Ecotopia (25 page)

Marissa’s attitude toward me has somehow changed. Maybe it’s my participating, even if sort of inadvertently, in the war games: she seems to feel I am a better person for it—more solid and real. (In a roundabout way I mentioned that I thought I had seen her in the park—could she have been there? She laughed and denied it.) And I
am
proud of myself, after all. I will treasure my scar. Most
of all, it feels good to be treated as less of a foreigner by her, even in jokes: “Anyway,” she said, “now you have a little Ecotopian blood in your veins!” (because of the transfusion during my operation).

What with the wine and the good company, it turned into rather a party. It was fine to be the center of attention, and I blurted out, “You know, I’m not used to being made happy when I’m supposed to be suffering!” This caused a burst of laughter. Linda looked at me protectively, as if I was a child who had just said something ridiculous but lovable, and everyone was beaming at me. It was some kind of magical moment. I became overwhelmingly certain that I was, indeed, going to get well. “You certainly have funny hospitals in Ecotopia,” I said. “We try to stay out of ours, but yours are about the nicest places to be.”

“That’s the idea exactly,” said Linda. “People recover best if they’re happy. We don’t separate medicine and life. So we
do
try to make the hospitals the best places there are. That’s why what you said about suffering seemed so crazy to us.”

“Don’t patients just try to prolong their stays indefinitely, then?” I asked. “Why go home?”

“No, actually, they don’t. They really truly recover, and want to get on with living. You’ll see. In a couple of days….” She smiled at me softly.

(Don’t you see, I wanted to tell her, I am still needy of contact and affection and human directness, from Marissa and you and everyone, and I love you because you sat by my side during the long night when I was raw and wounded in body and soul, and because you somehow know what I need and simply give it to me, for this little while when I need it most, without my having to give anything in return—)

(June 15) “We believe in encouraging all your life forces,” the doctor said when I expressed pleasure in Linda’s massages. And then, as I half expected (is it Doctor’s Orders or her own initiative?) in giving me a sponge bath she wryly stroked me into an erection and got me off. My ambitions leaped up, quite obliterating thoughts of sutures and bandages. Marissa has gone back to the
camp, speaking stern words to Linda on leaving. Linda’s hands and quiet smile fascinate me, but the pains I still have under the bandage keep me from moving my pelvis very much. Will I be considered well enough to leave just at the point I am well enough to really fuck her?

(Later) Cable sent over from Cove:
“WHY DON’T YOU GET A GUITAR AND GO SING UNDER THE PRESIDENTIAL BALCONY? FAINT HEART NEVER WON FAIR INTERVIEW THEN GET YOUR ASS BACK HERE WHERE IT’S SAFE, FRANCINE.”
That damned woman could foul up my whole project yet. Hope the Ecotopian secret police have a sense of humor—and still understand our kind of women.

HOSPITALS AND HEALTH CARE:
THE ECOTOPIAN WAY

San Francisco, June 15. An unfortunate accident has given me the chance to observe Ecotopian hospital procedures firsthand. I have been recuperating, the past few days, from a nasty gash. But I am mending well, and expect to be out of the hospital tomorrow, though I will have to take it a bit easy for a while.

The greatest difference between Ecotopian hospitals and ours is in scale. Though the medical care I have received seems to be at the highest level of sophistication, from the atmosphere here I might be in a tiny country hospital. There are only about 30 patients all together, and we are practically outnumbered by the nursing staff (who, by the way, work much longer hours than ours, but in compensation spend as much time on vacation as they do on the job). X-ray, surgery, anesthesia, and other services seem to be fully as competent as ours, though the physical appearance of the hospital might strike an American as a bit rustic: the walls are not tile, and I missed the smell of disinfectant which I’ve always associated with hospitals. On the other hand everything seems clean and well cared for, and the doctors, though clearly unfamiliar
with the expectations of American patients, are alert and seem well trained.

In one respect the Ecotopians have taken a profoundly different direction than our modern hospitals. They do not employ electronic observation to enable a central nurses’ station to observe many patients at once. The theory, as I have gathered it, is that the personal presence and care of the nurse is what is essential; and the only electronic gadget used is a small radio call set that can retrieve your nurse from anywhere on the hospital premises without bothering anybody else. The nurses are highly trained in a number of specialties unknown to ours, particularly massage, which they regard as important for stimulating the body’s recuperative powers.

Ecotopians are covered by a type of cradle-to-the-grave medical insurance which has had drastic effects on the medical system. Instead of control by the profession itself, the clinics and hospitals are responsible to the communities—normally to the minicity units of about 10,000 people. Thus the power of the physician to set his own fees has evaporated, though a doctor can always bargain between the salary offers of one community and another, and in fact doctors are reputed to have among the highest incomes despite the fact that they are much more numerous than with us. Doctors perform many duties that nurses or technicians perform in our more specialized system; on the other hand, nurses and technicians also perform a good many of the services that our doctors reserve for themselves. I have noticed that conversations among doctors, staff, and patients are a good deal livelier than in our hospitals; evidently the moral and scientific authority of the doctor has been diluted. Conditions can’t be too miserable for the doctors, however, or more of them would leave the country; as far as I can tell, only a few hundred left at the beginning (mostly very high-income specialists) and none at all have left in recent times. Ecotopia does not import foreign-trained doctors to staff its hospitals, as we are still forced to do, because its medical schools were almost doubled in capacity immediately after Independence.

