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My Turn in the Scanner

After a stroke, I found myself embedded in BC's strained healthcare system. A report from the front lines.

Crawford Kilian 3 Mar

Crawford Kilian is a contributing editor of The Tyee.

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Sooner than you expect, it may be your turn.

On Jan. 9, sitting down to lunch with my Tyee colleagues at a good Chinatown restaurant, I felt my face go numb. Not all of it -- just a small patch around the left corner of my mouth. Part of my tongue was numb too. It felt very much like dental anesthetic that hadn't quite worn off yet.

Am I having a stroke? I wondered. As a matter of fact I was, but it would take me a week to confirm it. In the process, I renewed my respect for our healthcare system.

For a few days I managed to ignore the numb patch. It felt funny, but it didn't hurt. I expected it would fade away. Then, on Jan. 13, I woke up with a cramp in my left leg. I rolled out of bed to walk it off, as I usually do, but this time the leg would barely support me. It was still weak when I got up to walk the dogs.

Two alarms on the same side of my body told me that something was wrong and wasn't likely to fix itself. That morning I called my doctor; he was booked solid, so I made an appointment for the following Monday afternoon. Then I took myself to the Park & Tilford walk-in clinic.

The doctor listened carefully and did a couple of simple tests: I bared my teeth in a big grin, and held my hands out side by side. No real problems, but the doctor wasn't persuaded. Suspecting a transient ischemic attack he told me to go straight to Lions Gate emergency.

So my first step into the healthcare system was a solid one: a doctor who listened, observed, and took action.

Once in LGH emergency, I waited a few minutes before being admitted. Someone escorted me to a bed where I had to don a hospital gown over my shirt and pants, bringing back memories of my two weeks in a polio ward back in 1948.

Life in emergency

I phoned my wife to let her know what was happening, and then settled down with a good book. But it was easy to be distracted by watching life go on in emergency.

Maybe it got more exciting that night, but Friday afternoon was very calm. Nurses were friendly and cheerful. Everyone cleaned their hands at the dispensers. A doctor showed up before long, listened attentively, and packed me off for a CT scan. The techies were young women with impressive poise. Back I went, pushed in my bed by a guy who didn't seem to mind all the chauffeur service.

More time passed, interrupted by frequent blood-pressure tests. At one point I took off my robe and marched out to feed the parking meter. Soon after, I was rolled back for another CT scan, this one an angiogram: dye was pumped intravenously into my system to see if my veins and arteries were OK. The techies warned me that this time I might feel as if I'd peed myself, but it would be an illusion. They were right.

This scan showed some contraction in my carotid arteries, which the doctor explained clearly. He said he'd referred me to a neurologist at Burnaby Hospital for the following Monday. The scans didn't really confirm a stroke, but something was clearly not working properly.

And it wasn't transient. The facial numbness persisted. Over the weekend I was aware of a persistent weakness in my left leg and an annoying inaccuracy on the left-hand half of my computer keyboard.

At Burnaby Hospital, I spent some time waiting in a room with several other patients, including one in a bed. A big TV blasted us with high-definition junk; by now I suspected that the major problems in Canadian healthcare are TV and parking.

A new hole in my head

The neurologist, casually dressed in a striped sweater, listened attentively to my story. He had me grin and hold my hands out. He also mapped the boundaries of my numb zone with the point of a safety pin, tested the strength in my left hand, and made me hop on my left foot. Then he walked me down to a third CT scan. The drill was slightly different, but the young women technicians were again poised and professional.

After another wait, the scan arrived by email on the neurologist's computer. He pointed to a dark patch on the right side of my brain, in the thalamus, and explained that it controlled the sensory input on the left side of my body. The dark patch, a lacune, was the site that, until a week ago, had told me what was happening around my mouth and the left side of my tongue. Now it was a brand-new hole in my head. It had taken this long to make itself visible to a scan.

"You've had a mini-stroke," he told me, specifically a lacunar stroke, and then he concisely described my future: "One baby aspirin every day for the rest of your days," to keep my blood thin. A low-carb diet and enough exercise every day to make me break a sweat for 20 minutes. "Stick to it, and you're golden."

