On the road to Montreal from Boston for the last stage of our adventure.
We left for Boston after a day of rest at the campground. My husband obviously did not drive. The trip was supposed to be a mere couple of hours. Due to a foolish decision on my part to avoid interstates and construction on winding country roads, it took us almost 8 hours to roll into our Boston area campground. My husband slept through most of the trip. His quiet disturbed me. As soon as we arrived at our campground he went to bed and kept on sleeping. I did all the unpacking myself, and then looking at him, I had an uneasy feeling. I decided to unhitch the trailer and remove the canoe from the carrier. I also checked out the pet sitting policy they advertised before tumbling into bed beside him utterly exhausted.
Unfortunately, as is usually the case for me, my intuition was spot on. I opened my eyes and looked at my husband and he was clearly yellow tinted again. I made some inquiries at the campground office and double checked the online reviews for the hospital they recommended. One point of irony, our union representative called back in the midst of this to explain that the hospital had two Richard Gordons and the fuss that I was subjected to was for the other one, not mine. Apparently the two insurance companies had hired the same clerking company to oversee who got what. It would not happen again. I was not particularly comforted by this. We called the insurance company again, and left after with their approval (apparently we were now some kind of kid glove case because they were SO SO very nice.) On our way out we arranged for a pet sitter to come by and walk and feed the dogs. On this point we were lucky again because the insurance company could have said this was now a preexisting condition and refused to cover it. They didn’t. Instead we arrived and the hospital was assured we had full coverage. I was very happy with the ER staff and the surgeon they called in. I was even more amazed by the speed of medicine in the USA because they did another ERCP within a couple of hours.
The surgeon then sat me down to discuss the results. He had removed the stent the previous fellow put in. The bile duct was completely blocked. He was not sure why. It might be a narrowing from an inflammation of the duct. It might be due to an error of the previous surgeon. Cutting the wrong duct by mistake was a fairly common complication. The situation was beyond his ability to handle. He would arrange for an immediate transfer to best hospital in the USA to handle it, the liver transplant unit of the Harvard Medical Hospital associated Beth Israel Deacon Medical Center. They would figure out what was blocking the duct and fix it or do a bypass procedure connecting the intestine to the liver. He explained everything and an ambulance arrived. My husband was still groggy from the anesthetic and it fell to me to explain what was going on. My husband looked so defeated as they wheeled him off for his ambulance ride. I raced to my truck and followed him.
I was very glad I had grown up in Montreal as I navigated the traffic in Boston. I must have done very well because I arrived before my husband did. Helpful security directed me to parking and my truck fit, just. When we arrived we knew the drill. Rest, fluids, a chance for the liver enzymes to drop to normal and Monday the ERCP. Of course this ERCP was a special one. This ERCP was extra long and could reach the entire length of the bile duct and it had a special balloon on the end that could be used to expand a constriction. The specialist made a joke about how the new advanced ERCP was putting his surgeons out of business.
Another fuss happened with the insurance company. Suddenly, they wanted to fly my husband to Toronto. Fortunately, the doctors talked them into waiting for the ERCP result first and claimed my husband was too unstable to fly. The next two days were long. I woke up early each morning, telephoned the hospital to see how my husband was doing, walked the dogs, fed the cat and then left for downtown Boston. The staff at the campground were wonderfully supportive. It also turned out the folks in the next trailer were fellow Jews and they adopted me as family right away, something I will be forever grateful for. It would have been much harder without their support. By Sunday morning my husband was much better. His yellow colour was gone, all his tests were normal and he was getting cranky about the IVs and feeling hungry. I commented to one of the many doctors that my husband didn’t look like a man with blocked bile duct anymore. The doctor agreed.
