Year: 2020

Exhausted but Learning

December 29, 2020 / Tamara

The week before the holidays I completed my supernumerary (orientation) period and I wrapped up my induction to the National Health Service (NHS) Foundation Trust. The foundation Trust, an important detail in the words, is a different type of NHS organization with a stronger local influence and some may say is leading to the privatization of the NHS.

During the holiday week I was christened as a solo nurse. I held my head above water but my arms were flapping the entire time. I have an impending doom feeling at work. Worried constantly I will do something wrong. Miss an important part of the process, a piece to the puzzle I cannot see right now. Be misunderstood due to the language difference. Or give confusing information to a patient for the same reason.

The puzzle of the commode chair going up the stairs

Communication

The other day I asked a patient who had fallen off their bicycle and scraped his legs an instinctive phrase, one I have recited many times, which could have turned out to be a very awkward moment. I handed him a gown and asked him to “get undress and please make sure to take off your pants”

“Pardon me?” he responded with shocked unsure look.

“Please get undressed including your pants,” and that is when I heard myself. “Oh, your trousers I mean, you can keep your pants on.” My explanation of having just arrived from the US did not soften the mood. The phrases I once recited without thought I now must alter.

Medications

As I mentioned before, medications are in locked cupboards that require a code to unlock. Inside the locked cupboard is another locked box with the controlled. The keys for the box and cupboards are held by the charge nurse but get passed around throughout the day depending on who needs them.

You prepare your own medication. I already got my first nick from an ampoule (yes that is the correct spelling or at least in the UK) bottle. Everything seems to be in ampoule bottles and I am still figuring out how to finesse them. We do not have a pharmacist to double check or prepare our medications. This week alone I prepared an insulin infusion, multiple antibiotics, and the trickiest was acetylcysteine for paracetamol (Tylenol/acetaminophen) overdose. The acetylcysteine had to be calculated based on weight. Then drawn up from 5 ampoules, pushed into an intravenous bag filled with glucose. But first I had to create the 200ml intravenous bag since there were only 250ml bag. Talk about thinking things through.

Another revelation is narcotics are given out less frequently. I have not given out more than 10mg of Morphine in the last month, and that was divided between two patients; the first with a sternum fracture after blunt chest trauma and the other for a kidney stone. The first choice for analgesic is paracetamol 1 gram intravenous, which works wonders but is not used in the US due to high markup. How is society different when narcotics are given out more conservatively? I hope to investigate further…

Critical Thinking

I was told by a fellow US nurse working in the UK that once I got here all my critical thinking skills would be pushed aside. “Nurses are more tasked oriented”…. that’s what she said. Like everything this holds some truth, but I feel I do more critical thinking here than back home. Here you do not have a computer or an electronic medical record system (EPIC) to guide your triage. You have a bare box for your chief complaint to be described in less than 500 characters. Your knowledge base must be solid to differentiate a cardiac chest pain versus pulmonary emboli. Choosing those 500 characters carefully, remembering the PQRST of pain assessment. And you triage based on Manchester Triage System (MTS), which I am still learning, but also on your clinical knowledge. And as many fellow nurses know, not every chest pain is Emergency Severity Index (ESI) level 2.

Even with newness and overwhelming feelings I am still happy to be practicing nursing in the UK. Colleagues often ask me why I came to the UK which is not a straight forward answer but one I will elaborate on another occasion. But one of the key reasons is to care for the patient without the worry about the cost to them. Healthcare here is a human right, one that is given to all. I have had more than one person reply to this sentiment by saying “yes, it is nice to see at least some of your tax money coming back at you.”

I no longer have an anxious patient worried about their co-payment or deductible. Or the asthmatic patient who “bounced back” to the ED because they could not afford the prednisone, and now is in worse condition. Those stressors are no longer existent.

Colleagues

At least ten different countries represent the nursing pool in the A&E including Philippines, South Africa, Australia, Ireland, India, and Burma to name a few. We all choose nursing not for the high pay, nonexistent here, but for the desire to help people heal. We all come with different training and experience and we united to help those in need, a melting pot of nursing. Some with strong community ties bring food for each other and I often walk into the break room with a curry based picnic of sort.

The Hill

I wake up nearly every morning tired and sore from being on my feet for twelve hours, climb on my bike in the bitter cold, wearing five layers to stay warm. I bicycle up the steep hill towards the hospital. Some days I am defeated by gravity early. Others I inch a little further up the hill before I jump off to prevent toppling over. Slowly I push my bike the rest of the way. I know someday I will glide up the hill as though it were second nature. Until then I will keep peddling a bit further every day. The same goes for nursing. I have a steep learning curve and I know someday it will be instinctive to be a nurse in the UK. Until then I will keep learning and growing as nurse as I care for those in need.

