Pneumonia, on a Friday Night in America

The terror of being sick in the United States.

Image courtesy of Shutterstock.com

It’s a Friday night in the United States of America, and I won’t know I’m insured until Monday at 9 am. This is unfortunate because I’m seriously ill.

It’s important to know a few things about me. I’m in an upper middle-class economic bracket. I have a great deal of medical literacy. I’m white. Although not wealthy, I have all the privileges and protections one could dream of in this country. 

My husband was recently “phased out” at his job. His benefits ended November 30^th, so we decided to get Cobra.

If you’re not familiar with Cobra, here’s the rundown. If you’re terminated at your job and receive health insurance from your employer, you can continue to have the same health insurance if you pay a lot of money for it. We’ve opted to do exactly that, and my husband got it sorted this week.

“We’re good to go,” he said. “Covered for December. They said to just keep using our same card.”

But when I give my insurance card to the young woman behind the counter at Urgent Care, she says,

“Is this an old card? It says it’s inactive.”

I’m in Virginia taking care of my 94-year-old mother as her life winds down.

The more days I’m able to do this, the greater the chance her estate will not be wiped out in medical debt. We get care in for her on the days I’m not here. It’s $35 an hour. The cheapest we found is $30 an hour. Please note, this isn’t nursing care, but companion care. Nursing is much more expensive. It’s $9,000.00 a month to put her in a facility, and we want to avoid this if humanly possible.

I don’t have a doctor in Virginia because I live in New York. It’s Urgent Care or emergency room. When the receptionist tells me the insurance card isn’t good, my first thought is,

Of course.

There is always some red tape when insurance changes. It usually ends up being some weird technicality, one of the countless glitches designed to screw the American consumer any way they can.

We are probably fine. We are probably insured, of course we’re insured. They said we’re insured. We’re insured.

But the card doesn’t work, and because it’s 7 pm, it’s the weekend. This could get difficult.

I am very sick. I think I’m running a low-grade fever, but it’s not so low, it’s 102 F. I will discover within the hour I have pneumonia in my right lung.

When you take care of an elderly parent, there are no sick days. My brother and I work together to help my mom, but he has a full-time job. I’ve been powering through this illness, hoping I’ll get better. Because if something happens to me, what happens to her?

Because I’d been in the same Urgent Care earlier this week, the receptionist says she’s just going to process me under the same card whether it works or not. I have a $20 co-pay.

I try to call the insurance company. I get my hopes up because a human answers. I give her the rundown. She says she’ll transfer me to the Cobra office.

“Wait,” I say, “Could you just tell me if I’m covered?”

“No,” she said. “I can’t tell you. I don’t have that information. Please hold.”

I talk to the Cobra benefits person. I give her the rundown. It’s very difficult to understand her, but eventually she tells me she can’t help me, I must talk to the Plan Administrator.

What’s a Plan Administrator?

I don’t understand what this means and ask her to text me the number of this person. She does not.

What it means is my husband will spend forty-five minutes on the phone Monday trying to find out if we are insured, and there’s no way to know for sure till then.

The woman behind the desk at Urgent Care says,

“You were just here four days ago.”

Don’t get me started, honey.

“Right,” I reply. “I was told I had a tree mold allergy.” Then I ask,

“Is the same woman who saw me then working tonight?”

“Who did you see…I think…no, we have a PA tonight, a guy. I think that was actually Karen’s last day.”

The jokes write themselves.

Karen, who lectured me on the evils of antibiotics. Karen, who told me to clear out my sinuses and use the inhaler, and I’d be good as new in a couple of days.

I wonder what the odds are of being Karen’s last patient on Karen’s last day.

In an exam room, the PA walks in. I like him immediately. I’m coughing as he enters, and he says,

“Did you get prescribed steroids for the cough?”

Which makes me laugh, except laughing is just a cough with irony now. I explain that on Karen’s Last Day, she told me steroids don’t help a cough. (Karen is wrong.)

He examines me, then says,

“I think we need to do an X-Ray.”

Great. I know what this means. It never occurred to me I could have pneumonia.

He tells me I should take off my necklace. It’s tiny and silver. I can’t make my fingers work, and say,

“Could you…”

And he immediately comes over to help. There isn’t a whiff of resentment or attitude or not my job. He just walks over and finds the tiny clasp on my necklace to unhook it for me. He’s very gentle.

It’s a human moment. So much of the medical world has lost its humanity. I say,

“You must have a wife.”

“A husband.” He tells me easily, smiling.

“Ah,” I say, “Well he must wear jewelry.” This makes us both laugh. Then I tell him, because it’s the truth,

“He’s a very lucky man.”

“Thank you,” he says. “There. All done.”

To fully appreciate this exchange, you wouldn’t have to have lived my life exactly. But you might have to be a certain age, from a certain kind of place.

I’m in my original hometown in Virginia. Although it’s a bedroom community of D.C. now, it’s still conservative. I grew up here in the seventies and early eighties. The county is positively saturated with fundamentalist churches.

I graduated high school 40 years ago. It wasn’t simply homophobic, it was dangerous. If you were LGBTQ and wanted to stay alive, you kept your mouth shut. Slurs were part of the vernacular.

And tonight, this beautiful young man felt safe enough to say the word husband.

It moves me. I’ll never forget it. Because it means despite all the horror and hatred in our current world, things can change in a lifetime. He let me know who he is without worrying about who I might be. It’s no small thing.

A dose of hope on a bleak day.

I am X-rayed. I wait, and the PA comes in and says something about good news and bad, which always means just bad. He says he doesn’t like the look of my right lung; seems some pneumonia may be brewing. Something about a cloud.

