As I sit perched on my hospital bed, recovering from a post-surgical infection, pain managed by a magical concoction of drugs, I can’t help but think about our health system and others, of which I have recently been a super-user.
I’m at the Ottawa Hospital in the physiotherapy gym, which has been transformed into a pop-up unit. There aren’t sufficient outlets to run the beds and the IVs at the same time and there’s no oxygen but overall, it’s set up well as a ward. Perfect for the couple of days you are supposed to stay. I’ve been here for seven.
I ended up in the hospital after a drastic drop in my blood pressure and a significant fever. After an overnight in the ER and a short stint in the pop-up conference room ward, they brought me upstairs. The hospital is overcrowded, the staff exceptionally busy and patients are suffering from multiple ailments. There is no privacy.
It is frustrating, painful, shameful and demoralizing. I still prefer it hands-down to the private system.
In January 2021, while living in Brasilia, I saw the second line appear in the test I was holding in my hands, a happy positive: I was pregnant. I had been in Brazil since 2017, and attended to in their private system. It took a while to find a good ob-gyn; there are many and it is hard to find credentials or referrals. It’s easy to set up an office and put some diplomas on the wall. It’s harder to assess the schools from which they come. We settled on our third practitioner, paid for our consult and she immediately sent me for the exact same blood tests I had had a couple of weeks earlier. They cost more than $1,000. Your blood type doesn’t change, no matter how many times they run the tests, but who was I to question?
Next up was the ultrasound, the second already by week seven; the credit card changes hands and the pattern continues until the end of the first trimester, my arm a pincushion and my pants lined with ultrasound jelly. Things that would not be indicated here were required there.
After a successful battery of tests and a perfect first trimester ultrasound, I was finally able to relax a little. Until I found a lump. In this, the private sector has the advantage of speed. I had an ultrasound two days after discovery and a biopsy result by the end of the following week. I was 15 weeks pregnant with Invasive Ductal Carcinoma, good old breast cancer. The pay-per-use, pay-then-claim system I was beholden to at least ensured my expenses were covered but there is no easy way to explain the bureaucracy.
The detailed hospital bills itemized by piece of gauze; the need for me to arrange my own anesthesiologist; to pick the lab to which I would submit the test-tube containing the material of my illness; the immediate direction to the finance desk upon arrival at the ER regardless of how sick I was. No centralized records, no system to share results. I carried multiple MRI and CT scans around town. Unsure, why, before the cancer, I had needed that many scans, but every doctor ran their own tests. Then came the claims: better not lose a receipt.
No centralized records, no system to share results. I carried multiple MRI and CT scans around town.
So when the oncologist called me on a Friday with news of my diagnosis, she launched into a treatment plan that involved starting chemotherapy the following Monday. My head still spinning, I was unable to process her plan: 16 rounds of chemotherapy every two weeks and then every week. We called the hospital, because it was up to us to book those things separately, to ensure we requested the right needle and proper number of hours. The conversation was confusing.
I hit pause and decided to think over the weekend. I was abroad working for the Canadian government but I had to come home. In five days, I packed my life with two senior cats and a new husband in tow and got on a plane in the midst of a pandemic.
Blessed with a family doctor in Ottawa, I had a referral to the Ottawa Hospital immediately and met my surgical oncologist via Zoom from the mandatory quarantine hotel at the airport. I had a medical oncologist and radiation oncologist on my team already and was due to meet them within the next couple of weeks. Everything was taken care of and I comfortably started chemo with precautions before I was even done my two-week quarantine. I never scheduled a thing. Appointments were made for me, I never doubted we were testing for legitimate things rather than to inflate the bill, and I was never worried to ask for a water for fear that a $10 charge would show up on a bill prompting an insurance refusal. I have never felt that the care I have received is subpar.
My gratitude has only grown with time and experience. Support group calls with women in the U.S. are always underscored by financial stress, worries about co-pays, and losing their insurance when they aren’t able to work any longer. In fall 2021, within eight weeks, I finished chemo, my son was born by c-section, and I had my first cancer surgery, followed by an infection which required hospitalization. A few days later the pathology came in and I underwent another, more drastic surgery. I cannot fathom what this would have cost in the private system but I can imagine how stressful it would have been negotiating with the insurance company and the hospital accountant.
Canadians know the weaknesses in our system, made even more evident by the pandemic, but fewer know the pitfalls inherent in private health care. We need to do better; our system is here when we need it and it needs us to fight for it now.
Jessica J. Mills is currently on disability leave from her role as a Foreign Service Officer with Global Affairs Canada. She is married with one toddler and lives in Ottawa.
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