Thursday, December 18, 2008

Madrid blog--Different Perspectives on Medicine

House-calls

One of my most pleasant surprises here in Madrid is the discovery of a pediatrician who not only gives you his cell phone number (that he picks up), but who will make house-calls. With four children, one of whom is in his first year of preschool, can I say what a life-saver this is.

Dr. J is probably way over-specialized to be dealing with my children's flus and sniffles (he's also a neonatologist), however, he never makes me feel bad when I call him, even one time when the school secretary sent my daughter home saying she had conjunctivitis and it turned out to be a pimple on her eyelid. I am under no illusions that tending to my progeny's medical needs has much to do with what he studied in medical school, however since the morning portion of his work is related to social-security and making the rounds of day-cares, I feel like a relative prize--something along the lines of Mrs. Pumphrey with her pampered lap dog Tricky Woo from the BBC series "All Creatures Great and Small," about a Yorkshire veterinarian in pre-war England. Or, at least someone who pays full cash fees for quick and easy work. On that note, I need to think of Christmas present to send to the nice Dr. J. to express my gratitude to him.

The Great American Medical Factory

I really like my children's pediatrician in the US, but his office, part of a multi-doctor practice, feels like Grand Central Station. He's a good doctor, very in demand. To make an appointment with him for something like an annual check-up requires a minimum of six weeks advance notice. The children have to be really sick for me to be motivated to take them in because this requires a drive to a medical building with inconvenient parking, followed by a 45 minute wait with a bunch of other snotty-nosed children. You wonder what they're there for, and hope you won't be back in the office one week later with something far worse than the original illness. The American medical visit is truly a triumph of process engineering, with its supporting army of receptionists, medical techs, lab technicians, nurses, back office accounting and insurance professionals, its shiny medical buildings, disposable paper covers for examination tables, in-house testing with immediate results and its various protocols. By the time you go through the whole experience, the doctor is the person with whom you will spend the least amount of time.

I have the television series House, especially the clinic duty segments, to thank for the uncompromising vision of exactly how our doctors must view us: an endless procession of whiny patients with the same uninteresting complaints. Every time, Dr. W patiently explains the same thing to me. "Mrs. Fleury pretend that this is 1907 and I'm here with my little black attache case. There is nothing I can do for your child: it's a virus." I reply: "Yes, but he's had this for more than two weeks and he's not getting better," to which he replies: "He probably caught a second virus." Meanwhile, he's got some urgent communication from the nurse, which, from the little I can gather, involves a diagnostic tour de force along the line of "sarcoidosis with Colonel Mustard in the Billiard Room."

First Madrid experience, in the Office of Dr. "R. G. de L."
Same flus and colds, same forty-five minute wait with snotty-nosed kids, different hours, different decor.

Before I discovered Dr. J., I used to take the children to another doctor, whose name I got out of the health insurance booklet. Dr. "R.G. de L." is the only pediatrician in our neighborhood on our private health insurance plan (everybody else they will re-imburse at 80%). His hours are from 5pm to 9:30pm. His receptionist doesn't even know how to contact him during the day, so if you can't wait until evening, your only option is to go to "Urgencias," the emergency room, which everybody here seems to visit at the drop of the hat, whether it's because they can't see their regular doctor or they don't want to go to various different labs and wait one week for the results of a strep test. In fact, none of my Madrileno friends has ever heard of a strep test. If the child has white pus in the back of their throat, the doctors assume they have a throat infection and give you antibiotics.

Dr. R.G. de L., an older and very dignified person, reminds me of my childhood pediatrician, which is to say he says the same things as Dr. W, but with the the bedside manner of a mortician. "Madam, since this is your child's first year in preschool, you might as well expect for him to have a runny nose all the way through May. The cough is a healthy mechanism because it gets rid of the mucous in the lungs. If he wasn't coughing, he'd get a bacterial infection for sure."

His office isn't in a medical building at all, but in an elegant nineteenth century residential apartment building. As for the inside of the office, it looks like something out of a period movie from 60 years ago with reproduction antique furniture and books whose publication date probably coincided with the Spanish Civil war. Exactly nothing in the place is child-friendly, from the bay windows with low handles that my 2 yr old wanted to open and pitch himself out of, to the antique looking type-writer on the floor with loads of intriguing electrical wires. Ironically the only concession to juvenile furniture---plastic Ikea kid stools, posed the biggest problem. My 2 yr old proceeded to steal them from other children. Then he discovered that it was more fun to throw them on the floor and watch their legs and tops pop off. This was before he started to climb on the adult chairs and try and pull down the oil paintings (conveniently within the enterprising child's reach) and reach for handfuls of the random pamphlets with information about aloe vera hand creams, "sexo con seso" ("sex without stupidity?") for adolescents, even though I've never seen a child older than 9 at the office, and Parkinson's disease (in a pediatrician's office?) Needless to say I spent the whole time trying to control my little American savage, cowed by the disapproving regard of the other parents and, later, Dr. R.G. de L.

