Facility Fee

UCLA Medical Group Physicians’Billing Office

PO Box 240005

Los Angeles CA 90024

April 30th 2014

To Whom It May Concern:

I received a letter today requesting that I pay an outstanding medical bill. The tone of the letter was accusatory. Apparently I have not heeded several notices for payment of the enormous sum of $40.78 (forty dollars and 78 cents). I have not ignored any of your bills. I have simply failed to comprehend them. They are written in a language and in a manner deliberately intended to confuse and frustrate me so that I will concentrate on the sheer impenetrability of the bill and not the outrageous sums you charge me. I made an appointment a few months ago to see a dermatologist. I was told I could see a doctor at an office in Santa Monica some time in the future or see a doctor on the UCLA Campus that day. However, should I choose to see the UCLA doctor there would be a “facility” charge: $25 (twenty five dollars). Yes, you charged me because you operate out of a building. I looked for an outdoor doctor, one whose overhead might run to the occasional trimming of a tree or the unblocking of a storm drain, but failed to find one. I went to the UCLA based doctor because I was afraid the blemish I had found might be cancerous. Is that worth $25 extra dollars? For being able to see a doctor indoors? I was shocked when I was not charged to use the bathroom.

Here’s what really sticks in my craw. A couple of years ago I went to one of your very prominent Ear, Nose and Throat surgeons, Paul Kedeshian. I had suffered from sore throats for a while and they were getting worse. Dr. Kedeshian diagnosed me with acid reflux. He did this in about seven minutes. The rest of the ten or so minute appointment was taken up by my insisting this was not possible since I felt no discomfort in any area of my gut or esophagus. Well, says the expert, that’s perfectly possible. I am foolish enough to think an experienced surgeon might know a thing or two so I try a slightly restricted diet which does no good. Did I mention I make my living as an actor? This is really important.

When this first corrective fails I am referred to a vocal therapist. She is very good. She puts me on an extremely restricted diet and puts me through vocal exercises. On this diet I lose twenty pounds in three weeks because it is so boring I cannot eat. I buy a wedge shaped mattress to elevate my head, thus driving my spouse to distraction. My voice continues to deteriorate. Eventually my voice disappears completely. I am unable to work and am now disappearing into a deep depression. When I visit the vocal therapist in an emergency she sends me to see whatever surgeon is available. I see a resident who diagnoses post-nasal drip and prescribes appropriate medication. It helps for about two days. Then I become, essentially, unable to speak. That’s when I am referred to an ENT surgeon named Dr. Long who has been advised to put a strobe camera down my throat. Yes, I know, you’re thinking - What? All these weeks and months and no one thought to do this when the patient first came in? Guess why this was not done? Because my HMO would not have paid for it. Now I can hear your next question: why was the patient not offered the possibility of paying for this himself? After all he is an actor. If a carpenter came in with a smashed hand we would x-ray it. Wouldn’t we? 

Doctor Long puts a camera down my throat (this is a camera on a stick which takes precisely three tenths of a second to find what is actually wrong with me and for which I am charged more than eight hundred dollars). I have, and have had for a very long time, a cyst on my vocal chords. It has grown very large. It will require surgery. Now, here’s my favorite part. By coincidence, as I leave the room in which the root of my problem has been found, I encounter Doctor Kadeshian. I ask him if he remembers me. He does. I tell him that I do not have, have never had and almost certainly never will have acid reflux. I have a cyst. Do you know what his response was? “I knew we’d find out what was wrong eventually.” Then he went off down the hallway to ruin another life. 

I used to work in the Standardized Patient Program at UCLA in which actors pretend to be patients to help medical students get a sense of what it is really like to encounter human beings. My favorite part of the whole program, though I only encountered it anecdotally and never took part, is the session in which the students get to practise their prostate exam skills. The men who volunteer for this are a mixed bag. Some of them live quite marginally, borderline or even entirely homeless, drug addicted and the occasional man who is rectally stimulated. Any of those men, even while another man’s finger is inserted in his ass, would have done a better job than Doctor Kadeshian. 

