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How to Not Die in America

On the second Tuesday in June, I start to feel fluish. If this is 2016 and I’m still a freelance writer, I’m losing money immediately on the assignments I can’t complete because my vision is blurry and my thoughts are erratic. If this is 2013, I am soon taken off the roster at the cafe where I work.

I am out of my mind with anxiety as I hobble to the clinic, sweating, and pay $60 for cough syrup, $300 for the 10-minute visit (if I even have that in the bank; it’s about a week’s worth of my earnings slinging coffee). Once I realize I can’t keep down the cough syrup and start spitting up bile, maybe I’m so feverish and broke I stay in bed without realizing the bacteria I’ve inhaled is more lethal than the flu. So perhaps I just up and die right there.

But let’s say I somehow make it to the hospital. A friend drives me, because a 15-minute ambulance ride can cost nearly $2,000, which I don’t have. I’m struggling financially and I’ve fallen behind on my ACA payments. My friend realizes in the car I’m not making any sense, and that’s because my organs have already begun to shut down. My temperature is well over 100. When the doctors can’t figure out what’s wrong, they submit me to a credit check before advanced treatment.

 My credit is awful. I have a massive, unpaid bill from a few years back when someone made international calls on my stolen phone. Maybe, because of this, I’m transferred to a public hospital, where there aren’t 20-odd specialists to arrange an “unusual” surgery. Doctors are required to stabilize a patient, but they aren’t required to, say, stabilize a patient just long enough to keep them breathing and take them to another hospital with a full infectious disease wing to do something risky. So maybe that’s when I die, before they even figure out what’s wrong, because I’m not the type of patient whose financial health can support an elaborate, life-saving procedure.

But even if the hospital could be convinced to ignore my distinct lack of liquidity, in one of these alternate timelines I don’t have a parent with the time and language skills and resources to come down to New York and negotiate with doctors who need a legal surrogate to parse a series of difficult options. It’s not like I can do it myself, in a medically induced coma. And already, two days after being admitted, I am racking up bills for anesthesia, the input of six specialists, radiology, and antibiotics that come to nearly $30,000. And without the treatment, which costs an additional $12,705 for just for a few hours of the surgeon’s time, I am dead.

Let’s imagine, though, that I get lucky and my mother makes it to New York in time. She demands they do anything within their power to save me and puts up for the surgery, using her own credit. She convinces the paper-pushers she’s good for the bills. I am, after all, her only child. I’m in the ICU for 10 days; the baseline cost can be up to $10,000 a night, which doesn’t include the ventilators, the sensors, the multiple IV drips jacked directly into my neck.

By the time I’m out of the hospital, we have been billed $642,650.76. If this is a few years earlier, the well-regarded medical center where I have just spent nearly a month is flat-out refusing requests for financial aid, sending bills for emergency surgery to a collection agency that puts liens on the homes of patients’ families and forces them to foreclose. I’m probably not aware this is happening until I’m back in my apartment, on a three-times-daily schedule of antibiotic IV treatments, which have to be administered by a home nurse. She’s expensive.

In this version of the story, I have survived, but been without a paycheck for the better part of the summer. Around the time I run out of oxycodone and start waking up in tears, completely paralyzed by pain, the medical bills have begun to pile up on my stoop. I am woozy, spending long, featureless days in bed, trying to remember what kind of person I had been before I went under, and I need help to raise my scooped-out torso from bed. I can’t lift anything or cook for myself or walk more than a block. Maybe I fester for awhile in a rehab center, in the absence of there being anyone readily available to make sure I don’t waste away.

Never mind recovering physically or financially in any of these scenarios: I can’t imagine surviving emotionally, fielding calls from collections agents, facing eviction, waiting for the pain meds to hit so I can keep at a futile job search with an IV still dangling from my side. I am 29 years old, with no pre-existing conditions before this moment, and I am unemployed and exhausted and in pain all the time.


Of course, this is not what happened to me. I am not one of the 28 million Americans who are completely uninsured, or one of the 45,000 people who die every year for lack of coverage. I am not one of the 3/4 of U.S. citizens who don’t have access to paid sick leave, and I don’t live in one of the 45 states without short-term disability plans. I’m not one of the 30 percent of insured consumers who are slapped with hefty surprise bills after a hospital visit. Which is why I did not become one of the millions of people who default on their medical debt every year, regularly making healthcare bills the leading cause of bankruptcy in this country.

Instead, on that second Tuesday in June 2017, I found myself in what I worry could be a fleeting moment in my life, one in which the institutions around me find it advantageous to protect rather than screw me. I find it baffling that, since my illness, well-meaning people have repeatedly referred to me as a “survivor,” as if the fact that I got to go on with my life had to do with some inherent moral strength, rather than the material forces put in motion long before I got sick.

That whole week last June, I worked from home, assuring my editor I’d be back in the office shortly. “I haven’t been this sick since I was, like, 8 years old dude!” I told her over Slack, the same day I would be put into quarantine. We have generous time-off policies in our newsroom, thanks in large part to our union. I was told to rest and get better. I didn’t.

A major feature of a person’s twenties is that while you’re ostensibly old enough to take care of yourself, you haven’t really lived through enough to be cautious. As someone with a pack-a-day habit, I got a little sick every year, and my response was to sleep (or work, or drink) through it until the issue somehow resolved. Before 2017 I don’t think I’d been to a doctor in about five years—though as was later reiterated to me by one chagrined specialist after another, my abysmal life choices up to that point didn’t end up making much of a difference.

Either from feverishness or denial, the conviction that I was simply a little sick remained well past any logical point. I have health insurance now, but I’ve spent portions of my life without it, and with my organs sputtering and a spiking fever I wasn’t exactly thinking clearly. I thought of the friend stuck with thousands of dollars in bills, picked up by an ambulance after a bike accident. Call it a reflexive reaction to living in a country where one-third of the population delays medical care out of concern for the cost.

A very expensive hospital room

After a weekend of still feeling off-kilter, I went to a clinic for cough syrup, which I quickly found I couldn’t keep down. Two days later, sweaty and half out of my mind, I stumbled back to the same clinic. I’d tried to brush my teeth and ended up spewing bile. The doctor didn’t even examine me: “The only way you’re leaving here is in an ambulance,” she told me. She wanted to call the hospital: I protested, still of the opinion that a hospital visit would be too pricey. I called a friend, who called a car, and we drove to the closest ER.

source: splinter

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