Opinion

'Slosh, slosh, slosh': the maddening, twilight world of medical waiting lists | Neil Macdonald

Our treasured Canadian health care system is corrupt in the sense that not all of us are treated equally, and it's a purely political matter, writes Neil Macdonald.

Our treasured health care system is corrupt, in the sense that not all of us are treated equally

Ann Bagyan, Bill's wife, says she's frustrated by all the delayed surgeries and is worried about the toll the ordeal is taking on her husband's mental health. (Jean Delisle/CBC)

When Bill Bagyan was woken earlier this month, lying in a hotel room he'd paid for himself after making yet another drive to Ottawa from his home in Kingston, and was told told in sorrowful tones by a hospital staffer that he was once again being bumped from surgery, the first thing he thought of was climbing the stairs to the roof and jumping off.

From 14 floors up, he reckoned, he'd be dead as soon as he hit the pavement.

His second thought was to go get a shotgun.

"I wondered, if I walked in with that, whether they'd change their minds and do the operation," Bagyan says.

But then his mind cleared of what he calls the stupid things flying around his brain, and he told himself "that's just not me."

With that deep sense of acceptance and duty bred into older generations of Canadians, he trudged over to the hospital and sat, depressed, in the anteroom of the surgeon's office while the doctor's assistant chirped practised apologies as she clicked through her boss's schedule looking for a new date. Maybe January. Then again, maybe not.

Repeated delays

It has been six years since doctors first accurately diagnosed what was making it so painfully difficult for Bagyan to urinate. What they'd thought was an enlarged prostate was in fact a buildup of scar tissue blocking his urethra. 

For the first few years, his urologist repeatedly tried to clear it out, inserting catheters and scopes and even a scope with miniature scissors into his penis, working up to his bladder. Each time, the scar tissue would just thicken.

"He was making it worse," says Bagyan, in the deliberate, fatigued cadence of someone for whom pain and discomfort never abates.

He needed surgery. But only a few surgeons in Canada had the training necessary to operate.

So patient Bill Bagyan entered the twilight world of the Canadian waiting list – a place of voicemails and messages and sitting on hold for an hour at a time.

The system's defensive cocoon is, by design, nearly impossible to pierce. But he persisted.

Finally, in the spring of 2016, he was told that his name had somehow been misplaced, that he was not in fact on the waiting list, but that it had been corrected and he'd hear back by Christmas. Or maybe by early 2017.

A year later, in April of 2017, he contacted the Ottawa Hospital's patient relations staff. When they got back to him a few weeks later, it was to tell him that unfortunately, he'd been misplaced again.  

At around that point, Bagyan's doctors in Kingston inserted a catheter through his abdominal wall. It drained into a bag he wore under his clothes.  

"But," Bagyan explains in that tired voice of his, "catheters have a high risk of infections."

He did indeed get infections. And even when he didn't, the catheter would get "pretty rough" by the time the nurses at the hospital in Kingston got round to changing it.

Bill Bagyan sits in a chair with his catheter bag. The Kingston, Ont., man says the presence of the catheter makes it difficult to play with his grandchildren, as he's afraid they'll yank the tube out. (Jean Delisle/CBC)

Meanwhile, no lifting, no walking on uneven terrain, no playing with the grandkids. The nurses told him he could swim if he "wrapped it in Saran Wrap," but that didn't work very well, and he just wound up with a wet rope of plastic wrap trailing from the catheter and bag.

And there was the humiliation.

"After an hour or so, enough urine builds up that it starts sloshing when you move. I mean, you're out in public, and slosh-slosh-slosh, and people hear it and look at you, and it's kinda embarrassing there, you know?"

Just to be clear, the system regarded this state of affairs as a satisfactory enough interim situation that the corrective surgery was classified as "elective." Meaning that in the eyes of the system, it was really just something he wanted, rather than desperately needed.

So years passed. Finally, this past April, he was given a surgery appointment for June 4. But even as he was eagerly agreeing to that date, the hospital official informed him the scheduled waiting room was not equipped properly. Maybe the end of August.

By August, it was pushed to September.

Then to Nov. 4.

'We have a new date for you'

And so Bagyan came to be in that hotel last week, where he was awoken with the news that the surgeon had an emergency to tend to, and that he'd been bumped again.

Once the thoughts of suicide and violence dissipated, he tried, Canadian that he is, to go through the regular channels again, to contact patient relations, in the hope that they would accompany him to the surgeon's office to push for a new date. But of course there was only voicemail. He left a message, and no one showed up.

Finally, angry and desperate, and realizing he could be wandering this maze indefinitely, he called a reporter and agreed to exacerbate his chronic embarrassment by talking about his condition publicly.

My colleague, Laurie Fagan, began making some calls, and suddenly, Bagyan's phone lit up.

A hospital official was on the line. We know you've been in touch with the media, 
and we have a new date for you, Bagyan was told.

Nov. 13. Tomorrow.

Bill Bagyan says the four-year wait for surgery has been physically and emotionally difficult.  1:34

Bagyan, ever the placid Canadian, puts it all down to systemic inertia and bureaucracy. Maybe, he kindly allows, there are many other Canadians in even worse shape than he is.

So I asked him if he thought the prime minister, or a member of the federal cabinet, or a VIP from the private sector, or even a senior police official or civil service mandarin would be left sitting on a waiting list that long, unable to reach anyone, let alone get a straight answer.

He paused, then allowed that that would be unlikely.

You bet it would.

Our treasured medical system is corrupt, in the sense that not all of us are treated equally.

The fact is, our treasured medical system is corrupt, in the sense that not all of us are treated equally. 

If you're connected, or rich, or powerful, it's one thing. If you're Bill Bagyan, it's another. 
And operations are rationed, which is something that goes undiscussed. But of course we are all expected to pay the taxes that fund the system, aren't we? Everyone gets to do that. Bill Bagyan, a former engineer, did so for decades.

The boomers are aging. Demands on the system will only increase. In Canada, unique among Western nations, it is a purely political matter, given government's complete and exclusive control of medicine.

So the time to press for change is during election campaigns. But in our wisdom, we spent the last one talking about blackface and hypothetical abortions and tax cuts and Doug Ford.

I wish that at every single campaign stop, Justin Trudeau and the other leaders had been asked instead about Bill Bagyan.
 
Because he is how health care in Canada sees all of us. Or most of us, anyway.


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About the Author

Neil Macdonald

Opinion Columnist

Neil Macdonald is an opinion columnist for CBC News, based in Ottawa. Prior to that he was the CBC's Washington correspondent for 12 years, and before that he spent five years reporting from the Middle East. He also had a previous career in newspapers, and speaks English and French fluently, and some Arabic.

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