Rhonda Bracey: At Random

Regular readers will know that we had our en suite bathroom renovated recently, and as part of that renovation, we had a ‘smart’ toilet installed (an Arcisan Neion Intelligent Toilet NEO41005; details:
https://www.streamlineproducts.com.au/neion-wall-faced-intelligent-toilet-with-remote-and-arcisan-concealed-cistern).

So, what’s a ‘smart’ toilet? Why did we buy one? And what advice do I have for anyone, like me, who is using one for the first time? Read on… (content warning: I won’t get too graphic, but naturally, I’ll have to talk about bodily functions at times)

Bottom line (sorry!): Would I get one again? Yes!

What is a ‘smart’ toilet?

In a nutshell, it’s a toilet with built-in cleaning (bidet) functions. But unlike classic European bidets (that I’ve read about, but never used), it’s not a separate item in the bathroom that you straddle (facing the wall). Instead, you use it as you would any other western-style toilet, with the cistern at your back.

The built-in bidet functions of the one we have includes settings for women and men (for the anal, perineal, and perhaps vaginal areas only, not for the urethral area on women), adjustments for cleaning wand position, temperature and flow rate of the water, temperature of the drying function, self-cleaning and deodorising functions, and the ability to program different sequences of settings for 2 users (not tried yet). There may be more functions I haven’t tried.

It’s operated by a battery-powered remote control (see image below) and/or a knob on the side of the toilet seat that you push or turn in various directions for the various cleaning and drying functions (I haven’t tried the knob yet).

In the case of the one we have, it also has an built-in night light so that you don’t have to turn on an overhead light in the middle of the night and thus cause your eyes to adjust both to the brightness and then back to the dark as you go back to bed after a middle of the night pee. A light may not be as necessary for women, but it’s very necessary for men.

Notes:

• None of the functions relates to flushing—that’s still done manually. One of the biggest questions I had when I was investigating the toilets was ‘What happens if the power is out?’ and the answer is that you still use the toilet as per any other manual toilet because the flush mechanism is manual and not connected to the power at all. You just can’t use the cleaning and drying functions during a power outage.
• The electrics for this toilet had to be hard-wired behind the scenes (there are strict rules in Australia about water and power in bathrooms and how close they can be), and I think the electrician installed a junction box inside the wardrobe of the spare room behind the en suite bathroom. He also added an on/off switch for the entire toilet underneath the light and fan switches inside the toilet (also not used—we just keep it turned on, but if we were going away for more than a day, we’d consider turning it off because you don’t need the light etc. to remain on).
• This brand/model doesn’t have a heated seat function, which really isn’t necessary where I live in Australia—there might only be a couple of days a year where I’d think that would be ‘nice to have’. Speaking of the seat, the seat and the lid are ‘soft close’, so no worries about dropping the seat in the middle of the night and waking up anybody else.
• The water usage for the 3-minute (default, but you can stop it at any time) cleaning function is between 350 and 650 mL/min, depending on the flow rate chosen, so between 1 and 1.9 L of water. I haven’t measured the power usage as yet, but when I do, I’ll report back.

Handheld remote control for the smart toilet, showing the icons for each function

Why did we get one?

These smart toilets aren’t cheap—in fact, they cost quite a bit more than a high-end standard toilet, so why did we get one? In simple terms—age.

No-one is getting any younger and the aim of our bathroom reno was to make our en suite bathroom as accessible as possible to cater for us as we age (we’d like to ‘age in place’ in this house for as long as possible).

That meant:

• having doors wide enough to cater for a wheelie-walker, wheelchair, someone on crutches etc.
• adding a grab rail to help someone with an injury or disability or just plain wonky on their feet to help themselves onto the toilet or in getting up from it
• adding a toilet that could help someone who has difficulty twisting to wipe themselves, or little power in their hands to do that for themselves, or who has temporary or long-term continence issues. No-one likes even thinking about the idea of having to help their life partner with toileting, cleaning up after them, etc. And the person this has to be done for may find it very difficult and ‘undignified’ to give control of something so personal to someone else.

One scenario we hadn’t considered was recovery from an abdominal operation and the resulting bowel issues that came with the effects of the drugs, and then the laxatives to make toileting easier so that constipation and straining didn’t cause the surgery to tear and create a hernia. But less than a week after the bathroom renos were finished, I had an emergency appendectomy. I was extremely thankful for the grab rail in the toilet as it meant I could get myself up and down without assistance. I was also extremely grateful for the cleaning functions of the toilet because I couldn’t twist my body easily without the fear of tearing anything, and because the violence of some of the diarrhoea I experienced meant that my bum was red raw, and even the thought of using a very soft toilet paper wasn’t appealing. The gentle warm-water wash of that toilet was a godsend!

