Friday, 28 April 2017

Adventures in UK Healthcare, Part 2: Or, My Immersion in England's North East

“Would you like vodka or gin in this cocktail?” the anesthesiologist asked as he put me under, just prior to my surgery at University Hospital of North Durham in March.

It’s the last thing remember, before I woke up 5 hours later. At least I had gone to sleep smiling.

That anesthesiologist looked more like Gene Parmesan than any other person I’ve ever met, and he and I already had quite the repartee going. I’d met him an hour beforehand, in a consultation room where we ran through some basic pre-surgery questions.

Gene Parmesan
But when I first walked into that consultation room and greeted him, he’d startled me by exclaiming, “Well, there’s an accent that feels like home!”

I couldn’t tell if he was joking. He did not sound American to me. “Really?” I said. “Where are you from?”

When he said, “Glasgow,” I was even more confused.

“You think I’m Scottish?” I said. It’s possible that my American accent has been altered somewhat by 20 months of living in England, but I’d never dreamed a Scottish person would take me for one of their own.

But I understand now what happened. When I first spoke to him, his ear caught out a sound that was, at least, different – an accent that didn’t belong to the North East of England.

In my room at the Durham hospital,
March 2017
In the Durham hospital, it seemed, everybody was local: almost all of the staff, and every other patient but me. I was immersed in North Eastern culture as never before. Of all the patients and nurses and nurses’ aides who spent their days on Ward 9 with me, I was the only non-English person. Everyone was white as the snow except for the doctors who dashed in and out on occasion, many of whom were of African or South Asian descent. The only accents I detected that were not North Eastern belonged to those fleetingly-heard doctors, too.

That Scottish anesthesiologist, I think, felt some instinctive affinity for me – or my voice – simply because I didn’t sound like almost everyone else in our milieu. Though he and I ultimately agreed our accents are not the same, in the Durham hospital we did have in common a sense of standing out in a crowd.

I was in that hospital for 5 solid days, and I kept my ears open. The North Eastern accent became a kind of background music that played all day long and all night. I was so immersed in this particular sound, I heard it even as I fell asleep.

The North Eastern accent is very distinctive: to my ear, it is high-pitched and lilting, with extra emphasis on the long vowels. It was also, to my ear, exotic. It was strange to me; it was new.

It’s not what I’m used to in Durham, which may be surprising, since Durham is a town set smack dab in the middle of England’s North East. But Durham is an anomaly in this region. It simultaneously partakes and does not partake of the local North Eastern culture.

While I’d never claim to be an expert on North Eastern culture, I think I can say that the popular musical and film Billy Elliot tried to capture certain aspects of it. If you’ve seen the movie, you’ll know that Billy Elliot – filmed in County Durham – portrays this part of England as far from the centers of political power and wealth.[i] The North East of England was once defined by blue-collar jobs such as shipbuilding and mining. Now, as those jobs have disappeared, the region is on the whole economically depressed. These circumstances, combined with the North East’s geographical isolation from England’s capital and larger cities, cause some to view it as a sort of English backwater.

On the other hand, it is a part of the country where communities are close-knit and people are generally very friendly, and the pace of life is gentle, laidback.[ii] People seem proud to belong here – to identify as being Geordie.[iii] There’s even a vocabulary particular to the region – a vocabulary I find entrancing. Here’s a sampling of it, based on notes I took from my Durham hospital bed:  

Eeeee =           Oh my; oh my God

            Bairn =            Child; kid

            Champion =    Awesome (e.g. “Eeeee, that’s champion!”)

            Aye =              Yes; sure

            Ta =                Thanks

            Us =                Me (e.g. “Go on & give it to us!” – as the speaker extends a hand)

            Me =               My (e.g. “She was me mentor in school.”)

Meself =         Myself

            Dead =            Very; extremely (e.g. “My garden was dead sunny yesterday.”)

            Canny =          Quite a (e.g. “He’s a canny lad;” "I've a canny few syringes here.”)

            Pinch =           To borrow (e.g. “Can I just pinch that folder off you?”)

