This Might Hurt A Little

My room in Missoula’s ER. Clean but comes at a price.

The afternoon of September 10 found me merrily making a Dorset Apple Cake (recipe supplied from D, my baking guru back in London) when I felt a twinge in my bladder. “Hmmmm,” I thought, “I hope I’m not getting cystitis. That would truly suck.”

My Dorset/Montana Apple cake

Over supper that night, the pain and the pressure and the need to go to the loo increased rapidly. I had congratulated myself on bringing my Potter’s Antitis from London, which for the last ten years has worked miracles ‘down there’.

Well, not this time. These Yankee urethra-decimating bacteria are in a whole other league. By midnight I was bleeding so much, and felt so feverish and ill that I rang Missoula’s main hospital. I was in so much pain that when the nurse asked me to rate the pain, I ranked it at 7.5 with childbirth at ten.

“Wow”, she said.

After listing my symptoms, she then gave me four hours to get myself to the hospital as it seemed pretty clear to us both that these bacteria were heading for my kidneys.

J and I woke E and bundled her in the car. I checked in and then J headed back home with E. There I was alone in a new city in the hospital in the middle of the night in pain. What do you do in these situations? You take a few snapshots.

I liked the colours of these…

… and these.

While I waited in my own private room (I know, amazing!) two parallel thoughts kept racing through my brain. On track one was: “This place is so CLEAN and QUIET… where are all the drunk people and junkies and cyclists with bleeding heads you see at the Royal London at 1:00 a.m?” I was almost relieved when a young inebriated woman was brought in to the room next to me. When the doctor asked her to sign the waiver that would allow them to treat her and bill her, she shouted, “How can I sign that f***ing thing when I’m not sober?” So they got the nurse to sign for her. I wondered if this were legal and then thought, yup. This is the American healthcare system. Anything is probably legal.

There were so many empty rooms…. I guess that’s what you are paying for?

Along with all my marvelling at the sparkling floor and the pristine instruments and the shiny bathroom, the other parallel train of thought was chugging along: How much will this all cost?

As someone who has only ever lived in Canada and the UK, I have never in my life had to access health care that needed to paid for in this way. Of course in the UK we pay with our taxes, but it seems a drop in the ocean compared to the sort of bills people get here. I was seen quickly and diagnosed. I was asked if I wanted a pregnancy test to which I relied “No.” Every time I was asked if I wanted anything (a blanket, a blood test, an extra urine culture) I countered with, “How much will that cost?”, to which I was told, “Oh, sorry I have no idea.” So, like any sensible person, I said no to any further tests. I did find out that the bacteria lining my bladder was e coli. But I had to fight to get the information from them for free. The staff were lovely but probably not used to being asked so many questions. I was sent off with antibiotics and painkillers that turned out to be so good, I almost started liking Big Pharma. Almost.

The walk-in clinic. So clean you could eat off the floor… well, almost.

That night was OK but the next few days I felt down and still in pain. The antibiotics hadn’t quite done the job. So what next when you are uninsured? I called around to find out the cheapest way of seeing a doctor. The thing I have learnt on this crash course is that anything to do with hospitals, clinics, doctors, nurses, or treatment is run like a weird secret cabal. No one can tell you how much anything costs until AFTER you’ve had it done. As a guy I met here said, “It is the most expensive and least transparent body in the world”. And he’s right.

It’s also insanely complicated. The names for things sound like double speak. A ‘Health Care Provider’ is a ‘Doctor’. A ‘Provider’ is someone who evaluates and diagnoses patients. A ‘Primary Health Care Provider’ is a ‘GP’. And then there is the whole gamut of insurance names and terms. Some doctors only work with some insurers. Some hospitals only work with some insurers, but are staffed with doctors who work with several insurers. If you’ve been seen in a hospital using one kind of insurance, then you can’t see a doctor who works for a different insurer. Well, you can, sometimes. Ach. I still don’t understand the nuts and bolts of it all except to say that the doctors seem great and the insurance companies seem truly evil, just like Michael Moore said in his film ‘Sicko’.

