Liam Neeson, one of my favorite actors, experienced a great tragedy last week in the death of his wife, actress Natasha Richardson. I don’t usually pay too much attention to celebrity lives, but having two teenage boys similar in age to hers, I found Natasha Richardson’s death especially poignant.
As a mom, I must express my sorrow for the family’s misfortune. And as a physician, I have to ask: what can be learned in this case?
For the two or three Americans who haven’t read the details, Natasha’s death was the result of a head injury while skiing — not a high speed Sonny Bono-type wipe out, but apparently a fairly innocent fall during a lesson. She developed an intracranial bleed, and by the time she was able to receive the necessary level of care in Canada, her intracranial pressure was excessive and ultimately fatal.
The easiest lesson is to wear a helmet on the slopes. (As a snowboarder, I have been wearing one for years, but I notice that skiers over the age of 10 generally don’t think it necessary.) But that’s not the big lesson here.
As reported by the Associated Press, Montreal’s top trauma neurosurgeon cited the lack of emergency helicopters as a contributing factor in the death. “Our system isn’t set up for traumas and doesn’t match what’s available in other Canadian cities, let alone in the States,” said Tarek Razek, director of trauma services for the McGill University Health Centre.
Secondly, even after arriving in Montreal, the patient had to be transported by land to yet another facility where a neurosurgeon was available. Now, this is not some podunk little community hospital area — this is a major metropolitan center without air medevac, and apparently without adequate neurosurgical capability, or at least a system of trauma triage.
I have never been to a ski slope in America that didn’t have medevac capability. And, we have a trauma system to facilitate appropriate and timely transport to those facilities which can care for head trauma.
Fifteen years ago, we had enough neurosurgeons and trauma surgeons to staff our hospitals round the clock. For most large metropolitan areas, we still do. I don’t live in a major metropolitan city like Montreal. I don’t work in a university center like McGill. But even in my city of 100,00 people with its community hospital, we have medevac helicopters at all hours.
We have CT scanners positioned next to the Emergency Room to scan trauma patients on the way to the Operating Room — usually within minutes. And if this particular type of head trauma occurs, we can transport the patient to a neurosurgeon within an hour. Canada has ground ambulance and CTs which are in need of parts.
Canada has government-run medicine, which, like every other government program, is inefficient and ineffective — especially in this sort of emergency when seconds count. It is generally true of socialized government-funded medicine that low-end care is cheap and available, but high-level care is underfunded and available only after a long wait, or to those privileged to jump the line.
Low-level care requires a minimum of technology and can be applied by less trained providers. (President Obama said that the provider gap developing in our country will be filled by Nurse Practitioners and Physician Assistants. There may have been P.A.s and Nurse Practitioners in the first hospital to which Natasha was taken, but, unfortunately, these lesser trained providers do not take the place of neurosurgeons, or any other specialists.)
Government-run medicine mostly treats ideology by emphasizing “prevention,” lifestyle counseling, and free clinics for VD, abortion, and the common crud. It is free “feel good” medicine that convinces the masses — especially young people who are generally healthy — that government medicine is great. It treats the 90%, but woe unto you if you are the 10% who need real high tech treatment quickly.
Epidural bleeds are a very dangerous, so I cannot say with 100% conviction that Ms. Richardson would have been saved in the United States. But, I’d sure rather take my chances on an American ski slope — at least for now. A recent Canadian visitor to my area remarked how thankful they were to have had their heart attack in the U.S., because in Canada, they would have died. (Here, they had emergency cardiac catheterization and bypass surgery.)
So, Mr. Neeson, perhaps, when the pain of the immediate tragedy is past, if you wish to do some good in your wife’s memory, perhaps you could stand up for private free market non-government medicine. Look around the world. Look in detail. Don’t be fooled by the theory-spouters who don’t actually see patients.
Talk to doctors outside of the big centers, such as the oncologist in Sweden who sees 12 patients a day in spite of the line of patients waiting to be seen. He doesn’t get paid any more after the twelfth patient. Ask the surgeons in Canada who have too few operating rooms available to do surgery, and who spend three months a year in Florida because their income is capped. Ask the Mexican in the free government-run hospital whose hip fracture is being treated by massage because they have neither equipment nor doctors.
Then come back and remind whoever will listen that it is profit, and the free practice of medicine, which makes medevac possible and puts a neurosurgeon within reach.
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