I relate this so long after the events because I want you to know that I am, firstly, not a litigious person and have no interest in pursuing the matter legally. Secondly because I want you to know that I do pay my bills even when part of any given bill is for the privilege of being indoors while being treated. Thirdly because the Audiology Department was excellent and Doctor Long was excellent (she removed the cyst, I stayed silent for twelve days and I now am as normal as I will ever be). I know that part of my payment will make its way into Doctor Kadeshian’s pocket and, in exchange for that small dividend from me, I hope you will let him know that I am aware that he diagnoses people with acid reflux because it gets them out the door quickly even though he knows that very few people actually suffer from the condition and certainly not to the extent that they need any kind of serious treatment. His incompetence and arrogance almost ruined my career. The resident who saw me, by the way, was right. I do suffer from post nasal drip sometimes. Tell Kadeshian that, too. The residents at UCLA are more competent than he is. 

I hope my payment helps the building.

Faithfully

John Lee

Eulogy

My family and I want to thank everyone for their good wishes and sympathy and for being here today in this church which was such a central part of dad’s life. Our family isn’t just my mom and dad and my brothers and me. Our extended family, our uncles and aunts and our cousins are very close and it’s that closeness that has helped us through a very difficult few weeks. Just a few days before my dad died we lost one of the mainstays of the clan, our Aunt Alice, Alice Cuddihy, my mom’s sister. Anything we have to say about our dad is equally true, and maybe more so, of Aunt Alice.

 

The family want these days surrounding dad’s death to be as much about celebration as about mourning. If we can do both equally we will have done Jimmy Lee’s life justice. So, what I’m going to do is ramble on about the things dad liked and loved and the things he loathed and despised. He was always funny about both. Let’s begin at the beginning. Dad was from Kilmaganny, in County Kilkenny and that village and that county are first on the list of things he loved. Though he spent almost all of his working life as a carpenter he started out as a blacksmith working with his dad, Ned Lee. I always tell people my dad was a blacksmith because the stories he told of his life in Ireland are stories of his days working in the forges in Kyle and Newmarket. If I told all the stories of those days we’d be here for, well, for days. Suffice it to say that they involved bicycles, spuds and talking horses. His love of his home was most deeply expressed by his love of Kilkenny’s hurling team. In fact it’s been little noticed that dad’s decline started when the Kilkenny Cats were beaten in the All Ireland this year. Yes, the Kilkenny hurlers are responsible for dad’s death – it’s a little known medical condition. I could tell stories of dad’s trips to Dublin for All Ireland Hurling Finals involving many pints, posh hotels and a mysteriously mobile spittoon but, again, we’d be here for days.

 

Dad moved to England in 1952. Dad had an unbelievable memory for people and places and dates – he was the repository for all the family stories and one of the hardest things about losing him is we are losing the family memory. That memory is best summed up by my brother Jimmy who asked dad about another of the great loves of his life, the Antelope pub on Stratford Road. “Dad”, Jimmy wanted to know, “when did you first drink in the Antelope?” The answer was something like this: “February 12^th 1952. It was a Tuesday”. In the Antelope dad had the little piece of Ireland that sustained him throughout his years in Birmingham. Again, the stories are endless, involving pints, music sessions and the occasional juke box smashed to bits and thrown out into the Stratford Road. It was in the Antelope that dad displayed one of his most remarkable skills. He could sum up his philosophy of life or the current political situation in very few words. Usually this involved the things for which he had no time whatsoever. When I heard dad had died I thought of his dislike of those he felt had not earned their place in life, mostly the rich and famous and, particularly, politicians. Whenever someone rich or famous, but especially famous, died he’d say – Do you think they’re digging a bigger hole for him than they will for me? He detested the modern tendency to make almost anyone into some sort of celebrity and he was in the Antelope one night around the time David Beckham has broken his foot just before the World Cup. Someone was selling copies of an Irish newspaper in the bar and approached dad’s table. Dad said to him: “I’ll buy a copy of that if there’s no mention of Kylie Minogue’s backside or David Beckham’s foot”.

