Canada's health care system is hopelessly sclerotic. We need to wake up: Neil Macdonald
We should stop bragging about our health care system, and start yelling about it instead
Abruptly, last week, I wound up in an ambulance. Something in my hip had gone sideways, and was delivering a lesson on pain.
As we rolled up to the emergency ward, one of the paramedics leaned in: "They might not get to you until tomorrow morning, man. That's the way it is now. I'm going to give you another shot before we go in to keep you going."
And into my arm slithered a dose of morphine sulfate, with all its cottony comforts.
Later, when my mind cleared, I found myself in the business end of the health care system Canadians brag about so much: a big, crowded ward full of hurting people, some of them yelling profanely, and few staff in sight. A voice on the public address system made deliberately incomprehensible announcements — Code Blue, Code White, code whatever.
Eventually, a rushed-looking nurse waggled her fingers near my face, intent on making me understand it would be many more hours before they could get to me. And then she was gone.
As the pain intensified (What do you answer when someone asks "On a scale of 10, where is your pain now?" Is 10 a first-degree burn? Childbirth? It's not that bad, but it's pretty freaking bad. I don't know. Nine? Will nine get me something?), I began to groan. You can't not groan, no matter how much you see yourself as a stoic.
A phone attendant at the nurse's station told me, impatiently, that there were no doctors or nurses available. Finally, I just yelled, and I hate yelling. You've completely lost control when you yell. I figured I'd at least get the security detail's attention. But a doctor showed up, telling me she'd heard me across the hospital.
I gasped something about not caring.
All right. Calm down. We'll give you some fentanyl.
Fentanyl? Jesus. Really? I don't need heroin. Can't I just have some painkiller? Fentanyl is a painkiller, sir.
By the next morning, I was admitted, in a room, having been scanned, still not knowing what was wrong with me. Busy, efficient nurses were now my keepers. Their job, it turned out, was to deal with pain and divulge nothing. They had talking points for any request for information. The doctor would be along. Let's see what he says.
Meanwhile, morphine and fentanyl had given way to Dilaudid. Fentanyl is for the emergency ward, and morphine is for the ambulance. Here we use Dilaudid. Why is that? And why are you jabbing it into my shoulder instead of into the IV? Please explain that to me. I'm sorry, sir, we use Dilaudid. This is going to burn a bit.
(Dilaudid is a semi-synthetic opioid nearly identical to the oxycodone they give you in an American hospital. A doctor friend says the reason hospitals prefer Dilaudid is because it isn't called "oxy," and therefore is more politically acceptable to the provincial health care bureaucrats who run everything.)
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Days passed. The doctor responsible for my floor, I discovered, was an inaccessible creature who would suddenly appear, tell you a little, then leave you to the nurses, who are better at guarding information than our security agencies.
I was sent for an ultrasound scan. At a certain point, the technician grimaced, and pressed harder, then did it again. She left the room to consult someone. You found something. What did you find? A mass? I don't know, she said, "I'm just the picture taker." You'll have to ask the doctor.
Back to my room, where it was obvious the nurses had seen the results, too. The doctor will explain it. When will I see him? Probably today. But certainly by tomorrow. Which of course meant tomorrow.
How do you feel? What, aside from this pain? I don't know, scared, maybe?
Evening came. No doctor. Apparently he wasn't answering pages. But you must wait for the doctor.
Now, at this point, I took my accumulated white male privilege and experience and used it. I have a right to know what that technician found. I will find out. I will find the doctor's home number and call him there – yes, I can do that, and I bloody will – and if I don't find him I will find this hospital's chief of staff. And I'll do it at midnight. Nobody needs the headaches I will cause.
As I lay back, fuming, I heard a whimper from the next bed, through the curtain. A woman, older than me, obese, with a slew of issues and no one to visit her, or advocate for her. She'd bounced from one room to another for a week, and desperately wanted to go home. She'd tried bluster, with predictable results. She couldn't understand why they were keeping her, and now she'd lost control and soiled her sheets, and was mortified. That she was in the same room as a man was just wrong. Surely they could have moved a few beds around.
"The nurses have stopped answering my bells," she sobbed. Yes, they had. An orderly cleaned her up.
By early morning, I had my answers. Nothing too serious. I really shouldn't have been in that hospital bed all week, but at least they took care of me. A few hours later, I was back in the world, sun on my face.
But I'm 62, and hospital is now a frightening prospect. Ask that woman. She's 66.
Every doctor I have seen since my return from abroad four years ago has, privately, apologized for the sclerotic system here. One specialist told me that if the waiting line is longer than a month (some people wait six or eight months or longer), it's no longer health care, it's gambling, because people die on waiting lists. Try to argue with that. My family doctor's phone recording advises callers that no new patients are being accepted.
An acquaintance and former doctor in Ottawa who now runs a lighting store quit medicine because he felt he couldn't properly care for his patients. They should put doctors on salaries, he says, then we wouldn't have to rush them out or refuse to discuss more than one problem per visit.
In the U.S. – yes, sorry, the U.S. – surgeons and doctors usually give you their cell phone numbers, and tell you to call anytime if anything goes wrong. They often call to follow up after a visit, or go over test results. They have email.
I was once met at the hospital door in Washington by a woman who told me she was a nurse with a medical degree. I can answer all your questions. I will be here when you go to sleep, and here when you wake up. Anything you want to know … anything … just ask me. I wanted to hug her.
That was at the Sibley, by the way, which is a public hospital. Everybody gets the same treatment there: private patients, Medicare patients, Medicaid patients. Yes, American medicine has its pathologies, but Canada's does, too, and we need to wake up. Government controls everything here, and governments only pay attention to polls at election time, not to angry patients.
Our population is aging. More of us will need those hospitals every year. The rationing our system practices but pretends it doesn't will get more severe. Rich provinces will cut back further, poorer provinces will be a disaster. Quebec's system already is.
Either we fund it all properly, which means more taxes, or we allow people to spend their money on their own care, which is un-Canadian, but is what the rest of the world does. Even in Scandinavia.
Our virtuous system is already corrupt. Does anyone seriously think that cabinet ministers or captains of industry or powerful officials wait in the same lines as the rest of us?
My dad, toward the end of his life, said our health care system expects you to check your brains at the door. He was right. Yell at your politicians. Lose control.
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