My heart, his childhood. He is one of the reason we are here.

And so it begins…

December 12, 2020 / Tamara

Almost two weeks since I started working at Winchester Accident and Emergency (A&E) aka Emergency Room/Department and it has been a whirlwind. I am still working on processing everything I am learning. The onslaught of information has been exhausting.

Walking down the corridor I was brought back to my time in Haiti when it was so hot and humid with no way of cooling down. This time it is not the heat, it is the surplus of information that I have to process. I often want to run into the break room, take off my mask and drink another cup of tea, even though I just had one.

Going back in time with paper documentation.

Vitals aka Observations are paper documented and there is a whole process/booklet for mental health patients

Information overload…

I am processing a combination of information- English hospital policies and procedures, written and observed. Deciphering the many accents of colleagues and patients and different medical vernacular. And to top it off, differentiating between sincere British kindnesses versus them politely attempting to tell me it is done differently here. While the people from the southern United States are good at passive aggressive comments, the British invented and perfected it.

Florence Nightingale worked at Winchester Hospital and it is surreal to know I walk the same halls. The A&E was broken apart due to COVID then loosely pieced back together back. Prior to COVID it has three major areas, minors, majors, and pediatric. Now it is subdivided into roughly twelve areas that fall into two categories of hot or cold. Hot for high probability or confirmed COVID patients and cold for low probability or negative COVID patient. And in the sideline there is also an Amber section for all the “maybe” and a completely separate pediatric area. And each hot/cold section has its own section of chairs “sit to fit” (mid acuity patient, a healthy chest pain vs chest contusion), trolleys aka gurneys (same as chairs but unable to sit), and resuscitation.

Now I am the one with the accent

The vernacular has my ears sticking out. I have learned it is not dry heaving, it is retching. Giving report is “handover” as in “did you handover to the floor?” Transporting to xray you would “shift” the patient to xray. Vital signs are observations, so you getting a set of obs. And when I ask if they want me to complete an EKG (electrocardiogram: a quick Polaroid of the electrical activity of a heart) they look at me with a contorted face, till I correct myself by saying ECG. But maybe my favorite is “do you bleed?” It is how they ask if you are able to do venipunctures (blood draw) or cannulas (IVs). I keep wanting to say, yes I do bleed don’t we all, but I don’t want to cause unnecessary wrinkling of the eyebrows.

A pediatric needle for a blood draw.
I have never seen these before and they work great!

Certain things are the same, short staffing, lack of breaks, and making sure patients take off their brassiere before x-rays. But other things have my jaw on the ground. First there are no discharge instructions or paperwork, a note is sent to their general practitioner. The provider evaluates the patient; casually mention the patient is discharge well after the patient has left. But if the patient requires antibiotics prior to discharge you obtain it from the TTO cupboard (To Take Out) and just give it to the patient.

Oh medications, all medications are in cupboards (cabinets) with locks. No pharmacy verification or Pyxis machines (Pyxis: automated medication dispensing system supporting decentralized medication management. It helps clinicians safely and efficiently dispense the right medications, for the right patients at the right time.) You do require all IV medications including Normal Saline or NCl as it is written here to be double signed by another registered nurse. A bit of a nuisance but quicker than waiting on pharmacy as my fellow Washington nurses will related

The reality of the NHS

All discharge medications are £9.15 and paid for via a kiosk

A revelation I could have learned through Google prior to my arrival is that the National Health System (NHS) does not really communicate with each other. I imagine a country wide EPIC (electronic medical record system used in majority of Washington State hospitals) system but in reality it is broken up into different little branches “trusts” that do not really talk to one another because as my mentor stated “they are competing for the same funding and staff.” One Trust might be more advanced and better off than another.

Another shocker, children do not have annual visits to their primary care provider/general practitioner like in the states. Therefore, after immunizations are complete, the child can go the majority of their childhood without seeing a provider. Hence the importance of the A&E.

This is the tip of the iceberg. I have already written pages and pages of things I want to share. I just need to get them typed up. Things that have left me pondering for hours, a different way of practicing medicine in the A&E (ED) and funny stories all intertwined. I hope to have them ready to share soon but first I must continue to process all the information.

