Where to begin…
With a sequence of events not entirely unlike a roller coaster ride–the kind you wait in line nearly half a day to ride and get off feeling sick, exhilarated, and thankful to be alive–it’s hard to know exactly how to begin to tell the story of the last two and a half days. This may eventually make its way into the draft copy of that book I told you about.
Monday there were yummy (vegan) Gingerbread Cupcakes with Lemony Icing.
I had an interview on Tuesday morning with the CEO of a dynamic and specialized medical company looking for a Clinic Coordinator. The long term goals of the organization are quite inspiring and I was honored to have made it to their short list. However, I think our recent relocation may have given them the idea that I may not offer them the longevity they are hoping to find in the right candidate, raising a tiny red flag. Although I can’t make any promises about what the next five years hold for us, this opportunity would be a dream for someone looking for career advancement in my field– and in related fields. There are quite a few potential leads in the wings at the moment, but I am intrigued at the challenges presented for this Clinic Coordinator as well being very impressed with the clarity of the plan. The environment is small and manageable enough still that there should be a moment to get acquainted with the role before the expansion and growth begins. There is a bright future for them, regardless what they decide about me.
There are several other opportunities in the wings that are more closely in line with the work I was doing when I left the states. Unfortunately, I will probably not know anything about those opportunities until January as most employers during this season are just lining applicants up for hiring at that time, when teams have returned from holidays. I do find it a bit strange that my previous employer has not contacted me since I arrived in the UK, though I did make sure to pass along my contact information and I had received such positive feedback from the team here. It seems I was more starry-eyed about them than they were about me.
Headsick and hopeful, I left my interview to get you some photos of Carnaby Street. It’s a fun little pedestrianized shopping street near Oxford Street Tube Station where big Macy’s-Day-Parade-like snowman balloons hang in the air above your head as you wander along shopping.
Wow, snowmen and tea shop window displays do wonders for that part of my head that almost never stops asking questions that keep me awake at night.
You know what else eases my mind? Modern dance done well. I know that seems like quite the non sequitur, but stay with me here. It has always been my view that Drew could appreciate modern dance if we were to identify a choreographer that had something in common with him. Tuesday night I had the chance to find my answer.
When Drew was offered tickets to Matthew Bourne’s Edward Scissorhands at the Sadler Wells Theatre in our neighborhood I was thrilled. It is essentially a contemporary ballet (which relies heavily on movement as a theatrical tool as well for its purely enjoyable aesthetics). The show is a must see for contemporary theatre, Danny Elfman, and dance lovers. Though the story took a slight departure from the film, it was still an incredibly staged adaption ending in [SPOILER ALERT] snow for the audience, too. I much appreciate the live orchestra and superb company of dance/actors as well as the talent and vision of the team who put the show together. Wow. Even Drew was really impressed and dance is not normally his favorite thing. Dang, Gina. I wonder if there are any dance classes in the area for old, out of shape, degree holding dance minors who can sizzle like bacon and rise like smoke from an invisible fire…
And this is where the story starts to get really personal. It’s hard sometimes to decide what details to share with the world. I am quite aware that my potential employer might be the type that Googles every candidate and well aware that my former students cannot be kept from reading something publicly available on the world wide web. With all of that said, you know that I do give great consideration to the content of our blog and that I make every effort to ensure every embarrassing and/or personal divulgence is relevant to some worthwhile point. I talk too much.
There is such a thing as being too eager. I am suspicious that this eagerness is often the catalyst for the weird situations in which I find myself. Wednesday morning I nervously rushed around to be sure that I had everything I needed for my first appointment at a clinic here in the UK: plenty of water in my body, passport, National Insurance number on my welcome letter, my pap smear results from my April exam back in the states, and a vile of urine.
Drew, my sister, and I went through a lot of trouble to get those stinkin’ lab results from my physician before we left the states because I had done research on the subject; my sources strongly advised having original medical and dental records upon arrival in your new country of residence. Besides, it is programmed in my thinking that you cannot get a prescription for birth control without those yearly exams and I intended to avoid an unnecessary exam if at all possible. Ladies, are you with me?
(If you really don’t want to get to know me personally, skip the next paragraph or several. If you can talk about medical things that happen and apply to us all (or the women in your life, for the gentlemen) without thinking about the fact that it’s me in this story, read on. But be forewarned.)
