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This is the third instalment of a Global News series called Unheard. Unserved. Maritime Women’s Health In Crisis.
In our first two stories, we introduced you to a woman who struggled for years to get a PCOS diagnosis, and a prospective mother feeling wronged following expensive fertility treatments.
When doctors spotted the invasive mammary carcinoma on Kim White’s spot mammogram at the Cumberland Regional Healthcare Centre in Amherst, N.S., they told her a doctor would be in touch if there was cause for concern since she didn’t have a family practitioner of her own.
The 58-year-old mother and grandmother of five went home and waited — anxious for the results that had the power to turn her life upside down.
She says five days went by, then six, then seven, with no call.
“I’m thinking we’re celebrating,” White says, nodding across her living room to her husband and daughter. “Because obviously I don’t have cancer, because I didn’t get a phone call.”
But on June 7, the phone rang.
It was a receptionist at her local hospital, calling to schedule her a biopsy appointment with the in-house surgeon.
“So that’s how I found out I had breast cancer, because they don’t call you into an office to tell you that everything’s negative,” White recalls through tears. “Just the callousness of the fact of finding out from a receptionist … it just made me very angry.”
This wasn’t White’s first cancer diagnosis.
Twenty-five years ago, when White and her husband were living in Ontario, she found out she had acute leukemia. She says Ontario was far ahead of Nova Scotia when it came to cancer care — even decades before.
“My diagnosis was immediate, the treatment was immediate,” White says. “But this experience with the waiting, it’s just, it’s agonizing.“
White says that when she went into her appointment with the local surgeon in Amherst, she was informed she wouldn’t be able to have her surgery locally due to the hospital’s safety policy that prohibits operating on patients with a higher body mass index (BMI).
“Being a big woman, you are stigmatized every day,” White explains. “Yes, it’s my choice to be overweight, but being discriminated against in all aspects of life? Even the mammogram machines — this breast had to be done twice,” she says, gesturing to her chest.
“I’ve never been one for looking at my weight as a discriminatory mechanism for health care, but obviously, it is.”
White was referred to the IWK Health Centre in Halifax for surgery — about two hours from her home in Amherst.
But she was denied again, this time, she says, because her BMI wasn’t high enough for the women’s and children’s hospital to intervene.
She was sent back to Cumberland County to undergo pre-op tests, all of which cleared her for surgery, but alleges she faced further weight discrimination during her consultation with an anesthesiologist.
According to Nova Scotia Health, “anesthetists generally assess each referral considering multiple contributing health factors (e.g. heart or lung disease) to ensure the safest possible care,” but White doesn’t believe her tests were properly consulted when determining surgical candidacy.
“He didn’t look at any information in my file because he asked me all the same questions. Do you have any difficulty climbing stairs? Do you have any difficulty walking? Do you have difficulty breathing? Those are all weight questions,” she says. “And then at the very end of all those make-me-feel-worse-about-myself questions, the answer is no. Because we have a policy.”
With no surgery date on the horizon, White began phoning the premier’s office.
She says she left 14 messages, demanding an appointment before it was too late.
She also sent a letter to the standing committee on health asking it to request a plan from the Department of Health and Wellness on what steps it will take to close the gaps in breast cancer care in the province. To her dismay, the committee decided not to proceed.
“Recently the IWK hired a nurse navigator, this would offer a central point for unattached patients to be able to ensure they receive timely results, referrals, diagnoses and care. The creation of a breast health research unit is also underway at the IWK,” Susan Corkum-Greek, the PC MLA for Lunenburg, said at the Sept. 9 committee meeting.
“And for that reason we will not be supporting the motion.”
Increased access and more research is vital, according to experts like Tammy O’Rourke, a nurse practitioner based in Cape Breton.
However, O’Rourke says, the province needs to scrutinize its existing policies surrounding BMI.
“Knowing what we know about the accuracy of BMI and knowing what we’ve seen in systematic reviews about the use of BMI for surgical candidacy, we need to rethink it,” O’Rourke says. “A woman should not be regarded only by her BMI for life-saving surgery. There is no way that should happen in Canada — morally, ethically, socially — we should not be allowing that.”
In her opinion, whether or not a hospital performs surgery should be determined on a case-by-case basis.
“We need to think beyond the BMI for surgical risk,” O’Rourke says. “(Thinking) ‘OK, so what’s going to happen if I don’t operate on this patient? What’s the outcome going to be in comparison to what could happen if I do operate?’ … It comes down to a benefit-risk analysis.”
In a statement, Nova Scotia Health says while it can’t comment on individual cases — like White’s — it recognizes how vital timely access to quality surgical care can be.
“Nova Scotia Health does not have a provincial policy regarding BMI and surgical eligibility,” it added, and “patient safety is a top priority and occasionally a case may be referred to a specialized centre if it is felt to be in the best interest of the patient.”
But O’Rourke believes Nova Scotia’s medical system is hypocritical in its policies around BMI.
“There shouldn’t be an out for a rural hospital to set their own policies on BMI that are not scientific or evidence-based,” O’Rourke says. “It’s something else behind that policy, aside from patient safety. Because when there’s two hospitals in the same province who are at odds about the patient safety and the BMI, that’s an access issue that they’re not admitting to.”
Access issues, White says, Premier Tim Houston needs to address.
“Maybe he should start putting in policies and tools in rural hospitals to look after the women in this province,” she suggests.
“This was mentally debilitating to not only have to deal with a cancer diagnosis, but to have to deal with the medical system that was biased against you from the beginning.”
White hopes updated medical equipment, revised policies and sufficient staffing would allow women with any BMI to receive timely surgery, regardless of whether they live within the Halifax Regional Municipality or elsewhere in the province.
“You have to rely on your health-care system,” White says. “But when that health-care system fails, it costs people their lives. It’s costing women … their lives.”
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