Linda and I have a strategy for living in desert heat: leave town in August.  So, we had been planning for this getaway cruise to the Baltic since January, and now, finally, it was time to tavel.  To prepare for this trip, I wanted to reduce weight at home so that I could gain weight eating on the cruise.  

So, for the month of July and first week of August this summer, I have been carefully recording and monitoring my daily intake of calories with the goal of losing from my high of 212 lbs to a permanent low of 197 pounds.  Just before leaving on our Cruise of the Baltic I weighed in at about 205, so I thought that I had a good chance of maybe holding even weight on our travels.  But, I did not plan to take extreme measures because, after all, it was a vacation, and food is one of the great features of every Crystal Cruise.  

Still, before it ended, I found myself adhering to the Helsinki Diet Plan, and I did so with great success, losing 8 pounds more and returning home at 197 pounds.

We left Bakersfield on Wednesday August 10 and from the moment of departure, everything about our vacation became intimately associated with numbers.  We left home on time at 8:00 am and arrived at Ontario Airport safely, parked our car in Park N Fly stall 1008.  We departed as scheduled, 12:56 pm and arrived in Salt Lake complete with luggage and a sense of holiday fun still hanging all over us.  We made our connection to Minneapolis and spent the night there resting and awaiting our 4:30 pm flight out of Lindbergh Field to Amsterdam the following day.

On Thursday August 11, we checked our three pieces of luggage through to Stockholm via Amsterdam and boarded right on time.  Sat there awaiting take off when the captain explained that the plane needed a battery replacement so we would be delayed “about an hour.”  We felt blessed when it only took about 40 minutes, and the flight across the Atlantic was comfortable, though as always, tiring.

Because of strong westerly winds we saved one hour of flight time and that was really encouraging to us because we wanted to make sure our luggage was transferred in Amsterdam.  As we began our descent, we were told that we would be delayed and have to fly a holding pattern for about 30 minutes.

That was the bad news: the good news was that we escaped three bolts of lightening exploding just off of the right wing.  The passengers were stunned by the first; it was close, loud, intensely bright and felt lethal.  The captain assured us that the plane was not hit and we landed shortly after.

By now, the transfer time to our KLM from Amsterdam to Stockholm was very short, a window of perhaps only 20 minutes.  We ran as best we could to customs, cleared through quickly and hustled up another concourse to finally get to our gate which had closed 10 minutes earlier.  However, they re-created our boarding passes and allowed us to fly, warning us that this was likely the last flight out of Amsterdam to Stockholm that day because of the heavy rains and poor visibility.  We were also told that our luggage would definitely not be on the plane with us, and that we should check with “baggage control” once we arrived in Stockholm. 

This did not sound like a disaster, so we jumped on board (where else could we go?) and had an uneventful flight.  Once in Stockholm we waited for our baggage, knowing that it would not be there, but needing to do this so that we could formally report to the baggage agent that it was delayed. (Bureaucratic procedure).

Then we filled out forms to have it sent to our ship, Crystal Symphony, melded with another group being escorted to ship by the Crystal crew and got ourselves aboard and settled in our cabin (though without luggage) by about 5:30.  We had now been awake/traveling about 22 hours, and we thought that a good meal would set us up for a good sleep.

About midnight I awoke with cramps and a feeling that I had eaten something on the trip that was not doing well with me.  I struggled with sleep until morning, then asked the ship’s doctor to come visit.  He did, within about 5 minutes.  He found no fever, drew blood which passed all tests and suggested I see how the day went.  I did, and the day went well until about mid-afternoon when I developed a severe set of chills and began vomiting.  The abdominal pain grew worse. 

I could not walk to the doctor’s office, so they came and got me. Linda had  now returned from the Stockholm Tour which I urged her to take while I slept the afternoon away.  We were told in this visit, that I now had a temperature, and blood work showed  an infection number of about 80 (normal is 0).  I received about 3000 cc of antibiotics, IV, along with two pain killer shots.  It was Saturday, August 13.

This was supposed to be one of the “formal dress” nights on the ship, a welcoming evening of dining and get-acquainted visiting.  However, British Air in London suffered an unexpected walkout of its employees and pilots and had to cancel all flights thus putting several hundred passengers in the same position we were….NO LUGGAGE.  So everyone dressed with what they had and ate a nice meal.  We stayed in our cabin, and I had toast and tea.
 
