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Archive for the ‘Observations of Britain’ Category

Something I Miss:

The chemist’s shop (pharmacy) in the little town where I lived in the UK was a step back in time, and delightful and frustrating for it in equal measure.  If it had disabled access, I was unaware — all I know is that it had a narrow doorway and an awkward step that was incredibly difficult to manoeuvre with a heavy pushchair.  The hours were posted on the door: Monday – Saturday, 9-5; closed for lunch from 1-2; half-day closing on Wednesdays.

Once inside, there was an old glass-and-wood counter on the right from which you could buy magazines, cigarettes, wine and whiskey, or sweets.  To the left was a rabbit’s warren of shelving units — packed so close that the pushchair only just fit through — offering a dizzying array of almost anything a person living in a small town might want.  The carpet was trodden to a manky brown-grey by a thousand muddy boots, and jarred with the sleek and brightly lit cosmetics displays.  The place smelled musty, always, as if what it really needed was for someone to throw open the windows and let the wind blow through.

At the far end of the shop stood the chemist’s counter, with the traditional set-up of the cashier’s till at the ground level where the customers were, but the chemist (pharmacist) work up high on a raised dais.  The chemist popped down regularly to answer questions and give advice any sort of ailment that was presented — in the traditional role of a sort-of doctor’s stand-in — but then went back up to the solitude and privacy of the mezzanine to work in peace.

The cashiers knew our names — it was a small town, after all.  They saved my favourite magazines for me.  And the prescriptions — every one and every time — cost £7.20.

Something I Love:

Here in the US, the girl’s doctor asks me which pharmacy we use, as she peers squinty-eyed at her computer screen.  I tell her and she taps in the prescription.  “Are you going straight there?  They’ll have it ready in about 20 minutes.”

When we pull up, the girls are asleep, exhausted from the adrenaline kick that a visit to the doctor’s always brings, so I go round the back to the drive-thru.  The cashier doesn’t know us, but she checks our insurance card and, as promised, the prescription is ready, all packaged up in its paper bag and waiting for us to collect it.  There are two more refills, and the pharmacy will hold those on file until I ring next month to say I am ready to drive-thru and pick those up as well.

And the girls sleep on — undisturbed and unaware — and I marvel at how easy this is.

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Hold on…  lifts hand with index finger raised
Hold on…   I’m be with you in a minute — I’m just reading through these papers…  I’m choosing between some of these military protection plans.  I’ll be getting all the standard coverage of course: basic national defense, overseas campaigns, that sort of thing.  And I’m including all branches of the military on that and the Coast Guard as well.  But… do I want to add the foreign and domestic terrorism riders?  I mean, domestic terrorists could hit anywhere really, so I think I’m going to go with that, but…  do I think foreign terrorists are going to go for Western Pennsylvania?  Probably not, so I could save some money there.  Except, wait… the G20 summit is being held in Pittsburgh next month, so maybe I do need to worry about foreign terrorists.  And… oh, what’s that in the fine print?  The domestic terrorism rider does not cover terrorist activities of any person, foreign or domestic, who received training at any time lasting more than two months in any of the following countries: Pakistan, Afghanistan, Yemen… Hmmm, that complicates things.  I don’t know how likely…  Mmmm… Well, I’m not sure what to choose there…

Choosing the school options was much easier.  The girls are bright and I want to give them the best chance in life, so I went for the most comprehensive choices I could get.  I didn’t take the remedial tutoring option, of course — they won’t be needing that and I feel confident I can ensure that by taking a greater hand in their studies at home.  And I saved quite a bit by opting out of the school lunch option — with their allergies, they can’t eat the school lunches anyway, and I don’t want to be paying for anyone else’s peanutbutter sandwiches.  I’m only going to pay for what’s right for us!

