What Canadian health care is really like: 3. Heart surgery in a public system
Access is an issue, but it's a geographic one. I was lucky I live in Toronto
In July 2008 I learned I would have to have heart surgery to replace my defective ascending aorta. Since I also had a bicuspid heart valve, my surgeon and I discussed whether to replace that at the same time. This conversation did not involve money, because money wasn't a consideration for either of us. Neither my insurance company nor any level of government were even consulted, because it was a matter between my doctor and me.
We decided to leave the valve where it was, for now. I got to set the date of the surgery, and with some irony decided on the day after my birthday: September 5. The surgery would happen at Sunnybrook Hospital in Toronto. (Sunnybrook is a teaching hospital and research center, but because there's only a single tier of health care in Canada, everybody in the community has equal access to it, regardless of their demographic. My GP is at Sunnybrook, but I needed no particular privilege to get her.)
At this point, all sorts of things were set in motion, but all I had to worry about was keeping in good physical shape, not getting sick--and banking blood. This last activity is an option for major surgery, where you may go through many units while on the table. What you do is donate to yourself ahead of time. So, on two occasions prior to the surgery, I went downtown to the blood bank to get drained. The procedure was, of course, to flash my OHIP card and then fill out a form; and then to get hooked up.
Having already been entered into the system, the process on the day of the surgery was even simpler: I just showed up, lay down on a gurney, and was taken to the OR.
--Actually, that's not quite true. I had to sign a waiver: $3.00 for the use of the phone next to my bed, once I got up to the recovery ward.
Having a so-so time
The surgery went really well--five hours in a cradle of crushed ice, with no pulse and my chest splayed open. It was afterwards that things got a little dicey.
My heart wouldn't settle down. Rhythm problems afflict about a third of heart surgery patients, so it wasn't at all surprising--to them. To me, though, the next ten days were hellish, because with my heart popping into atrial fibrillation at the least provocation, I couldn't even get out of bed. The first few times it happened, they cardioverted me (which is to say, they put the paddles on me and stopped/started my heart). After the third time, they decided something a little gentler was called for, and put me on a drug called amiodarone.
Amiodarone is sometimes called "the devil's anti-arrhythmic" because it's incredibly effective--and has incredible side effects. --Side effects like crystallization of the corneas, and stiffening of the lungs. For the first three days I was on it I threw up constantly. To cope with that, they fed me a cocktail of other drugs with exotic names.
All told I spent eleven days in hospital--six more than usual. Normally they kick you out less than a week after the surgery. Normally, they don't ply you with all the drugs I ended up taking. But, because I had my surgery in a public system, the extra time and the cost of those drugs weren't factors in anybody's decision-making. I got the care I needed, and when I did go home I was ready for it.
I was also, by the way, in a semi-private ward, meaning I shared a room with two other guys. We had physios, TV, 24-hour nursing care (of course), and utterly abysmal food that was the only element of the system prepared by a private company. (They should be shot for giving nauseated heart patients meals consisting of two slabs of white bread with a dry piece of turkey breast between them; my wife snuck in rich pate-and-crackers, and fresh raspberrries--high-iron foods, both.) I'd brought in my iPod and a portable DVD player, and watched many episodes of Avatar: The Last Airbender while waiting for my heart to settle down.
All this did end up costing us; aside from the $3 waiver, there was about $100 in parking that my wife paid for. For everything else, however, economic considerations were simply not a factor; nor was access.
Then I got home, and had to face six months of recovery. Luckily, a system was in place to help me with that, too.