As for the urine sample, picture this: I have taped aluminum foil around the specimen cup to avoid getting the label wet. Like a ten year old with a science project, I have also constructed an aluminum foil funnel that I am also seriously considering using. This is the only time I have ever stopped to consider the convenience of being a boy. Anyway, due to lack of time and planning I decided to forego the funnel. My brain may have stopped functioning for a few fractions of a second when I got creeped out by having my hand dangling in the toilet; instinct told me to stand up a little and try to look to see if I was about to accidentally put the cup in the water. You know what they say about stopping mid-stream. Fun times. As a side note, I have a legitimate reason for being freaked out by the whole peeing in a cup scenario, but that’s another story for another day.
So, I jaunt off to my appointments with all my documents and urine sample in cup in a baggie in another baggie in my purse. I am supposed to see the doctor at 10:20a and the nurse at 10:40a. A little weird to see the doctor before the nurse, but no one else seems to think it is weird, so why should I? On my way to the clinic I went over in my head all of the ways in which I could be discovered carrying urine in my purse. What if a cyclist mowed me down and the nurses in the emergency room had to go through my things to get my ID before I regained consciousness? What if I fainted and someone wanted to see if I had a cell phone to call an ambulance? What if I stopped to buy a bottle of water on my way to the clinic and the clerk saw what was sitting next to my wallet? I can’t believe this is a normal practice here. Weirdos.
I arrived at the clinic just prior to my appointment and waited my turn to speak with the receptionist. When she was free, I gave her my name. She greeted me as if she expected to see me and I was very impressed. I handed her the paperwork I had brought with me and asked if that could be added to my chart. She took it, said yes, and went back to her computer screen so I took a seat amongst the other waiting patients. It was weird to walk away without marking on a sign-in sheet, getting out an insurance card, or paying a co-pay.
The environment was very different from the private practice offices I am used to, but similar to the clinic I remember on my university campus. When it is your turn to be seen, your name and room number pop up on an announcement screen. A loud beep sounds each time a patient is directed to a treatment room so that everyone knows to check the screen. Moms sat with children and cute little old people nodded off in their chairs. There were also a few young-ish people reading magazines while they waited. Everyone seemed to get pretty comfortable in their chair before they were called back, but I didn’t notice any really long wait times, except for me. At 11:30 my heart was pounding. I was afraid there has been a mistake and I was keen to get it straightened out; I preferred to straighten it out like a normal person and avoid being perceived as a self-absorbed American, but I was slightly concerned because I know that missing an appointment can result in being removed from a practice’s treatment list and I wanted my first appointment to go smoothly. In my two encounters with this receptionist she has been impersonal, if not rude. I finally ended up approaching her. She motioned for me to talk to her even though she has just said hello to someone she called on the phone.
Me: Hi, I am really sorry to bother you. I have been waiting for over an hour for my appointment and I just want to make sure this is normal.
Receptionist (with the phone to her ear, apparently on hold): What time is your appointment?
Me: I had a 10:20 appointment with the doctor and a 10:40 with the nurse.
Receptionist: You didn’t sign in.
Me: I’m sorry. I thought all I needed to do was give you my name, which I did when I first arrived.
Receptionist: You didn’t tell me you had two appointments.
Me: I didn’t realize it mattered or that you wouldn’t already know that I had two appointments. I just said my name and I thought you knew why I was here and then I asked you if my medical records from my previous doctor could be added to my chart.
Receptionist (with a flash of recognition, a touch of color coming into her face, and sterner, louder tone of voice): You just handed me papers to go in your chart. You didn’t tell me you had an appointment. You have to sign in for your appointments. I am afraid you are not going to seen.
Me (wondering why else I would have been in the clinic if I wasn’t registering or turning up for an appointment): What should I have done to sign in?
Receptionist: You have to come to the counter and give me your name. And you have to sign in.
Me (attempting a sincere tone of curiousity and well intention): What do you mean by “sign in”? Do I have to actually sign something? What part of “signing in” did I fail to do?
Receptionist (apparently the other party on the line is speaking to her now): Hold on.
Big, fat, crocodile tears began to fall uncontrollably down my face. (Don’t get too upset, I am a self-professed crybaby experiencing PMS, it could have happened at any moment anyway.) There was no sobbing, but my face is hot and wet. I was embarrassed that I had somehow missed something after attempting so hard to meld into the system. I was embarrassed that this person had raised her voice at me, had become defensive at my mere request for information, and the fact that she was belittling me at a medium volume in front of her colleagues and a small waiting room crowd. I was embarrassed that I was letting it affect me–and that I was falling apart in front of all of these people–while she took a phone call. When she had hung up and turned her face to me again, I calmly attempted to speak with her again.
