Not a Cancer Blog: Some Thoughts on Healthcare

How quickly the personal becomes the political. Perhaps inevitable in this super-charged political world we’re now experiencing. In just ten days, we have experienced the medical systems in two countries, giving rise to some reflection about what it means to be adequately cared for. Canadians, who most frequently compare themselves to Americans, take pride in their medical system. Compared to Americans, so they should. Compared to the rest of the developed world, it seems we’re middling at best.

Two weeks ago today, Jack visited a specialist in the city of Leon, Mexico—a man who speaks passable English and who is well-known for his diagnostic skills. Jack had phoned for the appointment two days earlier. When we arrived at his office, the doctor was waiting for us. He spent the next hour and a half with us, grilling Jack about his symptoms and giving him a thorough examination. At the end of the visit, he suggested that the best way to get to the bottom of the problem was to admit Jack to hospital for two days of tests. We paid up and left.

The following Monday, we checked in to Aranda de la Parra hospital in downtown Leon. I say “we” because it was assumed I would be with him in the spacious room that included a comfortable chair and a bed for me. By the end of that day, we knew. By the end of the second day, we walked out with blood and urine test results, CAT scan on a CD, fancy colour photos of Jack’s esophagus and stomach, and a receipt for several thousand dollars.

Throughout our stay in the hospital, where the care and the accommodations couldn’t have been better, we were repeatedly required to sign receipts indicating that Jack had, indeed, received this pill and that test. Before we could receive copies of test results, we had to settle up at the cash counter. This was a top-tier hospital.

Mexico does have a universal public healthcare system. No one with resources would choose to use it.

We made the decision to come home without a second thought. We knew the first step would be to get a referral to a specialist from our family doctor, and we dreaded the wait that might entail. Our daughter-in-law, who works in the system and knows how to get around hurdles, stepped up. She arranged for a quick appointment with a urologist/oncologist, based on the Mexican doctor’s referral. So, we entered the Canadian system one step closer to treatment than we would have been if we hadn’t had an inside track.

When Jack saw the urologist two days ago, the doctor made it clear—in the nicest possible way—that while he accepted the diagnosis from Mexico, he wanted his own CAT scan. He would order it as an urgent matter, it would be done within forty-eight hours, and he would see Jack again today to discuss results and make a plan. Except yesterday the office called to say oops, they can’t get him into the CAT scan queue quite that fast. But it will be soon. We’re quite sure early next week.

This is how it works in a system where everyone has an equal claim to service. You can’t jump the queue because you’re the most important person to you. Or because you have deep pockets. Still, urgent cases do move into and through the system in a reasonably timely way.

Fortunately, the doctor also assured us—and this is backed up by other sources—that urgency is a relative thing in this case. Renal cancer is slow-growing, and a matter of days or even weeks is unlikely to have an impact on the success of treatment. Which is good, because the approval of a cardiologist is also required before doing surgery on a man “of Jack’s age”, and we live in an under-serviced area where cardiologists are booked solid.

We are not panicking. But we are pretty sure that in Mexico, the kidney would be gone by now. Along with a chunk of our money. In the US too, of course, with perhaps more money than we have. We’re also sure that, if things move too slowly here, we can go elsewhere in Ontario. Privilege is not without some advantages here, either, though they are fewer and subtler.

I am a firm defender of universal, single-payer medical care. I’m proud of Canada’s system, though as you can see it’s far from perfect. I’m also a self-interested human being. If there were, at this moment, an option to pay more for speed of service, I’d have my credit card out in a second. And if you don’t think you would, I’d challenge you on that. The fact that I can’t is what keeps us from the multi-tiered Mexican system where the bottom tier provides minimal service, or the cash-driven American system where the poor may be unable to afford the care they need.

So, the personal does become political. The balance between the individual and the common good is never easy to strike. Based on my own and others’ experiences in our medical system over many years, I am confident that the urgency of Jack’s situation is being taken into account and that he will receive the necessary treatment within a medically appropriate timeline. It might not be our timeline. Reluctantly, I must accept that. At least for the moment. We’ve only been home for four days.