Back in the early 2010s a friend in Sydney (mid-30s, let’s call him Paul) had an awkward fall from his bicycle, which resulted in him sustaining a messy elbow fracture. As you would expect, he went to emergency, got it checked out and they sent him off to get surgery. The surgeon then opened up his arm, screwed the pieces of bone together with a metal plate, and sent him home with his arm in a sling – all thanks to the government-provided Medicare.

Though admittedly this was was a bad break and pain was to be expected, as soon as Paul got out of surgery and the drugs wore off, he already knew something was wrong. The pain was excruciating and as the days went on was not subsiding at all. His arm was stuck in a sharply bent position at the elbow, with his hand hovering near his shoulder on the same side (you can picture the cliche pose of a socialite holding a small handbag). Paul also couldn’t feel or control his hand which was perpetually numb, grey and clammy.

Despite the clear indicators of a problem, the doctors and surgeons assured him that that this is just ‘how it is’. “You totally smashed your elbow, what do you expect?” and so on, and they sent him to physiotherapy.

Physiotherapy

Paul’s first physiotherapist was “useless”, so he complained and they escalated him to a different guy who dealt with more serious cases. This therapist (who was also a martial arts instructor) happened to be interested in his case for some reason, and was willing to advocate for his cause.

Medicare originally said that Paul could only have 6 or 8 physiotherapy sessions, but the therapist said that was nowhere near enough. He was going to need at least 6 months worth of sessions at 3 times a week (ie. in the region of 72 sessions).

Fortunately he was able to pull some strings so the sessions were done at a discounted price, otherwise Medicare (Paul didn’t have private health insurance) would never have covered it.

Painkillers

The therapist told Paul that he was going to need serious painkillers, since when he pulled on his arm it was going to cause intense pain. The pain management people, however, said they couldn’t give Paul opioids for 6 months since he’d end up addicted and at that point it would be almost impossible for him to stop. As a result, after the first 1-2 weeks of opiates, they provided Paul with only Nurofen/Panadol standard headache tablets, which did essentially nothing.

From here, Paul was doing 3x excruciating physio sessions every week, and every 2 weeks he would get perhaps 5 degrees more movement out of the ‘frozen’ muscles on his ‘dead’ arm. Since there were no ‘official’ medical personnel who were able to help him, he was regularly driving out west to track down and buy blackmarket pain pills from ‘flexible’ doctors, just to get through the sessions.

Second Opinions

Even with the pain pills, Paul was still struggling to sleep at night and his life was essentially a nightmare, not knowing if things were ever going to improve.

As the weeks went on, the physiotherapist started to agree that there was something not right. Paul should have been making some improvements and not be in so much pain after all these weeks – but he was.

Paul booked appointments with the original surgeon, asking if he could remove the plate or try something else.. but was essentially just fobbed off and told to stick it out with the rehabilitation. Will it get better? Maybe, maybe not. Great.

Of course Paul contacted numerous other doctors and surgeons, attempting to get second opinions and to see if they would help. None of these people wanted to touch his case (or perhaps second guess a fellow surgeon?) so Paul would end up going back to the original surgeon who refused to do anything, and the cycle continued.

This dynamic persisted for close to a year, with Paul miserable, depressed, in constant pain, basically unable to work, and surviving on black market painkillers.

The Expert Ex-surgeon

Finally Paul managed to get referred to some big-shot retired ex-surgeon who did private consulting on special cases. Paul got $1000 cash together for his fee and drove out to the the surgeon’s rural mansion.

Paul was let into the house by the man’s wife to find him sitting at a desk holding tweezers, intensely focused on putting a ship into a bottle. Apparently these guys enjoy flaunting their fine-motor skills even when people are paying effectively thousands of dollars an hour for their time.

Anyway, Paul explained his story, and showed the surgeon his clammy, numb, useless hand, which the surgeon briefly glanced at.

“Yep, it’s f$#ked.” he said, barely looking up from the ship. “Okay, so what do I do then?” Paul asked.

The expert surgeon then told Paul he would just write a recommendation to the existing surgeon who did the procedure, suggesting that he pull the plate out.

“But that’s what I’ve been asking him to do all year” “Let’s see.”

Returning to the Original Surgeon

The next week, Paul went to another appointment with the original surgeon, and showed him the recommendation letter.

He was immediately irate, and shouting Paul down. “Why did you go talk to this guy?” “Who said you were supposed to do that?” and so on.

Paul asked what him what the difference was – and anyway was he going to take the recommendation or not? The surgeon said he’d think about it, and told Paul to come back the following week.

Paul returned the next week to find that this surgeon – in the space of mere days – had retired, and moved to Tasmania. That was it. No further details or explanations were offered.

Sitting in the office instead was a brand new young surgeon from the UK who – strangely – was only too happy to remove the plate. They booked a date for the surgery, Paul had the plate removed, and he felt better immediately – even as he walked out from the hospital.

Reflection

So what happened here?

It would appear that Paul suffered some kind of Ulna nerve damage, and the plate was impacting on that nerve, on blood flow, and causing the arm to be ‘stuck’ somehow. Nobody knew apparently, and it was ‘not common’.

