Letter from America Part 2 – A Rock in a Hard Place
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  1. The Avocado’s Revenge

My trip to Seattle from San Diego on Alaska Airlines was short-story inducing (soon on this website!) but otherwise uneventful. My sister-in law picked me up at the airport on a windy, rainy day (Seattle’s weather mimics London weather most of the time. Or is it the other way ’round? Nah. We Brits had it first!) and soon, reunited  with my brother, a medical professor, and his wonderful son J, we were dissecting the world around their capacious gloriously liberal elite dining-table…

And the next morning, the discussions continued.  Between Ain’t it Awful and If Only They’d and The Real Meaning of (insert Religion, Politics, Philosophy, the Bible, carbs, Economics and on and on – here) we had adequately succeeded in convincing ourselves that we are smarter, more informed and generally prettier than, say, Trump supporters and were preparing self-congratulations when we were interrupted by an avocado.

I explain: the previous evening we were discussing what we enjoy for breakfast when I casually mentioned that I love fruit in my morning cereal and sometimes use an avocado. Shock! My American sister-in law was not just shocked, she was incensed. Annoyed. Affronted. Nevertheless, she was kind enough to buy a particularly lush example of that fruit and all discussions halted as she demanded to watch what I was going to do with this offensive thing.

Casually, I sliced the avocado in half and separated the two sections (mentioning at the same time that due to the sudden popularity of the fruit in Britain there had been a substantial increase in the number of middle-class patients in Casualty as a result of slicing their dumb fingers off while extracting the pip with a knife). I chopped half of it up and tipped it flamboyantly on top of the porridge. Then, to add to the horror, I plopped some yoghurt on top.

After the expected expression of horror we continued our conversation which was, I seem to recall, comparing the economics of Hayek with Keynes….

And then the avocado struck back.

An invasion of pain, starting in the upper right quadrant of my chest and spreading like burning coal from there sideways and downward. This was not wind. This was not a gastric bug. This was something much more sinister. 

I stood, muttered an excuse and headed upstairs to my bedroom where I lay in horrible agony, sweating profusely, writhing in pain. My brother, being a professor of medicine, made an executive decision not to investigate, at least for the first hour of the visit of the nether regions of hell to my nether region. 

In my experience if you want to be ill, never do so in the house of a doctor. Their medical training is firm on the matter: treat patients in a clinic! Otherwise you will probably be sued. For this reason many doctors will accelerate past a road accident. And I should have known: years ago, my cousin the doctor was staying with me in Chelsea when I had a heart problem. I will never forget his casual dismissal when I told him my symptoms. And that ended in the Emergency room…

So there brother the Professor was outside the door of my room, politely knocking and querulously asking if I was alright. No, I said, I am not alright. You can come in, I said, I am in need of medical advice!

Admittedly it didn’t take him long to diagnose a stone in the gall bladder probably caused or exacerbated by the onrush of avocadoey goo to that organ. But since it wasn’t actually his stone, he was remotely casual about it and asked whether I would be ready shortly for the planned ferry ride to an island in Lake Washington. No, I said, that would not be a great idea. Polite as always, he suggested that when I felt better we could perhaps undertake a smaller expedition which would still get me back in time for my planned flight to San Diego.

Slowly slowly the pain decreased as a result possibly of some Tylenol and being prone on my back. To the extent that I gave a doubtful ok to the limited expedition plan. But in the car, despite the beauty of this wonderful lakeside city, the fires of hell began to build up once again and by the time we got back to the house I knew I would not be flying that evening. I told a surprised brother, and said the only place I wanted to be was hospital.

2. A VIP Emergency in America

We arrived at the hospital around 4 on that Sunday afternoon. The Emergency Room at Washington University Hospital has, as one would expect, a waiting area. Tiny. Capacity about twelve people. In the U.K., fifty. Triage happened in about twenty minutes. UK, possibly similar depending on time of day. Initial treatment (a shot of morphine) within an hour of arrival. U.K. Up to 4 hours but I think in this sort of case it may be quicker. 

The arrival of the Accounts Clerk – the member of the Raptor clan designated to appear in any emergency room in the US with a clipboard and the demand for a payment method – however, happened within twenty minutes of my lying down. Now that doesn’t happen in the U.K. We just assume every patient in emergency is an emergency. First we treat, then we enquire if the person is a British and therefore entitled to free treatment.

Brother kindly kept me company while waiting for a doctor and a diagnosis and some treatment but eventually (9.30 or so) I sent him home. He had work the next day. I’ve forgotten most of what happened in that emergency cubicle, thanks to the deliciousness of the morphine, so lucky you, no gory details…I know had a CT scan which confirmed the gallstone diagnosis. I know that shortly after brother left I suddenly got terribly cold and began to shiver, shake, go into a horrible shivering fit which felt like it lasted at least twenty minutes. Nurses seemed not very bothered. They gave me blankets – no help, assured me the temperature was 70 degrees. No help. Gave me more morphine. Helped. Certainly no explanation, no doctor. Horrible.

Then, suddenly, all smiles I was informed that I was being transferred to a ward.

I must tell you that the most notable difference between the UK and the US hospital is the number of staff. Sheeeeeesh! They paraded in and out of my cell like an endless stream of intensely grinning clones, each determined to outdo the others in spreading lovingkindness all over me. And just as I began to fall in love with this or that carer, he or she would be rapidly replaced by another equally lovable being, who would introduce him/herself as “I will be in your team….” and then would just vanish!

Which phenomenon continued in my room in the ward. Or rather, my ensuite suite, with its bathroom, tv entertainment centre, its cheery information board and its endlessly loving staff who, should there be any remote chance of my falling asleep would come bouncing into the room at least every hour to tell me that they were my team. All night. Imagine if I had gotten them all together in one room! Sure as dammit that would have to be a helluva BIG room…

In the morning, two cheery bearded chaps radiating love came in to tell me they are my team, and to announce that a decision had been made to do another MRI to investigate the situation in more detail. Should there be doubt, they would send some tubes down my throat to find out more, and if necessary they would cut out the gall bladder and feed it to the pigs. Or not. Knowing I would never see either of them again I sadly consented to this strategy and waited. 

Which gave me time to reflect on the intensity, sincerity, complexity and utter luxury  of my treatment. There can be no doubt I was receiving a massive amount of attention, and at last I realised why. Of course! Brother is (holy word) Faculty. A Professor of this Institution. A legend, in fact. Probably the leading Rheumatologist in his field. Worldwide. So no surprise then that people flooded into my room to see the legendary brother of this legendary figure and hopefully to leave such a good impression that I would not hesitate to commend them to the Prof.

And there I was thinking it was my charm and my accent…

Much later (around 4) I had my second MRI and much much later the results – the stone had gone. Been expelled. Yes there was “mud” left behind which is likely to turn into a stone some time in the future (50% chance within two years) and I am recommended to have the gall bladder removed within 6 weeks. A remarkable recovery.

And I wonder this: did the shivering fit somehow shake that stone loose? If so, nice one Immune System! Proud of ya.

Returned now to Brother’s house feeling shaken and stirred and determined to avoid all puns with the words “gall” and “galled”. I’m flying to San Diego tomorrow and London on the weekend. My hoped-for trip to India is probably off, as I will have to get the NHS to do some cutting soon – and I certainly don’t want to be caught with a gallstone in Mumbai or Varanasi…

Now that would be galling!


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