Surgery experience at Nuffield Wessex Hospital/ Nick Boeree

[spinches]

I chose Mr Nick Boeree as my surgeon for a two-level cervical ADR. He performs his surgeries at Nuffield Wessex Hospital, which is part of a private chain of hospitals doing business as Nuffield Health. I attended a "Pre-Assessment Clinic" at Nuffield on August 22, had surgery on August 24, and was discharged on August 29th. I believe that Mr Boeree did a really great job on my cervical spine and I would highly recommend him as a surgeon.

I was not happy with my experience at Nuffield Hospital, and am posting some details for the benefit of other people who are considering having surgery there. Several other members have posted that the treatment they received at Nuffield was wonderful, and I can only say that their experiences were obviously different from my own.

Nick Boeree has not involved himself with any kind of medical tourism service, so international patients get very little help with travel lans. Jo Haley, who is Mr Boeree's PA, did send me a list of hotels near the hospital. Communication with Ms Haley about travel plans was not easy. There were delays of a week or more in getting back replies, which were not generally very informative. Also, the staff member at the hospital who manages financial arrangements was out of the office for weeks during the time when I was trying to work out travel and cost issues. I was not given the name of anyone else to contact in her absence.

I chose one hotel to stay in before the surgery and a different one to stay in afterwards. It turned out to be quite important to be able to get out and walk around in pleasant surroundings, both before and after the surgery. The first hotel (in Winchester) provided those opportunities, but the second one (near Southampton) entrapped me in the hotel.

I planned to do the surgery in August because I am self-employed and that is when my business is slowest. This is also when friends were most available to help me. I thus inadvertently scheduled the surgery during tourist season. This meant higher prices for plane tickets and hotels, and less availability. I made travel plans well in advance, in June, with all this in mind.

At the beginning of July I received a health questionnaire from one of the Nuffield nurses. There was a question about my "support arrangements at home following surgery." In my answer I included the information that I was traveling alone, but had help once I got back to the U.S. (I had already told Jo Haley all this a couple weeks previously). I subsequently received an email from the nurse telling me that "we do not recommend" traveling alone. I responded that I had already made all the (non-changeable, non-cancellable) reservations for the trip. I asked this person to share her specific concerns, so that I could plan for any problems I might encounter. She sent me instead a snotty email in which she said she would "tell Ms Haley and Mr Boeree." I forwarded the email exchange to Jo Haley, and told her that if the hospital required me to "be escorted" I would probably not be able to comply at this late date and would have to cancel the surgery. She replied that Mr Boeree did not want me to change anything about my travel plans, and that was the last I heard about this matter. I once again invited the nursing staff via Jo Haley to share their concerns with me, but I did not receive a reply from them.

I thought this was an isolated incident, but unfortunately I was treated in a similar manner throughout my hospitalization by most of the medical staff at Nuffield. With a few exceptions, I was not treated as an adult. I was excluded from all decisions made about my care. Various tests were performed without explanation for why they were prescribed, and when I tried to get an explanation, I was given evasive responses, like "It's for safety." I was not told the results of any of these tests. On one occasion when I had an uncomfortable complication after the surgery, there was absolutely no willingness to engage in a problem-solving process in which the nurse and I both participated. Many if not most of the nurses at Nuffield seem to be quite unfamiliar with the concept of "empowering" people to participate in their own healthcare decisions. On the contrary, they hoard power by withholding information, by refusing to consider patient's suggestions, and by simply telling patients what to do. There were a few notable exceptions among the nursing staff, but the prevailing treatment stance was intensely authoritarian and paternalistic. The message communicated to me on a daily basis, both verbally and nonverbally, was that I was expected to passively submit to whatever was done to me and not question why it was done. I was also told on several occasions that the nurses were behaving this way because they were concerned about my "safety." I saw no willingness to reflect on what other motives might be driving such controlling behavior.

