A day in the life of Danish Health Care

A young man is getting chemo for his cancer. He has about a 60% chance of cure and it's very important that he gets scanned on time between his chemo treatments.

His chance of cure may fall to 59% or 59.5% if he doesn't get scanned on time, or it may not fall at all, statistically. But for his kind of cancer, having spread the way it has, this particular scan and this very particular time will guide which chemo he gets next.

But Denmark needs money. So the health care budget grew less than it should, meaning each hospital got less money. At our hospital, the radiology department was hit unreasonably hard. CT slots were cut. Nurses, techs and radiologists were no longer allowed to work overtime, as this is usually very well-paid in Denmark.

The wait-lists grew, but since our patients tend to be very sick and very salvagable, they tend to get the scans they need, and I have only been vaguely aware of the problem.

Until Thursday, when I realized my patient hadn't gotten his scheduled scan. My first thought (my first fear, rather) was that I had forgotten to schedule it. But no; there it was, clearly ordered for a specific week. I called radiology and was told it couldn't be done on time. I had to tell this to the patient. He is a nice guy, with a warm smile, but he was visibly worried about the delayed scan. I had to walk a tight line between blaming "the system" (and keeping his faith in me) and pretending the scan could easily wait (keeping his faith in the system).

I got his scan scheduled today, after reaching an onco-radiologist, who sympathized with my plight. Still, the scan will be a week late.

For those interested, here are my thoughts on the future of the Danish health care system.

I think the standard of care is running away from Denmark. So far, we have been saved by our wealth and a health care system that offered high-level care in bare-bones surroundings. In Denmark, we have been able to treat people with $100,000 biologic agents, while they sleep in 3-bed hospital rooms with a shared bathroom (if they are lucky; sometimes, they sleep in the hallway). But the growth in the number of, and duration of, treatments have outpaced economic growth. Where, just 10 years ago, some diseases had very cheap, palliative treatments, there are now piles of novel, or biologic, agents to try. They are without serious side effects, so you can use them in everyone.

We're seeing some rationing, but it's politically impossible for anyone to devise a list of who can receice which drugs, and who can't. Drug costs will rise exponentially and the health care budget will stay steady.

I'm not optimistic. The Scandinavian credo has always been that everyone deserves the same care, rich or poor. In ten years, a wealthy American (or a wealthy Chinese, for that matter) will receive care that is unavailable in Denmark. Can we stand that?

Now, I'm not neccesarily a fan of the American health care system. Where I frequently work, it's not unusual to see people in their twenties with dentures, because their parents couldn't afford dental care (or the one medicaid dentist in the area moved). I have seen old couples ration out pills between them, because they couldn't afford meds for two.

I don't know what's right, but I don't like what I see.

In other news, I'm fat. Natali thought it was funny that my man boobs jumped up and down last night. I am so miserably out of shape.

In other, other news, the Girl and I have a plan. It's great; it's a dream, and my spirits are high. The plan? I can't reveal it, for fear of the Girl changing her mind.

All over again

We're back from an almost month-long vacation. First, it was two weeks in America; then, half a week back at work and off again to Mallorca for our triathlon training camp.

We had a great week there. The island is mostly known for its white sandy beaches, but cycling is another major source of tourism. We didn't train as intensively as the other members of our group, who are all accomplished triathletes (most of whom have completed Ironmen (Ironmans?) in 10-11 hours).

They would get up and swim every morning at 7 and then ride around a hundred miles a day.

The mountains on Mallorca go up to 1400 meters, with the highest paved mountain pass at 1100 meters. The longest climb is 13K at 7.4%. I've never climbed real mountains before and loved every minute of it. If I lived by mountains, I doubt I would be a runner.

Christian has no idea whether he is in Denmark, America or Spain. He liked the beach and the fact that we bought him toy cars and ice cream. He loves Lightning McQueen and screams "Lamma Queen!", when he sees anything related to Cars (which is all the time on the Mallorcan tourist strips).

Because of our peculiar life, Natali travels a lot, but she only sees the same two countries, and most of her vacations are spent at her mom's house. She lapped up the sights and sounds of Mallorca and tried speaking a little Spanish here and there. She is such a thinker; she notices and questions everything.

After we got back from America a few weeks ago, she missed her mom so much that she would wail in frustrated despair. It was difficult for a few days, but it got better. She has always stated that she wants to stay with her mom, and she smiles when I go on about how much I'm going to miss her. I think she considers me the strong parent; the one who will stay a constant in her life, no matter what. She often mentions that her mom does not miss her enough, and that she never seems sad when she says goodbye.

Now, her move back to La Crosse is just a month away, and she can see it coming. I realized that I have no more weekdays off until we leave for America in June. I told her, and the realization that we wouldn't have any more afternoons together dawned on her. I won't be biking her to school or picking her up - ever. Not for the foreseeable future, anyway.

Yesterday evening, we played soccer with the neighbor girls. She wore her new Barcelona jersey (number 10 Lionel Messi, away colors) and did the Messi cheer when she scored. She asked me whether I thought she would play soccer in America and if I would pay for it, if her mom couldn't. Later, she asked when our annual spring day in Tivoli (the old amusement park in downtown Copenhagen) was going to be. She perfectly well knew that no such day will happen this year, as I have no days off. And then, trying to pretend all her questions were unrelated, she wanted to make sure I would call her every day. She figured out that I could stay up till 11 and she would hurry back from school, and we could talk that way, despite the time difference.

It's horrible that she is leaving. I dread it and it clouds my mind.