At Home

My dad calls me and says, “two weeks.” He’s a respiratory therapist, and that’s how long until his hospital system expects to be overwhelmed by COVID-19 cases. He’s worried about me, in New York City, and calls most days to check in. I turn down his plan to rent me a room in mill-town-turned-hip-locale Millvale, just outside Pittsburgh, insisting that fleeing New York is anti-social behavior (“But you’re a Pittsburgher!” he responds incredulously). He insists on mailing me some gloves to wear when I go to the grocery store; they’ll arrive tomorrow morning.

He tells me about a gunshot-wound victim he has in his hospital unit today—”not a coronavirus case!” he jokes in the typically dark fashion of someone who has worked in the ER for years. I ask him if he’s heard that John Prine has coronavirus. He has—he was never much of a Prine fan, he says, but he once read a Rolling Stone story about Prine in the ‘70s that mentioned the songwriter’s days as a mailman, and that he’d occasionally squeeze into a mailbox along his route to practice songs, a tale that delighted my working-class artist dad.

Being in New York during the coronavirus crisis is getting a bit concerning. They’re building field hospitals in Central Park and in a stadium in Queens; they’ve turned the Empire State Building into a flashing red siren. People are dying trying to get into hospitals, dying in hospitals, dying at home because they were turned away from the hospital. If you get sick, the hospital no longer seems to be an option. The state’s governor holds press conferences where he says he won’t entertain a bill proposed by the state senate to suspend rent—tomorrow is the first of the month and even the New York Times estimates that 40 percent of New Yorkers may be unable to pay rent. Yesterday morning, as I was sitting on my stoop, a little girl walked up to me, an umbrella shielding her from the early-morning drizzle. “Do you have any money for sandwiches?” she asked. “My mom is out of work and me and my sisters are going hungry.” I handed her the money I had on me and weakly wished her good health.

Doctors say hundreds of the city’s inmates have coronavirus now. The jails are completely unprepared, and the authorities are taking their time releasing people. Construction workers text me several times a day about how filthy their job sites are—the governor finally shut down “nonessential” construction sites this week but, would you believe it, there are loopholes to the executive order. A reporter I follow online tweets that while 332 people died of coronavirus today in New York, the rate of increase has been steady, rather than rising, for the past couple days (I try to feel relieved?).

I walk to CVS to pick up Prozac. There’s a line of six or seven people, mostly older, all with masks, waiting to enter the store. Social distancing means a store can only let in a handful of people at a time. I walk to the back of the line and cover my face with a keffiyeh—I have no idea where people are getting masks.

We hold a staff meeting, via Zoom, a video-conferencing app. Coworkers call in from Istanbul, London, Dublin, Berlin, Toronto, and across the United States. Several of us live in buildings that are going on rent strike tomorrow. Most people don’t have the savings to cover a month of New York rent, so regardless of what the governor or anyone else says, people simply are not going to pay. I think about my laid-off roommate, a bartender. I take notes for a coworker who is quarantining in Australia and thus asleep at the meeting’s scheduled time. As my coworkers discuss the financial state of our publication and Tiger King, I stare at a photobooth set I’d picked up on the floor of a Manhattan karaoke bar last year which has now freed itself from a nearby pile of papers stacked in a milk crate. Two strangers look back at me, making silly faces, cocktails in hand.

Lately, books turn to ash in my hands. I inspect my bookshelves in hopes something will attract my attention. A biography of Paul Robeson that I didn’t know I owned? Dead Souls? The books crookedly pile up beside my bed in the room that I rarely leave. I take a break from work to force myself to read an essay I’ve had open on my computer for a while. In it, the author reflects on his failed efforts to evade commodification as a young writer. He writes: “I realize now that I was trying to undo by writing what could only be undone by action, not alone but with others—and through connections that incantation alone would not conjure.” I’ve been wondering why writing feels so meaningless during this pandemic, even emptier than usual. It isn’t totally useless, of course; the future is open, now more than ever, even if the forces of Left and Right that seek to shape it are on nowhere close to a level playing field. But action, right now, is hard to come by—I haven’t left my neighborhood in weeks. The emergent wave of walkouts and sickouts by essential workers—at Amazon, General Electric, Whole Foods, and so on—and the tenant organizing are actions needed to force the hands of the rich and powerful, who are very busy attending to their own our problems. When the system is so hostile to reform, much less radical changes, no amount of correct phrasing or clever proposals can really shape history.

