On Being Ill in America

Amongst the initial differences I experienced when moving from England to Texas in 2011 was the food; not major differences, but small variations from what I knew. For a start, it's a great deal easier to eat out in San Antonio than it ever was in either London or Coventry. There seems a greater variety of places at which to eat, the average meal tends to be considerably cheaper, and the chances of finding anything genuinely disgusting on one's plate appears greatly reduced.

Shopping for ingredients with which to cook for my wife and myself is also a quite different experience. I'd been told that you simply can't get decent cheese or bread in the United States - to name but two from the list - which isn't strictly true. It's more the case that it's easier to buy tasteless cheese or unpleasantly sweet, mushy bread over here than it was in England, so I take care and shop around; and it's probably worth noting that here in San Antonio I am able to buy a wide range of weird and wonderful Mexican cheeses, none of which I could ever find in London, not even in the most balls-achingly pretentious delicatessens of East Dulwich. I also have to be careful about what milk I buy, because I find that the ubiquitous Oak Farms brand tastes like ass in both tea and coffee.

True to the received wisdom, there are indeed some things I simply can't get without a serious headache, or in a few cases, at all. Lamb is unpopular here for some reason, and the few stores carrying liver paté only seem to carry a fairly unpleasant brand, prompting me to make my own. I've found a place which sells Argentinian black puddings, which are delicious, although my wife views them with extreme suspicion so they have become a rare treat because when I cook, I tend to cook for the both of us.

I've acclimatised to the bacon, which is uniformly streaky. Ordering what was described as an English-style fried breakfast in a local theme pub, I was so surprised to be served what I would term proper bacon that I had the waitress ask the chef about his supplier. It turned out that he had it shipped from North Carolina.

Marmite is freely available, if a bit pricey, although I'm one of those people who quite likes Marmite, despite the mythology. I can take it or leave it, so its availability or otherwise has never troubled me. Pork pies are unknown, and the closest I've come to getting my hands on one has been with an online supplier who would have charged me a few dollars for the pie, but asked for something in the region of $70 shipping - which would be eccentric for something which I eat on average once a year. Then there's fish and chips, but we have a fast-food chain called Long John Silver's which gets it close enough for me to not care about the minor details, paradoxically meaning it's actually a little easier to get decent fish and chips in San Antonio than in London. I miss steak and kidney pie, and will probably have to get around to making my own at some point; and I occasionally crave a proper doner kebab served in pita bread and newspaper with a half pint of chili sauce dribbled across by a bloke who speaks English fine but doesn't feel like doing so, and is probably going to thump the next drunken arsehole who calls him Stavros.

So, there is the minor inconvenience of a few items I can't get or can only get with some difficulty, balanced against all of that which is available here but which I would be unable to find in England - decent Mexican restaurants, Jim's diner, chicken fried steak, and so on and so forth; but it's a minor inconvenience and only a fucking idiot would move to a different country with an expectation of everything being exactly the same as it was in the one he's just left.

There is a purported truism of the American diet being generally overly reliant on salt, sugar, fat, and everything that's bad for you; and that this explains why everyone in America is fat, and they all carry guns, and they all believe that the Earth is only six-hundred years old and that the capital city of France is Poland or one of those places, and they're all in the Klu Klux Klan, even the black people and the Mexicans...

Being as I had no plans to base my diet around the nearest branch of McDonalds - a chain which has a much lower profile over here than English people seem to realise, possibly due to the stiff competition of rival chains serving meals which more closely resemble actual food - and as I never intended to sit on my arse watching Jerry Springer for ten hours a day, I assumed this wouldn't be a problem; and it hasn't been a problem. I've filled out a little, but then I'm nearly fifty and I no longer smoke, so it would be stranger had I remained the same size. Nevertheless, I've had some sort of trouble with indigestion over the last couple of years, something which comes and goes, which hasn't been so bad as to keep me awake at night but which has left me tired and uncomfortable some mornings. The condition was so infrequent that I assumed it to be just one of those things, something unidentified which had disagreed with me as can happen from time to time. Occasionally the discomfort was with me almost every morning for a couple of weeks running, but still nothing so definite as to inspire concern; and even more occasionally I would worry that I simply wasn't built to digest American food or that I was developing some sort of allergy.

