Why I Chose to Stay in Germany for my Treatment

Getting diagnosed with cancer back in July was a bit fortuitous in its timing in some respects: while I had to cancel my travel plans - sorry Camino de Santiago, maybe I’ll be able to hike you in a few years - I was gifted with options as to where I could receive my care. I’m a Canadian citizen who had been living comfortably in Seattle USA for the past decade and had moved to Berlin Germany about a year and a half ago. Unfortunately, due to personal reasons my time in Germany was cut short and I was planning on moving back to Seattle at the end of August. With all the doctor’s scans and pre-treatment work needed, the timelines meant that I could begin chemotherapy at the end of August. My oncologist in Berlin gave me three options:

1. Start my treatment in Canada, or
2. Start my treatment in Seattle when I move back, with about a 2 week delay to the start of treatment, or
3. Start my treatment in Berlin immediately

There were all interesting options, with different pros and cons. At this point the oncologist had already defined a chemotherapy treatment plan, so transferring the data over and starting would be relatively trivial compared to the tasks of getting diagnosed in the first place. I’ll break down each option below.

Start treatment in Canada

The Canadian healthcare system has historically been good. It’s a publicly funded system, which means that I wouldn’t worry about having to go bankrupt while seeking treatment. The service and care that I would receive would be entirely in a language that I’m fluent in, which would make talking to doctors, nurses, and other care providers easier. I also could stay at my parent’s place during treatment and have my family care for me during this process. My old high school friends still live nearby so it would be good to see them again.

On the other hand, I haven’t properly lived in Canada in nearly a decade so I would be mooching off of the taxpayer system. I also would have to re-establish myself in Canada during my time there, setting up a cell phone plan and a bank account and mailing address and Amazon Prime subscription (you need a different one per country).

Finally, the word historically is doing a lot of heavy lifting. Up until 5 years ago, the Canadian healthcare system was able to reasonably guarantee fast and efficient care. Since then two things have changed:

1. Covid has increased the number of people needing care while also burning out the doctors and nurses
2. A change in immigration policy has made the Canadian population explode without proportionally increasing the number of healthcare providers to adequately treat all of the new people.

This means that the Canadian hospitals are understaffed and overworked. There would not necessarily be a guarantee that I would be able to start my treatment as soon as I get to Canada, and I might even be triaged to start chemo a month or two later. My tumor had already grown in the month and a half since I first noticed it, and I wasn’t willing to potentially wait double that time to start chemotherapy.

Verdict: Not Canada

Start treatment in Seattle

Seattle has a lot of nice things going for it. The air there is clean thanks to the city being sandwiched between a mountain range, a rainforest, and the Puget Sound. I have a house and car and strong support network there of friends and in-laws. I already had a flight ticket booked to travel there at the end of August so moving logistics would have been a non-issue. The University of Washington hospital network is renowned for its top-notch treatment, and their English-speaking care providers meant that I could talk to them without worrying about information being lost in translation. I would be in the correct time zone for job hunting, which means that I wouldn’t have to schedule interviews in the late evening after exhaustive chemotherapy treatments.

On the other hand, Seattle is still in the USA.

The USA health care system is built on the idea that you are only worth caring for if you are bound to indentured servitude, or if you are incredibly wealthy. Health insurance is provided by employers who may or may not cover the monthly premiums. If you are not employed, you can purchase private insurance or qualify for public-assisted health care (“Obamacare”) – an option that the American (Republican) government has been trying to roll back.

Once you do have health insurance, you will get covered treatment if the providers are in your network. The word covered is key here – if your insurance provider decides that your treatments do not qualify under their coverage plans then you’ll be paying tens of thousands of dollars out of pocket, putting you in crippling debt for the rest of your life. If you are covered, you still have to pay up to an out of pocket maximum before the insurance starts covering everything. This usually means that you’ll still be expected to fork over $10-15k for your health coverage.

Seattle is also an incredibly expensive city to live in. When I moved to Berlin my grocery bills nearly halved, and the cost of going out for food and entertainment was also about half of what I would pay in Seattle. My burn rate in Seattle will be significantly higher than in Berlin, even taking into account that I already have housing covered in Seattle.

I have enough in financial instruments to cover this – I think – but it would lead me to be in a really vulnerable position.

Verdict: Not Seattle.

Start treatment in Berlin

Germany’s public healthcare system, despite what the Germans may claim, is really good. In fact, if it wasn’t for the accessibility of the system I would not have gotten my tumour diagnosed for a few more months, or even a year. I woke up on morning and felt a small lump on my leg, and since I was in Berlin I could easily walk into my local clinic and get a referral for a scan for the following week. If this were in Canada I would have a weeks-long wait, or in the USA I would have probably held off on seeking an opinion to save money.

Likewise, if I continued my care in Berlin I would have been able to get treatment immediately with the world-class Charite hospital system, with all of my costs already covered by my taxes. My information and diagnostics are also already within the Charite records, meaning that my doctors would have full access to all of the information that they need to ensure that I recover as cleanly as possible. I also could go on medical leave from work, meaning that I would be collecting 2/3rds of my salary while getting care.

On the downside, I would be trapped in Berlin for the duration of my care. This would be a 4-6 month timespan where I can’t travel anywhere and I would be isolated from most of my friends and family. My german is still not that great, so I would have problems communicating or feeling at home whenever I go out. Psychologically, this is like going back to the peak of the lockdown era of Covid.

I’m also still job hunting, so it means that I have to take into account a 9 hour time shift between Seattle and Berlin. This means that most of my interviews will be from 6pm-10pm Berlin time (9am-1pm Seattle time). This constraint will make job hunting more difficult.

Logistically Berlin would also have a few issues. I would have to continue paying for a storage unit in Seattle to house all of my stuff. I would have to rebook my flight tickets back to Seattle to whenever my care would finish (aka: Christmastime, when flights are the most expensive). I would also have to find an apartment/extend my lease of my current unit, and negotiate with my company that I could un-quit so that I could go on long term medical leave – thus extending my visa and affording me health care.

Given the medical and financial benefits, it seems like a no-brainer to stick around in Berlin

Verdict: Deutschland baby!

Looking back after 5 months

Now that my chemotherapy is over, I can apply some hindsight to my situation.

• My fears about the language barrier were overblown. My German was good enough to fill in the gaps for when I didn’t have an English-speaking nurse. I have yet to have issues due to mistranslations.
• The quality of health care has been superb. I have never had to worry about scheduling hospital stays or scans, everything was on time.
• When I learned that my initial chemotherapy treatment was ineffective, my medical team was able to quickly pivot and move to a different treatment plan than what we had originally outlined. I don’t think that we could have done this in Canada or the USA as quickly or openly.
• Job hunting while in Berlin sucked. There were instances where I was doing interviews while in the hospital ward for chemotherapy treatment. Having to manage my fatigue while being up late definitely led me to underperform in interviews as I was not clear-headed. That being said, I was able to consider multiple offers before accepting a job.
• Being so far away from friends and family was a drain. Prioritizing my physical health was paramount over my mental health, but I’m glad that this is over.