Medical Anthropology

No picture on this one, for reasons that will become obvious...

I was (embarrassing number of years old) before I realized -- I mean, really had it sink in -- that perhaps the US didn't have the best everything on the planet. I think this is normal for most people, and I think it's especially normal when it comes to medical systems. I mean, those are thoroughly grounded in science, aren't they? And science is universal -- so of course they should all be identical, and, if they're not, ours is right. Right?

In rural Thailand, there are livestock roaming the hospital, and if your visiting bipolar friend needs Lithium because he's about to run out, you just walk around until you find a bored 20-something doctor playing games on her phone and ask for it, and she'll consider for a minute and decide writing a script is less effort than arguing with you, and do it.

In Mumbai, the doctors ask whether you're veg or non-veg (this doesn't seem like such a bad practice, honestly). At a routine gyn visit, when the doctor learned that I was unmarried, he told me he would only do an external exam. When my 30-something self burst out laughing, he spent the rest of the exam silently but strongly radiating the accusation that I was the Whore of Babylon.

In England, you get a letter in the post inviting you for a flu shot, or for your pap smear, or for whatever else you ought to be having done. I like this a lot, because I can never remember when I'm supposed to get routine care, and always feel like I'm bothering an over-burdened system to go in for something that isn't an emergency. Getting a friendly written invitation is very civilized.

I really didn't want a pap test, not least because they're called "cervical screenings" here, and that's pronounced (per TH) "cer-VYE-cal," and I wasn't sure which was worse, to obstinately call it "CER-vicle," or to refer to it as a "pap smear" if that's not a meaningful term here. But I was overdue for one even before accidentally moving to another country a year ago, and, anyway, like everyone else, I've heard horror stories about the NHS. Might as well get on the wait list and deal with the appointment six months from now. "Of course," the friendly receptionist said, when I phoned on Monday (asking for the cer-VYE-cal screening; social anxiety trumps standards). "How about Wednesday?" "THIS Wednesday?" I sputtered.

So, Wednesday I strolled to the medical center that's a mile down the road (everyone is assigned to their nearest, though you have some scope to change that if you want). I presented myself to reception, and waited for the clipboard. You know, with the ten pages of stuff about insurance and billing and family history and HIPAA and everything else. There was no clipboard. I had brought every form of British ID that I've diligently acquired: my residence permit, my learner's driver's license, my NHS number, my US passport. They did not ask for a single piece of ID. (I was upset about that later, and raised it with TH as a serious flaw in the system. "Who'd want to take your pap smear in place of you?" he laughed. "Well, of course, someone who doesn't have their own insur....oh." I said.

I waited perhaps five minutes before a TV screen invited me to proceed to an exam room. I hate not knowing the protocol in a given situation, and I had interrogated TH before I left for the appointment: when I go to the exam room, do I immediately take my pants off? "Er, perhaps best to wait for the nurse and make sure you're in the right room," he advised.

The room was not the standard US doctor's office room: you know, aggressively sterile, full of aluminum countertops and jars of prodding instruments and swabs, and posters on the wall of the interiors of bodily cavities, and perhaps some unidentifiable large equipment that vaguely suggests that some unknown percentage of people who have previously visited these rooms has suffered abrupt deterioration necessitating immediate, heroic, and very expensive technologically-assisted intervention. I also truly hate those kinds of rooms. This was a clean and practical space, but it was also clearly a former residential house. It did not cause my blood pressure to spike in the way that those hyper-clinical sani-rooms do. ("Medical theatre," TH sniffed, when I told him about this later. "You're paying for the experience, and the customer wants to see value for money. They want all the swabs on the counter.")

The nurse was slightly nervous (not surprising, as my file probably said "is au fait with worms" and not much else), but extremely warm and chatty, and completely unhurried. We talked through things, I confirmed I was in the right exam room and dropped trou, and we proceeded with what was a fairly familiar routine. (No stirrups, though -- they don't have them here. And why on earth would anyone, really?) I was out the door a leisurely 20 minutes or so later, not having had to return to reception. 

You know that thing, where you wait for weeks for a bill from your insurance company, and then have to decipher all the codes, and then check they did it correctly (one time I was billed for, I shit you not, my son's circumcision. For those who don't know me: I don't have any children), and then a few weeks later you get a bill -- or two; you never know how they're going to divvy it up -- for labwork, and you just have to hope the lab the doctor chose was in-network? And then even if they are, you have to create a login on the medical center's website and submit your copay and then set a reminder to log in a few weeks later to make sure there's nothing left after everyone has allegedly paid? There won't be any bills whatsoever here. (After all, they invited me.) The entire experience was 100% paperwork-free, aside from that initial letter, from start to finish.

Anthropologists aren't supposed to be prescriptive: "right" and "wrong" are culture-bound and relative, and meaningless across different belief-systems. I'm not an anthropologist, though, so I'm just going to say it: Yeah. This is the right way to do medical care.

A Conservatory Is Not A Grilled Cheese Sandwich

 First - yeah, okay; it's painful keeping a vein open, which is what this blog is supposed to be, and, I guess, why everybody doesn't just do it. I'd entered a script contest, working extremely long and hard on my submission, instead of waiting until the last minute and dashing it off like I usually do (which also confers the benefit of being able to say, "yeah, but I dashed it off -- the real victory is in finishing it at all"). And, of course, I still didn't win. Perhaps it was because it was a series of submission windows, and I waited until the last one, and they reported far more entries in the final window, and it would've won in a previous one. Perhaps it was because it was a British contest and a US-set script. Perhaps it was because the fashion these days is for bold, impressionistic, and emotionally raw pages, and mine was a coldly cerebral little thing, full of wordplay and burning questions of interest to anyone with a passing fancy in semiotics. Or perhaps it just stunk. I don't know, and, more annoyingly, I'll never know. What I do know -- honest -- is that writers much better than me shrug off a hundred rejections before landing anything. The problem is, there's a huge gulf between knowing that and feeling each failure as a visceral gut-punch that causes you to take a month(-ish) off from writing with a good sulking wallow in the mire of self-pity. Fail again, fail better, blah blah blah; I'm back.