The one time I did bring all 4 children to his office, it was total chaos. The children brought balloons and proceed to run around tossing them to each other, screaming and fighting. My children not only stand out because of their unruly behavior, but also because of their number. With the exception of immigrants, the average Madrileno my generation seems to have one, at most, two children. I couldn't tell if it was with pity or disapproval that Dr. R.G. de L. told me, after our first vist "Usted tiene muchos hijos" "You have lots of children." At that point, I was so exhausted and worn down, I couldn't think of anything better to say than "Pues alguien tiene que tenerlos" "Well, somebody's got to have them..."

Wednesday, December 17, 2008

Chocolate con Churros--The Neighbors Strike Back

Some of you may have become acquainted with our neighbors in my previous blog entry. Since that time, they have not been idle. In addition to a hostile visit from the forty-something single woman who lives with her mother in the apartment below us, the building association (representing the owners of the exactly 12 units in this place) sent us a certified nastygram citing "numerous complaints" about the noisiness of our children and telling us that noise is forbidden in the building before 9am. Almost none of these people, in the almost four months that we have lived here, has ever bothered to introduce themselves to us, but they apparently organize enough amongst themselves to dispatch certified communications via the post office.

None of this bothers my French husband in the least. He, himself, has vivid childhood memories of ongoing noise complaints (regarding his brother and himself) from the curmudgeonly old lady who lived in the apartment below his family. One day, in a scene reminiscent of Tatie Danielle, his mother tried to shut the door on her, but the sturdy old hag stuck her foot out, at which point his father had to physically push her out.

I wonder if there isn't something particularly Anglo-Saxon, reinforced by the American high school experience, about the tendency to spend so much time worrying about whether people (whom we may not even like ourselves) like us?

In a nod to Stephen Colbert, my phrase of the day, came across it in a Canard Enchaine article about a French socialist political convention, is "petits meurtres entre amis," which I roughly translate as "little assassinations among friends." This phrase conveys, for me, two sentiments: a dismissive tone regarding a petty domestic spat and the slightly more sophisticated and cynical perspective that the greater the degree of intimacy among people, the greater the likelihood they'll be at each others throats--especially when the stakes are low.

You can't control whether people like you, but you can force them to respect you.

On that note, I exacted my own petty revenge on the neighbors. I complained to the landlady that the owners renovating the third floor apartment were giving the building keys to very unsavory sub-contractors--that these people entered the building at all hours of the day with no supervision, and that they were coming up to our floor acting like they were casing it out for future robberies (all true). The upshot is that they changed the keys to the building, thereby inconveniencing everybody. Because of the key situation, I found myself in the ironic position of letting the judgmental neighbors' adolescent children in the building at one thirty in the morning, when their parents were out of town. They were standing outside the door as we were returning from a party. We let them in and chatted briefly on the elevator, and, really, their children were quite nice.

Wednesday, November 19, 2008

Chocolate con churros--Meet the Neighbors

This is my favorite Spanish breakfast--Spanish hot chocolate is very thick and soupy and churros are sort of like string shaped donuts with no sugar. It is in no way heart-healthy and the first time I tasted it, I thought it tasted weird, but it grew on me. I've finally found an unpretentious bar--Cafe Simpatia--on my walk back from taking the children to the school bus--where this costs two euros twenty centavos and the barman automatically knows what to bring me.

My biggest preoccupation in Spain is the details of daily life and raising four children in a foreign country. Any insights I might have will reflect that, so if you are expecting to read about the latest, coolest nightclub or the most up-to-date cultural offerings in Madrid, this is not the spot. "Chocolate con churros" is a metaphor, for me, of adapting to a different place and the quick sketch writing that most suits my schedule and interests.

Meet the Neighbors

We live in a nineteenth century building in the Barrio de Salamanca whose twelve units (mostly still owned or rented out by various descendants of the original family) are occupied by older inhabitants, who never had children or whose children are mostly grown up. My husband now has proof of my laughable American naivete in wanting to invite the neighbors over for a get-to-know you drink. Apparently the neighbors, at least the across-the-hall and floor-below inhabitants, don't like us, or rather they don't like our noisy children. Nobody in this building seems to really talk to each other (I speak more to the live-in help than to some of their employers, whom I have never met), so the central point of communication is the "portero" (doorman). He transmitted the neighbor's complaints to our landlady, who communicated them to us. To know us (or our children) is not necessarily to love us; the cultural quirkiness lies in specifically why our neighbors consider us to be deviants. It all hinges on our schedule, which is "desfasado" (off kilter) with that of self-respecting Spaniards.

