A bad accident changes your life in a second. It happened to me a couple of weeks ago as I was striding briskly along the sidewalk on a cold winter day. I stumbled and landed hard on my hands. I realized with a sick feeling that I had broken both my wrists.
Toronto is full of good Samaritans. One of them helped me to my feet and took me to a coffee shop, where he phoned my husband and then an ambulance. The paramedics started the morphine drip right away.
If you must shatter your wrists, Toronto is a good place in which to do it. It has some of the finest hand surgeons in the world. They can bolt you back together with screws and pins and plates and bone grafts that will make you almost as good as new. Skillful therapists will teach you how to use your hands again, and you'll never get a bill.
This is not to say that all is well in the land of Canadian health care. In fact, my recent experiences with the system have led me to conclude that things on the front line are in awful disarray. This observation will come as no surprise to those people who actually work on the front lines, or to those thousands of patients and their families who experience unnecessary misery every single day. The system is in chaos. It's overwhelmed by too many demands, too much bureaucracy, too much complexity and a stifling emphasis on process that gets in the way of simple kindness and common sense.
These days, you have to be desperately sick to be in the hospital. There's nothing like casts on both arms, a sore hip and a hydromorphone IV drip to remind you how dependent people are on the kindness of nurses. I sympathize with nurses - they have tough jobs and too much to do. But bad nursing care can have outsize effects, and quite a few should be in other lines of work.
My mother-in-law has spent several weeks in the hospital over the past year. Her skin is paper thin, and it's hard to get an IV line in. Mostly they succeed; sometimes they don't. Sometimes they don't succeed but pretend they did. Then she gets an infection, and her hand swells up like a balloon. But she's old and polite, so she seldom complains. "Nothing matters more than a bit of kindness," she says. A few weeks ago, she fell ill at home, and managed to phone her doctor, who phoned 911. She was in emergency for two days, confused, before she was admitted. The hospital never phoned us. We only found out there was something wrong when a neighbour noticed the newspapers were piling up, and phoned us.
My own nursing care ranged from exemplary to painful. The night after my surgery, I was attended by a relentlessly chirpy student nurse. They decided to let her try to catheterize me. Bad idea. She couldn't find the relevant tube. But neither could anyone else. After 45 minutes of stabbing at my innards, they gave up. The next morning, a more accomplished nurse got the job done inside of 10 seconds. Later on, when another nurse threatened to work me over again, I suggested that what I really needed was a steaming mug of tea. The nurse agreed. But then she disappeared, because her shift was over, and I never saw her again.
Beware shift changes in hospitals. They last forever, and you can't get hold of anyone. On my second day in hospital, they took me off the IV drip that was controlling my pain and switched me to oral painkillers. No dice. My hands began to feel as if someone were pounding on them with hammers. The nurse and I agreed that I should switch back to the drip. For that, she needed the okay from someone on the pain management team. Alas, it was a shift change, and such a person could not be found. Once they did find him, they had to get a drip. Elapsed time in agony: far too long. My advice to anyone with pain management issues is to never be alone in the hospital without an advocate.
Not everything on the front lines has changed for the worse. The young residents have much better bedside manners. They often have to deliver awful news to elderly, mortally ill people they've never met. This they do with great skill and compassion. I know this because the wards are so crowded that you can't help overhearing people's most intimate conversations.
In a world increasingly dominated by depersonalized medicine, the human touch is more important than ever. During my own mother's final illness, I sat with her as an impossibly young doctor told her with infinite gentleness that she would not recover. If only all her care had been so kind. She wasn't terrified of dying, but she was terrified of pain. We promised she wouldn't suffer. All the doctors promised her that, as well. In fact, her pain was frequently excruciating, but when she - and we - pleaded for relief, too often it came too late or not at all. Every shift change brought a new and unfamiliar nurse, some more responsive than others. One evening, after I rang and rang and rang for a pain pill that never came, I tracked down her elusive nurse. Why hadn't he responded? I demanded. "It's the end of my shift, and I have to do my charts," he said with a scowl.
Our hospitals are the most modern in the world, decked out with light-filled atriums and crammed with high-tech stuff. But not all the best equipment there is can make up for the loss of a bit of kindness.