Day 49: Murnau – Second-class patient


Thursday, Oct. 13, 2016

After I had been at the Bogenhausen hospital with Samir a few months ago where they recommended we go to a specialized clinic for paraplegics, I had made an appointment in Murnau. We submitted the medical recommendation letter at the district office and received a commitment for the assumption of costs a few weeks later.

(The whole story about Samir can be read here)

Exactly one month ago, I was in Murnau with Samir. We were accompanied by a retired physician who speaks up for refugees in Erding. Samir was driven to Murnau by an ambulance service, which we had previously ordered. He was accompanied on the trip by the retired doctor. I went to work for a few hours in the morning and then set out from there.

I was looking forward to the day full of hope. I imagined potential treatment and rehabilitation facilities and saw Samir already back on his feet. But I was to be sorely disappointed.

BGU Murnau (emergency hospital of the Employer’s Liability Insurance Association)

We met in the cafeteria of the hospital, went briefly through the documents and then made our way to the patient admission desk of the medical care center. I pushed Samir’s wheelchair through the aisles while paying particular attention to not banging his outstretched legs against any objects. He was silent. I felt his strain.

When we came to the admission desk, it soon turned out that they had given us an appointment with the wrong ward. We feared already to have come all the way in vain. However, a doctor then did agree to be willing to look at our case. The neurosurgeon asked us to come inside the examination room and listened intently to the summary of Samir’s situation. He asked several questions and was interested in particular in the stimuli-induced feelings still existing or recently again occurring in his legs. Then he told us that Samir would require an appointment at the paraplegia center and that perhaps they could help him there. This would again mean several weeks of waiting, Samir would be put off again, we would have to re-reserve an ambulance and I would have to take another day off. I had imagined something quite different. While we were still in the room with all that going through my head, the doctor picked up the phone after all, trying to reach someone from the paraplegia center. On the wall there was a poster on which big letters just spelled the word “moments”. I had to smile and somehow it made me feel optimistic. I entertained hopes that we would still have a medical examination.

The doctor reached the senior physician but he seemed not to have any time. He tried again at a different number, this time reaching the chief physician of the paraplegia center. She asked him to once again call the senior physician and promised that she would instruct him to look at the case.

So he called the senior physician again and started to describe the case, however, stopped in the middle of a sentence, listened and said, “I think this here is a different case…” Again he listened “… Yes, but are you sure?… I cannot accept this like that, I need a name from you.” The doctor seemed irritated. “… Do you really want me to pass this on to the patient like that?” Then he hung up, looking thoughtfully at Samir’s documents for a few seconds before lifting his head and saying: “I’m sorry, but the paraplegia ward refuses to accept your case.”

I am confused and deeply shocked and believe in a confusion. “What do you want to say: they reject to accept the case? Don’t they even want to examine him? May they do that? Just like that?”

The doctor looks at me with contorted face, himself visibly irritated, and says: “What shall I tell you? I cannot understand it myself. That’s why I asked once again.” He reflects, types a number into the cordless phone and says: “I will again talk to the chief physician.” He talks to her briefly and then hangs up saying: “So, apparently she once again phoned the senior physician and he will now come here after all to look at your case.”

The doctor brought us to another room and we waited for the senior physician to come from the paraplegia ward. When he entered the room he greeted Samir and then all others gravely. Again I described the situation. He listened to my summary impatiently and without asking even one single question, he asked us to put Samir on a stretcher. The ambulance driver and I lifted Samir from his chair with difficulty and heaved him onto the stretcher. Then we turned him to his side. The doctor opened the bandage covering a pressure ulcer at Samir’s buttocks, glanced in – for no more than 10 seconds – covered the wound again and said, “He must lie in a specialized paraplegia clinic for at least 5 months.” This statement pleased me because I thought he now realized his error. The retired doctor accompanying us said questioningly: “That needs a surgical revision, doesn’t it?” The senior physician replied curtly “Several! Several surgical revisions.” Then he left the room. Three minutes later he came back in and asked the doctor accompanying us to come outside with him. The gesture annoyed me. I wondered why he did not lead this conversation right in front of Samir because the doctor was only there as a helper.

5 minutes later, both entered the room again. The retired doctor twisted his face in frustration and the senior physician told us: “His decubitus wounds are too deep and bacteria have already settled in his bones. One can’t get rid of them. One can only change his dressing regularly. We can do nothing for him here.”

My cautious optimism gave way to absolute disbelief. He had just said that several surgical revisions were needed, and now suddenly regular dressing changes would be all they could do for him? I asked: “Isn’t it possible to perform any surgery on him?”

One could, of course, try to scrape off the bone and to clean the wound, but it is uncertain and the prospects of success are low. And besides, that would be far too expensive. We’re talking about an estimated 150 thousand Euros. Who should pay for it? Moreover, we cannot admit him here as an in-patient. We already have three paraplegic Syrians. We also have to treat our people… you know? Germans.”