I had additional problems with the administrative staff at the hospital. The staff person in charge of finances finally emailed me 3 weeks before the surgery with information about payment options. The letter said that if I had to wire the payment money at least 4 full business days "before admission" to Nuffield. According to their other literature, "admission" means the day you go into the hospital for the surgery, i.e., Aug 24th. I had my credit union wire the money on the 17th. When I arrived for the pre-assessment clinic on the 22nd, the staff person entered the reception area and asked me if I had wired the money. She asked me if I would put the charges on a credit card, as they had not received the payment. I told her I couldn't do this, whereupon she said she would go back to her office and call Nuffield's bank to find out if the money had been received. Another person subsequently came into the waiting area and told me there was no problem. No apology was offered.

Another staff person who escorted me to the nursing assessment area had the impression that I was there for admission on the 22nd. I told her I was scheduled for admission on the 24th. There was obvious surprise and irritation about this, and my escort had a conversation with another staff member who confirmed that my surgery was scheduled for the 24th. My escort then said to me, "Someone was supposed to call you to see if you were here but they didn't."

The nurse who assessed me expressed surprise that I had already completed the health questionnaire. She seemed confused about how to proceed. We got through this, as well as some testing, then she told me she had to take some blood from me. She was unable to place a needle correctly in a vein, and tried to remedy her error by repeatedly, aggressively jabbing the needle into the vein and within it. She clearly had not been well-trained in phlebotomy. I yelped a couple times during this experience, and had blood oozing down my arm and under the skin. The nurse then told me I would have blood drawn again by another staff member after a wait of ten minutes. The purpose of this second draw was to show that I was the person from whom the first blood was drawn. I asked if there had been an incident at this hospital involving an error in matching blood to the correct patient. The nurse said she didn't know.

The next nurse came in and I told her she could not use my left arm again. She looked at it, said "You will have a bruise," then quickly commented, "It's inevitable really." When I did not respond she became hostile and said, "Surely you appreciate that these things happen," or something like that. I stopped listening after the "Surely you appreciate." Actually I don't appreciate being mistreated by poorly trained medical staff, and more than that, I did not appreciate the message that I should shut up about it.

By the time I saw Nick Boeree two hours later I was very fearful that I had made a mistake in coming to Nuffield Hospital for surgery. I did not want to spend my limited time with him discussing the incompetence and nastiness of the Nuffield nurses, however. As it turned out, he had a lot of information to cover, and I did not bring up my concerns.

After the surgery my contact with Mr Boeree was very limited. He appeared in my room briefly at his morning rounds. He had not been informed about complications I had experienced the previous day. One of these was an allergic reaction that had not been treated in a timely or competent manner. During that experience I asked the nursing staff twice to call Mr Boeree, and they did not do so, nor did they tell me they would not. I do not know what physician was actually responsible for my care at Nuffield. I was told by the anesthesiologist (they say "anesthetist") that he and Mr Boeree would be consulting together about my care. I don't recall speaking to the anesthetist after the surgery at all. There is a staff physician who is apparently a general practitioner, and I was expected to deal with her whenever (someone) prescribed more tests, or when I needed additional prescriptions. She seems like a sweet young woman, but my interactions with her did not lead me to trust her or her clinical competence.

I was scheduled to fly home on the 29th. Jo Haley had asked for and received detailed information about my itinerary prior to the surgery, so she should have known this. I reported to Nuffield Hospital on the 29th to have the "clips" around my incision removed, then I left for Heathrow Airport. The next day I received an email from Jo Haley telling me that Mr Boeree wanted to see me before I left. I replied that I was already back home.

I encountered no problems at all traveling alone to and from the UK. The only need I had for a companion was for advocacy on my behalf against the Nuffield staff. I don't know that this would have done any good, however. These people appear to be convinced that their way is the only way, and they construct every frustration I had as being due to some psychological issue of mine. For example, after I told the staff doctor that I was distressed by the blood draw incidents, she decided I have an aversion to having blood drawn, and said "I know this is not your favorite thing."

My overall impression is that Nick Boeree wants international patients and that he is well-equipped as a surgeon and as a person to work with them. He is very warm and has excellent interpersonal skills. I don't know, however, whether Nuffield Health really wants international patients. Certainly they are not prepared to receive them. The staff seems ignorant of what spine patients have to go through to arrange an international surgery. Not only are they not helpful, they create difficulties that interfere with carefully arranged plans, and they caused me a lot of stress by doing that. Additionally, the staff at this hospital seems to not understand what sort of person undertakes a journey of this type. I spent months researching my spine condition, the available treatments for it and the surgeons around the world who might best treat me. I am not the sort of patient who enters a hospital and submits without question to tests and treatments that are not explained to be in an open, honest, rational manner.