While they politely note that our children are mostly silent after 8pm, they particularly resent the fact that the children get up at 7am and trample around the apartment like a herd of wild elephants. This is a necessity during the week since the children have to be on the school bus on or before 8pm. Unfortunately, getting my children to sleep much past 7 or 8 am on a weekend is luxury I have yet to enjoy. My childless neighbors don't get up until 9 or 10am and the older children of the other neighbors happily sleep in on the weekends as well.

If you are going to live here and don't come from some Latin or other country with a similar timetable, the first thing that takes some getting used to is the schedule. People don't seem to work much before nine thirty in the morning, many shops don't open until 10 am. Lunch is at 2pm instead of 12 and most of the shops and public services close from 2pm to 5pm. If it's a public service, it usually opens at 9 and closes down for good (to the public) at 2pm. I don't know what kind of lunches working people take here, but most stay in the office until 7pm or much later depending on their profession and level of responsibility. 8pm is the happy hour and nobody has dinner until 10pm. Most restaurants don't even open until 9pm, and even that is considered a rather uncivilized "giri" (foreigner) hour.

It seems that if I were Spanish my children would adhere to a more civilized schedule, or at least be more silent and better behaved, but also I wouldn't give much of a damn what the neighbors thought anyway. I discussed the neighbors' complaints with some of my husbands' local family members and their feeling was why in the world would anybody care about getting to know their neighbors? They have lived in compete anonymity, or, barring that, a detente of mutual dislike with theirs for decades, exchanging nothing more than the requisite hola (hello) and hasta luego (see you later) on the elevator. They told me that the official noise ordinance is from 12pm to 8am and, as long as I generally respected that, there's nothing anybody can do.

This point was really brought home to us by the story the landlady told us about the previous tenants who lived in a state of open war with her family for generations, protected by some grandfathered rent control law, whereby tenants can inherit apartments and inflation-indexed rent from their parents and spouses. The grandfather of the deceased spouse of the last tenant rented our apartment in 1931. As the years passed, land values and rents increased dramatically beyond the official inflation index, but nobody could kick the tenants out as long as they paid their ridiculously low hereditary rent. The landlords couldn't sell the apartment because the undesirable tenants and their low rent went with the property. The only thing they could do was prevent the tenants from doing any work to the apartment, so at the end they had to wait until the widow of the grandson of the original tenant died to recuperate an apartment, that was in shambles.

Sidenote: The portero also inherited his job from his father. He seems to occupy an executive function over invisible subordinates. In his case, doorman is somewhat of a mis-nomer, since he is present at unpredictable hours, spends most of his time smoking outside and gives me a look (with my baby carriage or shopping bags) that dares me to ask him to open the door. Other times, he relies on a tactic of turning the act of opening the door into an exaggerated parody that brings home just how inconvenient my presence is, accompanied by a smirk of satisfaction in being the central dispatch for the neighbors complaints about us, and the certitude that he (or his descendants) will outlast us.

Thursday, September 25, 2008

Bring on the Bitch

This Hilary vs. Sarah Palin parody is hilarious.

The friend who sent me the link, is more politically conservative than I. She is arguing with me that Sarah Palin is more than a beauty queen bimbo. At the same time she has some useful advice for me about how to avoid the six-year old nightmare birthday party from hell. Between the two classes where my twins are in enrolled, there are fifty children...

"Just invite the boys so you only have 25 kids to deal with. I, in the meantime, have been trying to negotiate the smallest possible party with my son. There are 10 boys in his class so I told him he can have twelve kids because all the favors I have to buy come by the dozen. So I told him I would pass on the savings to him by reinvesting it into the final product of his party. Meaning that for his Indiana Jones party, instead of getting a bag full of crap, each kid will now get an authentic Indiana Jones whip that they can take home and terrorize their younger siblings with. I figured I'd try to teach him some precepts of capitalism before it becomes totally antiquated...as it seems to be headed. :-)"


I am excited because my first-choice candidate for a live-in helper has accepted the job. It's so nice to have somebody who is excited to work for me--not because the children or I are so nice and lovable, but because in the local job market I pay top-of-market wages and am a catch as an employer. Although I have four children, the three older ones are in school most the day, I don't have a ginormous three story house to clean, I don't require every article of clothing we wear to be hand-ironed, don't require them to wear a uniform, and I am willing to provide food and pay social security.

