The Last Letter from Melbourne

The Letter began simply as a way to let my American friends know how my year in Oz was going. But after the third letter (Halloween and Gun Control in Oz) I thought the Huffington Post would be interested in posting them. They were.
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I've been back in California for nearly two months - enough time to readjust to America: from driving back on the right side (not as easy as I thought) to listening to endless automatic telephone menus when I call the phone or cable company (actually worse, if any Aussie can believe this, than Telstra!). I've written a couple of "Letters from Melbourne (CA/ED)" which was supposed to mean "California Edition," but it's time to end the series.

The Letter began simply as a way to let my American friends know how my year in Oz was going. But after the third letter (Halloween and Gun Control in Oz) I thought the Huffington Post would be interested in posting them. They were. The most recent Letters can still be archived on

Then, over time as I made more and more Australian connections I began adding my Australian friends to the Letter from Melbourne email list. I was so pleased that these Aussies made it clear that they appreciated this American's view points and analyses on many, even familiar Australian subjects like footy or ANZAC Day.

But it's time to say goodbye for now. I met my primary goal in living a year in Melbourne -- which was to slow time down. My year was very, very rich and varied. It was not all good. Leaving my prostate in Melbourne was totally unexpected but in the process I met my best Australian mate who was there for me before and after the surgery. We had known each other for only two months but he supported me through the pre and post-surgery experience for which I can never thank him enough. But I think he also thought I was a bit of a hero when, for example, I showed up, at Jewish High Holy Day services, with a catheter in place -- I really needed to pray before the surgery.

My observations about the differences between these two overtly similar countries have been reinforced after being back here in the U.S. Australia is the more civil society, happier country than America is these days. The pressures on most Americans to maintain their standards of living appear so much greater than those on the Aussies. Aussies know how to work but they also know how to enjoy themselves. Americans are so pressured and worried, they've have forgotten how to play without their phones or iPads connecting them to their work.

Aussie friendliness in the work place seems authentic and genuine. While there are exceptions, much of the supposedly friendly exchanges at stores and restaurants in the Bay Area strike me as formulaic, forced or pressured. When the CVS pharmacy check out lady greets me as I walk into the store with a monotonic "How are you today?" I do not feel connected. Her greeting and motivation if anything is off putting.

In so many other American encounters I am feeling lawyers' legal influence on basic human interactions. So many exchanges require signatures, initials or listening to preemptory exculpations ("Your conversation may be recorded," "A listing of benefits is not a guarantee of coverage," etc.). The threat of suits and protection of rights have unintentionally but steadily added to the decrease of civility in American daily life.

The homelessness situation is truly out of control in the Bay Area now and throughout America. It is a gross national shame and has decreased the quality of the urban experience. I compared homelessness in both countries last year in The Letter. Australians, unless they have visited an American city, just have no idea how minimal their problems are compared to the American situation.

Some U.S. leaders feel that that the American homelessness can't be solved without some reduction in the civil rights of the mentally ill, e.g. more involuntary hospitalizations and treatment. But I realized Australian rights for the mentally ill -- being held for no more than 48 hours against your will in Victoria without a hearing -- is very similar to California laws, where it is 72 hours. So the differences in the magnitude of the problem between the two countries is not because Australia is tougher on the mentally ill. Might the difference between the two countries have to do with Australia's $19 an hour minimum wage compared to America's $7.75?

Working as a behavioral pediatrician in Australia helped me immeasurably in my professional life as well. I recognized that I'm "not crazy" to feel that American healthcare is out of whack when it comes to the diagnosis and treatment of children's emotional and behavioral problems. As an M.D. in the U.S. I am considered a virtual heretic for not medicating every child who comes into my practice.

In Australia, by contrast, I was considered a relative proponent of medication. It was so refreshing to work with Australian psychiatrists and pediatricians who were still committed to non-drug strategies for children and their families. I really needed their particular injection of reality. Upon my return, I have renewed energy to continue to resist the American corporate world of medicine where the influence of insurance companies and big Pharma predominate.