The poster for Michael Moore’s ‘Sicko’

In short, when it’s the middle of the night and you are bleeding profusely from where you should be peeing, you are sweating, shivering and in pain and someone starts saying things like, “When you get your Primary Health Care Provider, through Gateway or peripheral assessment, any coinsurance or copayments will be organized then. That is unless you have a Group Purchasing Arrangement,” you just want to cry. At least I do. In fact I did.

So the darned infection didn’t clear and after many phone calls, I found out that there are walk-in clinics in Missoula. They are the cheapest option and you pay up front so at least you know what the damage will be. J took me to the nearest one and again it was clean and efficient. I was seen quickly by a doctor. She was nice but again spoke in terms I found impossible to understand. She also offered me a pregnancy test, which I politely refused. She explained that the antibiotics she was prescribing were known to go into breastmilk and no tests have been done on that. I assured her I wasn’t pregnant, thus once again, saving a few bob. I was sent on my way after paying $135.00 for ten minutes with a doctor who dipped a urine sample and wrote out a prescription.

So far I have spent $55.00 on drugs and $135.00 on the walk-in clinic. The bill for my lovely stay in the Emergency Room just arrived to the tune of $610.00. I got a discount of 5% for paying quickly and all in one go. Oh how I long for the NHS.

The second round of antibiotics worked. It was called Levofloxacin. I was loathe to take it as the list of side effects is like something from Monty Python:

1. Confusion
2. Feeling that others can hear your thoughts or control your behavior
3. Seeing, hearing, or feeling things that are not there
4. Sensation of burning on the skin
5. Severe mood or mental changes
6. Trembling
7. Unusual behavior

So, my cystitis seems to be clearing up, but I might be rendered completely insane. I feel there is a metaphor here.

Our Obamacare kicks in October 1^st. J has been trying to sort it out since we first arrived in the US at the end of July. He has spent hours, days, weeks on the phone and on their website. The incompetence has been astonishing, so much so that J keeps saying he is becoming a Republican. My timing was off for getting sick and now we’re paying for it, big time.

Advertisements

Keep Missoula Weird (Not)

They’re selling bumper stickers. When do the coffee mugs and fridge magnets arrive? Or have they already, and I’ve just missed them.

When J was out here in Missoula in February checking out schools and places for us to live, it was dark, dank and cold. He called me one day and said, “Remind me why we chose Missoula?”

I replied, “Because you can’t buy KEEP MISSOULA WEIRD t-shirts, yet.” It was my shorthand for, “Because it isn’t Portland, Austin or Brooklyn”. Our home in East London is basically a clone of these hipster hotspots. There is ample artisanal bread, home-made cheese, men in checkered shirts and facial hair, and children taking ironic banjo lessons around our neighbourhood. Missoula, we thought would be so off the beaten track, that self-knowing kookiness would not prevail.

And we were sort of right.

Missoula does seem to have its share of eccentrics. You do see people buying pet pigs because they are allergic to cats and dogs, as one of my neighbours did recently.

Ruby, the pet pig who lives down the road

But this city, although proud of all that it does right (and it does an awful lot right), lacks that smugness you see in self-proclaimed ‘weird’ places.

For readers who have never been to Montana, it is important to know that Missoula is not Montana. Just like London is not England nor is New York the USA. Missoula is a liberal bubble in a very Republican state. If it needs to be a bit weird in order to stay sane, then that’s fine by me.

Missoula does those famous Big Skies really well               (seen from the deck off my bedroom)

So the Keep Missoula Weird bumper stickers may have arrived, but one thing Missoula is, which I was not expecting, is old-fashioned. In a good way. Not in a “You need to be making pies and darning socks all day, girl, between delivering your own babies”, but in a way that feels at odds with the life I lived in London. For instance: where’s the advertising? E doesn’t ever stand at a bus shelter with a woman’s larger-than-life naked thigh shimmering next to her head. Nor do we walk down the street having to look at American Apparel billboards flashing twelve-year olds – usually open-mouthed and legs akimbo – in their underwear. (American Apparel recently fired CEO Dov Charney – who had several sexual harassment claims made against him – who made out his ads were ‘pushing boundaries’. Yeah, right). The targeting of children to get them to want to look a certain way just doesn’t exist here in an overt way. I wonder if the consuming and the sexualising of girls is inherently bound up with living in a big city?

