Health

No One Tells Me Nothing


Animated sagittal MRI slice of my beating heart

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The Canadian health saga continues with Rob’s first cardiac rehab meeting yesterday. His cardiologist – the one I’ve yet to even lay eyes on and who he saw just once during his procedure (which the doctor didn’t perform but merely supervised in any case) – referred Rob to a five week program designed to assess his fitness to return to work and get him back on the healthy heart road via an exercise program and fun little classes on weight control or sexual function.

Oh, that last wasn’t an either/or, but examples.

The cardiac rehab is located in Edmonton. Per usual the parking options were limited. So hard to come by in fact that a portion of the orientation is devoted to parking issues.

Rob was probably one of the youngest participants. Certainly no one else showed up with an eight year-old in tow. There was perhaps one gentleman in his late 30’s or early 40’s, everyone else was qualified for the discount menu at Humpty’s.

As we walked in, each patient receives a personal packet of info containing his/her appointment schedules and a menu of rehab class options in addition to the ones pre-selected to match his/her “event”.

No one has heart attacks. There are “cardiac events” only. It’s a pc thing.

The nurse who conducted the session tried hard to be brief and witty and was neither, but she told a little story at the onset which neatly sums up the health experience here from my perspective.

The operator at the hospital received a call one afternoon from an elderly woman wanting to inquire about the status of a patient.

“Who is the patient?” asked the operator.

“Helen Finley,” the old woman replied.

“Well,” the operator said, “I’ll be happy to get an update for you. Let me put you on hold and I will contact the nurse on the ward for information.”

A few minutes go by and the operator returns with good news.

“The nurse tells me that Helen is doing quite well. Her blood work came back normal and her blood pressure and other vital signs are good. In fact, she’s doing so well, that her doctor is planning to release her this evening.”

“Oh,” the old woman’s voice shook, “that is good to hear.”

“I’m glad I could help, ” the operator said. “Is Helen your daughter?”

“Oh no,” the old woman said, “I’m Helen and no one tells me nothing.”

Of course no one laughed. I suspect that any of the other people in the room could tell stories that mirror our experience. But the nurse didn’t mean to highlight one of the chief problems with the system here; she was trying to make a point about asking questions. The assumption being that patients are in the dark because they don’t ask questions rather than the fact that often there is no one to ask questions of.

After the presentation, which could have been mailed to Rob and lost nothing by way of information, we hung around until the auditorium cleared. Rob’s goal for the afternoon being to arm wrestle someone into giving him return to work clearance.

“After your stress test tomorrow and a couple of monitored exercise sessions,” the nurse explained, “you will meet with the occupational therapist, who will give you her recommendations to take to your family doctor. He will give you clearance.”

“Um, that’s not what I’ve been told, ” Rob said and went on to inform her of the buck-passing he’s encountered ever since he first asked “when can I go back to work.”

He had hopes of heading off to work on Monday when Dee returns to school. I kinda had hopes in that direction myself, but it could be another week or so.

Provided nothing goes wrong at the stress test.

That thought just won’t completely go away, and it’s silly because Rob hiked six miles not two weeks after he got home from the hospital. He’s installed air conditioners, and this last weekend, we were up and down the stairs at the Shaw Conference Centre from the river to Jasper Avenue more times than my legs care to recall. If he was going to drop, he’d have done it by now.

And his job is, frankly, physically more restful than any of his hobbies are.

A Stress Test


Stress at a plane with an arbitrary orientatio...

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Our entire summer could easily qualify as pushing the emotional boundaries, but aside from a few ER trips and a two nighter at the hospital, it hasn’t pushed me physically over the edge.

During the years I took care of my late husband, solo-parented and held a full-time job as a middle school teacher, I regularly broke physical stress limits.

I averaged 5 hours of sleep a night, worked out sporadically and ate just as haphazardly. When the body protested – and it manifested its displeasure vehemently – I ignored it.

“Suck it up, Buttercup.” Was my response. And for the most part it did and gave me what I wanted.

Today the old bag of bones is not so willing.

Less than 7 hours of sleep?

I don’t think so, says the body. We will now be sick.

Seriously, my body goes on strike if it is asked to do anything even remotely reminding it of days of yore.

So, this summer’s events have really only pushed my emotional buttons and redirected my thoughts to dark places I remember but have no real interest in revisiting.

This morning the phone rang. And rang. And rang.

Not quite 9:30 and I was still in bed.

Vaguely I recalled Rob getting up earlier and wondered why he wasn’t picking up, so I scrambled across to his side and grabbed the receiver from the nightstand.

“Hello,” I wheezed.

“May I speak with Robert?”

Robert is official. Someone who has business with him calls him “Robert” whereas telemarketers ask for him with a “Mr” followed by a rather East Indian pronunciation of our last name.

