Mom's Mission: Grand Finale

After weeks of tests, waiting periods, treatments and emotional battles, the end was drawing near. Although mom was not quite back to baseline, by week 3, the neurologist along with the various specialists that were involved in our case (neurosurgery, cardiology, gastroenterology, ENT, speech therapy, physiotherapy, occupational therapy) finally gave mom clearance to fly under certain conditions (to be discussed later).

Mom's health status at this point was as follows:

• Nausea and vomiting were absent, occasional headaches occurred.

• Her nasogastric tube was replaced by a PEG tube (directly into the stomach).

• Her enteral feedings (Ensure) were relatively tolerated at specific bolus schedules.

• Although capable of walking a few steps, her endurance and core strength were still a work in progress.

• With multiple sessions with speech therapy, her voice was soft but comprehensible.

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One important factor I had not mentioned in the previous chapters of this story was the hurdle of dealing with travel insurance. For my fellow avid travelers, I cannot stress enough the importance of ensuring that you purchase it if not offered by your workplace, or simply double check that you are covered by it. From the beginning of this journey, the financial stress exerted by the hospital was manifold. Let me explain.

Just like any country, there are public and private hospitals. When you are a "foreigner", it is strongly suggested that if you ever fall ill, to go along with a private hospitals as this increases your chances of being covered by travel insurance. Why? Simply put, you must be receiving care from an internationally recognized and accredited institution for the travel insurance company to pay the hospital bills. In the Philippines, however, a HUUUUUUUGE policy/drawback they have is this: they will not let you leave the hospital premises until your debts are paid. This then turns into a vicious cycle: the longer you stay, the more you pay. Because of such a rule, we had remained in hospital an additional seven days waiting on documentation from the hospital's and the travel insurance's end.

Hurdle #1: Billing for EVERYTHING

For all my Canadian folks, one thing you should never take for granted is free healthcare (yes, it may not be the fastest, but it is better than nothing). While in the Philippines, I remember seeing the hospital bill sometime after mom had gone through surgery. This was at a time where we were not even sure mom was covered by travel insurance (luckily she was by spousal affiliation). I kid you not when I say that you are billed for each and every little thing: gauze, saline flushes, syringes, cups, diapers, wipes, etc. Additionally, we were billed by "daily rental" for use of the wall suction (when mom could not swallow her saliva), commode, IV pumps and the feeding pump. Each specialist involved had their own fees as well. From memory, I can only remember a few numbers: cardiology ~1000$ CAD, neurology ~6000$, neurosurgery ~9000$. Mom's surgery cost roughly 3000$. For different types of therapies, not only did they have a base fee, but each session had its own cost. (You can see why I was VERY VEEEERY frustrated with physiotherapy there). Furthermore, an ICU stay (300$ per day) was obviously more costly than a regular unit stay. Given that we were not permitted to be discharged from the hospital until our bills were paid, another seven days of billing piled up.

Hurdle #2: Paperwork

Travel insurance companies are very thorough. Although we had started a claim form for mom's case in the early days, there were many verification points to be done by them. In order to do that, many documents were sent back and forth from the Philippines to Canada, and vice-versa. The travel insurance agency required paperwork from mom's family doctor as well as the treating doctor abroad. One thing that is universal about healthcare is this: getting insurance forms signed by doctors requires a craaaaazy amount of patience and persistence. I am usually patient and considerate (or at least I'd like to think I am), but it came to a certain point where I kept hassling the nurses, and the medical records department to obtain the necessary documents to speed up paying our debts.

Hurdle #3: Different time zones

There is a twelve-hour time difference between Canada and the Philippines. Because of this, email communication was the best way to go about the situation. However, this did cause some delays in obtaining certain documents. For example, 08:00am Canadian time, I could receive instructions as to what forms needed to be filled out. In Filipino time, it is 08:00pm, which meant that the medical records department was already closed for the day.

Hurdle #4: Fear of not being covered

Simultaneously being one of mom's caregivers and addressing financial issues such as a hospital bill abroad is a level of mental stress I wish no one has to endure. Throughout the whole process, it was not clear if the bill would be covered until the day it was actually paid out. I remember seeing part of the bill for the first time (it was nearly 40 000$ at the time) and thinking to myself "What happens if the insurance decides not to cover this?"

The intrusive thoughts that came to mind were

1. Selling a kidney or any organ;

2. Becoming a "dancer" (trying to keep this PG-13 here);

3. Taking a loan from my line of credit and slaving away once back in Canada.

Fortunately, none of these options were necessary.

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Win #1: Being discharged

I remember this day vividly. It was close to midnight and we were informed by a nurse that it appears the insurance company had settled the bill. The nurse then proceeded to tell me that to validate the information, I would have to go to the billing department (the only open one was near the emergency room). I ventured off to see the person that may release us from what felt like prison at this point. After speaking to the billing representative, he confirms that the bill was paid, and returns the initial deposit that was made upon entering the hospital (~100$ CAD). As soon as I received confirmation, I ran back to mom's room and told her and my cousin: "Pack up, we are leaving." Although the nurses stated that we technically paid to be in the room until 11:00am that same day, the desire in me to leave the premises was strong due to preventing another mishap. What stuck in my mind was: the longer we stay, the more chances we are giving them to cause another delay. Not on my watch. We packed up a month's worth of belongings, called a Lyft, and headed to a family friend's condo apartment that was vacant.

Win #2: Having some peace and quiet

After spending a month in hospital, it was nice to not be interrupted in the middle of the night or at random moments during the day by strangers. Having our own space (and an awesome view, I must say) reminded me that we were closer to finishing the mission. The travel insurance company had sent instructions on the next steps to follow for repatriation. In three days, we would be escorted back to Canada by a doctor. Since mom was still being fed through her PEG, for the next three days, every two hours, I gave mom her feedings manually via a makeshift feeding pole. Again, although this caused me sleep deprivation, I would take this over being in the hospital another day.

Win #3: Family support

Upon news of our discharge, the majority of mom's family came to visit us at the condo; her siblings, nieces and nephews. In order to get to us, the drive from mom's hometown was roughly 12 hours. Before we knew it, more than 15 individuals were inside the studio. After a month's ordeal, being able to see my cousins, uncles and aunts all together was a blessing. Seeing mom's smile whilst being surrounded by her loves ones was priceless. They had stayed with us until our sendoff to the airport. It was the hardest goodbye.

Win #4: Getting back to Canada ... in business class

As I mentioned earlier, mom was given clearance to fly under three conditions:

1. She required a doctor to escort her.

2. Given the need for manual feedings, she required a nurse as well (me!).

3. She needed to fly business class (unable to tolerate long periods of sitting).

Initially, only mom was covered for her business class ticket. I, on the other hand, had to dish out 3000$ as there was no way I would leave her side (I was partially reimbursed by the travel insurance after writing them a letter explaining the situation).

Mom and the doctor

We met mom's doctor at the airport. Given that it was our first time ever flying in business class, he introduced us to the waiting lounge (all-you-can-eat buffet!), and on board the plane, showed us the ropes as to how to adjust the seats, and the items we could order (unlimited champagne!). Given that I was a young and exhausted daughter at the time, I could not help myself from eating and drinking whatever I could to satisfy my mental and physical needs. Don't worry, I still fed mom every two hours with a syringe through her PEG while the doctor fell asleep during that 15-hour journey ...

As you can tell, we made it back to Canada safely and soundly.

Mission "get-mom-back-home" was accomplished on April 2, 2019.