There's the North East of England!
If I’ve gotten any of the above vocabulary wrong (or attributed a North Easternism to an expression that is actually more widely used), I hope my UK friends will forgive. The point is, all this North Eastern-ness felt new to me. In the local hospital, I was surrounded by it for the first time. It is possible, I learned through this hospital stay, to live in Durham for a while, as I have, and never interact much with North Eastern culture.

Within the context of the North East, the town of Durham often feels like a world set apart. As the home of a World Heritage Site cathedral and castle, as well as a world-class university, Durham has a very different flavor than most of the surrounding small towns, many of which were mining towns in the last century. Walking around Durham most days, you’re more likely to hear Southern accents (the university students and profs) – or languages other than English (tourists and expatriates) – than you are to hear the local accent.

Durham, in my experience, is a surprisingly cosmopolitan town. Even today, in my yoga group, 6 of us were standing around afterward, and someone said, “I think each one of us is from a different country!” It was true. We went around the circle and each said our home country: Germany, Iran, Poland, Sri Lanka, England, and the US.

Durham Cathedral
Adding to this international atmosphere is the fact that various blockbuster films have been shot in Durham over the years, including Elizabeth and some of the Harry Potters. Even as I write this, the latest installment in The Avengers is being filmed in Durham Cathedral. (Dave called from his office to tell me. He’s been watching the film crew set up there all morning.) Does this mean that Robert Downey, Jr. is now prowling the streets of Durham? I can only hope this is true.

It makes sense, given my own predilections and life experiences, that I’d be drawn to this more global aspect of Durham, and that my friends here are – almost exclusively – fellow expatriates, or English people from different regions. In the classic “town and gown” divide, I’ve lived almost entirely on the “gown” side.

The Durham hospital, for me, was where local and global cultures finally met.

Some of the gowns in the town!
By the morning of the day after my surgery, I felt more or less like myself, at least mentally speaking.[iv] I began to converse with anybody who walked into my hospital room. The younger nurses’ aides, especially, found my Americanness to be a great novelty. “I’m so glad you are here,” they’d say kindly, as a way to make me feel welcome. Sometimes they asked, “How do you stand being so far from home?”

Or they’d joke with me about how I’d have to write to my family to say how well I’d been treated in Durham. “Tell them you’ve got a penthouse suite with a view of the sea!” one nurse quipped. Really it was a room about 10 feet square, with no TV or WiFi, nor yet with a toilet or shower. (Those were a ways down the hall.) My room over looked the emergency room entrance, one floor below – my window open, I heard ambulance crews unloading there every night – with the sea about 10 miles away.

One nurse’s aide stopped alongside my bed to list all the places she’d lived. She counted them off on her fingers. Consett, Chester-le-Street, Bishop Auckland. To someone (moi) used to the wide spaces of the US, those towns are all suburbs of Durham – a 20 minutes’ drive at the most. “But I got homesick there,” the aide said of her residence in those other towns. “I had to come back to Durham.”  

Lake Louise, in the Canadian Rockies
Summer 1992
It would be easy – too easy – to paint the staff of Ward 9 as provincial. But that wouldn’t be a fair representation. They were as lively and interesting a mix as you might found in any town Durham’s size, if you look hard enough. One nursing staff member had spent a week in Toronto, on a birthday trip with her father; from there they’d flown to Calgary, rented a car, and driven across the Canadian Rockies to Lake Louise and Vancouver. She listed the places of interest they’d driven through, and one by one I remembered those places, too – from the same drive I’d taken, with my friend Jennifer Lindberg, when we were in our mid 20s.

There was also the male nurse, obviously gay, whom I’ll call Andy. With his Geordie haircut and a fully, beautifully made-up face every morning, he sang 80s pop songs as he made his rounds – and was obviously a favorite among the staff. Andy was the one who determined, my second day on the ward, that my bed was too short for me. He went to the trouble to find an extra block of foam and to wedge it at the bottom of my hospital bed, to give my mattress more length. 

Cup of tea, with NHS logo, and
my compression-stockinged feet
Meals on Ward 9 were a big part of the day. At least, they provided regular markers of the day passing. Breakfast at 8:00; a hot drink and biscuits (i.e. cookies) at 10:00, then lunch at noon. (I was often delighted to have, as a cross-cultural experience, the choice between fish and chips or pork pie.) Around 5:00 we had tea – in other words, supper – and then a hot drink again. My last several days on the ward, I often missed the hot drinks cart as it came around because I was in the halls, walking. By then, however, the nursing staff knew all about me. They’d leave a cup of tea by my bed – black, with one packet of sugar, the way I like it – without having to ask anymore. Once when I came back to my room and found my tea waiting, Andy winked and said, “We’ll be charging you board next!”

