6000onions

Well, after seven days of steadily getting sicker instead of better, I caved in and went to visit the Sisters of Mercy. The Sisters of Mercy are an Asheville institution – they’re not sisters, they’re not known to be particularly merciful, but there you have it – a nominally Catholic, theoretically nonprofit urgent care center with several locations scattered around the area. The first time I ever went to them was about 14 years ago, right after we had first moved here, when both kids and I were all horribly sick. The doctor explained that moving 500 miles and having kids in two different schools was a recipe for disaster and that we would all continue to be horribly sick for the next year. Heh heh, he almost said, but didn’t quite. He was ex  military and his hands shook. That visit cost $85 each, I think, and then prescriptions. I had never before encountered the beast known to some as doc in a box and I kind of liked the concept. I liked the doctor, too, and as it turned out he was right and it was a rough year until our immune systems settled down.

The next time I went it was for a broken rib. “They’re just bruised,” said the young Indian doctor roughly, “If they weren’t you couldn’t have waited 72 hours to come in. You’re fine. You just want drugs. I don’t care. Here’s a list, pick what you like.” Well. That visit, too, cost $85 and the joy of discovering some seven years later that two of my ribs had been in fact not only fractured but smashed, that they had left behind a nice mass of scar tissue pressing up against my lung on the left hand side and, uh, thanks for the Vicodin, I guess. I should have gone for better, because as it was I was afraid to take it and relied instead on Guinness and ibuprofen. I was never a successful enough druggie to pick the right pills off a list.

My third visit was because I am an idiot who, despite frequent and painful bouts with poison ivy, had never learned to identify it successfully. The doctor was a super cool lesbian with green hair and horn rimmed glasses. She prescribed steroids, warned me that they might make me go insane (they didn’t, but that is probably because I kept such a vigilant and neurotic eye on myself or, of course, that it was too late) and I think that I must have had really good insurance at that point, because I don’t remember it costing much of anything. The poison ivy went away and now I can spot it from 50 paces and have learned that the real trick is to take a shower – with serious soap, like Dr. Bronners or Dawn dish soap or something skin destroying like that – immediately after hiking or gardening. But when I do fail in this and catch it anyway, I get it in all kinds of weird places, because once you’ve had it systemically, it can show up anywhere on your body that it feels like. True fact. I think.

So my experience with the Sisters of Mercy was that the clinics were kind of dingy and run down and you never knew who you might see but the odds were okay that it would be decent, affordable medical care in a pinch and you could go on weekends or in the evenings, thus not missing work. I had heard rumors that they had gotten meaner and meaner and that the odds had turned against good medical care but I didn’t, personally, know.

Yesterday, I went to the Sisters of Mercy yet again. You know how in magazine articles they’re always urging you to “Ask your doctor” and “Talk to your doctor” and so on? I have always thought that those articles were pure-D bullshit because firstly, I have never met a doctor who had TIME for that kind of nonsense and secondly, what is this “your” doctor kind of thing? Are these people all living in British murder mysteries where they have giant houses that came complete with doctors and lawyers in the attic? Or is this one of those curious remnants from the days when America worked and there was infrastructure and education was funded and people actually cared, or pretended to? In my experience most people don’t have doctors – or, hell, insurance – they have clinics where they might or might not see the same doctor twice and that doctor has like eight minutes to talk to them and doesn’t give a rats ass about whether they should eat brand a or brand b or if they’re going to keel over and die the minute they start exercising. The exception, I should say, to this rule has always been gynecologists, because pretty much every woman (including me) seems to have one of those, but honestly they’re not much good for ailments above the waist. But my experience, up until recently, has been that of a pretty damn healthy youngish woman. Now I am not youngish, really, to my astonishment and dismay, and I would appear to not be so healthy either. I need a doctor doctor. But it is not so easy to get one: you have to find one who accepts your insurance and is accepting new patients and then you have to make an appointment months in advance and etcetera, etcetera – all things I haven’t done.And, of course, I can think about doing this only because I actually have insurance. If you don’t have insurance, and many people do not, because the Affordable Care Act, at least in North Carolina or as we like to call it now, North Kochalina, is not turning out to be what we members of the working poor would call affordable at all, then you are just shit out of luck. There is ABCCM for you, show up at 7 in the morning rain or shine and stand in a parking lot for two hours and hope against hope that you are one of the lucky few they will see that day. That’s your option. They don’t prescribe painkillers, by the way.