Me: I apologize, again. This is my first appointment with a physician in the UK. I understand that I have missed my appointments today and will not be seen, but in future, I do need to know how to sign in.
Receptionist (calmer and in her regular loud voice): You just come to the counter and give me your name and sign in.
Me: Ok. This morning I gave you my name. How do I sign in?
Receptionist: Everything is computerized so when you sign in we let the staff know you are here and they can call you back. When it is your turn your name and room number will come up on the screen in the waiting area and you go to the room indicated.
Me: Ok. How do I sign in?
Receptionist: You give me your name and you sign in.
I was absolutely exasperated at this moment and I took a moment to breathe. I knew that the issue may have been that I am pretty intelligent and that she didn’t know how to explain what I needed to know. We had both made some incorrect assumptions. I got it. She obviously didn’t.
Receptionist: You handed me paperwork; you didn’t say you were here for an appointment.
Me: So, to “sign in”, I need to tell you I am here for an appointment. [Because you don’t know to expect me and have not looked at the day’s schedule. I have worked in a busy medical clinic and our front office staff knew who was on the schedule to be seen that day, even when we had over a 100 patients on the schedule. If they didn’t recognize your face, which was rare, they sure as heck recognized your name as one being on the schedule when you went to the window and gave it to them.]
Being a nice person who could see a miscommunication for what it was, she kindly phoned the nurse and doctor to explain what had happened and arranged for me to be seen.
The nurse was very kind and let me pull myself together before she started taking the necessary vital signs and history. She teared up as she asked me to explain what had gotten me so upset. I gave her the short version of our relocation trials and explained that PMS+last straw+being new to everything at almost 30=occasionally getting overwhelmed. The nurse also explained that people pop in to drop off paperwork or pick up prescriptions. It is quite common that people show up in the office without appointments for other reasons. Note to self. I saw the doctor next. This is your intermission. Take the opportunity to make a bowl of popcorn or warm your coffee. I’ve been working on this entry for about three to four hours already, so we all need a break.
As far as I can tell, no one ever looked at my chart or those lab results I brought that caused all of the confusion. By the time I sat with the doctor I may have been in shock already. These rooms in which I met the nurse and doctor were more like offices than exam rooms. Except, they were more like the offices you met your biology professor in to discuss taking a test early so you could miss class for an out of state trip with this color guard group–that no one understands is really a sports team competing in world class competition, sort of like the Olympics (well, maybe that’s a stretch). I explained that I just wanted to get the birth control and migraine medicine most similar to what I had been taking. I looked around the strange room while she Googled the brand names of my prescriptions. Yes, she did.
What she said next kind of made my head spin. If you have ever felt faint or been on the Tilt-A-Whirl, you know you the sensation I mean. In the UK, migraine sufferers (especially those who are age 35 and/or smokers) are not prescribed combination type birth control pills, which is the most popular type of contraceptive. This is what I had been taking. Apparently, the risk of stroke is something taken very seriously. My natural defenses were lit and I felt offended that she might be implying that American physicians are ignorant or reckless. Of course, I was too dumbstruck to know what to say in response. She said that I could opt to use occasional methods which are widely available at pharmacies over the counter or I could choose between two more effective treatments available through the clinic. The progestogen only pill is an option only slightly less effective with a different set of potential side effects. Equally as effective as this option is the insertion of an intra-uterine device (IUD) which prevents pregnancy without chemicals (though you can opt to have one with hormones for symptom management or as a spermicide). Both of these options holds a new set of risks. I’ll let you do the research you care to do. That part isn’t really what’s important in this story.
I enjoy a healthy dose of drama just as much as the next girl. But this was more than I thought I would be faced with at this juncture. This type of combined-hormone pill therapy was something I chose as a treatment option ten years ago when my doctor recommended it for symptom management. It has been something I have been thankful for as I enjoyed having time to be married without children. And it is something that gave me time to enjoy working with that crazy string of teenagers I love so much (not in the weird Michael Jackson way). I have always looked forward to having kids, but I have also wanted to wait until I had more patience, more wisdom to share, and more love to give to them as a less selfish me. Babies are a thrilling and heartwarming prospect, but it’s not something I want to juggle alongside getting settled–and I need to earn a little money for a while to kick start our plan. Having a baby, though awesome, has more serious consequences than dropping an M&M.
