The Métropolitain

A system “to die for”

Par Beryl Wajsman le 7 septembre 2015

It is 3.40 in the morning, Saturday, September the 5th as I write this. It’s the kind of sultry late summer night that Montreal famously seduces you with. Gentle, tangy breezes caress your face. Somewhere in the distance people are laughing. Elsewhere, there is the sound of a deep, soft saxophone bringing Coltrane’s “Night Train” to life again.   I am savouring the first sips of Irish whiskey slither in their serpentine manner down my throat. I’m an Irish whiskey guy anyway, but tonight’s brand, “Writer’s Tears,” is particularly aptly named. Because I’m not drinking to top off what should have been an evening of passion and pleasure.  I’m drinking to take the edge of a harrowing fourteen hours that could only have been dreamt of in the imagination of Franz Kafka on crack. Or been realized in the brutish, venal, petty reality that has come to define the daily combat between governors and governed in Quebec.

It all started around one o’clock Friday afternoon. We were just putting the finishing touches on one of our editions here at The Suburban. My phone rang, and just the tone of my friend’s voice on the other end told me that this was not going to be good news.

She had just learned that her father had fallen three hours earlier and fractured his hip. She’s a lawyer and was stuck in court so her mother couldn’t reach her. They all live in the west island. My friend’s dad had just left a meeting at McGill’s business school and the accident occurred right at the entrance on Sherbrooke St. The heart of downtown. 

One would think that a man laying on the street in the heart of a metropolis, surrounded by people trying to help, would get picked up by an ambulance fairly quickly. But no. It took some forty minutes for Urgences-Santé to get to him. When the ambulance arrived, the paramedics quickly and ably got him inside and ready for transport. That`s when the real nightmare began.

My friend’s father told the paramedics that his doctors were at the Montreal General. Just five minutes from where they were. However the medics were obliged to call into dispatch. Dispatch told the medics that their patient was to be taken to a hospital in the east end. The medics were incredulous, but they assumed the General was full in ER so they asked. Dispatch said no, that wasn`t the issue. The new rotation system called for that east end hospital to be the next recipient of an emergency patient. 

Urgences.jpgThe medics suggested to dispatch that the General be called. Dispatch said no, even after a rather animated argument. So the “system” forced a patient of the General, who was five minutes away, to be transported forty-five minutes away to a hospital where no one knew his history and where is family could not reach him for hours. And why was this man a patient of the General? Because he had a bout with cancer some eight years earlier and was under regular supervision. In fact he had just visited one of his doctors there some two weeks earlier.

My friend just wanted her dad transferred to the General - where they knew his history - or at the least to a hospital more accessible for her mother and herself.  In my best “don’t worry about a thing” voice I told her that I’d take care of things. But my gut sent me an “I don’t have a good feeling” about this signal. My gut proved to be terribly right.

I first, innocently, called Urgences-Santé. As I tried to explain this predicament in my best easy-going, off-hand manner that I hoped would thaw the bureaucratic icicle voice I knew I would greet me, I quickly lost hope. I was told very brusquely that: 1.Urgences-Santé knows the procedures it must follow; 2.In any case this person was just a dispatcher; and 3. A supervisor would be required to listen to my request but that everyone was very busy and that I should not expect a call for at least three hours. Okay, I thought to myself. Quebec  étatisme in full flight.

I had a friend who was an expert in the draconian maze we laughingly call a health system. He was not only a doctor but an advisor to many organizations. He was my next call. After hearing me out, he said, “Welcome to the Soviet Union!” “Great,” I answered,” tell my something  I don’t know.” And he did.

There were actually two – and only two – situations where Urgences-Santé is obligated by its own rules to take a patient to a hospital of their choosing. The first is if the patient had seen a doctor attached to that hospital in the past six months. Well, my friend`s dad had but since he was now in an ER in the east end, we were a bit late for option one. Option two was, I had to get the ER doctors of the admitting and receiving hospitals to agree to a transfer. Then the hospitals would inform Urgences-Santé and the patient would be transferred. Now that sounded like a plan.

I am fortunate to know directors of a number of hospitals throughout the island. I called four, including one from the east end institution. He, and another director of a centre-city institution, called me back within minutes. I explained the situation. They got to work. And within five minutes I got called back that the ER doctors had spoken to each, the ambulance was ordered and all was going to be taken care of. Great, right? Uhh…not so much and not so fast.

Not knowing what awaited us in the belly of our leviathan health beast, I called my friend’s mother with an upbeat tone, told her everything was taken care of and that I’d pick her up and we’d go meet the ambulance and get her husband. I texted my friend the good news. Her mother and I set out for the east end around two o’clock. 

We arrived at the hospital some forty-five minutes later. Everybody was as nice as could be. The ER doctor had even gone over to my friend’s father and told him that we and an ambulance were on the way. Relief was written all over his face. And then - as one of my dearest and oldest friends who was a medical student in the Soviet Union says – “Vee vait!” Yes, dear readers that is a “V” not a “W.” Just to give you a soupçon of a taste of the old `Back in the USSR.” 