The next day I got exposed to one of those insanities of American medicine that make it so expensive. The unit where the ERCP would be done was a couple of blocks away from his hospital room. Liability issues meant he had to be transferred by a full ambulance team at a cost of $2000 each way. The team was late. We began to worry the ERCP would be cancelled. I offered to simply walk my husband over in a wheel chair. This is a fairly common solution used in Canadian hospitals. The possibility was greeted with absolute horror. This was the most expensive ride my husband would ever take and he could only go in the ambulance. I thought about how in Canada there would have been a proper skywalk or tunnel constructed in short order. Because all costs come from a common pocket, there was absolutely no way that situation would have been permitted to last in Canada. However, in the USA the hospital did not want to fund a tunnel or pedway walk. The cost could be offloaded onto patients instead and so patients would continue to be required to pay for the ambulance ride instead of having the problem fixed by having appropriate infrastructure built. This sort of silliness is the basis for much of the astronomical cost of American medicine. Patients were being billed enough in ambulance fees in a single month to pay for a pedway. This had been going on for years.
Ridiculously expensive ambulance ride not withstanding, the new experimental ERCP did its job. The second stone had apparently passed by itself over the weekend and that explained my husband’s improvement. There was a bad narrowing of the bile duct though and they had used their balloon thing to open it up and had left two stents in. The stents would remain in for six weeks and the bile duct would heal up open and be functionally normal. There was just two little problems. The extra long stents could not be removed by a normal ERCP and the procedure was considered elective because it was planned. Our insurance would not cover it and it would be very hard to find someone in Canada who could take the stents out. My husband was discharged the next day.
I had six weeks to fix these two problems. Thus began a difficult period of calling in every chip I had in the medical world to try to fix the situation. I wanted three things. I needed a way to get the long stents removed without resorting to the bypass surgery. For that I needed the special extra long ERCP. It needed to all be in Canada where we would be covered. Finally, if at all possible, I didn’t want our trip to Boston where my husband was a visiting professor at MIT cancelled. I started with Winnipeg where our family doctor talked to the surgeon who handles such cases in Winnipeg. The surgeon there had never worked with the long stents but he assured us he was not concerned. If he couldn’t get the long stents out, he would just do the bypass surgery.
I reviewed the whole procedure and the risk benefits of the bypass and I decided the last place we would go was back to Winnipeg. If my husband had the bypass surgery, the possible lifelong risk of complications would mean we would never again be able to travel in the USA. No one would insure us with that kind of preexisting condition. Most likely my husband’s life would be shortened. I was now looking right at the demon of Canadian medicine. Old and outdated procedures and lack of the latest and best treatments, especially in places like Manitoba, are commonplace.
Eventually I found two units, one in Toronto and one in Montreal. Both had the same kind of new ERCP machine and a doctor who knew how to use it. I decided we would try for Montreal since we could drive there in a day. We had to get our family doctor in Canada to make a referral to the doctor in Montreal and then the doctor in Montreal had to get the information from the doctors in Boston. As soon as I identified where we wanted to go and who we wanted to see, the wonderful fellow who had referred us to Harvard in the first place stepped in. It was all arranged. Since American doctors are wonderfully practiced at navigating paperwork obstacles thrown up by insurance companies, the Canadian health care system seemed easy by comparison. We had an appointment in Montreal for the same procedure on the same day as had been booked at the Harvard place to remove the stents. Air miles would cover the hotel costs. Since the procedure would be done in Canada, our Manitoba medical insurance would cover it due to provincial reciprocity and the fact that Manitoba didn’t have such a machine and the surgeon here had recommended it.
The rest, as they say is history. My husband suffered for weeks with pain and fatigue. We worried about what would happen if he got an infection and had to go back in before the stents were removed. The weeks passed. My husband did what work he was able to in his visiting professorship in spite of his pain. We traveled to Montreal. We found a hotel near the hospital that allowed dogs. We left the cat with our wonderfully supportive new friends Geoff and Ellyn. We had one long lovely drive in the fall from Boston to Montreal and back. The procedure went well. The surgeon announced the stents were out and the bile duct was well healed, open and flowing properly. He had used the balloon to open the constricted area up just a little more but the stents had done their job. My husband astounded me by announcing he wanted to walk back to the hotel instead of taking a cab. We stopped at a deli serving Montreal smoked meat. He insisted we go in, following the wonderful smell. He ate a sandwich with gusto. I had my husband back.