The retired doctor beside me remained silent. His gaze fixed a point on the desk and I seemed to literally sense his disappointment. Samir sat in his chair, he did not say anything either and looked at the floor. He seemed to understand and to lose himself in contemplation. For a moment I was speechless, then I tried to make the best out of the situation and said:

Ok, I understand that maybe you don’t have any place here, but that is another matter. I expect, nevertheless, that you give us an option here, a path which is to be followed. A qualified statement about possible treatment options.”

It’s best to get a home care service and a wound manager who takes care of him and does that in the nursing home then,” he said.

“And what about his back, his paraplegia?” I asked, as this was one of the main reasons why Samir had taken on the whole journey.

”There is nothing that can be done about it any more. That was 5 years ago. We only perform acute treatment. Once the spinal cord is injured, it’s injured forever.”

He said so as if he were talking about a broken-down car, an object, for which even the attempt to fix it would not be worth while, and all this without even having looked at the documents we had brought with us. Before my eyes I saw Samir crossing the sea in a rubber boat sitting in a rickety old wheelchair and asked me if that should be all now.

”Well, and that’s it?” I ask in disbelief. “And what about rehabilitation measures? Can’t one do anything there?”

Yes, of course, he can do some sport, with the arms and the upper body.” The senior physician stretched his arms as if lifting an invisible weight and then stretched them out in front of his body. It looked as if he would advise someone with sore muscles to do some stretching exercises. I wondered whether he was making fun of us.

“No physical therapy?” I asked incredulously.

Yes, of course, a therapist could help him a bit with it.”

The conversation left me flabbergasted. Never before had I felt being given such a short shrift by a doctor, even though it was not myself being fobbed off, but Samir. In between, I time and again interpreted for Samir. Very quickly I saw how he resigned himself, his thoughts floating away. It was as if an inner flame was about to be extinguished. He asked me if the whole journey here had been in vain. I had no answer for him. Because at the moment it seemed to be that way.

The doctor promised to write a report and said goodbye dryly before he went.

Later, I spoke with the retired doctor and asked what the senior physician had said outside the door.

“He said that all this was too expensive, that they already had three Syrians who did not speak any German and that, therefore, the nurses were defecting. He furthermore asked rhetorically who of all people should pay for all of this? I answered with another rhetorical question: who would pay for it for the Germans? He replied that of course the insurances would pay for it. Unlike the refugees, the Germans had also paid into these insurances for years.”

The medical report

Two weeks later, Samir received the promised medical report by mail. In the report, the decubitus at the buttocks is described in such a way as it could not possibly have been assessed in the few seconds and particularly, in the light conditions prevalent there. Furthermore, the bedsores on the feet were described, although the dressings at them had not been removed during the examination, so that the doctor could not possibly have formed an opinion of his own on them. With respect to the injury on the back, he writes that it is without any signs of inflammation, even though he had not taken the trouble to examine it at any moment.

And although I had anticipated that the report would not provide any founded diagnosis, I was surprised at the obvious and shameless pretense of having conducted a regular examination, with not only me and the retired doctor, but also the ambulance driver, having been there to watch.

I called the retired doctor and he resolved to send an e-mail to the chief physician of the paraplegia center complaining about the senior physician’s way of handling and asking for a second ordinary appointment for a qualified opinion.

Two weeks later, a response is still pending.

A glimpse of hope

The day in Murnau was a major setback and is still very stressful both for me and all the others who care about Samir. My co-worker, who also speaks Arabic and often interprets for Samir or simply just goes to see him, the German teacher who does a lot more for Samir than just teaching him German, the nurse from the retirement home, who personally supports him together with her husband, the retired doctor, who had accompanied us and still tries to activate his network – all of them responded with disappointment, bewilderment and most of often even fury.

But no one was able to empathize with Samir. For two days, I heard nothing from him. He told me later that he had had to digest it first of all and that his mind was in a haze.

I tried to encourage him and promised to continue to speak up for him. I arranged things with the other volunteers and the German teacher promised to go and see him more often. We found a physiotherapist who promised to visit Samir regularly. Meanwhile, he is visiting him at least four times a week and exercising with him. The ultimate objective is that Samir can heave himself alone into the wheelchair, thus gaining autonomy. The physiotherapist is in good spirits and has found that Samir cannot have a complete paraplegia. Samir himself says that he has since been sensing things he had never felt before.

We will try again to take him to the Bogenhausen hospital, where we feel that interaction with people like Samir is more humane.

The retirement home

The situation in the retirement home, however, is still difficult to borderline. A few weeks ago, Samir asked to be taken to hospital for the catheter for micturition to be replaced as he had the feeling that it was clogging more and more. Normally, it has to be replaced every 6 weeks. However, since the last change already 8 weeks had passed. We asked the management of the retirement home several times to get him to a hospital. Over 3 weeks we were just put off. When Samir begins to complain about headaches and pressure in the abdomen, the retirement home offers him a painkiller, which he politely reclined. My colleague and I then decide to call the ambulance on our own. Samir is brought to the hospital, where they detect that the catheter was clogged and his bladder was full.

 You can read part 6 of his story here

Translated by Manuela Hoffmann-Maleki

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