But I have insurance, expensive insurance that costs me nearly $150 a month, or 10% of my income, which is deemed affordable and probably is if your income is $40,000 a year instead of $15,000. Thus, when my cold started out bad and just kept on getting worse for a whole week, I went off to the Sisters of Mercy. They have a fancy new building on Patton Avenue now – well, new, like in the last five years I guess – and it is all much more professional than it used to be. You come in and sign in and get the usual paperwork and then sit down. The paperwork informs you that if you are there after office hours – at any time other than 8 am to 5 pm, Monday through Friday, there’s an additional charge of $35. And there’s an additional $25 charge to be there at all. And you have to pay NOW, as in, they call you up to the counter and if you do not fork over the cash, you do not see a doctor. I have heard from two people that they say that if you are low income you can get a reduced rate, but both of the people I know who asked about that were flatly turned down for being too rich – they made, respectively, $9 an hour and $12 an hour, both part time. Also if you ask for the poverty discount, you have to take a ton of paperwork home and come back the next day, which is not so good if you’re really sick. I have insurance and didn’t ask for the poverty discount; my copay was $50. OK. I paid it and sat down and waited for the next three hours.

Those three hours gave me plenty of time to learn about other people’s financial straits. There was one woman who needed some kind of Medicaid referral. She made a lot of increasingly loud phone calls, trying desperately to get a human being on the phone so she could see a doctor. It didn’t work and she left. I hope she didn’t die. There was another lady who thought she had Medicaid, but she didn’t, really. She had partial Medicaid, which is the Medicaid that NC is required to give to women by some kind of law*, and it’s the smallest, tiniest Medicaid ever: it covers only a well woman checkup. That’s it, nothing else, not even anything else gynecological. I am familiar with this because I myself used to have this peculiar form of Medicaid and now I have an outstanding bill for $600 from a year ago that I just recently found out about. I – and my gyno’s office – had naively assumed that if a problem was found at the well woman checkup, a problem that required further tests, as mine did, that this Medicaid would then cover that. No. It would not cover that. The woman at the Sisters of Mercy similarly thought that if she had a Medicaid card she could see a doctor if she was sick. No, no she could not. They sent her away, with her husband, and they clung together looking upset and lost. They were not young; they didn’t look wealthy. Then the three women at the reception desk sent away somebody who didn’t speak much English and they sent away a guy who said he had been injured at work but did not, apparently, have the correct forms of ID. I sat there with my kleenex and coughed and sneezed and felt like death incarnate.

Eventually I saw a doctor – well, a nurse practitioner who looked to be in high school but presumably was a little older than that. She told me I had acute bronchitis and possibly a lung infection – she kind of breezed over that, but it’s worrying me – and gave me a prescription for a Z-pack of antibiotics and some codeine cough syrup and told me I could go back to work on Friday. That’s tomorrow and I really don’t feel all that much better – plus that cough syrup is, like, yellow and thick and beyond disgusting plus I think it is what is making me so dizzy and freaked out – but I will make it somehow, I hope. I had better: I can’t go back to the doctor because I don’t have another $50. Meanwhile, though, I’m thinking about Sisters of Mercy, and how you used to pay at the end of your visit and not the beginning and how I guess that didn’t work out for them. I’m thinking about being poor in America and being sick in America and how this sort of story is not the kind of story you hear in England or Canada or even Brazil. I’m thinking that something has gone so terribly wrong here that even the efforts to try to fix it are so broken they should be scrapped. And I wish I had a doctor I could ask.

* You find out about this well woman Medicaid thing if you go for food stamps, because all over the food stamp office are posters that say “You may qualify for medical help!” You don’t, it’s a lie. Nobody gets Medicaid unless a) they are under 18 – well under, as in I think it might actually be under 12 or something –  or b) over 65 in which case they get Medicare anyway or c) permanently disabled or blind. Also, of course, your household income has to be under the poverty line, which is to say like nothing at all. I love these myths that there is some sort of social safety net in this country. There isn’t.