The Utter Gall

Me again. Had a busy couple of weeks.

What you may be about to read has nothing to do with my usual lines of inquiry or attack, so you don't have to stick around if you don't want to. But there is a story and a point to it.

First, you might want to check out this New Yorker piece about the history of health-care reform in the United States. You also might want to read these two unrelated stories from the November 29th edition of News of the Weird:

In April, Richard Huether, the manager of the HoneyBaked Ham outlet in Cary, N.C., was shot in the stomach during a robbery of the store and hospitalized, with medical bills paid through worker compensation and his employee health benefits. In September, when his worker compensation expired (and though still at least three months away from returning to work), HoneyBaked fired him (forcing him to begin paying 100 percent of his insurance premiums and making subsequent insurance prohibitively expensive because of his new "pre-existing condition"). However, HoneyBaked human resources executive Maggie DeCan told WRAL-TV that the firing was for Huether's own good, in that it would clear the way for him to receive Social Security disability payments. Said DeCan, "We couldn't feel any worse for Rich, and we would do anything we could for him (except keep him on the payroll)."

Patient Jim Bujalski complained to St. Anthony's Central Hospital in Littleton, Colo., in September about the cost of his prescription Plavix and Crestor tablets, which he was forced to "buy" from the hospital because it administers only drugs under its control. The Plavix was $248 each (he pays $8 at home), and his Crestor ($3 at home) was $65. The medications were part of his $58,000, one-day hospital stay.

Oh. and you might want to watch Canadian comedian Mary Walsh get insufficiently cerebroid presidential would-be Sarah Palin to say that the Canadian health-care system ought to be dismantled in favour of the American style of health insurance.

Keep these things in mind as you read the following.

Just before 10: 30 on the evening of Tuesday, November 17th, 2009, I got a phone call from my husband*, Jim, as I was heading home from work. (We don't own a car, so I get the bus or, more usually, accept a ride from a co-worker.) He had had a sudden attack of abdominal pain and needed to go to the emergency room immediately, so I advised him to call a cab, which arrived seconds after I did.

We were checked in to triage by 10:40, and sat down to await a doctor. Jim's pain flared up and subsided repeatedly, becoming less acute with every wave. We were fairly certain that it was related to his hiatal hernia, which had been diagnosed some time before. By 11:30 or so, we were in an examination room, and by 12:10 a doctor had arrived. By this time the pain had diminished almost to nothing, and the doctor agreed that it was probably the hernia, so Jim was released.

On Wednesday we both stayed home from work. Jim improved.

On Thursday, I was at work when I got a call from a co-worker of Jim's saying that she had brought him to the emergency room with the same pain he had had on Tuesday night. Coupled with the attack a couple of days previous, this was considered worrisome and unlikely to be related to be the hernia, so Jim, stable and no longer in pain, was asked to be at the hospital at 7 the next morning.

We had to wait a while, maybe three hours, to see a doctor: this is unsurprising, as we are in the middle of flu season and the media have done a very good job of terrifying the populace. Some blood was drawn, and a sonogram was performed. We had to wait another few hours for the results of these tests to come back. When they did, the conclusion was unambiguous: an inflamed and possibly infected gall bladder that had to be removed as quickly as possible.** After another short wait, we spoke to the doctor who would be performing the operation, and she immediately put us both at ease: forthright, no-nonsense, willing to answer all our questions, not interesting in sugar-coating the facts of the operation*** but also unworried about its likely outcome.

While Jim waited in the examination room for a hospital room to open up, I scooted home by cab to get some necessities for Jim's stay. A few minutes after I got back, he had a room, and he was prepped for the first of two operations: an endoscopy to clear out the bile duct, which was apparently clogged with at least one gallstone and what all the doctors unnervingly called "sludge". This was performed Friday night, and although it went perfectly, the less said about it, the better. Let's just say that Jim doesn't like endoscopies.