I came expecting the unexpected and I know the challenges are far from over. But I was still caught off guard when our relocation affected me in such a truly personal way. You don’t get more intimate than this. (I have done some research today and I am certain that I already have all of the side effects that any of these options could cause [in less than 3% of subjects studied versus those on placebo].) BTW, if anyone understands why those two people on top of the cliff are holding hands from separate bath tubs at the end of the Cialis commercials, please fill me in.
Before this experience I had no frame of reference to even begin forming questions about it. Now, I am prompted to research things I never thought would be applicable to me. It’s quite funny considering that I have worked in pharmaceutical related industries for ten years and medical related industries for four of those. You would just think that I might have come across this information in my research. Well, maybe not. Not every woman relocating from the states to the UK is a migraine sufferer on combined hormone birth control pills. The IUD is also less commonly used in the states. None of my friends have mentioned it. Is someone holding out on me? Point being, who knew?!
There was no time to sit around and feel sorry for myself for being conflicted about some serious choices ahead of me and having been so fantastically embarrassed. I had an appointment with a genius at the Apple store over 2 miles away. Carrying my computer to the tube station nearest me on the Central Line and getting off in the busiest area of town year round, let alone at Christmas, was probably quite a site for people watching. Dang Gina. By the time I got to the Apple store I was hot and sweaty, but thankful to be somewhere quite familiar. I had an appointment. I was thirty minutes early. It was awesome. Maybe it wasn’t that awesome, but in comparison, I didn’t know that. There were fun people waiting beside me and I had a short conversation with two of them. Then, I discovered that my genius was personable and we ended up having a pretty cool conversation. He asked me out on a double date; he and his fiance are in the process of relocating here from Australia and we have both put in some time in the field of clinical research. Did I just make a friend? (If any technophiles have made it this far, I just need to replace the RAM.)
Later that afternoon, I got my prescriptions filled at my local pharmacy (chemist). A very nice family runs it. My migraine medicine was £7.10 for 6 pills, a year’s worth of the progestogen is free, but I may not need it that long. The jury is still out.
At the end of the day, the two contrasting experiences left me with a sense of being from another planet.
The communication breakdown at the clinic combined with the realization that medical care is structured more differently here than I had imagined started that train of deep thoughts and ranting… It was like I said to the nurse, I will eventually be thankful for the emotionally poignant experience I now have to remind me that there is no shame in admitting you are new to something and that reaching out is worth the difficulty of doing so. I was also reminded that the world is big and that as much I want to be unbiased, I am still displaying stereotypical American traits that are not so desirable. (I am proud and I assume MY WAY is THE WAY.) Maybe the staff at the clinic will appreciate this opportunity to reassess how new patients are handled. Perhaps I have helped them to identify a breakdown in their systems and procedures. If not, I at least modeled an attitude of flexibility and willingness , without looking to place blame, in the midst of a stressful situation.
I don’t think my experience with the receptionist at the medical clinic brings to light issues solely related to the medical community here. There is a culture of impersonality that permeates London. People are not unfriendly, though. I have enjoyed my share of impromptu conversations with strangers. Most of the time I smile at someone, that smile is returned to me. Today I may have made a friend in a busy store. The issue is sheer volume. The number of people conducting business–or just going about their day–in this big wild city have changed the way people interact. It is certainly foreign to me. I am still attempting to enjoy those tiny human connections appreciated in more rural areas through such conventions as customer service. When you hear it said that people in cities like New York, Paris, and London are unfriendly and callous, you should consider that your perceptions are based on societal norms that don’t apply in that place. It’s not a case of Nashville versus Venice; it’s a case of “when in Rome…” As for me, I will continue to smile at strangers and give open-mindedness a jolly good go. I will also bite the bullet more often and ask questions, even when I think I know the answer.
About nine years ago I had a brilliant dance instructor that told me to quit thinking of gravity (or more so the concept of weight) and the floor as obstacles, but to be mindful of them as essential tools for movement. Part of the trick was, of course, learning to properly use the tools. For me, it was one of those concepts that I could only understand at first in bursts of what I describe as being wow-the-universe-is-big moments. Once I was in that moment, I really felt like I was part of the floor and I could work in tandem with gravity. But, it is also knowledge like everything else, that fades in to the recesses when it isn’t being used. That concept, at least, does seem applicable to this situation and quite often in life. Maybe Edward Scissorhands tickets weren’t so random after all. It may have been the reminder I needed that there is no coming to consciousness without pain.