I have had some time to think about my experience in Canada after falling and injuring myself and thus ending up in the emergency room at the Port Hardy Primary Health Care Center. There is always that talk about the difference between American and Canadian health care and I had a chance to experience it firsthand. And as it turns out, I also had an opportunity to appreciate my own privilege and realize the access to health care that I take for granted.
First things first, I had an ambulance ride and arrived in the middle of the night to the hospital. I was in my wet and mud spackled hiking clothes toting my backpack with my loose sleeping bag and trail shoes hanging off it. The information was passed on that I was a hiker and had fallen.
The room I was left in to wait was right next to the counter where the staff stand, talk and enter things in the computer. I could over hear them talking and basically they didn’t know what to do with me. I wasn’t Canadian and everyone in Canada has insurance. The same insurance. They asked for my ID and insurance so of course I handed it over but it looked completely foreign. So, they asked for my credit card which I promptly handed over. All I could think was, let’s get this going. I’m in pain.
I could hear them debating about whether or not to sign me in, they kept saying it would automatically charge me. There were several calls “down island” to figure out how just to sign me in so I could have a patient ID number. I have a feeling the nurse was reluctant to do this anyway. In MY mind I already knew that was inevitable but I guess they didn’t know I was “really” hurt yet.
They hadn’t really offered me any pain medication at this point but that wasn’t completely different having been in the ER for a migraine before and their American counterparts were reluctant to give out the drugs then, too. But the difference was that they kept talking about how much it would cost me.
I noticed during this time that each room in the center had the price list posted right on the wall. Yes, the PRICES FOR EVERYTHING. Non-Resident of Canada prices (no insurance). This included the base fee for being admitted to the ER, the price of the X-rays, etc.
And of course at this point, I DIDN’T CARE.
Eventually, I had the nurse and doctor standing in front of me asking me to move my arm so they could see what was wrong with me. WHAT?!? I mumbled something about how there was not going to be any “moving my arm”, I was in extreme pain and it simply wasn’t going anywhere. Then the doctor said, “If you don’t move your arm, we can’t help you.” I was perplexed for a moment, shaking my head. What? I thought, can’t you just take an X-ray??
Then he said, “If we have to take x-rays, it will cost you a lot of money.” I thought, how much can it cost? Thousands of dollars? I was pretty sure that wasn’t the case but he was making it sound like it. I told him yes, I want x-rays. Just do it.
This turned out to be the theme for my time in the ER, “It will cost you a lot of money.” I was so perplexed at why they kept saying that. And all I could think was, I DON’T CARE. I have money. Not a lot of money, but I have a saving account, a good job, retirement, I own my home. I have a credit card. A fantastic credit score. JUST FIX ME.
Okay, maybe not quite like that but I did almost remind them that I had given them my credit card.
It was probably another hour before the on-call x-ray tech was woken up and arrived to the clinic. Or at least it felt like it. At this point, the conversation out front was that the nurse had to admit me because the X-ray tech couldn’t do what she had to do without a patient number. So the nurse reluctantly admitted me and I was finally taken for x-rays.
The tech asked me a few questions, moved me into position and went back into the little booth to push the button. Or whatever it is they do back there. After two images, she stopped and said, “Oh, I don’t think we really need to take anymore.” Then she came over and said, “You must have a high tolerance for pain.”
Oh, you don’t even know, lady.
Returning to the room, the tone had changed. Everyone’s face had gained a look of concern for me. I was given morphine and the doctor told me he was going to show the x-rays to the orthopedic specialist “down island”. I had a dislocated and broken shoulder (which I had to have him explain more specifically to me that my upper arm where it joins the shoulder blade had broken in several places). My orthopedic doctor here has since used the word, “crushed”. He even cringed and sucked in his breath while looking at the MRI and muttered, “Ew, that’s bad.”
Okay, more waiting. Morphine doing nothing for me except make me sleepy.
The return of the doctor brought news that it was okay to “reduce” my shoulder.
“What’s that?”
“Put it back in.”
“Are you going to give me more drugs for that because the morphine is doing nothing.”
“Yes, we will put you to sleep.”
Okay, I’m good with that.
He said they could transfer me to the hospital in Nanaimo where I could have surgery. His face was very serious and he asked me what I wanted to do. I didn’t really want to have surgery in Canada so I asked him what needed to be done so I could go home. He said he could reduce my shoulder but that I would need to see a doctor soon for surgery. I assured him that I would be but I could see by the look on his face that he had his doubts.
At this point I’d had a dislocated shoulder for about 7 hours.