 

 

My most treasured memory of his political commentary was when Margaret Thatcher became Prime Minister – oh, how he detested Margaret Thatcher – and I was watching television with, I think, my brother Eddie and dad was doing that remarkable trick so many Irish people seem able to do, watching the telly while the screen is completely obscured by a newspaper. For dad, always the Daily Mirror, he’d never lower himself to read The Sun. There’s a report on the news about Thatcher’s arrival at 10 Downing Street and, of all things she could do to infuriate what dad would call decent people, she starts quoting Francis of Assisi. “Where there is despair, we will bring hope” and so forth. Very slowly the Daily Mirror starts to descend, dad looks over at me and my brother and says, “Oh, we’ll all be millionaires”. Then the paper goes slowly back up.

 

Dad also had pithy comments for those he loved. High on the list were the four of us, his sons, Eddie, myself, Jimmy and Gez. When my daughter was born, while others congratulated me, his only comment was, “You’ll have to buckle down now”. We were only slightly more loved than the many cousins here and in Ireland. His summing up for us mostly consisted of a clip round the ear. However, above us all, the love of my father’s life, the center of his Universe, was Gret Rafter who became Gret Lee and our mother. There are many reasons people emigrate from Ireland – poverty, lack of work, adventure – but dad came, I believe, to follow mom. He told me a story of a falling out they’d had and how he had persuaded her to take him back and this is how he summed it up: There must have been something there. Indeed. Sixty six years they knew each other, more than fifty eight married. A flat in Balsall Heath where they lived when Eddie was born, the first house they bought in Fernley Road in Sparkhill where Jimmy and I were born then fifty two years at 66 Phipson road and the last of their children, Gerald. There must have been something.

 

Dad wasn’t one for expressing his love for us in words. As my mom got frailer and dad became her full time carer I visited and told him how great he was doing with mom. His reply was not a thank you or a boast or a complaint, it was the simplest and most moving thing I ever heard another person say: “Sure, didn’t she look after me when I was sick?” A man who kept his promises. He expressed his love through doing things, not saying things. I decided a few years ago, however, that I would tell him that I loved him. Whenever he took me to New Street or Digbeth Coach Station to head back to the States I would say, “I love you, dad” and he would just mumble and nod. I didn’t need him to say it, he’d shown it in so many ways. One time we were visiting, my wife and daughter and I. Now, one of the things you never did to my dad was tell him there was anything wrong with him. My wife is American and they often have a need to confront things even if you point out that Irish people tend to keep their families together by never talking about anything important. Both mom and dad were getting deaf and I said to my wife; “Don’t tell dad he’s deaf, start by telling him mom is deaf and needs hearing aids”.  So, she did. “Jimmy”, she says, “Gret is getting very deaf and needs hearing aids”. Then came the response: “That woman isn’t deaf, she’s heedless”. Mind you, he did get her hearing aids.

 

Now, on that same visit my dad’s deafness produced a minor miracle, My daughter, who was about seven at the time, came from the kitchen to the sitting room and said to my dad something like, “Granddad, where’s the butter?” My dad’s response was” “I love you, too”. I didn’t laugh then and I am crying now but I love that the one time I heard him tell someone “I love you” was because he misheard. It was, though, the greatest summing up of his life. In that one “I love you” was this thought: I will shelter you and clothe you and feed you and protect you, I will educate you and when you are in trouble I will help you. There is only one thing left to say. I love you , dad.

When applying to Wells Fargo Bank for a re-finance of a home loan I was asked to explain why my 2011 income was lower than my 2010 income. Here's my response.