While 5 days seemed a very long time to stay in the hospital, the memories I took away are of people’s almost unmitigated good humor and kindness. The staff consulted me about when I wanted my morphine drip stopped, and when I was ready to have the Novocaine-administering ports in my abdomen removed as well – and finally, when I wanted to go off Codeine. (In this way, by the time they released me, I was no longer taking anything but Paracetamol, i.e Tylenol.)

Walking the halls of Ward 9
I also remember the nurse who brought me a fan in the night when my temperature rose, and then directed the breeze deliciously onto my face. Another nurse, seeing me pace the short hall of Ward 9 for an hour – I was restless! and I wanted the exercise! – encouraged me to get dressed and wander the hospital freely.  

Of course, there were aspects of my hospital stay that felt strange, even alien. There was the aforementioned room, Spartan by most US standards, with the bathroom away down the hall. (I was grateful, though, not to be a room with 5 or 10 beds, as I’d been warned could easily happen. As I walked around Ward 9 myself, I spotted several rooms with multiple beds—all of them occupied. It seems, on this count, I simply lucked out.)

But as strange as some features of a UK hospital stay seemed to me, I know I was strange to the people who took care of me, too. They handled me with good grace. Sunday lunch, for example, is a huge deal in England. It’s usually a “Sunday roast” – a meal comprised of roast meat, roast potatoes, Yorkshire pudding, and some sort of nominal veg. Apparently it is as an important and cherished a Sunday tradition as going to church used to be.

But when Andy came around, Sunday lunchtime, to offer the beloved Sunday roast, I asked, “Could I just have a sandwich instead?”

Sunday roast
He did not, or could not, hide his horror from me. “A SAND-wich?!” he said, with one hand at his throat. I might as well have said I felt like eating a baby puppy.

But to his credit, once he got over his shock, Andy found a cheese sandwich for me.

[i] And if you haven’t seen Billy Elliott, I recommend it; the film is funny and tender and genrally brilliant.

[ii] To paint in broad strokes, I might say that the North East of England – politically, economically, and culturally – is to the rest of England as the South of the U.S. is to the rest of that country.

[iii] The term “Geordie” used to refer to anyone from England’s North East. If I understand correctly, it’s often used more narrowly now, for inhabitants of Newcastle and its suburbs.

[iv] This essay, apparently, will not dwell much on medical matters. But I did come through surgery well; I did recover from it very quickly. My surgeon wanted me to stay in the hospital for what seemed a long time, however, because I lost a fair bit of blood during the operation; he wanted to get my hemoglobin levels back up before he let me out onto the streets.

Thursday, 13 April 2017

Adventures in UK Healthcare, Part I

One of Durham's many hills -- with a
good-looking man halfway up it!
This winter, as I looked ahead to a major surgery in March, my primary fears weren’t so much about my health. No: when I woke at night, in the weeks leading up to my abdominal hysterectomy on March 22, it wasn’t to worry over that surgery’s outcome. For one thing, I felt very healthy and strong. I was walking a minimum of 3 miles a day (up and down Durham’s hills!) and taking fairly rigorous yoga classes 5 times a week. For another, my doctor had said that he thought the recent developments in my uterus—a thickened uterine lining, and a fibroid that had grown exponentially over the previous 6 months—were a direct result of taking Tamoxifen daily, as I have done and will continue to do in this decade following my incidence of breast cancer in 2014. My doctor had made me feel pretty secure that these new developments, while ultimately not good for my body (otherwise, why have this surgery at all?) did not signify cancer again. And that was the main thing for me.

August 2014 -- day after my double mastectomy,
in Chicago.
Nor was I very anxious about the surgery itself—though it would involve a 6-inch vertical incision from my navel to my pubic bone and would probably last 4 to 5 hours. This sounds kind of major, I know, but so does a double mastectomy, right? And I’d already had that adventure in 2014, in Chicago, the last year that Dave and I lived there. Based on my recent history, I felt confident that I’d come through my new surgery without complications and would bounce back to normal quite quickly. (Which, by the way and praise Jesus, has turned out to be true.)