In an essay on “not going home,” critic James Woods writes of a sort of secular homelessness—or “homelooseness,” as he grotesquely phrases it—the type of leaving home that is voluntarily chosen but nonetheless inflected with an “afterwardness,” a term he borrows from Freud. As he writes,

To think about home and the departure from home, about not going home and no longer feeling able to go home, is to be filled with a remarkable sense of ‘afterwardness’: it is too late to do anything about it now, and too late to know what should have been done.

Afterwardness saturates the present. We never knew we were entering a new era until it arrived. What was once unthinkable—30 percent unemployment—is now fact. Much of what came before feels irrevocably distant, or distorted; hazy. The past had a fog and we didn’t even know it. Only now, in the midst of the pandemic, is the fragility of our way of living clear. We face the facts, and in doing so, transform what came before. We can never go back.

My dad calls again. He’s decided to rent the room in Millvale himself, in case he needs to isolate away from my mom. He spent one night in a hotel last week after a coworker suspected they’d been exposed to the virus (it turned out to be an unnecessary precaution: the coworker tested negative for COVID-19), and he doesn’t want to rely on the hospital for housing next time. I tell him I wish he could stay home, and to have a safe rest of his shift.

sue

My aunt died today, apparently of neglect by a rehab facility in Florida. She was rushed to an ICU with infected bedsores, and the hospital was so shocked by the state they found her in that they’re initiating some kind of criminal investigation into the facility. Who knows what will happen. I imagine we’ll have to push for a thorough investigation, though it must’ve been pretty bad for the hospital to be taking action unbidden. She was no vision of health but I have to assume other patients are experiencing similar neglect.

There won’t be a funeral, so, that’s it. No condolences needed, we weren’t close. If we were, I’d write some memories of her here, but all the ones I have are no good (she did love her cats, so there’s something). I’m just noting that this happened because it feels like someone should, and I doubt anyone else will.

Case Study of 1

A red ticket-dispenser in the psychiatric department instructs me to take a number and wait until it’s called. So, I do.

I am trying one last time to get mental health treatment. At least, that’s what I said two months ago to trick myself into following through on it. Suppressing doubts about whether this latest attempt would work, I looked up my health insurance’s list of local mental health care providers. The first few weren’t taking new patients. The next two said they didn’t take my insurance, even when I said I was sure they did. The next one was a hospital. The receptionist said there was no room for new patients. I told her that I could wait if needed and no, I am not suicidal, but I need help. She found me an appointment in two months’ time.

So two months later, I’m here. Another hour and I’m called to the registration desk. The receptionist says she isn’t sure if they take my insurance, and to go to the financial counseling department and then come back. Her coworker disagrees, so she just calls the counseling department instead, who confirm the hospital takes the insurance. The receptionist hands me a yellow paper square with my new number—“We call people by numbers here, not names,” she says—and instructs me to wait. The paper has a big “1” written on it. A good sign, I think, looking at the overflowing waiting room.

A nurse calls out “1” an hour later and I pee in a cup and return to waiting. Thirty minutes later, a therapist appears, asking for “1.” She seems nice, though she doesn’t look up from her computer when she asks if I’ve ever tried to kill myself. But when I tell her I how I’m doing, she tells me she is sorry and I decide that she sounds like she means it. We schedule a follow-up and she walks me to the psychiatrist’s office.

I enter and begin repeating the answers I’ve just given the therapist to the standard mental health questions. No, I am not suicidal. I live with roommates. I do not have children. If I’m out with friends, I can definitely down a few drinks, but that happens maybe once a week. I work full-time. I have tried Wellbutrin and Effexor, but they did not work. I am desperate for something to work and willing to do what is needed to get better. I am trying to be responsible.

***

I blame the medical bills.

They pile up in a corner of my room, collecting cobwebs under the bed. Every few months, I gather them up, opening a few. There are doubles, triples, of the same bill, differing only in their dates. Others are solo, lone socks in the pile. I consider using them all as wallpaper.

After I was hospitalized with a particularly nasty skull fracture a few years ago, something snapped; suddenly, I could barely call a doctor. It might have something to do with the way the hospital treated me—a nurse said that they had all believed I was uninsured and had given me “different” treatment because of it—but I think it’s the bills’ fault. They started showing up mere weeks after I was discharged. They never slowed down, no matter how often I wrangled with my insurance company on day-long phone calls. I was broke, and the bills broke me.

So after the first hospitalization, hospitalization became my health care strategy. If you have a severe injury, the hospital will find you a primary care physician and force you to book an appointment. For the skull fracture, they did likewise for a psychiatrist, among other specialists to deal with the aftereffects of the injury.