Choosing the police coverage was pretty straightforward — we want full coverage there — and I chose the elite force even though it costs a bit more, because the faster response time is worth it.  Same with fire, although I did opt out of the cat-stuck-in-a-tree rider, seeing as we can’t have the cat with us anymore-.  For public roads, I went for all the entire local road network, and added the option for occasional roaming.  It doesn’t include the Erie-Cleveland network though — I can’t see us ever needing to go there…

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The response to my blog post on the NHS was overwhelming, and I found it fascinating to read the comments as they came pouring in.  It’s been equally interesting to Google my blog post and see all the various sites that have linked to it, and then read the comments that have been left there as well.  But time and time again, there have been replies from people who say that they like the current American system because they want “choice” in their healthcare.  They want to “choose the right plan” that suits their personal situation.   Being  covered for anything and everything that might happen in their lives doesn’t fit that scenario — they want to be able to specify exactly what ill may befall them and what benefits they’ll be entitled to.

Several people said they liked choice in healthcare because they didn’t want to pay for someone else’s maternity care or stomach-stapling operation.  It makes me wonder if they just don’t understand how the insurance they’re buying actually works.   If they’re getting major medical, of course they are paying for other people’s benefits, even the ones they don’t receive themselves or perhaps don’t want to support.  Insurance companies take everyone’s money — whether they’re paying a lot for comprehensive coverage or a just little for bare-bones coverage — and then put it into one big pot to use when they have to pay out on claims.  In choosing a plan, these people are only limiting the benefits they will receive, not controlling how their premiums will be spent.

But to the rest — the ones who do understand how insurance works and are still saying that, instead of being covered for everything, they want choose  a plan that will suit the healthcare they personally will need — to them I want to ask, how do they know?  Yes, major medical covers a wide spectrum and catches the most likely scenarios in its net.  And yes, there are armies of actuaries working out the probability that one person will be more likely to contract Disease A over Disease B, so that people can make “informed” choices.  But nature can (and does) defy even mathematical probabilities.  The unexpected does happen.  The unforeseen is… well, unforeseen.   Aside from the obvious probability that most single men and nuns won’t require maternity cover, it defies my understanding how someone can actually know ahead of time what kind of medical care they will need in the future.

The girls’ insurance does not cover seeing a nutritionist.  It’s a moot point as to whether I would have chosen a plan that did, because this was the single only long-term policy that I could find that would cover them under our circumstances, but if it had been a few years ago and I’d have been in a position to choose between several plans, I never would have even considered that we’d one day need — be desperate — to see a nutritionist.  I mean, I know how to cook, we have a varied diet, and we’re none of us really overweight.  What do I need a nutritionist for?  A few years ago, I’d never have guessed that I’d have a baby who would suffer from food allergies so severe that she’d drop from the 98th percentile to the 1st percentile in her first year, who would stop gaining weight for seven months and grow so thin I could count her ribs, who wouldn’t double her birth weight (something most babies achieve by four months) until she was nearly two years old.  And so, not knowing that, but guessing that we wouldn’t need a nutritionist, I would have happily foregone that option.  And though it wouldn’t have been a disaster in our case (nutritionists being at the more affordable end of medical care), it serves as an example that people simply cannot really know what kind of care they’ll need in the future.

Or even that they’ll need care.  When we were preparing for our move and I was speaking to insurance agent after insurance agent (before I realised that none of their policies could cover us due to residency requirements), they all asked me the same questions: “Are you generally healthy?” and “How often do you feel you’ll need to the see the doctor?”  I hardly knew how to respond.  The first question implied that past performance predicts future results — in which case I’d have made millions in the stockmarket — and the second assumed I could see the future — in which case I’d have made sure I’d won the lottery by now.  But we were relatively healthy and we didn’t see the doctor that often, and that satisfied the agents.  “Then you probably won’t need very extensive cover,” they all predicted, and suggested low-premium high-deductible plans.  And then we immediately turned all that on its head by developing significant health problems as soon as we arrived, and running up thousands in medical bills within a couple of months.

