Alberta HealthCare

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.

The Patient’s Wife


There are studies showing the effect of care-giving on spouses, and they aren’tpretty. But they miss the heart of why it sucks to be the spouse of someone who’s dealing with a severe illness, no one is interested one whit in how they feel or how they are doing.

While healthcare professionals of questionable intellect, and dubious interest, carted Rob thither and yon today as though he were just another carcass, I rated nowhere near as important as meat on a rolling slab.

Never did I even see a doctor. The only nurses I encountered either ignored me or made it clear that I was wasting their time, though I can honestly say I didn’t see a single nurse above LPN status doing anything other than visiting with other staff members.

Granted, I was not ill. Rob was ill and seriously so with blockage that required a stent to correct. But I count. Regardless of my healthy status, I am deeply affected by anything that threatens my husband’s life and having had one die on me already, I have no illusions about it being impossible a second time.

Dr. Fortune Cookie had come and gone by the time Dee and I reached The Fort Hospital, a place I hope to never have to utilize again because there are one, maybe two tops, nurses on staff who seem to have any idea whatsoever of what is going on.

Exaggerate? Not I.

The nurse who helped load Rob up for his trip to the Royal Alexandria Hospital in Edmonton didn’t know that Dr. Fortune Cookie hadn’t shared any of Rob’s test results with Rob or me and that I had never even spoken to the doctor. She was slightly (emphasis on slight) surprised to find that neither Rob nor I had any idea of what test he was going to have once he got there or that we would even want to know that.

Earlier I’d asked Rob if it was typical of Alberta doctors to not bother to discuss things like what’s wrong with you or treatment options with patients and their families.

“It’s the nanny state in action,” he said. “We simply surrender to the void.”

Void is a good word for it.

Dee was a weepy mess by the time the EMT’s had loaded Rob onto the ambulance. As she and I stood there at the back of the ambulance bay waving goodbye, one of them jumped out and gave her a teddy bear – she was that distraught and I could tell it was making the EMT’s uncomfortable.

To their further credit, the EMT in charge attempted to explain Rob’s labs to me and update me on the angiogram he would be having.

EMT’s are apparently not required to take the same “patient’s and their families are incidental to the great health care process” course that RN’s and Doctors receive in the Great White Socialized Medicine North.

And I am not knocking the idea of universal heath care in general. Rob and I will never see a bill regarding his heart attack, treatment or follow-up care, but the system only sorta works. And the people who make it run on a nuts and bolts level are as big a part of the problem as the politicians who continually under-fund and slash health care budgets.

Half way to the hospital, my cell rang – and yes, I answered it because my husband who just had a heart attack was having an angiogram and god only knew what else because I sure hadn’t been briefed.

It was the nurse at the cardio-cath lab. Rob had asked her to call and give me an update. She told me that he was just going in and that the procedure would take 45 minutes to an hour and that we could see him after at the Digital Imaging Recovery Unit. She even gave me directions.

She would turn out to be the ONLY one who told me anything.

Dee and I found Edie and Mick in the waiting area. We dutifully waited for close to an hour before I questioned the receptionist – who unsurprisingly didn’t know squat. Couldn’t even find Rob’s name on the list of scheduled procedures and just waved me toward the recovery unit with instructions to “ask someone there”.

Just a note about the reception desk at  the Royal Alec imaging wing – it says “someone will be with you shortly”. Dee, Edie, Mick and I came in and sat for nearly an hour – were they only ones there – and the dimwitted receptionist never once asked if she could help us or who we were waiting on. Perhaps it is not her job, but it is the only waiting area for non-patients in that area.

Not only that, the doctors who treated Rob didn’t come out after the angio to let us know that it was over and that all was well.

I was told by the two nurses behind the desk in recovery that Rob was on his way to admittance.

“He’s being admitted?” I asked. I’d been told he would go back to the Fort Saskatchewan hospital – even if they ended up treating him. “Why?”

No reason was given and they dismissed me with instructions to meet up with my husband in admitting.

Needless to say, he wasn’t there. But a kindly young registrar made a couple of phone calls and at least tracked down his unit and room number for us.

Of course when we got to Unit 24 – the cardiac wing – he wasn’t there either.

And the nurses chattering happily away to each other behind the desk were in no mood to make a quick phone call to see where he was or if he’d come through the angio okay or if he was being admitted because something further was amiss or had gone wrong or he was going to need surgery.

Do I sound frantic? Ready to drop-kick lazy nurse ass all over Unit 24? Because I was.

