Health care and its twists
By Bernie Krewski
Equity, equal access, is a cornerstone of Canada’s health care system. So is the less documented frequency of chance, possibility, surprise, and fortuitous circumstances that may arise when one is seeking treatment.
There is much news-talk about the health care system being “broken.” Such discussions often fail to distinguish between the debates over health policies, usually about costs, and the internal operations of health care delivery.
Pat and my experience on Thursday, February 13, is an example.
For two days I had been experiencing severe stomach pains, often recurring every 10-15 minutes. The evening before, we contacted the Alberta Health Link 811 and spoke with a physician who was unable to identify the problem based on the information we provided. He recommended seeing a doctor immediately. Knowing that “walk in” appointments for the next day are now highly problematic, we checked emergency wait times at various hospitals. Most were 4-5 hours, the University Hospital (UAH) was 7 hours - Leduc Hospital (a half-hour drive south of Edmonton) was 1 hour.
By 5:15 a.m. on the 13th, having had little sleep, I was ready to endure the drive to Leduc since the wait time at UAH at that hour remained lengthy - six hours. Departing our residence at 5:45, I thought it might be worthwhile, however, to stop at UAH to check its wait times in person. The screening nurse at the entrance told Pat, while I waited in our vehicle, that priorities were based on the severity of one’s condition.
I joined Pat amidst 30 other people in the waiting area, some asleep in chairs (possibly the “homeless”). The nurse recorded a few notes on a 4x6 inch card, referencing my stomach pain and treatment pending for the recurrence of oral cancer. She consulted the intake main desk, and said we were “admitted.” – a six-minute process.
I was conscious that everyone waiting there deemed their health status to be an “emergency.” And justly so. Was I being favoured, being able to clearly describe my symptoms? Some might infer that I was a participant in “queue-jumping”? Or are the admission criteria in emergency well established, determined by “severity”?
By 6:10 the first stage, “blood work,” was done. By 6:20, I was on a gurney in a cubicle waiting for an emergency physician who arrived in several minutes. Based on the symptoms I presented (abdominal pain, stomach distension, and constipation), she ordered a series of “imaging tests” of the abdomen and chest, 12 lab tests, the insertion of a gastric tube, consults to Gastroenterology and General Surgery, and a Sigmoidoscopy (a camera inserted to observe the inside of the stomach).
That was the first “twist” we encountered - the speedy and smooth entry into the UAH emergency process.
A short walk for a chest x-ray, followed by the insertion of a gastric tube to empty my stomach (which I endured for the next 13 hours), started the diagnostic process. What followed during the next five hours was intense activity and engagement with emergency staff representing various health disciplines - multiple trips for more x-rays and CT scans, discussions with gastroenterology and surgical residents and their mentors, nurses, and medical technicians.
My laryngectomy and stoma, surprisingly, became another twist – drawing attention. A male nurse noted I was only the second patient he had ever seen in Emergency with this condition. He asked if a student nurse, soon to graduate in April, could see my stoma, explaining to her that I breathe through my throat and not my nose. Later, a respiratory technologist brought stoma supplies, mentioning I had a “nice stoma” that was “very clean,” adding that some are not.
A third twist arose when I was returning from another CT scan, noticing a physician in the hallway who looked familiar. Pat eventually found him, working on another unit in Emergency. I was his mentor during his first two years of medical school when the PIE program (Patient Immersion Experience) was inaugurated in the Faculty of Medicine 2014. He told Pat he noticed my name on the admission list!
At 1:00 I was on my way to Endoscopy (images of interior structures of the body). That procedure, a flexible sigmoidoscopy, is often reported as an unpleasant experience. It’s an exam to see inside of the rectum and part of the large intestine using a thin, flexible tube with a light and camera.
As reported on my file: “The patient underwent moderate sedation. He experienced no blood loss. The procedure was not difficult. The patient tolerated the procedure well.” This was another twist – I was not aware that this procedure even happened!
Returning to Emergency, I was visited by Dr. Klaus Buttenschoen, the general surgeon on call, and his resident. He described Sigmoid Volvulus, a rare form of intestinal obstruction in which the sigmoid colon twists around its own base (“The Twisted Colon: A Review of Sigmoid Volvulus,” Journal of Surgical Sciences, 2019). In my case, I learned, it was only a half-twist!
The term “volvulus,” which may involve any segment of the intestinal tract from stomach to rectum, is a Latin word for twisted, used by the Romans to signify this condition.
Dr. Buttenschoen indicated there is a 50% chance of recurrence. I was given the option of immediate surgery or waiting to see if the condition returned. After more discussion, I chose the latter option, partly because I would soon be having oral surgery.
At 6:00 I was moved to the Rapid Transfer Unit and given food. It consisted of a half-cup of cereal and milk, two crackers, applesauce, and water. We were told that a discharge physician would be visiting. We waited.
At 9:45, another twist. Unexpectedly and to my great surprise, I had a bowel movement. It led to an immediate flurry of activity. The emergency physician doing rounds quickly appeared. The paperwork was completed in several minutes and we left the hospital shortly after 10:00.
A day in the life of a cancer patient! These twists, besides offering comfort, provided many lessons in health care.