To Whom It May Concern:

 

I have been told by the person In Wells Fargo’s mortgage department who has been dealing with our application to refinance our home loan that I need to answer one more question: why was my income in 2011 lower than my income in 2010? Early in 2010 I was at a farmer’s market and, most unusually, a vendor was offering geese for sale. This vendor assured me that one of her geese laid golden eggs and, despite the very high price she was asking, golden eggs were simply too good to pass up. Now, you may think that I was idiotic to believe this vendor but, as she pointed out, more ludicrous propositions have been presented to the general public and she told me of a time, not so long ago, when banks were offering loans to essentially destitute people who then bought four bedroom houses in wealthy suburbs without the bank even checking their income. Impossible, you will say, but I have seen evidence of this. I took my expensive goose home, and, like a magic mortgage backed by nothing more than a wing and a prayer, it laid golden eggs. Really. So, 2010 proved to be a very good one for me and I made money hand over fist even though I had to spend a lot of money on the very particular diet this golden goose required. Mind you, my accountant assured me those expenses are tax deductible.

 

Imagine my dismay when, on the first day of 2011, I found the golden goose had flown the coop. It seems that this particular breed mated only once in a lifetime and that mating takes place on a remote island off the coast of Scotland on the first day of the third year following the birth of the goose, after which the goose expires. Thus was my income drastically reduced in 2011.

 

I could as easily have written that the reason my income was lower in 2011 than in 2010 is that I earned less money. A better man than I might have taken this question in stride and supposed that there is a good reason for the question in the first place. I do not know if this question originated with Wells Fargo or with some branch of government. I do know that it is the stupidest question I have ever been asked, with the possible exception of, “You don’t believe there was really an ark with all the animals on it?” So, having wasted time, paper and ink on this idiotic inquiry I repeat: my income in 2011 was lower than my income in 2010 because I earned less money. If you have any vestige of humanity you will know how embarrassed I am both at being asked this question and at having to answer it.

Noise Box

Staying with the language theme, however loosely I may be following this supposed thread, I was reading today about the latest plea from pediatricians for parents to prevent their young children, those under the age of two, from watching television. They claim that watching television harms the development of language. Parents talking to and with their children apparently is better than television. Obviously, given my age, I watched much less television than children growing up today, in fact I watched precisely no television until about the age of four when mom and dad finally scraped together enough money to buy a set. You see how old I am? I still call it a television set, not just the television. Clearly my language skills are greater than those who had a television in their first two years because I use more words. I imagine that many years ago pediatricians and academics were pounding out papers telling us all that allowing our children to listen to excessive amounts of radio would soften their brains. Soon we will unearth a scroll in which various high ranking courtiers were predicting that excessive reading of the products of Guttenberg’s printing press would lead to the death of conversation and a diminishment of listening to the lute. None of these doctors and experts can explain to me how listening to and watching television is worse than listening to parents. I gather that it’s that awful word “interactivity”. The child will, I am told, be more linguistically adept if the activities in which it is engaged involve some sort of back and forth. None of these doctors seems aware that what goes on in a child’s head is entirely opaque. When my daughter watches a television program she laughs at the jokes, she covers her face at the scary bits and she switches channels when it’s boring. This indicates at least some form of thought for which we must now use the word “interactivity”. She is reacting, she is thinking and she is probably listening to people with better grammar than most parents. The only reason parents want the television turned off is because they want to talk to their child. They want to know what is going on in their child’s life, at their school, with their friends. Here’s what’s going on in your child’s life: everything is more interesting when she is watching television and less interesting when she is talking to her parents: school is dreary and utter drudgery: she does not want to discuss her friends because that’s private stuff and interesting precisely because you, her parents, know nothing about it. As for the younger than two year old, she likes bright colors, she likes the songs and the songs teach her language better than you do.

