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Sun Feb 19, 2012, 11:24 AM

 

break a leg! ... but only if you have a universal single public payer health insurance plan ;)

Ten days ago, I slipped and fell. Why did evolution make us walk upright, and then make us so incapable of doing it properly and give us such fragile little things to do it on? I've sprained ankles more times than I could count, broken my left fifth metatarsal twice (falling off a sidewalk curb and the edge of a driveway) -- not to mention other broken bones associated with gravity -- and now snapped my right tibula a couple of inches above the ankle joint.

I heard the snap and felt my foot point in an unnatural direction under me as I went down, and I couldn't get up. Fortunately I had on high loose boots, so I got that one off and waited a few minutes for the co-vivant to come back to where I was, an outdoor storage room attached to the garage. He tried to help me up but I felt my ankle waver and I dropped back to the floor. It's winter here, and the entry to the room was blocked by an immovable parked car and snow and ice. There was just no way to get me up and out without proper assistance. So he called an ambulance.

The paramedics arrived first and did the usual paramedic stuff, blood pressure and blood oxygen and questions. Had I hit my head? No, nothing but the foot at all. Was I coming into the room or going out? I don't remember. Does that happen often? The question confused me, but then I got it. No, no! it's just that I'd been in and out of the room 50 times in the past two hours carrying boxes out and I don't remember which way I was going this time (15 minutes ago, by then). I don't seem to have dropped anything and from the direction I'm facing, I was coming in.

The ambulance guys couldn't get the stretcher in the door, so I was going to have to get out some other way. The good luck was that the room contained the detritus of various of my family's households, and we've all broken bones, so there were three pairs of crutches within arm's reach. The guys hoisted me upright expertly, I hobbled on crutches about 20 feet to the stretcher, and they loaded me in.

I reported my pain en route as about 3 out of 10. Amazingly, just not hugely painful. Arrived at the hospital about 2 pm (we'd been directed to the one I consider my local hospital, the ER where we always go when under our own steam), and I waited a half hour in the ambulance intake area to be triaged to ER, then promptly got xrayed and transferred to a hospital stretcher in the plaster room across the hall. Around 4 pm, a doctor looked at my leg and pronounced it broken. Then we waited. Around 6 pm, an ortho resident examined me and ordered more xrays, and came back and said somebody would see me in about 20 minutes.

At ten to eight I was bored out of my freaking skull from being left waiting in a room with no idea what I was waiting for, and decided to stop being the cheerful, chatty model patient I had been until then, and the co-vivant wheeled me outside for a smoke. I left a note on my pillow saying I would be back at 8:05. Of course "they" came to see me while I was gone, as everyone who saw me come back told me. So I wheeled myself out to the desk and kicked up a fuss. My co-vivant (as we had told a nurse hours before) had not had any insulin all day (he had been in the same ER twice two years ago in diabetic ketoacidosis and come thisclose to dying), I had waited six hours for I did not know what, and I'd had enough. Well, we had had the misfortune of being there on the busiest ortho day they'd had all year. There were people lining the halls. My immediate thought (and the co-vivant's, he mentioned after) was to turn to the hallway full of people and say "Hands up everybody who has been here since 2 pm." But I restrained myself.

So they agreed to have the co-vivant register so he could get his insulin, which he got promptly, and we went back to the room to wait. Before too long the senior ortho resident came in, explained my fracture, explained the risks of surgery/no surgery, plastered my leg, and got my consent to surgery, and said I would get a call from the "walking wounded" service, ha ha, for the day surgery appointment in the next week. And sent me for one more set of xrays. It was almost 10 pm when we left and got a taxi home ... where I hauled myself up the five steps to the front porch and in the door and down the hall on my bum, and was finally able to hoist myself into an arm chair. Not an ounce of weight was to go on the foot for 6 weeks.

That was Thursday. Next day I got a call. But not for surgery; for my follow-up appointment at the fracture clinic. I didn't want a follow-up appointment. But there was apparently no way around this. So a few days later, I hauled myself on my bum down the steps to a taxi and got to hospital for a 10 am appointment. At 10:45 I pitched another fit. Evidently they had told everybody who had been at the ER when I was to show up at 10 am that day. I said I was leaving, they said I shouldn't do that as I had a broken leg. Duh. I got seen at 11:45.

This time, it was Dr. Bigwig Ortho Surgeon ... who couldn't bring himself to advise me whether to have or not have the surgery -- inserting a plate and screws to hold the fibula together and ensure that the broken off lower part did not interfere in the ankle joint, which is the real problem. Apparently the sticky outy pointy bit of the bone doesn't bother them. This is one of the most common injuries known to orthopedics. I keep getting "smoking, bone healing, tsk tsk, blah blah". Yeah, well, alcohol and caffeine, tsk tsk too, and I don't do them. And I smoke whether you do the surgery or not. (Although I am cutting down - the patch is no good since it's the nicotine that is the problem. And I'm eating the most bone-healthy diet imaginable.)