I felt pretty good and slept well while the Crystal Symphony sailed from Stockholm to Helsinki.  I returned to the ship’s doctor for follow up about 9:00 a.m., August 14 and found that my fever was still there and that my infection number had risen from 80 to 220. 

This was Sunday, August 14. Clearly antibiotics were not controlling the infection (I now believe that the onset of chills signaled the perforation of the appendix).  The ship’s doctor was pretty convinced that it was appendicitis.  He explained that some doctors in the US were now using ultra-sound in cases like this to see whether the condition of the appendix was such that it could be treated just with antibiotics, but if it could not, then surgery was next.  He could not do ultra-sound aboard ship, so he made arrangements for the Helsinki Port Authority to come and take me to the Helsinki Health System.  There I would get further evaluation, perhaps ultra-sound, but certainly access to its medical care resources. 

Within 10 minutes, Linda and I were escorted off the ship to the expert hands of the local representative of the Helsinki Port Authority, along with a young, extremely intelligent student who was to be our escort, interpreter, and driver for the next 9 hours (he would have stayed with us so long as we needed him…a wonderful young man).

Our arrival in Helsinki coincided with the World Track and Field Championships being held at Olympic stadium, and the marathon was to be run that afternoon, thus blocking off many of the streets normally available for travel.  Our young man, whose name we never did write down, knew every turn and detour, and took us directly to our emergency clinic where we would gain entrance to the Helsinki Health System.

HELSINKI HEALTH SYSTEM:
I need to pause here for just a moment to describe how lucky we were that we were going to be treated in Helsinki.  I have no doubt that the medical system here saved my life. 

Health care in Finland is remarkable. It is based upon a funding program in which municipalities make contributions to the general health care fund, the amount depending upon their population; this money funds about 80% of national system costs; patients pay about 7% of the price of their care, and the additional amounts are funded in part by State Funding for Education and Medical Research (3%) and costs associated with extremely specialized procedures performed by Helsinki University Central Hospital (10%)

Emergency clinics are all over Helsinki, within easy distance of residents, and as one moves through the screening process, one gains access to more and more specialized care.

There is no duplication of specialized medical services in Finland.  All organ transplants (last year they totaled 170 kidney; 40 liver; 15 heart; 10 lung and a few heart/lung) are performed at Helsinki University Central Hospital, called Meilahti.  

Seventeen hospitals devoted to various specialties are located in and around this Central Hospital. These are hospitals for Childrens' Care; ObGyn; Oncology; Eye and Ear; Skin and Allergy, etc.)  All of them feed when necessary into Helsinki University Central Hospital, Meilahti, where all surgery is performed.  Several of these hospitals are connected by warmed underground tunnels which allow patient transfer during the worst of weather. 

In United Nation Studies of countries around the world who are educating students, (adjusted for regional features, income, and many factors), Finland almost always produces the most accomplished high school students in the world, as it did again last year.  Thus, doctors, nurses, medical technicians and support staff in the health system are among the brightest of the bright, and the association of the University with Meilahti Hospital places medical students, interns and specialists in training in a constant educative atmosphere.

Of its 4.5 million people, Finland has 1.4 million whose municipalities choose to belong to the system.  Those 1.4 million are served by  2300 doctors (1:600 persons) 11,300 nurses (1: 127 persons) and the system annually has in training 350 general physicians, 250 M.D. specialists and 4000 health-care students.

Finally, I need to mention, that Finland is doing something we only talk about.  It is converting all medical records into digital format, so that a patient’s medical history can be accessed at any time by any doctor in any district and in any hospital.  So, taking medical history need be done once in a person’s lifetime, and then just added to for future reference. This project will be completed by 2006.


HERE WE GO:
So, into the system we go, first to an emergency clinic where we are seen in about an hour.  The doctor decided that I probably did have appendicitis and she referred us to Meilahti Hospital Emergency where we were taken by our remarkable young escort (he was just incredibly helpful, cheerful, and supportive), and I am seen in about an hour.  The doctor there does further examination and says that she will have conversation with the surgeon, Dr. Mika Väisänen as soon as he is out of surgery- in about an hour.  (At Meilahti Hospital they are doing surgery 24 hours a day, seven days a week.  They get lots of practice.)

