A tragedy in Canadian health care

My father died a couple of months ago. It wasn’t a complete surprise; he was 85 after all.?But it was rather sudden, an unhappy story, and a reflection on the state of the health care system.

A year or so ago, he received a letter notifying him that his family doctor was moving away. He never did find a replacement, due to an ongoing shortage that sees almost one in four residents where he lived going without one.

He had a specialist or two that followed his prior conditions, but nobody looking at what was ailing him on a day-to-day basis. He complained more about the lack of a family doctor than he did about symptoms; it was a substantial stressor that he didn’t need at 85.

In the months leading up to his death he complained of dizziness, irritable bowels, nausea, sometimes headaches. He’d report a complaint, and then a few days later he’d say he was okay. This was less than ideal – but with no family doctor, he just carried on.

One day he called sounding more out of sorts than usual. I did a Google search and found a new ambulatory care (walk in) clinic a few miles down the road. A neighbour took him that evening. The doctor ordered a brain scan and booked a follow-up appointment. My father did not live long enough for the follow-up appointment a month later, let alone the requested scan five months on.

Coincidentally, I had a trip planned to visit him the next day. When I arrived, he seemed fine at first, but soon his speech and motor function became strange. He couldn’t stand up even with help, so I called 911.

Next came the impressive part of the health care system. An ambulance arrived promptly, and Dad was assessed and taken to the ER. The ER also moved quickly – a doctor ordered scans, and results came within a couple of hours.

It wasn’t good news; his head was full of tumors. The next several days were a blur of tests and hospital personnel, trying to develop a treatment plan.

One of the doctors pointed out a cruel irony. My father had lived with a slow-growing brain tumour for about a decade. He had two surgeries to remove it and was regularly watched because it continued to grow back. His annual scans, however, were focused in tightly on the site of the original tumour. Had the lens been drawn back for a wider view, they might have found the others before it was too late.

Eventually the doctors at the smaller-city hospital decided to send the old guy to a larger centre where a neurosurgeon would look at him. The plan was to take a biopsy to learn more and develop a treatment plan. It sounded promising.

This is where some of the less encouraging parts of the health care system were revealed.

First, it seems the only way to gain admittance to a hospital is through the ER, even if you are expected and intended to be admitted, as my dad was. Arriving at a big-city ER after supper, we met long line ups and rows of ambulance crews and their patients waiting in hallways. We think this may be where he picked up COVID, but who’s to say?

He stayed in the ER behind a curtain for several days. He was told a number of times that he was being prepped for surgery, which meant no food – and stopping the meds that had been easing the worst of his symptoms. Despite these difficult preparations, the surgery never took place. I am not sure why, but my guess is that patients with better odds came along and they were given the OR time. Fair enough, if true, but an explanation would have been appreciated.

After about a week we were informed that his scans showed rapid tumor growth and there was no hope, no treatment, and no surgery. That came at the end of a very tough time for my father who had been hungry, confused, dizzy, in pain, and felt the bed was moving under him. And who knows what else he was experiencing.

Next came palliative care, which I will sum up as a well intentioned but ugly process to watch and likely to endure.

Overall, we experienced a mix of docs and nurses. Some clearly caring and doing their best, some worn out and beaten down by the system.

The news these days is filled with stories of the crisis in health care, overflowing ERs, doctor shortages, and more. I don’t envy the folks who work in health care or those who are working to fix it. Two in three Canadians consider the health care system to be in a state of crisis and almost six in ten think the main cause of problems in the system is poor organization (rather than a lack of funding).

My father’s experience also highlights some challenges in the system.

1. There is a need for more personnel – from family docs to ER staff, nurses, and so many others.
2. Treating individual symptoms can overlook a bigger picture and leave patients with more serious problems. Many individual symptoms can be written off as age-related but someone needs to recognize when a combination of symptoms is pointing to something more serious.
3. Diagnostics outside of emergency are in too short supply. The scan appointment ordered for my father after his ambulatory care visit is still a couple of weeks away.
4. Health records must be improved. We were asked questions that suggested the hospital health care team didn’t have access to the records from his former GP. Maybe some clue as to the primary cancer that was feeding his brain tumours would have been found there.
5. Communication is critical for patients and their families. A lack of information compounded our difficulties needlessly.

While our governments and health administrators work through the system issues, some communication changes could be made to bolster the confidence of Canadians and improve the experience of patients and family/caregivers. Given the near constant barrage of bad news and negative commentary, governments should let Canadians know what they are planning for health care and how they intend to improve the system. Front line workers should also find ways to improve communication – even if beds are scarce, information doesn’t have to be. Simply knowing why decisions are being made – that there is a rationale somewhere – can help provide comfort to people who are feeling out of control in unfortunate circumstances.