But why didn’t the original surgeon want to fix it? Was he concerned about staying under some kind of accident quota? Was he concerned about liability? Or his insurance premiums? His reputation? Ego?

And why didn’t any other doctors or surgeons want to get involved? Was it professional courtesy to one of their fellow brothers-in-white? Did they not want to dig up a fellow surgeon’s mistake and then have to not only expose them, but also deal with the problem itself? Was it a ‘no-win’ scenario where they figured they were not going to be able to fix the problem anyway?

More importantly, why were they – along with the original surgeon – willing to let Paul spend the rest of his life in constant pain with a frozen dead arm, just to avoid whatever career inconvenience this may have caused?

Some Anecdotal Research

I haven’t gone deep into this, but I have spoken to some surgeons (overseas, not in Sydney) who claim that when they work in a hospital, it is the HOSPITAL itself which has the insurance policy, not the individual surgeons – who are all covered by that overall policy. Apparently as long as they behave within certain guidelines (which are not difficult to stay within), the surgeons don’t have to worry about being liable for any kind of harm to patients regardless of whether the patient ends up dying or whatever. How encouraging to know.

If anyone has insight into why the original surgeon (and the others) didn’t want to touch this with a ten foot pole, please email since I’d be interested to hear what mechanisms could be at play.

Closing Thoughts

For now I’ll leave this on a positive:

One thing my friend did take away from this year of physical and psychological hell, was a newfound healthily expanded distrust for the medical system – something that served him well in seeing it for what it was in the years to come.

He realised that if you don’t proactively complain or call out problems that you see in front of you, they will happily ignore you and allow you to ‘fall through the cracks’, for their own convenience. Most others around him just accepted what the doctors said at face value, to their detriment.

Paul also said that he feels extremely lucky to have gotten through this as he has, with his arm now fully functional. He believes that the proactive physiotherapist saved his life, and that ‘something’ happened. Maybe it was a guardian angel or who knows what, but something helped him get through it.

So what’s the catch? Well I was told by the partner of a high-level executive in an international bank that these expat packages are not merely designed to attract ‘top talent’, but are specifically engineered with one key goal in mind – to create leverage over their new hires.

You may be aware that international schools in key Asian international cities are prohibitively expensive – think $40,000 USD per child, per year, before debentures, capital levies and so on. One reason these schools are so expensive that is that the big banks and multinationals routinely pre-buy blocks of slots every year in order to distribute to the families of their expat employees.

The management technique, then, goes like this: HR brings a guy – let’s call him Ken – over from the US with his wife and kids. They get the local work visa approved, and they get Ken all settled into the big apartment – all covered under their housing allowance. A couple of months in, Ken’s wife is making friends at the yacht club, she’s got the domestic helper all trained up on the grocery shopping, and the kids are all in school. By the time 6 months have passed, his wife has a healthy social calendar, the kids friends’ parents are also her friends, and most importantly: the kids have stopped complaining incessantly about going back home, because they’ve finally started to make some good friends at school. This is when Ken’s boss first asks him to come into the office on a Saturday.

As soon as this happens, Ken intuitively knows he’s screwed. He knows this isn’t a one-off.. it’s not a favour to a mate.. he’s getting punked out in the prison shower.

What’s he going to say – no? If he loses this job, he knows there’s no way he’s going to be able to find a replacement position with that kind of salary and benefit package. Will his wife want to run back home to the US with their tails between their legs? They’ve just spent the last half a year humble-bragging on facebook about how lucky they are to have a domestic helper and a personal driver in this tropical paradise.

It is possible that if he really hustles, Ken may be able to find some kind of replacement role at another firm with a workable salary, but there would need to be serious cutbacks. He may be able to convince the wife to move into a smaller apartment, he could let go of his driver, sell his car, give up his yacht club membership, cut down on the restaurants and start riding the subway.

A cost-saving measure he likely will NOT be able to pull off, is convincing his wife to get his kids – now that they’ve all finally settled into a foreign country and made some friends – to leave their hyper-expensive international school, and transfer to a cheap local one where they won’t even be able to speak the language.

Every other perk and luxury, he could theoretically decide to ditch. Ultimately these things are really just luxuries for him, and – practically speaking – not worth the cost. The ‘cost’ of course, being the burden of 24/7 slavery to upper management who have full knowledge that they have you directly in their pocket.

The genius of the package’s complimentary ‘high-end’ schooling, is that the school slots are not HIS perk to give up. Ken’s dilemma, then, is to either rip the kids out of school and create a domestic nightmare for himself, or to be financially destroyed trying to pay the absurd ‘market rates’ for kids’ schooling which – ironically – he used to get for ‘free’.

For these reasons, when Ken’s boss casually asks him on Friday morning if he minds coming in on Saturday – he already has a pretty good idea what that answer is going to be.

Over the course of dealing with hundreds of these applications, they have observed some clear trends in the family makeup of these individuals:

One: The parents of children who have ‘decided’ to have no gender, are predominately (70%+) academics or medical professionals.

Two: If a teen wears a nose ring, it’s a safe bet that the father doesn’t live at home.