Ill Winds

When you travel a lot, sooner or later, a trip ends in the emergency room.

The first time it happened to me was summer vacation, 1986. Violently ill, I received a diagnosis of mild appendicitis at the E.R. and was sent home. When my appendix ruptured the next day, we returned and I was whisked into surgery.

It all turned out fine in the end. And in the intervening decades, rural resort-area hospitals like the one on Martha’s Vineyard have drastically improved, thanks to partnerships with better-equipped affiliates in nearby cities.

But the experience left me with insights that years of later travel have only reinforced. One is that, for a variety of reasons, you may be more likely to end up ill or injured while away from home (more on that later). Another is that the health facilities where we vacation are frequently inferior to those back home.

There are plenty of exceptions to these observations. But they hold true often enough that I’ve come to realize that I need a new strategy for dealing with health issues on the road. Most insurance policies are local, and while I’ve written from time to time about various types of travel insurance — including the ever-changing world of travel health insurance — I’m embarrassed to admit that my routine for the past 20 years or so has remained the same: I pack my bags and, feeling young and invincible, hope for the best.

That strategy has proven naïve. Or put another way, I could at this point write a book entitled “Emergency Rooms of the World” (not that anyone would buy it — but as a cautionary tale, maybe they ought to).

Why are we more vulnerable when we’re away from home? For starters, the stress of travel and jet lag lower your immune defenses. Wandering around a foreign city in a sleep-deprived daze is a great way to trip over an unexpected step or crash into a pillar — as my brother-in-law found out when he landed in Prague, looked up to snap a photo, and promptly sprained his ankle on a quaint but unanticipated footbridge. (He spent the week laid up in his hotel room, and tells people he’s been to Prague but never seen it.)

Our tender stomachs are thrown off by unfamiliar foods and dining schedules, not to mention holiday excess. Locals instinctively navigate broken-up sidewalks, uneven cobblestones and careening buses without breaking their necks — but not surprisingly, we foreigners often don’t.

In Nice, I learned that French yogurts frequently come in clear-glass bottles by slipping on the broken detritus of one in a supermarket and cutting open my knee. I also learned that in this favored British resort, your average Algerian-born busboy speaks better English than the E.R. doctor.

I resorted to my high school French to explain to the surgery resident that after a dozen needle stabs, the anesthetic wasn’t taking; his faulty stitches slid out hours later. “Socialized medicine,” muttered my doctor back home in New York as he examined my knee (which healed up scarred but fine).

These experiences point to the scary reality of travel medical disasters: No matter how good your insurance, when someone is unable to walk or is vomiting uncontrollably, the immediate recourse is the nearest hospital — good, bad or unknown.

I learned this again recently when, on my recent Passover trip to Bulgaria, my husband became suddenly ill with acute pancreatitis. Bulgaria is one of my favorite countries to vacation in. But I’ll be honest: my first reaction was, Why did he have to get sick here?

Why in a country where there were no beds left in the hospital I.C.U., where Oggi was stowed, vital signs unmonitored, in a regular bed — one my mother-in-law had to push herself into the elevator, while an orderly demanded a bribe? Where we were sent out to the pharmacy to buy dye for the contrast CT scan, since the hospital had none left? Where official visiting hours were restricted to Thursday and Sunday afternoons — the better to demand more bribes from the anxious families waiting, pathetically, outside locked corridors each day?

Truthfully, it wasn’t coincidence that Oggi wound up in digestive distress during a feast week in a country where firewater is served with the salad course. Another unpleasant truth: even if we’d had the kind of insurance that evacuates you to a first-world hospital, which we didn’t, Oggi wasn’t in any condition to be moved during those first tense hours. When I was in Nice, I needed that knee stitched up pronto.

Scenarios like these force us to acknowledge that the rewards of travel are inseparable from a certain risk. All the insurance in the world won’t buy us the ability to communicate effectively with hospital staff in a country where our grasp of the language is shaky. It can’t help us if a drug is urgently needed but doesn’t exist in that time zone.

Oggi is recovering well from his week in a Sofia hospital, where a $20-per-day private room bought more considerate care. But while we won’t stop exploring the world, we’re finally ready to acknowledge that we’re not invincible kids; we need a backup plan when we travel.

So I’d like to ask my readers: What’s your healthcare plan when you travel? Do you buy a travel health policy — and if so, have you ever used it? With what results? What’s been your best or worst healthcare experience away from home?

Send responses to hilarasha@gmail.com, and in a future column, I’ll share the collective wisdom. In the meantime, as they say in Bulgaria: Na zdrave! (To your health!)