The last couple of days off have been a balance decompressing, life, and parenting. Decompression consists of numbing my brain watching bad rom-coms or playing games on my phone. Life is walks into town or through the local fields, runs, and of course laundry and dishes. Through parenting I am reminded that this will ultimately have the biggest effect on the world.

Questions for US Nurses

November 24, 2020 / Tamara

Last May I interview at the local Emergency Department (ED) with a Senior Sister (charge nurse) and the manger for my now current job. She asked about quality measures we follow in the US. I recited the ones burned into my brain, blood cultures first followed by antibiotics within 4 hours of a pneumonia diagnosis. The catheter-associated urinary tract infection (CAUTI) bundles to decrease UTIs with Foley use. And a big one for the ED is having appropriate documentation and orders for patients in restraints. Both interviewers gasped “OH NO! We do not use restraints!” And “please tell us you will NOT put anyone in restraints.” During my previous shift I had put a combative child into four point restraints. It broke my heart and this was a welcomed concept. But then I wondered. How DO you manage combative patients in the ED? And more questions arose…

The things I learned as a bystander about healthcare since our arrival is that are two emergency numbers you can use. The first, 999, is equivalent to 911. Then there is newer non-emergent number 111. We used it during our isolation period when Gary had cellulitis. You dial 111 if you need help but it is not an emergency. Or if you are unsure if it warrants an ED visit. You might have a medical provider come assess you and then an ambulance might or might not transport you to the ED.

As in the case with our elderly neighbor, he got evaluated by a solo paramedic and then an ambulance was called to transport him. All ambulances have lifts, so there is no strain on the back. And this crew was all female which brought a smile to my face.

Questions…..

So fellow healthcare workers in the USA what burning questions do you have for me about the healthcare system and how things are done here?

I am taking note of them and hope to answer them via the blog as I document my journey as a nurse in England.

Yes I might have been the noisy neighbor taking photos but check out the lift and the
pre assessment vehicle

The questions I have come up with for now are

How do you get by not using restraints in the ED? Especially with a patient effected by drugs or alcohol?

Can you send away a patient to follow up with their general practitioners if it is a minor complaint without full ED provider evaluation? Like after getting triaged?

Do you have less tests or more test done since it is a national health care system?

Do you practice to protect your license less here and hence less unnecessary testing?

Will I get more quality time with patients?

What questions do you have for me??? Go the contact page if you are unable to see the form below to send me your questions

Life after Isolation

November 14, 2020 / Tamara

Last Saturday, just as we finished dinner and started on a game of Bananagrams we heard the “thump, thump, thump” of someone at the door. I was in the living room away from the front door setting up our beloved game and I asked Gary who was there.

Alvin with his sparklers given to him by the neighbor

Cheerfully he responded “the neighbors!” “Which ones?” I ask. “All of them” he sputtered. It turns out a gaggle of neighbors were at the door, they had come to guide us to the ridge for the Guy Fawkes Night celebration. A firework show was being put on by the city since due to the pandemic the traditional bonfire was not possible. The group waited as we masked up. They handed Alvin a light sabre sort of glow stick, he was in heaven. I felt like the first kid picked at the schoolyard. The fireworks illuminated the city. An appropriate celebration for us since earlier in the evening we had learned about Biden and Harris’s victory.

The neighborhood…

Our neighborhood is chatty and filled with playmates for Alvin. In the morning in unison we all walk to the neighborhood school. Alvin’s second grade curriculum (here referred to as year three) consists of cursive writing, fractions, multiplications, and Roman history. The students at public schools wear uniforms. An even playing field in my head; even if it is only a figment of my imagination, I’ll take it. We no longer have to figure out what to wear in the morning rush.

We walk, forced to be active keeping our health and spirits in good terms. Ten minutes to Sainsbury (think Fred Myer) or thirty minutes into town. The walks are lined with homes that remind me I am in a country that was bustling and industrializing when the United States was figuring out its independence. I reflect on the meaning of time as I pause and take in.

A door at The Hospital of St Cross built in the 15th Century
https://en.wikipedia.org/wiki/Hospital_of_St_Cross

The weather is crisp, the foot paths are layered with golden leaves. Our small home with a cupboard under the stairs includes a simpler way of life. No dishwasher, television (for now) or excess furniture in part because of a lack of a vehicle. It allows us to focus on the details previously covered with things. We laugh at words like pipping hot or heat on the hob listed on the back of food labels. We read, play games, still dance and take family walks. Two weeks out of isolation and I still feel as though I am in a dream.

Goal Accomplished….

