George Jonas

Never let them know you're famous

by George Jonas
National Post

You won't get any argument at a dinner party if you say the next best thing to having no heart attack is to have one just as you enter a hospital. If it's a hospital that specializes in cardiac ailments, so much the better.

The only person who will say "not necessarily" is a friend of mine, a cardiologist. In his 80s now, he gave up his clinical practice some years ago, but retains his affiliation with a hospital and continues chairing conferences around the world. He has the kind of pallor that prison inmates share with Geneva-class experts who spend most of their lives being hurled through the upper flight levels in metal tubes.

Having forgotten more about hearts than most cardiologists ever knew, he was rather upset this winter when he suffered what he diagnosed as a minor cardiac infarction, or a mild heart attack. Had he been at home, he would have taken a couple of Aspirins and gone to bed. He knew his own ticker, and was quite sure the best medical response was no invasive intervention. But as he happened to be at the entrance of his own hospital, he walked over to emergency. It seemed the prudent thing to do, and it was certainly what he would have advised anyone when he was still in clinical practice. Patients, of course, are rarely qualified to choose their own therapies, but for him, who was, imprudence might have been the prudent course of action. Imprudently, my friend chose prudence.

While waiting for the triage nurse, he telephoned his wife to tell her he would be late for dinner. They lived nearby, so she arrived within minutes, just as the nurse embarked on a litany of supercilious questions, having no idea the pallid emergency patient was a renowned heart specialist.

Knowing that her husband would never tell the nurse who he was, let alone pull rank and make her stop wasting time, my friend's wife reached into his husband's jacket pocket, took out his hospital ID card, and hung it around his neck.

This startled the nurse. When startled, some people become huffy, slipping from martinet into offended party, without even grinding the gears. "We treat everyone the same," she sniffed, taking cover behind the parapet of egalitarianism, which is socialized health care's first line of defence against criticism.

Only societies that turn envy from a vice into a virtue experience what happens when equality becomes the measure of everything, from government to medicine. Never mind how we treat you; just remember, we treat no one better.

Once upon a time it was quality that was the gold standard; now it's equality. It would be a flawed, pinched, and narrow ideal if meticulously implemented -- but of course it isn't. Health care in human societies, like other scarce commodities, ends up being invariably and inevitably rationed. Under private medicine it's rationed by price; under public medicine, on paper, it's rationed by medical need, or by one's place in the queue: First come, first served. In practice, it's rationed by pull.

Despite the triage nurse's protestation of treating everyone the same, word spread of a Geneva-class expert having a heart attack in emergency. It brought stray heart doctors drifting into the area. Soon the trickle became a flood, and before long cardiologists were swarming like cats in the back allays of Rome at midnight when restaurants throw out fish heads from the daily catch.

They all wanted a hand in my friend's heart, and in the end they prevailed. Despite his misgivings, he signed on the dotted line, let the wining cat -- sorry, cardiologist -- carry him into the nether regions of the Institute, and, in the process of manipulating an unnecessary stent into a blood vessel where it couldn't do much good, knocked loose a piece of plaque, blocked an artery, and induced a major heart attack that nearly killed him.

He recovered, but looked pensive when I saw him the other day. "Neglect is the key," he said. "If they think you're a V.I.P., you're dead. Don't let them recognize you. If you ever fall into their clutches, make sure they treat you like everybody else."