While my conservative friend dedicates her time to worthy charities to make the world a better place, I, Wellesley graduate that I am (like Hillary and also that bitchy stock broker played by Sigourney Weaver in that 80s movie "Working Girl," the one who rightly gets what she deserves from the hard working blue collar secretary played by Melanie Griffith), in the words of the twenty-something, American current incumbent of the job (with the kind of self righteousness that you can only have when you're still subsidized by your parents)--am "taking part in the exploitation of the third world and women."

This moment of zen is seconded only by my IT industry marketing skills, which included hiring females to liven up our user conference party. On the advice of my older cousin, who at 36 married a 20 year old swim suit model and event promotions girl, I learned that I could request head shots of these girls before hiring them, dictate what they wear and request "that they not chew gum." When I told this to a good friend and colleague, he drily suggested that if JBoss didn't pan out, at the least I could get a job as head of HR at Hooters.

Ironcically, thanks to my experience at JBoss, I can now afford to contribute to the Arts as a playwright/expiate the sins of my past life and experience catharsis therein, by writing about characters as self-indulgent and flawed as myself.

A former boss of mine, who took pity on me and hired me, partly because I could talk about literature and partly because I reminded him of a Wellesely girl he dated in the fifties (he, himself, was a graduate of Harvard Law who never practiced law a day of his life, but went into advertising instead)--once had this to say about that great American contributor to the Arts, Aaron Spelling, "if you want to liven up a tier-three soap opera that is going nowhere (Melrose Place), sometimes you gotta bring on the bitch (Heather Locklear)."

Of course, if you were talking about Shakespeare, she'd be Lady Macbeth, but same premise.

Wednesday, August 27, 2008

Postcards from Spain: Culture in Context

The first thing that strikes me when I think about writing about my experiences here, as an American living in Spain, is all the things I don't want to write.

This is because of all the times I have been on the other side of the fence. When foreigners implore the "Natives" to read their cute little blog musings on the natives' little corner of the world, they don't imagine that how offensive the Natives will find some of those musings," for ex. "Have I become dumber since moving to America?"

Genre and the American Travel writer

The Self-loathing American/Geography snob
This is the type of person who usually grew up somewhere in bum-fuck and could not wait to move to New York, San Francisco, or Abroad, to manifest their innate sense of superiority to all the rubes they grew up with. This kind of person inevitably becomes "more" New York, San Francisco or name your Euro capital than anybody who actually grew up there. I think there is something innately fishy about being ashamed of where you come from, especially when that person came from the same place (in a manner of speaking) as me, and, therefore, looks down on me! I am not always proud of my country and don't agree with its current government, but there are still a lot of things I like about America, that I am grateful for. I realize that where I come from has played a significant role in my identity today.

The American Bigot
I was well into a reverie of the reverse type: "When Americans go abroad, waxing poetic about their fresh baguettes and Tuscan views and how they just love the relaxed pace of living in the 'Old World' they don't realize that this is because they are 'On vacation' and they are not having to get anything practical done."

This was in a moment of frustration, dealing with the headache of getting papers here, like the NIE--foreign tax ID number, whose only benefit is a big "come and get me" to the tax authorities--it's harder than you think to get, and without it you can't even get a mobile phone in Spain. Or, dealing with Customs and blocked containers and more administrative papers. In short, huffing and puffing because my immigrant status here forces me to deal with that most international, illogical and pernicious of characters: the low level civil servant.

Just at the moment, I feel myself slipping into the American bigot rant, which frankly, being married to somebody from somewhere else and having dealt with the INS on his behalf and seeing what kind of treatment you can expect from them, even if you do have a higher education and speak perfect English, and God forbid you move to another region of the US and they can't locate your file..., I was still tempted to feel all American-bigoty about how much more efficient we are at getting things done, when what do I get in my in-box? A note from my surgeon's "appeals professional," apparently he has a full-time person with this title on staff. The letter informs me that Cigna (which has now been bumped ahead of Blue Cross Blue Shield in my personal circle of Hell ranking of health insurance companies) has decided to only pay half their portion of my surgery, from back in June.

Nastygram to Cigna

So I spent the morning writing an appeal to Cigna, pointing out that the first reason they denied partial payment on my claim--that I had co-insurance, was patently false, I do not now, nor have I ever had co-insurance. So that does not exactly inspires me with confidence at how closely they reviewed my dossier, as a whole. Or, do they automatically deny payment as a policy, assuming that not everybody is going to be pissed off and energetic enough to appeal? I had a PPO, what ever happened to my choice in health care? Why should some paper pusher at Cigna determine that I should go to some hack who just happens to be in their network to have my belly sliced open from hip to hip when I could have a laparoscopic procedure done by The Male Surgeon and His Colleague, who have more published successes in this surgery than anybody else in the World, let alone the Atlanta metropolitan area? I have a poor history of wound healing and four children to run after...and so on.

