll be easier to visit him.

PS1: Today’s German Music tip: Reinhard Mey, Über den Wolken… (1974). Unfortunately, I couldn’t find the slightly psychedelic original version, but here is one from 1998:  http://www.youtube.com/watch?v=Cu57mDP75Jo
(Watch or: listen out for the “Luftaufsichtsbaracke’:)
PS2: Just missed the 12 o’clock deadline for the second time in a row – so, despite showing Sunday’s date, this is Saturday’s blog!