The second operation was scheduled for Saturday at 9 a.m., but an emergency operation of some sort took precedence, and we had to wait some more; at least four hours, we were told. I went home to do some housework and get some groceries, and returned to the hospital around 1. Jim was wheeled in to surgery around 2 p.m., and a little before 4 was back in his room, groggy and gall-bladderless, but not too much the worse for wear.

The next day around 1 p.m., already mobile, he was released. He took a week off work to recuperate, becoming visibly stronger by the day, and today he's back at work. He won't be able to go to the gym for a few more weeks, and the incisions aren't pretty to look at, but he's basically repaired.

And now, the point of the story. The cost of the entire adventure:

Oh, maybe a hundred and fifty dollars for the various cabs to and from the hospital from Tuesday night**** through Sunday afternoon, and $13.28 for the prescription vial of tiny Dilaudid***** tablets to ease postoperative pain. And Jim spent $27.12, tax included, to rent a television for three days in case he was so bored that he needed to resort to its mindless blather, though he used it for maybe an hour total.

If it had occurred to us to request the semi-private room in which Jim was settled, it would have cost an extra $65 a night. (A private room would have been $75.) Since he was simply assigned the next bed that came available, there was no extra charge. The many bags of Ringer's Lactate and potassium hydrochloride that were hung on his IV pole to hydrate him and keep his electrolytes up, the various antibiotics to keep the pre- and post-op bugs at bay, the Dilaudid injections immediately after surgery, the operations themselves, the room, the eventual meals (Sunday breakfast and lunch, since he had put nothing in his stomach from Thursday night through Sunday morning), the nursing care; no paperwork, no co-payments, no for-profit medical-insurance bean-counters deciding which procedures and line items might or might not be covered. We needed emergency medical care and we got it, promptly, professionally, excellently. I do not pretend that every Canadian gets such good care or such results, and I do not claim that it was the Platonic ideal of medical care, with no waiting time and every single decision the correct one; but the fact is that like us, every Canadian has the right to whatever medical treatment is required to make them healthy and whole, without fear of bankruptcy or dunning creditors for years to come. We paid for it, of course, through our taxes, but when the time came for us to use the medical system, it was there for us.

There is a lesson in this.

* We live in Canada, we're legally married and we're two men, and although "husband" is the entirely correct and logical term, I still hesitate before I use it, every time. Old-fashioned of me, I expect, and I know the next generation won't even blink, but I still can't help thinking that where there's a husband there must also be a wife, and I'm nobody's wife. I generally use "spouse", though I guess I'm not altogether happy with that, either. No pleasing some people, especially me.

**This should, of course, have been discovered on Tuesday night. We were led to believe that the doctor who saw us that night was disciplined for making what could have been a very serious, possibly even fatal, oversight.

***A cholecystectomy, as it is called, is nowadays generally performed laparoscopically, which means that a few very small incisions are made into the abdominal wall to allow the insertion of a tiny camera, a pump to inflate the belly with CO2, a cautery to seal the wound left by the removal of the gall bladder, and the device which actually does the cutting and withdrawing. If the gall bladder is too large or dangerously inflamed, or if the patient is over 50 (Jim just turned 50 weeks ago), then the laparoscopy may not be feasible and a larger incision through the abdominal muscles must be made. This takes a harrowing four to six weeks to recover from, as opposed to a week or two for the laparoscopic procedure. The doctor said they'd start with the laparoscopy, but if it couldn't be done, they'd have to convert to an open cholecystectomy: luckily, this didn't happen.

****On Tuesday night, the cabbie, seeing the gravity of the situation, ran a couple of yellow lights, and I tipped him almost 100%. I think he earned it.

*****Dilaudid is a really horrible drug; Jim had an awful time with it, and after a couple of days he just jettisoned the stuff. We were happy to be rid of it. It's basically heroin, or at least morphine, and I can't conceive of how it could be used for pleasurable purposes, because some of its side effects are dizziness, sweating, and hallucinations. But then, I don't even drink.