Harvey, lying flat on his back on a chilly sidewalk on a side street in Villefrance-sur-Mer on the sunny Cote d’Azur, some of the world’s most expensive real estate, gazed at the blue sky. Two stories up an elderly woman peered over her balcony. An American sprawled on the sidewalk, she thought. Haven’t seen that in weeks. Then she continued sprinkling her azaleas, water overflowing from the planter and spilling onto the sidewalk below, gently splashing onto Harvey’s head. Sandra sat next to him on a stone wall, dialing on her cell phone for the pompiers – the firefighters – to come in their ambulance to cart her husband off. Passers by passed by until one young man walked up to Sandra, glanced at Harvey lying on the sidewalk and began speaking to her in rapid French. Oh, thank you. I’ve called the pompiers, she replied. They are coming. He continued speaking rapidly, increasingly frustrated at her incomprehension until he held up an unlit cigarette and gestured. No, Sandra, replied. I don’t have a light. He walked off in a huff.
We’d taken five weeks off the barge to warm up in the south of France then on Madeira, off the west coast of Africa.
Soon, we heard the eeeee-ahhhhh, eeeeee-ahhhhh, eeeeee-ahhhhh of European sirens, the sound that in films indicates the Gestapo is closing in on Anne Frank. The siren faded in and out, first from the north, then the south, east, then west. Apparently, the ambulance was approaching in a spiral rather than directly. It arrived and out leapt three young pompiers in full uniform, ankle-to-neck blue jumpsuits, black boots, reflective tape covering at least a third of their outfits, backpacks, shoulder bags, suitcases, strange square black boxes, badges, insignia, caps, rubber gloves. Pompiers are a big deal in France, a big deal having little to do with fighting fires, or even driving ambulances. The primary job description of pompiers appears to be to jog in unison through cities in packs of a half-dozen wearing skin-tight black tee shirts with matching and equally tight short shorts while fashionable women sip coffee at sidewalk cafes along their route sitting at strategically placed tables so they can comment on the merits and virtues, or lack of same, of the parading pompiers. A highlight of the social scene across France every Bastille Day is the local Bal des Pompiers, the Firemen’s Ball. Unlike in the U.S., where the only number to dial in an emergency is 911, France presents a menu of emergency numbers. The universal number for any emergency is 112. For emergency medical help you dial 15, which gets you to SAMU, the nation-wide medical emergency system. For police, you dial 17. Nonetheless, we’d been told, although on reflection perhaps we’d been told mostly by Sandra’s French women friends, no matter what your problem is, dial 18. That brings the pompiers. Hopefully by a vehicle and not by foot, in a pack.
The three pompiers stood in a circle around Harvey and unpacked their equipment, preparing for a long stay. What was the problem, they asked. Probably that is what they asked. At least, none of them waved unlit cigarettes so they were not asking for a light. We told them we’d been for a long walk. To see the Rothschild estate on Cap Ferrat, we said (although actually Harvey had been more interested in finding Villa Nellcôte, the mansion trashed by the Rolling Stones when they recorded Exile on Main Street there). We’d walked and walked and Harvey became dizzy. Each time he became dizzy he sprayed a shot of the medication the cardiologist had prescribed for heart problems. Then Harvey did what for him had historically been what induced cardiac distress; we visited an art museum, the Chapelle St-Pierre, a small church decorated floor to ceiling by Jean Cocteau. After all, it was a visit to the Boston Museum of Fine Arts that sent Harvey to the Brigham and Womens Hospital cardiac emergency room almost two years ago. Walking from the artistic church, Harvey had to sit, then, sitting, he said he had to lie down. Sandra called the pompiers.
Harvey was lifted into the ambulance and wrapped in a gold foil warming blanket, carefully tucked in until he looked, as one pompier said, like a saucisson, a sausage.
Twenty minutes later we arrived at the Hospital Louis Pasteur in nearby Nice – a teaching hospital with a noted cardiac unit – and Harvey was rolled into the emergency room. A nurse spoke English and questioned him about what had happened. She took his medical history, including the Boston cardiology experience. Was he in any pain, she asked, now or when he’d been dizzy, especially any chest paid? No, Harvey replied, no pain at all. She asked what he’d eaten during the day. She listened to his heart and took a drop of blood from a fingertip and tested it on a device. The doctor arrived and the two of them spoke, again in rapid French. Harvey attempted to understand what they were saying. One phrase drew his attention. Pas de pain, they repeated to one another, apparently with great significance. Ah, Harvey thought, “no pain,” it means something important that I have no pain, that’s good, I suppose. Last time I was at a hospital I had chest pain. Now I have none at all. Pas de pain, no pain. Good, he thought. The doctor repeated the phrase, questioningly, pas de pain? The nurse turned to Harvey and said, in English, the doctor does not understand why you had no bread with lunch. Suddenly, Harvey understood. “Pain,” as in pas de pain, had nothing to do with pain – as in “pain in the neck” – but “pain” as in bread. Your blood sugar is low, the nurse said. You should eat bread. She gave Harvey a cup filled with sugar water and had him drink it.