Advice for new users

I’ve now been using our smart toilet for almost 3 weeks, so I’m still a new user. I certainly haven’t tried all the functions, but I have settled into some of those that seem to work for me. Everybody’s body and how you sit on a toilet is slightly different, so trial and error is the name of the game for the first few weeks or so. Read the operating manual and try each function—you can’t break it.

Other advice and general comments:

• The remote control is a bit finicky to respond. I’ve tried hard presses, soft presses, medium presses and still haven’t figured out what the optimum is. In some cases I’ve had to press a button 2 or 3 times before it activates. I’m sure with time I’ll get better at figuring this out, but for someone who has limited hand mobility or arthritis this may be a problem, in which case it may be easier to learn the controls on the side-mounted knob.
• The remote control is a beige colour and the icons are medium-grey outlines—there isn’t good contrast, and for someone whose eyesight is not particularly good, this could be a big issue as they can’t see the icons clearly. This is a design issue, where the manufacturers seem to have gone for fashion over function. It would be good to have an optional overlay (or a choice of remote styles at the time of purchase or later) so that the contrast is far better than now.
• When a function is activated on the remote, it beeps and then is lit from behind with a blue LED, which is reasonably easy to see.
• The lid and seat beep anytime you open or close them, or sit down and cover the sensor. There’s only a couple of beeps and they aren’t too loud, but they’ve been a bit disconcerting and I’d prefer to turn them off, but I can’t find any information on whether I can or how to. Again, I’ll likely get more familiar with them over time and eventually I may not even hear them.
• For the first couple of weeks, every time I sat on the toilet (even just to pee), there was a noise that sounded like the cistern was filling with water or a motor starting up. I had assumed this was in preparation for the cleaning function, and it was annoying to hear it when I just wanted to pee! However, this got solved a little later once the flushing issue got sorted out (see below) and the noise stopped completely.
• Flushing: The bathroom reno project manager told us that after we’d had a bowel movement to push the full flush button in and hold it in until we heard the tank fully empty. We did that, but it just wasn’t enough. In most instances, we had to do a second (full or half) flush, which was counter to the idea of conserving water. (For non-Australians: Australia has mandated dual flush toilets for several decades, and over time the amount of water for each flush has also decreased—initially it was 11 L for a big flush and 5.5 L for a small flush, but modern toilets sold in Australia these days are now around 6 L and 3 L respectively, though some are set for 4.5 L and 3 L [see https://en.wikipedia.org/wiki/Dual_flush_toilet ]). After we complained about having to do 2 flushes almost every time, the project manager (he’s an ex-plumber) came out and adjusted the float in the cistern—it had been set by default to 4.5 L, so he raised it to the maximum 6 L, and the issue with having to flush twice has gone away (and that refill noise when we sat down has also gone too!). He did say that the government (and industry?) push is for making 4.5 L and 3 L the standard, and he believed that all new toilets would go to that in time. Fortunately, ours was one where 6 L was still a possibility.
• Usage advice:
  • Remember, I’m still getting used to this, so my advice may change over time. Remember also, that your body shape and how you sit on a toilet is likely marginally different to someone else. Manufacturers do their best to cater for the most common shapes and positions, but they aren’t the same for everybody. You will need to trial the settings and adjustments to find what’s right for you.
  • I initially tried the ‘anal wash’ setting only (the one with the male icon), but found it wasn’t for me. Then I tried the female setting—that was a bit better, but I’ve had to drop the flow rate a tad and activate the oscillation icon to suit me better. No matter which setting you choose, the water flow (even at the highest rate) is comfortable and not at all unpleasant. Same for the temperature (which I’ve adjusted down a tad for the drying function).
  • Because all bodies are different, you may need to wriggle around a bit on the seat or lean forwards or backwards to get the coverage you need. With luck you’ll find settings that can cater for that, over time.
  • You don’t have to let it run for the maximum 3 minutes for either the washing or drying, and you might only want the wash not the dry. It’s completely up to you. You can press stop at any time.
  • The big one: toilet paper! When do you use it (before or after), how much do you use, do you use it at all? Well, of course, there are as many recommendations as there are people. Again, you’ll have to trial this for yourself. A US friend of mine who is a BIG bidet fan, suggests a quick wipe before the wash, while the project manager suggested a quick wipe after (for drying mostly, especially if you haven’t used the drying function). Some say a little before and after. Some website articles suggest you’ll never (or rarely) need to use toilet paper again (some even compare the ‘cost’ in water etc. of making toilet paper with the amount of water and electricity used in operating a bidet once or twice a day—the manufacture of one roll toilet paper comes out as far less environmentally friendly). All state that you WILL use less toilet paper, though few claim you’ll use none at all.

Bottom line (sorry!): Would I get one again? Yes!

[Links last checked April 2023]

Short summary: I had an emergency appendectomy on Saturday 18 March 2023, after being taken to hospital by ambulance late the day before. This post is a compilation of notes, emails, and Facebook posts I wrote at the time and in the days following, plus my memory of what happened.

