Slicing sternums

Brian
Brian Jones
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Thanks to Dr. Thierry Mesana of the University of Ottawa Heart Institute, I have a mental image of some poor guy on an operating table - not poor financially, but poor in condition, and perhaps even a premier beloved by most Newfoundlanders - while a surgeon fires up a circular saw.

Picture the resistance you meet and the sawdust that flies when you cut through lumber, and you can imagine the much more complicated and ghastly process of cutting through breastbone, even with refined surgical implements.

Thanks to Dr. Thierry Mesana of the University of Ottawa Heart Institute, I have a mental image of some poor guy on an operating table - not poor financially, but poor in condition, and perhaps even a premier beloved by most Newfoundlanders - while a surgeon fires up a circular saw.

Picture the resistance you meet and the sawdust that flies when you cut through lumber, and you can imagine the much more complicated and ghastly process of cutting through breastbone, even with refined surgical implements.

And those clamps you use to hold pieces of wood together ... well, some sort of high-tech version would be used to keep the chest cavity accessible to the surgeon once the rib cage is cracked open.

Gruesome image

Granted, this is a primitive picture.

Those of us who don't actually perform heart surgery or assist in it don't know what it really looks like. All we can do is use our imagination, based on descriptions we've heard or pictures we've seen.

The surgery Premier Danny Williams had in Florida has been described as "less-invasive" - a two-inch incision near the armpit, with surgical tools inserted through the ribs to repair a heart valve. No slicing of the sternum. No spreading of the rib cage.

Dr. Mesana's opinion is that the less-invasive method is merely cosmetic, and the traditional method of heart surgery is preferable.

According to The Canadian Press story this week that quoted Dr. Mesana, there are 30 facilities in Canada that perform heart surgeries. Only four of them do the less-invasive method that Williams had done in Florida.

Setting aside for a moment all the heated, angry, accusatory rhetoric both criticizing and defending Williams' surgical foray to Florida, it seems this large and emotional issue can be whittled down to two blunt facts: in the U.S., people can choose to have a heart valve fixed with a two-inch incision at the point of entry, while in Canada the majority of patients will undergo the slicing and sawing of their sternum and the cracking open of their rib cage.

Big boost

By now, all of North America - with the possible exception of Mexico - has heard about Williams' surgery in the Sunshine State and how he has, in one fell swoop, insulted Canadian doctors, shown no faith in the Canadian health-care system, and endorsed the privatization of health care and its accompanying benefits for the rich.

On the contrary, Williams' actions might give a long-term boost to Canadian health-care by helping to smash its lofty, unassailable, mythological status.

Here, concisely, is the largely unquestioned myth: health care in Canada is free, universal and equally available to all.

Wrong, on all counts.

Not free

Health care is not "free." We pay for it with our tax dollars - billions of them annually. You might not have to pay when you visit your doctor or surgeon, but they still get paid and their services come at a cost.

Health care is not universal. Medicare does not cover many aspects of necessary health care, such as dental care, physiotherapy and eye care, among others. Health care is not equally available to all.

Given the huge importance prescription drugs play in maintaining health, whether a person has a good employee health plan or private plan - or has one at all - will influence their quality of life, and cost of life.

Strangely enough, we have yet to hear anyone - doctor, surgeon, medical expert, politician, health-care bureaucrat, union rep - state succinctly why the Canadian health-care system is so dysfunctional, and how it can be fixed.

At least Williams' trip south ensures Canadians will keep debating the issue, as we should.

Brian Jones is a desk editor at The Telegram. He can be reached by e-mail at bjones@thetelegram.com.

Organizations: University of Ottawa Heart Institute, Canadian Press, The Telegram

Geographic location: Florida, Canada, U.S. North America Mexico Sunshine

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