This winter and spring, my fears turned instead on how my days in the hospital, after my operation, would be. I had reason to believe that my experience of major surgery in the UK would be quite different from the one I’d had 2.5 years ago in the US.

To begin with, my doctor here seemed to think I’d need to stay in the hospital for 5 or 6 days. I could not imagine what for. In the US, after my double mastectomy, I’d been released within 24 hours. I’d been proud of, and pleased by, this fact. Going home as soon as I could seemed the natural and preferable option – and after all, it’s common practice in the US, because of the extremely high insurance costs for a hospital stay. In the UK, however, doctors feel far less pressure to get patients back out on the street. So this time around, I was looking at close to a week in the hospital recovery ward.

University Hospital of North Durham: my
local hospital here in the UK
Not only that, but it sounded like I would not have much privacy, either, during this insanely long stay. My English friends warned me about it. No one in an NHS hospital, they claimed, ever got a private room, unless they were highly contagious. I should expect to spend my recovery days in large open ward, with 5 or 10 or maybe 20 beds all in one room. To make matters worse, I wouldn’t have much of Dave’s company; he wouldn’t be allowed on the ward except for two separate visiting hours. Here in the Durham hospital, Dave could visit from 2:00 to 3:00 PM and from 6:00 to 7:00 PM. Otherwise, I would be on my own – or as much on my own as a person can be on her own, when sharing a room with 9 or 10 others.

“That’s just how it is here,” one of my English friends said. “As the patient, you’ll be looked after well, but friends and family don’t get much attention. It's just an attitude handed down from the 1950s, when the doctors and nurses knew best and the family had busy lives to be getting on with (down t'pit or similar)[i], and this attitude hasn't really left us.”

Coal miners of County Durham, 1940s
None of these prospects – the long hospital stay, the ward full of beds, the short visiting hours – filled me with joy. In fact, they filled me with dread. (Hence the waking up in the wee hours, those first weeks of March.) Could my English friends have been exaggerating? It was a tempting thought. Based on my previous visits to the Durham hospital, though, I had reason to believe my English friends weren’t shitting me. In many ways, the UK healthcare system is much more hardcore than what I knew in the US. And since they are the people who’ve interacted with this system all of their lives, the citizens of England—I’ve now come to think—are somewhat more hardcore, too.

During some medical errands preparatory to my surgery, I got my first glimpse of these rather more hardcore ways. The MRI that I had here in England was done in the back of a truck. Yes, a truck. A truck which is driven around the North East, from one medical center to another. At about the same time I also had a D & C, a procedure which I’d had once before in the US and for which I had to be admitted to the hospital, given twilight anesthesia, and taken into the operating room. Here in the UK, a doctor performed the D & C on me right there in her exam room, with no anesthesia at all – on an examining table that didn’t even have stirrups. It hurt like a mother, and lent a whole new level to my understanding of the British stiff upper lip. On the other hand, the whole thing was over in maybe 10 minutes -- and gave me a real opportunity to practice my yogic breathing.

Based on these two examples alone, I’d say that the UK healthcare system is absolutely about doing what needs to be done for the patient, but doing it efficiently. With a degree or two less physical comfort – or luxury? – than what we’re accustomed to in the US. The most obvious reason for this, I think, is that US hospitals know the patient is shelling out major bucks for her healthcare -- or her insurance company is. In US medical centers, then, there's an element of wanting the patient to feel more like a customer: like she's getting her money's worth, so to speak. Getting the full-service treatment.

In the UK, meanwhile, that just isn't much of a concern. If you're a tax-paying resident of this nation, you'll get your healthcare: you know this. (And you will get it for free.) But no one on the medical staff is necessarily out to impress you. As far as I can tell, and rightly so under these circumstances, they don't see that as part of their job.

Speaking of which, let’s just think for a minute about hospital d├ęcor. It may sound like a trivial aspect, but the variance between the amount of money spent on hospital facilities in the US and in the UK is so striking – so vast – it seems a reflection of somewhat different priorities, too.