So now what? I have reached my goal. Do I create a new goal? Do I rest and take a breath? Taking in the accomplishment that took years in the making, but for how long is acceptable? During isolation we occupied ourselves by unpacking, settling, and distracted with Alvin’s school work. Alvin now in school and with the days free I sit taking it all in. We are in England. I reached my goal.

The peace and joy that comes with this accomplishment are like a foreigner in my house. We see each other but we speak a different language. I could distract them with a drink or creating unnecessary tasks, but I am glad they here. In the past they have only visited, never stayed. Intrigued by these visitors my anxiety comes out to greet them. I recall reading once that happiness is like an organism. If you think about it too much you lose it. My anxiety takes the lead reminding me to not focus on the bliss. I am trying to sit with them but they are such strangers. I feel like an introduction at an AA meeting “I have a problem I do not know how to live with joy or peace.”

Brené Browns’s says, as a society we have a hard time accepting joy. It makes us vulnerable. I gently ask my anxiety to sit in the corner while I try to get comfortable with peace and joy. I voice my gratitude the neighbors, the vast open fields, the walking paths, time to write and read, a small minimalist home. All there to make them feel welcomed.

Things have changed.

We do not have the spectacular views of the Narrows Bridge at sunset, cocktail hour with neighbors or family stopping by for a quick visit. We do have children running down the street, big meadows for long walks and old buildings to remind us of the scarcity of time. And the space to learn to live with peace and joy.

Delightful Interiors: 14 days in Isolation

October 31, 2020 / Tamara

Even in isolation we got to observe the National Health Service (NHS) in action. As an American trained nurse eager to learn I observed. Gary had a couple of healing abrasions on his left elbow which got muddy while assembling the grill. The grill, one of the first things to put together, an essential item in any Glasgow house caused a sore elbow worse by the evening. We figured he had case of tendonitis since he had to tighten all the screws by hand, but next day his elbow and arm were red, hot, painful, and swollen; an obvious case of cellulitis.

We call the NHS helpline (111), an nurse advice line, to point us in the right direction. Gary was advised he needed to be seen by a general practitioner (GP) with in six hours. We explained we had just arrived from the USA, still in isolation, and had not established care. The nurse provided me with three numbers of “surgeries” primary care offices to contact. I called the closet surgery.

The receptionist stated Gary could get seen by a provider but first needed to fill out a couple of documents online. She guided us on how to submit paperwork and called us back less than hour later stating we were in queue to have a telephone consult with a provider. We connected via video with the provider after some technical difficulty due to poor WiFi on our end. She assessed Gary, reviewed his medical history, medications and then prescribed him antibiotics to be picked up at the local grocery store. The neighbor, also named Tamara, picked up the antibiotics which were free due to Gary’s age. She told us that children and elders get free medication. As Gary said “I am not sure if I should be offended.”

Pain Assessment

The pain assessment caught me off guard. The doctor asked if his pain was “extreme, does it interfere with your daily functions?” Gary not sure how to answer since it was severe but he was still able to get dressed and cook said “it hurts.” She proceeded to asked “does it hurt when you are not using it?” He said yes. I proceed to interfere and ask “Do you use the number pain scale, 0-10?” she answered no. I will learn more as I start work but for now I know providers ask if the level of pain severe, moderate, or mild and if it interferes with daily functions. In my eyes that is a much more appropriate assessment of pain.

In the time of Quarantine

We are in the final hours of quarantine. The time has been quite pleasant. We unpacked, put together furniture and even designated a junk draw. The house is comforting. The rooms have an endearing musty smell, the windows are weathered, and the toilets with their deep basins and odor of water that has stood too long all bring me back to childhood. This new house carries the spirit of my grandparents’ farmhouse in Rancho de Pena (Chihuahua, Mexico). Even the oatmeal taste like the avena mi abuela made and I find myself going after a second bowl.

Quarantine gave us the freedom to settle into our home with ease. We dictated our schedules. Cooking with detail, relearning the art of dicing an onion. We have dance parties or midday baths because we can. Build a Lego costume and Lego castles, not just Alvin. We do not get dress unless it is for ourselves. And at the end of every day, we do not rush to get ready for bed because we have nowhere to be in the morning so we read an extra chapter. We slow down and floss. The peace that has resulted from the last two weeks of quarantine feels likes a gift from the universe especially after the move. I am grateful.

The Mountains we climbed to get to England

October 17, 2020 / Tamara

Certain dreams materialize with ease, like booking a trip to Hawaii. Soon after your toes are sinking into the warm sand of a utopian beach as you snack on poke. But other dreams, the ones that define you, the ones that are at the cores of who you become, you fight for those dreams. We climbed mountains with every step of this journey; it challenged our goals, our beliefs, and confirmed once again that this dream is worth the fight.

