Doctors

I've always tried to avoid going to the doctor. In America, I stayed away as much as possible because I didn't have medical insurance once I got kicked off my mom's in my early 20s, and going to the doctor was too expensive. In Turkey, the cost is less prohibitive and I even have private insurance, but I still avoid going unless it's absolutely necessary. Like, threw my back out and can't walk necessary. Having a baby necessary. That kind of thing.

At first, I avoided the doctor out of habit, and also because of the nuisance of trying to describe a health problem in my broken Turkish, or worse, to the doctor who claims he speaks English but would be lucky to be placed in a Pre-Intermediate class by my reckoning. In my early months here, I picked up a nasty urinary tract infection that not only bled, but caused some serious cramps while I was teaching which caused me to get very pale, dizzy, and break out into a clammy sweat in front of my students. They were very alarmed and I was really embarrassed. Hülya, the student in the class closest to a doctor (she was a horse vet at the nearby racetracks) and coincidentally the worst student in the class (after eight months she still didn't know how to say 'dog' or 'house' in English) very sweetly offered to take me to the doctor.

When you go to a doctor here, you go to a hospital. Of course there are clinic doctors, and private ones, but usually it's a hospital. I didn't know this when I first came here. When students told me they had been ill and had gone to the hospital, I got very worried about them. After a few months, I just decided this was a race of panicky hypochondriacs. But when the urinary tract infection that got out of hand made itself known to me in front of fourteen Elementary students, I was taken to the Acıbadem Hospital across the street from my school by sweet, probably-still-hasn't-learned-a-word-of-English horse vet Hülya.

Acıbadem is like the Ritz-Carlton of hospitals. You won't find that hospital-y smell there. Everything is gleaming and new-looking, like a shopping mall or a business park. Unlike the state hospital where I went to get some forms stamped for my maternity leave, there are no rusting 50-year-old gurneys creaking out of Nightmare on Elm Street, or cats running in and out, or hordes of villagers pushing to get into a door where they heard there was a doctor but where there in fact is none because she's out at the bazaar. At Acıbadem, the person at the Information desk is bright and cheerful and often a keeper of useful information. She won't look at you in utter bewilderment like you're the first person to have entered the hospital seeking medical treatment, then disappear down the corridor for 20 minutes while she asks someone what she should do. And at Acıbadem, smoking is confined to the cafeteria and perhaps a few other designated places.

But the trade-off is this: If you go to a posh hospital, expect posh treatment. I don't mean the good kind, like down pillows and martinis and string quartets while you wait for the doctor. I mean the scary kind, like a full blood work-up, plus some other tests, plus some other tests. I guess they figure if you're paying a lot of money, you might as well have a lot of treatment, whether you need it or not. And whether or not there's anything actually wrong with you, you can expect to be given several prescriptions. A high-paying customer can hardly be asked to leave the doctor empty-handed, after all. In most cases, you will be prescribed either antibiotics or cream. Sometimes you get both. Sometimes you get an antibiotic cream. Antibiotics are doled out like aspirin here. Sore throat? Chills? Ague? A cough? A sniffle? Went outside with wet hair? Feet got cold? Antibiotics cure what ails you. If you don't want to go to the doctor, you can just report any of these symptoms to a pharmacist and you'll get the antibiotics. If the pharmacist is closed, just go to your mother-in-law, as she will most certainly have a drawer full of half-empty boxes of antibiotics left over from previous family ailments.

I'm sure my dear readers have noticed by now I often have a tendency to exaggerate. Well, I'm not joking or stretching the truth on this antibiotics thing. This past summer, I got a strep throat-type thing with a high fever that wouldn't go down and icky white crud on my throat. The doctor gave me a shot of penicillin right there in the hospital and to my amazement, I started to feel better in a few hours. It was gone the next day. Completely gone. The doctor had told me that I should come back the next day for another shot, and when BE called him to tell him I was all better, the doctor went, 'Ah, of course! She's American! They aren't immune to penicillin like we are!'