I phoned my wife with the news and then headed to the appointment I'd made with my GP the previous Friday. By now he had the results of recent blood tests, as well as the neurologist's faxed diagnosis. My blood pressure was higher than it should be in a guy who'd had a mini-stroke. My blood sugar was high also, enough to be considered pre-diabetic. I would indeed go low-carb, which also meant less alcohol.

Back to basic

The last few weeks have reminded me of basic training in the U.S. Army back in 1963, only with less yelling. I can't argue with my new regime. The exercise is as exhausting as double-timing across the sand dunes at Fort Ord. But where I gained eight or 10 kilos in a few weeks on exercise and army chow, I've already dropped seven or eight kilos by eating less, walking fast and chopping a lot of firewood. I sleep almost as hard as I did in basic.

The prompt and professional response of healthcare workers certainly contributed to my changed behaviour. Cases like mine must be routine, but no one treated me that way. Attentive, observant and decisive people were serious about me; I have to be serious about myself.

Still, I saw some aspects of the system that need improvement. At LGH, the woman in the bed next to mine had a full colostomy bag: "I stink!" she declared. The nurse attending her couldn't do much about it because no replacement bags were available, but he tried to reassure her that the smell wasn't so bad.

At Burnaby I again found the involuntary intimacy that patients must often share. Some were lying on gurneys in a main corridor just steps from the cafeteria. Others, some in hospital gowns, waited their turns for a CT scan; they looked either grim or anxious as they contemplated what the scan would tell them. As I learned only later, Burnaby has had recurring problems with outbreaks of Clostridium difficile, an antibiotic-resistant bug that's believed to have been a contributing factor in the deaths of 13 people from 2010-2011.

While we all faced our own mortality, we were not, at least, wondering how the hell we were going to pay for all this treatment.

Counting the cost

Politicians moan about the growing burden of old folks on our healthcare system, not to mention the way we soak up CPP and OAS. So I wondered how much I was costing the system. What, for example, was the cost of my afternoon in LGH emergency? And what about those three CT scans?

Considering the politicians' angst about health costs, the numbers were hard to find. I finally got some from a very nice PR person at Vancouver Coastal Health. She couldn't estimate an average cost for a visit to emergency; "That comes out of block funding."

But uninsured and out-of-country persons who show up in a Vancouver emergency department are looking at a per-visit fee of $500, plus an emergency doctor's fee of up to $500 more. These rates are closely aligned with those in Washington state hospitals, to discourage uninsured Americans from crossing the border in search of a bargain.

As for CT scans, she told me that they range from $650 each for an uninsured resident to $1,325 for a nonresident. So if I'd been a foreigner, diagnosing my mini-stroke would have cost me around $5,000 -- not counting whatever the neurologist would have charged me.

I'm aware that fewer workers are available to cover the costs of more seniors. Back in the 1980s, I was writing articles and giving speeches about just this demographic crunch. I don't feel remotely guilty about imposing this burden on younger taxpayers.

After all, I've been paying taxes for almost half a century to cover their education costs (and their parents'), not to mention their own medicare. My own demands on the system over that time have been few and far between.

The value of young Canadians

Sure, older folks will need more support as the baby boomers retire. The answer is not to cut back on seniors' pensions and healthcare, but to ensure that young workers are as productive and well-paid as possible. Young Canadians have the value of scarcity, and we shouldn't let a single one drop out or drift into a dead-end job.

That means (as I used to say in the 1980s) that they need a major investment in their education, so they can earn high incomes. After all, they won't just be supporting the old folks. They'll have to support themselves while bringing up children whose education will be equally critical.

We can and should bring down healthcare costs wherever possible: using generic drugs, limiting needless tests, and especially practicing preventive medicine.

But we should never simply "cut costs," least of all on the pretext of a generation war against seniors who live inconveniently long. That doesn't make the costs go away. It only downloads them onto the old, the young, the sick, and the poor -- and those remarkable healthcare professionals who look after us all.

We need to remember that -- sooner than we expect -- it will be our turn in the scanner.

[Tags: Health.]  [Tyee]

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