Notes on Healthcare

Our weekend was interrupted by a trip to the local emergency room (don’t worry, everyone’s fine). While it’s still fresh in my mind, I thought I’d write up some thoughts on the experience.


When you’re in the trauma room of the emergency department you feel oddly secure. You’re in a space that represents the sharp tip of the medical spear and all the wood is pushing behind it.

It’s a massive room that balances plenty of open space with literally millions of dollars of life-saving equipment. Racks of gear that blinks and wheezes and sucks surround you; bins containing every variation on suture, clamp and connector lie in wait. Wheeled machines are ready to stabilize and scan and monitor. Any free space on the walls is adorned with home made flowcharts outlining inscrutable jargon-heavy algorithms for dealing with cardiac arrest or other common procedures.

At least one nurse is dedicated to the room and you’re never alone. Doctors enter and exit, sometimes trailing their rolling wares, like a lost travelling salesman who roams hospitals instead of sidewalks.


In general, the emergency rooms of hospitals seem to be peaceful places. It’s an odd juxtaposition of people going through unlikely traumatic events and professionals for whom this is just another day at the office.

The nurses and ambulance attendants maintain the casual pose and jocular banter that I assume is found amongst people whose work randomly switches between the banal and the violent (I suspect soldiers and policemen are similar). The doctors flutter about, quietly moving from patient to patient. Security guards stare lazily into the distance and furtively sneak glances at their smartphones.

And then there’s the patients.

They’re mostly silent. There’s little moaning or crying. Most sit silently; in the children’s hospital they’re usually accompanied by a small posse of weary parents who seem resigned to a wait and are already calculating the impact of this on child care arrangements.

Even babies don’t seem to cry. It’s like they can sense that they’re entering a special place and they retreat into themselves. Odd.


It’s incredible to walk into a hospital and know that you won’t pay. This is truly one of the things that Canada has gotten right (America-I love you and you should learn from this).

The peace of mind that comes from knowing that you’re going to get world class care and not have to worry about being bankrupted is zen-like. I’m so glad that Canada didn’t tie health care to employment like in America.

There are, of course, consequences to this. The first is that you’ll wait a bit longer than you would if you were paying for it. The Canadian hospital is the ultimate meritocracy of distress; if you’re in truly bad shape you will be seen right away, but otherwise you’re going to wait.

It’s not an unreasonable compromise and it gives you a chance to hang out with a bunch of people who you otherwise likely wouldn’t. The Canadian hospital is the great equalizer; we are all in the figurative boat.

One thing that was reinforced for me while waiting several times in the hospital over the weekend is how Vancouver is ground zero for multiculturalism in Canada. The Children’s emergency room was an almost even split of Asian and Caucasian with a healthy dose of South Asian as well. If you want to see what a multicultural metropolis looks like, come to the Lower Mainland in 2025.


Healthcare costs a lot of money. The people, the tools and the costs of mistakes. All of this was on display during our visit.

People: they’re everywhere. Dozens of nurses, lab techs, custodial staff, ambulance attendants and the odd doctor. They’re simultaneously busy and doing nothing. Putting an IV in a patient and then waiting thirty minutes for it to be finished. The whole system feels designed to succeed at peak capacity with a lot of redundancy when it’s not rush hour.

The redundancy abounds. Some is technology; some is process. For instance, a nurse can’t start an IV without scanning their badge; the machine literally won’t pump.

Ditto for constantly checking that they’re working on the right patient. Nurse A put a syringe in our IV; nurse B came to turn it on – but before he did he verbally confirmed that the he was working on the right patient. Same for the lab techs; after drawing blood they verbally confirmed that it was the right patient. Very reassuring.

Less reassuring is watching how cost creeps into the system. We were transferred from one hospital to another via ambulance. Our son had a heart rate monitor attached to his foot while at the first hospital. They left it on (it’s just a bandaid with a wire) so that the second hospital could use it – except that it didn’t fit their machine. It was the identical set of pins, but manufacturer B had put a little flange on the plastic that meant that it couldn’t connect.

And that’s how cost slips in. No one makes a decision on health care based on the cost of cord. No one is going to decide whether to buy a machine based on whether the cord is interchangeable. But cords cost money (and I’ll be the margin on them is insane; that’s one way how consumer electronics manufacturers print money); multiply this by the millions of decisions around equipment and you can see why healthcare costs so much.


But I’m not worried about the costs because that’s a solvable problem and we seem to have great people working in health. Everyone we interacted with was focused on the best outcome for our family. It made us quite happy.


There were a couple of odd things that happened during our visits.

The first was that we were constantly asked the same questions: Any allergies? Any contact with people with chickenpox? Any contact with someone with MRSA? etc., etc.

Again and again.

Literally, we would tell this to the admissions nurse, then the nurse who visited us in the acute room. Followed up by the nurse practitioner and then finally the doctor.

I’m not sure if this was redundancy (always testing for the same data) or a sign that there’s a broken process.

The other odd thing was the different advice we’d get for the same thing. One healthcare provider told us we should come back if something happened and lasted one minute. Another told us five. The same person then told us that they wouldn’t actually recommend coming back for that at all, rather what mattered was temperature.

A little disconcerting – and a sign of just how complex healthcare is.