Saturday, May 13, 2017

More Doctors and Nurses, Less Waiting

I went to the CCAC yesterday after my surgery on Tuesday - the Community Care Access Centre - an agency I only heard about when they had a local whistleblowing scandal a couple years ago questioning the decision to reduce case managers instead of front line therapists, and then more recently, when they spent money to send employees to a conference, which turned out to be largely funded by donors. It's a very necessary agency that cares for people after surgery among many other things, and it's a concern if funding is mismanaged.

It's also a concern if funding is reduced.

It's a complicated system to an outsider. After my surgery, I felt fine and declined homecare, but changed my mind once the drugs wore off, and it took many phone calls to relay that decision because homecare is under a different umbrella than the regular CCAC on-site work staff. This article says the system in Ontario is, "plagued by inconsistent standards of care, byzantine processes and a troubling lack of transparency for both patients and family caregivers." And apparently they're all going to be shut down soon anyway to be replaced by LHINs: Local Health Integration Networks.

Whatever they're called or do, I haven't really followed it all, but they are ABSOLUTELY NECESSARY.

Or something is necessary.  I don't really care how they operate so long as they exist - so long as something's in place when you leave the hospital. It would be kinda nice if it was your own surgeon who could answer questions, but their costs are too high and their time too valuable. Or something like that.

I got my drainage tubes out this morning. When we got there, the cab driver questioned my intentions: "Carpenters?! Is this a union office? Are you part of a union??" No, silly, Care Partners. Well, yes, actually, but that's a longer story, and what's it to you, bub!?


The CCAC nurse warned me that I might faint because the drain was "right up in there." I didn't, but it was significantly worse than with my mastectomy. The armpit has a bevy of nerve endings. My surgeon was right: boobs are just blobs of fat - easy peasy. Lymph nodes are much more integrated and involved in things. The nurse had concerns. I was reporting more pain that I should have at this stage, but maybe I'm just sensitive. But the blood in the drain was more thick and dark than is typical, so she expected a clot, but couldn't find one, and I had way too much bruising way too far from the site, and it shouldn't be swollen right down to my wrist! She removed the tube anyway (thank God), but told me to see my doctor immediately.

Before I left, I asked her about aftercare. Shouldn't I be doing exercises of some sort? I had a booklet to take home after my mastectomy. She thought the surgeon should have given me something, but the day surgery staff was pretty sure CCAC should have something for me. There are too many cooks stirring this soup!! Thank god for Google (and here too). We're on our own, here, kids.

I called my surgeon, but he, as with most of the doctors I try to see, lives behind a protective wall of receptionists or assistants or a "care team" of some sort. They told me I don't see him for that kind of thing, and that I couldn't see him anyway because he's not in on Fridays. It's my family doctor from here on in. So I called her, but she also doesn't see patients on Fridays. Okey dokey. I know her well enough to know that she wouldn't know what to do with my engorged black and blue arm anyway. So, her receptionist suggested emerg was my best option. Middle of the afternoon, how bad could it be, right??

I went to work in the afternoon because I'm out of fully paid sick days from my surgery in the fall - yes, I've got a strong union, but the public perception of being allowed to carry over sick days was deadly to that clause of our contract. God forbid we piss off the public. That fear also ensures every PD day is spent in useless meetings rather than being allowed time to prep classes and mark work in a timely fashion. That part of our job is to be done on weekends and evenings. But I digress.

Okay, one more thing. When I had surgery last semester, I went part time for a week. I had all my classes in the morning and my prep in the afternoon. So I taught A, B, C, 3/3 of my courses, then went home to fall into a mild coma. That counted as half time because I was only in the building for half the day. This time, new semester, I have two classes in the morning, and one in the afternoon. I decided I'd come for the afternoons and teach that one class and stay for my prep. But that doesn't count as a half day. This time it counts as 1/3 day because I'm only teaching one out of three classes. Hmmm.  Doesn't that seem a little fishy to count by day portion or number of class, whichever is less? . . .  Whatevs.

So I went to the hospital right after my class instead of staying for my prep period, because I'm going to do all my marking at home anyway. I half expect to be docked 1/6th pay for publicly acknowledging leaving early - that's fair, teach one of three classes for 1/6 of your pay. And I'll be spending my weekend prepping for the supply teacher and marking even though I'm on sick leave because supply teachers aren't mandated to mark or prep anything. IF I PUNCHED A CLOCK.... Blarg!!

So I got to the hospital at 1:40. It was packed. I finally met with the triage nurse at 3:00. He said I should be seen within an hour because the section I needed to go to was moving pretty quickly. I asked about my meds, which I was scheduled to take at 3:30. A different nurse insisted that the hospital needed to dispense all that rather than my kids coming to deliver them. After an hour of figuring that out, and being given only an Advil because they can't actually dispense Tylenol 3s or any of the other nerve repair drugs and aromatase inhibitors I'm on despite insisting they must be the only dispensing physicians while I'm in their care, I called my daughter to bring me my plethora of pills.

