I am a bit of a science nerd and a computer geek. The scientist in me was raging against the conclusions reached by my highly qualified physicians. The only evidence of high blood pressure was the readings from the machine in the medical centre. There was a stack of anecdotal evidence to suggest that the readings of that machine had to be called into question. I needed hard evidence and providence provided it.
My next visit to the medical centre was to ask the doctor about obstructive sleep apnea. My brother has OSA and has had a cpap machine for years. I spoke to him about my situation and he explained that it was high blood pressure which had eventually led his physicians to diagnose and treat him for OSA. So I suggested OSA as a possible cause to my doctor. He grumbled a bit and then, without speaking , typed into his computer for 5 minutes, left the room and came back with a printout which he signed and stamped. He handed me the printout. It was a referral to the sleep unit at a local hospital. I was stunned. So stunned I just got up and walked out of the consulting room without thanking the doctor. He hadnt actually spoken to me so I didnt feel discourteous.
I called the hospital, arranged an appointment and booked a day off work. The whole experience of going to a public hospital in the middle east is worthy of a book in itself. The whole concept of a hospital is turned on its head. Let me explain my attempt to attend my pre-arranged appointment with the sleep consultant.
I arrived at the hospital in a taxi benevolently provided by my employer. The idea was that I would get back to work quicker if I wasnt driving. My appointment was for mid-day, I arrived at 11:45. I go to the outpatients building and there is a guy in a booth with a big sign above it saying "Please ask me for help". So I asked him where I went to see the sleep consultant. The guy looked at my referral letter, mumbled something in arabic, shouted to a friend, lots of upraised palms and shrugs and he told me he didnt know. He then dismissed me by asking an arabic lady behind me if he could help her. OK, new country, lets try again. So I asked him where I went. He gestured to a sign which read "Main Building" and said "Main Building". SO I followed the sign for "Main Building". This led to another sign and another and another and finally the signs stopped and I was standing in front of a door with a sign saying this next door led to a ward exclusively for ladies and if you go through this door you better have ovaries. So I made my way back to "Please ask me for help" guy and got lost. I found another "Please ask me for help" guy who gave me a bewildering set of directions which sounded like a memory test they give spies. Anyway, I ended up, completely by accident back at the out-patients reception.
I had a vague memory of reading something on the internet about the sleep clinic being directly above the reception of the out-patients. So, with nothing to lose, I walked up the first set of stairs I found and looked for a sleep clinic. What I found was a massive waiting room. Actually, two massive waiting rooms, one male the other female. I walked over to the male waiting room and spoke to the lady at the desk.
The lady was wearing a full veil so I could only see a tiny portion of her face. I couldnt help but think she looked like a ninja and I inadvertently giggled and then I quickly made it appear like a cough. I asked the lady if I was in the correct place to attend my appointment with a sleep consultant.
She turned her head in my direction and said "Paper".
"What paper?", I replied.
"Paper, paper", she said in a harsh tone and she slapped her hand on the counter.
"I dont have any paper", I said innocently, feeling guilty about my paperless situation.
She expelled air and looked up at the ceiling. Its amazing that even through a full veil she conveyed utter contempt for me very effectively.
"Is it first?", she barked, still looking at the ceiling.
I pondered this for a moment. I didnt want to offend her again as I was genuinely afraid that she would slap me instead of the counter. so I ventured, "First appointment?", in a hesitant please-dont-slap-me questioning voice.
There was a pause of a few seconds. She was still looking at the ceiling but she was motionless and obviously contemplating my violent demise. The pause made me sweat, heart pounding. Then she looked at me for a whole second and then said something which brought me immeasurable joy.
She said, "Referral letter" and the universe made sense and old people and children slept securely in their beds.
Grinning like an idiot, I handed ninja-killer-receptionist the referral letter which I brought with me purely by chance.
She took the letter, did some typing, ripped a printout from an ancient dot-matrix printer like she was ripping the head from an insolent sick-person and then slammed the printout and the referral letter on the counter.
"Go there and pay" she commanded in the same way as Henry VIII ordered beheadings.
"Go where?", I asked by reflex and immediately regretted the words. I was merely offering ninja-decapitator the golden opportunity to publicly display her disgust at having to deal with a stinking, offensive trouble-maker like me.
She made a grunt noise and gestured with the back of her hand to one corner of the massive waiting room.
I bit my tongue and looked in the general direction of the gesture. I had no idea I was going to be asked for money but I was willing to pay a massive wad just to get away from the ninja-testicle-crusher. I walked off in the direction of what looked like a queue of people.