Now I realise that most of the time, when people talk about choosing a plan, the “needs” they are talking about are not the diseases they think they’ll get, or even the structure of their care, but the premiums and deductible they can or want to pay.  They are not making choices about their care — they are weighing up their probable future health against what’s in their wallets and then hoping what they’ve bought will align with whatever may befall them in the future.  And therein lies the unappealing truth that we all know: in the choice between care and money, we tell ourselves that it’s all about care, but the system — and thus the choice — is all about the money.  The idea of having that choice, of picking amongst a series of plans — with varying (and often confusing) benefits, various (and confusing) restrictions, and a range of prices — is appealing because it gives people the feeling that they are in control, they are tailoring their coverage for themselves.  And it blinds them the fact that the NHS system that I described — and so many disagree with — gives no such choice because it’s simply not necessary, because the system’s mission is to cover everything, for everyone, for their entire lives — and that where it is restrictive, it is no more restrictive than the insurance companies who take their money and then decide — sometimes retroactively — whether their claims match the fine print.

We fund the police, the military, and our public schools in a collective, socialised way, and we accept that when we receive the services they provide, they will be comprehensive — we don’t pick and choose the “package” we want because we know they will cover (or attempt to cover) whatever needs may arise.  In fact, the concept of trying to anticipate our potential future needs to these services and limiting our access that way just might look a little silly, if someone were to write it out.

Does it make a person lefty to support comprehensive universal health?  No more than it makes a person lefty to support their local schools, their police and fire departments, or our military.  These are socialised institutions that have been in our midst for generations, and which we have chosen to support and fund this way because they are so vital to the fabric of our society that we are willing to work collectively to ensure these key services remain in place.  And yet our national character has survived!  Having a public schools, collectively funded police and fire services, and socialised military has not wrought havoc on the nation — our country has remained capitalist.  Healthcare — with its ability to bankrupt overnight; with its ability to create a life-sentence of astronomical on-going costs; with its central role in the health of the nation and of its workforce and its economy — is one of these same essential services.  We have ignored that fact for too long and now that we face this rare opportunity to reform healthcare, it’s essential that we see the situation for exactly what it really is.  A public healthcare option — like public schools, like our police and military —  is not something to be feared as some sort of Great Socialisation of America.  It is simply a logical step that will ensure this one other essential service is accessible to all Americans — for the betterment of our countrymen, our businesses, our economy, and our country.

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As the healthcare debate picks up pace, I find myself being asked with increasing regularity what I think of Britain’s healthcare system.  Six months ago, I’d have jumped into the answer with gusto, but these days…  I don’t know, I am just so fatigued by all the fear-mongering and hysteria, the ignorance and the downright idiocy of the current debate that I can hardly summon the energy to add my voice to the cacophony.

But the other night when a friend of my mother’s emailed me and asked that now-familiar question — what was my experience and what did I think of British health care? — and I was surprised to discover that, once the initial weariness had worn off, I found myself turning her question over and over in my mind, composing my answer.  When I sat down last night and started my reply, the words fell out me, my fingers tapping rapidly at the keyboard and my mind so engrossed in the assignment that I was stunned when I finally looked at the clock: it was 2.30 in the morning.  I had been so consumed because what I had to say had been bursting to come out, an outraged truth that was tired of being bottled-up and was begging to be told.

When I lived in the UK, I railed against the NHS (the National Health Service).  I cursed every delay, every perceived inconvenience, every way it differed from the care I had received in the US.  But I moved to the UK only a few months after graduating from university and, until then, I had been covered on my parents’ very generous insurance so I had experienced American healthcare only as a dependent.  I was judging my British experience from a lofty and privileged position of someone who’d always had gold-plated insurance.  And I was naive, because I’d never had to pay for it, never had to worry it wouldn’t be there, never really had to deal with the paperwork.  I never really understood what I was comparing the NHS to at all.

I also realise with hindsight that a lot of what I held against the NHS had nothing to do with the system itself and actually were issues that could happen in any system.  I blamed the whole system when the loo in my local doctor’s office or hospital wasn’t clean enough.  I blamed the whole system when the only space I could find at the hospital carpark was miles away in the very furthest corner.  I blamed the whole system when the doctors’ receptionist was grumpy or I didn’t much like my doctor’s manner (or his diagnosis).  But the truth was that I believed in the healthcare system I had grown up in and I didn’t like the idea of socialised medicine — I didn’t like socialised anything — so I saw problems with it where-ever I chose to look.  And I held onto that belief right up until I arrived back in the United States, and discovered that grumpy receptionists and dirty hospital bathrooms and annoying carparks can happen in any system — because they have nothing to do with the system itself.  They’re management issues, human nature issues, and they happen everywhere.  And a lot of the fear that Americans have about change in their healthcare actually center around these kind of issues that have nothing to do with the system itself, be it socialised or for-profit.