Looking back on the experience, I am glad I had Nick Boeree for a surgeon, but I would not want to be a patient at Nuffield Hospital again. I wish I had looked more closely at other options outside the UK. I wish I had known what questions to ask about the treatment philosophies of various hospitals regarding communication between patients and medical staff about medical decisions. Unfortunately, the literature from Nuffield, even had been able to examine it closely beforehand, would probably have misled me.

I don't know how much of the authoritarian treatment philosophy at Nuffield is derived from the surrounding culture. I went there prepared to be as sensitive as possible to cultural differences. I found the staff to be very defensive on the subject of whether their medical care is as good as the care in the U.S., even though I did not raise this subject with them. Academic people who specialize in intercultural communication frequently state that U.S. Americans place more value on autonomy than do the members of most other cultures. I don't know if this is true, or if it explains any part of why I felt so oppressed and disempowered at Nuffield Hospital. One thing I will predict with a high level of confidence is that no one at Nuffield is thinking about any of these things.

Anyone who is considering going to Nuffield Hospital for surgery and who wants to talk to me further is invited to PM me.

Sandra

[KanRunMo]

Thank you for your information. I can relate to the blood drawing since I've at times had problems with newbys trying to draw my blood and not being able to get it right. I've gotten so I say, "you've got once chance to get it right then I'm calling for help." When an experienced nurse or physician draws blood, it makes all the difference.
I hope that you are recovering well and all goes smoothly from here on.

[laid up doc]

yikes... i am setting up a consult w/ Nick Boeree, but i'm not sure how i would have handled such a hospital experience. i am an MD who works in a hospital, and paternalistic or cold nurses would probably have sent me into absolute rage (being a woman, this is unfortunately almost always tears!!!).

this is one of many concerns i have about having surgery overseas... my knowledge of medicine and ability to be cool under pressure when i'm the physician somehow metamorphosises into anxiety and getting upset over my perceived breach of what i consider to be "protocol" when i'm the patient. i have zero needle issues and great veins, but often "floor" nurses are downright crummy at iv sticks or even just routine blood draws. ER nurses are the best - they do it all day, every day.

i haven't had any trouble recently, but i about lost it when i had my gall bladder out as a med student and i saw a nurse care for a contact iso pt w/ MRSA w/o a gown and didn't wash her hands before heading my way. i was already nervous about having surgery, and in the end the hospital sent me a letter of apology and a gift certificate.

if i indeed go overseas, my companion will likely be a good friend who is a pharmacist. he wouldn't take kindly to being blown off either. and i'm not sure if he could stay til i had to go home, and i'd be having lumbar surgery. sighhhh....

[Margie]

hi all
I agree with Sandra but had some different experiences than her. I am an MD as well in the US and it is just hard to accept not being in full control and knowing more than the nurses who as she said don't really understand many of the problems she outlined. No matter what you do it's just unpleasant and painful to have spinal surgery. The good news is that after 2 days most pts feel much better as far as acute pain so it is short lived. I did not have a problem with the blood draw but I can see how that could happen since I told the nurse to use a butterfly needle and she refused because she never had before.
They are extremely concerned about infection and MRSA probably excessively but at the same time I would guess that being proactive about DVT's and infection lowers their risk to the pt. I think they are just starting to work more with US pts and therefore have not worked out these problems. I think since they are trying to get US pts the doctors there especially Mr Boeree would be open to looking into improving the system but it is true while you are there you don't feel the time to complain to him.
As much as there are problems there the hospital experience I had which was far from perfect --it was far superior to US hospitals and I have been to the best here. THe surgeons are good here but the hospital and staff are horrendous in the US. i have had major problems getting adequate pain control right after the surgery and had similar problem at nuffield. It got worked out and they tried but I was very drugged after the surgery and wasn't pressing the morphine button as strongly since my arm and thumb were weak. They did not believe that I could be both sedated and in pain and thought if I was falling asleep it meant my pain control was adequate. they realized that I was not getting morphine and had me blow in a straw which solved the problem. As bad as these problems may sound I am happy with my decision. I was at U of Penn and NO ONE cared about pain control so i had to call a nursing supervisor at 3 am. Some easy tips esp for the MD who is traveling with a pharmacist. They ask you to lock up your meds. It's simple. Don't give them all your pills. I kept pills in the draw next to me and used them myself. It is likely you will feel more in control that way and solve them by keeping that autonomy. Ask for Toradol. It works better-at least for me than morphine for pain. I did acupuncture on myself for pain control--I'm not an expert but it helped and I was appreciative that the nurses did not have a problems with it. i just kept the needles in an enclosed space. The more autonomy you can create for yourself the better you'll feel.