One of the banned – yet boundary pushing – ads seen in London                                Photo credit: American Apparel

In the month we have been living in our house in Missoula, not one adult has commented on E’s appearance. This is almost unheard of in London where well-meaning adults so often make unwanted comments to little girls about their hair, their clothes, their appearance in general. It is meant well but it does two things: makes girls sensitive and self-conscious about their appearance and makes them value it over their achievements. The emphasis here in Montana, from what I can see, is squarely on what girls can ‘do’ rather than on what they look like. At E’s school, girls play soccer. E is as yet to be convinced about this and still prefers her ballet. Maybe she still sees it as a boy’s game. She won’t say. Hopefully in time, this ungendered Montanan mindset will rub off on her.

Missoula does Babbling Crystal-Clear Brooks really well

And bound up with this lack of bombarding children with reminders of how they should look comes an emphasis here on the outdoors. You would be crazy to play a computer game or watch TV when you could be swimming in the river or cycling through the hills. Montanans are now the thinnest people in the US. I am always struck when I look at photos of children just after World War II. They seem to have a sort of vigorous leanness to them. A leanness you just don’t see anymore in this world of transfats and television. This is exactly what I see when I drop E at school: a wonderfully gangly scrappy bunch of kids with retro physiques.

A cute wolf cub from E’s postcard collection

And then there is the politeness. This also feels very 40s. When E gave a card recently to a 10-year old for her birthday, it was shown around to everyone as if E had just given her the crown jewels. The card was a photo of a wolf cub and the levels of appreciation almost made me cry. How many times have us big-city folk seen the birthday cards chucked to the floor and the recipient of the Gameboy/Barbie/arts and crafts set be utterly disappointed that the toy wasn’t something else? I have seen this dozens of times in my own kitchen (embarrassed cough).

Photo by E of her last birthday cake in London. I don’t remember any tears, but then you block these things out, don’t you?

I cannot help make a link between the appreciation of a simple birthday card with the lack of Bratz dolls and plastic, disposable, sexed-up merchandise which you see at eye-level in every London newsagent’s. Is this similar to the video game debate whereby gamers deny the fact that shooting prostitutes all night on a computer screen makes them no less violent in real life. I don’t feel I have the answer at all. But what I am seeing is so vivid and so ‘in my face’ that I can’t deny the effect Montana is having on E. A lack of advertising and a whole load of physical activity is just a better landscape for children to navigate. You simply can’t deny it.

Our neighbour’s backyard as seen just before school. I know deer are not wanted in cities but I can’t help admire them. Missoula does Fawns, Does and Bucks really well

Perhaps my glasses are rose-tinted. Perhaps come February, I will be asking J, “So why on earth did we choose Missoula?” And who knows what he will say. Maybe he won’t have an answer.

Wolf Watching in Yellowstone

E’s drawing made after wolf watching

On Saturday, J and E and I found ourselves waking up at 4:30 a.m. in a motel room in Gardiner on the edge of Yellowstone National Park. Our friend Ilona, who is a poet, wolf advocate and font of knowledge about all things wild, collected us well before dawn to take us into the park. We drove for an hour along the northern range of the park in pitch black drizzle towards a pack of wolves known to wolf-watchers as the Junction Butte pack.

One of E’s abstract ‘Night’ shots from the car

We stopped where other eager wolfers had set up their scopes. Ilona introduced us to ‘Rick’, the biological technician for the Yellowstone Wolf Project. Rick has spent more than 14 years observing wolf behaviour and pack dynamics and is locally famous for chalking up more than 5,000 consecutive days in the Park watching wolves at dawn and again at dusk. Much of what we know about pack behaviour comes from his observations. He knows these animals intimately. After setting up scopes in two different locations without any sightings, we got lucky the third time.

