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l’azile » phoning it in

October 24, 2006

phoning it in

catherine @ 2:41 pm

This expression has always amused me in its conceptual representation and I find it unfortunate that it can not be directly translated into French. I have never been amused however by what it stands for.

It has now been almost a month since I had my hip surgery and while convalescence has been challenging at times, in the last week or so, I think that things have indeed gotten better. The pain is much more manageable and the long incision left from the surgery is for the most part healed. In principle, in a couple of weeks, I should be able to start rehab.

Then last night, I noticed that something was poking out of my scar. It took me a few hypochondria-fuelled minutes to realise that it was in effect a stitch, the interior kind they install to hold things together at a deeper level. Usually, these are self-dissolving but by all appearances, this one does not seem to be. So it was left in there and as is usually the case, my body is trying to expulse it because it has no business being there. But since it is probably still tied inside and the incision is healed at this particular place, it is stuck there. And it can not be left there because, well, aside from the trivial fact that it is kind of weird having that little piece of material poking out, it can obviously lead to infection, which is the last thing I need.

After my surgery, a referral was sent along to my neighbourhood CLSC (a kind of local community clinic for health and social services) in order for a nurse to come by and remove the staples that had been installed at the surface level. But no mention was made of the fact that there was also this stitch. And besides, considering how deeply embedded it would be, I doubt this is the kind of thing she would have been able to remove herself. And, at my follow-up appointment at the orthopedist’s that lasted all of three whole minutes, he made no mention of it. Maybe he forgot, who knows.

And since he quite clearly articulated that he felt his job was done, that he did not even consider it necessary to do a follow-up x-ray at the six weeks mark (which is how much time that is usually needed for bones to heal), just to make sure everything was as it should be (I have a long history of not healing to standard expectations) before I started rehab with my prosthesis, considering also that calling his office is just about as complicated as calling the city of Montreal’s adapted transportation services, I would most likely be wasting my time. Nevertheless, I have left several messages but even if they ever do bother to call me back, I suspect they would just tell me to go to the emergency. So of course, despite the fact that there is nothing technically urgent about this, I will probably have to go spend at least 8 hours at the emergency, exposed to all sorts of super-bugs and aggressive drug addicts going through withdrawal, so that they can open me up again to remove a stitch that should not have even been left there in the first place.

I call all this phoning it in. It may seem harsh, I understand that mistakes can happen and that in the grand scheme of things, this one is minor. But mistakes have been made ever since I broke my hip and I have usually ended up paying for them. I will forego the details, it would take too long and if all of this is any indication, who, besides me, cares. But this has been an ongoing saga and most of the mistakes made were due to not taking the time to do things right the first time.

Due to decades of drastic budget cuts and mismanagement, our health care system here in Quebec went to the dogs a long time ago. Cancer patients often wait months to start chemo. It is now considered very normal to wait hours on end, if not days, to be treated in the emergency unit (to the point that for years now, the media regularly publishes on the Web estimated waiting times in the city’s various hospitals). I recently learned that preventive mammograms are now only covered by the system once you turn 50 ! Out-patient surgeries are now so common, people are often sent home the same day they had rather involved surgeries only to return a few days later in worse shape because they were just not strong enough or did not have the family resources to support them. Abuse, all manner of malpractice and avoidable death happen all too often though we usually only hear about the sensational stuff. Now I know that compared to some parts of the world, what we have here is not too bad but considering how incredibly taxed we are in Quebec, a good chunk of which should go to health care, we should have access to a better level of care than we do.

All of this obviously effects how people working in the heath care system do their job. But doctors are a special breed and orthopedists particularly so. I have had a lot of experience with doctors so I think I know enough about them to be able to make this kind of statement. And although once in a while, you are lucky enough to happen upon a doctor who understands that he or she is dealing with a real person (like my wonderful doctor at the rehab institute), to most it is just a job, a very lucrative job, but a job nonetheless. Expediency and overbooking are the norm and the more often they can swipe your health insurance card the better.

And of all the kinds of doctors I have been treated by, orthopedists are the least easy to deal with. They are the hockey players of medicine. They break bones. They drill and saw and hack away at you. They make you hurt. In essence, they are paid to be brutal. Not necessarily on a human level but on a physical level and naturally, that will spill over into how they deal with their patients. And besides, it takes a particular type of personality to practice the kind of medicine they do so you can not expect sensitivity and gentleness. But you should be able to expect them to do their job properly.

I also think that one of the reasons that I, more than most people I know, have such bad experiences with doctors is due to the fact that I have a disability and a complicated one at that. Which means that my problems are usually not your run-of-the-mill ailments and even when they are, it is generally not as easy to treat them as with someone who has no disability. I can usually tell at the first encounter how a doctor feels about disability. More often than not, his eyes will glaze over and I can practically hear him thinking “oh no, one of those cases, the kind I might end up spending years treating with minimal successful outcome”.

And the fact that I have been around hospitals all my life and know more about my condition than most doctors I meet means that I am usually more informed and will not hesitate to ask questions and want assurances that whatever they are proposing really is the best course of action. And whatever their speciality, most doctors really hate that. They hate having to explain themselves, they hate having to spend that extra time to prove, to whatever extent possible, that procedure X or pill Y really is in your best interest. They would much rather deal with a confused 87 year-old who thinks they are the second coming. And most of all, they hate being proved wrong and will rarely, if ever, take responsibility for whatever mistake they may have made. And here in Quebec, considering how our system works and how closely-knit this “boys club” is, it is next to impossible to hold them accountable for anything.

So if, like me, you are someone who has to deal with the medical establishment on a regular basis, you really need to be determined and persistent. You need to be willing to put in the extra time to ensure that your rights as a patient are being upheld. You need to be willing to take it upon yourself to ask the tough questions. And you need to try to not take it too personally. Considering that this is your heath and, in effect, your life at stake, it is not always easy. But then, the important things rarely are.

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