I am contemplating earlier generations who had much less television, including my own. Without going back too far let’s list a few of the things that these linguistically adept people have given the world. The First World War. Soviet Communism. The Second World War. Vietnam. Trickle Down Economics. Rupert Murdoch. Apartheid. Need I go on? Had earlier generations been watching more television there might have been greater harmony. I have stood in a pediatrician’s office and been told that my child should eat low fat food despite massive evidence that eating less fat is about the worst thing you can do for your health. The same doctor told me that we should play Mozart to our child. There are no words in any language for how utterly fatuous this notion is. I have conducted a study recently that took me about thirty seconds and involved precisely one participant, myself. I asked a simple question: Which is worse for your child, watching television or doing what pediatricians tell you? All the evidence I have gathered in the thirty seconds of the study suggests that your child should watch television. It’s funnier, it’s better written, it actually is intended for the child and not for you or your child’s doctor (and to sell lots of toys, as opposed to your child’s doctor who is trying to sell you lots of drugs) and it is utterly harmless.

More Noise

It seems I have been bitten by the language bug since my now ended silence, I cannot stop analyzing what people are saying. Today I read about another political misstep by Scott Brown, soon to be former Senator from Massachusetts. It’s not that I am particularly focused on this man, it just happens that he embodies a certain approach to both political turmoil and the language he and his associates use to try and extricate him from his difficulties. What people forget in their times of trouble is that others do not forget. The political chattering classes will always tell us that such and such an incident will be forgotten “come voting day”. What actually happens is that the arc of the story of any given individual allows us to set aside certain mistakes, foibles and peccadilloes. We all knew Bill Clinton was a philanderer but it was his very success as a philanderer – his charm – that made him so appealing (cries of shock and horror at such a notion). No, we did not take to him because he was good at seducing women, he was someone whose ability to charm translated into what we call charisma. Others were notable seducers (Gary Hart, John Edwards) but lacked whatever it is that transforms good whisky talk into overwhelming public approval, though Clinton’s very small electoral victories seem to belie the notion of the extent of his skill. Part of what Clinton did, or John Kennedy in his time, was subtly alter the message depending on which constituency he was aiming at. Clinton was more Southern in the South, Kennedy more Catholic in the Northeast. Obama has that same skill, though his charm is not as warm as either Kennedy or Clinton. Clinton, like Nixon, looked straight into a camera and lied to the entire population of the United States, yet he left office still very popular. How? Clinton winked.

The first thing of any consequence I ever taught my daughter was how to wink. With this wink I also taught her to pucker one side of her mouth and use the side of her tongue to make a clicking sound as she winked. I told her that this would carry her further in life than anything else she would ever learn. Why, then, was Sarah Palin’s winking so abjectly unsuccessful? Well, take my daughter’s wink and click. She turns out to be a natural. Had I discovered that my daughter simply looked like someone with a facial tick I would have discouraged the winking. Sarah Palin is not a natural winker because she uses it only when the camera is on her. Clinton winks through life. Palin’s wink is a self conscious “see, I’m just like you” sort of activity while Clinton’s is a “wouldn’t you like to be a member of this club?” motion. Nixon was incapable of anything remotely associated with winking. I have noticed that the people who wink more than any other are the Irish. We consider the Irish to be very charming but, as I like to say, you don’t have to live with them. So, Clinton’s, or Kennedy’s or Obama’s story is what attracts us and we choose to set aside the less comfortable aspects of their personalities or styles. Recently Scott Brown made an insulting remark regarding his likely Democratic Party opponent in next year’s Senate race, Elizabeth Warren, specifically about her appearance. This will not be forgotten because it is the opposite of Clintonian. Remarking on a woman’s appearance is the least charming thing you can do and cannot be set aside because it indicates how you will regard women’s standing in the legislative process and how slightly you regard the effect of legislation on women. Whatever it was that Clinton exuded it reassured us that he would not slight women, no matter the position of his pants while talking to them in the Oval Office.