In the end it is over with fairly quickly and I think is better than any US hospital in my experience. Also make sure they are giving you NSAID's right after the surgery. Overall I would choose Mr Boeree over any of the 7 MD's I interviewed and am glad I made the decision to see him. He has a warm bedside manner, is a wonderful listener and I think a really good diagnostician. Highly recommend him.
Margie

[Marti in Benicia]

While each person has their own attitude and perception of what's happening, I can't say more emphatically that Sandra's experience represents NOTHING like my experienced with/at Nuffield nor that the MANY others whom I've spoken to about their surgical experience at Nuffield, where surgeon Nick Boeree practices.

I'm a bonafide medical world phobic who can't do needles without near hysteria, and must be "out" before she leaves the hospital room so they can manage my adrenaline. (Believe me, some idiots here in the US ignored my warnings and the surgical theater wasn't a pretty place between my screaming and the anthes. yelling at me.) Bottom line is I'm VERY picky about how medical world people deal with me and VERY picky about what's done/not done, how it's done, information or physician access, etc. (FYI -- When I was there, the medical charts were kept at the foot of our beds; THAT'S information access.)

I, too, have allergies: medicines (can't take any pain killers), surgical scrubs (soaps), and tapes (the Nuffield pharmacy consultant finally identified it as a latex allergy; no US doctor or Rx took the time to figure that out, even when asked to!). The entire surgical preparation and follow up was cheerfully adjusted to accomodate thnose allergies and terrors.

The nurses, in house physicians, and staff we had were the most personable, informative, concerned people either of us has experienced in several US hospitals and medical practices. It was Jo (Sam while Jo was out) who was my life line and I couldn't have asked for a better one.

As scared as I was, we went with open minds, treated others like we wanted to be treated (and received in kind) with respect, asked for what we needed or wanted, and received treatment that a lot of US hospitals need to model. My husband and I were so thoroughly impressed with the treatment we received before, during, and after my surgery that we asked to meet with the hospital administrator to say so and then wrote a follow up letter to insure every staff member who intereacted with us could read the praise themselves.

I'm sad for Sandra. However, I would say that Sandra's perceptions of the behaviors of people there are completely contrary to mine and many, many others. If I needed surgery for any other reasons and could afford to, I'd go to Nuffield before I went to a US hospital ... and I'm surrounded by some pretty famous institutions here in the San Francisco Bay Area.

I have and will continue to recommend Nick Boeree as the ideal care source for spinal options not available in the US. I can't speak highly enough about those who work with and around him. My husband has the same opinion.

[Katie]

we went with open minds, treated others like we wanted to be treated (and received in kind) with respect, asked for what we needed or wanted, and received treatment that a lot of US hospitals need to model.

Marti, I think you have said it all right here. And Sandra, I am not dismissing your experience in the least. Please believe me on this.

I do have to say however, that I think you get what you give when traveling to international hospitals. Here is our experience for instance; we flew to Brazil after a somewhat whirlwind diagnosis from Dr. Pimenta (keeping in mind that it takes up to a year to get an initial appointment with any kind of specialist here, and we were offered surgery within a month of our original telephone call). As it was, we chose to wait three months because of logistics here at home. There were very few people on his staff who spoke fluent English; surgeon himself with his assistant a very close second. We were also able to have a good discussion with the anesthesiologist as well the day before surgery.