Friday, August 22, 2008

Postcards from Spain: Afernoon in Ikea

Ikea must truly be the world's most democratic place. While equipping our apartment in Madrid, we made the requisite stop there. After spending an hour and a half configuring something called the "blobbi" or the "schlaghklumf" or some other lump of unpronounceable Scandinavian syllables for our living room couch and various other pieces of furniture, we were in for a nasty surprise. Things have changed since our last stop in Ikea outside Paris in the mid-nineties. You no longer drop off your ticket at the warehouse and wait for them to bring you your boxes. Each piece of furniture comes with it's own aisle and item number; you grab your cart and off you go to the warehouse to find each individual item and lift it onto your cart, before proceeding to checkout. This might work just fine for one or two items, but gets tiresome when you are equipping a whole apartment.

Talk about a company that knows how to squeeze a margin. I look at the smiling employees (they all mostly seem happy to work there) re-stocking items and ask my husband if we couldn't just hand one of them 20 or 30 euros to get our stuff for us? He said this just isn't done and they would be offended that I am trying to subvert their egalitarian Scandinavian ethos with my filthy American money and expectations. I wonder about the supposed high level of youth unemployment in Spain and other European countries. Surely it wouldn't cost Ikea anything to let these people earn tips by getting people's boxes for them at the warehouse? Where's the evil in paying for extra service? Why isn't Ikea online, or is it?

Marc tells this story to Sacha (Labourey)--our friend and former colleague at JBoss and RHT, who sympathizes. "I know what you're saying. The other day, I needed to buy some furniture for a family house in the mountains. I called up Ikea and told them that I had rented a truck and was going to drive 200 km just to get some furniture there and could they please reserve the pieces I wanted. They responded: No, we can't do that. All we can tell you is that there are eight of those items left and they are going fast, so we recommend you hurry."

We find ourselves reflecting. When we were young and didn't have money, we went to places like Ikea. Now that we're older and more settled, we are still still doing many of the exact same things. Some things don't change.

Tuesday, August 12, 2008

Live and Let N.I.E.

Confession: I didn't even make up this title, I found it on a Spain Expat blog.

For those who haven't contemplated moving to Spain, this is their foreign tax ID number. As far as I can tell, it conveys no advantage whatsoever to the holder besides acting as a giant "Come and Get Me" to the fiscal authorities. Unfortunately, every basic transaction you might want to perform in Spain requires the NIE, from getting a telephone to opening a bank account, to getting your stuff through customs. You would think it would be easy to get.

Perhaps it is...if I hadn't decided to engage the services of BlahBlahBlah (prestigious international audit, tax and consulting firm). When I had less, I used to fantasize about how much easier life would be if you could Pay People to Do Things For You. Sometimes it is. Sometimes it isn't. In the case of the immigration services provided by BlahBlahBlah, I've learned more in one hour on Google than anything they've told me or provided me with so far. My husband says that it's my fault, I should have known that BlahBlahBlah is far more concerned with its fat multinational corporate clients than private individuals, unless, perhaps, you happen to be Bill Gates. I engaged BlahBlahBlah in the hopes that it would shield me from the usual insults and injuries wielded by that most vicious of creatures--the Low Level Civil Servant, in this case employed by immigration authorities.

In my experience, the Low Level Civil Servant (LLCS) is an international breed, whose temperament tends to worsen when deployed in highly populated capital areas (conversely it can be quite nice and personable in the more sparsely populated rural settings). The typical LLCS exists in limbo between gratitude for its job for life and generous employment benefits, mixed with subtle disdain for the mind-numbingly repetitive functions it must perform, and outright contempt for the people it is compelled to serve. The Low Level Civil Servant is programmed to follow a systemic series of rules and to exist in a world with no individuals, only check-marks. Asked to perform any function not automatically subsumed in the order and exact definition of the checkmarks, the LLCS automatically spits out a "No" response. Regardless of one's circumstances, there is a two-step approach that can improve your odds with the LLCS. 1)self-abasement and recognition of the LLCS' superior authority. "Oh most powerful one whose hand rests upon the stamp that I currently need, please forgive my ignorant ways and failure to blah blah, I beseach you to look with favor upon your humble supplicant" is an appropriate tone to adopt, followed by 2) The VCH (very compelling story)