An American in the UK National Health Service

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An American in the UK National Health Service

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It had been a stressful few weeks, with far more than the usual amount of fuckery and frantic frenzy, and I arrived in Liverpool last Friday on a total of about 4 hours of sleep in two days. Walking around the Liverpool One area shortly after dropping off my bags, heading towards the Tesco to get some supplies, I realized that I was sweating like Nicholas Cage on a meth bender and my heart was racing like, well, the same.

I felt a tightness in my chest, short of breath, needing to sit down, and I thought, "Well, fuck, this would fuck up the next week or so." When your Dad dies of a heart attack at 46, you take that shit seriously.

So I found a National Health Service walk-in clinic just around the corner from Tesco. It was in the same space as the NHS's sexual health office, which offered free morning after pills, among other things. I went in and there were maybe twenty people sitting there. I don't know how many needed sex-related attention and how many needed regular medical help.

But a very nice receptionist took my name, date of birth, and phone number, and then she asked what was wrong. I described my condition without the mention of Nicholas Cage or meth, which could have confused the whole situation.

She very nicely told me to take a seat and that triage would be with me shortly. The triage nurse, I learned, examines everyone to see who might need to get in sooner than others. Apparently, I was looking terrible enough to be bumped to the front of the line.

After a few moments, I was called back to see the nurse practitioner, Niamh (pronounced "Neeve" because, well, Irish names). I can honestly say that I've never been treated with as much care, patience, and good humor by a medical professional as I was by Niamh.

She asked permission every time she wanted to do anything, from take my blood pressure to listen to my pulse. Even as I kept insisting that I was probably just exhausted and whiny, she took everything about my condition incredibly seriously and assured me that I should just follow through with what she was recommending.

"It won't cost you anything," she said more than once, as if understanding the anxiety that Americans have about health care spending. "Unless you're admitted to hospital." She laughed and joked, and we talked like we're human beings having a conversation, not a transaction.

Niamh asked me a few questions about health insurance in the United States and shook her head at it. "I'm afraid we're going to head to that kind of system," she exclaimed. She told me a story about when she and her family - husband and five children - visited New York City the previous year.

Her youngest, a toddler, had gotten an ear infection, so they went to a walk-in clinic, just as I had come to this one. She told the receptionist that they would pay out of pocket for expenses because they would be reimbursed when they came home. "Now, they prescribed my little one a medicine," Niamh said, "one that I know is in that locked cupboard behind you.

And I know that it costs about three pounds. Do you know how much they charged me in the states? $354." She laughed, as one can when they get the money back for outrageous expenses. I told her that her experience is pretty typical.

Apparently, the way the UK system works is that whoever is taking care of you stays with you until you are moved on to the next person. Niamh recommended that I go to the Royal Liverpool Hospital for blood tests. She called ahead to see if they could move me through quickly because she knew that I wanted to get back to what I was doing. And she insisted, gently, that I take an ambulance to the hospital, even as I said I could just take a cab and would be embarrassed by such a fuss.

She thought I was foolish for saying that and said that she didn't want to have to worry about anything happening to me on the ride over. I relented when she said I wouldn't be wheeled out on a stretcher. Just a wheelchair.

The two EMTs were also kind and professional and chatty, utterly and completely concerned with my well-being. One of the EMTs, a woman named Phil, told me that she had just gotten into the Royal Coast Guard sea rescue training program.

The other, a man named Jack, told me about his two teenage boys, one who loves history and one who was an IT guy. When we arrived at the hospital, they advocated for me to get treatment, even though my blood pressure had returned to earth and, really, I was feeling much better.

Phil and Jack said their good-byes when a nurse took me (by now, I was on a wheeled stretcher) to check me in, sitting in the hallway outside the emergency room. I was placed next to another gurney with a grizzled old man there who said he was "Mike" and wanted me to fist-bump his scabby, fungal hand. I did because, fuck, why not.


People working there wanted to talk about New York and New Jersey. One attendant, an old guy named Mick who sounded like John Lennon, chatted me up about Bruce Springsteen and Jake Clemons. The nurse who did my ECG (my second of the afternoon) wanted to talk about The Sopranos and places she could visit from the show (looking at you, Holsten's Ice Cream).

Finally, I was brought to a curtained room in the ER where, after a bit, a doctor came in and took blood samples. The doctor examined me again and, even though she insisted I should stay for another two hours and await the lab results, she brought me forms where I could discharge myself, promising I would call to see if the tests showed anything. (Spoiler: They didn't. I was fine.) As I filled out the forms, I asked her and the attending doctor, who needed to witness, for restaurant recommendations, which they readily gave me.

I've sped up the last part here, but, from walking into the clinic to leaving the ER of the hospital, it was a total of four hours. And there was not a single person I met who seemed angry or beleaguered or disgusted by the system they worked in.

Every one of them was simply devoted to making sure I was ok. No profit motive. No forms to fill out. No card to check. No in-network or out-of-network. No phone calls to beg for approval. I didn't pay a dime. That's how you treat a guest.

I was blown away. Obviously, I know it can't always work so smoothly and efficiently (and that there are rocky times ahead for the NHS), but, holy shit, there was something so sane and humane about the entire process that I felt a revulsion towards what we're put through in the United States just to try to not die, the degradation of putting a price tag on our health.

If we actually lived up to the ideals that we supposedly have as Americans, we'd look out for each other by making sure that no one has to have one's worth measured against what one can afford.

Fucking pass single-payer. Or stop fucking pretending that we're a society and just admit that the USA is a Darwinian dystopia.