The care was absolutely wonderful, especially considering the situation. Nurses checked on us at very regular intervals, and their station was just outside our private room. If we had any problems with communication, Dr. Pimenta had arranged for an administrator at the hospital to visit us at least daily. He had spent several months in the US and had a wry sense of humour. Not only did he act as a tour guide, but a cultural one as well. He drew maps and recommended places for us to visit before we flew home, explained the customs and places to avoid and brought large bowls of fresh fruit from the local market to entice me to eat. (My appetite was not the greatest because of withdrawal from narcotics).

I have had several surgeries before this experience, and recognized that some ways of doing things were quite different than what I was used to at home. It wasn't bad medical care, or wrong, just different. Like the measuring of fluids going in and coming out for instance. The nurses eyeballed it instead of having every milliliter checked. Despite their not speaking English, I could easily get across that I was nauseous and needed medication, and that I needed to have the UT catheter reinserted as things weren't working at the beginning. I was treated like a princess...they bent over backwards to make sure we were well taken care of. The one thing that stood out was the cleanliness of the hospital, from floor to ceiling. If a fly dared to enter, there was a squad of nurses quickly on site to dispense with it. There was no normal hospital smell...just sweet normal fresh air. It was the first time I have ever had surgery without a resulting secondary infection afterwards. Given the choice, I would fly there again for any surgery, let alone spinal reconstruction.

Now, if we had expected a private translator, or started to complain about anything, the situation could have been vastly different. It took a lot to get used to the food there...especially since I am an extreme ciliac case. Btu we treated it as an adventure and recognized that everyone was doing the very best to look after us, and that just because it was different didn't give us the right to complain. As the saying sort of goes, I had just enough knowledge to be either dangerous or really annoying I knew that my veins rolled in one wrist, so asked that the other be used, little things like that. I had the impression that they appreciated it, as it saved some time and frustration.

Above all, we engaged the staff, and thanked them profusely for all the little things they did, whether it was part of their job or not. As we come to learn as patients, just because medical staff are supposed to do things, doesn't mean that it gets done either on time or properly. So to show that we appreciated their good work did not go unnoticed.

So I guess I am just repeating what Marti wrote above. This would be my greatest advice if thinking of traveling abroad, even if not for surgery

[mike86]

I had an M6-L installed by Mr. Boeree last november. This is very upsetting to hear, especially when considering the amazing experience I had myself. But I really do find it incredibly hard to believe that somebody would complain so much about such an amazing staff.

They took care of me like a baby.. they dealt with any and all concerns I had in a timely manner.. and Jo was kind enough to guide me through the whole process.

I think it's a simple case of somebody being pampered too much and expecting everything to be done for her. I always take responsibility for myself, and I understood the risks of going abroad for surgery. But most importantly, I understood that it's a whole different ball game abroad... and to my surprise, it was a much more pleasant experience than in the US. I recently had shoulder surgery here about 3 months ago, and they kicked me out of the hospital in less than an hour. I can't imagine what they would do to back patients here.. Nuffield, on the other hand, had such caring stuff and it really grinds me that they've been talked about them in this manner. I miss them dearly!

I still recommend Boeree and Nuffield as the best option out there.

[recently3]

I also have to say that my experience was also quite different from Sandra's. My care was excellent and I was treated very well by all staff I came into contact with. I had a previous back surgery in the US earlier in the year from one of the top spine hospitals and I found my care and treatment by Mr. Boeree and his staff as good if not better than what I received in the USA.

I traveled to England in August of 2011 for a single level L5-S1 lumbar disc replacement with using a Spinal Kinetics M6-L. Beforehand I also had contact with Jo and Sam in preparation for the trip. I had been asked during my phone consult with Mr. Boeree if I was going to be traveling alone (which I was not) and was told that while it was possible to make the trip alone, many people react differently after surgery and having someone with would be a good idea just in case I needed help getting around the hotel afterwards. They also informed me that I could stay in the hospital for 75GBP per night after my hospital stay (If I were traveling alone for major surgery to a foreign country, I would have personally chose to do this as you never know what could happen after a surgery, even in the best of circumstances, but I know some have aversions to hospitals and might chose something different for themselves).

