Doctors With Borders

Americans take the leaving personally

Speak no evil, gringo

The first New Zealand doctor I ever saw was an American. When she called my name, I heard at once the same flat, open vowels of the West where I grew up.

“Where ya from?” I said, as I sat down in the examination room.

“I’ve lived in New Zealand for thirteen years.”

She was a white woman in her late 40s, maybe early 50s. A seriousness about her. She had auburn hair and wore a pounamu, a pendant of traditional Māori greenstone, on a cord around her neck.

I waited but she offered nothing more. Then, god help me, I asked the follow-up:

“Where ya really from?”

She kept her eyes on my chart. 

“I’ve lived in New Zealand for thirteen years.”

Well then. She was one of us, alright. In my years among expats I’ve found only Americans—a fringe sect of us, but Americans all the same—will commit to such a complete rejection of home.

As we briskly completed the appointment, I told myself I’d have never pressed her if she wasn’t, or hadn’t once been, a fellow white American like myself. I’d grown up blindly assuming myself to be the national default; I figured she’d be conversant in that same absurd but very real privilege. The question only gets ugly, or so I thought, when aimed by the majority to a minority as an exclusionary request for identification: tell me how you ain’t like us.

Hadn’t I’d done the opposite? Hadn’t I asked, with that easy American intimacy and puppy-dog cheer, for the doctor to celebrate how much we were alike?

But papers, please is still papers, please. Any request for declaration of identity draws a border. In asking her to acknowledge her past or present Americanness I’d demanded that she renounce, in a small but very real way, the clinic where she worked, her neighbors and patients in the waiting room, the fading public health notices tacked up in the hall, the little town where we lived, and the entire island nation beyond. The doctor did not hesitate. She chose New Zealand. 

For me, this has never been a zero-sum question. Maybe it should be. Stand in the place where you live, as the poet said. There’s an admirable loyalty in the doctor’s insistence on making a home here and only here.

But doesn’t this sentiment come undercut by a faint nationalist tang? To so vigorously reject hybridity—isn’t this the creed of flag-waving zealots the world over? Certainly that’s long been true among certain so-called patriots of the nation she’s rejected, and only more so in the mad 13 years since she’s left.

Here in New Zealand, meanwhile, Prime Minister Christopher Luxon’s conservative government began its term with a controversial and now scuttled campaign to redefine the Treaty of Waitangi, the long-debated 1840 accord between Māori leaders and the British Crown that effectively served as a starting gun for mass European settlement. Their goal, it seems, was to change the nation’s founding document from an agreement “between the Crown and Māori” to one between the Crown and “all citizens of New Zealand.” See the trick there? One nation, under one hot take on history. No second opinions.

Dr. Thirteen Years would doubtless recoil at the comparison. The pounamu around her neck suggested that New Zealand’s Māori heritage was, for her, one of its chief appeals. As it happens, Māori culture calls for introductions to include a pepeha, a handsome summary of the speaker’s homeland and genealogy that can feel positively archival to footloose Americans like the doctor and I. But the contradiction here is precisely the point. What nationalists loathe is not hybridity—Luxon’s government didn’t ban the use of Māori names for government agencies, just shoved them back down the letterhead—but the notion that we’re free to set the levels in our own mix.

And that’s the best of us Yanks right there, ain’t it, doc? Freedom. Pursue that happiness, Dr. Thirteen Years, even if leads you across the sea. That tightness in her voice: leaving America was not an easy move. God knows what hell she left behind. Claude Rains to Humphrey Bogart’s lost American in Casablanca: “I like to think that you killed a man. It’s the romantic in me.”

Such freedom has its cost. Both Bogie and my doctor never tell, but Americans understand their secret not as evidence of a rational market-base choice or frustrating systemic failure but as a biographical burden the leaver must carry alone. British and French expats I’ve known around the world tend to bob along as British and French wherever they’ve landed, but Americans take the leaving personally. The U.S. government even publishes a quarterly (!) roll of “Individuals, Who Have Chosen to Expatriate.” The list is names and names alone, no forwarding address, set in brutal all-caps like a banishment nailed to the door of the village church. Note the comma, separating these crazy drifters from the nation whose heart they broke. To search the rolls for Dr. Thirteen Years would give the nationalists a win. (A little light googling, though? It’s the romantic in me.) I never did see her again.