Finally, a couple of Saturdays ago, whatever it was came back with such force as to make me doubt it could really be anything so innocuous as an undigested taco. It wasn't quite pain, but it was certainly unpleasant. Now beginning to worry, my wife went out to pick up Pepto-Bismol from Walgreens predicated on the idea of my simply having terrible indigestion. I sat at the computer, looking at pictures of cats on facebook as I awaited her return. After about thirty minutes, beginning to wonder where she had got to, I stood and realised that I couldn't stand because I was now in serious and unambiguous pain, and I knew that I could no longer put off taking whatever I had to the doctor.

Had I still been living in England, I would almost certainly have wandered down the road to the medical centre to get myself checked out some time before, but the process appeared less straightforward in America and I'd been hoping to avoid it.

The popular model of England as home to a wonderful free health service whilst Americans have to pay for everything isn't quite true, or at least it's a gross oversimplification. For example, in England I was unable to get free dental treatment through the NHS, and lacking either health insurance or a means of paying for the sort of treatment I needed, I was pretty much screwed until I came here; and I've experienced fairly shabby treatment at the hands of the NHS in respect to other medical problems. None of this has really been the fault of the NHS, or of socialism - as some of my more moronic adopted countrymen would have it, apparently without feeling any strong need to actually understand what the fuck they're talking about. Rather it is directly the fault of those forces which would prefer that healthcare in the United Kingdom were more like the American system. Cutting funding and thus disabling the system whilst pointing out that the system is disabled and therefore needs to be scrapped in favour of something else is the act of someone who shouldn't be left alone in charge of a pan of hot water, let alone be allowed near any sort of office; but that's politicians for you, and it's not like they're any better over this side of the pond.

Contrary to received wisdom, if you happen to come a cropper in America, there are places you can go without having to worry about the expense or health insurance, namely the military hospitals. I had been told these are places you would not wish to find yourself in the event of an emergency, waiting rooms creaking with coughing and spluttering characters from a New Yorker cartoon patiently waiting for somebody to come along and sew a severed head back in place, impromptu surgery performed with rusty cutlery in the corridor and so on; but Bess and I visited her late father in a military hospital after his last stroke. Regrettably he didn't come back from this one, which has been tough all around, but it was pretty clear that the medical staff did everything within their power, and there was no obvious evidence of underfunding, lack of training, or anyone being overworked. The place appeared clean, efficient, and conspicuously lacking anything I'd been led to expect from the aforementioned horror stories. If anything, the military hospital made King's College  back in Camberwell seem decidedly ropey by comparison, which I suppose might be due to its military credentials, that being one aspect of American social infrastructure which never seems to experience any trouble with funding.

In any case, I'm covered by the health insurance which comes with my wife's job, or at least I'm mostly covered. Thus far I've only had to whip out the magic insurance card for dental treatment, some of which has been pretty expensive. Health insurance covers most of the costs, or in certain cases will meet you half way depending on various esoteric stipulations; so while I haven't necessarily had grounds to live in fear of a huge bill should it turn out that my arse is about to undergo gravitational collapse, it has tended to encourage discretion, meaning you visit the doctor only when it's pretty certain that ibuprofen and a nap isn't going to help.

Something is throbbing in my lower gut. It is painful and obviously sufficiently so to justify medical attention. I call Bess, getting through after the usual round of swearing at the phone, my wife's messaging system, and the button which somehow served to turn the fucking thing off because the battery was low whilst I was trying to get to the text message function, which is apparently how these things work. Eventually I get through, and at least save my wife the cost of a bottle of Pepto-Bismol. She is home within minutes and rushes me to the emergency clinic on Broadway.