So, I was soon on a table in the ER and the on-call anesthesiologist was woken up and arrived to help put me under for the procedure. Out like a light, I woke up with my arm comfortably laying across my middle and a great reduction in pain (that must be why they say “reduce”!). The pain was still there but I could breathe normally and didn’t feel nauseous. They had used one of those emergency gauze triangle bandages. I would see on the wall later that an arm sling costs $40. They never offered me one (I picked one up at Bartell’s for $10 when I got home and I’m okay with that).
I was wheeled in to the x-ray room to see how things inside me looked now and then wheeled back out. It was now about 3:30am and they said they would let me sleep for a bit. Turning the lights off in the main ER room, I was soon fast asleep. For about 3 hours. They had to get ready for the new day, so it was back to fluorescent lights and I was put back in the small room I had started in. The doctor told me that the specialist had said not to wake him up again so he was waiting until a decent hour again to show him the new x-rays and see what would be the next step.
It was kind of awkward because the staffing had changed at this time and my family was calling to check on me. They were able to get a few calls in before the front desk gal that arrived for the day cut them off. I really felt like I was alone and just waiting because no one had told me I was okay to leave yet.
Eventually the doctor came in and with his continuingly concerned voice asked me what I wanted to do. I was told my arm was now “in a good position” and I would be okay to travel. He repeated his offer to transfer me to the hospital “down island” to see the specialist and talk about surgery. I didn’t want to have surgery in Canada, I wanted to go home where I had insurance. And my family. I told him I was okay and would go home.
“How are you going to get home?”
I guess I have to drive home.
“You don’t have anyone here? You are all by yourself?”
“Yes, I came up by myself.” Again, a look of pity. I wanted to say I do this solo hiking thing all the time. Because I like it.
He would only give me a prescription for Naproxin (Aleve) because I was going to be driving home (no narcotics for me). My care had been excellent and everyone, except for maybe the morning gal at the front desk, had been so nice. Except the gal in records once I was home. Definitely not helpful.
A taxi was called and I gathered up my backpack with my sleeping bag hanging off it (now in a plastic grocery sack I found in my pack; there was NO way I was going to be able to get it back in the compression sack in my condition). I had the hopefully once-in-a-lifetime experience of “exploding my pack” on an ER bed as I tried to get everything more compact then how it had been hauled off the beach the night before. Much harder to do one handed, I must say. I had to ask the nurse to help me put my shirt back on, at this point I had been standing around in my sports bra all morning.
After she called the taxi for me, I ended up sitting in the lobby for maybe an hour waiting as I watched as patients came in for the lab and took a number to be seen like at the DMV. I eventually asked the nurse if it takes that long for the taxi to come (the town is NOT that big) and with another call the taxi was there in just a few minutes. He helped carry my pack into the van and I was on my way back to my car.
Later that day, I ran into my original nurse at the local coffee shop and she was surprised to see me. I had changed my clothes at this point (AKA looked like a normal person) and let her know my brother was flying into get me. She seemed genuinely happy to hear that.
Since I have been home, I have thought a lot about my experience and how it all seemed so strange. Totally not what I was used to. At first I thought it was because I simply didn’t have insurance. But the more I think about it, the more I realize it was something beyond that.
Looking back now at how I was treated, I realize that the staff must have thought I was a person of misfortune. Possibly homeless. I’m sure I looked like hiker trash. Are most of the people who injure themselves on the trail Canadian? Are their only experiences dealing with non-Canadian hikers people who do not have means?
I take for granted that if I get hurt, I can just go to the clinic and someone will help me. I will be treated like someone who can pay their bills. Like someone who takes care of herself.
When I returned to the States and saw a specialist here, I was told I didn’t need surgery. This bothered me, I was sure that they weren’t paying enough attention. Why would the ER doctor been so insistent that I DID need surgery when the doctors here were certain I did not. What I have come to believe is that the staff in Canada thought I was only trying to get as little care as I could so I could leave the ER. Because I could not afford it. That once I left, I would not be following up. That by telling me that I needed surgery they hoped I would seek follow up care.
As it turns out my total bill had exactly 3 items on it: the ER admit fee, the X-ray tech fee, and the specialist fee. With the .78% Canadian exchange rate right now it was more than a bargain for the care I received. I am glad to pay it. Not cheap but definitely cheaper than care would have cost me here in the U.S.
I’ve walked away with not only a greater sense of appreciation for my life situation that allows me to take my health care for granted, but I believe I also saw the difference in medical care between staff who were concerned for how much care would cost me versus concern for whether or not I would pay (aka: whether or not they would get paid).
Have you had to have emergency medical care in another country? What have you observed? And on the other side, has your doctor ever asked you if you were sure you wanted to have something done because it would cost you a lot of money?
For more of my Canadian story, read You Can’t Always Get What You Want.
*You will often see hikers with their packs “exploded” on the ground or on picnic tables as they try to find something hidden on the bottom or rearrange a new supply of food to all fit within.
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