'The margins are clear,' said the doctor... 'What?'
(Margo wrote this report when she went to London in December to help her cousin, Berta Freistadt, after her mastectomy. See also NOTES FROM MARGO.)
THE SHORT VERSION: I have arrived safely in London just in time for the countdown to Christmas. Cousin Berta's operation seems to have been a success, and she is recovering nicely. She is tired and rests quite a bit, but for the most part she is in good spirits.
It's hard for me to tell how much of her unwellness is from the cancer, how much from the mastectomy, how much from the chemotherapy and how much is the Parkinson's Disease.
She struggles with a lot of stuff. Her spirits are amazingly good, without being the least bit Pollyanna-ish. She has a few tears occasionally, but that seems well within what you might expect, given the circumstances.
THE LONGER VERSION: We went Friday for the follow-up appointment to the surgeon, who seemed to be giving us good news. “The margins are clear,” he said, as if we would know what that meant. I asked him to explain, and he said it means that among the lymph nodes that were removed, the outermost ones were clear of cancer. So the doctor is fairly confident that they were able to remove the cancer.
Berta will have to take radiation therapy in January and take an anti-recurrence drug for five years. But the doctor is optimistic.
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For me, one of the most interesting bits of this whole trip is the inside view of the British health care system, which is sometimes touted as a model for what the U.S. system might be. I could live with this system. It is not particularly gleaming. Some of the clinics and hospitals are old, but they are well maintained.
The staffing is abundant by American standards. Nurses seem able to chat a bit, and the personnel – doctors, nurses, cleaning folks – are not always rushing away to another patient.
The fact that all Britons have the care they need, or at least some level of care, for free, seems to make everyone relax a bit. Also, there doesn't seem to be the big liability layer that is at the forefront in American health care, so there isn't that cloud of worry hanging in the office that we're going to sue. It seems to make everyone willing to talk more frankly.
For drugs, retired people like Berta just get a scrip from the doctor, take it to any pharmacy on any street, and they issue the drugs for free. (Berta says the drug system not like that for younger folks.) For care, you just appear and identify yourself, and you see the doctor. The appointments can take a long time to get, but there's no co-payment or issue about who is responsible for the debt.
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We spent an entertaining hour or so scanning the catalog of post-mastectomy prosthetics – or as we say, falsies. Berta got a standard issue temporary falsie from her favorite nurse, Vickie. After she heals up a bit, she'll get a standard issue falsie for longer term use. But there was a catalog for those who prefer a slightly classier edition of the prosthetic. There were cotton ones, and silicon ones. Some were OK for swimming. Some were outfitted with the nipple. Others were labeled “nipple not included.” So strange – I would think if you paid for the prosthetic breast, you should get the nipple, too.
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Most doctors seem to be Middle Eastern or East Indian, so it occurs to me that the native-born doctors may be working in the private hospitals and clinics rather than the public ones. I asked Berta about that, and she said she didn't know. She thought there were plenty of native-born doctors working in the public hospitals. It was just chance that her doctors were from the Middle East.
The nurses and other employees are from every ethnic group imaginable: Plenty of native-born English folks, but lots of Jamaicans, Africans, East Indians, Czechs, Russians, Pakistanis, Romanians – you name it.
We often think of San Francisco as being multicultural. We haven't seen anything yet.
It's the same in the Kilburn High Road shopping area near Berta's house: Ladies with modest head scarves talking Arabic to each other; women with every inch of themselves covered with yards and yards of black fabric moving silently down the street with just a slit in the dark scarf for their eyes; folks of African extraction with their hair in elaborate braids talking with perfect British accents, others talking with Nigerian accents, South African accents, some Caribbean accents I don't recognize; Thai folks, Chinese folks, Persians arguing outside their rug shops, a Pakistani delicatessen supply store, halal butchers, Indian restaurants.
This is as polyglot a place as I've ever seen. It seems relatively peaceful, although Berta says that the code word, when white people speak disapprovingly of non-Anglo-Saxons, is “these people.” I haven't heard it yet, but Berta says it's used.
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Anyway, we're preparing for Christmas and Boxing Day in a slow and sort of quiet way. When Berta felt strong enough today, she directed me to put up holiday lights in the living room and kitchen, and we wrapped up some presents – some she had bought, and some she had directed me to buy. With the Parkinson's, she's been functioning with diminished strength and energy for a long time, so she plans ahead. Each time I've gone up to the High Road shopping area, she's had something I should look for: scented candles or gel pens or cheesecakes, whatever. A little bit at a time, and we were ready.
On this evening, we had a little drink after dinner and looked at some recipe books from 50 to 100 years ago. I know it sounds like a weird way to mark Christmas Eve, but it was very sweet. Dozens of chutney recipes. A whole book of banana recipes: banana soup, banana pudding, banana fritters, banana salad – and a listing of the banana freighters that were running between the Caribbean and England. Unfortunately, no date on the book. There was a series of Aunt Kate's books: Aunt Kate's baking book, Aunt Kate's kitchen tips, Aunt Kate's cooking, etc.
The plan tomorrow is to have a drink with the neighbors on one side, and have a big mid-day meal with the upstairs neighbors on the other side. So that'll be Christmas.
BERTA’S next visitors were my sister Delisa and her friend Betty Burns, then our dear friend J.P. (Jack) Uhlrich. At last report, Berta was doing well.
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