After speaking to him, she told us that Dr. “Mika” wanted to do a CT Scan rather than an ultrasound because it was more informative.  Now, to do this, I had to drink a solution and wait for four hours.  This meant that there was no way that Linda and I were going to be able to get back on the ship before it left for Tallinn, Estonia at 4:30 p.m.   So, our escort took Linda back to the ship where she packed all of our things (remembering that we still did not have our luggage), checked out with the concierge and hustled on back to Meilahti.  She said that was the fastest packing she had ever done in her life.

As soon as I was admitted to Meilahti Emergency I was asked if I was in pain, and I said, “yes.”  So they gave me pain shots every two hours.  I learned that wherever I went, and each day I was greeted in the hospital, I would be asked “are you in pain.”  They are very strongly committed to keeping one out of pain to assist healing and curtail needless suffering.  I liked that.

When Linda returned, she was told that I would be ready for the CT Scan  “in about an hour”.  After the scan I was told the results would be available, “in about an hour.”  At that time, Dr. Mika visited me to say that he believed that I had a perforated appendix and he would have to “operate”. (I never once heard the word “surgery” mentioned…only “operate” or “operation.” )

I said, “o.k., let’s do it.”  He said that first they would have to increase the clotting power of my blood because I was on blood thinners.  To do this, I would need 3-4 pints of plasma.  How “clean was the plasma supply?”  We were assured that it was tested and retested and retested for HIV and that it was safe. (Given the alternatives, surgery or no surgery, life or death, I would have taken any kind of plasma they had.)  How long would it take?  Thaw it out; “in about an hour”.  Put it in with IV: “in about an hour”.

So about 11:00 p.m. I was being shaved and prepped for surgery while the plasma was dripping through the IV. At 12:02 Monday, August 15, I went into surgery and exchanged cute jokes with my anesthesiologist.

She asked me whether I drank or smoked. I said “no”.  She asked if I had any dentures?  I said “no”.  I opened my mouth and tilted back my head so she could see that there was easy access for her to intubate me.  She was very pleased.

Then, I gave her two instructions:  (1) keep me breathing; (2) let me know when she was going to let the sleeping potion flow.  She laughed and said she would and then, in a few minutes, she said to me, “o.k., here we go…this is the real thing.” 

I awoke at 2:15 and soon after was taken to my room.  There I spent the next 3.5 days with antibiotic IVs fighting the effects of the poisons which flowed into my peritoneal cavity after the appendix had ruptured.  Dr. “Mika” said that it was perforated at its tip, so perhaps I did not have as widespread infection as I might otherwise have had.

I had also been on massive antibiotics since my first evening visit with the ship’s doctor.  My recovery the next three days was “normal” in the experience of my doctors and nurses, and I developed a wonderful, warm, and friendly relationship with many of them.

LINDA LEARNS FINLAND:
This was also the “Time of Linda.”  Remember that we are in a foreign country where the native languages are Finnish and Swedish. The medical community all spoke a little English, some very good.  But of course, shopkeepers, taxi drivers, and people on the street in general did not.  Linda could not ask for an address nor could she understand such verbal expressions as the price of goods she was buying.  She just had to read the printout (currency is Euros), because she could not understand what the verbal answer might be. 

Still, working with the hospital staff, that first evening, they assisted her with written notes in calling to get a hotel room for her to stay in, and then for the next four days, she carried messages of direction from hospital to taxi; from taxi to stores; but from stores, she just had to walk home because she could not find people who could communicate with her.  She walked an average of 6 miles a day, seeking food treats for me, some clothing for herself (OUR LUGGAGE WAS STILL “Out There”), and reading material that was in English….oh, how I came to love the sight of my native tongue.  Linda was just magnificent, and amidst all of this managed to visit twice a day, supervised my pill taking, then took care of me after I left hospital while we spent four more days in our hotel room waiting for me to get strong enough to fly home.

BUSY ON THE WARD FLOOR:
I came to have quite an interest in the hospital and its doings.  Laundered  pajamas, towels, socks were on a stand in the hallway, and each morning you could get your fresh clothing as you walked to the very large, “walk in shower.”  I was shown with emphasis which side of a rotating Finnish sign meant "open", and which meant “occupied”.  