Wolf watching in the rain: J kneeling with E behind him

We scaled a small hill and set up our scopes in the rain. Ilona had thoughtfully brought a small one for E to look through. After some patient scoping of the landscape and observing a few bison lazily grazing, we managed to spot an alpha female nonchalantly watching five wolf cubs play around her. I wasn’t expecting to have an emotional response to these animals. I had been reading about the reintroduction of wolves to the park in 1995 and about the various points of view surrounding their presence. Ranchers don’t like them. They see them as a threat to livestock. Hunters feel the same. Conservationists see these apex predators as essential to restoring balance to the land.

It has been a wet summer and fungi are sprouting from bison scat

Since their introduction almost fifteen years ago, the debate still rages as to the extent of good and/or harm these wolves effect. With wolves in Yellowstone hunting and killing prey, the elk population has been reduced, thus increasing the growth of young willow trees. These trees provide food and habitats for a lot of animals in the park. By bringing back the apex predator, some scientists and conservationists believe that a balance has been restored. I have also read that another knock-on effect of wolves in the park has been an increase in bear populations. Vegetation has generally improved as a healthier balance of predator and prey is achieved. The doomsayer in me who sees ecology as something that doesn’t move in straight lines, and rarely has a happy ending, sees this issue as one that is so complex that our limited human brains cannot comprehend it. I fear this solution – although wonderful  – is not the full answer. But with conservation in an area where tourism also thrives, there really is no answer. In fact, I am not even sure of the question anymore as we humans have simply meddled too much with our planet.

You can’t see them with the naked eye, but this is where the wolves played, hopefully unaware of our greedy stares

The story of the reintroduction of wolves to Yellowstone is like a reverse fairy tale. It is a story you hear recounted in Montana with pride by some people and with derision by others. But what interests me beyond the facts is the gut reaction people seem to hold for these creatures. Their portrayal as villains in fairy tales, as ravenous beasts, as creatures of the night, as agents of a dark subconscious is one we accept unchallenged. Humans vilify them in a way that feels irrational. I was thinking all this as I watched through Ilona’s scope, these gorgeous animals nipping each other on the ear, diving on top of each other, rolling in the grass the way puppies do. I really was mesmerised. I felt I was watching something forbidden. Their play felt intimate and private – something between them and the land that really I had no place witnessing. But the more I watched, the more I wanted to watch. I started to be able to tell them apart, to see these cubs as individuals. Later that night, I lay in bed glad that these wolves were there in the wild, protected, mostly unseen and yet living and breathing all around me. And as I fell asleep I couldn’t help feel that we need them, and I wished that they didn’t need us for their survival.

Mammoth Hot Springs in Yellowstone

After our wolf watching expedition, Ilona took us to another part of the northern range of Yellowstone: the Mammoth Hot Springs. Geothermal activity here has created a landscape that made me think of Cormac McCarthy’s ‘The Road’. It is apocalyptic. All sense of scale disappears as trees are buried in growing deposits of calcium carbonate, and hot gases make their way upwards from a deep magma pool under the park – a remnant of the super volcano that created some of this landscape – to form boiling acidic pools. Being here is like watching nature make a hot, toxic sculpture.

The Liberty Cap, a 37-foot tall limestone and calcium ‘tower’

After our time in Yellowstone, J and E and I drove to Livingston, a small town on the banks of the Yellowstone River, surrounded by three mountain ranges: the Crazy, Absaroka and Bridger mountains. It looks like something from a Sam Peckinpah film. Which is no coincidence as he lived in a suite (now called the Peckinpah suite) in the Murray Hotel in downtown Livingston toward the end of his life.

