If You Feel Three Fetal Movements in the Space of an Hour...

It's rare I write about my work. For one thing, it's rarely really exciting, and it tends to be very repetitious. But I don't want you all to think I spend all my time frothing at the mouth about religion or Arabs.

Israel has a quasi-governmental health service. Every citizen in Israel pays a monthly sum from his gross income, and it entitles him to a "basket" of basic [very basic] health services via one of the four Sick Funds. You are at liberty to choose which of the four funds you wish to belong to, although in outlying areas there is usually only the largest, Klalit. It is also the oldest and is part of the Histadrut trade organization and the Labor Party. In most respects the kupot are alike these days. Each kupah has its own supplemental packages, and nearly every Israeli takes at least one, because the basic basket really isn't adequate.

So every Israeli has access to doctors, treatments, and medications at either no or vastly reduced cost. Hospitalization is free in most cases. All costs associated with birth are free. Well, not really free, of course; the taxpayer pays. But in general, it's a good system for most Israelis. As a type II diabetic, I have not only a GP, but an endocrinologist, podiatrist, opthalmologist [each costing me the gigantic fee of about $7 per quarter] have free blood tests, blood testing supplies for my glucometer at nominal cost, and my oral meds at about 75% discount.

I work in the Women's Clinic of one of the kupot. We see several different populations: couples in fertility treatment, high risk pregnancies, and "emergency" patients in a special walk-in part of the clinic. Very rarely are these patients really emergencies and that's what drives me crazy. "My regular gynecologist is overseas", they begin. Goodness, if this was really true, at least 75% of Israel's OB/GYN doctors are off on perpetual junkets. A variation, slightly more believable, is "my doctor's not available". Next they want to know why they have to wait their turn for a prescription for birth control pills that they've known for a month they're running out of. "It will just take a minute" they wheedle. Sorry madam, but you see this woman is bleeding all over the floor, she has precedence..."But she arrived after I did!" comes the insulted reply.

Other patients manufacture reasons which they think will get them ultrasound exams that will show what the gender of the fetus is. They are entitled to, nay, encouraged to have ultrasounds at certain points in the pregnancy, but there are those without patience to wait. Yet others demand ultrasounds as some sort of miracle exam that not only discovers all problems but solves them too.

There are minor irritations. "Please weigh yourself". In spite of a big notice on the wall above the scales, the women invariably leap onto the scales. "Step down," I drone, perhaps 50 times an afternoon. "Press the green start button, wait until you see zeros on the scale, then step up onto it". We used to have an electronic scale that switched itself on when stepped upon. This is an "improvement". Today, in the past three hours, I've done 12 fetal monitors [NST], not one for a good reason. All could have been avoided if the women drank enough fluids. "But then I have to pee all the time", they say. With the baby's head pressing on your bladder you're going to run to the bathroom all the time anyway, dear. Go drink at least a liter. I guarantee that within 30 seconds the woman has returned, swearing she's drunk "more" than a liter. One of the doctors I work with has no problem in sending a woman back to me for two or three repeat monitors because he won't transfer a woman to hospital if he can avoid it, and if he does, he wants to be sure there's no fetal distress first [which sort of defeats the purpose].

But more, I guess, is the simple imbecility of a great many of the women who show up. I've known smarter cows. "Three days ago, for 20 minutes, I had contractions; am I in labor?" "Two days ago I was on a bus which came to an abrupt halt. I'm feeling movements all right, but I just wanted to be sure the baby's OK". "Yesterday, I saw a dead kitten in the gutter. I want an ultrasound to be sure it's soul didn't pass into my baby" [yes, really]. There are the women who inject themselves with fertility drugs but find it difficult since they don't remove the cap from the syringe needle. Or the women who call, half hysterical because their glucometers always read the same thing and upon investigation this phenomenon happens even before they stick their fingers with the lancet, as if the machine intuits their blood sugar by telepathy. [they are reading the stick quality assurance code]

I enjoy teaching, but I'm finding my patience has its limits. I've just said the same thing too often, explained the procedure or the process too many times. But I need to continue working until the summer of 2010, because once I have 7 years' seniority, if I become an old age pensioner, I'll get all my medications free for the rest of my life.

So I'm hanging on. Barely.