I was comforted by the way that meal time was announced.  Each wing had its own small kitchen where food preparation could more easily be specialized for the type of patient in the ward.  When it was ready to be served, one of the aides would step into the hallway and ring bells, (the sound of Christmas jingles).  Then patients could get arranged and such, and the food would arrive about 10-15 minutes later.  It took awhile for me to want to “hear the bells” but the last day or so, my appetite began to improve a lot.

The intensity of cleanliness was palpable.  At the entry to every room, and the entry to every ward, and above every wash basin, there was a dispenser of antiseptic lotion which EVERYONE used upon entering.  This kept hands free of germs and the spread of infection.  The floors were cleaned twice a day, carefully, with disinfectant.  There were signs along each wall reminding people to “wash their hands.”  I was impressed, and most importantly, I did not contract any “bugs.”   Course with the antibiotics flowing through me that would probably have been difficult.


HUMOUR IN HELSINKI’S MEILAHTI HOSPITAL
As you will note in my narrative above, the response to every medical question which asks “about how long” is the same.  Everything is “about an hour.”

My “rounds” doctors who saw me each morning with a group of medical students in tow came in on Tuesday.  They were very careful in using English because they wanted to be sure that they did not misinform.  I asked the name of my surgeon and they gave it to me: Dr. Mika Väisänen, Ph.D./M.D./Head Surgeon. I told them that if this all turned out o.k. I would report their names to the people back home too.
They looked puzzled, then realized that I was making a joke; everyone laughed including the medical students.  (However, I cannot find the names of my attending doctors on any of the documents we took home so that I cannot praise them by name.)

So then I said that I really liked Dr. Mika.  Although he said fewer than 20 words to me in both visits, I said that “he certainly seemed to know exactly what he was doing.”

One of my attending physicians then said quietly, “He’s surgeon.”  The meaning of that phrase was that Dr. Mika was a surgeon, and that all surgeons think that they always know exactly what they are doing.

I had a great laugh and the two doctors smiled quietly, but the medical students just sort of looked askance (who would dare make a joke about a surgeon?)

My nurses (about 6-8 as they rotated in and out of their own work shifts) were just wonderful.  They were sincere, caring, precise and responsive to every need, and their presence gave truth to the described purpose of Meilahti: “our staff is here just for you.” 

After surgery, I tried to walk as much as possible to get gases moving and get rid of the bloat that made almost all food hard to eat.  I asked this one nurse about how best I could “get things moving.”  She said, “walk.”  I said that I have been walking, and as she left the room, she turned to me and made this exaggerated motion with her arms (the way one would move arms if you were cross-country skiing), and she said, “WALK MORE!”     So I did.

When I was about to be discharged, two of my nurses came in to see me.  One of them had been kind enough to invite me to walk a bit outside the hospital, and I learned some about her most recent educational goals and some about her husband’s winter activity.  Although she has been in nursing for 30 years, she continues her education seeking to finish a two-year program which will allow her to “dispense medicines” as per doctor’s orders.

Her husband is one who likes to “winter” swim.  He gathers with friends for about 50 minutes in sauna, then they run outside and jump into freezing water through holes dug in the ice.  They are in the water for about five minutes, then climb out and run back to sauna.  They repeat this for hours on end.  Sort of like ice-fishing…..sort of…male comradeship and away from domesticity.  She found it all amusing. 

The other nurse, whose name I think I remember as Luäola, was always just so energetic, helpful, precise and cheerful.  Very, very serious but very warm.  She could dispense medicines and the two of them worked as a team when they were on shift together.
 
They came to discharge me and the “Sauna” nurse said to me, with Luäola nodding agreement:

“There is in Finland an expression that what one says in the forest, stays in the forest.”  Then she waved her arm slowly around the room and said, “this is our forest; what we say in the forest, stays in the forest.” 

Then they proceeded to say wonderful things to me, comments which moved me deeply and cheered me thoroughly.  What did they say? 

It remains in the forest.

Dick     
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THE HELSINKI DIET PLAN
l-r:  Nurse "Russia";  Nurse "Sauna";  Bloated Dick and Nurse Luaola.
We were leaving; they were a big reason why.  My Helsinki Plan was a success!