So many layers.

It always amazes me how we bring many lenses to any situation and these are how we see the world. Some, well maybe most of us, have several lenses, or maybe should.  What do you think?  Which lens rises to the top depends on so many things.

In the story of today, shall we look at this through the just get the person to safety lens?  How about the really weird, as in I can hardly believe I felt this and though it cannot be close, here I am, standing in another’s shoes lens?  Or the health-care system, it really can be better lens?

Or all of the above.  They all fit for me. I like the notion of multiple views.

The story:

It was a busy week back at the ranch, er job: several evening events, a night on call, but no matter.  I had made plans to take Friday off and even arranged coverage for Monday; we were going to the snow, heading for Canada.  “We” would be my neighbors and me.  They drive, I have the housing arranged: me in one room, their daughters in the other, the parents in the living room.  A close friend’s daughter with a season pass wanted to come too and she could sleep in my room.  All set.

Then my friend, mom of the kid who would be my room mate, decided to rent a place in the same building and come as well with another friend of ours.  All good….except she was tired and it was a long week and she was ambivalent.  Her daughter and I both talked with her, and in the end she decided to come.

Thursday evening we all (including my friend’s husband) were at a fund raising dinner, and all seemed ready for the next day.  I arose Friday, packed, and my neighbors and I hit the road.  Many hours later my friend, her daughter, and our other friend arrived.  My friend did not feel well, was nauseated and had abdominal pain all day.  She had not eaten since the night before.

Saturday morning it seemed clear that my friend needed to be seen at the clinic.  She, our mutual friend, and I (all family medicine doctors) feared appendicitis. While my neighbors, my friend’s daughter, and I went to ski, the other two went to the clinic.  By lunch, we knew. Her daughter and I headed down the mountain:  appendicitis.

We were in a location with no hospital.  We knew the ones along the way from there to Seattle.  Her husband was not with us because he had been on call, but had gotten sleep and was able to drive to the border and meet us. We knew there were surgeons in Squamish, then Vancouver, then Bellingham, then Everett, hoping to get her to Seattle.

The punch line is that she did get to Seattle, had her surgery around midnight Saturday night, and was home Sunday evening.

But that in not the point of this post.

I mentioned three lenses above.

Get her to safety: Who should go, where to go, who helped us know?  We had many possibilities.  Who should go?  Should her daughter drive her to Seattle?  What if she got sicker along the route and a doctor was not with her?  How luxurious that there were two other doctors along.  And who should go?

Stand in shoes:  The two doctor friends (Diane and me) decided to drive her to the border. Had we crossed the border, the wait to go north was close to two hours. We did not want her husband driving across. And she did not want us crossing to deliver her and face that wait. We opted to park at the Canadian border, talk to the guards, walk to the US border (about an 8 minute walk, in the pouring rain, our friend doubled over, us carrying her bags), talk to a US guard who by cell phone instructed her husband how to get to us without getting in the 90 min line, and delivered our friend to her husband.  Something hit all three of us, only shared after the fact. What we felt walking across, pouring rain, was a sense of vulnerability. It was a trek. 

Although we knew we had what we needed to get our friend across to the USA and us back into Canada, we were nervous and vulnerable.  How is it for others for whom the border cross has even higher stakes ?

We stood in line at the US station for pedestrians.  There were border patrol folks milling around.  It looked like they were not attentive to the lines and were not doing work.  We stood there.  Our friend was getting more and more hunched over.  We were scared. How much time did she have until she ruptured that appendix?  Finally we asked for help. The guard heard us and did help and a few minutes later our friend was on her way south and we two others were trudging back to Canada.

What do others feel in that walk between borders?  Really, we all knew ours was only 8 min between the two borders in that nomad’s land and yet each of us silently felt that anxt: what if it does not go well?  We all have enough life experience to know that what we felt had to be, given the certainty of our getting across, just a tiny fraction of what many millions feel when crossing a border under duress.

And the health care system:  Our friend had lab results and CT scan that showed the appendicitis.  We had seen the monetary charges: they were half what they would be in the good old USA.  Yet people complain about single payor.  Really? 

OK, once we handed her over to her husband, they were in the good ol USA.  One hospital/ surgeon on call would require she go to the ER.  Even if they accepted the CT scan and labs, there is that charge on top. (and by the way, there would be the delay and risk of rupture) A second hospital/surgeon would admit her straight to a room and then the OR.  Guess which was chosen? Surgery that night, home the next day.

Patients or money first?

What do you see in this story