After a suicide attempt, a stack of medical bills. Illinois Writer Takes on Healthcare Industry in ‘Cost of Living’ | app
EVANSTON, Ill. — Months after Emily Maloney attempted suicide, she finally opened her mail. She was 19, lived in Iowa City, an undergrad at the University of Iowa. She felt she never really knew how to be a person in the world. In high school, back in Lake Forest, Illinois, she wore wedding dresses and combat boots to class, she wore bowler hats and tuxedos. She said she never fitted in alongside the young descendants of Chicago’s business barons. She graduated early, and now, alone in Iowa City, she was depressed. She was recovering.
The mail has piled up.
We met the other day at a cafe in Evanston, down the street from her house. She’s 36 now, with big dark eyes and a pleasant, easygoing disposition. This suicide attempt – it was her first and only attempt, she explained, but she had already been hospitalized for fear of taking her own life. She spoke informally, then with the precision of the healthcare industry, which she now knows a little too intimately.
“I have been hospitalized several times for being actively planning potentially but not yet executing an attempt. I would go to my therapist and say everything is fine. I always wanted to be a good patient so I took whatever they prescribed, whether it was good or bad for me. I would tell them it was okay, but those are my feelings and then they would be like, ‘Whoa, no, something is seriously wrong with you.’
“In the end, there was the attempt.”
After months passed, she grabbed a mail, opened it and found a notice from a collection agency. It was a big five-figure medical bill. She remembers thinking:
“Suicide should be cheaper.”
She writes this early in “Cost of Living,” her first book, a fascinating new collection of essays about her history with therapists, the drugs they prescribed, her chaotic upbringing in Illinois, and the inevitable cost of health care. It’s a clever title. Her medical debt, she writes, “was the cost of living, and I accrued it in the telemetry unit, on the fifth floor, at a community hospital in Iowa City, hundreds of miles from my home. “. She figured she owed, “Twenty-five dollars a month multiplied by the number of years that’s a bed on a custodial floor.”
If the suicide attempt is the dramatic heart of the book, its bill becomes a seething antagonist, a catalyst for depicting how Maloney paid off a debt, month after month, for a decade. Ironically, here’s how: She worked for Chicago-area hospitals and drug companies.
Shortly after starting to work in an emergency room, she felt she had finally found her people. She felt comfortable. She tied herself to work. She just wasn’t very good at it, she laughed.
She told me that she had always had a lot of jobs but had “never been a great employee. Because I work hard and burn out quickly. There are other ways, but I don’t know them.
In the author‘s biography of her book, it is noted that she worked as a pastry chef, dog groomer, general contractor, tile setter and catalog model and sold ceramics at art fairs; if there was more room, it might have added that she also trains horses and, more relevantly, has worked as a medical publications manager for healthcare agencies, including the Danish drugmaker’s Deerfield divisions Lundbeck and Takeda Pharmaceuticals.
The juiciest material comes from her six months in what she identifies as “a Level II trauma center just outside of Chicago.” In the book, she never mentions a hospital by name or identifies where she worked; she changed the names of the colleagues. She wants the book to be read as personal experiences that could have been had in any hospital in the country. In conversation, however, she notes that among the places she worked was the emergency room of what used to be Rush North Shore Medical Center (after a change in ownership, it is now Skokie Hospital ). Her duties included administering CPR and managing the EKG. Among his secondary tasks: studying patient records and giving an estimate of care – information then translated into an invoice.
I asked her if she was good at it.
No, she wasn’t particularly good at it.
But she was observant.
There’s nothing particularly shocking or damning about the “cost of living,” but rather, it often reads like a sort of prolonged, resigned sigh at the way health care works, at professionals doing often doing their best with limited resources, to long hours that lead to glassy expressions staring daily, hourly, at concerns. A child needs staples in his head. (“How much should it cost to put staples in a child’s head?”) There’s the doctor who, Maloney describes, “orders too many tests and blood cultures for anyone who might have an infection, that is, almost everyone who comes to the hospital.” There’s the medical equipment sales rep offering a $50 gift card to any nurse who can save a patient by using a new chest compression device Everything costs something, and “suicide attempts,” she writes, “were particularly dependent on resources”.
There is a physical cost, a psychiatric cost, additional medical costs, dressings…
Although Maloney loved medical environments, she decided while at Skokie that she should become a writer. She entered the MFA program at the University of Pittsburgh, where “Cost of Living” chapters (including the title essay) were developed. She hadn’t expected to be there or to write books. She never made a career plan.
Before becoming a condo, she grew up in Lake Point Tower, overlooking Navy Pier; later lived in River Forest; then eventually, moved to Lake Forest. She describes in the book her family’s fortunes swinging back and forth, from color to “bankruptcy”. They were involved in real estate, but 2008 came along. She describes her family in the book as loving, equestrian, but unconventional, demanding the use of some toilet paper but missing utility bills. Her mother, Cynthia Maloney, who hadn’t read the book yet, told me, “I don’t think Emily fully understands everything that happened at the time, but that didn’t bother me. more importance. Because it’s her story – don’t you think she’s great? I mean, she’s a brilliant writer. She describes her daughter regularly leaving school to take the train to Chicago and visit art museums. She says her Emily rarely fits easy molds.
A chapter in her book is a sort of taxonomy of all the therapists she’s seen since she was little. Another chapter – “A Brief Inventory of My Medicines and Their Retail Prices” – is an account of the more than two dozen prescriptions she received. “At the end of the day,” she told me, “I don’t know if any of them were really a good idea.”
As she describes her work in healthcare companies, as she explains her own healthcare, you paint a disturbing picture, one that is professional, threadbare and arbitrary. She told me about a disaster drill at a job, where fake patients were treated alongside real patients, to illustrate staff flexibility. Which quickly became a sobering illustration of their meager resources. It was a decade before the pandemic.
Again, not shocking, just the cost of living.
Prior to the suicide attempt, she had been misdiagnosed with bipolar disorder. Several years after her attempt, she was diagnosed, she says, with a “non-verbal learning disability.” I learned to behave, but only later in life. I speak fast and I think slowly. It made sense to her. She was also diagnosed with thyroid problems and vitamin deficiency. She knows how mind-blowing that sounds. In fact, when she thinks back to her suicide attempt — she swallowed a bottle of lithium — she realizes that if she had been taken to another hospital, declared destitute, placed in county care, she would not have had of debts.
Indeed, 10 years after she started paying her medical bills — at $25 a month — she called the collection agency to tell them her bank had been acquired and she had new routing numbers. It was kind of a routine, routine call. She had new checks printed. The woman who took the call looked at her account and informed her: In fact, this debt is now beyond the statute of limitations. If Maloney stopped paying now, no one would look for the remaining balance and nothing would be reported to a credit agency.
“Have a nice weekend,” the woman said and hung up.
Maloney sat in silence.
No, no, that’s not right, she thought. Someone would call back in a minute to say a mistake had been made. But no one ever called. These days she is working on her next book. “The funny thing is, if my bank had never been bought, if I didn’t have new routing numbers, I would still be paying off that suicide attempt, long into the foreseeable future, forever. “