“Hang on,” I tell the woman as I scramble into my robe and head down the stairs to hunt up my husband.

He is nowhere but Dee is in the kitchen getting her breakfast.

“Where are the waffles?” she asks.

“Where’s Dad?” I reply.

“Oh, I haven’t seen him,” she tells me.

I have sent her out to the garage to look for him before I remember he had a doctor appointment in town.

“May I take a message,” I ask.

“This is a reminder about his stress test tomorrow with Dr. La at the crack of dawn,” and she begins to ramble off instructions for preparation.

“What?” I interrupt. “He has an appointment tomorrow? I thought it was this afternoon. No one told us about tomorrow.”

“Yes, ” clearly she is annoyed. She is a robo-receptionist and I am asking questions that prevent her from merely vomiting information and moving on to the next patient call on her list. “well, today is the rehab intake and tomorrow is the stress test.”

Which tells me all of nothing and it par for the Canadian medical experience course. In fact, I think the motto of Alberta Health is “information is for the professionals; just listen and obey”.

“He should take all his medication as usual, eat a light breakfast, dress appropriately as he will be on the treadmill and refrain from smoking prior to the test.”

Smoking?

When Rob got home, I told him about the appointment.

“Oh, it’s probably about my back to work release,” he said. “What time do I have to be there?”

“Dawn, more or less.”

“Really?”

We live outside of the city, an early morning appointment – factoring the rush hour means everybody up and ready with the sun – or there ’bouts.

“That’s pretty early for you and Dee,” he remarked. “Assuming you are coming along.”

“I was planning to. Don’t you want me there?”

“Well, yeah, just in case I drop dead it would probably be a good idea.”

“I wish, ” I replied, ” I could say that it hadn’t occurred to me that you might die, but it totally did.”

Why? I mean people take stress tests every day and mainly survive. My near 80 year-old mother just had one in the spring and emerged just tired.

Rob’s late brother-in-law, however, dropped dead after his.

I suppose that’s what they mean by “context”.

I reminded again by all this that I haven’t cried. Teared up once at the hospital the day of the angioplasty when they “lost” Rob for about an hour, but haven’t cried.

It’s like I am waiting for something to cry about because, as it’s been pointed out to me, nothing awful has happened to me.

And the point has been taken. So I suck it up like the Buttercup I am.

Tales from a Canadian ER


They call it “emerge” here. It’s Canada-speak for “emergency room”, and it confuses me in the same way that “ah” sounds are “aaaa”. Paaaasta versus pahsta. Just off enough to make me pause for a moment so my brain can catch up to my ears.

But whatever. When medical situations arise, Canadians go to the “Emerge”. And so went Rob and I on Friday just shortly before noon because he’d slept late and woke feeling light-headed and slightly heart-attacky again.

“I hope we don’t have to wait long,” he said as we walked in the front entrance of the Fort Saskatchewan Health Centre. Not hospital. It’s not big enough to warrant the title and that’s not my opinion only but the provincial health system’s too.

“Just mention the chest pains and follow it up with the fact that you had a heart attack three weeks ago,” I suggested. “I’m pretty sure that will warrant queue jumping.”

If there is one thing that Canadians pride themselves on it’s queuing up for health care. No one jumps the line. No. One.

Incoming patients are evaluated and served according to the seriousness of their condition but for the most part, everybody waits.

And waits.

I have yet to go to the doctor for any reason and not sit for at least two hours before actually being seen.

And absolutely everyone gets the same slightly understated care.

“Hi,” Rob greeted the admissions clerk, a big haired woman with that “another one” look on her face that they all have.

“Alberta health card please,” she asks even before inquiring what brings Rob to the centre that day because not having that card means that the next question is “and how will you be paying today? Cash or credit?”.

“I was here three weeks ago and had an angioplasty,” Rob tells her when she finally asks the nature of his visit.

Rob still has trouble with voicing the heart attack thing.

“And you’re here today…?” Because “angioplasty” doesn’t clue her.

“I’ve had chest pains …”

To her credit, he doesn’t get any farther. She directs him to the ER intake and asks me to come back for his paperwork.

Chest pains opens doors and makes hospital folk look attentive and even behave in a way that makes one feel as though perhaps their attention has been adequately captured.

That’s just an fyi.

We walked through the packed waiting room. I noted with interest the young punk-ish woman sitting between two RCMP officers manically chatting away for the alarming edification of all. A mother gathering her brood ever closer as the girl babbled.

“I told the operator that they could come get me and bring me to the emerge or send someone for my corpse.”

More on her later.

To gain admittance to the emerge wing, you go through triage which is manned by an EMT trainee – always – no exception that I have ever seen. You don’t see a nurse or a doctor until the trainee has practiced on you.

