By: Michelle Chin
I am a child again and my joints are limber enough to swing from the monkey bars without concern of injury. Youth assures me that if such a thing were to occur, I would be okay, regardless. Then, suddenly, there is a terrible day in the news and the public transit lines that bridge Manhattan to the outer boroughs and suburbia shake. Our teacher keeps us away from the classroom television and a social worker enters the room uneasily, knowing thirty years of this have not necessarily prepared her for these sorts of moments of national terror. Some parents do not return home, but mine did, and so I forget.
I am a teenager with a face full of acne that is worsened by the mounting stress of college applications and an unsuccessful topical cream. My parents had spent so much to even bring me to the dermatologist and my ungrateful body could not even respond appropriately to the drug that I was prescribed. I do not know how much the follow-up visit would cost, but I feign defeat with my skin, stating that I would rather wait until adulthood for my hormones to settle and my pores to breathe. My mother is unhappy and ashamed of my appearance. In the battle between the family purse and her pride, I make the choice to be deliberately nonplussed about the smoothness of my skin. At the library, I research cheap at-home remedies for pimples.
I am still a teenager and equally as sweaty my senior year of high school as I am my junior year. I have managed to make the cut for varsity tennis and am finding myself increasingly sun-kissed. It is the day before a game and my left hand has become swollen. I find myself struggling to close it around the handle of my racquet for my back-handed returns. Biting down my discomfort, I play and lose spectacularly, noting the redness in the tips of my fingers as I sit on the sidelines in the aftermath. Many days later, my pediatrician reprimands me for waiting this long, while my parents stand silently by. She sends me to the emergency room for IV antibiotics and comments that I would have significant difficulty playing tennis without a hand. The treatment is relatively quick and I am back playing by the following week. I can feel the weight of the hospital bill on my family’s shoulders.
I am twenty-two years old and recently committed to the idea of medicine, absorbing everything around me to the best of my ability, knowing how much of it gets lost in translation. My fingers fly over the keyboard as I draw up the visit note for the seasoned emergency medicine physician in front of me. There is routine here, and I am slowly growing into the habits of the individual doctors who I support. Dr. Tully hates double spaces after the ends of sentences and I strive to rewrite my muscle memory. Dr. Li prefers long, winding sentences that capture the majority of the HPI and leave my mental voice breathless. Dr. Casanova avoids the use of any acronyms whatsoever.
The doctor with whom I am working with today is a seasoned veteran of the emergency room. He tells me of the chaos that happened on that fateful September day, of the sheer amount of patients they saw that will never be documented - the worst of them made it into the system for an admission, but triage was a storm itself, hovering within the smoke and debris that circled about in the city air that day and would hang on for many days. That smoke was a smudge in the window of the Long Island Rail Road as it eventually carried my father back to work all those years ago.
I blink, then, and I have written another eight notes. My back aches from sitting on the rickety stool without any lumbar support. The pain between my shoulder blades radiates unforgivingly down my flanks and as always, I regret my poor posture from my days in the restaurant industry. It would have been better not to have carried those eighty pound boxes of chicken than to have carried them quickly and improperly. I am still debating if I could afford physical therapy even twice a month when we are summoned to the bedside of a young man with a bandaged right hand. Per triage notes, he is missing a finger.
He is hesitant to speak at first, his words halting, but gains confidence when the attending physician responds in Spanish. Relief breaks over his face and is quickly subdued by the discomfort from his wounded hand. It was the typical story - knife slipped, the manager sent him home. He would not - “could not” - file worker’s compensation. He had no papers. He needed to work. When can he go back to work? Later in the day, I hear him crying as they wash his hands. He is still wearing his apron, smattered in grease. I feel lucky to have made it out with just a bad back. I think of my mother, recently arrived to this country, sweating in the back of a pizzeria in Queens.
I am a woman now, feeling younger than what my driver’s license suggests. I have survived the pandemic and several apartment moves in the past few years. My back is better; it aches sometimes, but I can walk a ten mile trail and remain on my feet comfortably. Every day moves quickly but constantly and for the first time in my life, I have tasted stability. The phone is ringing and I quickly pick up the receiver. I had already spoken to the physical therapist and the patient’s primary care physician. It wasn’t the patient’s fault that there was no-one in-network with Aetna that serviced the home in their area.
“I can’t afford $75 each time.” The woman’s voice breaks. For a moment, she is an old friend, sitting in the back-of-house shortly before he clocks into the kitchen, debating if today is the day she takes her diabetes medication, or if she can wait another day. The pill bottle says to take it once before meals, but she is already maxed out on her credit cards, and her Medicaid application is mired in red tape. I take a deep breath and the woman on the phone is not my friend but a patient, someone I must help professionally. I see people I love in my patients all the same.
I had already discussed this possibility with the rest of the care team - it was now a final decision in her hands. Although, I hate to phrase it as her choice. It was always a rock and a hard place. We speak softly to one another on the phone. I am appreciative that in times of frustration she is able to speak civilly. I had already received three threats in the past hour due to patients’ inability to afford continued therapy sessions. It was never personal. They were screaming at me for a moment, but I knew that when they hung up the phone, the weight of the difficult choices would lay with them.
The woman agreed to once a week. It was not what any of us wanted, but it was what she could afford. “Not meeting the requirements for restorative care” was mentioned. However, it was the best thing she could do. She would later tell me that she would do her home exercise programs twice as much to make up for her shortage of visits.
“I have to get back to work. I’m running out of money.” I hear myself in her voice, and can already feel the chilling urgency of looming bills and a body that cannot keep up. We wish each other well. When she calls me the following month and tells me that she will discontinue care in favor of preserving her grocery bill, I can only sigh. Her physical therapist draws up a detailed exercise regimen on paper for her discharge. He tells me that she is determined and made of sheer willpower. I think about how much more she must pay in willpower than others. I am tired, but I brush off my own fatigue, saddled with a strange sense of guilt for my own powerlessness in the complicated network of insurance premiums, denied claims, and fine print. Somewhere along the recovery process, the world loses sight of the goal.
The phone rings again. I see a familiar number and know the rage that awaits me on the other side. My boss told me once that I was one of the best bearers of bad news at the company. As much as I wished for it, I could not force Medicare to repeal their denied claims on the physical therapy of a late-stage Parkinson’s patient. My body pulls in on itself. Pushes and pulls, I tell myself - pushes and pulls. I mentally steady myself, knowing that the best I can do is listen, and answer the phone. I listen.
“I’m so sorry for your loss,” I say. I add fuel to the fire that burns in the pit of my stomach, the one that dreams of something different. I am hungry for something else.
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