Wednesday, January 23, 2013

Drama at the dog park (or, Humphrey in the dog house)

My daughters' school bus stop is adjacent to the local dog park. It's not a full-time dog park, just a place where people are permitted to run their dogs off-leash between 6 and 9 in the morning. The rest of the time it is a football pitch, a baseball diamond, a basketball court, and a play area... and a footpath, a community garden, and a picnic spot. It's only a few acres, but there isn't much spare land in Cambridge so things need to be multi-functional.

The dog walking community is a strange complex breed. The dogs are, on the whole, fairly similar but there are some weird and wonderful humans hanging onto those dog-less leashes on weekday mornings. We used to watch them from afar, but now we have The Truff we find that we have been welcomed into the community. I know a few of the owners, The Truff plays with a few of the dogs, and Iola tries to sit upon Humphrey. Ahhh, Humphrey - love of Iola's life.

When I was a child, my best friend was a girl called Zoe who had a bloodhound called Blue. I adored them both. We were reading the Famous Five books together at that time and Zoe became George and Blue was, in our minds, Timmy. He was the biggest dog I could ever have imagined: larger than the pony that I rode at the local park. Most things seem bigger in childhood: it's the way that our minds work, but Humphrey is bigger than my remembered Blue. I'm reading the Famous Five books to my own girls now and Iola imagines that Timmy is Humphrey: colossal and kind and willing to be sat upon and mauled at the slightest opportunity. Sadly, not everyone sees Humphrey in the same way.

There is a woman - I am sure that she would prefer that I called her a 'lady' - who visits the dog park with her two dogs. She is often accompanied by her cat. It's a nice cat, but it is very cat-like... it is not, for example, trying to disguise itself as a dog. Which would probably be the wisest course of action if one was a cat and visiting the local dog park during off-leash hours. At the weekend, Humphrey saw the cat doing its cat thing and, being a dog, chased the cat. Unfortunately, Humphrey caught the cat and there was a tussle. The cat escaped uninjured and Humphrey was reprimanded by his owners. The woman was, understandably, very upset.

Yesterday, I bumped into that same cat-walking woman. She was loudly proclaiming to all who would listen that Humphrey was a vicious dog who should be euthanized.
'Humphrey?' I asked, incredulously. 'But he's my daughter's best friend.'
The previous night Iola had been designing a boat which would carry her and Humphrey to Kirrin Island. There isn't space for a lake in our multi-functioning dog park, but Iola has a good imagination.
'Vicious,' spat the woman through a very lady-like mohair scarf.
'What has he done?' I asked.
'Nearly killed my cat.'
'That's terrible,' I said, and I meant every word. We once had a cat called Wide-Eyed Jefferson who was killed by a dog. It was a horrible thing to witness. No-one wants to see that side of a dog's nature. 'Is your cat alright?'
'The dog's owners have paid for me to see three vets and each one thinks that he's alright, but I don't think he is. He's very upset and won't come on walks with me. I'm going to take him to another vet this afternoon.'
I made consoling noises.
'And their dog attacks dogs!'
'Really?' I visualized Humphrey as I had last seen him. The Truff and he were chasing a ball. The Truff wanted the ball more than Humphrey and snatched it from his mouth. Humphrey is three times the size of The Truff. He'd done a kind of doggy-shrug and had come back to play with Iola, who was telling him what kind of picnics they'd share in the summer.
'And he attacks children!'
I don't know the polite way to call someone a liar in company. If we were in a politics in New England it would be acceptable to be offensive and say all kinds of things, but at half past eight in a morning in a dog park... I was, unusually for me, lost for words. 'Are you sure?' I mumbled.
The woman nodded sagely while people all about us looked shocked. 'He attacked a baby in a baby carriage.'
'Well, he took a toddler's hat.'
'So he didn't attack the baby.' I wasn't disagreeing. I was just trying to understand.
'It must have seemed like that to the mother.'
'But he wasn't being vicious? He hasn't attacked any other children?'
The woman bristled in umbrage and a look of confusion moved through the audience. I agreed that it must have been a terrible thing to happen and I agreed that the dog should be better controlled, but I stressed that we shouldn't accuse dogs of viciously attacking children if that wasn't really the case. Quite a few of the local dogs steal mittens and hats and toys - personally, I think it's reprehensible and the dogs should be better trained, but I wouldn't equate the behavior with viciousness.

I take the safety of my children seriously and I take my responsibility as a dog owner seriously, but I was completely unsettled that Humphrey was being accused of being a vicious dog. Not knowing what else to do, I telephoned the Animal Control Administrators. They were pleased to hear from me. The mohaired cat-walking woman had made an allegation that Humphrey was a vicious dangerous dog. There is going to be a formal hearing to decide whether he will need to be euthanized. The mohaired cat-walking woman has made a lot of claims against Humphrey which, in the spirit of transparent bureaucracy, the Animal Control Administrator was willing to share.

