Privilege and health

By | Saturday, July 01, 2017 Leave a Comment

Not dead yet - in the hospital after heart attack

From time to time I am stunningly reminded of the privilege that I enjoy. Not only privilege, but also access to resources provided by the society that I live in - at this exact place and time. Not only am I an affluent, 
adult, white male. I was born in America and I have chosen to stay here. Some of these fortunes were bestowed upon me, while others result from my own choices. For example, while I have the resources to be able to live just about anywhere in this country, I made the choice to live in a Californian metropolis, with all that it has to offer (and all the costs and inconveniences that come with living in a highly desirable place.) In the past I have seriously considered moving to other countries, or remote, quiet, locations in the USA. But, in the end, I settled in the Bay Area. An opportunity provided by my privilege, and a choice I made for myself within my place of privilege.

Three weeks ago, at 3:00am, I was awoken by a strong burning pain in my chest. This was no heart burn. This was a heart attack - though I didn’t want to admit it. I picked up the phone and dialed 911. After a few questions, help was dispatched. I don’t really know how long they took, but I am sure that it was less than five minutes before a fire engine and ambulance were at my house. The EMTs brought in a portable EKG, checked my heart, gave me aspirin and nitroglycerine, and whisked me off to the nearest hospital with a cardiac surgery unit.

It turns out that regardless of being white, male, and affluent, I live in a place and a time where, at 3:00am, emergency medical technicians will come to my home and save my life. There was no question of whether I could pay for treatment. No question of who I am - not race, creed, religion, nor nationality. No question of whether or not I deserve to live. In America we have created this structure, and it works. God bless everyone involved. If I lived in less affluent country, or a less affluent community in the US, would I still be alive? Even if I lived in California, but way out in a cabin in the woods, would they have gotten to me in time? I really have no idea.

At the hospital, more tests were done, then I was wheeled into an operating theater where a team of surgeons removed blockages from two arteries and installed two stents. At one point while they were prepping me, I made a joke. The attendant didn’t laugh. I said, “oh, come on, that was a least a little funny.” He replied, “fifteen minutes ago I was asleep. Please just let me do my work to help you.” So again, here I am in a society, in a culture, at a certain moment in time, where unbeknownst to me there are highly skilled surgeons and medical technicians ready to awaken at a moment’s notice and save my life. Or your life. Or the life of anyone that shows up at the hospital. Wow.

Let’s not take this for granted! This is major. With all the talk of the Affordable Care Act, repealing it, retaining it, replacing it, updating it, and so on, let us not forget: If you live in America and have a heart attack (or stroke, or car accident, or poisoning…) there is someone who will try to save your life. But only because we all, as a society, care enough to pay for this. In many places, the hospitals are too small, or understaffed, and people die. Let’s not forget what we might be giving away if we don’t care for these institutions.

Did they treat me better because I am an affluent, white male? Did I get better care or a better room? I don't know. Probably, but, maybe not. Earlier this week I received a bill from the hospital. I called my insurance company to find out what was going to be covered. They told me that they hadn’t been billed by the hospital yet. So, I called the hospital. It turns out that they never got my insurance information from me. The ambulance picked me up. The hospital admitted me. The surgeons operated on me. The intensive care unit cared for me. Meanwhile, at no time did anyone even ask if I could pay. Or had insurance. Or if I was a citizen. Or anything. That’s pretty remarkable.

Nonetheless, I am privileged. Hospitals are lousy places to get well. Really. There is non-stop noise, and endless injections and blood tests. IV’s need to be added and removed. All sorts of poking, prodding, and testing is done round the clock. If you want to get out of bed, you have to push a button to call for an RN or a “care giver” to help you. Maybe they come when you call, maybe they don’t. If you get out of bed without a nurse to help, alarms go off. As an adult, white, American male, I used my sense of entitlement to justify pushing all the buttons to get someone to come help me when I needed to get out of bed. I imagine that someone who felt less entitled might have meekly pushed one button and waited. Finally, when I could no longer tolerate the understaffed care, I used my money to hire my own private care-giver/attendant. Hopefully this not only helped me, but also reduced the load on the hospital staff, allowing those who couldn’t afford a private nurse to get more attention. At least, that is my rationalization.

When I couldn’t stand the hospital any longer, and convinced myself that I was declining, not improving there, I used my position of entitlement and self-authority to check myself out of the hospital “against medical advice.” All the while I wondered if someone with less privilege would have felt that this was even an option. I was also able to hire round-the-clock care to stay with me at my home – definitely not something that everyone can afford.

So, I find myself vividly reminded of my privileged place in society, and I am also made newly aware of the services that we have collectively decided to offer to anyone that needs help. This is a remarkable society we have created, and its institutions should be cared for as they care for us. Regardless of privilege.

As a final thought – when thinking about the Affordable Care Act, what may follow it, and how we provide health care in America, let us not forget about this astonishing safety net that we have created – a safety net that is indifferent to race, creed, age, gender, sexual orientation, nationality, and even ability to pay. This is a magnificent treasure. Losing it would imperil us all.

[Addendum: at the time I wrote this, I was quite focused on the fact that when I called 911, I was asked about my health situation and nothing else. This continued when the ambulance arrived and when I got to the hospital. Question after question about my health, nothing about my ability to pay (or citizenship, or anything else.) And, as I noted, afterward the hospital (and ambulance company) billed me, because they didnt have any insurance information for me.

What I ignored in this essay was that fact that I did have insurance, and my insurance did pay for all of this. If I hadnt had insurance, or my insurance was insufficient, I and my family could have been wiped out by this single misfortune. Furthermore, even with insurance, many would have been driven into bankruptcy merely by having been unable to work for a number of weeks.

I also ignored the fact that if I lived in a "project", or homeless encampment, or even a less affluent neighborhood, the ambulance may well have taken much longer to arrive, and may not have arrived at all.

There is no doubt that my affluence and privilege were vital to me in this situation. Thus, it is vital that affordable health insurance and health care be made universal in this country, that our staggering wealth inequality be reduced, and that those less fortunate than I am be cared for in a way that currently they are not.]

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