A tale of 3 Hospitals – Canada Medical vs US Medical – a winner is declared

We talk a lot here in Canada about our medical system – how long it takes to be seen, how inexpensive it is compared to the US version, how our doctors compare. But until push comes to shove – it’s all highly theortical.

I have been lucky – or unlucky depending on how you see it – to be up close and personal with 3 – count’m 3 – hospitals in the last 4 weeks. Which is about 3 hospitals more than I normally see in a year! So I feel uniquely qualifed to pontificate on how an unwitting participant in the medical world feels about the going on’s.

My first hospital was St. Mary’s – here in Montreal, Quebec, Canada. I’d always heard really good things about St. Mary’s – so when my husband was scheduled to have his full hip replacement there – I was pleased. Then we found out that cut-backs at St. Mary’s resulted in the death of a man taken there – incorrectly it turns out – instead of to the new ‘Glen Site’ hospital. Unknown to the amulance folks, St. Mary’s had had it’s ability to perform vasculary surgery taken away. So despite the fact that a surgeon capable of doing the work was standing in the emergency room when the amulance drove up – the patient was sent on. And he died.

oops.

No one was all that happy of course – but consider the point of view of scheduled patient. What happens if something goes wrong with my surgery – and I need that specialty. Do they take me out of the operating room and transport me to the other hospital? Yikes.

But my husband is the braver of the two of us – and he really seriously wanted his hip done and the pain gone. Plus he liked his doctor. So St. Mary’s it was.

The whole thing flowed perfectly. We arrived on a Friday morning at 6:30 AM – and parked right across from the front door. We signed in, went up to pre-op – and my husband walked himself into the closed pre-pre-op room. Next time I’d see him would be in his room on the 6th floor. (also the top floor – if you are counting.).

I sat in the small coffee shop (not the most comfy seats in the world, but the food was reasonable and not too $$), did email and got nervous, until it was time to go upstairs. The 6th floor is divided into 3 sections. The orthopedic wing where my husband would be, the general surgical wing, and of all things – the Kidney Dialysis section. Naturally – that section was only in use during the week. On the weekends – it’s was closed up tight. In fact – the entire hospital was very quiet on the weekend.

But the doctor came by Friday after his surgeries were fiinished, and again twice on Saturday and twice on Sunday. So we didn’t lack for opportunity to ask him detailed and proably pretty annoying questions.

Most of the rooms on the 6th floor are doubles – and although my husband asked for a private room – he was quite clearly informed that he’d be sharing. The private rooms were being held for patients that required isolation for some reason – and he clearly did not. Opposite his bed was a ‘white’ board that held various symbols – and as his ability to move freely improved, different symbols were circled to clearly indicate what he was considered capable of doing – only stay in bed, get out of bed with 2 helpers, get out of bed with one helper, get out of bed on his own.

Missing from the board were the names of his nurses – and since they were constantly changing – it would have been really handy had they been recorded there. Because it was the weekend – every shift he had someone new, and I never really caught their names, although a very accomplished nurse from the Philipines stood out.

His roommate was a bit of a sad case. An older woman in the early stages of dementia, she had fallen and broken her hip – which is what had brought her to the hospital 2 days before my husband’s arrival. But in her case – she still required significant help to get out of bed. She often clearly knew where she was and why – but then would suddenly become highly confused and bewildered. We gave her the flowers one of our visitors brought on the day we left – and her graditude was heart-wrencing.

In the 3 days we were there – only once did she have a visitor – her son showed up on Saturday night for an hour. He brought her a deck of cards – and it wasn’t until mid-day on Sunday that she unwrapped them – before that she proudly showed all the staff that he’d spent a whole $6 to get them for her.

On friday – the halls of the 6th floor were crowded with patients, food carts, linen carts, laundry recepticals. By Friday night, everything was cleaned up for the weekend, and the halls were relatively empty. Plenty of room to walk – and walk we did. On Saturday, my husband was allowed his first walk, on Sunday he was climbing stairs and wandering down to the lower floors of the hospital, and on Monday we checked out. Daily parking charge – $15.

This would have been plenty of medical for me – but on Easter weekend my mother-in-law, who spends the winters in Florida, suddenly became ill. I rushed down to Florida from Montreal on Sunday – flying all day to arrive in the hospital after closing hours.

She had been taken to the Bethesda Hospital in Boynton Beach – and what a hospital it is. Wow. Double Wow. Even closed up tight it was impressive. The lobby looked like a 5 star hotel, marble floors, high arching ceilings, and scrolls honoring donors decorating the walls. One section for donors of over a million dollars, a 2nd section for donor of over $500,000 – and a third much larger, but with much smaller type – for those who donated over $250,000. It felt like a very fancy theatre – albeit a bit medicianal. Daily parking charge – Free.

We had to walk around thru the Emergency section to get into the hospital proper, and we were immediatly shown to the elevators that wisked us up to the 4th – and top – floor. Unlike St. Mary’s – most of the rooms were private – with only a few with double occupancy. My mother-in-law had a room to herself – large enough to hold her bed, a bed for me, 2 visitor chairs, plus a reclining chair for her use. Her bathroom was as large as mine at home – and featured a full walk in shower in addition to the requsite toilet and sink. There was a stack of clean towels and wash cloths for her use, plus back-up clean hospital gowns. And of course a bit of storage.

