I met and interviewed a couple last week, so full of passion and energy that an hour and a half with them flew by and as I waved them off at the door, I knew I wanted more time. Luckily for me, they felt the same way and the next day brought with it an invitation to visit them at home to continue our chat and to meet some of the people living in their community.
Seeing their hometown meant travelling out of Chico, which for me meant taking the local bus. I wasn’t alarmed by this concept but as I started out on my journey it became apparent that taking the bus is not a regular occurrence for most Californians and indeed can cause alarm for some. I’ve never been asked quite so many times why I was using a bus, both by the station staff and in fact by other passengers…
There’s something a bit surreal about asking for a ticket to Paradise, not to mention a day return, but that was my destination and I was excited. I’d been told contrasting things about the small town of Paradise; sitting 15 miles away in the foothills of the Sierra Nevada Mountains, it has a more forested landscape and cooler climate than Chico. Formed initially as a retirement community, the town now attracts a more diverse population including those of lower income due to more affordable housing.
I have been helped by members of the community each step of the way whilst I’ve been in the States, to such a degree that sometimes it can seem overwhelming. I’ve never felt quite so British and reserved as the times I’ve stepped into clothes shops here and headed instantly to the sales rack in order to bury myself deep inside and avoid being asked in every possible way how I might be helped and how my day is going. It’s a nice thing and I’m slowly getting used to it.
However, the day I travelled to Paradise was not such a time. After several enquiries as to what the heck I was doing getting a bus, I was informed by the driver that he had no idea where the address on the piece of paper I was clutching was and indeed no clue as to where I should alight.
To my horror and the instruction to ‘get off in the centre and see’ I found Paradise to be the most confusing small town I’ve ever encountered; confusing and completely pedestrian unfriendly. Luckily Google Maps, sustained by a solitary bar of signal, got me through and after half an hour of wandering wooded streets I found myself in a small cul-de-sac believing I was in the right place. A mildly intimidating unmanned dog made the final journey to the door all the more exciting (he actually turned out to be the softest thing imaginable).
I was greeted by my hosts with a homemade cake and yet another opportunity to explain that, yes, I was British but didn’t really like tea. Therefore, with juice in hand we cracked on. I’ve touched on it before but being welcomed into someone’s home to talk provides in many ways a much richer experience than interviewing in a clinical space. Within minutes I’d taken in so many clues about the life this couple led and whilst conversation with these two was never going to be difficult, picking up on things that were of interest to them brought them to life even more.
After being shown around the house I was taken to see their collection of guitars, including their most prized: a replica of one played by John Lennon. Whilst there had been passing comments, I’d not realised the extent to which music played a large part in their lives. Piece by piece the story unravelled of a couple brought together at a very young age by a mutual passion and formation of their rock band.
As I listened to them it was clear that whilst age had changed some things, it hadn’t altered that passion and not for the first time, my inferior music knowledge was put to shame as I was played track after track from bands I ‘really should know’. The highlight was definitely dancing to Madonna in the sitting room at 11am; an activity I am always happy to engage in.
As the story continued, the picture became a bit different; they had tried their hands at many things, at one point even moving to Arkansas to open their own restaurant but life had been a struggle financially and they now found themselves moved to a small town, admittedly beautiful, but perhaps not where they would have wanted to end up.
Their candour was humbling and as we moved back to the topic of healthcare I heard tales of years riddled by chronic pain, depression and anxiety for both of them. The conversation brought us to the subject of pain medication; a topic many have chosen to discuss with me during my time here. Opiate prescribing in the community has traditionally been more common in the US than perhaps we are familiar with in the UK. However, recent increasing restrictions on this have left those with an established reliance on these medications in a dire situation. My hosts were honest in acknowledging that they are struggling with the current changes and that their lives at the moment revolve much around organising picking up prescriptions and getting to appointments. They brought up at this point the huge gratitude they feel for their own GP who has worked with them over the years and who, they feel, knows and respects who they are. For them, the relationship they have with one physician who they are able to see regularly and who knows their situation is crucial and of the utmost importance in ‘keeping them sane’. They are entitled to Medicare; an insurance plan which covers the over 65s as well as those with disabilities. They expressed feelings of relief at having this plan as it provides the option of seeing the doctor they trust.
