Wednesday, March 4, 2020

Healthcare for Most of Us

by Germar Derron

This is an award-winning essay that I wrote while in law school.

It was Sunday, muggy, and hot. I began a walk that I’d never forget. When I moved to Denver, into a hostel, a longtime resident shouted, “they hirin’ at the King Soopers!” I soon learned that King Soopers is the Colorado take on Atlanta’s Kroger grocery stores. I never worked there, but I shopped there twice a week. I often walked, through storms and trudged through snow, not for the picturesque scenery, but out of necessity. The city bus was an option, but my feet were faster. They didn’t have a schedule to keep, and they didn’t stop at each block. Cabs were too expensive. Normally, I reached the store within 20 minutes. About two blocks into this familiar trip, I felt a very unfamiliar “crampish” pain in my abdomen—right side. I thought “dehydration,” then stopped at the gas station, where I sometimes waited for the bus. There, I bought a Sprite; then, I continued on.

The pain worsened, as I thought to myself, “get to the store, get the groceries, go back home, take a nap.” I drank more and more of the Sprite, but it seemed to fuel the pain, like lighter-fluid igniting hot coals. Finally, I tossed the Sprite. As long as I held it, I sipped it. The more I sipped it, the more my body revolted. I tossed it. The pain intensified.

I continued on, towards the store. This would likely be my only chance to pick up food for the next three days. I passed seven restaurants on my way to the supermarket. They were beyond my budget. I thought, “get to the store, get the groceries, go back home, take a nap.” The air was thick; the wind whipped. The normally-light jaunt felt like a footrace in mud. After an ever-intensifying 45 minutes, I reached the store. The pain surged. I loosened my pants, hoping to feel some relief. My head throbbed. It seemed as if the sun was unusually bright, and people were unusually loud, and everything was unusually slow. I thought, “get the groceries, go back home, take a nap.”

I wanted to call someone, but lacking a phone or person to call, I just walked. I wondered what was going on in my body. I guessed appendicitis, but hoped for gas, or constipation. I shopped furiously, with no care for what I grabbed. My shopping constituted the smallest items in the store. I often paid three times as much for travel-sized items. I never bought in bulk, and I never spent more than 20 to 30 bucks. My normal routine included filling my book-bag with a few items, then carrying a large plastic bag in each hand, right and left. I lived in poverty. Premiums paid out of necessity are one of many unseen, unreported, and unfair expenses of poverty. I bought a big box of detergent once. For the next three days, I couldn’t lift my arms without wincing. On that day, I made sure to get a small bottle of concentrated liquid laundry detergent. I also bought the healthiest, cheapest, transportable food items available: frozen dinners, tortillas, and soda.

By the time I made it out of the store, the pain tore through my belly. This was childbirth, but not at all. The short walk home became an impossibility. It felt like an infuriated warrior stabbed my gut—over and over and over. The pain never eased, it only spread. I had to find a hospital, I might be dying.

Luckily, I shopped at a strip mall, one of the last places in this country, where one can find a pay phone. I dialed 911. A crowd gathered. Everyone knew that “something” was happening. Apparently, the authorities informed the store manager, because he raced out to find the cause of the disturbance. People mumbled about theft, violence, and mental illness. No one seemed to think that I might be a victim, or in need of assistance. I dropped my bags and clinched my side; food rolled everywhere. I informed the crowd that I was in pain, and had already called 911. The crowd dispersed.

A fire truck arrived within five minutes, and I thought, ‘“kcuf.’” I understood that when the call goes out, first come serve first. Of the emergency responders, firefighters often respond first because fire emergencies are reported less frequently than crimes and medical emergencies. They asked questions, and took vitals. I raised my hand for some reason, and my loosened-pants opened wide. I was “exposed” at the local grocery store, but I was in far too much pain to care. The ambulance arrived. Though I was present, and responsive, it was all a blur.

In the ambulance, I noticed that a young man took care of me, while taking orders from an attractive older woman. Training. Their new guy controlled my fate. I listened while they debated incessantly about my heart, appendix, kidneys, and intestines. I remained totally exposed until the trainee put on gloves, and made me decent again. He asked what hospital I preferred. I lived there for only a year or so. I knew no hospitals. I moaned a response: “the closest one.”