Because of his cardiac history – and his severe bread deprivation – the decision was made to admit Harvey to the cardiac intensive care unit for observation. Observation and bread. Machines were connected. Tests were taken. Scans were done. Tubes were inserted. Interns, residents, medical students, cardiologists, nurses came and went. An American patient was an oddity and everybody wanted to visit. The resident had studied at Beth Israel Hospital in Boston. A cardiologist had spent three years at Brigham & Womens Hospital. They wanted to reminisce about Boston. A nurse was soon to vacation in New York. Did Harvey have any restaurant suggestions? Another nurse was going to Miami and Orlando in a few months. Was Disneyworld wonderful? The nutritionist walked in carrying a clipboard. She looked at it with a worried expression and confirmed that, truly, Harvey had eaten no bread with his lunch that day. You should eat bread, she said. Not surprisingly, every food tray delivered to Harvey’s bedside for the next two days contained half a baguette.
We’re keeping you overnight for observation, the cardiologist said. The next morning a tray was placed next to Harvey’s bed with, voila, half a loaf of bread and a soup tureen containing some black liquid. That was breakfast. Must be no cafeine in the cardiac unit, Harvey thought, not even the thimble of coffee, all that gets served in French cafes. A tentative sip from the tureen, which took two hands to hold, revealed that the vat of black fluid was coffee, enough coffee to bathe in. Not surprisingly, Harvey’s blood pressure, taken as soon as he’d slurped the last of two liters of tepid coffee, had jumped. The tray was not removed until the last of the bread disappeared. Thus fortified, next came a stress test on a stationary bicycle, another test that disclosed no heart problems.
That was enough to have Harvey ejected from intensive care and sent to a room with a roommate, a worried man who spent the day talking on his cell phone in Arabic, from time to time removing his hospital johnny and getting dressed and disappearing, gesturing that he was going outside for a smoke. He, it turned out the next morning, was having the battery changed in his pacemaker.
People came and went but identifying who was who in the hospital presented problems since there did not seem to be any system to the uniforms people wore. Perhaps they said who they were, but it flew by too quickly to understand. One woman who ordered Harvey out of his bed was not there to examine him, as he thought, but just to change the linen. A young man with two days’ beard, torn jeans, a leather jacket and a motorcycle helmet who dropped into the room to chat turned out to be last night’s cardiologist, on his way home.
The next morning resulted in more tests and more cardiologists all finding no problem. It was a mystery. Finally, one doctor asked about the spray Harvey had used when he became dizzy. Had he taken this medication before, the doctor asked. Harvey explained that he’d been given the same medicine, in small pills, back in the states and had been told that if he had heart problems he should take one pill, wait five minutes, take another if needed, wait five minutes and if he needed a third pill he should go to the hospital after taking it. Absolutely no more than three pills should be taken. Three pills had preceded his U.S. hospitalization. Arriving in France, a cardiologist had prescribed the spray rather than pills but said it was the same medicine. The day before in Villefranche, Harvey explained, he’d taken three sprays. The doctor’s eyes went wide. Three sprays, he said and explained that one spray is the dosage of three pills. Harvey had taken the equivalent of nine pills. No wonder he couldn’t stand up.
That could be the problem, the doctor said. More tests were done, all revealing no irregularities. It was decided to discharge Harvey after two nights with a monitoring device connected to electrodes on his chest. This device would record 48 hours of heart rhythms. Come back in two days, he was told. And eat bread.
The next day, with Harvey fully wired and recording, we took the train down the coast for 40 minutes to Italy, to the hilly town of Bordighera. Harvey put his heart through the paces, climbing hills and walking all day, eating pasta and calamari. And drinking coffee, strong Italian coffee. Two days later we returned to Hospital Louis Pasteur, where the cardiologist spent a half hour reviewing the output from the monitor while we waited. We never made it to his office. He met us in the hallway.
You’re fine, he said. You have no heart problems. Eat more bread. And he walked away to deal with sick people.
He seems to have been right. We’ve spent the past two weeks in the warm sun of Madeira, off the west coast of Africa, doing hours-long hikes up steep mountain trails, without a hint of a problem. The wonders of medicine.
As a final note, three days at Brigham and Womens Hospital – admittedly one of the finest hospitals in the world, a Harvard teaching hospital – had resulted in a bill for $60,000 (yes, that is sixty-thousand dollars), fortunately covered by our U.S. medical insurance. We never even received a bill from the French hospital, not even from the pompiers. We have an expat medical policy – the French health system doesn’t cover us – a policy that costs for one year what our U.S. insurance costs for one month. That policy seems to have covered everything. The return visit, at which the cardiologist spent a half hour reading the cardiac monitor, cost us 34 euros.
The experience, while scary, was yet one more French surprise and a true immersion in France. Harvey left with a prescription for exactly the same medications he’d been taking before the whole experience. Best of all, though, was doctor’s orders: eat more bread.