(commentary on the state of Quebec Health care at the end)

I had a sore throat starting last week towards the end of my trip to Seattle, no big deal. It persisted and got worse each day, and by Tuesday I was convinced it was strep, there was a lot of swelling back there. Wednesday soup was about as much as I could eat, and even that was hard, I decided to see a doctor on Thursday. I prepared a brief document explaining my problems as speaking was difficult (I even had google translate take a whack at french) I went to the walk-in-clinic first thing Thursday morning to discover that they didn’t actually accept walk-ins until 2:00 that afternoon. Allison rescued me and took me to another (open) clinic where everyone spoke English. My fever was high enough that they fast-tracked me, the doctor who saw me took one good look, concluded it wasn’t strep, and decided I was hospital-bound.

The swelling in my throat had started symmetrically, but the right side had swollen enough that the uvula was seriously off center, and had actually pushed my jaw off to the side. On a 0-10 scale (0 = No pain, 10 = Most extreme) I was at about a 4 for much of the week, a 5 by Thursday morning, and a solid 7 by the time I got to the hospital.

I went through triage, handed over my admission form from the walk-in-clinic doctor, and waited. The secondary examination nurse gave me the option between a suppository tylenol, or oral. I opted for the latter, but it was a tough battle by then, even with a very small pill. She then took some blood, and I promptly fainted. Wheeled out of the room I saw the E.R. doc who was incredulous I wasn’t yet on antibiotics (silly clinic doctor!), she then proceeded to not give me antibiotics. I was also visited by the Short Stay unit (an E.R. step down unit) as I would be admitted and would spend the night. There was universal appreciation of just how my my throat was swollen (“wow! that’s huge”). Then I got morphine and a saline drip, and finally some antibiotics, they put me in a gurney for this which was probably prudent: everything is awesome when you’re on morphine. The ENT doctor arrived to lance and drain my throat (as gross as it sounds). Despite both topical sprayed antiseptic, and injected stuff, this was a full 10 on the pain scale, plus I couldn’t breathe. Not my finest hour. Allison did get to watch it happen though, apparently it was pretty interesting; I was busy trying to scream. After spending a few minutes to recover, and some more IV pain killers, I was wheeled up to the short stay unit. They hooked me up with IV antibiotics, provided me with a vacuum tube to drain any saliva (still couldn’t swallow) and I promptly fell asleep.

My now seriously abused mouth and throat had two distinct states: either it was open and incredibly dry, or it was closed and full. Since my sinuses were congested my mouth open when I slept. So I’d wake up every hour with a painfully dry mouth and some new swelling in my palette. I’d chew some ice chips (getting to use my jaw for something was glorious), and swish some water. Closer to morning I was mostly able to swallow water (though with great difficulty).

I spent the day in the short stay unit on a clear liquids diet, not very interesting (or filling). My ability to swallow and then to speak improved as the day went on. Towards the evening a new ENT doctor came by to examine my throat. He did a quick test with a needle and found more pus, so he drained it once more with Allison conveniently holding the flash light. The swelling reduced considerably and immediately. He wrote me a prescription for serious antibiotics and pain killers and sent me home. Having now had a full night of sleep (the first in many nights), I’m feeling pretty good.

If you're interested in what my unshaven, not-recently brushed teeth, but recently lanced throat looks like (gross): mouth pic. You can sort of tell that the swelling has pushed the uvula off to the side in that picture, during the peak of it, it would have been much further off.

A comment on the state of health care in Quebec.

The time from when I decided to actively seek medical attention to a trained specialist applying an intervention to resolve the issue was less than 12 hours. That time includes having gone to a closed clinic, waiting for a ride, driving outside of the city, then back to the downtown ER, etc. A more accurate number would probably be nine hours. Sitting in a waiting room feeling like crap is a pretty miserable place to be, but really, it’s fine. In both the walk-in-clinic, and the ER I saw new patients arrive, and be seen before me: this makes sense. They were in worse shape medically than I was. I also saw myself seen ahead of some people and again I think this makes sense: I had a decent fever and my airway was at risk (at which point things tend to get serious rather quickly). In the ER I was seen in a room by a doctor, then moved back to the waiting room until I was needed again. This was kind of annoying, since the waiting room is miserable and full of sick people: in an ideal world they’d have enough rooms to deal with all the people they’re seeing at the moment, but that would be a LOT more rooms, and it wasn’t the end of the world. Having us all in a single room also made it easier to monitor us: this way someone who arrived alone couldn’t fall unconscious un-noticed. So it may even be sensible this way. Would it have been nice for things to have gone “faster”? Sure. Am I happy with the level and timeliness of care? Absolutely.

The most annoying part for me, was watching the relatives of the ill either walking around glaring at everyone who had received a bed (while their loved-one hadn’t) or asking everyone they could find how much longer it would be. I would honestly estimate that forward-facing medical staff spend between 5%-10% of their time politely telling people that they have no idea, or can “look into it to make sure nothing has been missed”. The five well relatives to a single ill patient ratio some groups were presenting didn’t make the crowded level of the ER waiting room any better either, especially since it was apparently “a very busy day”.