So my return to the US and my sudden immersion in the American healthcare system was a rude awakening for me and it made me look at both systems a little more realistically.  There are great things about healthcare in the US — great things — and I truly do believe that the quality of the care here is second to none.  But there are great things to be said about Britain’s system as well and the trouble is that, at present, far too few people are saying those great things and far too many here in the US are beginning to believe utterly ridiculous things about the NHS.  Let me play a small part in putting that right by outlining my experience of the British healthcare system.

  • First, I’ll start by pointing out that the NHS is truly one of the most socialist — almost Soviet — healthcare models that a country could possible choose.  Unlike the health systems in France, Germany, and most of the rest of the developed world, it is totally government-run, almost totally centrally-controlled, and supported entirely through taxation.  It is mammoth — the single largest employer in Europe, which is incredible when you realise it serves a small country with only 60million people.  And with that kind of size come huge problems — consultation times are too short and it takes too long to get test results, amongst other things.  It is not a perfect system by any stretch of the imagination.  But it’s important to realise that when I talk about my experience, I am talking about the kind of system that truly is the very far extreme of what the nay-sayers are claiming will be the end result of public health provision in the US.  The British system is the very stuff of their nightmares and yet, the truth is, it’s nothing like what they imagine.
  • My healthcare in the UK was never dictated by a bureaucrat.  Decisions were made by me and my doctor alone, and whatever we decided was the right course of action was the course that was taken.  The scope of care available to me was far, far wider than what is covered even by the ‘very good’ insurance policies I’ve had here in the US.  There were no limits on the number of times I could see my doctor, or the number of tests/procedures/consultations/etc that I could have in a year (or month or lifetime…)  Whatever was deemed medically necessary by my doctor was covered — period.  In fact, I’ve experienced a lot more limitations on my care since I’ve moved back to the US — the most memorable of which was when I had to beg the insurance company to cover a single visit to a nutritionist when E2 was diagnosed with 12 food allergies and was severely underweight.  That simply never would have happened in the UK — if she needed it (and she did), she’d have got it (as her sister did after being diagnosed with a single allergy). To illustrate the point further, when I gave birth to E1, I stayed in hospital for five days because she had problems with breastfeeding — and that was entirely my decision.  I was free to leave hospital whenever I wanted, be that after one day or after a week, and I had the full support of the midwives to stay until they were sure we were breastfeeding properly and ready to leave — no administrator/bureaucrat/insurance company made that decision for me!
  • There are delays — there are delays — but to be honest I have experienced delays just as bad here in the US.  In the UK, I might have to wait weeks or months to see a specialist if my case was not urgent, and that was frustrating.  Here in the US, when I was in excruciating pain last year (so bad that I lost control of my bodily functions when the pain hit), I was referred to a breast surgeon by the ER doctor (7 hour wait in ER) — but the trouble is that we had to call five medical centers before we could find a surgeon who could see me any sooner six weeks, and even then it was only because they had a surprise cancellation.  And the last time I needed to take E2 to the allergist here in the US, the earliest they could fit me in was two months later.  There are delays in both systems.  And by contrast, you can get very speedy service in the US… and you can get it in the UK too.  When I needed to see my GP in the UK, I rarely had to wait until even the next day.  When I thought I’d found a lump in my breast, I saw the doctor the next day and was sent to a specialist within the week.
  • I had my choice of doctors.  My small rural town had two GP offices (a GP is a General Practitioner, a family doctor) with about 5 GPs in each office — I could choose either office and any GP in that office I chose.  I could choose to go to the GPs office in a neighbouring town if I prefered (though some offices limit the regional area they’ll cover).  I could change GPs at anytime for any reason, no questions asked.  When I had my babies, I had my choice of any of the hospitals in the region, or a homebirth (the midwives in my area loved doing homebirths!).  When my GP referred me to a specialist, he’d send me to whomever he thought best, but if I wanted someone or somewhere else, I could request that, no problem.  And I always had the option of a second opinion, either through another NHS doctor or a private doctor.
  • I never once received a bill in the UK.  There are no copays, there are no deductibles, there is no such thing as max-out-of-pocket.  I have an NHS card which I showed at my GP’s office when I registered, and from that point on, I never had to fill out any forms or show any ID ever again. In fact, I think I lost my NHS card years ago — I have no idea where it is. It doesn’t matter — I don’t need because I am covered for everything once I am registered with my GP.  When I stepped on a piece of glass and sliced up my foot, I went up to the local hospital, was seen immediately (rural hospital on a Tuesday afternoon), they took note of my name and address, patched me up, and I went home — simple as that.  No bills, no paperwork, no hassle.  Yes, Brits pay to cover it in their taxes, but the cost spread across the entire country and so it isn’t nearly the burden that insurance is for Americans.  In fact, Brits spend only 8.4% of GDP on healthcare, compared to the 16% of GDP spent by Americans and what they get back is a system beats the US on so many basic measures of healthcare results.  This is good quality care.