For us, and especially me, England is that dream. It represents my desire to live overseas, travel the world with greater ease, gun violence at bay, and experience socialized medicine first hand. We did not have the comfort of “the company” moving our things. We had to save, make cutback, and work overtime to be able to afford this dream. I am making half, yes half, of what I made as veteran nurse in the USA. Why you ask? That will follow on another post but just know it has all been worth it.

As Ralph Waldo Emerson wisely said “To finish the moment, to find the journey’s end in every step of the road, to live the greatest number of good hours, is wisdom.”

The mountains we climb that led us to our Dream

March

Gary is proactive (for the first time in his life, his own words) and sends off for his passport renewal, so in two years he doesn’t have to it in England
Pandemic=lock down
Remote Learning/Homeschooling starts
Passport offices close. Gary’s passport is lost in the system. Online says to call. When he gets a hold of a representative on the phone, they tell him he has to check online.

April

I get contacted by the hospital stating they would like to move forward with hiring process, if I am still interested. Gary and I have a heart to heart whether it is good idea we move in the middle of a pandemic.
Waiting for the manager to interview me for the position

May

Now waiting for the hospital to issue my certificate of sponsorship
Waiting for Gary’s passport

June

Got my certificate of sponsorship and applied for my visa. Waited again for 3 weeks for the United States Citizenship and Immigration Services (USCIS) field office to open and schedule my biometrics (fingerprinting and face photo, confirming that you are who you say you are) appointment.
Original month of departure prior to pandemic has come and gone

July

On the 9^th Gary’s online passport status changes from “received” to “in process”.
July 29^th at 1pm was my biometrics appointment. I attend and it went smoothly. The lady that took my photo and my fingerprint liked my mask made by my good friend Adrienne. While at the UPS office, about to send off my paperwork to New York to the UK visa office, I notice #1 I had made an error on the application in my haste stating I had never been to England and #2 there was a page that needs to be sign at my “appointment.” I quickly got into my car, drove back during rush hour traffic to the USCIS office and made sure I was not supposed to sign it front of them. They kindly told me, “no, you just have to sign it and send it off.” As in regards to error #1 I Googled and emailed the UK visa office (every question you send them cost £5), Learned I needed to write a letter explaining the error, cross it out on the visa application and cross my fingers. A high anxiety day.

August

We came home from camping trip to find Gary’s passport had finally arrived.
August 17 2020 at 10am I got my UK visa and started working on Gary’s and Alvin’s visa application. Was told “no appointments available”.
On the 30^thbroke a toe on my right foot and was not able to run for six weeks, my primary method of stress relief. Wore a boot for the first week and could not work at the hospital.

For three weeks, everyday I checked for an appointment. My spirit were momentarily lifted as the spinning wheel turned then crushed with image above. After three weeks of my spirits getting weathered, I decided to go to the (VSF) Visa Facilitation Services Global offices in The Columbia Tower in Seattle without an appointment.
August 31, 2020 our day and experience at VSF office. We got Alvin’s and Gary’s biometrics completed and their visas applications sent off. Time to start planning our departure. Another 3 weeks of wait and see.

September

Looking for Renters: Blaine and Summer planned to live in our house the two year that we lived in England. We had been sharing a house since June a hidden blessing in the chaos of moving. Intrigued by the housing marking Summer and Blaine started looking for a small investment property. They fell in love with a cute house in a great neighborhood and we of course we relinquished them of any obligation they felt staying at our home. So we were on the hunt for renters and a property manager.
3 interviews later we found Deric, a great straight forward property manager. He told to depersonalize the house and paint Alvin’s bedroom.
Now we needed to empty the house of everything (rags, collection of mason jars, excess cloths, toiletries never used). Our things had two futures: it was either worth staying and went into the attic or garage; or it came to England with us. Anything that it did not fall into one of those categories left our possession.

Gary went hard to work in getting the house ready for renters
- the deck rail off our bedroom had rotted wood and need to be replace so the nail gun broke
- the back yard needed weed whacking so the weed whacker broke
- Repainting Alvin’s bedroom after the property manager pointed out the dirty the walls. Well it had been 9 years since we paint the room and a Alvin had lived in it for the last 6…
- Taking down our photos, filling the holes and painting. Realizing the paint is 10 years old and 10 year old pain clump up
- Building a temporary wall down the middle of the garage so we have a storage for our furniture.