My surgery in Melbourne offered another unexpected benefit. Planning the year in Australia I had signed up to be a medical provider. I wound up also experiencing Australian health-care as a patient. Overall my care was absolutely first world excellent. Indeed, my PET scan to rule out metastases (there were none) was a quasi-experimental procedure performed in only four other sites in the world (apparently San Francisco coincidentally is one of them).

But I completely was taken by Australian informality even in the hospital. My discharge orders were written on a Friday and I could leave ANY TIME I WANTED on Sunday. I signed only a one-page form to authorize the PET scan. There would have been several initials and signatures required in the U.S.

I saw the simplicity of the single payer model in operation and wished that I could have participated. As a non-resident alien I learned to automatically approach reception with my credit card extended saying "Overseas, non-Medicare, self-pay." The receptionists were often confused because everyone has a Medicare card and either pays nothing or a nominal co-payment.

I was also impressed with an attitude of health caring so different from the anxious, legally driven U.S. model. I'd summarize the Australian system as treating the patient with "You'll be alright, mate," versus the hand-holding, suit-fearing American system. I must admit initially I felt a little uneasy with the single scheduled two-week post-op visit with a nurse but of course it worked out fine.

Australia ain't perfect. I noted so many of the social/economic trends that have led to a second Gilded Age in the U.S. (the one per cent phenomenon) operating in Australia, especially the exorbitant real estate prices and tax-benefits to the wealthy like negative gearing. The Australian media tended to glorify excessive luxury consumption much like Americans. Indeed, the Australian cautionary caveat of "Don't be a tall poppy," is waning. "Watch out Australia!" is my advice - if you don't want to become another America. Most Australians I met are aware of these trends - but it will take great national Aussie resolve to avoid the tentacles of the efficient but amoral global market economy.

Australia's success and attractiveness makes it a haven for legal and illegal immigrants. Australia has successfully moved from a whites-preferred immigration policy to a successful multi-cultural melting pot. But it's handling of illegal immigration has resulted in the international scandal of Narau and Manus, Australia's equivalent of America's Guantanamo Bay prison.

Perhaps my biggest take-home lesson I learned had little to do with Australia itself. Pulling up stakes in the U.S. and setting ourselves up in a new country at the age of sixty-three turned out to be much more physically challenging to my wife and me. We may have had the drive of forty-somethings but our bodies were mid-late middle age. We often were so surprised how physically tired we were during the specific times of transition (It took nearly three months to ready our home and my office for our departure from the States).

But on the other hand our Australian experience left us confident that we could handle nearly anything. Apparently I'm not completely done with my prostate problem as I have had a recent bump-up in my PSA which is calling for a visit to a urological oncologist. No worries - there's still no evidence of anything beyond a local problem but further treatment may be warranted. My year in Melbourne has me feeling strong that Denise and I will competently get through this challenge as well.

So I'm back "home" and the treadmill beckons. I've learned from the Aussie way of life. I'm going to try to work a bit less. I've changed my hours in the office so I'm less tired. I'm committed to not falling entirely back into a rigid routine because while comfortable and predictable, routine makes the time I have left speed by too quickly.

I am very grateful to all of you who have read The Letter. So many of you responded with support, occasional corrections and advice. Even negative comments were appreciated because I knew people were reading these missives. Writing The Letter became one of my most pleasurable activities during my stay in Oz.

I've been urged by a number of you to put all of The Letter from Melbourne into a book. I've scantly pursued this idea. If you have any contacts or leads, especially within the Australian publishing world -- which remains much more robust and friendly to non-celebrity writers than the New York publishing scene -- do let me know.

But until I return to Melbourne - my hope is January 2018 (winter in California and summer in Melbourne) -- I'm signing off for now.

Best to all my mates on two continents


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