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!

Having lived more than half of my life in Ireland, taxi drivers still ask me whether I like living here (I stopped thinking about this a long time ago) and colleagues at work wonder why on earth I still haven’t figured out how things are done: put pressure on your TD, have a chat over coffee – but never refer to any kind of written agreement, regulation or procedure, unless you really want to get yourself into trouble. They think, I am German. Here in Germany, I am Irish: I don’t believe in timetables (works of fiction – but: it’ll be grand), I try to connect with people (rather than procedures), and I can’t believe that the former president of Germany has just been put on trial, having resigned over the affair some time ago, of course: he had allowed someone to pay a 700 euro bill for him at the Oktoberfest (I would have expected a tribunal of investigation).

Why is this relevant? Here is one reason: I am on a bus this morning to go from Hamburg via Bremen to Münster to collect a car our German relatives have organized for us. At 08h28, the driver stepped onto the bus, took off his jacket, sat down, and pulled out at 08h30. Within minutes we were on the motorway because the rush hour, of course, was long over. I was so proud that I had discovered this bargain when I bought the €25 ticket for the 330km long journey – until an elderly lady told me that she had just paid €37 for her 800km return trip to Düsseldorf (there was a bit of ‘Schadenfreude’ on her face when she did:). So, if you want to visit Pádraig and cannot find a cheap flight to Hamburg, check out the flights to Berlin, Köln, Düsseldorf, Bremen (Ryanair), Amsterdam – they all have good-value and regular bus connections to Hamburg. No matter where you will arrive in Hamburg, central train station (or Hauptbahnhof), bus station (right beside the train station), or airport, just take a 10-15 minute ride on the Hamburg equivalent of the DART (S-Bahn) for less than 2 euro: it’s the S1 and you get off in Friedrichsberg – kind of in the middle between the airport on one and the central train station on the other side. From there, it’s just ‘um die Ecke’, a 5 minute walk to the hospital.

But there is another reason why this is relevant: people are held responsible and accountable for what they are doing here. ‘Herr Schäler’s’ favorite nurse comes in every 15 minutes or so to check on Pádraig apologizing, of course, for the interruption when she comes in. She tells Pádraig who she is and explains to him what she is doing. When it’s going to be uncomfortable, she tells him in advance and apologizes. But there are also limits to her kindness – when I went out to the corridor in my blue gown and mouth protector to look for a second chair yesterday, I was told quite firmly to get back in, and quickly: can’t leave the room in this gear! In fairness, she then organized a second chair for us, ‘kein Problem’. Turns out she also checked out the bed sore on Pádraig’s right heal and took pictures of it to document that this injury hadn’t happened under her watch. (She removed the bandage from the heel, and it’s healing well.)

She also removed the Beaumont ID arm band, and another strange looking ‘ID tag’: his Oireachtas arm band / ticket that his friends had brought in for Pádraig as he couldn’t make it in person to Killarney this year. When a colleague told her that this was not just another auld hospital ID tag, but a very valuable concert ticket she went through the bins, found the armband she had cut off, then taped it back together, left it in his drawer – and told us all about it (we didn’t even have to ask).

I am still on the bus, listening to the regular announcements of the driver’s ‘navi’ (“Fester Blitzer in 400…300…200…100 Meter”) warning him of the ever-present and, no doubt, well-functioning stationary speed cameras. It’s all under control, now we’re movin’.

(Note: I wrote this blog on Friday morning. By the time I got back, visited Pádraig,  collected Pat and Maria, drove our new car up to Tating, and managed to publish the blog, it was just after midnight, Saturday morning.)

Sometimes, it’s the small things that matter – because they are an indicator of what a place is all about. Making sure that Pádraig is comfortable, that he is positioned correctly,  that his arms are supported, and that his head is straight – these are all small things that add up to making a big difference.

Pádraig still has a slight fever and is getting the antibiotic he was started on the day before we left Beaumont. The microbiologists will tell doctors here tomorrow whether they should adjust them or whether it is ok to continue the current course. The physios started to work with Pádraig today and are beginning to develop a feel for his condition and his personality. Some staff are still addressing him as ‘Herr Schäler’ and ‘Sie’ but this happens less every day.

Staff close the door to give us privacy, they apologize for the interruption when they come in, they introduce themselves to us, and they explain to Pádraig everything they do so that he is fully kept in the picture and understands what is going on.

Last night, Pádraig clearly responded to me a number of times when I asked him to blink once for ‘yes’, and twice for ‘no’. Today, before Pat arrived, I spent a few hours with Pádraig and when I asked him three or four times to squeeze my hand, and to let go of my hand – he did it. No doubt. – Of course, these are all only small steps (and not entirely new to some of you), but for us they are amazing because they demonstrate that Pádraig understands what we are saying to him and that he is able to react to what we are saying to him.

Pat and I feel really privileged that we could bring Pádraig to Germany, into a hospital where we feel people really care for him and have access to the necessary resources and manpower to do the best job possible – although one nurse today showed us that good care does not necessarily require expensive high-tech sophisticated equipment. She had noticed that Pádraig’s hands were very cold. So she put warm water into two of these surgical gloves, knotted them up, put one of them under each of Pádraig’s hand, and secured them with a towel around each of his hands.

A small detail – but one of many that make a big difference Pádraig feel he is in safe hands, that he will receive the best care and therapy there is to help him wake up again. And he is responding.

So, what is different here compared to Beaumont? The short answer is that we don’t know yet – apart from what we can see at first glance. It’s definitely quieter here than in Beaumont, and not just because Pádraig is the only patient in a two-bed room, but also because there are hardly any visitors, measured by Irish standards. Another difference is that none of the staff wears a casual dress on the ward, and that includes doctors and consultants. In fact, it would be impossible to tell nurses and doctors apart based on their dress: they all wear the same ‘proper’ hospital gear; and they wear name badges with their job title, instead of the 24-No-More buttons we became so familiar with in Dublin. There is an obvious resource advantage here in comparison to the ward we got to know in Ireland – everything looks new, and you get the feeling that patients get what they need.

One thing that is not different to Dublin is that they were not prepared for Pádraig’s height. While the bed itself could be extended, they are still looking for an extension to the standard mattress.

Finally, I  explained that he would never react if addressed as ‘Herr Schäler’ and with the formal ‘Sie’, as Doctors did yesterday when we arrived. It will need some time not just to get over this exhausting trip but also to get to know each other on the ward. We will need to get beyond of what we can see at first glance – although what we have seen so far is  promising.