My understanding from the outset was that I needed the surgery. So, with 30 seconds remaining to decide my own fate and no input from him, I said surgery. He left me to have my cast cut and bandaged together, to save time on surgery day. I changed my mind and decided to go with coming back for the next one-week appointment, so I wheeled out to the desk in the waiting room. The clerk wanted my appointment slip and my green card. I didn't know what an appointment slip was, and I had never been given a green card (it's the hospital registration card you get when you register at ER, but nobody gave me one). She said I had to have a green card or they wouldn't have seen me. I announced to the waiting room at large that I . did . not . have . a . green . card. She retreated back to the consultation area, and behold, out came Dr. Bigwig Ortho Surgeon, saying I really needed to have the surgery. I suspect I had been pegged as difficult and it took being more difficult to get somewhere.

So next came the pre-op interview - by phone at the appointed time; they knew better than to make me come back. Then the call to give me the date next week; I call the morning before to get the exact time. It will have been nearly two weeks between injury and surgery and I am really not happy about that. Recovery time is extended accordingly: six weeks from surgery before the leg can be used at all. Six weeks stuck in the 40 feet between the living room couch where I sleep and the home office where I work. Fortunately, there's a bathroom in between. But the shower is upstairs. That isn't happening anytime soon.

Surgery is at the hospital in another part of town where ortho day surgery is done, which is also where I have had several eye surgeries. (It has no ER or inpatient services.) I will have either a general anaesthetic or sedatives plus an epidural. Sedatives don't sedate me, but general anaesthetics are to be avoided if possible ... I'll be having a serious chat with the anaesthesiologist.

The hospital systems in medium and large cities in Ontario are completely integrated, and some hospitals in each city are very specialized; in Toronto, e.g., there are two that handle particular cancer treatments for the entire area. (Hospitals here are publicly operated, but this is not an essential feature of a single payer system. It just makes the health system infinitely more efficient and less expensive to operate.) My mother and sister, who live north of Toronto, both had to go to the superlative Princess Margaret in downtown Toronto for radiation therapy, because they had the misfortune to get cancer a year or two before their regional hospital got the radiation therapy facilities needed to serve the burgeoning bedroom communities in the area -- but there was a free shuttle bus service from their hospital to the Toronto one for radiation patients.

So that's my report from the trenches of the public health insurance system. The usual Ontarian pissed off about ER wait times and now a little pissed off about surgery wait times.

But: out of pocket $15 so far for a Percocet prescription. (The public plan here doesn't cover drugs and I don't have an employer-based or other supplemental plan and am not a senior or low-income. I didn't like the Percocet, and have been taking Tylenol 2s and 3s donated by my mum, a senior who gets her prescriptions for $2.) And about $40 for taxis, and another $40 on the day of surgery. And $80 to rent a wheelchair for two months (which a supplemental plan would have covered if I had one). I may have to pay extra to get a fibreglas rather than plaster cast; that was the case 20 years ago when the ER doc didn't want to charge me $100 for that even though I wanted to pay it, and ended up deciding I didn't need a cast for the metatarsal. Not an option this time.

Just after I did this to myself, we were watching a US television channel and saw an ad for health insurance -- obviously aimed at the segment of the uninsured demographic there that consists of young people who choose not to have insurance. A skier tumbling downhill, with each injury and its cost shown on screen. The one like mine was shown as $10,000.

One other thing that might be worth noting about our health system, although unrelated to insurance. The co-vivant and I are not married, and for next of kin purposes in medical situations are treated as spouses. The same is true of same-sex couples, married or not, and this is also the case for all varieties of spouses for virtually every other purpose in Canadian society: taxes, immigration, pensions, inheritance, etc. At one point I was covered under his employer-based supplemental health plan, and he would be covered under mine if I had bought into a private plan for the self-employed. Which is beginning to look like a good idea. Although really, I'm looking at a grand total of maybe $300 in taxis and prescriptions and equipment rentals, which might not be more than the deductible for some plans.

Now just don't get us Canadians started on the parking fees at hospitals. Ask one of us about our health care experiences, and you will always hear the same thing: "... but it cost me X to park." And the Canadian Medical Association Journal has just taken up that cause:
http://www.thestar.com/news/canada/politics/article/1100874--cohn-why-hospital-ceos-can-t-feel-your-parking-pain
-- because essentially, this does amount to a "user fee". Of course, those of us not driving would still be stuck with the taxi fares ...

I paid $750 for my coverage last year, which is calculated and paid on my income tax return, being in the second-highest income bracket for the Ontario premium calculation. (I assume that since I claim the co-vivant as a dependant this covers him too; I've never thought about it. He just has his own card.) The scale here goes like this:
under $25K: 0
$25 - 36K: $300
$48 - 72K: $600
over $200K: $900
(with various calculations in between those brackets)


For anyone interested, this is what my leg looks like. This isn't my leg. It is a leg on an internet site that looks like mine. I wasn't given a copy of my xrays, to show my family doctor or for any other reason, because anybody who needs to see my xrays has access to my medical records electronically. Canada is behind every other jurisdiction in the world in getting the whole electronic medical records thing going ... except the US, of course. But my community clinic, where I go for primary health care, is wired and my doc there has access to everything that happens in connection with my health card.

http://www.medical-definitions.com/images/broken-fibula. jpg



We in Canada didn't get a universal plan overnight. It was incremental: first in one province, then nationally for hospital care, then nationally with loopholes for doctors to opt out and charge extra. It took decades to get what we have now, which is under constant threat from efforts to privatize one thing or another -- and of course is constantly affected by right-wing governments' funding cuts. But if I had picked another day to slip and fall (and I have to say there seemed to be an inordinate number of dislocated shoulders in the ER that day), I likely wouldn't be complaining at all.

