“Code Blue, intensive care unit,” “Code Blue, intensive care unit!”
When the Code-Blue alarm sounded over the hospital’s loudspeaker system, my husband and I knew it sounded for our daughter. It was 11 p.m. The hallways of the British Columbia hospital were dark. Only one emergency operating theatre was in use. She was in it. The skeletal staff came running. Resuscitation carts were rushed toward the theatre.
My own heart nearly stopped, because she is my heart.
To follow Dr. David Gratzer’s plainspoken definition (the good doctor is a Canada-care whistleblower), Code Blue is “the term used when a patient’s heart stops and hospital staff must leap into action to save him.” My then 12-year-old had stopped breathing on the operating table and was being revived.
Earlier that day she had broken her arm sliding down an embankment with friends. She arrived home, coat draped awkwardly over her disfigured limb, and stood in the doorway sheepishly. Sheepish because she feared I’d be angry. You see, she had fibbed about her whereabouts and was supposed to be studying.
Sheepish, but heroic, as we would soon discover.
“Oh those bones, oh those bones,” goes the old song. My familiarity with the structure of the human arm until then extended to, “the finger bone is connected to the hand bone, and the hand bone is connected to the arm bone, and the arm bone is connected to the shoulder bone, Oh mercy how they scare!”
A subsequent X-ray of Nicky’s arm many hours on would reveal that nothing much was connected any longer. Hers was not just any old fracture. The humerus and the ulna were completely severed. The free-floating bones were pushing out against the skin. Yet the child never so much as whimpered.
We rushed her to the hospital where we imagined she’d get care right away. Recent immigrants to Canada, this was our first encounter with the single-payer health care system. Back in the “old country,” South Africa, we had benefited from a thriving, profitable, private sector in medicine, where relatively unrestricted entry into the profession, and the prospects of a lucrative, prestigious career, attracted the country’s crème de la crème, and ensured a steady supply of graduates from excellent medical schools. (These once venerated institutions have since succumbed to the malignant effects of affirmative action that privileges the majority population. Consequently, South Africa’s medical schools are no longer internationally recognized.)
The old-fashioned family physician had pride of place in this market and still made house calls. Emergency calls were answered by an “on call” partner in a practice, and not an answering machine. If you had no insurance, you’d contract directly with your medic, and pay him off, little by little, if necessary.
Commensurate with job satisfaction, voluntarism was high among the doctors I patronized. Once a month, my daughter’s pediatrician, bless him, would venture into the “bush” to treat underprivileged children, gratis. Another specialist repaired cleft palates, also for free.
These superb practitioners had done stints in Britain’s government-run National Health Service. Obama would call them racists, but, as they told it, the NHS was staffed mainly by graduates of Pakistan’s medical schools. Oxford and Cambridge-bound students were less likely to be enticed by the prospects of capped physician fees and squalid working conditions.
My daughter was born in a private, spiffy, state-of-the-art South African clinic, entirely within the financial reach of a middle-class young family. Now she was writhing in excruciating pain, on a hard bench, in full view of her unforgiving caretakers, in the dilapidated corridors of a state-run Canadian hospital.
In retrospect, the admissions process was devoid of any manner of medical prioritizing. A woman who complained of a migraine was being interviewed at length ahead of us. She took her time, as did her interviewer. A few sullen sorts were being checked out for mild sniffles as we waited.
It was abundantly clear that the service, perceived as free by the freeloading public, was being overused. Yet separating urgent from trivial cases did not seem to form part of the protocol. This was compounded by the cruel indifference of the gatekeepers – the receptionists and emergency nurses.
So we sat and we sat. Every now and then I’d rise to plead for a palliative for my agonized child and her detached limb. Cold stares and stern admonitions were all I got. Two hours into the wait, my daughter finally began sobbing quietly. Still, the staff stared. When we were eventually summoned, a bureaucrat began filling in a lengthy questionnaire. I realized where she was going with her probes. Before the medical abuse would cease, child abuse had to be ruled out. The woman was investigating us for breaking our daughter’s arm!
Next in store was a protracted stretch on a gurney, unattended. Another eternity passed before the mangled arm was X-rayed with great difficulty. A tired looking young surgeon explained the severity of the fracture. This was not a case for a cast. Nicky would require surgery sometime that night. When, he could not say. An inept nurse began poking the child’s arm for a vein. I swooned at the sight of the punctured, bleeding little appendage. My husband kept vigil as I recovered outdoors. After another nurse was called in, a morphine IV was finally inserted. It stayed in until she was operated on – hours later.
A cursory investigation into why Nicky coded that night was conducted. The findings were, conveniently, inconclusive. The custodians of Canada care had tried to convince me that my daughter had reacted to a compound in the chemical cocktail that was the anesthetic.
A decade on, the same precious person required wisdom teeth extraction, this time in the United States. She had forgotten how close she had once come to dying, but the thought of another such procedure panicked her mother.
Nicky’s American oral and maxillofacial surgeon, however, had no qualms whatsoever about putting her under in his well-appointed rooms. (Yes, we paid him out of pocket; ever heard of saving for a procedure instead of going on holiday?) For after hearing all the facts of the case, he was in a position to explain what had happened 10 years back.
It took a free American practitioner, in private practice, to deconstruct for me what had transpired on that fateful day.
The subpar care Nicky had received entailed the ongoing administration of morphine. Morphine, especially in a young child, depresses the respiratory system. Administered following hours on morphine, the general anesthetic acted cumulatively to stop her breathing.
Why is this episode typical of a day in the life of a patient interned in a state-run health care system?
As one wag warned: “Power will intoxicate the best hearts, as wine the strongest heads. No man is wise enough, nor good enough to be trusted with unlimited power.” (Except for Obama, naturally.)
The license to exercise near-unlimited power goes hand-in-glove with an indifferent, cruel and invasive bureaucracy.
In the U.S., an overly litigious society has led to the practice of defensive medicine. But in the “public option’s” sphere of influence, responsibility is collectivized. The culprits of a Code Blue or the odd slip of the scalpel have no out-of-pocket payments to fear. Had I sued the hospital, the comatose Canadian taxpayer would have been forced to pony up for the malpracticing parties.
In defense of the medics who ministered to Nicky let me say this: Most were good. All were hopelessly locked into a professional gulag in which wages are tied to a negotiated deal with labor, rather than – as is the case in a competitive market – to the individual physician’s performance.
For his considerable skill, the surgeon who pinned Nicky’s shattered bones together is rewarded with an increased workload, but no extra pay. Medical men and women like him must watch as mediocre practitioners are elevated beyond their capabilities, and as underperforming hospitals are “fixed” with infusions of funds. For such are the perverse, inverse incentives in all government departments – failure is rewarded with more resources. Coupled with capped fees and overflowing waiting rooms, these medical conscripts must contend with antiquated equipment and obsolete drugs.
Doctors are all corralled into this one and only “company.” There is no other option, public or private. Should their instinct for freedom get the better of them, they must defect to America.
And soon that option will die, too.