Friday 17 March 2023

There’s always time for new experiences! Today I had an ambulance ride to hospital and tomorrow I get my appendix removed!

Around 2pm I had some abdominal cramping and thought it was my guts/wind. At 3.30pm I went to pee and had bad pain in my lower right side when getting up from my office chair, and even worse pain when trying to get up from the toilet. It was a sharp pain like I’ve never felt before, and a pain I certainly couldn’t ignore—this was not going away, it was getting worse. I asked my dear husband (DH) to confirm where my appendix is (he knows far more about anatomy than me). Yep, the appendix was right where I was having pain and I knew I’d never had mine out. He offered to take me to the doctor, but that could be 2 week wait! I said I’d call the ambulance. He said he could take me but I refused because an ambulance will do an initial assessment, give drugs for the pain, let the hospital know I’m coming and what their initial assessment is, and admit me to emergency via a different route. If he took me, we could be in triage with the general public for hours before getting seen.

I called the ambulance just after 4pm, and, based on where we live, I knew it would be 30 minutes at least before it got to me. I stood for the entire time while I was waiting as sitting or moving was excruciatingly painful. The ambulance arrived around 5pm (from the Brunswick Junction subcentre) and the volunteer ambos (the angels called Rodney and Wendy) did an initial assessment, measured my blood sugar and blood pressure, asked me lots of questions, took lots of notes on their iPad, and gave me the ‘green whistle‘ (a device that dispenses a pain inhibitor straight to the brain), then rolled me into the ambulance on their fancy collapsible gurney and I was at Bunbury Regional Hospital’s emergency department by 6pm (no sirens and no fast speed, thank goodness). Fortunately, ours was the only ambulance in the ambulance bay (BONUS: no ramping at 6pm on a Friday!) and I was the only one in the triage area at the ambulance entrance, which meant it didn’t take long for the handover to the hospital (into a wheelchair) and they could depart for other calls. At home I’d told my DH NOT to come in until I called once I knew what was going on—there was nothing he could do, and until we knew what it was and how long I might be in hospital (if at all), there was just no point.

Despite an easy entry into the hospital, and then past the main triage area to the ‘fast track’ area, much of the rest of the night was spent waiting (and sucking on the green whistle). I estimate it was about an hour before I saw a doctor (Dr Rachel), who drew blood, put in an IV line, prodded and poked around my belly (she was very gentle), got me to pee in a tiny container** then set me to wait in another area. After more waiting, I was taken further into the hospital to wait some more, this time for a CT scan. The operator told me he’d inject a dye into my IV line and that it would feel like I wanted to pee (yep!), but that was the drug/dye marker. I had to hold my arms over my head (while lying on the narrow platform), which is not something I found easy (2 shoulder surgeries will do that). After several trips in and out of the CT scanner, I was left outside to wait in my wheelchair (not one I could propel myself) for someone to collect me and take me back to the previous waiting area. I asked the operator what the dye did and he explained that it goes into the blood and quickly goes to all areas of the body. If there are areas of infection/inflammation, the dye will concentrate there because the blood is trying to fight the nasties. If the dye was really obvious at my appendix, then that would confirm my initial self-diagnosis. (BTW, the ambulance people had said that while it may be appendix, it could also be something like kidney stones or a twisted bowel or something else entirely.)

The nurses then put me on a drip for pain and hydration (but I wasn’t able to have any food in case they needed to operate that night—not that I felt hungry!) while they waited for the results of all my tests (the CT scans had to be checked by people in Perth—thank goodness for the internet!). Around 10:30pm a nurse came out and told me it looked like it was my appendix, but that would be confirmed soon by a doctor. Around 11pm or later, the emergency surgeon (Dr Natasha) sat with me to explain what would happen next and to get my consent, and to ask many of the same questions I’d already been asked numerous times since I made that call to 000 some 7 hours before (I know they have to do this to cover their asses, but really?? When you’re in pain and drugged up and can’t think clearly, this is the last thing you want). The scan had confirmed the appendix hadn’t burst, which they likely knew because I didn’t have the symptoms of a burst appendix. And I was told they’d do surgery tomorrow to remove the appendix (likely laparoscopic surgery, with 3 small incisions, though she warned me that in about 10% of cases they have to cut you open). She also said that I would have to curtail my activities for at least a week, possibly two or more—rest and Netflix were to be my priorities, no cooking or cleaning, no lifting anything (possibility of a hernia), no driving for 1-2 weeks (an emergency braking situation could also cause a hernia), etc.