  • Brits believe that healthcare is a human right and are happy to have a system that covers everyone, all the time.  They are HORRIFIED when they hear stories of Americans who have to hold fundraisers to pay for desperately-needed operations.  It blows their minds that anyone goes bankrupt or loses their home because of medical bills.  The idea that someone would lose their coverage because of a pre-existing condition or because they are so sick they can’t work is totally alien to them.  These things simply do not happen in Britain.
  • Even with a comprehensive healthcare system that is available to all and completely free (at the point of delivery) the UK still has a healthy private system running alongside the state system.  There are numerous large private insurance companies providing private health insurance to those who’d like to have it (or whose companies want to offer it).  There are private hospitals up and down the country.  Most specialists practice both within the NHS and also privately (they split their weeks).  You can pretty much get your healthcare however you’d like — on the NHS, through private insurance, or paid out of your own pocket.  I hear people in the US saying that with in the British system, you can’t see anyone but your government-assigned doctor, but that is totally untrue.  And you can chop and change your care as it fits your life — I’ve had my care for an medical issue start on the NHS, and then switched my care to my private insurance if it suited my needs better.  I’ve had other medical issues that I stayed with the NHS for the whole way.  And when my husband had an elective medical procedure done that was covered by neither the NHS nor insurance, we simply paid for it out of pocket.  It’s a flexible system and the private sector has not been quashed by the fact that there is a comprehensive, free public system running alongside it.
  • Because healthcare is not tied to employment, companies are free to focus on their core business and people are free to make career decisions (and life decisions) based on what is best for them instead of what preserves their healthcare.  Brits never worry about keeping their healthcover — they never worry about pre-existing conditions; they never worry about continuity of care if they change jobs; they never get trapped into a bad-fit job because they have to keep their healthcover. They are much freer to be entreprenuers than Americans, because their only worry is whether their business will succeed, not how they’re going to provide healthcover for their families when they’re self-employed.  Companies, particularly small companies, are free to focus on their core-business because they not burdened by the administration of healthcare for their employees — they never have to pay someone in HR to manage health benefits; they don’t have to juggle insurance companies and negotiate lower premiums; they don’t lose employees because their healthplan isn’t as good as some other company; they don’t see their bottom line rocked by a sudden rise in premiums.  Decoupling healthcare from employment is hugely freeing to both individuals and employers, and can actually a very good thing for the economy at large.
  • When things go wrong, the government answers to the people in a way that insurance companies never do.  For example, there was a cancer drug called Herceptin which was not covered on the NHS because of the cost.  A group (led by Ann Marie Rogers) began a campaign to change this, suing their local health trust, and gained huge public support.  They ultimately won their case and got their local trust to offer the drug — but because of the political pressure this campaign had created, the government extended the drug to the entire country.  Imagine trying to convince an American insurance company to cover some expensive drug that they don’t want to cover, and then having that decision convince every other insurance company to do the same.  And again, when I moved to the UK fifteen years ago, wait times in the NHS were much worse than they are now — but the public got fed up with it, made their voices heard in the General Election, and the new administration made cleaning up the NHS one of their highest priorities.
  • There is an emphasis on preventative care and the simplest way this happens is that people actually go to see their doctor when they are sick.  Because there’s no cap on visits and no copay and everyone is covered, hardly anyone hesitates to go to the doctor when they need to, which gives them a chance to catch little issues before they become big issues and spot contagious diseases before they spread to the rest of the population.  And here’s another way the focus is on prevention: when I had my babies, the midwives came to my house to check on us every day for the first 10 days after the baby was born, and then the Health Visitor (a community nurse) came to the house once a week for six weeks, and then I could go to her clinic (held once a week in town) for as long as I wanted after that with any concerns I might have (as well as being able to see a doctor — my choice).  It’s all done to ensure the mother and baby are healthy and well, to support breastfeeding, and to catch problems as early as possible.  I was utterly shocked when I found out that most new mums in the US are simply sent home with their babies, with no follow up in the first six weeks, and left to muddle through as best they can!
  • None of this actually tells you anything.  Isolated anecdotal stories (like these) don’t actually give anyone the information they need to decide the merits of one system over another.  All it does is tell you whether my particular doctor was good or bad, whether the nurse I encountered was having a good day or a bad day, whether the receptionist liked her job or hated it.  There are good stories and bad in both systems, and it just depends on who you talk to.  It’s much like public schools. You could ask parents across the US to tell you what they think of their kid’s school and you’d get a whole spectrum of answers: some schools are good, some are bad, some districts are rich, some are poor, some teachers are passionate, some have lost the will to live. But none of these things tells you whether the overall concept of publicly-funded schools is a good or bad one. If you drew your conclusions based on a bunch of stories from a handful of people about their personal experiences, you’d only be getting part of the story. And it’s no different with the concept of public healthcare.