I was also informed by Sam that payment was due 4 days prior to admission, but my bank notified me that it can take a week to ten days to process a foreign wire transaction so I chose to submit the wire transfer with enough time to make sure that I could get a confirmation back before I departed the USA. My bank required some additional information to process the wire transfer and Sam was able to provide this information without any problems. The currency conversion rate and fees taken out by the banks was a bit higher than I expected which caused a small shortfall in the funds that finally made it to Nuffield Health, which Sam notified me of once she received the payment, but I was able to pay the small difference by debit card upon my arrival with no problems.

Upon arrival for my pre-assessment, I filled out my forms and also had blood taken twice by two different nurses with no problems at all. I found both the nurses to be very friendly and sensitive to any concerns I had. I was impressed by their adherence to strict protocols for keeping things sterile which was far in excess of what I had experienced in the USA. I didn't question why they needed two samples taken by two nurses, but I assumed it perhaps was to be proactive in avoiding any mixups so they would have another sample to test in case one was lost or mis-labled or something as can happen with any interactions with human beings involved.

As for my interactions with Mr. Boeree, they were excellent also. I had a phone consultation prior to coming to the UK, another in person consultation before my surgery, and another short consult immediately before the surgery to walk through all the risks one more time and to sign off that I understood everything. After the surgery, Mr. Boeree stopped up later that day, and checked in on my each morning I was staying in the hospital. He answered any questions I had completely at each meeting. The anesthetist, Dr. Herbertson also came to check on me at least once per day and I found his care and insight excellent also. A few days after I was released from the hospital, and prior to flying back to the USA, I had another post-operative consult with Mr. Boeree to cover any last questions and to provide advice for my recovery.

The nursing staff was excellent also. The day of my surgery, I had a nurse come and check on me every 15mins to make sure I was ok. She even turned the pillow over so I would have the cool side against my neck (I didn't even ask for that, but it was nice). I think I asked a nurse the same question multiple times at some point after my surgery as the medications made me a bit foggy, and she answered very politely each time and gave me the answer I was looking for (it was only after she left, I realized I had asked her the same thing an hour or so before). I never found them to be defensive or negative in any way during my experience.

I can only speak from my own personal experience, and don't mean to challenge anyone else's facts or personal experiences, but my care with Mr. Boeree and his staff was so good I felt compelled to share my experience here as well.

-Tim

[Chris G]

I also had a 2 level Spinal Kinetics cervical ADR procedure by Nick Boeree at Nuffield. The surgery was very successful (my 3rd cervical procedure) and I have been back to my active lifestyle for the past 18 months.

My experience at Nuffield was superior by far to all my experiences in Boston hospitals. the care was superb, the food was very good, ... I even had good wine my last dinner before checking out. My blood draws were uneventful and painfree.

Nick is a superb surgeon and has the best bedside manner of the 3 spine surgeons who have worked on me.

I have recommended Nick to 3 other people and they all had the same experience.


Chris

[Duane Burghard]

As with several others who have responded to this thread, while I don't mean to be dismissive of anything Sandra said, overall I had a VERY different experience with the staff at Wessex. But let's start with some areas where we had similar experiences. I would agree that communications with the hospital by email are occasionally problematic, but this is largely due to our relative locations on the Earth (e.g. when we're working, they're not, and vice versa). Throw in the frankly absurd number of "Bank Holidays" and the like that they seem to have in Britain (which did little more than make me wish I worked in the British financial industry) and delays are inevitable. Like Sandra, I was also frustrated by the hospital's lack of willingness to endorse a particular hotel (but I do understand their reticence). I ended up choosing the Hilton in Southhampton (because it appeared closest) and frankly had a mixed experience there. I thought the hospital's caution about MRSA (or MSRA, whatever) was a bit excessive, but my GP here in Missouri noted that, for whatever reason, it was common for hospitals in Europe to be kind of paranoid about it, and the test cost me next to nothing and took about 30 seconds, so that wasn't a big deal. I also found the hospital's militant insistence that I wear "flight socks" (aka DVT socks) to be frankly a little silly ... but guess what, they were right and I was wrong, and I haven't taken a flight since without them (it makes a HUGE difference in how I feel after flying, and I fly a LOT!). Finally, I did run into a similar concern about traveling alone, but they simply said they advised against it, I explained that it wasn't possible, and that was that). From here on, however (and particularly from the moment I arrived at the hospital itself), our experiences diverge pretty rapidly and radically.