Somewhere in there I called my DH and asked him to bring a bag of stuff in for me (I’d phoned him throughout the night as I’d found out various things, so while he was worried, I don’t think he was panicking as I was keeping him up-to-date). Oh, and someone brought me a very welcome sandwich (I hadn’t eaten for 12+ hours by then and could have it prior to surgery in the morning as it was outside the fasting times). My DH arrived around midnight and soon after I was taken to a bed on the day surgery ward. The nurse quickly shooed him out (I think he got lost getting out of the hospital and ended up in the private hospital next door and exited via their front doors!) and asked me to have a pre-op shower with a special soap, got me prepped with drugs, IV drip (delivering painkillers too), oxygen prongs, ear plugs, and a compression socks to combat DVT etc. I think she did an ECG as well.

The operation is scheduled for first thing in the morning. I tried to sleep but even in the middle of night, hospitals are noisy places with all the different beeps of the various machines—the ear plugs certainly helped, but I was limited in how much I could move, what with the pain (masked) and the various bits and piece sticking out of me.

** About tiny urine collection containers… Really? 50% of the population is female and those collection bottles just don’t suit the female anatomy, especially when you’re in excruciating pain if you move. It’s 2023 yet we women still have to suffer the indignity of peeing over ourselves while trying to position a tiny container underneath ourselves to try to get a urine sample into the container. They want mid-stream? They’re lucky they get ANYTHING! Challenge to inventors: Devise a urine collection container for female anatomy.

Saturday 18 March 2023

Next morning I was told I was first on the surgical list and that the operation would happen around 8am. One of those doing the surgical rounds about 7am was Dr Natasha from the night before, which was comforting. From what she said, I was under the impression she’d be doing my surgery.

By 9am nothing had happened. I was still in bed waiting. And the reason was that the scheduled anaesthetist had called in sick because his 2 kids had gastro and he didn’t want to give it to anybody else. The hospital had to call in an emergency anaesthetist but he wasn’t due until after 10:30am (it’s a regional town so there aren’t many around—with those times, it’s possible he had to come from Busselton, Mandurah or even Perth). Eventually, I was wheeled into theatre at 11:00am, so my surgery (and everyone else’s that day) was pushed back for 3 hours. Which means Dr Natasha didn’t perform my surgery, even if she’d been scheduled to, because her shift would’ve ended by then.

One thing I recall before I went into surgery is that they put sticky things on my forehead (as well as around my heart). I was told the ones on my forehead were to measure my brain activity—normal is 100% and when it drops to 30% with the anaesthetic, I’d be well under and they can start the surgery.

Of course, I have no memory of the surgery at all, just being wheeled into the operating theatre and squirming painfully onto the table from my bed, trying not to get any of the IV lines etc. caught up. Then nothing.

I recall people talking to me as I was coming to, but I couldn’t respond with anything intelligible, so I held my thumbs up to let them know I was hearing them and responding. By 3:45pm I was fully awake and in the day surgery ward, though in a different bay. There was lots of post op monitoring by the nurses for the first 6 hours, and a huge number of different beeps. And painkillers into the IV line. And a visit from my DH.

I slept well—lots of drugs in my system plus ear plugs. No pain… and no appendix either!

Sunday 19 March 2023

All clear to go home this morning, with strict instructions from the nurses and doctors about what I can and can’t do, which includes no cooking! My DH is so pleased….. Not! 😁
Basic rules are rest and Netflix! Have emailed my clients that I’m not available all this coming week and possibly the following week, and why.

Moving very gingerly and carefully, mouth tastes like crap no matter how many times I clean my teeth (drugs?), showering is interesting as the dressings, which I can’t see, have to be changed (DH has been wonderful). I’m taking all the drugs (including antibiotics) but not the heavy painkillers—just Panadol and Nurofen as advised. Can’t use the foot thingy on my recliner as it was super hard to push in with my legs before the operation and would no doubt rip things apart inside if I tried now, so I’m sitting fairly upright in the chair and using a footstool for my feet (new powered recliners are in our future?). Getting into and out of the car is done super carefully. For the first few days post-hospital I slept at least 3 hours in the afternoon, in addition to normal sleep at night—I never do that, so obviously my body needs that extra sleep to heal.

And I’ve given thanks for the smart toilet and grab rails that were only installed a couple of weeks ago as part of our en suite bathroom reno! The grab rail certainly came in useful the first few days, as did the toilet’s in-built bidet function, which meant I didn’t have to twist my body to wipe (yeah, TMI!) and thus put my healing body in danger of herniating. Another reason for getting a bidet I hadn’t thought of…

Days since

Each day the pain has been abating, and what I can do gets a little easier. To get me out of the lounge chair, DH took me to see my parents on Tuesday, and we went for another drive on Wednesday too, stopping for a lovely lunch overlooking the Dawesville Cut near Mandurah. By Thursday I could sit at my computer for a short time, and by Friday 24 March the horrible taste had all but gone (thank goodness—it was very metallic and put me off eating or drinking anything other than water), and I could spend more time in my office chair. Sitting at the dining table is still a bit sore, because I’m bent forward to read the newspaper, do the crosswords etc.