Sam Peckinpah’s home: the Murray Hotel in Livingston, Montana

More recently Livingston is the home of the writer Walter Kirn, whose book “Blood Will Out” I happen to be reading at the moment. It is a true-crime piece of non-fiction about Kirn’s relationship to the murderer and fraudster ‘Clark Rockefeller’ which is completely gripping. Kirn’s prose is addictive. Although it has only 7,000 inhabitants, Livingston has an amazing bookstore. We accidentally met the owner at supper one night as we asked him (not knowing who he was) if he could move his hat so we could sit down. Which, this being Montana, he did with grace and charm. The next day when we went into Elk River Books, where I bought a copy of the Whitefish Review (this one edited by Rick Bass, another local writer and activist), the owner of the bookshop recognised us as the people who had asked him to move his hat. He had just printed out the final page of his 220-page memoir/travelogue which sounded like a pretty amazing piece of work. Yet more intense chat about writing and publishing. It feels as if Montana is bursting with writers who are having conversations I want to be part of. The town is also incredibly beautiful with that light that comes at you from miles away across a huge sky. Like a snowball, the light seems to increase and gather speed as it travels. And Livingston, like so many places in Montana, is a sign-lover’s dream (yes, I hold my hands up high).

Livingston’s main street

Our motel in Livingston was an odd place run by the husband and wife team of John and Tillie Lamey. Tillie is a keen wildlife photographer and her work is displayed all over the motel as obsessively as any outsider artist’s environment. The motel is great, but I did have reservations about a series of photos they took of a grizzly called Adam lying in bed asking for morning coffee, standing by the sign reading “Pets Welcome” and leaning at the counter waiting to check you in. I asked about this series of photos and John told me how they have friends who work with wild animals for film shoots. These friends decided it would be fun to let Adam loose in the motel in order to photograph him, for laughs. Those of you who get wobbly at the sight of wild animals being tamed for the sake of human folly, look away now:

Postcard from the Livingston Inn where ‘Adam’ the grizzly was photographed in various poses throughout the motel

E and John Tillie at the Livingston Inn

The Livingston Inn, Livingston, Montana

On our way from Livingston back to Missoula, we decided to make one stop in Drummond, Montana, home to the self-taught artist Bill Ohrmann. He is 95 now and began life as a cattle rancher. He has only been painting since his early eighties and stopped just over a year ago as his eyesight is beginning to fail. His work is a searing indictment to human folly, to organised religion, to corrupt politicians, to the rape of the planet, to the mistreatment of indigenous people. He would hate the thought of a grizzly watching TV on a motel bed, which is part of the wonder of places like Montana: the extreme contrasts. Right next to Bill Ohrmann’s home is a museum dedicated to his work. We pitched up on a slightly overcast day and as we pulled up, a woman came sprinting out of his house with keys in hand. This turned out to be Bill’s wife Phyllis who was utterly beautiful, kind and charming.

Artist Bill Orhmann’s wonderful wife Phyllis

The creed on the front door of Bill Ohrmann’s Museum

One of Bill Ohrmann’s sculptures overlooks the seemingly endless landscape near Drummond, Montana

We spent a long time looking at Bill’s work. Sadly he is too frail now to greet visitors. But we chatted to Phyllis for some time and talked about his life as an artist and his life as a rancher. E was fascinated by the paintings and her attention was rewarded with Phyllis giving her a reproduction of one of Bill’s paintings of the original Eve.

A sign on the road back to Missoula

We headed back to Missoula for dinner with some new Missoula friends who had kindly organised a meal in order to introduce us to more Missoulians. Our day ended in the Lower Rattlesnake area of town, eating wonderful food and drinking wine under the stars with an absolutely amazing bunch of people. I was feeling overwhelmed by this point and also quite tired from our early start the day before. Montana is so vibrant and full of contrasts and contradictions constantly at play. It feels as if every corner brings up a dilemma requiring one to think about land and about its conservation and about our relationship to wild animals who are protected in parks and yet only a few miles way are paraded around the halls of motels for ‘fun’ photo shoots. And in amongst all this are some incredible people who are letting me get a glimpse into places and ideas I never even knew existed.

A back alley in Livingston, Montana

PS: In reading about wolves, I have come across a book by Emma Marris called Rambunctious Garden: Saving Nature in a Post-Wild World. Note to self: Sounds like something I should get my hands on.