The most remarkable things were in the technology area. Everything that could be done using a computer or a cell phone or an ipad was done using technology. When the doctors came in on rounds – they consulted their ipads. When the nurse finished changing an IV bag – she turned around and used the computer terminal (flat screen monitor of course) in the room. The work room for the doctors (yes – I peeked in) had computer stations. The Charge Nurse had a private room with lovely dark wood furniture. The nurse’s station was manned 24/7 – and the nurses never seemed to go on break.

On the wall opposite my mother-in-laws bed was a clearly visible white board with the names – and cell phone numbers – of her nurse, her charge nurse, and her PA (Patient Assistant). Every staff member had a cell phone – and every patient had a cell phone enabled hand held key pad to control the lights in the room, the bed position, and to call the nurse. No pressing a button and hoping someone responses. You called your nurse – who answered immediately – letting you know where she was – and when she’d be able to be by your side. If she couldn’t react fast enough – she’d call the orderly (I sit corrected – PA).

The IV’s were all dispensed by electronic dispensing equipment that monitored flow, and sent a beeping signal directly to a large display board opposite the nurses station. On the display board was the name of the patient, their doctor, their status, discharge notice if known, information from the IV equipment, and if the patient had pressed their call button – that information was also displayed. I was very impressed.

A bit like St. Mary’s – the 4th floor was cleanly divided into two sections, each with it’s own nurses station – the oncology and gastro section where my mother-in-law was located, and a much quieter, much calmer section clearly labeled as Hospice. Since my mother-in-law was doing a lot of walking to try and help what was ailing her – I got to see the 4th floor quite a bit. And even on Monday – the halls were kept clear and open. There was a place for everything – and everything was in it’s place.

The same could be said about St. Mary’s – it is just that some of the places were overflowing – and at the Bethesada – there was tons of room everywhere.

On the bad news side – we quite quickly ran into insurance challenges. The canadian based health insurance of my mother-in-law refused to pay the price of surgery at the Bethseda. Instead – they insisted that she be flown by air ambulance back to Montreal.

Consider for a minute what that says about the cost of the surgery at Bethseda. It was CHEAPER to use a small airplane, a pilot and a co-pilot, a special ambulance, and two medical professionals to fly my mother-in-law home (a 5 hour flight each way) – than it was to do the surgery in the US.

That’s seriously scary stuff you know.

Anyway – 24 hours after I arrived, my mother-in-law was taken by stretcher down to a special ambulance. There was an official transfer of information, the sweet folks at Bethseda being careful to be sure that the medical folks from the air ambulance people knew everything that they knew about my mother-in-law. Eventually the ambulance drove with my mother-in-law and the 2 medical techs to the airport in Fort Launderdale – and from there they flew to Montreal. Waiting for her in Montreal was another ambulance – which took her and the 2 medical techs to the General. The staff there was expecting her – and she was wisked into her private room there. The 2 medical techs flew home of course – so a total of 12 hours of travel time to save the cost of 1 small simple operation in the US.

In the space of that 6 hour (one way) trip – my mother-in-law went from 2016 modern to 1935 circa halls, walls, and patient facilities. The Montreal General is a huge – and very old hospital. There are banks of elevators – some of which only go to the 6th floor – other’s of which go all the way up to the 19th floor. My mother-in-laws room (better described as a large closet) – was on the 18th floor. Again – the floor was divided into two wings – only one nurses desk served both sides. The most remarkable difference – aside from the drastic room size reduction – was the amount of stuff in the halls.

There is clearly no storage anywhere in the General. I say this because there was stuff everywhere. Dirty linen, Clean linen, Walkers, Crutches, food carts, stands for holding bags for holding dirty linen and dirty paper gowns, you name it – it was in the halls. What there wasn’t in the halls were visitor chairs. Rumor has it that there were visitor chairs in a ‘sunroom’ located at the far end of the hall – but the same rumor said that the chairs were bolted into place to prevent visitors from moving them. The windows were cracked and dirty – and held together by duct tape. Prominent everywhere were hand wash stations. The amount of hand sanitizer used in a day must be enough to float a large battle ship.

Unlike my husband, my mother-in-law had a private room – just barely large enough to hold her bed. I sat on the narrow window sill when I went to visit, and other visitors had to share her bed, her one visitor chair, or a step-stool. IV drips were controlled by old fashioned plastic rotary clips – no electronics in sight.

To get a nurse – you pressed a red button. If you were lucky – and often you were not – a disembodied voice would boom over the speaker – asking what you needed and promising to let the nurse know. The bathroom had no shower of course – it barely had room for a sink and a toilet.

I will however admit that the floors were generally cleaned – although unlike at the Bethseda – I never actually saw a cleaning person.

But it’s not about the looks of the room, or the window, or the halls- it’s about the care. And while the nurses were much more scare, and I never did see a PA (Patient assistant) – the ones I did see treated my mother-in-law with respect and care.

The staff ran tests all day on Tuesday, and then decided to operate on Tuesday night. They did not find a blockage, but they did find a small tear with they repaired, and they could see where issues might have been that caused the problem.

She is now on the road to recovery – although she is still being held hostage in the hospital. Until something moves – she’s at the mercy of the hospital staff at the Montreal General. But the news is getting better and better every day – and today – Monday – she positively sounded bouncy.

So ends my tale of 3 hospitals. If money is no object – I choose the Bethesda. If money matters – then St. Mary’s is a clear winner. If I never return to the Montreal General – that will be soon enough.

Signing off to tell all her loved ones that she loves them (you might also want to do it now!) – the soup lady.

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