Denver, Colorado must not have many hospitals. When we finally arrived, I realized that I lived on the other side of the tracks. The hospital smelled like a potpourri factory. The halls were lined with beautiful paintings, roses, and candy cane. The staff catered and cooed, until they asked for an insurance card. I had no card and no insurance. I tried to enroll in a school plan, but they were too expensive. I worked two jobs, as a student employee, and never thought much about my lack of benefits. As a new resident, with no “real” employment, my options I had no options. Before moving to Denver, I received coverage from one of the big-three insurers. My monthly payment grew to $280 per month. As a student, my income averaged about $700 per month. I could never afford to pay as much as half of my total income to insurance, just in case something happened. Something happened.  
They said that I would see the doctor. Once I said, “no insurance,” no one mentioned a doctor again. But I heard him, just beyond my door, talking to the nurse. I asked for water multiple times. She responded twice, “no, not until we know what’s wrong.” After my third request, she asked the doctor.  He pleaded with her to get me water. “It’s likely a kidney stone. He’ll need to drink as much water as possible.” The thirst hurt almost as much as the stone. She filled a cup with water from the sink. It was warm. I could see a water cooler only three feet away.

I moaned and groaned for about 30 minutes. The pain hit nine (of ten) and remained. I explained that I took acetaminophen for pain, and possessed an unfilled prescription for anti-depressants. I could not afford seven to ten dollars per pill, especially for a Primary Care Physician’s assumption. While I moaned, I could hear them discussing me, as if I wasn’t there. They mentioned mental illness, drugs, and insurance. They confirmed the kidney stone, but believed that my response to the pain was an overreaction. My only actions consisted of muffled moans, and a slight arching of my back. My suspicions were confirmed when I saw my release papers. Part of the written diagnosis included: “mentally ill patient refuses to take medication.” The statement was untrue and unfounded, but nonetheless included in my medical record. Someone gave me morphine, and after some time, I was pain free, and asleep.

I was doped, dazed and drowsy when the nurse first asked for a urine sample. I fell asleep. When she asked the second time, she was furious and unconcerned for my lack of cognition. She didn’t point to a restroom, or close the door to my room. I asked where I should go, to provide the sample. She said, “I don’t care.” I urinated in a cup, in the emergency room, with the door open, totally unaware of where I was, and what was going on. I did not like this fancy fragrant hospital.

Later, a man in scrubs asked three times if I was ready to go. Each time he woke me, and each time I quickly fell asleep. During his third visit, he didn’t take no for an answer. He said, “it’s time to go!” On that occasion, he yanked the I.V. from my arm and ripped the attached tape off. It hurt. The adhesive side of the tape was covered with my arm hair. It hurt bad, but did the trick. It woke me. I bled a little lot. There were tape-shaped wounds on my left arm. Those scars remained for years.
I stumbled towards the exit, with some papers in hand. “What’s the name of this hospital? What side of town am I on? How far away is my home?” I only barely understood how to take public transportation to school. I borrowed a phone and phone book. I called a cab. The cab cost $40. Fortunately, my account balance was relatively high for me at $60. But then, I realized that I lost my groceries. I vaguely remembered firefighters trying to get my food into the ambulance. I was in too much pain to care about a few frozen dinners. I told them not to worry. I regretted that decision for a week.

The bill arrived within a few days: $15,000.00. The nearest ATM displayed an $18 balance, half of my $36 average balance. I shared a one bedroom apartment with a drug addict. I worked two part-time jobs for ten and twelve dollars an hour. Both rates reflected pay increases granted due to my graduate student status and experience in the fields. The other students envied my extra two dollars an hour. I was Rudolph. Our Santa loved me enough to make me the leader, but simultaneously ensured my status as a pariah. At the conclusion of that summer, and my time in graduate school, I was hired. I was hired because of my education, experience, and expertise. The job paid less than minimum wage.

For me, this story, and those like it, embody the healthcare quandary. Reform is a necessity. Under every policy before, and every currently ballyhooed idea, the impoverished citizen, who needs the most, receives the least. All educated, hard-working, law-abiding citizens should have equal access to essential care, regardless of their class, status, or account balance. The Patient Protection and Affordable Care Act merely takes the first small step in the right direction.

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