Second -- a conservatory, I had to learn, is not someplace like Peabody or Oberlin, where musicians hone their craft. It's a pretty glass room that is unfortunately often too cold in winter and too hot (briefly) in summer to be useable, and furthermore, as sniffed at me by a realtor (estate agent) evidently more interested in establishing our places in a hierarchy than selling a house, is terribly middle-class. I don't care; I like them. Do we have a name for them in American? Sun rooms, maybe? They're much cheaper to add to a house than they are in the US, probably because they're so common (in every sense of that word, I'm now educated to report). And they aren't really sun rooms, because there's not much here in the way of sun. But in a place where it's generally too cold or rainy to sit out in the yard (sorry: garden. There are no yards here outside prison. And "garden" is a much nicer word.), I like the thought of bundling up in sweaters (jumpers. Again, adopted without objection) and blankets on a couch in the conservatory and listening to the rain as I write. So, I've been assessing the conservatory potential on every house we've viewed, much to the dismay of most estate agents. Crass Americans. (What, you might reasonably ask, do they call places like Peabody and Oberlin? Conservatoires, apparently, but I use circumlocutions when the rare ostensive need arises, because I just can't.)

Third -- the grilled cheese. The picture above is of the extremely well-regulated Finzel's Reach Friday market, which employs a one-way system, socially distanced queues (li-- oh, c'mon; you can get some of these from context), and a gilet-jaune to enforce everything. Weirdly, on Saturdays, Harbour Market, about 100 yards away, is an undistanced and mobbed super-spreading madhouse. Choose your covid-theatre performance wisely. The reason we're getting to know the various street markets is due to TH's enthusiastic conversion from "you want me to pay £6 for a cheese toastie?" to learning that American grilled cheese, made by Americans, is really not even close to being a cheese toastie, despite surface visual similarities (the same deceptive gulf that probably runs, still mostly unbeknownst to us, between the American and British usage of similar-looking words, I try not to think). To be fair, this particular artisanal company churns its own butter. It is glorious. And TH is obsessed with tracking the company's appearance at markets, and I really can't object even if greater familiarity with grilled-cheese goodness leaves me slightly jaded, and I do think he should maybe keep an eye on his cholesterol. 

Fourth -- "A conservatory is not a grilled cheese sandwich" is the astute complaint TH lodged as we wrung our hands over whether to make an offer on the cottage in Clevedon. It has a superb conservatory, large and private. It is 14 miles from grilled cheese. Would we come into Bristol on a market day just to have a good sandwich (and also, it must be said, excellent coffee from a different vendor)? Is that even ecologically ethical? But one spends far more time sitting in and enjoying a conservatory than eating sandwiches, right? How does one even compare these things?

But compare we must. I think the inflection point was when we found a detached house in our strongly-preferred Bristol neighborhood. One hadn't come on the market in that area at all for, literally, months. (Okay: one under a million pounds hadn't. It's a nice neighborhood.) We rushed to see it, and, well, it looked tired and small. There was marble flooring in the kitchen, and it had been improperly set and was cracked and pitted. The otherwise rustic-style kitchen had also been fitted with glossy black IKEA-style cabinets that were a monstrous obscenity. One bathroom needed a stall shower to replace the 50's-style paneled tub, and there were settling (hopefully...) cracks throughout the house. All fixable, except the purchase price would've cleaned out our budget entirely, and there was already another offer on the place. I gamely indicated how we might be able to squeeze our stuff into the pocket-sized living room by filling up the single-space garage. TH gamely talked up the location and its nearness to the supermarket. We didn't confess to each other until much later, when it came time to actually write up our offer, that we just simply really didn't like the place. But this was, clearly, a fairly-priced property (witness the other offer and the difficulty in getting a timeslot to go see it). We couldn't afford a square foot more, and it seemed extremely unlikely that when another one comes up in the neighborhood, however many months hence, that it might somehow be better -- for us, for this area, this was realistically as good as it was going to get.

So we bought the Clevedon cottage instead.

Well: it's a process here, isn't it? The mortgage has been issued in principle, but we've had that happen before. I'm not regarding it as more than a 50/50 proposition until after the (in-depth) inspection. On the other hand: it's stood for more than 500 years. It'd be rotten luck if it fell apart during our tenure.

As the UK begins to open up again for the first time since three days after I unwittingly moved here, I'm lining up choir auditions and filling out volunteering applications and freaking out ever so slightly that all these things that are 14 miles away might as well be on another planet outside the limited possibility that I might be comfortably driving by the time of the move. It's a leap of faith, or perhaps a silly choice, or maybe just a frustrated and rash reaction to the forced yoking of incomparable decision factors. Perhaps I'll sit in the conservatory and work assiduously toward racking up rejections and TH can bring home the sandwiches on his way home from work. Perhaps neither of those things will happen, but something else will. A conservatory is not a grilled cheese sandwich, and there are sharp limits on our knowledge of the future, and, for disjuncts like this, research can only take you so far.