I can sum up my experience of the British and American healthcare systems in one simple sentence:  given a choice between the two systems, I’d choose the NHS in a heartbeat.  And though this is the experience of only one single person out of millions, unlike so much of the propaganda and hysteria surrounding the current healthcare debate, it is the absolute Gospel truth.

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Addendum:  This is an incredibly important issue with a lot of misinformation flying about.  If you have experience of both the US and UK healthcare systems, I invite you to please leave a comment here and let us all know what you think of both systems.  This debate needs more voices of experience and a lot less uninformed fear.

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I’ve come to an uncomfortable conclusion.  It turns out that… well… I’m quite boring.  I always had some suspicions  of this but I’d had enough social success to be able to brush those concerns under a convenient nearby carpet.  But just lately, that’s not worked and I’ve got to admit what I’m quickly realising to be true: I’m just not that interesting to talk to.

The problem starts with the fact that I am naturally very introverted.  And while I’m perfectly fine with old friends and people I’ve gotten comfortable with, I become only more introverted when I am in social situations which are new or unfamiliar — and that’s pretty much what they all are after you’ve just up and moved to another country.  So, being outgoing and interesting under those circumstances was always going to be a challenge for me, but… well, I thought I could get past that.  After all, I’ve moved before.  Hell, I’ve moved countries before!

Y’know, I used to have interesting things to talk about.  I used to know what’s going on in the world, have opinions, have angles on stuff.  Now… I’m a stay-at-home mum to two kids, one with allergies that have severely shrunk our social options, and I spend most of my week cleaning messes, keeping the household running, and interacting with only two other adults — one of whom is so exhausted at the end of the day that he’s often asleep within 30 minutes of finishing dinner.

And so, when I finally break free and get the opportunity to out for a while in the company of Other People, I  suddenly find that I just don’t have that much of interest to talk about.  My daughters dominate my conversation in much the same way they dominate my life, and I find myself going on and on about them regardless of whether my listeners are likely to be interested.  And then, without realising it, I find I’ve turned the conversation to the allergies because… well, they overshadow my day-t0-day  life so much that it’s as if my mind can’t shake free from them even for a few minutes.  Is the other person interested in the difficulties of avoiding our laundry list of allergens?  Probably not at all, but still I can’t seem to stop myself, even as it begins to dawn on me that I’m boring my listeners.