Housing

Winchester housing. Called multiple “letting offices”, many of which told me (insert stern British accent) “oh no, oh no, you must see the property yourself” or “no, it must be you, you cannot have a proxy” or “there is a cold feet clause and that is why you must view the property yourself.”
Did the math for the cost ($$) to stay at an AirBnB that accepts dogs for the first month. But after multiple calls at 5am we found a realtor that would work with us stating (insert kind British accent) “Oh yes we did this for another family living abroad last month, not a problem.”
With the help of Charters Estate Agents and Wendy Harrison we found a lovely semi-detached home but they could not confirm Gary’s income and we had to pay a full year in advance pulling the money from our nest egg. Ouch, to say the least!
September 21, 2020 Gary and Alvin got their visas!

October

We booked our tickets for October 9^th and called British Airways to add Jasper to our ticket
Jasper, the world traveling dog, has his own story. But in summary he caused us to change our flights twice, chase after a UPS truck, and his crate caused me to have an epic melt down in front of a stranger. One word of advice, if you are moving overseas with a pet during a pandemic, just don’t, or pay the big bucks for a private carrier.

A blessing in disguise on October 4^th Yoshiko (step-mom) leaves for Japan since her mother is very ill and I get to spend a week with my sister Anna. Anna sleeps in Alvin’s room, consisting of only a mattress. The spare room bare since Blaine & Summer moved out. Alvin relishing the chance to sleep with us for the week.
Oct 5^th I noticed redness to my right eye which worsened even with ophthalmic antibiotic ointment. This led me to the ED, my first contrast CT and being diagnosed with periorbital cellulitis. I was placed on three different antibiotics. In the following week, the week we are scheduled to leave, I had three appointments with Dr. Deem an amazing, patient, caring ophthalmologist. The kind of provider that takes the time to listen to his patients. He treated me well and by the time I arrived in England I was almost healed.

October 14 mercury in retrograde
2 flight reservation changes later we are schedule to leave on October 16, 2020
17 October we touch down at Heathrow.
Things have been going much, much more smoothly! Not sure if it has anything to do with the fact we are in quarantine, but I will take it.

The journey to England was made bearable because of our hidden angels. They gave us hope in our moments of despair.

Wendy Harrison, our eyes in Winchester, taking time from her busy schedule as a mom and with two new puppies to give us a first hand glimpse at our house. She also picked up the keys, hid them so we could come straight home from the airport, stock the frig and brought over her own plates and cups realizing we had an empty house. And to top we found a bouquet of flowers with a welcome card. A woman we only met once as guest of her AirBnB. She is a true angel.

Blaine and Summer for helping us move furniture, giving us an excuse to buy ice cream, and being faithful Bananagrams partners.

Stuart for moving the heavy furniture when he should have been studying and taking most of our food off our hands.

Yoshiko for letting us live with her invading every corner of the house during our last week in Tacoma.

Rick and Lynn for hosting us at Seabrook during the peak of the stress, for letting us spy on potential renters from their house, for caravanning to the airport with our 17 bags, and for being great neighbors.

Sil Underwood Wong, for using her buddy pass and accompanying me to drop Jasper off in LA. This is after she was up ALL night at the emergency veterinarian office with a sick kitty cat. And for being my voice of reason during the epic meltdown.

Kelly Melton, for bringing me a killer lunch and keeping me company the day I was in the emergency department.

To Manny, for writing one of the most thoughtful good bye notes I have ever received. A ray of sunshine during the stresses of moving.

Dr.Deem, for being a great ophthalmologist and helping my eyes heal.

And to the many unnamed rallying for us along the way. You are not forgotten, you are the reason we made it.

Jasper the World Traveling Dog

October 16, 2020 / Tamara

A simple plan or we thought….

Oh Jasper the world traveling dog! With the visas squared away we booked our tickets using miles for October 9. Two weeks to wrap up our life in Tacoma. I call British Airways to add Jasper to our ticket. I thought he might be in the cabin with us or they would guide me on how to get him on the cargo side, still on the same flight. We learn that British Airways partners with IAG cargo to transport animals to England. And, is the only airline transporting animals during the pandemic.

Not so simple plan…

All other airlines require you to use a private pet transport company. The only IAG office on the west coast accepting animals during this time is in Los Angele. Great, not only need to travel to LA to get Jasper to England he will not be on our flight!

