Friday, November 28, 2008

A Thanksgiving Ambulance Ride and the Tectonic Plates of Privilege

Yesterday on Thanksgiving, my wife and I were both in so much pain that we could barely do much of anything. We are both living with chronic pain of different kinds, although hers is definitely on the mend and self-limited whereas mine has no explanation and no apparent treatment that's helpful to any great extent. Mary had a steroid injection to her sacroiliac joint on Tuesday and it seems that it may actually be working, and that is something to give thanks for.

However, to add insult to injury, I had a fever of about 100 yesterday, and had several episodes of very intense bilateral chest pain. At about 11:30pm, we were watching a DVD (season 4 of "Six Feet Under", by the way), and I had a bout of chest pain so bad that I was doubled over on the couch, weeping like I was being mercilessly beaten.

Not knowing what else to do, Mary called 911 and the kind dispatcher calmly spoke with her and reassured us both. Minutes later, two paramedics and two police officers were standing in our living room, and I was summarily whisked away to the emergency room. I cannot state more clearly how kind, professional exemplary and efficient everyone was, from the paramedics and police to the ER nurses, attending doctor, radiology techs and phlebotomist. I was very well taken care of, and received a complete cardiac workup from head to toe.

As expected, the bloodwork, EKG, chest x-ray and vital signs were all normal, including my temperature. Meanwhile, the nitroglycerin given to me under my tongue in the ambulance caused a pounding headache, but I was simultaneously hydrated with a full liter of IV fluids as I rested. While it was offered for me to spend the night, I elected to come home and sleep in my own bed, and this morning Mary is caring for me like a saint, as always. My temp is about 99, but there is no chest pain in sight, although my body still feels like it was run over several times. Some holiday weekend.

What is very concerning about the episode described above is that we are about to be completely uninsured for the month of December. Mary and I have both started new jobs recently, and our insurance from her previous employer runs out at midnight on Sunday. Meanwhile, my new insurance doesn't start until January 1st.

So, for the month of December, we will more fully understand---through direct experience---the unfortunate uncertainty of living on that all-American edge of having no health insurance coverage. I think that we have planned well and won't run out of any of our medications, but the experience of last night (and my knowledge of the economic devastation that can be caused by unexpected health crises without insurance) does indeed give me pause.

Here in the United States, where more than 30 million Americans live without health insurance year-round, Mary and I are about to embark on a time-limited taste of that reality (something we did indeed experience back in the early years of our marriage when we were poor). We are determined to remain healthy and avoid any costly emergencies, and I'm certain that all will be well.

As professionals, we are indeed members of a privileged class of Americans who can rest assured that we have the economic wherewithal---even without insurance---to take care of our needs as they arise. With access to home equity, credit cards, and family who would of course help us in a pinch, we truly have nothing to worry about. Calling 911 and going to the ER last night, we knew that the entire affair would cost us precious little monetarily, and I received stellar care.

There are so many Americans who completely lack the the certainty that their healthcare needs will be taken care of. Millions of Americans lack insurance, have no credit at their disposal, and have families who are in no position to offer financial support.

As a nurse and as a human being, it is these people who I worry about. These are the adults, children and elderly Americans who live on the edge and who truly live their lives at daily risk of financial ruin and ill health. Lacking insurance, preventive medical care is eschewed, important screenings are missed, and future health and well-being is compromised.

I never want to lose sight of my relative privilege and how so many other Americans lack even the most basic assurance that their health, well-being and economic stability is important to others. It is crucial for those of us who do indeed have such privilege to speak out on behalf of those who do not, and to pressure the Powers That Be to change the calculus of privilege in this country.

Many privileges taken for granted by so many---healthcare, housing, food, education---are not really privileges at all. These privileges are, in my view, absolute rights. And we must fight for the rights that we feel all Americans deserve. It is my hope that the 21st century will be the momentous era in which American history and society undergo a seismic shift wherein the tectonic plates of privilege give way to a new foundation of national equality.

So how, you might ask, did I make the leap from a Thanksgiving ER visit to the utter lack of economic equality in American society? It is actually an easy leap to make, especially on a holiday that asks us to give thanks for the blessings and abundance in our lives. While I generally enjoy Thanksgiving and the true meaning of the holiday, my experience last night and early this morning only further drives home the point that so many Americans lack so much of what I can easily take for granted. And for me, I simply cannot rest until those disparities are truly a phenomenon of the distant past, a tattered remnant of an America whose bad old years are assuredly only a memory.
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