In examining me, the doctors found I had a heart murmur.  Checking into that meant an ultrasound.  Since there's usually nothing urgent about a murmur, the ultrasound didn't have to be done right away; I waited a couple of weeks, if I recall correctly.  What they found was that I have a bicuspid heart valve, which is pretty common; heart valves are supposed to have three flaps, but in some people they only have two.  These valves are typically a little weaker than tricuspid valves, but some people live their whole lives without any problems.

So the valve was fine; but my ascending aorta was not.  This aorta, which takes blood from your heart to the lungs and brain, is supposed to be 3 centimeters across; mine was over 4 and expanding slowly like a balloon. If it gets too big, it pops, and that can happen with absolutely no warning.  An ascending aortic aneurysm is one of the most notorious "silent killers" of cardiology, because often, the first sign that you have the condition is death.

The treatment is to replace the thing; but doing that is dangerous as well.  When I learned that I had the condition I was sent to a cardiac surgeon, and we decided together on a simple strategy:  we'd watch it carefully, and when the odds of my dying from the aneurysm became higher than the odds of my dying from the surgery, we'd do the surgery.

What followed was literally years with the sword of Damocles hanging over my head.  I would get an MRI once or twice a year, and for the first few years, there was no change between MRIs; yet every time, as the time between scans drew out, I would get more and more of a sense of dread about what might be going on inside me.  Was it expanding with unexpected speed?  That can happen.  

Here's where there may be a difference between the Canadian and health care US systems:  I suspect (though I don't know) that I would have had more frequent scans if I were living in the US.  On the other hand, more frequent scans may not make  a significant difference in the vast majority of patients, other than to provide emotional reassurance that they're being taken care of.  Hard to know.  What I do know, is that the nature of my treatment, and even whether or not to operate, was a matter strictly between me and my surgeon.  There were no other parties involved; nor, in this country, can there be for such a procedure.

We made the decision to put me on beta blockers, which can significantly reduce the risk.  Here's where traditional private health insurance comes in, because in Canada many drugs are not fully covered under the public system, so the patient has to make up the difference in cost unless they have a private drug plan.  I was covered, so my drug costs averaged about $2 a month; without that coverage, I would have paid about $15/month (the standard beta blockers are very old and very inexpensive).

In fact, there's tonnes of medical expenses here that aren't paid for by the government.  I pay my chiropractor directly, for instance, and get some of that back at tax time, but not much.  I pay for my eye exams and for my glasses. The Canadian health care system is a hybrid of public and private options--and as a consequence, Canadians are well aware of what their care actually costs, because we frequently have to pay for it directly.  We all have direct experience with both public and private health care.  Overwhelmingly, Canadians prefer the public option.

(Now, personally, I don't think you can call it socialism when the government is permitted to also be a player in a commercial marketplace, while being forbidden to monopolize where the private sector can do better; call me crazy, but to me that's just a level playing field.)

Anyway, for eight years I walked around with a time bomb in my chest, not knowing on any given day whether today was the day it would go off.  I became a much more cheerful person during these years; but the experience also aged me in unexpected ways.

And then, on June 6, 2008, I had my semiannual MRI and, in the followup appointment, my surgeon said, "You have a thirty percent chance of dying at some point in the next twelve months.  I think we should operate."

I could have said no, of course.  What I did say was, "How's six weeks from now?"

He shrugged.  "No problem.  We can do it whenever you want.  ...Next friday works for me."

"Um...   No, let's make it six weeks."

I'd been expecting this for eight years, but I would still need time to prepare myself.