I talked to Iola about all of this. I explained that it's not just children who tell fibs. Maya nodded sagely - she's studying diplomatic relations between the US and Syria at the moment and knows that there are far too many grown-ups on both sides who can't manage to tell the truth. Iola thought for a few moment and then compared it to the  man who wanted to be president saying horrible things about the woman who lives down the road (I think she meant Elizabeth Warren, but names aren't that important when you're 6). I told her that I had talked to the 'dog cops' and that they were keen to hear from people who knew Humphrey and who knew that he wasn't a dangerous dog. I couldn't tell  her that it would be ok, because I don't know if it will be, but I told her that we could tell the dog cops the things that we knew to be true about Humphrey. Iola thought long and hard: the kind of thinking that makes you screw up your eyes and wrinkle your nose.

And so, in the ridiculously cold New England temperatures this morning, Iola demanded that we arrive at the dog park half an hour early. She introduced herself to the other dog walkers and she told them that Humphrey was her friend. She told them that if Humphrey had played nicely with their dog, they should call the dog cops and tell them. She told them that Humphrey wasn't nasty to children because, if he was, he wouldn't be her friend. She was extremely articulate and extremely persuasive. Maya stood in the background, keeping an eye on things. She likes mercy missions. As usual, she was taking the side of the underdog.

Thursday, January 17, 2013

Things I have learnt...

We're fifteen months in and the things that seemed strange and exotic and alien when we arrived here, now seem everyday and normal. Ladies and Gents, this is Cambridge.

The advertisements claim that America runs on Dunkin Donuts. This is a lie. America runs on paperwork. The dance of bureaucracy is an essential part of the etiquette of New England society: efficiency and effectiveness are secondary to politeness and paperwork.

Eating and drinking:
Grilled food is barbecued  braised food is grilled, an entree is a main course, and pudding is sloppy because everything else is dessert. Candy is sweeties, cookies are biscuits, biscuits are savory scones, and - errr - scones are something else. You buy your meat and veg in the supermarket, your wine in the liquor store, and everything else in a drug store or TJ Maxx. Coffee is an industry to itself: even the local corner store will have at least 5 types of fresh roasted beans and a machine which lets you grind your beans according to your personal preference.

And a word of caution: following Prohibition, the Massachusetts bureaucrats (forefathers, I am sure, of our own administrators) decided that alcohol content should not be listed on the packaging of alcoholic drinks. Beer ranges in strength from 4.5% to 9%. There is no culture of binge-drinking, no headlines on how the French are better at drinking than us, and no culture of not drinking and driving. Deaths from sclerosis of the liver or bingeing on a Saturday night are rare, deaths from drunken driving are just another column in the local news.

Children climb aboard the big yellow Thomas school  buses from the age of 5. Education is called schooling and there are a huge amount of schools out there. Children attend elementary school from 5-11, then graduate and go to middle school (which is now called Upper School because the administrators decided that this sounded better). At 14 they graduate, and go to high school. Most children graduate from high school at 18 and then go to school (which is just called 'school', to distinguish it presumably from the other variants of school although we would call it university in England). After 4 years of general study at (university) school, the students decide to specialize in a certain field and begin 'grad school'. It seems, therefore, that the youth of America don't need to decide what they want to be until they are at least in their mid-twenties (which is fine by me, as I'm nearly forty and still not quite sure).

And throughout one's schooling there remain plenty of opportunities to change one's mind over what one wants to be. The pediatric surgeon who nearly treated Maya had completed a PhD in Philosophy 2 years previously. He had then decided to go into Medicine because, in his words, it had good prospects. As parents, we felt that the prospect of Maya having two fully functioning legs was more important than the prospect of thinking about having two legs, so we decided to go with a more experienced surgeon. You can make choices like that when you are buying your surgeon.

American children seem to have lots of fun at school. They learn to salute the flag, play basketball, make music, read books, and - in Maya's case - work out a solution for peace in Syria. There are no national standards, no national curricula, and teachers are trusted to be professionals (and have to work for at least five years after qualifying before attaining their 'professional licence' - similar to a realtor really).

Emergency services:
Fireman are sacred, cops are right, and ambulances are privately run. In case of emergency, you call 911 and in a matter of minutes, a fire engine, a cop car and a private ambulance or two will squeal to a halt (the first ambulance on the scene will get the fare). The firemen (always men, though I'm not sure why) are there to assess the situation, the cops are there to make sure that everyone does what the firemen tell them, and the ambulance will sit you down and ask you which hospital you would like to go to, because the fare you will be charged is dependent upon the mileage. If you have a child with you, the cop and the fireman will probably give you a teddy bear. The teddy bear is free.

Cops carry guns and have a massive amount of authority (a fact towards which members of the National Rifle Association openly aspire).