To some degree, I have always found that our impressions of the world around us are reflections of our own personalities. Insufferably chirpy and happy people seem to have experiences that reflect their disposition as do completely miserable people. I am neither, though I do find that, more often than not, I do at least try to view the glass as half full (and then, if it isn't, well, it isn't). But with that said, I certainly ALWAYS felt like I was being treated as an adult. Further, in dramatic contradiction to Sandra's experience, if anything, I not only felt like the hospital didn't withhold information, I felt they went out of their way to err on the side of providing information. I can't comment regarding how many decision about my care I was a part of or not (since I have no idea what may or may not have been discussed away from me), but it sure seemed like I was an active participant. I didn't find the staff either "paternalistic" or authoritarian. I found them to be genuinely caring and personally invested in my recovery.

I must say that I am a little annoyed that Sandra was allowed the option to pay by credit card (I was not and could have used the miles ... BTW, I've already given them this important two word tip; American Express!). That said, as I noted above, I do agree that there are administrative communication issues, but I largely chalked those up to doing business across continents.

I am most grateful that I did not have Sandra's experience drawing blood during the tests two days prior to surgery. I *did* have an intern do it, and I was asked in advance if I minded and told that, if I objected, a regular nurse would be used instead. I did not object, and the intern did fail on the first attempt to get a vein, at which point the supervisor stepped in and stuck me right away. I guess I'm just not the type of person to get annoyed by this type of thing. Perhaps it was my attitude that allowed them to feel comfortable and be pleasant and apologetic about the brief experience (and they did apologize, not that I particularly needed them to).

Whether or not my contact with Dr. Boeree after the surgery was "limited" or not depends on my expectation ... but IAC, it didn't seem so. The nurses were very careful to manage my expectations about when the Doctor would check up on me and, while a little late each time (which is normal), he was there. I do also specifically remember one post surgery conversation with the anesthesiologist. I saw Dr. Boeree at least three times after the surgery.

I think that, if I were Dr. Boeree, I would probably be a little put out by the implication that he "wants international patients." In my experience with him, I would say that he doesn't care where his patients come from (he probably even accepts people from Cardiff ... oooh I'm gonna get emails from my Welsh friends now ....) ... they could come from Mars for all he cares, he wants patients for which the M-6 is appropriate and who have a high likelihood of a positive outcome.

Next, while I disagree with the assertion that the hospital doesn't want international patients, I also think it's fair to say that they don't care where a patient comes from. I suppose it's accurate to say that there's no special effort made at the hospital for international patients, but I didn't come in with any expectation that there would be. And I couldn't disagree more strongly that the nurses seem ignorant of what spine patients have to go through ... they see it literally every week. The fact is that they can't possibly understand what we're feeling ... no one who hasn't felt the pain that we've dealt with going into this surgery can possibly have a clue what our suffering has been like. All they can do is be as kind, patient and understanding about it as possible. I'm sorry that wasn't Sandra's experience, but it was mine.

Finally, I'm not sure I would describe the hospital staff as defensive on the subject of comparing the hospital experience to that in the US, but I do specifically remember the anesthesiologist bringing it up in one of our conversations. The comment was made relative to the decor of the hospital rooms (which in fact aren't as nice looking as many in the US), but the quality of care I received was significantly better than in any US hospital I've been in. I felt neither oppressed nor disempowered at the hospital there. I greatly enjoyed my interactions with the entire staff. I am now Facebook friends with three of my nurses there. The staff taking my meal orders bent over backwards to make me happy (when I made an offhand comment about how I thought surviving the surgery earned me a milkshake when I got back home, the staff went and made me one). Even the cleaning staff smiled at me as I was learning to walk again and doing laps up and down the corridor. My recovery continues, and there are days (like today, as I type this) where I am still dealing with some pain. This isn't a "cure", this is a chance to be in substantially less pain and to preserve the maximum amount of mobility so that we can do the best we can under truly sucky circumstances. It's still depressing to me that there are things I will never do again (e.g. I will likely never be able to pick up my children again ... I mean, how awful is that) ... but Dr. Boeree and the entire staff at his hospital are not only not responsible for any of that, they've in fact done everything in their power to try to make it a little better for me, and I couldn't recommend them more strongly.