But there's a downside to all this treatment, which is this: Going to the doctor is scary even without the language barrier. Being told you need such-and-such a test, or such-and-such a treatment is also scary. We've all been taught to trust the doctor's superior knowledge and education. Just as most of us take take our cars to the mechanic because we don't know beans about the inner workings of cars, we take ourselves to the doctor because we haven't studied medicine for 15 years to know why our innards are making that pinging sound. The difference is, when a mechanic tells us the car needs $1,200 worth of repair, we might be suspicious and take it to another mechanic, or at least our brother's friend, before having the work done. But when a doctor tells you this, you kind of panic and get the work done post-haste because you're afraid if you don't, you'll die.

Unless you're in Turkey. I've learned to kind of take pause when a doctor tells me I need some expensive tests or treatment. I learned this the hard way at American Hospital, another posh medical joint. I wanted a good, English-speaking, foreign-trained doctor for a Pap smear and pelvic exam, as I just couldn't face doing one of these in Turkish, and it was when BE and I had decided we were into being fruitful and multiplying so I wanted to make sure everything was working okay. The doctor was perfectly nice, with excellent English. I was a bit confused by the pelvic exam because instead of doing it manually as they'd always done in the US, he used a vaginal ultrasound (or, to borrow a term from Bri, a dildo-cam), but because I was terribly amused when the doctor described my ovaries as 'fibrillating,' complete with a finger motion to demonstrate this fibrillation, I kind of forgave him.


A few days later, the doctor emailed me to tell me that the Pap had come back 'abnormal.' It was abnormal in what appeared to be a scary way, as showing pre-cancerous cells related to genital warts. A visit to Dr. Google only made it all more scary and aroused my suspicions that the Universe wasn't going to let me get away with all that promiscuity of my pre-married days. The American Hospital doctor recommended that I come back for a laser biopsy, just to be sure. A mere $800 of sureness, to be exact. Dr. Google had also mentioned that a yeast infection could skew the results of a Pap, so BE and I went to Kızılay hospital, a big step down from American Hospital in the Istanbul hospital food chain, but his parents' neighbor works there and she was able to get us into the gynecologist without waiting in line for four days. For 20YTL, the Kızılay doctor confirmed that I had a yeast infection (which by that time I could have told her as much myself without the Pap), prescribed some cream, and sent us on our way. So for 20YTL, I was able to learn not only that I had dodged the Universe's bullet, but that perhaps I have a little more American Puritanical guilt than I'm comfortable with.


So by the time I went to Medi-Life Hospital (a middle-of-the-road place, a few steps up from Kızılay and many steps down from American Hospital or Acıbadem) about the ache and clicking in my ears, I was an old hand. I'd long given up on the idea of ever seeing a GP again, as they don't seem to have them here. They only have specialists. When I got food poisoning, I went to an internist and when my back went out, I went to an orthopedic surgeon. So at Medi-Life they sent me to the ENT, a very jolly old guy with a very spiffy fiber-optic camera that allowed him to look into my ears, nose, and throat and which was attached to a monitor so I could also view the moist insides of the mucous membranes in my head. I thought the inside of my nose was the grossest, and will forever think of that gadget as the Booger Cam. After pulling some pea-sized balls of wax from my ears (did you know ear canals can stretch to accommodate pea-sized balls of wax? I didn't. It sucked.) and prescribing me some antibiotic ear drops, the doctor informed me that my nasal passages were malformed which may cause me to sleep with my mouth open and make my throat dry. 'Okay,' I said, more confident of my Turkish by that time, 'But how did those balls of wax get into my ears and how can I avoid ever having that again? I do clean them, after all.' 'Yes, yes,' said the doctor, taking out a pen and paper and drawing a picture of the malformation of my nasal passages, explaining how it was either congenital or that my nose had been smashed as a baby. I started to wonder why I should bother learning Turkish when some people seem to have their own conversations anyway. The doctor told me I should make an appointment for some radioscopic laser surgery to change the shape of the inside of my nose. When I asked how much it would cost, he said 'It depends.'