Houses are made from wood, schools are built from breezeblocks, sidewalks are brick. Every street in Cambridge is lined with trees and electricity wires. Local children are taught to never touch fallen wires or branches. Some states have problems with poisonous snakes or crocodiles. In New England, we have problems with electricity.

Recycling is something new. On a Sunday, people put out any things that they don't want any more but which they think might be useful to other people. Depending on who you talk to, this is called 'recycling', 'charity' or 'skip-dipping' and is a tradition of the area. On Monday morning, a few local characters rifle through the recycling bins that have been put out by the kerbs. They will take the bottles to the local supermarket and trade them in for a few cents a piece. This is a tradition of the area. Later in the afternoon, a man and a woman with physiques that you might use to advertise the positive benefits of steroid abuse race their private dustcart along the neighboring roads (imagine a cross between Benny Hill and Action Man). They empty the bins and take the recycling to be recycled elsewhere. This is new and looked upon with suspicion.

Most houses are poorly insulated, it is seen as impractical to cut one's engine because one's car is parked, advertisements boast about new eco-cars which can get as much as 18 mpg, and global warming is accepted as the 'new normal': many people are pleased that they don't need to jet out to Florida anymore to see the winter sun.

Taxes are low, philanthropy is big. My telephone rings each evening with calls from overseas agencies which strive to persuade me to support local charities.

In an attempt to simplify the English language (which isn't, in itself, a necessarily bad thing), complex spellings have been abandoned, most word endings have been dropped, and there is a commitment to phonics which would make a Welshman proud.

Hockey is played on ice; football is played with shoulder pads; church is an outing but baseball is sacred. In New England, sport is a family affair which always begins with a rousing chorus of the national anthem and is filled with Redbones barbecue, live bands, and cheerleaders. It doesn't matter if you don't really know what is going on as most sports have few rules. There is nothing like cricket.

There is a widely held belief that one is only safe in a car.

While it is a legal requirement to stop at cross walks, most drivers find that speeding towards pedestrians means that they get out of one's way. I have been harangued by drivers for putting my children at risk because I have been walking.

There are cycle lanes in Cambridge but they rarely meet up with one another. Car drivers sometimes move out when they pass a cycle, but normally don't. I have been harangued by drivers for putting my children at risk because I have been cycling.

There is a complicated arrangement of buses and an assortment of private subway companies which operate different colored subway lines around the area. Recently, the driver of one of the subway lines accelerated rather than decelerated as he came into the subway station and thirty-seven people had to go to hospital. I have harangued myself for putting my children at risk because of travelling by public transport.

Wherever you live in the city, however, you will see very large trucks squeezing down very small roads. It's just a question of respect, politeness and bloody minded determination. They teach different laws of physics in the schools of America.

Friday, January 11, 2013

The American Medical System from an Englishwoman's perspective

I have always had an aversion to doctors. It's nothing personal. It's just that, given the option, I'd prefer not to have to see them. I avoided hospitals throughout my childhood and through much of my early adulthood. Maya was born at home. And then, a week before Iola was born, my luck changed. I'm still waiting for it to change back.

It began inauspiciously enough with an accident with a shopping trolley in Asda. I was heavily pregnant and not looking where I was going. The trolley ricocheted against a tower of baked beans, sending Heinz's finest scattering about the store, and I damaged my placenta. Cue: daily visits to the hospital for a week before an induced hospital birth for little Iola. I discharged myself the same day (it's hard to avoid doctors when you're on their territory) but we were back within a fortnight with the first of many hospital stays: bronchiolitis; suspected meningitis; more bronchiolitis; chest infections galore; breathing difficulties... We have arrived at Lancaster Royal Infirmary on foot, by car, by taxi, and by blue-flashing light ambulance from the Lake District. Less dramatically, Maya has caused me to visit doctors on nearly every vacation we have ever taken - I've hung about in surgeries in Madeira, Spain, Toronto, Skegness, Scotland, and Ireland with an assortment of eczema outbreaks, asthma attacks, minor accidents, and ear infections. (We've also helicoptered across New Mexico with a crash team on stand-by and the trauma unit waiting for our arrival... but that's a whole different and much less humorous blog).

We knew that the health system in America was going to be different to that we had experienced within the UK and as tourists in different countries. (Of course, our experiences in the UK were over a year ago, and much has changed thanks to the ConDemNation... but again that is a story for someplace other than here). We had hoped, with the blind optimism of the naive, that we might be able to avoid doctors as much as possible. When we looked at health insurance, we chose a mid-range plan, convinced that we wouldn't need more than a couple of doctors' appointments a year. If you have read any of my previous blogs, you will have some idea of the irony of this assumption.

We're fifteen months into our stay in Cambridge and I am gradually becoming competent in navigating the American healthcare system. It's a little like learning to use the A-Z of a city you would never willingly choose to visit.