Rob assumes the position in one of two chairs they’ve set up for patient triage and the young man glances about with a slightly vacant but confused enough to convince me he is tracking mentally look on his face.

“Do you have paperwork?”

Protocol, people, it’s all about the proper paperwork.

“He’s having chest pains,” I explain, “the woman at admitting told me to bring him here and then come back for his paperwork.”

Big eyes. Falters slightly and then he begins intake while I head back for Rob’s passport to health.

At the desk the clerk has finished admitting Rob. She and her co-worker express horror at the fact that Rob is just 48. I am calm. That’s how it goes. Your spouse suffers from something that most people cringe away from and you are calm. Like there is another option, but people, by and large, find it hard to wrap their minds around. Been here before but forgot to get the t-shirt.

Meanwhile, the wild-eyed looking punk girl in the lobby is regaling the officers with her manic tales of suicidal intentions. As I listen, I gather that mental health services here are no better than in the States. The girl had been trying to get help for some time but units are full and the only way in is to suicide or state an intention to do so. She’d called the police, threatened to kill herself and they sent officers around to pick her up and get her admitted. She reminded me a bit of my brother when he is in one of his demonic up periods. I didn’t blame the others in the waiting area for seeking seats far away from her.

It took less than ten minutes to get Rob checked in and into a room. Chest pains rate a room as opposed to sitting in chairs that line the hallway. Which turned out to be good because an hour or so later, they brought a young man in on a stretcher and left him in the hallway – just across from the chairs – and he spent a good 30 minutes violently retching into a basin. Followed by another 15 or 20 minutes hacking up phlegm. I never did discover what happened to him though I knew that when Rob hit the 5 hour mark, the young man was still there. He’d been put in one of the cubicles and was no longer vomiting but they wouldn’t give him so much as a glass of water to rinse his mouth out because they were still waiting on test results. Canadian health care is big on assuming that anything could lead to surgery and therefore, no food or liquids.

Because of his history – Rob has a “history” now and it’s still something we are adjusting to – they followed the standard protocol.

Protocol demands two sets of bloodwork six hours apart and ecgs periodically over the span. In all, with the heart in play, expect to spend a minimum of 8 hours and as long as 12 being “observed”. And be advised that you could be in “emerge” for the duration.

There is nothing to do but wait.

We read and I occasionally broke the monotony by eavesdropping on the EMT as he admitted people.

One guy was quite interesting because it revealed something about the system here that in all ways but one is exactly the same as the plight of the un or underinsured in the U.S.*

He’d broken his arm.

A year ago.

He was in the Fort visiting his in-laws and his mother-in-law made him come to emerge because the arm was bothering him to the point where he couldn’t lift anything.

The nurse, and I, listened to his story and I suspect this is the norm for working poor.

He lived several hours away from the nearest health centre/hospital. He waited until the next day to go in because of the distance and he couldn’t miss a day of work. The x-rays revealed two hair-line fractures and he needed a cast but they wanted him to come back the next day for it. He couldn’t. A trip to the hospital cost him a whole day.

“It would’ve been seven hours,” he told the nurse. “I don’t have that kind of time to waste and the bus service ain’t that good. I wouldn’t have been able to get back until the day after.”

But as he was on vacation and in Alberta, health care works the same in Fort Saskatchewan as it does in Calgary, he let himself be talked into coming.

“i just need you to put a cast on it.”

Of course after a year it wasn’t that simple and the nurse finally gave up trying to explain it. She sent him to x-ray. Let the doctor deal with him – when he got the chance.

There was just one doctor on call. There is only one. There are five rooms and at least ten chairs plus a waiting room full of chairs. So in theory, the doctor can be responsible for over a dozen patients in varying stages of diagnosis and severity over the course of a shift.

The doctor this time – at least – discussed the situation with us and I actually got to listen in.

In the end, it wasn’t another heart attack. It turns out that the Lipitor is a hard drug and it could be that Rob won’t be able to tolerate the muscle pain it causes. Some people can’t. Some people are even debilitated by Lipitor as it breaks down muscle tissue in addition to scouring the veins of cholesterol. Lipitor actually triggered ALS in my cousin’s father within months of his starting it. He died a horrible death.

So it’s the Lipitor. The heart is okay. I am a tiny bit less worried about Rob dying on me anytime soon, but the ghost snuggled up to me in bed last night. Really. So things are apparently dicier than they appear.

*Universal health care sounds nice. You don’t have to worry about not being able to pay for the doctor visit or the trip to the hospital. But … isn’t there always? Drugs are covered. The time off work isn’t covered. And in a country where there are few big cities, many people live hours away from care. Getting to and from is arduous to impossible and that’s if they can afford to take time away from work or children. For the poor and working poor, the obstacles to care will always be. Just having access to care isn’t the end of the problem.