So I told him I'd discuss it with my husband and left. A couple of weeks later in the mail we received a glossy brochure from Medi-Life detailing all their new equipment and departments. Right there on page four was my jolly, rosy-cheeked ENT smiling next to none other than a shiny new radioscopic laser machine.

So what are you supposed to do when the doctor tries to upsell you on treatment? How do I know for sure it's not very dangerous for my throat to get dry at night? I suspect it's not all that important, but I'm not a doctor. How much and what kind of treatment you need seems to be entirely dependent on the hospital you go to and which expensive machinery they're still paying off. It also depends on how rich they think you are, and whether or not you've told them you have private insurance. So in the end, I usually decide that the recommended treatment and most of the prescriptions are a crock and don't take them. This is fine when it's just me.

But what about LE? It's all right for me to decide what's necessary and what's not for myself, but I'm way less willing to fool around with second-guessing the upselling medical professionals for him. For his pediatrician, we've stuck with International Hospital where he was born. This is also a posh place, though I think they've gone decidedly downhill since being bought recently by the Acıbadem Group. It looks nicer, to be sure, shinier with more glass and chrome, but suddenly the need for lots of expensive tests and interventions for patients has increased greatly. LE's doctor, certainly not one to send us off without reams of prescriptions, seems really obsessed with vitamins. First it was Vitamin D, which she was absolutely convinced couldn't be gotten in sufficient amounts from the 12-15 hours of daylight here. Now the bee in her bonnet is iron, and despite my telling her all the iron-rich foods LE eats every day, she thinks he's a little anemic because he's pale. Because he shows no other signs of anemia whatsoever, I'm pretty sure he looks pale to her because he's foreign. Still, she prescribed us some iron drops which I've never bothered buying. They need to be given no less than two hours from the time the kid had or will have milk or food, and they taste bad but can't be given with anything. When I asked her what I'm supposed to do, as the boy never goes 2 hours without food or milk, she just shrugged like it was my problem.

BE is mad at me about this. He wants me to bow to the doctor's superior knowledge. And granted there are times when I can't sleep that I convince myself I'm malnourishing the child and he'll get rickets and be a bit dim-witted as a result. The doctor is exasperated with me too. Every time she looks at LE's records and sees I've declined on all the vitamins, she gets a stern look and admonishes me a little. I just start wondering about who's paying who here? Are these recommendations or orders? Does anyone genuinely think I'm doing something on purpose to make LE unwell? In any case, for LE's next visit, she wants a full battery of blood tests and urinalysis for LE. How one gets a urine sample from a baby is something I'm curious about, as I have no intention of taking off his diaper and chasing him around with a little cup. I'm not particularly keen on the blood tests either, but if it will shut her up and make BE quit glowering at me every time we leave the doctor then so be it. I'll make sure BE knows it was for him and his peace of mind that we had to get the baby's feet repeatedly pricked like that. Of course if LE needs the iron I'll find a way to give it to him, but in the meantime I'm thinking we need another pediatrician.

Sometimes you can't avoid going to the doctor, and with a kid it's even harder. For me, choosing a doctor in Turkey is nearly impossible-- if I want a well-trained doctor (meaning foreign-trained, as I just can't convince myself Turkish medical training is up to snuff. Plus, if the doctor doesn't speak a foreign language, how do they read recent medical journals? Iffy translations that come out two years later?), I have to accept going to a hospital that's going to want to use every piece of amazing machinery under the sun. I have to be strong in making myself believe LE or I don't maybe have the deadly disease they've been newly equipped to test for. But if I go to a 'regular' doctor, I can expect to be given 'medical' advice that involves keeping my feet covered at all times. So it's quite the dilemma. Doctors aren't fun anywhere, but it's something in Turkey I find especially trying, and because I never went to medical school, it's not something I'm really equipped to decide about for myself.

Not fair, I say. Not fair.