In the afternoon they wanted me to meet a neighbour of theirs who they felt might have differing views. I was happy to do so and joined them, camera in tow, on the walk across the street. I noticed at one point that we were following a piece of string as we went and on asking about this was told that the neighbour we were visiting was blind following untreated macular degeneration in prison. The string had been put in place by the postman; it led to the post box, providing the gentleman a lifeline to his mail.
We were greeted at the door by the neighbour and the dog from earlier in the day, neither were intimidating now and I was welcomed inside. At first I didn’t know where to put myself; I felt clumsy and awkward with the camera as he wasn’t able to focus on me, but within minutes we were chatting freely, everything else forgotten, and very soon I knew I was going to like this man.
He wanted to start by recounting his experiences of healthcare in prison and spoke of how he had felt for the doctors who he believed were trying to care but, being so restrained by the system, were left as ‘nothing more than robots’.
He spoke of how his life choices had coloured not only how he felt about himself but also how he felt others, including medical professionals, perceived him. As an ex-Heroin user, he said he had experienced a range of reactions from medical staff on seeking help ranging from being inundated with opiates for pain relief to a flat out refusal and accusations of ‘drug-seeking behaviour’. His access to primary care came now in the form of a local Nurse Practitioner as no doctors were available. Whilst he had been happy to see a nurse initially, he stated he hadn’t felt listened to, had developed no rapport and now felt helpless in finding any other care. In a previous year and stronger moment, he had sought out help in the form of an addiction specialist at the local hospital. This had brought great relief and real progress until the physician had had to move on and the position was never filled again.
Whilst talking about volunteering for the homeless, a movement he’d felt compelled to be involved in since being homeless himself as a young man, the blind neighbour turned to me and said, ‘I get it you know; you’re looking for what makes humans connect and a form of caring that goes beyond ordinary medicine.’ It had come a bit out of the blue and to his amusement I choked a bit on my juice in response.
I’m sure we’ve all felt that wave of excitement when someone really does ‘get it’ in relation to something we care about. Here I was feeling totally understood by a man who, on paper, I had little in common with; a man who I’m ashamed to say I might have judged by some of his choices before meeting him; a man who couldn’t even physically see me.
Long after the camera battery had given up, it was time to leave and I tried to put all my feelings of enjoyment and gratitude into that handshake as we left him in peace. My timekeeping being as pristine as always, I had of course missed my bus, however my hosts were adamant that this was a good thing as it would give them the chance to show me the ‘real Paradise’. And so they did.
The town sits on the side of a canyon not dissimilar to it’s ‘grand’ relative. But here there are few people and only nature. It is absolutely stunning (and my photos do not do it justice).
A few days later, I received a letter at the practice thanking me for my visit. Amongst the incredibly kind words sat the comment that I would be ‘the best doctor my patients would ever have’. I mention this purely because I think, in the absence of them having witnessed any actual medical skill, it lays testament to just how impressive my Madonna dance moves really were…
But the sentence that really struck me relayed how they had enjoyed having someone of ‘my education and experience’ listen to their opinions on healthcare. It conveyed a lack of belief in the importance of their own views and I felt uncomfortable and a little sad at reading it.
It made me reflect on how I perhaps take for granted that my opinions are valid, not always right I admit, but valid. I do, for the most part, feel listened to. I couldn’t help but feel, therefore, incredibly glad that on that day I'd had the opportunity to listen and to record their words so that others might hear them too.
In the end, was it a trip to Paradise? I won't exhaust the potential for metaphor too much but I will say that one very tasty madeira cake, one very enthusiastic Labrador and three quite amazing people had a huge effect on me and that doesn't happen every day.