At 6:00, I won the lottery and got called on to move TO A BED, which was very exciting. I thought it meant I'd be seeing a doctor!! But hold yer horses. All in good time. I hadn't had anything to eat or drink since 11 in the morning  - I was terrified to leave the waiting room in case I missed my turn, and the water from the sinks in the hospital tasted horrible. I work right next door and drink the tap water there all the time. I'm not sure what makes the difference, but I tried to force down a few sips out of the tap while I waited. At 7:30 the doctor came to check me out. He said I have a hematoma, blood collecting under the skin, which was causing the extra special pain this time round. This called for an ultrasound to check for clots in the veins which could cause all sorts of problems. His turn was over for now, and he left.

At 8:40, I saw the ultrasound technician in a dark and creepy part of the hospital. We were the only ones there. After tracing all my veins with her gooey magic wand, she told me someone would come to take me back up, and I was left all alone in a hospital gown, open at the back, and my jeans. A thin coating of goo remained down my left side despite attempts at cleaning it all off. It's tenacious stuff. While I waited, I tried to wipe a bit more with a kleenex, and it was quickly saturated with thick, dark red globs. The sticky dampness I felt was pretty much all blood. My escort arrived and told me a nurse would redress that wound. Back in my curtained room, I scrubbed the blood from my jeans with the paper towel eroding as I rubbed, leaving traces behind in a bigger mess.

A nurse came and cleaned me up. She tried valiantly to find a pamphlet of exercises for me, but had no luck. The day surgery staff was long gone. She told me to call my surgeon on Monday, even though that first week after surgery is most important for aftercare, and I already know the surgeon doesn't take my calls. But don't worry - Google's got my back.

While I waited for the results of the ultrasound, I read every word of every poster in the room. One in particular warned people that they might get a call asking them about their experiences. They want to know what would make the emerge experience better. I'll tell you. It's one thing. There is one answer to that question: We need more doctors and nurses available. Just MORE. That's it. It's not complicated and doesn't require a survey. We need more money to pay for more staff so we have shorter wait times. No matter how it's organized and where little bits of money are misspent or where there's an overlap of services or cracks between them, those are all important issues and all, but nothing will get better until we have more staff to be able to take on more patients. But not just in emerge. We need more staff everywhere. It took me months to get in to each surgeon to find out I should have had surgery months ago. Take money from education if you need to. Cut my salary in half if that's the only place we can find a buck. I mean God forbid we raise the marginal tax rate or anything. I don't even care right now. I just want the Ontario health care system to be swimming in cash, at least enough for some quality water fountains so we're not so monopolized by Timmys to quench our thirst. This level of care is ridiculous. I feel like I live in the states!

Anyway, at 9:50, the doctor came back with the results. No clots in the veins! Hurray! I just have that hematoma that needs regular surveillance. Come back if it doubles in size or the swelling gets significantly worse (what does significantly look like??), or if it gets hot or I get a fever. All that jazz.

My incredible, beautiful, precious children had dinner ready for me when I walked in the door, eleven hours after leaving for a half day at work - ahem, a one third day at work. It's questionable for me to be back at work at all. I was advised to take two weeks off; I should be spending my days resting. I decided I could manage one class that's presenting seminars to me. But I should have been resting those other nine hours today instead of sitting upright in a hard chair lacking arm supports, in a crowded, noisy room full of contagious germs, with no access to food or water or necessary meds, and no accurate timeline of events - not even a reasonable guess - on offer.

My kids took pics of the hematoma so we could document any changes. You don't want to see that. [ETA - it's here, for the morbidly curious.]

Okay, it's amazing that I had access to an ultrasound tech immediately (relatively immediately). And of course there were a few patients screaming and growling in the triage area and an old guy too drunk to understand why his police escort wouldn't let him have a cigarette. We need more money in mental health services and addiction treatment. Absolutely. And whenever I felt impatient, I watched the number of people there with little ones. Sitting for hours in pain is nothing compared to sitting for hours with a child in pain. They should always get bumped to to the front of the line.

No. Scratch that. There shouldn't BE a flippin' line!


The Mound of Sound said...

My ex had been with the same GP for the better part of 25-years. He kept going until age 75 when he sought to retire and advertised his practice for sale. Five years passed with no takers. At age 80 he began offering cash for any GP willing to take over his practice. Finally, at age 85, he told his patients they would have to fend for themselves and find new doctors.

Even on the island we're running out of doctors. Mine is part of a clinic of 7-8 GPs. One has moved to Victoria, another is retiring. They're having a helluva time finding anyone to fill either spot.

British Columbia has two law schools, UBC and UVic. There is no shortage of lawyers and an absolute glut of law grads. Many are unable to find work after they're called to the bar, assuming they're able to find articles. Law schools are expensive. We ought to be able to close the UVic law school and direct that money instead to another medical school. The universities, however, are dependent on the generous funding they receive for professional schools and persuading them to give up one to make way for another doesn't fly.

It's not as though there aren't plenty of suitable applicants for medical school that are being turned away. There is an abundance of them and they often head out of province or out of country for their medical degrees. Unfortunately they tend to practice elsewhere afterward.

It's a damned mess but it's a political mess. Another example of neoliberal politics and the "everyday low taxes" mentality.

Marie Snyder said...

It's crazy. Like so many things these days: We know the solution; we're just not going to do it.