The Health System, a Semi-Outsider View

Part 1. What Happened.

We had some associates from the US visit us here, whom I will call Régis and Léontine (many of you reading will know who they are, but as this blog is publicly accessible this post will have some intentional vagueness).

Régis is in his 90s and in good shape. Even though it was unseasonably hot and humid during the time of their visit, he went on walks around Parc La Fontaine, walked from that area to the Avenue Mont Royal pedestrian street for dinner, and hiked all the way from the Smith House parking lot to the Mount Royal Chalet on the Olmstead Trail.

One hot afternoon, however, when Régis and Léontine were returning to their hotel after a boat tour on the St. Lawrence, Régis seemed to run out of energy. We all thought he’d been overdoing it, and that the cumulative effort of walking in the heat and humidity was taking a toll. So he went to bed early.

Late that night, I got a call from Léontine. Régis was so weak he couldn’t stand, and he had a 104ºF fever. The people at the hotel had called 911, and emergency services were taking Régis to the hospital.

The hotel is in the Plateau by Parc La Fontaine, where there are probably six or seven hospitals within a two kilometer radius, but the nearest emergency room that had capacity was Verdun General, about 12km away. Once we knew where he was being taken, Manon and I got an Uber and headed out.

By the time we arrived, they had him on oxygen and fluids and were already running tests.

The first impressions of the emergency area was a little scary. The hospital interior has that practical, dingy, fluorescent-lighted industrial feel of a public institution that focuses all its money on function rather than comfort. The external waiting area where we sat was also partially used for storage of transport chairs and equipment, had humming vending machines full of junk-food, and a single big TV screen running a slideshow of public health announcements, patient’s rights, and general information.

Beside the guard station, an automatic sliding door led to an admission area, where perhaps two dozen people were waiting to be seen in varying degrees of distress, listlessness, and impatience.

Beyond this, a security-controlled door led to the ICU, where the hallways were lined with people in mobile beds, and orderlies and nurses and other support staff moved through in a constant stream. Régis was in his own little curtained-off alcove-like room.

The doctor was kind and solicitous and spoke to us in English. he asked a lot of detailed questions, and he explained the different tests that would be run. At some point in the early morning, he told us that we should go home. Régis was sleeping, his temperature was back to normal, and no more test results would be coming until morning.

When I was visiting the next morning, waiting for information from the doctors, an orderly came by and clipped a piece of paper to the edge of curtain that divided his room from the next one. I looked at the paper, and it said “Covid precautions.” Since the orderly hadn’t done anything else, I wasn’t sure if it applied to Régis or the next room over. But before long, they moved Régis into a small, dismal isolation room with an automatic door that sealed it off.

According to Léontine, one of the doctors later described this as one of the worst rooms in the hospital. Régis is not a complainer, but did say that the constant traffic going by the room seemed to trigger the automatic door, so it was opening and closing all night long.

Over the next two days, Régis was treated at the hospital. They don’t have Paxlovid in Canada, but they administered cortisone. By the afternoon of the second day, his blood oxygen saturation was high enough that they considered it safe to release him to self-isolate elsewhere.

Part II. Some Thoughts.

Reading the above, you might see unflattering comments about conditions in the hospital. It’s not complete, either. For example, on the 2nd day when visiting, some of the hallways in the ICU were stacked two roller-beds deep with people, and the line in admissions was much longer than the night before. I saw people arguing with guards trying to get seen by a doctor, and I saw people in roller-beds trying to get someone to come and attend to their needs.

That being said, when I once broke my foot in Los Angeles, I waited hours in the emergency room of one of our vaunted private hospitals before I was seen (or even given an ice-pack). Emergency rooms always have triage and assessment of risk and prioritization of the incoming patients. I once had to spend the night at the Marina del Rey hospital (shortly before it was acquired by Cedars-Sinai) for observation and treatment, and I was provided a private room, but had to wait hours for simple requests for information or adjustments to the equipment.

I don’t know if Régis received special care here, or if everyone gets the same level of care. I could imagine that as a foreigner, or as a person who was paying outside of the Québec health plan, or as an elderly person he might have received premium care. He also had several visitors showing interest — as Manon observes, anyone who is hospitalized needs an advocate. It was clear to the staff that there were people who cared about Régis. Whatever the case, I feel like he received outstanding treatment. Additionally, everyone involved was kind and solicitous.

Fears of language-related issues didn’t materialize. The only place I had any language problems with my abysmal French was with the guards when I initially tried to explain why I was there and who I was visiting. The doctors, nurses, and orderlies communicated with all of us in English.

As alluded to above, the hospital required direct payment as Régis doesn’t have a Québec health card.

I spent a fair amount of time on the phone with Régis’ US-based health insurance and their representatives. They opened up a case, and then got their “global assurance partner” involved. Evidently, they try to get this third party inserted in the process so the billing goes to them, and they can negotiate a better rate and/or get involved in the approval process for the treatments. They asked me to get them on a conference call with the doctors to determine the course of treatment. Not surprisingly, the hospital had no interest in dealing with them. The doctors were not going to waste their time on conference calls with foreign insurance doctors.

Régis was assigned an case agent with the health insurance as well as one with their global assurance partner. The latter spoke with an exaggeratedly soothing, comforting voice as she explained the process to me and what they needed. She was so very understanding when I said I wasn’t getting cooperation, and suggested means I could try to get the hospital to call her back. After Régis’ release, I called to let her know. It was amazing how businesslike her voice became, and how anxious she was to end the call as quickly as possible. They’d never successfully interjected into the process.

Lastly, I was surprised by how blasé everyone was about Covid. Many people working in the emergency room and ICU were unmasked. They’d mask up when entering Régis’ isolation room. When Régis was released, the doctor was asked about precautions/protocols. The answer was a little surprising: he could mask up if he wanted, but “Covid is out in the world, and [shrug]”

Different doctors gave different answers about how long he’d be contagious. They didn’t seem to concerned about that at all. One said that if he wanted to fly back to the US immediately after release and that there was no reason to wait unless the airline still had special rules.

I tried to find Covid tests for myself, Manon, and Léontine. I tried three pharmacies — none had any tests in stock. I did finally find some eventually at a pop-up inoculation site.

In Summary

I’m grateful for the quick, kind, and effective treatment Régis received. As a non-resident, he did have to put a whole lot of expense on his credit card. I don’t know what would have happened if he had no financial resources.

Régis and Léontine have been voluntarily isolating and recuperating in an AirBnB before their flight home early next week. By some CDC guidance (but not all of it, since their web pages are self-contradictory), Régis should no longer be contagious by then.

Lastly, the medical folks may have been blasé about covid, but I’m not. It’s out there and spreading again rapidly. Take precautions! Wear a mask if you’re indoors or in crowded environments.