During the waiting time at the hospital, while my husband had his special stents removed, I looked around with a fresh eye after my experience in the USA. Several things stuck out. The hospital was shabby and ancient looking. Whatever was serviceable was still in use, no matter how old. The staff was hurried and worried looking compared to the Walmart smiles in the American hospitals. There were no curtains on the windows. The curtains dividing the beds were all different. The furniture did not match. It looked like stuff from a garage sale. One of the nurses commented about how they had moved the ERCP suite to another floor to keep from moving patients around and the new room wasn’t as big as the old one.
And then the bills started. It took us literally two years before the last bill was finally settled. The absolute insanity of the American billing system meant that we were chased for years by collection agencies for $35 bills from doctors which for various reasons seemed unable to find the right person to pay until the collectors got involved. Letters from one hospital were sent to the state of Manitoba from one department and promptly returned to another for insufficient postage (Manitoba being a province in Canada, and not a state) but it was the bill collector who telephoned us and then figured out why we never saw a bill until he got involved. The hospitals had all the information about who to bill, but not one of the doctor’s offices seem capable of picking up the telephone and calling the hospital to get our address. Many of the bills arrived a full year after the procedure meaning that our government would not honour them. In Canada a doctor has six months, and only six months, to submit a bill. After that time, no payment is allowed.
As the months rolled by with all kinds of bills coming in, including bills from doctors we never even saw, we became grateful for our insurance company who has an entire department experienced in dealing with one stupid billing mess after another. The other thing that department does, which astounded me, is renegotiate fees so that a $22,000 bill becomes $6000 instead. How can this be? Our experience is hardly unique. Our provincial government has a special appeals procedure specifically to deal with American late billings that permit late payment, and our insurance handled those appeals too. I was able to solve most late billing issues by referring the collections agent to our insurance company and the two of them would work it out. A couple a weeks later I would get a statement in the mail saying it was done.
We got a call from one doctor’s office. The lady on the other end of the telephone told my husband that the cheque had arrived in Canadian funds and their bank wouldn’t take a Canadian cheque. She had no idea how to fix this situation. My husband patiently explained how to get a Canadian cheque cashed and then hung up shaking his head over the total inanity of the situation. Two bills were refused because the procedures we were billed for weren’t us. (There was a $6500 bill for other Richard Gordon. When I pointed out to the collection agency the birthday was wrong and my husband had gall bladder surgery not an appendectomy, he took it from there. I often wonder how the other Richard Gordon felt when a bill showed up for $6500 over 18 months later.) Collection agents are the admirable masters of common sense, something the standard billing people seem to be completely deficient in.
The American medical system has a terrible problem with waste, poor management, and regulatory lunacy that is beyond stunningly stupid. It is also corrupt. How else can a bill be sent out at $22,000 be negotiated down to $6000 if its not corrupt? What do regular people lacking the negotiation savvy do? Americans have a bizarro privatized form of socialized medicine. Ridiculously excessive billing of those with insurance occurs in order to pay for those who don’t have it. Because everyone is out to make a buck, the most insane waste occurs as long the wasteful part of costs can be shifted to someone else. What could American medicine be if it was based on service, efficiency, compassion, and real concern about patients instead of the almighty buck? I think if the USA wants to straighten out their government and health care system, they should elect an experienced medical bill collector as President and put another one in as surgeon general. If they did that, then the American medical system would be not only the best and but likely the cheapest in the world.
In the end my husband was cured of a life threatening illness by American medicine. He was spared a terrible and risky surgical procedure by the innovation and the fine work of the best doctors the USA can offer. The cure he got from his advanced medicine will no doubt save the Manitoba government a lot of money because he was spared the complications he would have had if he had undergone the traditional procedure. I have come to think the USA really is the best of the best. If you need a wonderful new procedure done, especially if you have unusual complications, American medicine is the place to be. I sometimes trace my husband’s little scars, which are faded to brown now, with my finger and I always say a prayer of thanks that he got sick in the USA instead of at home. And that is what is right with American medicine.