My strength has not permitted me to do much investigating while hospitalized. However, the gravest problem of Ecotopian medicine would seem to be a dearth of really top-notch specialists.
Specialists do exist, and are consulted on many occasions, but they are required to do general practice as well. This wasteful system is justified by the argument that it keeps them in touch with the medical needs of the people as a whole; but it clearly represents a serious reduction in the best utilization of specialist training and abilities. In fact some specialties have died out entirely. For instance, babies are usually delivered at home by nurse-midwives except in a few cases that present complications, and the hospitals have neither maternity wards nor obstetricians.

Intensive-care units are also not developed as highly as in our hospitals. This clearly involves a certain hard-heartedness toward terminally ill or very critically ill patients, who cannot be kept alive by the incredibly ingenious technology American hospitals have. This may be partly an economic necessity, but also Ecotopians have a curiously fatalistic attitude toward death. They prefer to die at home, and elderly Ecotopians spend a good deal of time and energy preparing themselves for death. It is even said that, like American Indians, they can select the day of their death, and almost will themselves to die. At any rate, when they feel their time has come, they let it come, comforting themselves with their ecological religion: they too will now be recycled.

On the other hand, the Ecotopian medical system has a strong emphasis on preventive care. The many neighborhood clinics provide regular check-ups for all citizens, and are within easy reach for minor problems that might develop into major ones. No Ecotopian avoids getting medical care because of the expense or the inaccessibility of health facilities.

All Ecotopian doctors receive what we would call psychiatric training, though psychology and psychiatry no longer constitute separate fields. My doctor, thus, paid considerable attention to my psychic state as well as to my medical injuries. It is claimed that mental illness has shown a decline since Independence, but it would be extremely difficult to evaluate such claims because of the drastically altered circumstances. I can confirm, however, that Ecotopian streets are not enlivened by the numerous and obvious crazies we are familiar with in our cities. On the other hand, the security and confidence achieved by the Ecotopians with their
dense, highly personalized style of neighborhood and extended-family living are bought at a substantial price in anonymity and freedom. Ecotopians have the feeling, I was told by one doctor, of “never being alone.” The commonest psychiatric symptom for which people visit doctors, he told me, is having fantasies about solitude and about committing violent crimes. (It is a strange tribute to the ritual war games that it is mainly older people and women, who do not take part in the games, who are troubled by such violent impulses.) Some people find it helpful to take wilderness hiking trips by themselves, where they can be totally alone for weeks at a time. Still, it is doubtful if Ecotopians are happier than Americans. It seems likely that different ways of life always involve losses that balance the gains, and gains that balance the losses. Perhaps it is only that Ecotopians are happy, and miserable, in different ways from ourselves.

(June 15, later) Have just been given a message from the President’s assistant: they hope I recover satisfactorily. I am to let them know when I am back in action. Good news!

The doors in the thick masonry walls have been opened, and I can chat with my neighbor—a woman of 45 who almost lost an arm in a fishing-trawler winch accident. Her nurse is a debonair man, maybe 30, good at telling stories, and probably at other things too. Gets her to laugh a lot, anyway, sometimes with pleased blushes. I am now allowed to take short walks along the hill outside. We see other patients, generally (though not always) with opposite-sex nurses. Remarked to Linda that their intimate methods of treatment could sometimes pose problems for the nurses. She was irritated by my attitude. “First,” she said, “every treatment is unique. Second, there is something in every person to value and love” (here she smiled) “even in a dumb chauvinist ugly American bastard like you. Third, nurses are also persons, and we have control of what we do or don’t do. Do you think I’m your slave or something?” She made a face, cuffed me on the shoulder, took me back inside. I’m afraid she was right. My culture has inflicted many handicaps along with its blessings.

Have been reading some Ecotopian novels. They exude a curious feeling of security, almost like 19th-century English novels: a sense, probably derived here from the stable-state notion, that the world is a decent and satisfactory place which will sustain us despite some difficulties. There are terrible dramatic incidents and psychologically harrowing events, of course, but none of the totally freaked out, nihilistic paranoia of our novels. At first the stories seemed puzzlingly vapid to me; I couldn’t figure out why anybody would find them interesting. How come they didn’t have that exciting nightmare quality? Some of them even have happy endings…. After a while, they seem more like life—okay to spend time with, reassuring. Come to think of it, Ecotopia itself is beginning to feel a good deal more reassuring: when I needed care, I was taken care of.

(June 16) Now my wound has been given a new bandage—very small. Linda and I have initiated it with a long, gentle session of lovemaking—with hardly any pain, just occasional small squeaking shoots of discomfort.

Linda, I’m beginning to realize, really
isn’t
quite as pretty as I thought at first, and she is not perhaps the most piercingly intelligent person in the world either. But she is a born nurse: immensely kind, warm, sustaining, with an extraordinary accepting, loving, physical presence. Does she want me to leave, or stay longer? (I gather that an Ecotopian with friends or family in the vicinity would probably go home tomorrow.) But she won’t discuss it. “There’s nothing that can be said about that,” she always replies, a little crossly. “When you are well enough, you will leave. You’ll know when the time has come.”

“And then you’ll get another patient-lover?” “Idiot.” But she knows I have not overcome my confusions on these things, so she comes over and hugs me. “When you go, I get a vacation, and I can go anywhere, on my railway pass. I’m planning to go hiking in the desert. And I’ll think about you a lot. And you’ll write about me in your diary.” (She has discovered my notebook.)

“Yes,” is all I can reply, and I hug her, and feel like crying. This country has certainly taught me to cry, and for some reason it
feels good, as if it is not only my tear ducts that have been opened up….