Lost in Canada’s Health-Care Wonderland

[Editor’s note: Last week, Victoria-based writer, podcaster, filmmaker and playwright Mark Leiren-Young published on his Substack this tale of his ‘recent medical misadventures’ in the form of a fan letter to comedian Lewis Black. It’s funny and harrowing and made headlines. With his permission we share it here.]

Dear Lewis Black,

I don’t remember the exact jokes you made at your Victoria show about how terrifying it is to get sick in America and how awesome Canada’s health care is. But since I was sitting in the fifth row, laughing at those jokes while I almost lost my leg to an infection courtesy of Canada’s health-care system, I thought I’d share my adventures in our medical Wonderland with you.

First off... huge fan. I was devastated when you cancelled your original Victoria date, thrilled when you rescheduled. I remember thinking... I wasn’t going to miss your show for anything.

While I was lying in the emergency ward a few hours after your show I realized I probably should have added a bit of wiggle room to my definition of “anything.”

My ride started five days before your show with an odd combo of feeling flu-ish and wondering why my foot was hurting. I assumed COVID and arthritis. When the second stripe didn’t appear on the plastic rectangle I thought... yes, I can see your show!

But my foot was turning red, so I popped over to my pharmacy and the pharmacist was OK to take a look. I’ve had the occasional arthritis flare-up and asked if this could be something like that. He didn’t think so but gave me some painkillers and told me if it didn’t go away by morning I should check with a doctor.

I’m one of the lucky B.C. residents who not only has a family doctor, but has a family doctor who will make time for patients in trouble. But he works in Vancouver, a day trip and $200 in ferry rides from my home on Vancouver Island. I can’t stress enough that almost everyone I know would donate a vital organ to have a family doctor — even if a visit takes a day and costs $200.

But I couldn’t leave town, so I thought... I’ll book a virtual appointment with a doctor who can check this out on an app — because that’s how we do universal health care now. Telus Health — the doctoring company run by a phone company — had no doctors available.

Plan B... I’d visit an “urgent care clinic.”

Booking into urgent care is like phoning a radio station to win concert tickets. Call in at exactly 8 a.m. to listen to the hold music and hope that when the receptionist answers they pick up with their happy voice and declare: “You’re caller number 12. You win a doctor today!” I thought I was one of the lucky callers because the receptionist told me I was first on the waiting list and I’d likely get a call later to set an appointment. It didn’t happen.

So that night I kept logging on to the app hoping a virtual appointment would open up. Nope.

No worries. I’d go to a walk-in clinic and wait till someone could see me — regardless of how long the wait was. That’s when I discovered that post-COVID no walk-in clinics still do “walk-ins.” One “walk-in” clinic had a sign on the door that said they were booking a week in advance.

So I kept trying that app to line up a virtual visit. No joy.

The next day my leg was more inflamed, so I went to another pharmacist and convinced him to look. He was clear that this was not his world but didn’t think it merited a trip to emergency. He gave me a list of more obscure online medical options. I logged on to Tia Health and, much to my shock, lined up a Zoom-style consult for later that day.

Just before the appointment I logged on to their platform and received a message through it asking for a photo of my leg. Not quite a nude selfie, so why not. While I was in the virtual waiting room, I received a text telling me my consult was cancelled and I needed to go to a walk-in clinic so someone could check my leg in person.

So after trying to get a doctor to look at me for four days I finally had an appointment with a doctor who refused to even take one minute to talk to me and blew me off during our virtual appointment. On the bright side, her text did not suggest that my situation was urgent and she definitely did not suggest I had to skip your show.

Clearly I was done playing call-in clinic roulette and clicking refresh on the Telus Health app. If my leg still hurt the morning after your show, after four days of trying to get someone to check it out in person or online, I’d go spend the day and night waiting for someone to look at it in emergency. I’d go there right after I taught my class at the University of Victoria.

My leg and foot were sore enough that I used a cane to walk to my seat for your show but, hey, I’ve wanted to see you forever and like I said... Row 5.

I settled into my seat and didn’t try to get up again till it was time for your well-earned ovation. And I discovered that as much as the rest of me was into standing for you, my right leg was not on board with the idea at all. Maybe it didn’t like the health-care jokes.

Driving home it hurt to push on the gas pedal and the brake. My wife, Rayne, suggested calling an ambulance to take me to emergency. I called a cab.

I’ve spent too much time in Victoria’s emergency rooms — mostly waiting to check out something scary happening to Rayne. Our last few trips to the downtown hospital (Royal Jubilee, which is such an awesomely festive name) were a nightmare. The last one included a 16-hour wait for Rayne to have a 30-second conversation to learn that the results from a scan were negative, nothing to see here... and we overheard two other couples who’d waited close to a day for similar conversations. I opted to have the cab drop me at a newer hospital in the burbs, Victoria General.