Scott Brown has been caught plagiarizing the text of another politician’s website for use on his own website. When this copying was brought to his attention he had this to say: it was the fault of one of our interns. That sound you hear is a hammer blow to the coffin lid of Scott Brown’s short political career. “The Intern Did It”. If you scoured all the dictionaries of the world and commissioned speeches from all the great wordsmiths of the political universe you could not have come up with a string of more politically fatal words. Even under normal circumstances this would not be a good response but when thousands are camped on Wall Street and at City Halls and outside Federal buildings demanding that ordinary people get a fair shake, ordinary people who would be glad to have a job even as a lowly intern, you really have shoved a blade into your own artery. What possesses people in such positions to say these things? As I like to say in regard to Afghanistan or Iraq, why didn’t they just ask me? I could have told them. And if a sometimes employed actor in Echo Park Los Angeles could have told you, you know you’re in trouble.

The End Of Silence

“Ralph’s”. That was the first word I have spoken in two weeks and it was said not to my surgeon or vocal therapist, not to some close family member, but to a parking lot attendant near the University of California Los Angeles in the parking lot of a grocery store. This was another instance of the deference we pay to complete strangers, as I mentioned before when recalling the accidental clipping of someone’s heel in a movie theatre. One of the most despicable elements of visiting a medical facility in the United States is that you have to pay for parking. In the case of UCLA the rate is exorbitant. However, nearby is a Ralph’s grocery store that offers free parking for two hours. Usually this lot is unattended, you simply take your ticket from the dispenser, go about your business and, as long as you stay within the two hours, away you go. For some reason – almost certainly the likes of me who use the Ralph’s lot to avoid paying the UCLA fee – there was a uniformed Ralph’s employee (an understated lightish burgundy vest over white shirt and black pants) asking people as they emerged from their vehicles where they were going. In my guilt I stated “Ralph’s”. Had I payed UCLA’s wad of money there would have been no question asked and even if there had been no guilt would have forced me to be polite, compensating for my criminality by appearing wholesome and well mannered. My silence would have lasted until my appointment with my surgeon. So, there ended my odyssey in the last of the morning shade on the rooftop parking lot of a Ralph’s grocery store in West Los Angeles in the presence of an entirely oblivious but neatly dressed employee of a large grocery chain, whose sushi counter, by the way, is very good.

I have noticed something else in all this. I refer to the woman who removed the cyst in my throat as “my surgeon”. Why do we become possessive of the people who treat our ailments? She is just as much the surgeon of the person next on the appointment calendar and yet I, and almost certainly that next person, call her “my surgeon”. Illness breeds an awful sort of dependence and sometimes a dreadful resentment. I can remember my father being gravely ill in the nineteen seventies and the futility with which he attended his frequent appointments, the quiet rage and frustration that accompanied the apparent dying of his lungs. When he changed doctors a new diagnosis cured him almost miraculously. This past Summer I went to that doctor’s practice, where my parents still go, and was told that the doctor who re-diagnosed my dad is still alive, in his nineties. Without hesitation or sentimentality I said “Dr. Williams saved my father’s life”. I imagine my father is very possessive of Dr. Williams. What that experience taught me is that doctors are mostly guessing. Informed and educated guessing, but guessing nevertheless. This is not to be resented but it should be understood and the best doctors will tell you this themselves. I am ever grateful that one doctor guessed correctly. I also discovered that the cyst that was removed from my vocal chords was unusually large, possibly freakishly large, thus the very long enforced silence. Now, the surgeon, my surgeon, had told my wife while I was still unconscious that the cyst was “bigger than expected”. Do I regard this as a lie, perhaps a white lie, used to keep me calm and collected while I healed? Is it, perhaps, simple medical conservatism: nothing is so strange that it cannot fall within the parameters of “bigger than expected”? I appreciate my surgeon’s discretion, rather like my own with my daughter whose most frequent question is: “Daddy are you lying?” To which my usual response is: “Sweetheart, all parents lie to their children all the time”. Like the wonderful medical people at UCLA I am in favor of a mixture of the deceptive and the brutal. It breeds relaxed patients and world-wise children. Though my child almost certainly knows there is no Santa Claus she’s too smart to say so or she’ll miss out on an extra present.

