You Should Be So Lucky

If it needs saying ever, it is worth saying now: I am lucky to be sick in Canada, and specifically in Ontario. An activist friend (hat tip, Renee Lansley) posted this article, describing two sisters’ experiences of breast cancer in Toronto and California.  Rob tells me that there is also this video from the same case. It describes better than I could the positive side of illness in Ontario, where serious universal medicine is the responsibility of the collective.  While much has been written comparing the different systems, this article is particularly relevant for breast cancer patients.

Even before I was deemed “sick,” I was grateful to know that everyone, from my neighbours to the people who pour my coffee, has access to the same system of healthcare that I do. When illness strikes, my husband (always by my side) and I calmly get into our car and drive a few minutes to our excellent, local teaching hospital, where we can be assured of getting the standard of care for every problem identified.  We pay for parking and that’s about it, and by now we’ve learned where to get the best deals on parking.

The article mentioned above draws attention to the thick stack of bills that the U.S.-based sister confronts as she navigates her cancer, a stack that I don’t have to worry about. The author estimates that the same treatment for the same disease costs Ontario about 10% of the cost of California- based sister, likely because of the efficiencies built into our single-payer system with one point of cost-negotiation and nearly zero private administrative costs. But the most important thing, to the author and to me, is that it allows the sick person to just be sick and not to simultaneously sink days into the process of paying bills and making phone calls.

Of course, it would be naive to suggest that our system is perfect. Having spent enough time with physicians and health care professionals to know how dedicated they are, I do my best to act as the “good patient.” I put my education, social capital, and research skills to use asking the “right questions” and doing my research, even when the questions are annoying and repetitive.  Sometimes they come in handy later.  I carefully track which medications I take when, and I report back to the right doctor at the right time on side effects. Doctors look at me and think, “She’s a good patient, this operation/procedure won’t be wasted on her.” Perhaps my treatment might not be so good if I weren’t so well-educated and affluent.

I’ve also learned a thing or two so far, and am bound to know more in the future. Being a good patient does not mean minimizing pain. Recently I had the experience of a few procedures in which I was only too happy to let the doctors know just how they made me feel. Ultimately, I think this was a good thing for all of us. So what if I’m being a big baby, it turns out that the more you get stuck, the more it hurts. The stitches that you get in the hours after a lumbar puncture might be truly nauseating, and it’s fair to say so at the time.

Talk about lucky – turns out that I had brain tumours in the right place – the cerebellum, which is where they are operable. Along with so many other things, I did not know that there were “good” places to have brain tumors. Also, I did not know that my little Canadian city has a well-respected and well-established centre for neurosurgery, which also happens to a great place to need to neurosurgery and follow-up care. That’s lucky.

The day after I came out of surgery, I found out that Gordon Downie succumbed to his brain cancer, a case that was closely followed by all the Canadians I know, intensifying the significance of my experience. Rob quietly watched the documentary of his farewell tour in the week following my surgery. In roughly the same time frame, MBC activist Beth Caldwell also succumbed to her cancer, another example of a brave woman showing a way that life can go with this stupid disease.

So the moral of the story is, health care is not to be taken for granted. There is a real benefit that comes from covering everyone, from taking health care out of the hands of the private system and into the realm of the public. To say to every human being, “We will take care of you,  no matter who you are, even if you have a pre-existing condition,” is to say that you value every human being in your community, without any qualification that you or someone else might dream up. And this approach provides good quality, uninterrupted care that may ultimately result in better survival for those with chronic conditions. This is a matter of real political import.  I urge my American friends to put their political weight behind it, and I urge my Canadian friends to stop and think about what this really means to us.

This is not to say, either, that the U.S.-based system has treated me badly. When I was a teacher in Massachusetts, I had access to the best health care anywhere. And now that I’m in the market for a second opinion, I may once again find myself Boston-bound to take advantage of the best and most cutting edge clinical knowledge available. When I do, I will once again find myself between two systems, figuring out how best to be the successful patient in each one.  It is helpful to know what you are dealing with.