It’s 3:00 AM, July 3rd, 2020, in the Ottawa Hospital Civic Campus emergency department. I have been here since 3:00 PM, July 2nd. The journey began in mid-January when I started to experience occasional difficulty swallowing my food. Come early March, the swallowing problem is recurring, and there is now a soreness in my throat. My wife notices that the register of my voice seems to be changing. OK, time to do something.
Getting a problem looked at in Canada requires one to go through your family physician. By US standards, the Canadian health care system is conservative in its use of diagnostic procedures. The bigger problem, though, is the pandemic. All non-urgent care is postponed.
I get a chest x-ray and standard bloodwork, but they reveal nothing. I try to get a videofluoroscopic study of my swallowing problem, but I can’t get through the waiting list. Weeks pass. My PCP pleads with the diagnostic clinics. They promise to get back to me for a phone appointment to evaluate whether I need a diagnostic procedure. It doesn’t happen.
Then, on July 2nd, I start coughing blood. A quick conference with my PCP, the only course is to go to the ED. I get there at 3:00, and it’s standing room only. This is Canada, so the crowd is orderly and cooperative, but it’s not a good scene. Five hours of waiting and I see a resident. I tell him my story. He responds using medical words that translate to “uh oh,” and he sends me to get a CT scan. I get scanned at about 11:00 PM. And then I wait.
Which brings us to 3:00 AM. I am called to an exam room. An attending physician comes in. She says, directly but gently and gracefully, “I have serious news.”
There is a moment in Alan Furst’s The Polish Officer in which the title character, a WW2 resistance fighter, is woken by gunfire in the night. It’s the Wehrmacht, assaulting the barn where his unit is hiding. He looks at a comrade, and in the glance, they exchange the recognition that “The time that we always knew would happen has happened.” I have been through this with friends and family. Now it’s my turn.
The CT scan shows that I have a mass in my oropharynx, the middle component of the throat. Later that morning, I see an ENT surgeon who had the same view as the ED doc, “This is an oropharyngeal squamous cell carcinoma [OPSCC] until proven otherwise.” He did a biopsy with a needle through the side of my neck.
On the 7th, I got a call from my PCP with the results from the biopsy. “I am going to be straightforward. This is bad news.” The mass is indeed an OPSCC, with lymph node involvement to boot. The report also included word salad about the staining of cells on the slides. I’m sure it’s crucial, but it made no sense to either of us, which we found hilarious. Thank God that my PCP speaks my native tongue, which is Black Humour. The other good news is that OPSCC can often be treated with success.
The upshot is that I am now a cancer patient during the COVID-19 pandemic.
With your permission, dear reader, I plan to blog through this experience. There is a genre of health professionals narrating their experience as patients. That’s not quite what I want to do. I’m going to mostly avoid making this about me, partly because I’m not the writer that, say, Paul Kalinithi was. Instead, being a cancer patient provides a point of view to analyze the global crisis. The pandemic is obstructing the care of many other conditions. I may end up becoming collateral damage of the coronavirus because COVID-19 delayed my diagnosis. Or was that a fault of Canadian medicine? If so, how ought we address it? Or I might become a direct casualty of the pandemic because my age and illness place me in a high-risk category for COVID-19. You — meaning now the young and healthy population — have a role to play here: please wear your masks.
I have spent much of my career studying health care systems, often from an ethics framework. Perhaps we can learn something from this.
The next cancer post, about how my tumour was diagnoses, is here.