I sit groaning in the waiting room clutching my stomach for a couple of minutes, taking care to sit in such a way as to avoid exposing myself to other patients. I'm still in my dressing gown. I had been in too much pain to face the suddenly gargantuan task of dressing myself. My wife fills in the forms, copying down numbers from my insurance, social security, and green cards whilst I distract myself with People magazine, reading up on the royal family and Kim Kardashian's stepfather who is, I suppose, now Kim Kardashian's  stepmother.

We are ushered into a cubicle by a nurse who asks, 'what seems to be the problem?'

'It began about two years ago,' I begin, describing a career of suspected  poor digestion, eventually swinging around to the statistics of the pain. I hear myself embarking upon a detailed monologue describing that morning's bowel movement, and how it hadn't really seemed to represent anything out of the ordinary.

'He has stomach pains,' my wife interjects.

The nurse chuckles, a little embarrassed, still writing on her clipboard, and I realise this was all she had really needed to hear. Through the haze of my discomfort I have effected full transformation into Mrs. Brady, Old Lady from Viz comic. It's me back body, doctor. I've been getting dizzy spells when I pass water ever since 1947, and as for me number twos - oh my goodness...

We wait another minute and the doctor arrives, an amiable man who begins to prod my stomach, seeking to locate the source of the pain. 'So where are you from?'

It always strikes me as a peculiar question, but apparently the Texan ear has difficulty distinguishing between English and Australian accents to the point that I've had conversations in which people have made references to tinnies and down under before I've set them straight. 'I'm from England,' I tell him.

'Whereabouts in England?'

'London,' I say, because as a default point of origin its easier than listing the places I lived prior to London. Sometimes I'll say Stratford-upon-Avon because that was the nearest large town to where I lived when I was growing up, and everyone has heard of Stratford-upon-Avon.

'So you're in some pain here?'

'Yes.'

'So painful you couldn't put on a pair of pants?' He seems amused by this, the fact that I have arrived in just a dressing gown and slippers.

'It's because I'm English, and we're related to the Scots, and you know that whole thing with the kilt...'

He laughs, then tells me that I almost certainly have something called diverticulitis. The pain is in the wrong place for it to be anything else, and my urine sample shows no evidence of kidney stones. Diverticulitis is the infection and inflammation of small pockets which develop in the wall of the intestine as a matter of course in later life. The problem is usually brought on by tiny particles of food becoming trapped within these pockets, and my doctor lists sesame seeds, broccoli, and - oddly I think - Brussels sprouts as the most common culprits. The previous evening Bess and I each had a burger at Jim's, and the buns were of course covered in sesame seeds. The evening before that I had prepared salmon with broccoli, and on Wednesday it had been a roast dinner including Brussels sprouts. I've ticked all the boxes.

I have a prescription for antibiotics and codeine, and before I leave am given a preliminary injection of a painkiller. I am specifically given the injection in the arse, which is a first for me. I'm not sure I even realised it was a thing, something occurring outside of sixties comedy films in which Kenneth William bends over and pulls that face whilst Hattie Jaques stands behind with a cruel smile and a hypodermic syringe the size of a bicycle pump.

For three days I'm on a diet of clear liquids only, meaning just iced tea and broth. It's a bit boring, but the pain has gone and in any case my appetite is greatly reduced. This is followed with a month on a low-fibre diet, meaning no seeds, broccoli, or Brussels sprouts, and I'm going to have to peel potatoes before I cook them. This will be followed with the resumption of a high-fibre diet which will apparently somehow, cure the condition. It's awkward, but not as awkward as a nut allergy would have been, or any of the other conditions I've worried over these past couple of years. I speak to my mother on the phone and it turns out that both she and her father before her have suffered from diverticulitis. There was probably a certain degree of inevitability to my getting it too. I'm just glad it was nothing worse.