The IAG customer service representatives are working remotely from home and the method of correspondence is via email. They do not accept phone calls or provide you with a phone number. Therefore a quick 5 minute phone call took over two hours of back and forth emails in which I learned that Jasper’s processing time is 8-10 hours after arrival. We must now schedule our flight 8-10 hours after his since upon arrival we go into quarantine and cannot leave to pick up Jasper. We also learn he MUST travel cargo and cannot ride in the cabin on an international flight. Only service animals allowed to travel in the cabin. And Heathrow Animal Reception Centre (HARC) only accepts animals during the week. Our original departure date is now out the window.

The first change in our flight reservations: October 9th flight to Oct 14th. We request to book for Jasper to leave on the 13^th from Los Angeles International Airport (LAX) arriving on the 14^th, crickets. The HARC is fully booked on Oct 14^th. Second change to our reservations: October 14^th to October 16. Jasper is now scheduled to leave out of LAX on a direct flight to Heathrow London Oct 15^th allowing for the 8-10 hour processing time.

EEA Health Certificate

EEA Health Certificate: The EEA (European Economic Area) pet certificate aka “doggy passport” for Jasper required another juggling act of dates and appointment. First the EEA certificate needs to be completed by a FDA veterinarian (vet). Then it needs to be mail overnight to the FDA for their stamp, a literal stamp, of approval making it legit and sent back to us all within 10 days of traveling. To top it off Jasper needs to take a tape worm medicine in front of the FDA vet within 5 days of arriving which needs to be documented on the certificate. The catch…the only FDA vet at our veterinary’s office works part time on Tuesday/Wednesday.

October 7th she fills the health certificate it get sent electronically to FDA for their stamp of approval. Time is now ticking we have to be in England by the 17^th or at least Jasper does.

October 13 Jasper’s vet appointment for tape worm medicine. Still no update from FDA with the certificate which now needs to be amended stating Jasper received his medication. This is two days before Jasper departure date from Los Angeles.

The night of October 13 we receive a UPS notification that our package, the doggy passport, will arrive the following day by 9pm. The passport still needs to be amended by the vet. The vet kindly gave us her personal cell phone number and stated we could go to her house if the paperwork did not arrive prior to vet offices closing at 5pm. Since the following day I am scheduled to fly out at 6am to drop off Jasper in Los Angeles for his flight.

Jasper’s response when I asked him to get into his soft crate

Chasing the UPS Truck

October 14^th I took action. I called UPS to get the package delivered prior to the vet office closing for the day. The UPS phone representative indirectly state I could look for the truck by driving around my neighborhood, saying “well you could drive around and look for it if you wanted.” desperate I took it literally. Frazzled he wanted to take his words back but I was already turning my phone off. I started driving around the neighborhood using the UPS app that tracks the location of your package. I stopped and asked three UPS trucks driving till I found the sacred driver with my package. He asked what was so important that I was driving around looking for it. I told him an abbreviate version and by coincidence he said had lived in England for six months after the army. He loved it there. A small happenstance but one that made me feel I was on the right path even if it meant driving around stopping random UPS trucks.

Los Angeles

On October 15 one day before we are scheduled to leave to England I head to LAX with Sil a dear friend. She is a flight attendant and offered her buddy pass, her company and her to make sure things went smoothly, I gratefully said yes. We departed Seattle on the first flight of the day leaving behind misty cold fall weather and landing on a hot 93 degree LA day.

We walked around LAX dripping in sweat still wearing our layers from the Pacific Northwest looking the for the Uber parking lot and the shuttle to take us there, a mysterious invisible shuttle that is nowhere to be found. After an hour and multiple unsuccessful Uber requests I gave up and rented a car for the day. We took a random LAX bus to a bus stop where a van waited to take us the rental car office, a bit sketchy. In my haste I rented the car for the following day, not that day. The rental company kindly corrected my error. The hidden angels around us that give me hope.

After a quick jaunt to the dusty pee saturated off leach dog park near we LAX we attempted to drop of Jasper but the IAG cargo office but they stated we could not drop him off till 4pm. It as noon, we decided to get lunch and take a breather at the beach.

The Crate

We arrive at the IAG cargo offices promptly at 4pm. Sil and I planning to catch a 5:40pm flight back to Seattle. I filled out the paperwork, simple. I am about to send off Jasper when the attendant starts measuring the crate, then Jasper, then the crate over and over again. He notifies me that the crate is too small and Jasper cannot be accepted. He will be denied entry at Heathrow with his current crate.