And so I abruptly try to change subjects but, to my dismay, I realise the cupboard is bare.  As I stand there trying to think of something — anything — to talk about, I draw a complete blank.  I’ve nothing to offer.  Even turning the conversation toward the other person and asking questions instead — that time-honoured short cut to being a good conversationalist — can only go so far before it starts to feel a bit stalker-ish.

And then I’m done for.  I’m outta tricks.  And one of two things happens: either the conversation grinds to an uncomfortable halt and we both start looking around for someone else to slink away to or… or…  I suddenly try to save the situation by overcompensating and going back to my standard subjects (the girls, allergies) and just running wild with it, talking a mile a minute, trying to fill up the air with words and words and words.  It’s not good.

One more thing: I’ve realised I’m just out of step with the whole rhythm of social conversation over here.  The rules I follow are British (specifically rural working-class British) and they just don’t work here.  What is PC there is most certainly not PC here.  What comes quite naturally out my mouth doesn’t work at all — it’s all too risqué or too straight or too lewd or too dour.  So I fall back on humour — a last ditch, gut reaction attempt to save a dying situation — and being humour with that extra u, I find to my horror that what seems hilarious to me suddenly falls completely flat.  I go home berating myself.  Why did I say that?  Why did I open my mouth? And what happened to all the stuff I used to talk about?

And when did I become so boring?!?

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I love bluegrass.  And of course I can listen to bluegrass anywhere but it only feels right when I listen to it here, here in its home territory.  Bluegrass needs to set against the backwoods of America in order to really blossom into what it’s fully meant to be.  I’ve listened to bluegrass many times in the UK — either caught by chance on the radio or one of my CDs — and, though it always sounded lovely, it never was more than a shadow of its true self.  A little like  hanging an Italian Renaissance painting on the wall of a log cabin.  No… wait… more the other way round…  maybe like spreading an handmade calico quilt over a bed in a some swanky, modern, high-end New York hotel.  It’s still beautiful, but its beauty suffers for being in a place where it just doesn’t fit.

We listened to bluegrass on the radio on the way home tonight, driving down country roads with the windows open on a muggy evening that came at the close of a perfect, lazy, summer Sunday.  M has never appreciated bluegrass properly, but then he has never experienced it where it ought to be.  He still doesn’t quite get it really, but driving along tonight, with the warm air running over our skin and the girls falling asleep exhausted in the back, I think he started to.  A little.

I love bluegrass.  I love country music.  I love hot, muggy summer evenings that smell of the promise of a cool night to come.  I love storms, real storms — powerful, scary storms full of threats they can fulfill, if it turns that way.  I love diners, and oversized plates of good plain grub, with lots of needless melted cheese and served with endless refills of coffee — even though I can’t eat at them anymore.  I love closets…  forced-air heat… garbage disposals… mixer-taps.  I love country roads, yellow schoolbusses, and the possibility that there’s bear in them thar woods… because those woods go on for miles and miles.  I love fireflies, chipmunks.  I love hummingbirds — hummingbirds! — right there at the feeder on the backporch, whizzing past my head to get to it and scaring me to death with the sudden buzz of their wings.  And I love the backporch too, and sitting on the porchswing at the end of the day, and having dinner outside and a slow beer, as the girls run off the last of their energy with the neighbour kids, and I sit wrapped in that heavy, warm, still summer air.

M is in the wrong place — like the quilt, like the painting.  He doesn’t fit, and he is diminished by it.  And I’m not in the right place either, because I don’t belong here anymore — there is too much of me that is left in England and the separation hurts, every day.

And yet, at the same time, I do belong here — deeply, deeply belong here.  All these things I love… they are my childhood, they are my formation.  They are what made me who I am and, when I am in Britain, I am diminished no less by the separation from them too.

“Let’s face it,” M said at one point as we drove, “we’re not going to get back for at least five years.  There’s no way we’ll manage it sooner.”  I don’t like it, but I do think he’s right.  It’s a huge undertaking, an self-funded international move, especially with a family in tow.

