On February 14th I broke my collarbone while skiing at Vorlage, not far outside of Ottawa. While initially very painful, it wasn’t bad after a couple days and I was able to fairly dispassionately observe the system that supported me. I was and continue to be struck by the number of highly skilled people who contributed to my well-being.
The fall happened at the top of one of the hills. Within a few minutes of the fall a crew of three first aid volunteers were there to help. They placed me in a rescue sled, secured me in and brought me down the hill.

Kind of like this:

At the bottom of the hill they put ice on my shoulder, took off my ski boots for me and passed me off to my wife who drove me to the Ottawa General Hospital where I went into emergency.
I was seen, in order, by a receptionist, a nurse, a 3rd year med student, a 4th YEAR resident, an x-ray technician (who took three radiographs of my shoulder and sent them electronically back to the emergency room), the emergency room head physician and a 4th year resident, then two 4th year orthopaedics residents, who advised me to get surgery. Since it wasn’t an emergency, the surgery would be scheduled for about a week from that day. I went home – from breaking my collarbone to being snug in my own bed took only six hours.

This isn’t me, but this is what I looked like.

Surgery was scheduled for February 20th. On the 19th I spoke with a nurse for 30 minutes who advised me on how to prepare for the surgery (no food after midnight on the 19th and so on). When I arrived at the hospital the next day a volunteer took my belongings and locked them up for me. Then an orderly provided me with a gown, and after I changed, he took me to the pre-op. In pre-op a nurse talked to me for about 10 minutes about how the day would go. At about 9:30 a very happy orderly wheeled me to the operating room, chatting the whole way.

In the operating room the anaesthesiologist talked to me for about 10 minutes and explained what was happening and got my IV started. The OR nurse talked to me for a bit and got me on to the operating table. An orthopaedic resident signed my right collarbone (to make sure the operated on the right one). There were three other people in the operating room. I don’t know who they were, but it looked like they were preparing the instruments and equipment. Then the surgeon came in, said hi, and a few minutes later I was under and I don’t remember anything until I woke up in post-op a couple hours later. In post-op I was cared for quite tenderly by a couple of nurses and an orderly. After a few hours, lots of ginger-ale, and a bit of vomiting I was ready to go home.

Two weeks later I had a follow-up appointment with the surgeon, where I also received care from a receptionist, a nurse who removed the staples, an x-ray technician to shoot a couple more radiographs (and her student), and the surgeon. During the surgery I had a plate and pins put in to hold it all together, so now I kind of look like this:

So in summary, those involved directly in my care who had some level of health training included:

• three first aid volunteers
• a nurse
• a 3rd year medical student
• a 4th year resident
• an x-ray technician
• an emergency room physician
• another 4th year resident
• two 4th year orthopaedics residents
• a nurse on the phone
• a pre-op nurse
• an anesthesiologist
• an OR nurse
• an orthopaedic resident
• three other people in the operating room
• a surgeon
• two post-op nurses
• a nurse
• an x-ray technician and her student

24 people! Plus numerous receptionists, orderlies and whoever was responsible for cleaning everything. While the surgeon receives most of the glory, the skilled work of 23 other people was necessary to allow him to do his work. I am very grateful for such attention, and somewhat astounded. All that attention was for a somewhat painful, but not life-threatening injury. If I didn’t receive the surgery I would probably have slightly reduced use in my arm, a little more pain, but no serious limitations in my life.

Contrast that with the level of care that might be expected for a poor farmer in a low income country. Would a fraction of that care be available? I remember when I met the surgeon at the Ekwendeni Hospital in Malawi, one of the few surgeons in the country at the time. He had just got off the phone ordering surgical gloves. Why was he ordering gloves? Well, they ran out of surgical gloves because the cleaning staff had been using them instead of cleaning gloves. They had to cancel surgeries. And he had to order more gloves as he was the only person the system listened to.

So when that health system had a surgeon, they were not able to make full use of him, because the support staff and structures were not in place. In contrast, my experience was really marked by support staff, who were able to use very solid structures. I am grateful for and appreciative of the care I received, and I look forward to the day when at least a portion of such great care is available in Malawi, and in all LMICs.