One tiny corner of the hospital lobby
in Chicago.
My hospital in the US, in Chicago, was a thing of undeniable beauty. You entered a marble-floored lobby with a 3-story-tall ceiling and a waterfall – a real waterfall – crashing down all 3 stories into a marble-lined pool. Ornate arrangements of fresh-cut flowers rose up from every reception desk corner, and as you walked beneath gleaming skylights toward the twin escalators, you passed A) an ebony player grand piano, and B) a huge free-standing fireplace with leather armchairs drawn up around it.

In the US hospital where I was treated, the waiting room for a patient’s loved ones was similarly well equipped : more leather arm chairs, more fresh flowers. Plenty of electric outlets for people’s laptops, and a free Wifi connection. Large video monitors, placed in the waiting room walls, allowed people there to keep track of their loved one’s progress; during my mastectomy, Dave could see when I was in pre op; in surgery; in post op. When my operation was over, the surgeon came to that waiting room to tell Dave about how it went. And then – oh glory of glories – Dave could walk up the hall and be with me, just as soon as I’d woken up.  

My hospital here in the UK is significantly less glamorous. Inside its walls, there’s not a flower in sight. No high ceilings, no marble floors. To say nothing of waterfalls or grand pianos. In the exam rooms, the sinks are often just that – little sinks, stuck onto walls, with the plumbing beneath fully exposed. Throughout the building, the hospital windows can be opened wide – and usually are, no matter the season[ii]. The color scheme is all mauves and pale turquoises that remind me of the 1980s, and chairs are in short supply. What chairs you do find are hard plastic, and the waiting rooms themselves are miniscule, Spartan – because no one there really wants the patient’s family and friends to spend their time waiting around.

In February, when we went up to the hospital for my pre-surgery consultation, Dave asked a staff member about this. Where would he wait while I was being operated on?

The nurse practitioner running our consultation seemed a little nonplussed. “We don’t really have a room for that,” she said. “If you want to be near the hospital, though, there’s a coffee shop down the street.”

Dave has stuck right by my side
through all the health adventures
of the past several years.
(Here we are in summer 2014.)
So then it was our turn to look taken aback. “But how will I know when Patricia’s out of surgery?” Dave asked.

“Well, there’s a phone number you can call, after a certain number of hours.”

“A phone number,” Dave repeated. “Okay.” When the nurse practitioner just barely nodded, he said, “How do I get this phone number?”

The woman sighed. Maybe she’d had a long day. Maybe she had cause to think that Dave and I were ridiculously spoiled. “Listen,” she said, “we don’t cater to you like you may have been used to, in the States.”

Having come out on the other side of this experience, I can say that this woman – I see her now, in her tidy blue dress, her little cap of brilliant red hair – was by far the least pleasant person with whom I interacted during my whole hospital stay. I can also say that, in her claim about the UK health system not “catering” to us, she was both right and not right.

Part of my new scar!
April 2017.
In a similar manner, my time of recovery in a UK hospital was both like and not like what I’d feared.  I had a memorable 5 days. Uncomfortable, yes, in some ways. But almost delightful, in others. In my next blog post, 2 weeks from now, I’ll write about those 5 days.  

For now, though, what can I say except that I had a major surgery, 3 weeks ago, and am now almost fully recovered? The surgeons at the Durham hospital removed my cervix, and my ovaries and fallopian tubes; they removed my uterus and the 1.5-pound (yes, holy lord) fibroid. After that, they did some “washings” of my abdominal area to test for abnormal cells. All the pathology came back normal, thank God, and that six-inch long vertical cut in my belly is starting to heal up quite nicely.

I am grateful for the good care I received. I am awed that, like every tax-paying resident of the UK, I received all this healthcare for free.[iii]

A little post-yoga-class
excitement! Today.
And I’m amazed by the body’s recuperative powers. Today I did my first one-hour yoga class since my surgery! It made me so happy, I was almost in tears by the end. It’s so good to know that, even after the trauma it’s recently been through, my body is still here for me.

[i] Meaning “down into the coal pit.” County Durham was a major coal-mining area of the UK in the previous century.
[ii] Hospitals in the US, like most US hotels, have windows that are sealed tightly shut.
[iii] For more on this topic, see my previous blog post, “A Tale of Two Healthcare Systems.”