Because of Rayne’s medical adventures I’ve learned that the only thing worse than waiting 16 hours in an ER to see someone is being whipped through triage.

After a blood test, I’d just flipped open my laptop to start what I assumed would be a dozen hours of marking student papers when I heard my name. After a nurse helped peel off my jeans I saw that my right leg had Hulked out since the start of the day. Even a bit more swelling and I suspect the jeans would have had to be sliced off.

Then the ER doc stared at my leg and looked grim. As a connoisseur of ER visits I’ve seen docs frazzled from overwork, annoyed, bored and charming — which usually signalled shit was real. Grim was a first. I got why when he locked eyes and asked: “Do you know what necrotizing fasciitis is?”

Yeah. And as I processed what he was really asking I wanted to throw up, pass out or cry “Mommy.” Back in 1994, I was writing and performing topical political comedy and was set to open my annual year-end revue when Quebec separatist leader Lucien Bouchard lost a leg due to necrotizing fasciitis — a.k.a. “flesh-eating disease.”

I replaced about 20 minutes of solid material on Bouchard and separatism with 20 minutes of timeless gags and a very tasteless joke about his leg separating and a Terry Fox run to end Canada. Was this my karma? It wasn’t that bad a joke.

And while the majority of the swelling stopped just above my right knee, the infected red patches went all the way up to my groin. Did people survive losing an entire leg? Clearly, I hadn’t watched enough Grey’s Anatomy.

I’m sure I’ve been more scared in my life, but even months later I can’t recall when.

I am fairly sure that the answer I gave the doctor was: “It means I’m not coming out of here with my leg.” The doctor did not laugh. His grim expression did not change. “We’re sending you for a CT scan right away.”

The pain in my leg had started to shift into what would be my new normal and walking to the scan, even with a cane, wasn’t happening. I was rolled through the ER — very quickly. I hauled myself onto the table; the techs did the scan, rolled me back to a room in the ER and hooked me to a pair of IVs to pump me full of fluids and antibiotics.

I called Rayne. Thankfully, she had not heard of necrotizing fasciitis. I begged her not to Google the term till we knew whether I had it, because I didn’t think I was capable of talking about what was going through my head and reassuring her that everything would be OK — when I couldn’t think of anything at all OK about losing my leg. Though later a friend pointed out that I’ve written a book and directed a documentary about a killer whale named Moby Doll and if I replaced my leg with a peg it would be very Ahab.

And that’s when I heard several nurses talking about “the wrong leg... what do you mean they scanned the wrong leg?” And I wondered about the poor schmuck they were talking about — knowing it couldn’t possibly be me because I had one leg that looked like a leg and another that looked like the stubby grey leg of an elephant dipped in red paint.

Yes, you are getting where this is going before I did.

And when the nurse told me this I was laughing even harder than I did at your routine, and I laughed really hard at your routine. The Biden bit was freaking brilliant.

The nurse unhooked me, rolled me back down the corridor and I don’t think I stopped laughing until we hit the CT lab tech and she looked so mortified and said she was so sorry and I asked... how anyone could mix up my left leg and the thing that had replaced my right leg... and I started laughing again. And she apologized again and said that because the legs were so close together they had what they needed.

I was wheeled back, set up in a cushy chair and plugged into my IV drips. After two hours that felt like 20 years, I was told I didn’t have flesh-eating disease.

I had an infection known as cellulitis — likely caused by a very tiny cut on the foot, likely caused by a lifelong aversion to socks. I began to breathe again. Even as I heard the news I told the doctor... “Hey, it’s just pain. I can handle pain.”

As you know, that’s the type of thing that is dangerous for any character to say out loud in a movie. It’s usually said by someone, say, going on their first spy mission and about to be captured and tortured by the enemy where that character will find out there are levels of pain they can’t handle.

Basically, every nerve ending in my lower right leg was shredded.

When I tried to stand or move or, ya know, breathe, the pain wasn’t like anything I’d experienced or even imagined. It was like the scene from Alien right before the creature bursts out of her victim’s chest cavity. It was like my leg was filled with those aliens and they were fighting to see who could get out first. I kept wondering when, not if, my swollen leg was going to explode.

I’ve spoken to several people who’ve had full-blown cellulitis — including my friend Art who has had all sorts of injuries in a career as a farmer and theatre tech (best combo ever) including being run over by a tractor — and all said the same thing... “worst pain in their life.”

So... after a full night in the ER, I moved into a hospital bed in the hallway — which became home for the next five nights.

How overcrowded are our hospitals?

The hallway beds now have their own numbers. They don’t have curtains or privacy or bathrooms or anything like that — but they are officially part of the system. Many other patients had beds in the hallway too.