The Meltdown

This was the straw that broke the camel’s back. Remember, I am simultaneously dealing with a bilateral eye infection. I start SOBBING, loud ugly crying, mad as hell at Gary for incorrectly measuring the crate and Jasper. The male care attendant fidgets visibly uncomfortable say “let me see if I have another one” and scatters away. 15 minutes later he comes back with a wooden crate big enough for Jasper. Jasper hesitant to go in but I entice him some treats and guide him in.

My eyes still weeping now for Jasper, being forced to travel in an unfamiliar crate. The care attendant tells me he needs to find go out the cost of the crate asking me to wait in the lobby. I let Sil know about the delay. Now unsure if will make our flight I start to plan for the possibility of spending. Still weeping, I walk to lobby carrying the unused crate. I am slowly letting go of all the stress, the grief of leaving my home, and bitter sweetness of it all. Allowing the emotions drain out of me. The universe gave me those twenty minutes to gather myself. The attendant updated me stating they were waiting to hear from Heathrow to find out the cost of the crate. Another ten minute after that they come back with the new total that includes the wooden crate. I pay. We return the rental car. Take the shuttle back to the airport. Grateful that is no lines at TSA. We walk on the flight, the last two people on the last flight to Seattle.

on our way to our new home in Winchester England

Just in case, the Visa Facilitation Services Global office

October 10, 2020 / Tamara

Written the day of the appointment

I woke up wobbly and grumpy in pain this morning due to my broken toe. I poured second cup of tea and started calling my doctor to get a work release note. Then I called the orthopedic doctor to get an appropriate follow up. Both appointments would be tomorrow, Tuesday, the first at 9 am and the second at 4:30pm. The same day I had calculatingly planned to go to Visa Facilitation Service (VSF) offices in Seattle to complete Gary’s and Alvin’s visas applications.

The VFS Global office is the UK Immigration third party visa processing center. To complete the application we needed the biometrics (fingerprints and a formal head shot) both of which were done at VSF. I thought Tuesdays are better than Mondays. Monday everyone wants to get seen, you are catching up on emails, phone calls and so on. Tuesday they will ready for us. But as we know, things never go as planned. So at 10am I resolved we had to head there today, on a Monday.

Columbia Tower

We arrived at the tall striking Columbia Tower and take an elevator to the lobby. From the lobby we took another elevator to the 40^th floor, made a right turn and to another elevator to the 42^nd floor. But we could not push the button to select the 42^nd floor. A badge was required; the only button we were able to select was back to the 40^th floor and then to the lobby.

At the main entrance, we asked the security guard about getting to the VSF office. The guard stated “their security comes every 15 or 20 minutes to take anyone up that is waiting, we have no phone number for them or any way of contacting them. That’s the way they want it.” So we hunkered down and waited.

We wait…

Alvin played on Gary’s phone. Gary played on mine. I sat stiff, heart pounding, palms sweaty. Determined, hopeful that this crazy plan to show up with no appointment would work. I could no longer keep checking multiple times a day to see if there were appointments. Every time it said no, my dream moved further away. The website did say they were accepting walk-ins but we were unable to get into their office or even a way to let them know we were there. I sat I hoped I had enough karma points to cash in this time. There was a changing of the guards and after 45 minutes I checked in the new security guard that stated the same information but he added “they are only doing scheduled appointments right now because of COVID so if you don’t have one let’s just hope someone else has an appointment and then they might see you waiting.”

Gutted once again but attempting to stay hopeful. My mantra, positive energy, good thoughts, positive energy this will happen. I sat with my uneasiness and breathed, in and out, over and over again. After another lapse of time, I saw a slender man with a button up white shirt and black slacks. He was speaking with the lobby security guard then started walking towards us! He was the one, Ben.

Hope

We explained the predicament we were in, unable to get fingerprint appointments for Gary and Alvin, and my visa vignette only good for 90 days 30 of which have passed. He confirms there are no walk appointment but tells us to go with him to see if we can figure something out. We follow him to the coveted 42^nd floor and wait while he gets his manager. I am holding my breath. We meet Tim, the manager, he asks us to follow him to his office. Unsure if this will work. I desperately explain again with all the details, he says he can help us today. I breathe. Since they are not taking walk-ins he creates an appointment for “right now.” So after talking, hoping, breathing, and fingerprinting. Gary pays the fees and their passports are in the hands of VFS Global. And according to them and we should back in 3 weeks with the UK visa!

I asked Ben why he checked the lobby this morning. He said he just wanted to see if anyone was waiting, just in case, since they were ahead of schedule. Grateful to have listened to my own gut and grateful to Ben for checking, just in case.