Saturday, July 2, 2011

White Unicorns

It’s a dreadful scene and no one is permitted unescorted. Wash your hands and disinfect before entering. There’s a sign by the sink offering cheap parking, but that’s going to be little compensation.

There supine on the bed is your nine-kilo, 77-centimeter, one-year-old son: unconscious and stretched out before you with tubes in his nose, hands, and one between two of his tiny toes. His little limbs are lashed to the bed as if he were a suicide case.

You stand on the wrong side of his bed and it only gets worse. There is a roomful of them: a first-birthday balloon floats above the bedpost of one; a box of toys stands quiet on the windowsill of another. Some of them have been here for a while.


In the 1990s, there was a saying among foreigners: Get sick in Estonia and the only cure is a plane ticket out. Given the state of the healthcare system, it often seemed justified.

It was said that to get proper treatment a payment was necessary—and it didn’t have to be cash. I imagined Estonia’s top surgeons sipping tea from bone china in immaculately groomed gardens, surrounded by chickens, pigs, and cows which patients had given them in payment.

In case of illness, American Peace Corps volunteers I knew kept their own supply of syringes, so much did they fear rusty, harpoon-like Soviet needles.

A physician friend once told me that it was easier for a doctor to amputate than to set a broken leg. (He laughed when I took him seriously for a moment.)

But personal experience only served to validate the stereotype. In 1993, having taken a fall on the ice and suspecting a broken leg, I visited Mustamäe Hospital. Limping through its unmarked labyrinth, knocking on closed doors until I finally located a doctor. She stared at me for a long while, and I suspect the only reason she did not simply turn away was my accent. She agreed to do an xray, and in excruciating pain I dragged myself up two flights of stairs by the handrail while she led impatiently in front.

Once with Liina in Haapsalu, an emergency room physician, his face beet-red and breath like rocket fuel, was perturbed at being taken from his soap opera which blared in the background. He grabbed Liina’s wrist and twisted it. She screamed in equal parts agony and surprise.

“It’s not broken,” he said, and did an about-face to return to his television. (It wasn’t broken. An xray the next day at a private clinic proved him right.)

Soviet medical care is free, went the joke. And then the rejoinder: But care of this quality is free everywhere in the world. Truly, the plane ticket out was not a bad idea.

Although things have changed, memories like these still flood your mind when you visit a hospital today.

The Mustamäe Hospital, despite improvements to its facade, from many angles still appears from the outside as a horrific Soviet monster which feeds on the ill. Inside, though, and especially the children’s hospital, it’s a case study in how to resurrect an old commie building.

The equipment is modern and the hallways are spotless. The pastries in the children’s hospital café are as good or better than most in the city. The main hospital’s atrium café (in some freak accident of a public tender?) is actually run by Reval Café, a place regular human beings would otherwise delight in eating.

Estonia’s doctors today, in my experience, are superb. Though they may not know me, I have come to know many of them by name, and I am most every time impressed by their professionalism, commitment, and compassion.

And the nurses? As my mother was a nurse, I am probably predisposed to like all nurses. “You will only be allowed to stay home from school if you are bleeding to death,” was a familiar refrain of my mother’s, which perhaps epitomizes the spirit present in all good nurses, their instinctive ability to strike the right balance of taking no guff yet imparting some sympathy.

And beyond the medical staff, in the children’s hospital there are even occasional visiting magician clowns in lab coats, who I have seen make a sick little boy shriek with joy.

“Why is everyone so nice here?” I finally asked an allergist who showed herself to be the talkative sort. I noted that the myths of Soviet medicine sometimes still hang heavily over Estonia.

“It’s great to work with kids,” she said simply, and I wondered how were the state of things across the street at the big hospital. Was everyone there so nice, too? Or was the positive environment at the children’s hospital partly due to external factors, like community interest led by the Children’s Hospital Fund and the republic’s First Lady?

Of course it’s not all roses. Spend enough time anywhere and you start to notice stains on the carpet.

On some days you may begin to wonder if there are any ethnic Estonians left in the hospital at all. It can sometimes seem that Estonian may not be the best language to use when seeking medical care. But you soon realize that nearly everyone speaks enough. You meet a few native speakers, too, and it becomes apparent that, despite what we read in the papers, not everyone has yet gone to Finland.

You meet the wacky resident who delivers a lecture ad nauseum about how to weigh urine in diapers. He explains to you the meaning of the numbers to the left and right of the decimal point on the digital monitor. Kilos. Grams. (Ah, the thrill of science!)

I want to ask him how to know the difference between a “6” and a “9” on the digital thermometer, but Liina stops me. “Don’t make enemies here,” she says. Besides, one veteran doctor has already told the resident to shut up and stop spewing nonsense.

Then there’s the jailhouse food. While it may be good in the cafes, the food brought to your room causes you to wonder whether one of Stalin’s actuaries has conducted a calorie count, and you are being fed the bare minimum in order to keep you alive. This is somewhat mitigated by the very pleasant servers, who seem always in good spirits when they enter your room.

There is the pay parking lot patrolled so efficiently that its proceeds must fund half the hospital. Perhaps Liina and I are not the smartest parkers, but we have been fined three times, and we console ourselves by hoping the 35-euro fines might go to fund a new kidney machine or to fill the canyon-sized pothole at the turnoff to the hospital, and not go to put gasoline in some politician’s luxury automobile.

Once you’ve been there a while you disappear into the woodwork and start to hear private conversations in the elevator. Workers’ complaints about ridiculous bureaucracy. A nurse telling a doctor to stop treating them like dogs. There’s an ear doctor from Soviet era who still thinks it’s the Soviet era. And there are of course still a number of angry babushka types, who, in the words of a friend, are accumulating major karmic debt.

Some floors are run like prisons where the nurses are the guards. “We have rules here,” said Nurse Ratched, after she caught me sitting in the bed. “The bed is for mothers!”

“I thought the bed was for the parental guardian?” I replied. “And that would be me.”

She bared her teeth as a warning and moved on.

But other floors are little Utopias. Convalescing children do cartwheels in the hallways and socialize in the playroom. The staff is happy and smiling. For example, it would not be out of place on the third floor, I think, for a fairy princess to appear riding bareback atop a white unicorn.


When your infant son wakes in the ICU it’s the most unsettling part. He wants to cry out but can’t because of the tube in his nose. He thrashes about, pulling at his tethers. You can see the terror in his eyes. You place a hand flat on his chest and another on his forehead. But that doesn’t help at all; it only makes him want to be held.

After a while he steadies, he turns his head and stares you in the eyes. He melts you.

And you are as helpless as he. There is nothing for you to do but trust. Trust in fate, in your god, but mostly trust in the physicians and nurses.

And you do.