Silver lining

I had a realisation that all this was incredibly well-timed (you’ve got to look for a silver lining, right?). The conference I’ve been attending and speaking at in the US since 2015 (except COVID years) started this week (23 March) in Columbus, Ohio. Some 6 months ago, which is usually about when I book airfares, accommodation etc. and make plans for visiting friends and family or doing a course, I decided that I was still COVID-shy and still wasn’t ready to get on a plane. Besides, the airfares to the US were horrendously high in all classes, AND Qantas still owed me several thousand dollars, which I’d been trying to get from them since August 2022 (they eventually paid up earlier this month). So I decided not to go this year’s conference. Which was bloody lucky for me!

Had I decided to go, I either would’ve already been in the US when this happened, OR somewhere in the many flights between Western Australia and Ohio, one of which is about 17 hours non-stop. I cannot IMAGINE what either of those scenarios would’ve been like. Neither would have had good outcomes. Having appendicitis on a long flight across the Pacific would likely have meant either dealing with the pain with whatever the flight crew (or a doctor) had on board and hoping my appendix hadn’t burst or that bursting wasn’t imminent, or causing the plane to detour to a Pacific island to get medical attention for me, and thus likely being offloaded somewhere from where I would find it hard to move onward or return home one I’d received medical attention. As it was, I really only experienced that excruciating pain for a couple of hours before getting suitable drugs—that certainly wouldn’t have been the case on the plane. And had I had appendicitis on a US domestic airline, I can’t imagine what would’ve happened or even if anyone would’ve believed me (I certainly don’t have much faith in US domestic airlines). Travel insurance would’ve kicked in (NEVER leave home without travel insurance, particularly if you’re going to the US), but I doubt I’d have been in a fit state to contact the insurance people, and there’s a possibility my luggage wouldn’t have been with me either.

The other scenario is this happening after I arrived in the US. And that’s almost as unthinkable, because I have no idea how I would’ve got treated as a foreigner in another country where all my usual medical safety nets didn’t exist, and where I may have got treated but only after getting the travel insurance to kick it, assuming I was in a mental state to follow that up. How would I have got medical attention and an ambulance anyway? This could’ve happened in a hotel room and I may not have been able to contact anyone to help me (I would’ve been a single traveller). And that’s not considering that I have NO medical insurance (except travel insurance) to cover the costs of the US hospital system, which means that I may not have got treatment in a timely manner and could’ve waited days or weeks for surgery and then be left with an eye-watering bill at the end of it, assuming I survived, or had to pay in full upfront before I got treated.

Which brings me to cost…

Cost of all this

I’ll get a bill for the ambulance (probably about $1000; Update: It was $300 with the 50% rebate applied), but my private health insurance should cover that in full (if I didn’t have private health insurance, I could’ve opted for full ambulance cover for less than $100/year).

I may get some minor bills from the hospital, but that’s unlikely. Most likely, this whole experience (drugs, dressings, IV lines, surgery, doctors, surgeons, nurses, anaesthetists, bed in a public hospital for 2 nights etc.) will cost me absolutely NOTHING. My tax dollars at work!

Why? Because Australia has universal health care for all, which we call Medicare (same name as the US scheme, but a totally different model).

One of my US friends asked how this works, because something like this (or worse), could bankrupt many Americans. So here’s a quick (simplistic) summary of how the Australian health system works:

• Universal health care is a federal responsibility of the Australian Government (states are responsible for providing and staffing public hospitals etc.)
• All Australians who earn above a certain amount (from wages, salary, investments etc.) pay a Medicare levy of between 0 and about 2% on top of their income tax, depending on their taxable income each year. If you don’t earn much, you don’t pay the levy, but you still have access to public hospitals etc. If you earn a lot, you pay around 2% extra on top of your income tax rate, so if you were on the 30% tax rate based on taxable income, you’d actually pay 32%.
• Income tax (and the Medicare levy) is a federal responsibility, so Medicare is for ALL Australian citizens and permanent residents. States raise their taxes in other ways, such as license fees, land tax, etc.
• Public hospitals and some GP visits for some people (such as concession card holders) are funded by our Medicare system, which means we pay nothing for them. BUT for things like elective surgery (knee, hip replacement etc.), the wait lists for such procedures in a public hospital can extend many months and even years, and you won’t get your doctor/specialist of choice, just whoever’s on duty at the time. NOTE: Except in an emergency situation, you cannot see a specialist without going to your GP first and getting a referral—this stops people just calling up a surgeon, for example, and saying they want surgery. Your GP has to assess you first, then refer you to the specialist. The referral letter typically explains their assessment, and in most cases it expires after 12 months, so you have to revisit the GP if you need to see the specialist again at a later date (a real pain for lifelong conditions that need monitoring).
• Emergency department (ED) waits at public hospitals can also be long and as with many EDs around the world you get seen based on medical need (triage), not on your ability to pay. I only know of one ED in a private hospital in my state, though there could be more now—all are in Perth, some 2 hours away.
• Private hospitals also exist, and some specialists and GPs charge well above the set Medicare fee for their services. If you attend any these WITHOUT having private health insurance, or concessions (e.g. pension, veterans card), you would be up for the full cost, which COULD bankrupt you.
• Private health insurance is an option for all Australians, but it NOT compulsory—like any other insurance, you can choose to pay it or not, and how much you pay depends on the level of cover you want. In my case, I’m on top hospital and top ancillary (e.g. dental) cover and I pay about $240/month (just under $3000/year) for that private health insurance. I don’t HAVE to have private insurance… I choose to for the ability to get (elective) surgery done in a hospital of my choosing and with a specialist of my choosing and not be in a very long wait list for similar surgery in the public hospital system. Emergency is a different thing altogether… you need it and need it now. No wait list.
• Depending on your cover, private health insurance may cover you for a stay in a private hospital (often in a private room), specialist attendance while in hospital, some of the gap (co-pay) between the scheduled Medicare fee and what a specialist charges, and other ancillary services, such as dental, optical, physiotherapy etc. Even if I’d had this appendix operation done in a private hospital (most don’t have EDs, so that’s a moot point), it would’ve only cost me $150 co-pay (we call it excess) based on my private health insurance cover plus perhaps some (small) co-pay for anaesthetists etc. Oh, and that $150 excess I’d pay for private hospital surgery? That’s $150 for the year, no matter how many surgical procedures I had to have. Most years I’ve never needed it, but in 2015 I had 3 surgeries (shoulder, eyes, and breast lumpectomy and milk duct removal) and it cost me $150 TOTAL for the 3 hospital procedures, and maybe a bit of co-pay for some of the specialists, but not much (certainly well under $500).
• No health cover in Australia (private or Medicare) is tied to your employer. Employers have NOTHING to do with whether you have coverage or not—the Medicare levy is only based on your income at tax time and the federal government doesn’t care who pays you that income. Private health insurance is your CHOICE and the government doesn’t care about that either. My understanding is that in the US many jobs have the ‘benefit’ of employer-paid health and/or dental insurance—to me, that’s just a very heavy chain to keep you locked in to an employer, never allowing you the freedom to leave that employer, especially if you have sick kids, a disability etc. as you are unlikely to get similar cover with another employer. And god forbid you have your own business or are a freelancer, or are unemployed, or are single and thus have no spouse who has those ‘benefits’ for the whole family!

It would be extremely rare that getting sick in Australia (as an Australian citizen) would come anywhere close to bankrupting you. Our health care system certainly isn’t perfect, but getting sick won’t cost you your home, except in very rare cases. As I said, it’s not perfect, but it sure beats everything I hear about the US system.

Ambulance

In Western Australia, the ambulance system is run by St John Ambulance (SJWA) (other states have different systems). I believe the state government subsidises ambulance costs (50%?) for those meeting certain criteria. In my case, my private health insurance will cover whatever isn’t already covered or subsidised and I should effectively pay nothing.

In regional areas, especially smaller towns, SJWA is purely a volunteer organisation, staffed by angels called community members. I emailed the subcentre that looked after me to thank them for their care, and I got this reply:

Thank you for your delightful email. You made my day and I’m sure all our volunteer ambulance officers will be just as delighted to read your lovely words, especially Wendy and Rodney. It’s not often we get feedback. I’ve never tried the ‘green whistle’ personally but we’ve all seen the magic it can work.

You are why we choose to volunteer. I can’t imagine what the ambulance service would be like without so many dedicated volunteers adding value to the delivery of an ambulance service in a state as vast as WA. Our subcentre is self-funded—we get no direct funds from SJWA nor the State Government. Our funds come from our capacity to invoice our patients and from fundraising by attending events, both of which are set up by SJWA and the WA Health department. Our subcentre does not pay honoraria or wages to any of our workforce—we are all volunteers. We are about to take delivery of a brand new ambulance from monies the subcentre has raised over many years. We are very excited and looking forward to delivery of the ambulance.

And yes, I’d asked about donating to them specifically, and have now done so.