Traitors :)

Fast-forward now to March 2022, when my partner Jenny had a life-threatening stroke. At one point in our five-month odyssey through New Zealand’s health system we found ourselves in a nearby rural hospital bravely holding it together through the teeth of NZ’s pandemic. The carpet was ratty, the staff overworked, the emergency room crowded in exhausted vigil. A radio in the parking lot’s makeshift testing tent whispered classic rock all night. At each morning and afternoon smoko, a positively Victorian tea trolley rattled down the hall.

Let me say this loud and clear: New Zealand’s public health system saved Jenny’s life. Someday I’ll write about that free helicopter ride. But there were many long tea-fuelled nights where I reverted to the medical-consumer werewolf required by my native system. We’ll be moving to the private clinic in Wellington, I told every white coat I saw. I brandished a checkbook. I growled on the phone. No luck: In NZ’s public system, such a transfer needed paperwork only the doctor in charge of the rural hospital ward could generate. 

Well then. When can I see the doctor in charge?

Soon, the nurse assured me. And no worries: “He’s American.”

As in, he’s that good? Or he’s one of you? But you can’t ask that.

“Do you know where in America?” I said.

She only shrugged.

The American Doctor finally appeared on a bright fall morning, borne into our sunlit room on a cloud of nervous exhaustion. He was a small man, white, unshaven, early forties, an intelligent face creased with worry. I rose from the fold-out sleeper. I’d spent days imaging this meeting and now had no idea how to begin. DeLillo knows. From White Noise: “I’m never in control of what I say to doctors, much less what they say to me. There’s some kind of disturbance in the air.” I opened my mouth and out came my accent. The disturbance, here, was America.

Where ya from? I wanted to shout. Why’d you leave? How long ya been here? Are you here forever? Isn’t NZ crazy?? What’s up with that tea cart? Straight out of Kipling, amirite? Like we’re sweating out malaria in the colonies? Whaddya say we get my lady outta this field hospital and somewhere fancy that will take my money? You and me, right? You and me.

Everything in its right place

This was not the be-my-friend bid I’d tossed at Dr. Thirteen Years. What I wanted now was the “special degree of concern” between fellow countrymen the (American) philosopher Martha Nussbaum allows in her landmark 1994 essay “Patriotism and Cosmopolitanism.” Nussbaum’s mostly rooting for the latter, as surely the American Doctor and Dr. Thirteen Years once had, too. One only winds up this far from home if you feel a broad kinship with your fellow human, whatever passport they hold.

Once you settle down, though, Nussbaum suggests it’s no sin to love thy actual neighbor more than the rest of the species. Did the American Doctor retain this special degree of concern for me, his fellow countryman? Or had he, like Dr. Thirteen Years, switched allegiances to his chosen homeland instead?

But this was papers, please all over again. Slow down, gringo. A Kiwi nurse got Boris Johnson through Covid, didn’t she? Doctors are supposed to be without borders.

I related Jenny’s case. The American Doctor watched Jenny sleep.

I’ll write the letter, he said, without meeting my gaze. Then he turned and left the room. 

Took another month or so, but we made it to the private clinic. A long year of recovery later I spotted the American Doctor at a popular local trailhead. Both of us were running our children in the creek. A very New Zealand scene: barefoot kids; cold, clear water; steep green hills thick with what I still struggle to call ‘native bush.’ The sun had slipped behind the ranges and twilight was falling fast. He walked towards me along the bank with the speedy grace of a practiced hiker, calling gentle commands to his kids.

I immediately ceased calling mine. I let not a single American syllable escape my lips. As he strode past we nodded, silently, as dads out there sometimes do. Then he gathered his brood and led them up the bank towards home.

---