And so, off into the world of speech, little by little. I have photographs of my vocal chords, Before and After, and I shall keep them close.

Silence Day Twelve

I am assured this will be my last silent day. At the very least it will save the paper I have been using to scrawl my notes and I will no longer be posting my ramblings here. I can go back to wasting my time in the ways I always have. I am now faced with the question of what might my first word or words be after almost two weeks of silence. It’s a little like the opposite of a dying remark, famous first words. My daughter’s first words were incomprehensible though we did distinguish the word “Daisy” fairly quickly, the name of the dog who still lingers. She also wandered about saying something like “skoowonday” and we finally realized she was reciting a line from “Mary had a little Lamb”. She was saying “school one day” as in , “It followed her to school one day”. It’s only when you have a child that you realize what a monumental achievement the learning of language is and what a strange hybrid creature we have in English. All that mixing of the Angles and the Saxons and the Romans and the French and the Germans. Even some Chinese (Ahoy and Ketchup and, occasionally, Gung Ho). If you are foolish enough to hang around in the places I grew up you’ll hear odd grammatical constructions that are born of Irish usage and torture of the language of the oppressor. Oddly there are very few Irish words in English though I believe “brat” is one instance. One of my favorite linguistic moments was on a bus in my home town, Birmingham, in England and it demonstrated the future better than any gadget or academic study. A young man got up from his seat and was greeted by a fellow passenger who had not seen him earlier. Their conversation was in Urdu since the vast majority of my neighborhood is now Pakistani. The young man who had stood was surprised to see his friend and rattled of a greeting in Urdu in the middle of which were the distinctly spoken English words “fucking wanker”. So, the quickly spoken greeting went something like: “Urdu, Urdu, Urdu, fucking wanker, Urdu, Urdu”. What was so marvelous about this was that Urdu clearly has no equivalent of the delicious and demeaning phrase “fucking wanker”. It also highlighted something about the adaptation to culture. I have no idea if Pakistani personal interactions are similar to those in England, where English people deliberately distance themselves from any sort of intimacy by deliberately insulting those they most love and like. Here was, probably, a young man who had been born in England to Pakistani parents, much as I had been born to my own immigrant parents, and he had adopted the English way of dealing with friends. Insult them. I wonder if there are any good Urdu phrases that could be adopted into English for insulting people.

About ten miles from where I grew up is the Black Country, the original industrial belt in the middle of England where the modern world was created in the Industrial Revolution. It’s where James Watt put the steam engine to practical use and out there they speak a dialect of English which is almost incomprehensible even to those of us who grew up close by. Now, technically, a dialect is a grammatically distinct form of a language and must not be confused with the way dialect is often used, to mean “accent”. For instance, Black Country folk (if you are looking for where this strange people live find Wolverhampton on a map and you are there) asking you if you wish to do something, for instance, go to the pub, will ask: “Yam gooing down pub?”. The word “going” here is pronounced as I have written it, a long “oo” sound. “Yam” means “are you?” This use of the word “yam” for “are you” has resulted in people from the Black Country being called Yam Yams by those nearby. While being derided as bumpkins it should be pointed out that the great James Whale, director of “Bride of Frankenstein” was from the Black Country as is Robert Plant of Led Zeppelin. Here’s a link to how to speak Yam Yam. http://www.youtube.com/watch?v=vrIqSlt9PXg

Now that we’ve all learned a little more about the varieties of English I must contemplate my first words from my reconstituted vocal chords. Should they be purely medical? “Did you biopsy the thing you removed?” is one possibility. More likely is: “This is harder than I expected”.

“I can speak again, my family will be disappointed”.

“How soon will I be able to yell at my child?”

“I am really sick and tired of this. Can I go now?”

My mother is dependent on hearing aids and cannot hear me when I call her on the phone because the hearing aids seem to present difficulties that neither of us understands. Though she will not be able to hear me much, if at all, it will be lovely just to have her at the other end of the line.