He’s going to prescribe heavy hitter antibiotics and steroids. Take that, Karen of the Tree Mold.

“So I don’t have to go to the hospital?”

“I don’t think so,” he replies. “This antibiotic is strong. But I’m going to have a colleague look at the X-ray. Keep an eye on yourself. If you’re getting worse, you’ve got to get help.”

He tells me not to take the antibiotics on an empty stomach. We decide he should call them into the all-night pharmacy near the hospital; all other pharmacies close at nine and I want to start them immediately.

As I get in the car, I feel…not exactly dizzy; but the weakness is so pervasive I wonder if I can drive the couple of miles across the river. I decide I’ll be fine. I just need to not pass out.

When I arrive at the pharmacy, I explain I’m having trouble with my insurance card. They run it, then tell me my insurance is invalid. I tell them I’ll pay cash.

When I get to the checkout, it’s $104. The steroid cost less than a dollar.

I have $104. I wonder about people who don’t have $104 tonight. I know somewhere in America, there’s someone who doesn’t have enough money to buy the antibiotic which will keep them out of the hospital, because if they go to the hospital, it could bankrupt them.

This isn’t hyperbole. I once had a same-day knee surgery. The cost billed to my insurance was $170,000.00 with no hospital stay.

I go home, I get some food. I eat it and the antibiotic and take the first dose of steroids. Within an hour I feel like I’ve had ten cups of coffee. I try to Netflix my way out of misery.

A couple of hours later I lean back and shut my eyes. Maybe I can sleep. It will be good for me to sleep.

I start hallucinating. It’s like a bad acid trip. Truly disturbing images, monsters, terrifying things come at me.

I open my eyes because I can’t have this. What’s causing it? The steroids, the nuclear antibiotic, or the illness? Do I need to call 911 and tell them I’m hallucinating?

And what about my mother? I’ll have to call my cousin to come pick her up and keep her until I’m checked out of the hospital. If he carries her down the stairs, will her very fragile skin tear? Can I call hospice and ask them what to do?

But I can’t go to the hospital. Hallucinations aren’t going to kill me. I just have to suck it up. Keep my eyes open.

It does occur to me I could die. I am prone to hyperbole and mild hypochondria, but this time I don’t think I’m wrong.

My husband just returned to New York. My brother and sister-in-law live out of town. There are friends I can call, but I don’t know what to do. Everyone will tell me to go to the hospital and I can’t.

I am more alone than I’ve ever felt. I feel separate from the living. The fever seems to be consuming me. I’m breathing, but there is a weight to my lungs that’s awful. I have no strength. None.

I am not someone who leaves dirty dishes in the sink. The sink is full of them. Empty cups of water surround my bed because I’m trying to keep myself hydrated. I do not have the energy to return the empty cups to the kitchen.

I need to get up. I need Tylenol. I try to turn the light on, but the bulb burned out. I didn’t have the energy to go into the hall cabinet and get a new one earlier in the day.

I swing my foot around to stand up in the dark. I step on one of my mother’s adding machines.

Young people will have to google an adding machine, but people my age and older know they have a paper tape which records…adding. Numbers. They were used to keep a record of your math while bookkeeping. The adding machine existed before the calculator.

In the dark, I hear the adding machine percolating some mysterious sum my toes put together. I ask myself why I’m hearing an adding machine, then remember my mother used to sleep in this room. It’s probably a leftover from then. The sound is driving me crazy. I try to kick it back under the bed.

The house might be eating me.

I don’t want to die alone in this old house with my ancient mother who needs help I am no longer capable of giving.

We’re all going to die, and it’s going to be ugly. We are between two giant corporate entities struggling for every one of our dollars: corporate healthcare and corporate health insurance. We are not the winner in this situation.

My brother is a retired pulmonologist. We talk the next morning, and we run through everything. When I get to the part about the antibiotic, he stops.

“There is no reason—none—the antibiotic should cost $104. It’s been on the market for thirty years. It’s generic. I don’t know how they can charge that much for it.”

“They charge it,” I reply, “because they can.”

It is, after all, the United States of America, where consumers have a choice in healthcare. Competition is good for the consumer. Isn’t that what they tell us?

I don’t know anyone who has a choice about their healthcare. I do know many people who have no choice but to keep working in jobs they despise because of their healthcare benefits.

I’d just like to pipe up here and say my husband never gets to choose his healthcare plan. His company tells him what it is. They often change their mind and tell us we are switching plans. This can happen with a frequency I find incredible.

Invariably, the doctor who takes my current plan doesn’t take the new plan, and I must find another doctor. Invariably, I have a new deductible I must meet.

Choice is reserved for businesses. American workers are hostages to their health insurance plans, and most of us never had an opportunity to choose anything about it.

In thirty years, there will be twice the number of elderly people in the United States as there are currently. We cannot take care of the present amount.  

Republicans talk about the privatization of Medicare and Democrats talk about prescription prices. Gibberish. The entire system must be overhauled. We all need to know we can go to the hospital on a Friday night.

But tell me about the evils of socialist medicine. Tell me why virtually all developed nations have universal coverage, excepting the United States.

On Monday, we discover our insurance company will bill us on the 6^th and once we pay the bill we are retroactively covered from December 1^st.  They acknowledge we were not told this information.

“Why didn’t you tell me,” my husband asks them, “so I could pay the bill immediately and have immediate coverage?”

“You can’t be billed immediately. We bill on the 6^th.”

It’s December 6^th. I’m still unwell. My fever went up again yesterday. But as soon as my husband pays them today, I might be able to breathe.