“I know,” I said.  We drove on, and after a minute or two, I added, “But I am glad that you’ve been here.”  Because as crazy and as difficult and as exciting as the past year has been, what it’s really been is an education for him — a crash course on the subject of his own wife.  He knew me before, but he knows me so much better now.

He turned and looked outside for a moment, at the quintessentially American summer evening as it rushed past us, and the muggy air blew cool and fresh through the windows.

“Yeah…”  He looked back at me and smiled just a little.  “Me too.”

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I walked out onto the front porch tonight, just for a moment, as the sun was setting.  It had been a hot and sweaty day, with the kind of direct bright sunshine that I’ve never liked, but the evening had begun to mellow all that.  And though it had threatened rain all day, it never come true on the promise, and yet the smell of  an impending storm hung in the air.

I was only dashing out for a moment to grab something that had been left outside — the children still needed to be fed and bathed and put to bed — but I found myself paused there on the porch.  It was just too seductive — so balmy, and quiet, the sunset golden pink…  I didn’t want to leave it.  It was utterly enchanting.

I have always loved English summers, with their cool freshness, their faint mildewy-ness, the warmish days and chilly evenings.  But they were all the forgotten — the last 15 years melted away — as I was transported to back to the summers I grew up with.  And I stood unmoving, frozen in place for a few moments, to drink it in.

English summers are blues and greens, gentle, and tender.  American summers are dusty golden yellow, harsh, and brash.

And beautiful, beautiful…   beautiful.

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I hit a real milestone in our repatting adventure the other day, one I wasn’t expecting at all.  Indeed, I hadn’t even given it a thought before.

Growing up in the US with an English mother, I was used to way people treated her because of her accent.  In shops, salespeople would sometimes just follow her about, ignoring other customers and hanging on every word she said — sometimes she appreciated the personal service, sometimes she disliked the intrusion.  A realtor once took her to see a $1million house, under the mistaken impression that we must be loaded just because she sounded posh to him.  And often, people would reply to her in an attempted English accent — I always noticed her slight flinch, but I never really understood it.  To me, their attempts were charming, flattering, funny, and usually, I thought, pretty good.

When I moved to the UK all those years ago, I had a perfectly American accent.  In reality, if you listened very closely, you’d be able to hear a tell-tale lilt that revealed there was something different in my background, but most people didn’t catch it.  Certainly the Brits I lived and worked with didn’t — to them, my accent was as American as apple pie and Chevrolet.

And, apparently, my accent was just too tempting as well — at least once a week, and sometimes more often, someone tried to imitate me.  I’d say something perfectly innocuous and what I’d hear back would come as a complete shock.  What were they saying?  What were they doing?  That strange sound!…  OH! It’s… it’s… it’s supposed to be me?!?  This is what they think I sound like?!?!?

And I’d smile… or wince — I was never quite sure which expression my face pulled — but no matter how I looked outwardly, on the inside I was always cringing.  They never, ever got it right.  No matter how many attempts at an American accent I endured, week after week, year after year, not one of them was anywhere near as good as the imitator thought it was, and every one was painful to hear.  Ah… at last, I understood why my mother’s face always registered that barely noticeable flinch.

But now, we are back home and I should blend smoothly back into the crowd.  Except that after years and years abroad, I don’t sound so very apple pie any more — most Americans, in fact, hear my now mixed accent and assume that I am a Brit born and bred.  It’s confusing to them — and amusing to me — when I explain that, actually, I was born just down the road.

So I should have been expecting it, but I wasn’t.  I was chatting away quite cordially with my neighbour yesterday when her voice suddenly jacked up an octave and she began speaking peculiarly, mangling her vowels and sounding a bit like the Queen being strangled.  For a moment, I didn’t get it.  And then she did it again, and I realised… she was trying to imitate me! And it was awful… awful.  That familiar feeling came over me, and I cringed inside.  But I tried very, very hard to be smiley on the outside while I quickly brought the conversation to a close.

And as I took the girls’ hands and walked back to the house I realised with a sigh that I’d reached, again, that most dubious of expat milestones.  And then I realised with surprise that I’d one-upped my mum… Oh, lucky me — I get it from both sides now!

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