1. Waiting and waiting rooms.
The worst waiting room system was at our local practice in East London. One could either book an appointment to see a doctor in at least a fortnight's time, or one could arrive, take a seat, and wait. My longest wait in the clinic, accompanied by a 6 month old Maya who had an ear infection, was five and a half hours. It wasn't great. But it was free and the waiting room was always filled with people. It wasn't the best clinic in East London and, from what I have heard, the clinic has been subsequently closed. I don't know where you would have to wait if you were ill in East London now.
Our local American practice runs a different business model. Firstly, you make an appointment. The telephone system works well: someone always answers the phone immediately and you are hardly ever put on hold. You feel that you are important: the telephonist is very polite and does the best that she can do to get you an appointment in the next day or two (this isn't gender neutral: the telephonist is always female). Admittedly, the best doctors book up a year in advance. Seriously. The doctor who is listed as my doctor was listed as one of the top 500 doctors in Boston. I've never met her. When I tried to get an appointment with her it was at 10.05am on  February 5 2014. I'm ok about that: I don't like seeing doctors anyway! But my children's doctor always has space to see them within the next 48 hours.

So, once you've made your appointment, you turn up at the practice at the allocated time. The practice is larger than the average cottage hospital. I suspect that you could spend several days walking around the corridors trying to find out where you need to be. Fortunately, there is a very sweet young man at the front desk who always wears a lovely sweater and a lovely smile. He asks how you are. I've learnt from experience that he isn't really interested in how you are, he's just being polite. He is very good at being polite. He'll ask you to sign a disclaimer, agreeing to pay undisclosed amounts for your child's imminent treatment. He'll take a copy of your insurance card, swipe your credit card, and cross reference the details with those that he has on his computer. He has a lovely smile when he asks if you would like to settle the outstanding amount from your previous three visits. I've found that it's useful to smile back and explain that your partner deals with such things. I'm not sure whether the company has spent a huge amount upon professional development so that he knows never to stop smiling, or whether he was born like that.

When he is satisfied that you have signed in the right place and that you are who you say you are, he'll direct you to the relevant part of the hospital. It's worth listening closely to the directions, or you might get lost. When you arrive at your bit of the building, another receptionist will leap into action. She (and it has always been a she) will ask you how you are but, again, she doesn't really want to know. She's also being polite (perhaps she went on the same training courses as the male receptionist at the front of the building). She'll tell you to take a seat in the empty waiting room, but a nurse (male or female) will arrive before you reach your seat. This is important. The reason why the waiting room is empty is that my clinic knows that waiting rooms are not healthy places to be if they have sick people in them. No-one wants sick people hanging around: they spread diseases (even with the dispenser of free face masks by the door and the hand sanitizer bottles fastened to the wall at 10 foot intervals). The nurse's job is very important: s/he is charged with keeping you out of the waiting room. You will either be sent to a private room where the doctor will see you in the next hour (we now take a bag of books, coloring pencils and a small snack with us whenever we visit the doctors), or s/he will advise you that the doctor is running late. In that case you will be told to get a coffee at the onsite cafe. It's run as a franchise. Having people waiting in a cafe is good business sense.

2. Getting past the nurse hurdle
Before you are allowed to see the doctor - even though you are now sitting in one of the doctor's rooms - you will be tested by the nurse. The nurses are sent on different professional development courses to the receptionist staff: they don't smile as much and they never ask you how you are. As professionals, they don't need to be as polite as the front of house staff. You can expect a little whirlwind of activity as the nurse measures and weighs you, takes your temperature and your blood pressure, and then leaves. The time after his/her departure is often a good time to unpack your snack and make yourself comfortable. It tends to be quite a while before anything else will happen.

3. Seeing the doctor
Eventually, the doctor will arrive. This bit is the same as in England. Same questions, same faces, same answers.

4. Going to the pharmacy
If you have a prescription, you will need to go to the pharmacy to collect this. Make sure that you have your insurance card and your credit card. We tend to go to CVS. It's nice there. You can buy anything from a vacuum cleaner to a winter coat or a bottle of perfume. The pharmacist will smile and ask you how you are... and h/she will be interested in your answer. You can talk to him/her for ages about how you feel, what symptoms you are experiencing, what is worrying you, and your plans for the weekend. They'll seem genuinely interested: perhaps that has been part of their professional development plan. After all, they're the ones who need to make the profit by selling you the drugs.

5. Cutting out the middle man
A lot of the people that I talk to don't go to the doctors anymore. They tell me that they get their advice and treatment from the pharmacist. In terms of the children, I'll continue packing a snack and a coloring book and spending a few half days here and there in a small room at my local doctor's practice... but in terms of my own health, it seems that the American system suits me just fine. It's nothing personal - I just don't like doctors.