The Cost of Living with Emily Maloney
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You're listening to the Nocturnist Conversations. I'm Emily Silverman. American health care is a messy business. The system is a tapestry of providers, insurers and chargemasters and often leaves patients with unexpected and crippling bills. That is, if they show up to the hospital at all. Today's guest, Emily Maloney, has been on both sides of the healthcare cost equation. After being hospitalized for a suicide attempt, she began working as an emergency room technician to pay off her medical debt. Emily tells her story in a new collection of essays called Cost of Living. Previously, her work has appeared in Glamour, Virginia Quarterly Review, The Atlantic, Best American Essays, and the American Journal of Nursing, among others.
In addition to working as an ER tech and EMT, she's worked as a dog groomer, general contractor, tile setter, and catalog model, and sold her ceramics at art fairs. She's twice been awarded a McDowell Fellowship and lives in Evanston, Illinois. Before I spoke with Emily, I asked her to read an excerpt from her book. Here's Emily.
In 2008, the hospital where I worked, a level two trauma center just outside Chicago, was $54 million in debt. Everyone seemed to be aware of this fact. The figure floated beneath the surface of all our conversations, an unspoken rigidity we seemed to bump up against everywhere we turned. We were to be careful when we distributed small stuffed animals to unhappy children in the ER, were told to dispense fewer scrub tops to adolescents with dislocated shoulders and bloodied shirts, to pay attention to the way that canes seemed to walk off as if under their own power. Everything cost money, Helene, our nursing manager, reminded us, even if the kid was screaming and had to get staples in his scalp. I was an ER tech then, someone who drew blood, performed EKGs, and set up suture trays.
Most of my knowledge of the world of the ER came through direct patient care. If a nurse or a doctor needed something for a patient, I'd get it for them. I'd run into the stockroom, sort through yards of plastic tubing, through dozens of disposable plastic pieces, acres of gauze. We, the techs, were expected to guard against the depletion of resources. Helene seemed to remind us at every available opportunity by tacking notes up on the bulletin board in the staff break room. Please conserve your resources. Only use what is necessary. These notes were pinned next to our press Ganey survey results, a form sent to patients upon discharge. Helene blacked out staff names if the feedback wasn't positive. But the question of resources seemed like the kind of problem that couldn't be solved through gauze or surveys or suture trays.
When it was quiet, a forbidden word in the emergency department, I'd help with the billing.
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