Emergency medicine: US & Canada examples (Part I)

On October 11, 2005, I broke my tibia and fibula and dislocated my ankle here in Ontario. On May 27, 2006, my Mom broke her right arm near her shoulder (proximal humerus). With the appropriate disclaimers about anecdotal evidence, I think the comparison between our respective medical treatments, in Ontario & Virginia respectively, are enlightening vis-à-vis our medical systems, both care & costs.

My story first:

In my case, on a bright fall day, at high noon, I fell down 2 steps while walking through a walkway I had not previously taken in Guelph, Ontario. I simply didn’t see the steps – distracted, perhaps by window shopping. I knew I’d done serious damage to my right foot when I looked down and it was, well, in a completely unnatural position. I turned it back, a kind man rushed out from the pizza store close by, and I asked him to call 911 and bring me a bag of ice. I calmly called Don on my cell and told him I needed to go to the hospital, but I didn’t know what hospital.

The ambulance arrived (I was a bit surprised how long it took), and the paramedics, after taking my vital signs, offered me pain medication. I declined, as I was feeling no pain. (Minutes later, I regretted this decision. The intense pain started quite soon, and the paramedics had to decline my request for meds as by that time we were on hospital grounds. Lesson learned: if you are ever in an ambulance and are offered pain meds, take them!)

Within 10 minutes of my arrival at Guelph General Hospital, I had been seen by a doctor, was given some pain medication, and a nurse had called Don to tell him where I was. Within about 90 minutes, I was given some serious pain-blockers and taken to x-ray. Within 2-3 hours, I had an orthopedic surgeon at my bedside in the emergency room, who discussed with Don & me my options. Bottom line: he highly recommended surgery to (1) aid healing the fractures; and (2) help avoid arthritis. He scheduled surgery for that evening, at 8:30.

I was taken to a semi-private room, was kept comfortable and pain-free (morphine, I think) until they wheeled me into surgery. I was briefed by the anesthetist, and surgery began ) on time. The surgery took longer than the estimated 90 minutes, because I had dislocated my ankle. The dislocation wasn’t apparent to the doctor, as I’d done such a good job putting my foot back to where it belonged – but unfortunately, my actions, while appropriate, didn’t repair the damage my fall had caused.

The next morning, I learned about my surgery & the hardware: a plate & 6 screws on one side, a screw and a pin on the other. I was also in significant pain, at least when the pain killers began wearing off. Pain was the biggest challenge for me during the first couple of weeks.

My nursing care was extraordinary. Not only did the nurses take care of my physical needs – changing dressings, helping me attend to personal needs – they were also nice, and took the time to reassure Don & me that things would be alright. Because of the issues with pain management, I ended up in the hospital until Saturday, October 15. During that time, my doctor came in daily to check on my progress. All – doctor, nurses – were concerned about the pain, and tried various solutions.

I was non-weight-bearing on my right leg for nearly 8 weeks. While I was hospitalized, Don built a wheelchair ramp onto the front deck. Once home, I began physical therapy (called “physio” up here) immediately. We rented a wheelchair, and borrowed other assistive devices: a walker (from the Canadian Legion, of all places) , a shower chair (from a friend), a portable commode (from the Red Cross). We moved to bedrooms on the first floor. (One of these days I’ll blog about how extraordinarily kind Don was during this time.)

About every 2 weeks, I had to go back to the hospital, to its fracture clinic. In addition to the fractures, I had a complication of a wound that didn’t want to heal–apparently my disclocated ankle nearly broke the skin, and as a result I had a lot of serious tissue damage. We’d make an appointment at the hospital, arrive at the given time, had x-rays taken, then waited a short period of time for the doctor to visit. At least once the doctor brought in a wound specialist because of my non-healing wound. The hospital provided special dressings and ointments for home use. The system was remarkably was efficient, but I was never rushed. I was generally in and out within 45 minutes.

Because I was in between jobs, my health card expired on November 1. After that time, hospital visits – including x-rays – were about $200. My doctor, knowing that I was not then insured, only saw me when he deemed it necessary; if x-rays were not needed, I went to his office. An office visit with him was $19.50. Nope, that’s not a typo – nineteen dollars and fifty cents! Physio was covered when I was under government insurance, but when I lost that, it was $35 per hour-long visit.

Bottom line: I received first-rate care from my doctor, from the hospital, from the clinic, and from physio. (Indeed, I’d e-mail Mom (a former nurse) after various hospital/doctor visits, and her response invariably was: “It sounds like they know what they are doing.” At times, I think she thought I lived in a 3rd world country.) When I had health coverage, I needed only show my health card. No paperwork, no fuss. During the time I was temporarily not covered, the fees were remarkably reasonable.

Tomorrow – Mom’s experience.

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