“…our challenge is twofold: We have to find a way to cover all our people; and we have to figure out how to get better value for the US$2 trillion we currently spend on healthcare.”
— David M. Cutler, Otto Eckstein Professor of Applied Economics at Harvard University and Member of the Institute of Medicine -commenting on the US healthcare system.
Last month I was invited to speak for a week for The International Certificate Programme in Dual Diagnosis associated with Brock University under the guidance of Dr. Dorothy Griffiths & Dr. Frances Owen. Work I’ve developed over the past several years on psychotherapy for people with intellectual disabilities has been implemented in the States and most of the countries with socialized medicine. The Canadians have a real flair and passion for this work, and I savor the opportunity to travel there to teach and train.
The night before I began I treated myself to a day on the Canadian side of Niagara Falls. Although my diet is mainly vegetarian, I often supplement with fish entrees when I travel. A restaurant with herb-crusted salmon special and organically grown vegetables caught my eye. The dinner was delicious.
But around 2 a.m. my stomach heated up and soon I was revisiting the herb-crusted delight. Naturally I thought it was a bad piece of fish, and vowed to mend my ways back toward vegetarianism.
I was better — but not well.
Two hours later the scene repeated itself, but this time with an intensity that reminded me of the only time I had food poisoning. The pain increased with a burning in my lower stomach. The involuntary nature of this was overwhelming.
After a few more sleepless hours the pain in my lower right abdomen was getting worse. As the day progressed I started thinking about getting some post-food poisoning medicine and had the hotel direct me to a walk-in clinic/pharmacy about a mile from the hotel. By the time I mobilized myself the pain had doubled.
At the clinic I explained I was an American without a national healthcare card. The receptionist said there was a flat fee of $75 and a few minutes’ wait. I wanted a professional opinion so I paid the money, and the receptionist explained that I could submit it to my healthcare provider for the possibility of reimbursement.
So far, not much different than the U.S.
The doctor saw me within five minutes. I explained my tale of woe, and he had me lie down on the examination table. You know the drill:
- Does this hurt?
Does this hurt?
Does this hurt?
I let out a scream that emptied his waiting room.
Does it hurt more when I press in or out?
“You are not going to be lecturing at the university this week my friend,” he said.
“You have acute appendicitis. You need to go to the hospital NOW. How did you get here?”
“The hospital is about two miles straight down the road. I think you can make it, but if you want I will call an ambulance.”
An ambulance? For salmon?
I drove, and within 15 minutes of seeing the walk-in physician I was in front of the triage nurse at St. Catharines General Hospital in St. Catharines, Ontario.
He was reading the note from the walk-in doctor.
“So, appendicitis,” said the nurse. “Let’s get you set.”
Within ten minutes they had arranged for me to be admitted to the emergency room for observation and testing. They handed me some paperwork and told me to give it the emergency room registration receptionist.
“May I see your healthcare card?” She asked.
“I’m an American.”
“Ok, we’ll take care of that later on. When you’re done we can figure all that out.”
“Fine,” I said. But I was surprised that they didn’t want a credit card, a debit card, my bank account number, or a wheelbarrow filled with cash.
I was ushered into an examination with curtains for privacy. Within a half hour a nurse saw me for vitals and information, then a physician ordered blood work. Dr. Owen and Dr. Griffiths came to see me. I was embarrassed. The fact that I couldn’t rise above this to do this work was almost incomprehensible. But the volcano in my lower right side of my stomach wouldn’t see it any other way.
Instead of focusing on the embarrassment, though, I shifted to thinking about having a profound gratitude for being in the right place at the right time. The clinic physician told me had my appendix burst on the airplane I most likely would have died. Gratitude seemed a better way to go. Dr. Owen and Dr. Griffiths rescheduled my training for the end of the summer–another reason to be grateful. For more information on the power of Gratitude Interventions Project and other gratitude work check here.
The surgeon, Dr. Sawula, was on call. Each nurse, each physician, each orderly, sang his praises. “My, you are lucky,” they would say, “he is one of the best.”
They were right.
The nurse put in an IV line and asked what my level of pain was from 0-10, 10 being the highest.
Then nurse laughed. Then it sounds like time for morphine, ever have morphine?
After 10 minutes they could have come back in and announced that they were removing my ears and nose as part of the procedure.
And your skull and knees.
Good with me.
We might have to take your tongue and spine as well.
The next time I treat someone with an addiction to narcotics I will have much more sympathy.
The surgeon gave me his thoughts and approach and his best guess about my condition. Yes, it looked like appendicitis. Yes, my white count confirms it. Yes the CAT scan confirms it. And there is a good chance we can remove it laparoscopically with an incision about an inch long. There will be three cuts — one on the left side of the abdomen to inflate your belly, one above the navel for the camera, and the incision below the navel to remove the appendix.
“If it is still intact I can tie it off and take it out,” said the good doctor.
Let’s do it.
While I was being prepped, there was an accident. The two people in it were badly hurt, and were rotated ahead of me for surgery. After the first person was cared for, Dr. Sawula told me he had to wait to do the second person, that I was his intermission.
“I’m not anticipating any problem with this,” he said, “so let’s get it out of there.”
“Sounds good to me,” I said through my morphine haze.
Soon I was in the operating room. A Dr. Rose and Dr, Maximous assisted in the operation; it was about 11 p.m. when someone put a mask over my mouth.
“Daniel, Daniel Daniel Daniel!”
My eyes shot open. I’d never had an operation or general anesthesia.
“You did fine, it’s over, they got it out, and you’re in the recovery room. Everything went well.”
My stomach was like a basketball. The surgeon explained that afterward I would feel bloated, and that I might have gas. He was right about both. Toward the end of my two-day stay I asked if I could call Guinness to find out if I had just broken the world’s record of continuous flatulence.
Back home in New Jersey I went to my regular, trusted physician, Dr. Jeff Felzenberg. I explained that I had gratitude for the responsiveness of the healthcare system in Canada. They treated me as a person first and foremost, and responded according to my needs. Money was never an issue. The level of care was based on my need. When I was the most needy I was first, when I wasn’t I was repositioned.
He checked me out, admired the work of the surgeon and gave me the usual annual physical. We talked about the differences between the two countries and their approach to healthcare. He stuck a tongue depressor in my mouth, asked me to say Ahhhh, and then took a good look inside.
“Well you’re in great shape, you seem just fine after the operation. And you have a new tattoo on the roof of your mouth,” he said as he tossed the tongue depressor in the waste can.
A new tattoo. It says “Compliments of the Canadian government.”
Thank you, Dr. Sawula. Thank you, Dr. Rose. Thank you Dr. Maximous. Thank you, Dr. Griffiths & Dr. Owen. Thank you, Canada.
Postscript: A special thanks to my Canadian friend Barea for helping me recover until I could fly back to New Jersey.
About a week after I got home I contacted the hospital and paid the full bill for their services. I say anyone who saves your life deserves to be paid. I’ve submitted the forms to my insurance company. I’ll let you know what they say.