“Go down and wait by the elevator,” the nurse waved me off like Queen Elizabeth shooing the help away. “He has to come that way sooner or later.”

And so I paced and was furious – mostly because I was worried.

I still didn’t know what had caused Rob’s heart attack, the extent of the damage, what the treatment would be, how long he’d be in hospital. Nothing.

36 plus hours after he landed in the emergency room at Fort Saskatchewan Hospital and going on four hours into his disappearance into the bowels of the Royal Alec in Edmonton and I knew exactly nothing. Had spoken with not a single doctor and been treated like a nuisance by all but one nurse – and she was the first one back in the Fort ER on Thursday morning, an exceedingly kind woman who answered questions and treated us like people.

The girls offered to go on the hunt for their father. It beat waiting and watching me pace in a futile attempt to quell the rising tide of fury and fret.

They’d been gone about ten minutes when Rob arrived.

He looked better than he’s looked in weeks – all summer really – and I was in such a tizzy all I could do was hiss at the women pushing his bed.

Where had Rob been? What happened? And didn’t anyone think I needed to know any of this?!

I wanted information. I cannot deal with being marginalized and treated as though what ails Rob has zero effect on me. The bed-pushers patted my head – which did nothing to improve my mood – and move on into the now off-limits ward.

Rob had no idea I hadn’t seen a doctor after his procedure by the way. He planned to call my cell if I wasn’t on the unit, forgetting, of course, that I had taken his phone before they hauled him into the city. He was actually expecting to see us there and was confused by the fact that I was upset.

The unit had closed for its two-hour “silent time” when I noticed that every patient who was ambulatory or allowed a wheelchair fled to havens unknown.

The girls arrived and as they were planning to head to the family reunion if the news was positive, they needed to see Rob pronto. It’s a long drive north and they were already under the gun to arrive before the sun set.

I sent them in despite the “closed” sign.

“Just look menacing,” I said. “No one will shoo you off then.”

I was past menacing, in case you missed that. I radiated displeasure and staff that went in and out, ducked their heads and scuttled around my pacing dervish self.

At that point, I wouldn’t have spoken to anyone had someone bothered to approach me with information. In fact, when Dee and I finally saw Rob – almost two hours after our brief reunion in the hall – I ignored the nursing staff entirely. I’d taken the information that Rob had given me and called my BFF in the states. She is a home health care nurse, and she filled the details in for me.

Dee and I visited only a little while with Rob. He was tired. Hungry too because Dr. Fortune Cookie had needlessly starved him with a clear liquids diet back in the Fort – it wasn’t necessary for his procedures. And Dee and I were worn to a nub with waiting.

They put Rob in one of those horrid little quad wards that I noticed on a previous visit to the Royal Alec. I think it’s an English thing. They remind me of the psych ward Will ended up on before the doctors finally admitted that I was right and they were wrong and stopped treating my late husband’s illness as mental.

Which brings up the bigger point. Although my Canadian experience was worse, in some respects it runs par with what I encountered in the early days of Will’s illness back in the states. I was ignored and made to feel as though my stake in what was going on was negligible. My spouse’s illness was none of my business because it didn’t affect me.

And to that I say  – “like hell”.

“If I ever get sick,” I told Rob, “do not ever bring me to this place.”

“Stop, ” he admonished. “That’s not being very yoga.”

“No,” I said, “it’s not at all and I don’t care.”

“All that ground lost,” and I could see he was trying to get me to smile – and after a while I did – but I still will never willingly be a patient at the Royal Alec.

The least scungy looking areas in the Royal Alec are the main atrium and the food court.  Everywhere else: the wards with their double and quadruple occupancy rooms, the nurses stations, the Digital Imaging Recovery Room  – every washroom I was forced to use – ooze age in a weary day labourer pushing past middle age kind of way.

A person could be coerced to look beyond appearance if  the personnel exuded dedication and love of what they do, but generally, they came off as utterly uninterested in patients beyond what they needed to do in order to get paid, and they reacted to families like they were bad smells.

Ask a question?  At best you’ll draw a blank stare and at worst a suggestion that perhaps you go bother someone else. Somewhere you will have to hunt for and walk such a distance away from the first person you queried that you won’t  have the energy to double back to the unhelpful sot who knowingly sent you on a snipe hunt.

And back to the doctors. I am still not convinced they do anything other than phone in and it’s even possible they are urban myths.

The most important thing in the end is that Rob is going to be okay, and that he won’t be trapped in that disappointing, underwhelming medical experience for too long.