Trauma Healthcare in Portugal

A Personal Experience

I have a lot to say about healthcare in Portugal. So much so that I’ll be separating my experiences into two different articles. This one is about (acute) trauma care and my personal experience. The next is about preventative care. 

First and foremost, I want to say that overall, the healthcare I have received in Portugal (and I’ve received a LOT during the year I’ve been here) has been excellent. It’s better than what I received in the US during my life there. The doctors here are more knowledgeable in the areas of preventative care and natural medicine.

I suspect this is because there are no burning FDA hoops to leap through and no big pharma’s pockets to pad.

Just one example is an estrogen cream they prescribed me in the US. First of all, it was $55 per tube but more importantly, it was estradiol, which studies show, cause cancer. When I took this cream to my hormone doctor in Portugal it appalled her. She explained it was dangerous, especially since my immediate family has a history of breast cancer. She told me that estriol is not harmful and prescribed this form. It cost me €4 for one tube here. When I looked up the studies between the two I found that there are almost no studies in the US for estriol and it’s not FDA approved for humans and rarely used. When I looked up studies in Europe, it surprised me to find quite a lot of positive research here. That’s just one example. 

However, I also had a very intense experience which is what I’m mainly covering in this article.

If you’ve read my articles before, you’ll know I don’t like to focus on the negative. I like to focus on the solutions. However, the facts of my experience are somewhat negative and I’m saying that in advance.

Also: these are my experiences and may differ from the experiences of others. And, while I am an eastern medicine doctor, I am not a “western medical” doctor or expert.

There are two types of healthcare that I know of, available in Portugal. Public and private. The country of Portugal has a fantastic public healthcare system but… more and more people have signed up for it in the past ten years which extends the wait time, especially in bigger cities such as Lisbon and Porto.

Portuguese friends have told me it used to take much less time for appointments and surgeries.

This said, I spoke to a friend in the US last week who is on a seven month waiting list to see her primary care physician for an appointment.

My personal experience:

In June of 2023 I broke two fingers. The breaks were particularly bad. The first hospital I went to was a public one. It’s touted as the best public hospital in the city. I waited several hours in the trauma unit before they saw me and during those hours they did not give me any painkillers.

I sat waiting, screaming and crying in severe pain. Part of the experience was being alone in a foreign country and not speaking the language. I fully acknowledge that. It was terrifying.

However the way they treated me, unfortunately, was quite abysmal. The nurses told me to “shut up” and stop “over-reacting”. I should note here, that I have a very high pain tolerance. I’ve been told this many times, by doctors in the past. Two examples: I had a cavity filled without novocaine and a D&C after a miscarriage, also without painkillers.

This pain was intolerable, next level pain. I snapped two of my fingers in two, both facing the wrong direction. It took over three hours before they gave me any pain medication and then it was ibuprofen. The only reason they finally gave me anything is because I could not stop wailing.

I became a person in that hospital that I no longer recognized. As a long time advocate for my own health and a health care practitioner, I was appalled at the sheer lack of empathy and care afforded to me that day in the emergency room. Six hours later they sent me home, on a three week waiting list for surgery with my fingers bandaged (too tightly, cutting off circulation) and held in the wrong positions. They refused to prescribe pain medication.

Once home I lay on the couch, crying and screaming. The pain was so excruciating that I planned my suicide. I’m not saying this to be dramatic, it’s the absolute truth. And I’ve never been driven to consider suicide in my life, before then. I’d just decided on the method when my phone buzzed. It was my Portuguese teacher. I had texted her from the hospital. She had done some research and wanted me to see the best hand surgeon in Porto immediately. I didn’t want to leave my house. The pain and the way I was treated at the first hospital had broken my spirit.

But, I reasoned, it couldn’t hurt any more than it already did, so I picked myself up and ubered over.

This is where the second type of healthcare comes in. Private insurance.

In California I paid $1,000 a month for the worst level of healthcare possible. It entitled me to one fifteen minute face-to-face appointment with my family care doctor once a year. There was no testing allowed under this plan (blood tests, ultrasounds, etc.) but they did allow one mammogram every two years. My co-pay to see a doctor, even an OBGYN (after an MD referral), was $40 to $75, depending on the specialist.

My insurance, for tier two of three tiers (so the middle one) in Portugal is €100 a month. My co-pay is €17.

In Portugal, I went to the emergency room of the private hospital and as soon as they admitted me, my experience was vastly different.

At the public hospital, in the trauma emergency unit, people lined the hallways. There wasn’t enough room for everyone. In the private hospital there were only a few people waiting patiently in comfortable chairs.