I was told to elevate my leg, but the bed wasn’t equipped for that so I had to use my backpack and coat. I would have used pillows, but like a low-budget airline, the hospital didn’t have any to spare. I scored the strongest pain meds hospitals have and they were about as effective as Coke Zero.

Beyond that, being in a hospital for a week was about what you’d think being in a hospital for a week would be like. Except at least once each day a doctor or nurse would stare at the thing that had replaced my lower left limb and mutter: “Don’t worry. You’re not going to lose your leg.”

Until the first time I heard those words it hadn’t crossed my mind that losing my leg was still a possibility, but the way the first doctor told me, this sounded less like he was trying to convince me than convince himself. You know that calm voice pilots practise or, for that matter, the calm voice doctors generally have when they’re trying to make sure you don’t panic at the news they’re telling you? This was the opposite of that.

I’ve made my living as a playwright and screenwriter and the note I’d give to anyone playing the role of this doctor would be in what, as you as a playwright know, we call “a parenthetical.” For anyone not in this world, it’s a term for an acting note writers include (that actors generally ignore) to indicate how we’d like a line delivered. And my parenthetical before this line would be a word like “unsure,” “unconvinced” or, most likely, ”lying.”

There wasn’t quite a question mark at the end of the sentence, but there wasn’t a period either. The doctor just stared at the red, swollen elephant leg in the room, like he was also wondering if my real leg would ever reappear.

Apparently this doctor informed all the other doctors and nurses that they needed to repeat this line whenever they came and stared at me because I heard pretty much the same words, with the same unnerving tone, at least once every day that week, though, occasionally, one of the older nurses would improvise and add, “This is the worst case of cellulitis I’ve ever seen.” And again, they didn’t really seem to be talking to me.

I also kept being reassured that I’d be released “the next day” and the people assuring me clearly believed this because I was almost never asked to choose meals for the next day.

Rayne and the friends who visited and saw my not-so-leg-like leg during visits all believed it was going to be amputated. The friends who knew the word “necrotic” were pretty sure this was what necrotic looked like. I will always love them for not telling me this until months after I was out of the hospital.

The pain was so bad — and the distance to the bathroom seemed so impossible — that when I had to get up to relieve myself I kept wondering... how bad would it be if I just lay here and relieved myself on the cot? When I finally got home I wondered the same thing as I lay in bed before deciding that maybe, instead of walking, it would hurt less if I slid out of bed and crawled to the washroom on my knees. The answer? For about a week it did.

The rest of my hospital adventures were... hospital adventures... and the right leg is still attached to the rest of me. So winner winner. The cellulitis is mostly gone. So is all the muscle in my right leg, most of my butt and a fair bit of my balance.

And now... dear Lewis... back to laughing at the American health-care system.

Unlike a lot of British Columbians — and a lot of Canadians — I have a wonderful family doctor. He called while I was living in the hospital hallway. Sure, he doesn’t live on the same island I do, but I pray for his health daily because if he retires, the chances of me getting a new GP are only slightly better than the odds of my Vancouver Canucks winning the Super Bowl.

I spent six years living part time in Hawaii and had friends there who were afraid to visit the hospital for any reason because death — or loss of limbs — scared them less than bankruptcy. When I was looking at becoming a dual citizen I had three immigration lawyers tell me I should marry a local. All three gave me the exact same advice — walk down a beach and ask any woman I liked the look of whether she wanted to marry a Canadian so she could have health care for the rest of her life. One American friend with no interest in medicine had a health scare that led to her becoming a nurse — not because she had any interest in nursing, but because the job came with a lifetime health-care plan.

I am so grateful that I spent seven nights sleeping in hospital beds while a wonderful team of dedicated medical professionals pumped me full of antibiotics and did everything in their power to make sure I left the hospital with the same number of limbs I’d been admitted with. I absolutely get that if I were an American dealing with the same condition I could have lost my leg and my livelihood. And the only expense I paid out of pocket was the taxi fare to the ER.

But I also get that I could have lost my leg or, as several people have helpfully pointed out, my life, to a tiny cut that could have been treated with antibiotics before anything bad happened at all. And that’s because our health-care system is in about the same shape as my leg was in when the doctors were nervously staring at it muttering, “Don’t worry, you’re not going to lose it.”

So, yeah, if I get to see your show again I’ll still laugh at those health-care jokes because funny is funny. Also, the fact that we strive for universal health care is one thing that does make Canada that kinder, gentler nation one of your former president’s speech writers waxed poetical about...

And it’s one of those differences between Canada and the U.S. that we’re not so secretly smug about, eh.

But if everyone in your Canadian crowds doesn’t laugh quite so hard the next time one of your rants includes a rave about our health-care system, this’d be why.

Looking forward to being able to stand on two legs to applaud for you again sometime soon.