We knew that there would be some kind of a wait, but nobody, including the hospital staff, could imagine what would happen next.  Very quickly three o’clock turned into four and then five. The hospital in town had an orthopedic surgeon standing by. No ambulance.  At least no ambulance for my friend’s dad, even though ambulances were coming in with patients  two and three at a time every fifteen minutes and leaving empty. The nurses started to call Urgences-Santé to find out what was wrong. U.S. told each one that the hospital`s call was on the list but they could not say how long it would be. 

By 6.30, we had news, but it was not good. Indeed the hospital`s call for an ambulance was recorded just before two p.m., but some paperwork had not been processed until  4.11pm. But again no ETA. At 8.00 pm the ER doctor himself called to explain that the orthopedic surgeon who was waiting at the other hospital was going to leave and that this was turning into an emergency since his hospital only had orthopedic specialists on call from another hospital. Another hospital that was downtown. He was told by Urgences that they are very sorry, but they had to treat all calls the same – even ones by an ER doctor.

I then asked the doctor -  who knew my reputation – if I should call any political people and start some push. He said to wait until 9.00 and then I could do as I wish. He said delays were unfortunately common, but this he had never seen.

I walked outside for a cigarette. As it happens I was near the ambulance bays. I saw three empty ambulances with the crews just standing around. I walked over and asked if one of them could call dispatch and tell them that they could transfer my friend`s dad. They said no, they had to wait for dispatch to call them “because there may be more serious cases.” I asked if any were going off duty and could I rent the ambulance and pay them. No they answered. I then asked if there were any private ambulance services. I was told they were not authorized in Quebec and Urgences had the monopoly. 

Just then an Urgences supervisor drove up. I went over to him and tried to reason with him explaining the rules as my friend had told me earlier in the day. The supervisor completely agreed with the rules, admitted that clearly something went wrong, but he couldn’t free up one of the waiting ambulances “because there may be more serious cases.” I asked if he wanted to take the responsibility for my friend’s dad turning into a “more serious case” since he was a man in his seventies with a fractured hip who had now spent some seven hours unattended. The nice young supervisor seemed perplexed. A common condition in the “system.”

Just then my friend’s mother walked out. She had heard our conversation and brilliantly pointed out to the young supervisor that Urgences had committed an error that jeopardized her husband’s condition. And that since the supervisor had admitted there was an error somewhere, it was incumbent upon Urgences to fix it, make her husband a priority case and free up an ambulance. He said his hands were tied. I asked him if he knew what a “tort civile délictuelle’ was. I could have been speaking Greek. At that point I had had it. There were now five empty ambulances parked for twenty minutes as if this hospital was a truck stop.

I don’t know if there was more smoke coming out of my ears or out of my cigarette, but I hit the phones. I called several  MNAs on their cells. I got one who, before I could explain the reason for my call, told me how terrible the refugee crisis in the middle east was. I said yes, terrible, but isn`t it also terrible that our healthcare system kills our own citizens. I then recounted the day. The MNA responded that Urgences was independent of “political interference.”  I won’t give you the full thrust of my reply dear readers, but suffice it to say that my response included the request that I be spared any “political flatulence” and that  “since when is it political interference for an MNA to fix a bureaucratic problem that was threatening a life. If that’s not your job, what the hell is? Particularly since this system was put in place by your government!” The MNA assured me that calls would be made right away. After I made another two calls, I finally got a call from Urgences.

This was from a supervisor. Apparently a senior supervisor. He was very courteous and informed me that I definitely should make a complaint and an investigation would follow. That something had obviously gone wrong. At that point, according to my friend’s mother who I do not doubt, my voice descended to such a loud, menacing, growling basso profundo, that I could have qualified for an opera. It was now 10.15. I informed this supervisor that the only complaint I would make would be to the public and the only investigation I would be interested in would be a National Assembly commission looking into the operations of this monopoly called Urgences-Santé. And then for some reason I stopped and switched gears. I just asked him, “Why can’t you be decent. For one minute stop being an ass-covering bureaucrat and just do the decent thing. Remember decency? Your mother taught you that didn’t she?”

I could swear I heard his voice choke. There were some thirty seconds of silence. When he spoke he said, “Monsieur Wajsman, you’ll have an ambulance in seven minutes.” Not fully realizing what he had just said, I kept on making the case until his words sunk in. I said ,” Thank you, but there are five ambulances here now. You don`t need to send another one.” I proceeded to give him their unit numbers but he stopped me and said he couldn’t use them because, and I interrupted and responded, “I know, in case there are more serious cases.” He then added “Yes, but some are on shift break.”

At approximately 10.40pm, eight hours after our arrival, an ambulance arrived to transport my friend’s father to the centre-city hospital that had agreed to take him nine hours earlier and had had an orthopedic surgeon standing by. The surgeon had now gone home.  I am glad to say that my friend’s father received remarkable treatment at the hospital he was transferred to. But the experience we all went through will never be lost on us. If this is the reformed system, then “abandon hope all ye who enter.”

On the way home I thought to myself, we complain a lot in Quebec. High taxes, lousy services, fey and feckless leaders.  We are clearly too demanding. We should be grateful for the small pleasures the state gives us. After all, taking my friend’s mother back to the West Island at 2.00 am I just drove home with the 20 closed at the 13 and Decarie south closed at Jean-Talon. Thank you Transport Quebec  for those two lovely cérises to top off a delightful day. It was, as the fashionistas say, “to die for.” As is this system. Literally!