For my own reference in case I ever need to replace anything…

• Shower: Argent Palais Combination Shower (15-year warranty; SC11230B) 230 mm round overhead, 120 mm 3-function handpiece; chrome finish
  (https://www.argentaust.com.au/argent-showers-combination-showers-pallas-combination-shower?item=8693)
• Mixer taps:
  • Basin: Argent Pace Comfort 170 (mm) Basin Mixer (15-year warranty; BL222625); chrome finish
    (https://www.argentaust.com.au/argent-tapware-basin-mixers-basin-mixers-pace-comfort-170-basin-mixer?item=8824)
  • Shower: Argent Pace Comfort 170 (mm) Shower Mixer (15-year warranty; SL322625); chrome finish; 35 mm European ceramic cartridge
    (https://www.argentaust.com.au/argent-tapware-shower-bath-mixers-shower-mixers-pace-comfort-170-shower-trim?item=8826)
• Toilet: Arcisan Neion Intelligent Toilet NEO41005, wall-faced intelligent toilet pan and in-wall cistern (intelligent toilet = has bidet functions; different parts have different warranty durations)
  (https://www.streamlineproducts.com.au/neion-wall-faced-intelligent-toilet-with-remote-and-arcisan-concealed-cistern)
• Tiles (one new pack of each provided for future use in case a tile cracks or gets broken):
  • Floor: 300 x 600 mm Riviera Beige
    (https://www.cerdomus.com.au/product/300×600-riviera-beige-matt-r10/)
  • Wall: 200 x 750 mm AT Viggo Arce
    (https://myareeceramics.com.au/pamesa/at-viggo-arce)
• Paint: Taubman’s Aria Ivory [White] B37 (on the Taubman’s website, Aria Ivory is also known as T12 4.A9 in the visualiser and as T15 6.2 in the swatch colours)
  (https://taubmans.com.au/paint-colours/colour-families/whites-and-neutrals/aria-ivory)
  • Walls: matte finish
  • Doors, architraves and pelmets: gloss in the same colour
  • NOTE: The painter may have used a different brand of paint, using this colour swatch for the colour match
  • NOTE: As a bonus, this colour swatch appears to be the same paint colour as that used in the minor bathroom, toilet and laundry.
• Vanity and handles, and mirrored cabinet:
  • Vanity: Timberline Carlo Satin White, 1500 mm long, floor standing, ceramic top with centre bowl, 4 L bin inside right door of cupboard
    (https://timberlinebp.com.au/products/vanities/carlo/)
  • Vanity handles: Curve 198 mm handles, chrome finish
    (https://timberlinebp.com.au/products-handles/)
  • Mirrored cabinet: Timberline Tennessee 3-door, 1500 mm long
    (https://timberlinebp.com.au/products/shaving-cabinets/tennessee/)
• Rails:
  • Towel rails: Pegasi Towel Rail Single; 2 x 900 mm, chrome finish
    (https://armanti.com.au/product/pegasi-single-towel-rail-900mm/)
  • Hand towel rail: Pegasi Hand Towel Rail Single; 1 x 300 mm, chrome finish, installed on left side of vanity
    (https://armanti.com.au/product/pegasi-hand-towel-rail-300mm/)
  • Grab rails: Con-Serv Straight Grab Rails with Polish Supreme finish:
    • 1 x 450 mm in shower
      (https://www.con-serv.com.au/product/187963-cf-straight-rail-ps-450mm?categoryId=502)
    • 1 x 300 mm in toilet
      (https://www.con-serv.com.au/product/187955-cf-straight-rail-ps-300mm?categoryId=502)
• Shower shelves: 2 x Argent Universal Shower Shelf Rack 480 x 110 mm chrome plated, with soap tray (AR31060)
  (https://www.argentaust.com.au/argent-accessories-shelves-baskets-universal-shower-shelf-rack-480?item=8945)
• Exhaust fans: 2 x Fantech XXXX
• Clothes hooks: 2 x Parl of Meir’s Classic Robe Hook, chrome finish, attached to bathroom side of main sliding door
  (https://armanti.com.au/product/round-robe-hook/)
• Toilet roll holder: 1 x Pegasi Toilet Roll Holder
  (https://armanti.com.au/product/pegasi-toilet-roll-holder/)
• Shower screen: Frameless (no idea who provided this)
• Drains:
  • Shower: channel grate (unknown brand)
  • Floor waste: 2 x Bermuda Square Megaflex Floor Waste; one in toilet, one in main bathroom floor
    (https://armanti.com.au/product/bermuda-square-megaflex-floor-waste/)
• Sliding doors:
  • Doors: 2 x (came from Sydney, no idea who made them)
  • Handles: Finger pulls on bedroom side of bathroom entry door and inside toilet; ‘D’ handles on other side (i.e. facing inside the bathroom)

Bathroom reno done by Armanti in Bunbury, Western Australia. All warranties etc. held by them.

[Links last checked March 2023]

All done! Final tweaks and washdown done, carpet reinstated to doorway, and final payment made. I got the PM to install the old towel rails I’d salvaged from the strip-out to the backs of the sliding doors. Two towel rails only hold 2 towels, but not a damp bath mat, face washers, old towel to mop up excess water after squeegeeing the shower, etc. You can never have too many power points or towel rails!

I’m looking forward to a decent night’s sleep back in our own bed after a month in the spare bedroom!

The frameless shower screen got fitted today (the silicone has to dry for about 24 hours) and the PM was here for several hours refitting the fittings he’d taken off for the painter, adding door furniture, hanging the siding doors, siliconing the toilet area (it’s now ready to use!), aligning the doors on the vanity and overhead cabinet, washing down the walls and floors to remove any chalky residue from the grout etc.