In the public hospital the nurses and doctors lacked all signs of humanity. I understand this, I really do. I used to treat fifteen to twenty-four patients per day in my own private practice and I also developed a very thick skin. So perhaps it was karma. Or perhaps it was burn out. Or perhaps it’s the only way the human mind can deal with being surrounded by so much pain, disassociation.

But in the private hospital, the nurses and doctors were kind and attentive, as opposed to harried and exhausted. They gave me an xray and a CT scan. My hand was unwrapped and re-wrapped after they deemed the wrapping was too tight.

I was told I could have surgery in two days. At the public hospital I was on a three week waiting list. I opted to wait for the surgeon my teacher told me about and he was on vacation for four days. I was scheduled to see him on Monday as soon as he returned and my surgery would be on Tuesday.

They prescribed aleve (naproxen) which didn’t cut it. The pain was beyond measure, and I did not sleep for several nights.

Someone suggested I sign up with an advocacy service that helps foreigners navigate the healthcare system in Portugal. I did so. This concierge service spoke to the nurses for me and because they have doctors on staff, they finally prescribed pain medication. It had little effect. It was a tiny dose of tramadol, the same medicine I used to give my dog when he was in pain. But at least it was something and for that I was grateful.

Taking pain medication is something I prefer not to do. I have personal reasons for this as I’m in sobriety, but I also don’t like the way it makes my body feel. However, the pain was intolerable, and the medication made it only slightly less so. After three days, I could finally handle the pain level.

And then the first surgery happened.  The hospital charge was €5200 for the surgery, which included general anesthesia, and an overnight hospital stay. They gave me a private room that rivaled that of many hotel rooms I’ve stayed in, with a private bathroom. I was given IV pain medication and three delicious meals. Yes, you read that correctly, they have good hospital food in Portugal. At least in the private hospitals. 

My insurance covered all but €200. 

Once out of the hospital, the weak pain killers they gave me didn’t do much. And again the pain was unbearable. It hurt to move my hand and fingers, so I didn’t.

As soon as it felt like things were finally healing, I had a second surgery. The first one was to insert wires inside along the length of my fingers and the second was to remove the wires.

Thus, I started over a fourth time, with agonizing pain and a lack of proper medication.

So what happened?

I developed something called Sudeck’s Syndrome, also dubbed “suicide syndrome” and in the states known as Complex Regional Pain Syndrome.

This is when your vessels, muscles and bone atrophy. The pain is, you guessed it, excruciating. I couldn’t even move my wrist a single centimeter without screaming. My hand, fingers and wrist were frozen in place. 

That’s when the surgeon finally prescribed pain medication, but by then (two months later) it was far too late.

It turns out that the reason I developed Sudeck’s Syndrome is because they did not give me proper pain medication in the first place and thus, I didn’t move my hand.

As of this writing, it’s been four months to the date of my accident and I wish I could say I have the use of my hand back, but I don’t. And it’s likely I never will.

I go to physical therapy three days a week, which is not covered by my insurance. Some PTs are, just not the one I chose, as he was a hand specialist, like my surgeon.

I don’t have any resentment toward my surgeon. He did the best job he could. He also encounters a lot of Sudeck’s Syndrome because of the amount of surgeries he performs (not because he’s not an excellent surgeon).

I still can’t straighten any of my fingers or bend them all the way, not even close. Thankfully, I’ve stopped the progression of the syndrome and am no longer in constant pain.

When I shared my journey online with others, several people reached out. They have had this syndrome for many years. For them, it did progress. One person has lost the use of both her arm and her leg. She can no longer walk. Another person said it’s affected her entire body, though my physical therapist says it only affects the limbs. Regardless, of the five people who have reached out to me, no one has “beaten” it; even fifteen years later.

My surgeon assures me that every single one of his patients who have come down with this syndrome have completely recovered. I am not sure if I ever will. Normally I am an optimist but when things have barely changed after four months of limited movement, it’s difficult to maintain a positive outlook.

But I prefer to look at the solutions and what I’ve learned because dwelling on what could have been, never helps. In the past four months I’ve learned a lot about my body and myself.

I’ve learned I can tolerate even more pain and discomfort that I knew possible. I work on my hand movement every single day and even though I suspect I’ll never be 100% and never be able to practice trapeze again, I can type. And I hope to get more and more movement back as time progresses.

As for the healthcare system here, I truly do love it. 

I feel there’s a balance between overprescribing pain medication (as has happened in the United States) and under-prescribing. However, when I’ve been prescribed pain medication in the US in the past (back in 2018), I was only given two pills to last two days after a tooth extraction so things are changing there too.

While I wish I’d never incurred this trauma, I am grateful for all I’ve learned. Patience toward myself, kindness toward myself and my health care team, perseverance, forgiveness and never-ending hard work.

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Thank you so much being a part of this adventure!

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