10 Aug

An unanticipated personal encounter with the Canadian health system

IMG_0893.JPGThis weekend, while attending the annual gathering of science fiction and fantasy fans in Montreal for Worldcon, I overdid it a bit.

Well, I lie. I overdid it a lot.

The Worldcon was fantastic. Full of old friends and acquaintances. Montreal has fast become one of my favorite cities from what I saw of it, and everyone was super friendly. More surprising was how family friend Montreal was. People were constantly stopping to talk to the twins, and Emily reported a ton of help with navigating the stroller and babies around from random strangers. The phrase of the week for us is “Deux Bebes!” which we heard over and over again on a daily basis in a variety of locations and situations. The twins were a hit!

But there was a lot of walking. The Palais de Congress was a huge convention center, and several of my panels and lunches required me to walk across the entire thing. At night, the Delta-Centreville (party hotel) was a long hike for me, and then the Hyatt Regency, where we stayed, was a bit of a hike slightly uphill from the Palais. There was a crazy amount of weary, tiring, hiking.

By Sunday morning, I was feeling completely sapped, and not getting enough sleep. I tried to nap before the pre-Hugo ceremony, but felt like I’d hit a brick wall by the time I’d walked over. I had to duck out of the Hugo ceremony briefly to lay down. By the end of the night my pulse was racing a bit, so I went back to the hotel to sleep. When I woke up my pulse was even higher.

After checking it several times, I decided it was high enough that I would follow standing orders to check into an ER when this sort of thing happened. I took a metaprolol a bit early and told Emily we needed to pack and go.

I was a bit nervous, and asked for an ER, but mentioned needing it for my heart. I was taken to the Clinique de Cardiologie de Montreal by a taxi driver.

The biggest barrier was quite simply language. At first they were worried about flu, and had me in a corner for that, but someone with more English ability figured out that I was there for a racing pulse and things got moving. Emily and the twins came with (and throughout all this garnered a fair amount of attention and cries of “deux bebes!” from nurses and people in the waiting area).

Next up was that I didn’t have a health card or was in the system, so they (pretty quickly) created a temporary ID of some sort and took some basic information, then got me into a triage area. After taking my pulse and pulse-ox, blood pressure, and temp, they confirmed my pulse was high and something was up.

After a brief wait they stripped me of my shirt and got me into a booth where they strapped me to an EKG machine and took a look.

At this point, not knowing language, it got a bit hard to understand what was happening. From past ER visits, mostly what happened is that I was x-rayed, sometimes catscanned, and blood was drawn to look for signs of damage to the heart, and if none detected, I was released. This is pretty much what happened here. Once the EKG came back, they had me wait for a bit, then generated an ordered for me to get x-rayed. Unlike in the US, where you are put in a bed the moment you arrive, I walked to the radiology department. Then, since I was a furriner, I had to go downstairs and pay for the visit, which I’d been expecting to come at the end of things. The bill was $480 for the whole ER visit, one lump, with a couple receipts so I could send them to my own insurance agency when I got home.

After that I sat in the waiting room, then was taken in by a nurse to get my blood drawn, again my ER experience let me know despite language barriers with the nurse that this was to look for damage in the heart (it releases certain enzymes if its being damaged, I gather).

After that, things slowed down, and we got our only slightly tough period. I had to sit in the waiting room, with a mask on, with a gown on on top, while I twittered and texted various people to update them. The wait was maybe an hour, and then I got to see the doctor once the results of my bloodwork had come back and he’d looked at my EKG. It seemed longer because I was sitting and waiting.

The doctor talked to me for a while about the past incidences, quizzed me a lot on why the Ohio doctors hadn’t dug deeper to figure out why I’d had a PE instead of just treating it, and had some other questions. In the end, he told me I’d just overdone it. Stress, too much activity, pushing myself, all of which I just shouldn’t be doing. The mild tachycardia resulted.

He also wanted to talk to me about the big picture of dealing with my condition, as its something he’s familiar with at the clinic. He told me it’s not necessarily something I’ll get over, but that I’ll probably be managing for a long time (if not life), and that the medicine I was on was for quality of life, not a cure of any sort. He told me it was not dangerous, just annoying, and that I probably needed to adopt a more ‘zen-like’ approach to life in order to fold it into how I approach everything, keeping the fact that I have this thing now. There was a lot of great advice about holistically managing to prevent these episodes, some of it that I’d picked up on from Karl Schroeder (Toronto based, who went through his own experience, as he blogs here), and some much needed reassurance by the doctor about some of the details of these things by the doctor.

He also told me that I should have gone to a nearby ER, I sort of confused the taxi driver when I mentioned needing an ER for my heart, as the Clinic I was in was more of a total care place, even though it did have an ER. This may have explained the more walking about I did. But it also seems they decided pretty quickly on that I wasn’t in danger, which is why I was walked about, as other patients were there in wheelchairs or beds.

Then I was released.

Emily says we were actually in and out faster than we usually are.

I’m also still not sure what the difference would have been had we gone to a regular ER/Hospital.

As for differences between the US and Canada, which everyone right away asked about in my twitter feed and via email, here is what I noticed between this clinic and experiences back home:

-Fewer accountants and a vastly smaller billing department. Lima Memorial has a massive area for billing, this place had admissions, a secretary for handling the medical card (who gave me a temp), and downstairs where I had to pay cash because I wasn’t in the Canadian Health System, there was a small office near the cafeteria with one lady working a window who took my credit card.

-No crazy multiple billing system. The hospital charged me one fee. Hematologists, radiology, EKG reading, the ER doctor, and the hospital didn’t all bill me separately. In the US this visit would generate 6 or so bills from various departments, sent at staggered times. This alone reduced my stress level, as I knew right away what the total cost was and had it on one bill.

-No matter what, in the US I’ve been put in a private room on a bed, then all vital stats taken by people who came to me, or moved the bed around from station to station. The Canadian method of this particular clinic was to triage me, determine whether I was in trouble, then once they knew I was going to make it, dropped me down a notch and had me walking all over the place. This was a bit alien to me. But I don’t even know if this is US vs CA, it may be big city vs rural area, as I live in a much smaller town.

-In both cases nurses and doctors followed the same sequence for my symptoms, US or CA.

-The Canadian doctor seemed far more interested in getting me to understand how to deal with this as a person, not just turfing me back out once they’d dealt with the problem. I spent more face time with him in the office just talking, even if briefly, than with my main Ohio cardiologist who has me in and out in five minutes once he determines my EKG readings are okay once a quarter. The doctors in Columbus, OH, teaching hospital actually spent a similar amount of time, which was nice, but they also didn’t spent as much time talking me down off the ledge or giving me approaches on how to handle this thing as a ‘person.’ I don’t know if I just lucked out on a doctor, but it was very, very welcome this morning and will have implications on how I handle this recurring speeding heart.

Of course, the plural of anecdote is not data.

But, unlike what some people are screaming, I was not marched to a death camp and asked to choose how I wanted to die. I got triaged quickly, they figured out what was going on quickly, and then after a wait for bloodwork, they sat me down and walked me through some stuff I needed to hear that I hadn’t been fully explained before. I paid a single, total bill in one place, quickly. Had I been Canadian, I gather I would have had to just show my card, rather than take the step of sitting down to fill out info for a temporary Health ID.