8 replies, 2549 views

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Reply break a leg! ... but only if you have a universal single public payer health insurance plan ;) (Original post)
iverglas Feb 2012 OP
russspeakeasy Feb 2012 #1
iverglas Feb 2012 #4
Tuesday Afternoon Feb 2012 #2
iverglas Feb 2012 #3
Tuesday Afternoon Feb 2012 #5
iverglas Feb 2012 #6
Tuesday Afternoon Feb 2012 #7
iverglas Mar 2012 #8

Response to iverglas (Original post)

Sun Feb 19, 2012, 11:34 AM

1. Sorry for your injury, but thanks for the morning chuckle..

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Response to russspeakeasy (Reply #1)

Sun Feb 19, 2012, 12:03 PM

4. sniff

 

Why is it that when I do myself an injury, people always find it funny?

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Response to iverglas (Original post)

Sun Feb 19, 2012, 11:44 AM

2. hey iverglas!

tl;dr



I keed. keed.

----------------------------{{{{{{{{{{{{{{{{{{{{sending you some healing vibes}}}}}}}}}}}}}}}}}}}--------------------------




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Response to Tuesday Afternoon (Reply #2)

Sun Feb 19, 2012, 12:02 PM

3. ha

 

Too long for you ... imagine being me!

I don't want healing vibes, I want tofu casseroles ...

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Response to iverglas (Reply #3)

Sun Feb 19, 2012, 12:09 PM

5. ya want I should mail you one?

might be kind of messy when it arrives...

and QUIT SMOKING would ya ??!!



on edit: I was just talking about you last night

http://www.democraticunderground.com/?com=view_post&forum=1172&pid=15889

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Response to Tuesday Afternoon (Reply #5)

Sun Feb 19, 2012, 12:17 PM

6. tsk tsk blah blah

 

Smokers, the most persecuted minority on earth. Even those of us who support bans in bars, etc.

The fun part is the co-vivant having to learn how this household gets fed. He often does the shopping, to a list, but then it's a complete mystery to him how he ends up with a freezer full of carb-counted lunches and supper on the table every night. Not entirely, since he gets to watch me chop veg for two days and then clean up behind me, for the every 2 or 3 week cooking and freezing blitzes, but the mechanics of it escape him. Unfortunately, we were due for a blitz when I broke myself, and the freezer was virtually bare. I believe I will be getting fried cheese sandwiches for lunch, which he apparently remembers how to make.

Tomorrow he goes out for tofu and bok choy, and more cottage cheese and frozen spinach, and brocolli, and whatever else my little fibula desires. Right now, I have to pee, which is a lot more exciting than it sounds, and then get on with all the work I have to finish up before going under the knife ...


on edit too: the whole world is talking about me.

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Response to iverglas (Reply #6)

Sun Feb 19, 2012, 12:24 PM

7. your escapades are legendary

try not to pee yourself

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Response to iverglas (Original post)

Wed Mar 28, 2012, 01:07 PM

8. anybody have experience recovering from broken fibula?

 

The number of people who do this to themselves, I'm sure there are dozens here at DU.

Had the surgery 12 days after the break, Feb 22, under proper general anaesthetic, and went home a few hours later. Titanium plate and screws installed. A week later, had the temporary cast removed, xrays, fibreglas cast put on. Another week later, had that removed to check the surgery wound, all was well, new fibreglas cast put on.

Yesterday, three weeks later and five weeks from surgery, had the cast removed, xrays, saw the ortho doc who did the surgery (all hugely efficient, just talked to him at the central desk in the fracture clinic where the other staff, like the ortho tech I'd been seeing and the clerk who needed to do things like make my physio appointment, were also based and could join in, and i could see the xrays and so on). First he said I'd get an air cast, then he said the same thing as the doc I saw for the metatarsal 15 years ago: no supplemental insurance? you don't need to spent the $100, air cast isn't necessary. Suited me fine. So I can go ahead and start weight-bearing a week earlier than predicted. Tofu and cottage cheese and greens and handsful of supplements did the trick, I guess.

So now I have a swollen foot, pretty frozen ankle joint, not quite fully functional knee joint, and undoubtedly some muscle strength loss of course. I'm waiting for the physio appointment.

If I "go private", I can pay $60 per session at one of numerous private physio clinics not far from me in the city core with less wait time. Otherwise, I wait a bit longer and go back to the hospital where the surgery was done. I think I'll do what the co-vivant did when he broke himself: go to one appointment, get all the instructions, and work on it myself. The wait time in the public system is a minor annoyance again.

So I guess it will be a few months before I'm fully functional.


I'd be very interested in other people's experiences with the medium-term recovery process from similar injuries. Especially people who aren't under 30.

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