On Monday, the carpet layer comes to re-lay the bedroom carpet that was pulled up 4 weeks ago, then the PM will do the final silicone joints in the shower and the rest of the main bathroom, do a final clean and check, and then it will be ours, though we won’t be able to use the shower for another day while the silicone joint filler sets.

It’s been a long journey, but the initial design and every expectation that was set by the PM has been met, with no SANFUs along the way. I’m really pleased with how it’s turned out, the quality of the workmanship, the professionalism of everybody, and the respect they showed our property. I’d certainly use them again if I was to ever do this again.

Note: Some of the photos show the tiles darker than they actually are. They’re all quite light.

By noon today the first coat of paint had been applied, and the second coat was done by 2:30pm and I said goodbye to the painter. I’m very pleased with the colour I chose. And the bonus is it’s the same colour as used in the other bathroom, laundry, and 2nd toilet! That was a bit of serendipity—I chose the paint swatch for the new bathroom, then found out it was the same as those other rooms. Now it all has to dry fully, ready for the shower screen installation tomorrow.

Tuesday: Darn, Day 16 of bathroom renos didn’t start until a day later than expected. Why? The painter ran over on his previous job and threw the schedule out by another day. Monday was a public holiday here and with another extra day required early last week for the extra coat of waterproofing we wanted, we’re now past the 3-week time frame, and it will likely be 4+ weeks. Painting will take at least a day, possibly 2. Then the shower screen and the sliding doors have to get installed (none are here as yet—doors may not come until next week), and I think the painter has to come back to paint the doors too. And the carpet tradie has to refit the bedroom carpet that was pulled up to give clear access to the en suite bathroom. It’s so close…. And we’re getting sick of the broken sleep we get from the bed in the spare room—we’d just like to get our bedroom back at this point.

Wednesday: Update: Painter due here ‘before lunch’ today. Assuming that all goes well, shower screen due Friday. Doors that were due to come early next week now due to arrive tomorrow.

Wednesday further update: Painter now here; doors arriving today. And I found out from the project manager that 3 weeks = 21 work days, not calendar days, so we’re into Day 16 of the 21 working days.

End of day: The painter did a lot of prep work today—patching and priming surfaces ready for the full day tomorrow, which he expects it will take to complete the painting. But the big surprise when I popped my head in late this afternoon was the sliding doors—I had assumed they’d be the boring flat doors I remembered from my childhood, but no…. the project manager had ordered doors panelled and coloured the SAME as the other internal doors in the house! That was a lovely surprise.

The skip bin people were here bright and early to take the very full (and heavy) skip. The electrician arrived just before 8:30 to do the final electrical work (power outlets, light switches, exhaust fans) and was done by about 10am. No more tradies until Tuesday (Monday is a public holiday here) when the painter arrives. The OM covered over the new shower fittings in prep for the painter.

Full skip ready to be taken away this morning. Bye-bye bathroom!

New exhaust fan above shower (there’s a similar one in the toilet). Both the PM and the electrician say these are incredibly efficient, far more so than the previous ones we had.

Plastic protective covering over the new shower fittings in readiness for the painter on Tuesday.

TWO double power outlets! We only had one before, on that far right wall. And a new hand-towel rail.

Boring but functional—light and fan switches; the 3rd switch in the toilet is for the smart toilet.

Posting these pics a little late as the plumber didn’t get here until late afternoon. Progress today installing the pelmets for the sliding doors and fitting and testing all the plumbing fixtures, including the toilet. 

The fittings are starting to go in—there’ll be more this afternoon, so I’ll add more photos at the end of the day.

Later…

Double shelves in the shower because we BOTH have shampoos etc. These were going to be side by side, but the position of the pipework behind the walls and the narrow gap for the shower hose meant that wasn’t a good option in reality (it looked good on paper, but sometimes you have to make compromises along the way, such as the position of the mixer tap for the shower—that was meant to be much closer to the window, but the hot water pipes for the whole house are behind the first set of tiles on that wall and the pipework for the shower and its tap cross those pipes so we couldn’t put the tap there without ripping out the whole wall (a load-bearing wall) and starting again—not going to happen!). Also a grab rail for holding onto when you clean your feet and between your toes.

Smart toilet facing the wrong way, but ready to be installed when the plumber comes tomorrow. Toilet roll holder still to be added, but grab rail already in place—remember, we want to ‘age in place’ in this house, so putting these things in now means we don’t have to retrofit if one of us has a temporary or long-term disability, or just needs a bit of support getting onto or off the toilet.

Double towel rails on the wall opposite the walk-in shower (DH is ~1.9 m tall, so the top one is for him!). If we need more towel rails, they can go on the back of the sliding doors (I’ve already checked this with the PM). Oh, and the vanity top, doors and handles have been added.