Living to Tell the Tale

Michael Moore would love to have included me in SICKO. My medical crisis of about two years ago was precisely what the movie is all about: the dangerous gap between the failing health care system in the United States and health care in practically all other developed nations of the world.

It happened in Austria on a Sunday,  before a national holiday on Monday Aug. 15. And it had all the hallmarks of a life threatening medical emergency.

I was suffering from a severe attack of atrial fibrillation that manifested itself with tightness in my chest, nausea, and a resting pulse of over 200. A call to a cardiologist friend confirmed that I was in imminent and critical danger.

"Call an ambulance immediately," she said.

"Shouldn’t I wait till morning, to see if things might calm down?" I suggested.

"Call now!" she said. So I did.

Then began a series of events that could have been scripted for SICKO. Within minutes, a modern, fully equipped ambulance arrived to my rural home with three paramedics and a doctor. With calm and friendly demeanor, I was attached to an EKG machine and began receiving intravenous medication to stabilize and lower my pulse. The paramedics assured me that I was expected at the local hospital and that the staff was fully informed and prepared to treat me.

A team of three doctors met the ambulance and began treatment. After three attempts they had stabilized my heartbeat and the immediate crisis was averted. Thorough examinations including an echocardiogram followed within minutes.

The next day, Monday, was a holiday – the Feast of the Assumption. A handwritten fax was sent off to one of Vienna’s leading cardiology wards; the response was almost immediate: My condition would have to be treated in Vienna. I needed a procedure called catheter-based ablation followed by the implanting of a pacemaker.

On Tuesday, I was transferred to the cardiology unit of the Wilhelminen Hospital in an ambulance, with the typical, rather musical, Austria siren, not the wailing American kind (For the musically inclined, a repeating perfect fourth. I am a retired member of the Vienna State Opera).

On Thursday after another battery of tests, the atrial ablation was performed. Three days later, an (American) pacemaker was selected and implanted on the right side of my chest. (Pacemakers are generally placed on the left, but the cardiologist instinctively understood that as a violist, I would prefer to have it on the right.)

With the pacemaker implanted and adjusted, I returned home the following Tuesday.

Some months later my sister, a health care policy expert, sent me a link to an article in the New York Times: "Heart Therapy Strains Efforts to Limit Costs." (www.nytimes.com/2007/07/07/health/07heart.html?_r)

The article details an atrial ablation, exactly the kind of treatment performed on me, and describes the immense hurdles doctors and hospitals face in attempting to introduce this procedure in the United States, in spite of its proven effectiveness.

The procedure, at $25,000 to $50,000, is apparently too expensive.  It has not yet been approved by federal regulators; insurance companies consider it either "experimental" or are unwilling to fully reimburse the cost, and health care providers may have less legal protection from lawsuits if something goes wrong.

Still, those who can afford it take advantage of the procedure: "Estimates of the potential market for atrial ablation devices in the next decade range from $1.5 billion to nearly $5 billion, according to Medtech Insight, a market research company in Newport Beach, Calif," the article said. The waiting period is from "four to six months" according to Dr. Andrea Natale, head of the Cleveland Clinic program.

Back in Austria, I never received a bill, nor in fact any kind of accounting, for the atrial ablation procedure that was performed here swiftly and routinely by top-notch medical experts using state-of-the-art equipment.

And since then, I have enjoyed the best of health. I ride my bike regularly and revel in weekly saunas where the temperature often approaches 200º Fahrenheit (90º Celsius).