There was a loose collection of men in front of two tiny windows which were at my eye level. I stood at the back of the collection of men and moved forward as men walked forward, handed over paperwork and money, received paperwork and walked away. I got to the front and I was quite excited. I guessed that the printout was needed here so I handed it over to another ninja-payment-taker. She tapped on a keyboard and then put out her hand. I had no idea how much to pay her so I handed over the biggest note I had. More tapping and the hand reappeared with printout, money and a new pink card. I gratefully gathered this and walked away feeling like someone who had just taken delivery of a really great Christmas present. I did not hear one word spoken in the whole time I was in that queue.
I had no idea what to do now. I stood there for a few minutes observing the room. This was my first chance to really notice how truly disgusting the room was. There were about one hundred grey plastic seats packed tightly together. They werent individual chairs. It looked like plastic seats were welded onto a very spindly metal frame which looked unlikely to bear the weight of three sparrows. On the seats were a collection of men from various nationalities all coughing like hags and gargling on enough phlegm to collectively drown an elephant. Coughing doesnt really describe what they were doing. It looked like they were participating in a "First to expel a lung" contest. Hands wiped away dribbles of white foam from corners of mouths, hands were then wiped on clothing to deposit said foam and create white stains on dark cloth. There were Herculean sneezes which shook the building unhindered in their germ-spreading glory by any attempt to cover mouths. My observation revealed that most of the plague victims had a ticket with a number on it. I looked around for a machine but there wasnt one. My heart sank and my stomach churned as I caught sight of the first ninja handing a ticket with a number to a walking corpse who had light blue skin and purple lips. I gathered my courage and walked up to ninja-number-dispenser and just before I asked for a number I stopped still, thought for a second and I handed over the pink card. It seemed logical captain and I fully expected sudden, violent death. Without looking at me, ninja-happy-now-he-stopped-using-words handed me a numbered ticket. It said, room 219, 201. Now all I had to do was wait.
There was a digital display hanging from the ceiling facing the seats. Different numbers flashed up every 5 seconds which I now understood to be room numbers and the number of the next patient. A clue of some sort would have been good. My appointment was for mid-day. It was now 12:05. I hoped I hadnt missed my appointment. I would be happy to face open-heart surgery without anaesthetic rather than try to get another appointment. SO I resolved to sit and watch for my number. I spied a seat with the greatest number of free seats round it in the whole room and walked towards it. Then I caught the stench. If body-odour was an olympic event, I was in a roomfull of potential gold medal winners. I literally gagged and decided standing was better than vomiting.
1pm came and went. No-one seemed to be leaving the waiting room. I recognised many of the diseased lepers with open running sores had been waiting longer than me. 1:45 arrived and I was getting edgy. I needed to leave at 2PM so I could be home in time to pick up my children from school. I went to the desk and risked a ninja question. "When will I see the consultant?" I asked. She completely blanked me and dialled a number on her mobile and spoke quite loudly to her friend. I was pondering my next move when I heard a very arabic version of my name being called by a tiny ninja-nurse. I walked over to the ninja-nurse and before I could check that it was me she was looking for she walked off and gestured for me to follow. In the next millisecond she had taken my weight and blood-pressure and I was being sent back to the flesh-eating-disease incubation unit.
I stood for about 30 seconds and another arabic voice called my name. I couldnt see the source of the voice so I went looking. At the opposite end of the corridor a woman was calling my name from a doorway, facing away from me. I walked up to her, and , again, before I could check that she was looking for me she placed her hand in the small of my back and ushered me into the room. There were about ten people in the room. About half were wearing some sort of uniform. The other half seemed like members of the public who werent willing to risk sitting in the anthrax-laden atmosphere outside and had simply found a place to sit. Behind the desk sat a venerable Arab gentleman who smiled at me and very politely asked me to sit.
There were many conversations going on in the room. The Arab gentleman spoke and I didnt think he was speaking to me. He looked me straight in the eye and asked if I had been waiting long. There was a lot of talking going on in the room and I really didnt want to participate in a consultation with half of the middle east listening in. But, it was 1:55 and I needed to leave in 5 minutes. The whole conversation took 2 minutes. I was booked in for a home sleep study. As I was leaving the Arab gentleman asked me what motivated me to have a sleep study. I mentioned the blood pressure. He squinted at his notes. "133/85 today. No blood pressure issue here", he scoffed. Then it dawned on me. I wasnt stressed because it was done so quickly. Also, the cuff was huge and easily fitted around my arm. I asked him to write it down and I have kept that piece of paper to this day.
My taxi whisked me home and I asked to be dropped off at the medical centre. I walked straight into the blood pressure room and asked for my blood pressure to be taken. It was 158/90. All I had done was sit in a car for 40 minutes, not run a marathon. Yet here was my clear, quantitative evidence that the medical centre machine was wrong. The nurses and doctors all completely ignored my evidence and forever lost any belief I had in them.
In my next post I will describe how I personally have been affected by OSA.
Until next time.
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