It seemed great, but my enthusiasm waned when I left the hospital. Each doctor is a co-pay, and that’s if you’re insured. Without insurance, my first hospitalization would’ve cost $39,000 (I made $10 an hour at the time). With it, I was still on the hook for a few thousand dollars. Dizzying diagrams of future appointments and work schedules began to dot my notebooks alongside unworkable budgets. But I was unwell, so I lost track. Within months, I was missing appointments. Soon enough, I couldn’t remember the doctors’ names.

Eventually, I was without care again until being hospitalized in a new city, New York, where I’d just moved. I had no doctors here, and my mental health was declining precipitously. I chose to interpret this turn of events as a gift.

After a false start—I went to a hospital in my neighborhood, Bushwick, only to be discharged because the doctors “couldn’t figure out what was wrong”—I found a hospital rich people go to that accepted my insurance. My wish had been granted: I’d lock down future doctors. Thank god for my prematurely decomposing body.

It didn’t work out. The doctors were understandably focused on my physical ailments. When I mentioned other health problems, they told me to wait until I recovered to worry about the rest of it.

The night I was discharged, I was groggy, floating on morphine. I had complications that required the procurement of an ambulance to drive me home. Follow-ups were scheduled hastily as I was rushed out the door. Someone from the hospital called with the PCP’s information while I was horizontal, strapped to a stretcher. I scribbled the information on the back of my discharge papers. When I got home, I realized the pen had been out of ink.

Despite this, I found the doctor. I couldn’t remember any details about the appointment, but I returned to the upper-east-side hospital and spent a day asking administrative employees for help. Finally, a saintly woman in a tucked-away office, packed with precarious piles of papers, the Office of Historical Memories or something, tracked down the information.

As it turned out, the PCP was actually a clinic; I was seen by different doctors-in-training every time. It was rushed, and no one seemed to have notes. I asked for a psychiatry referral. They told me they couldn’t do that, and to find a psychiatrist myself. After further prodding, they offered the numbers of two psychiatrists. I again scribbled this information on the back of medical forms and left.

They remain in my room, a monument to the vast reserves of the human spirit—I, of course, never got an appointment. The first time around, it took me a year, maybe two, to disappear from the health care system post-hospitalization. This time, it took weeks.

I spent a year like this. I’m fortunate to have never had the type of depression that brings suicidal thoughts and extreme highs and lows; mine is the flat-line variety. Someone who takes days to respond to a text message does not have the ambition required to die—no thanks, sounds like work. But the depression got worse than I’d believed it could. And the bills kept arriving! The calls from unknown numbers multiplied. Once a month or so I answered one. Every time, it was a debt collector.

***

So I am here, making a good-faith shot of it, answering the psychiatrist’s questions.

We get through all of them. After a brief silence, she says she cannot prescribe me medication. When I ask why, she informs me that I am an alcoholic, and antidepressants do not work with alcohol. I say I am aware of the “don’t drink on meds” rule, and if it’s really the case that the medication will not work if I drink, then so be it, I’ll drink lemonade at parties. “I am desperate, and willing to do what it takes to get better,” I restate.

“You could not quit drinking if you tried, and you will not try,” she says. She has known me for twenty minutes at most. “I will likely recommend you get addiction treatment, which entails three appointments a week, and then you can get on an antidepressant.”

Perplexed, I tell her I do not need addiction treatment, that I sometimes go weeks without a drink, and besides, I work full-time and what with my whole exhausted-depressive thing, there is no way I could follow through on three appointments a week. I think about a family member who was court-ordered to attend AA meetings three times a week after an arrest, and how little the judge cared that he might lose his job for taking that much time off. This is criminal, I think.

She says that she will add to her notes that I am in denial about addiction, and if I’d like to get my blood work done so she can see the results and formally decide what treatment to recommend, I can do so. In the meantime, can I quantify my drinking for her notes on my alcoholism, she asks.

“Would you say you take like, ten shots?” She actually says this. I can’t speak, so I laugh. She is withholding medication I need as a perverse moral means-testing, because I mentioned I get drinks with friends once a week. The only possible outcome, should I refuse to go along with it, is that I will go untreated, or will lie about my drinking habits to a future psychiatrist if I ever get to see one. She must know this.

“It took me so long to get this appointment,” I say.

She stands and gestures to the door.

I get the blood work done. As I leave, I stare at the room of waiting patients, some of whom were here when I arrived six hours ago. This is a hospital for poor people. I can’t stop wondering how many of them this psychiatrist will also withhold medications from unless they, too, agree to whatever preconditions she chooses. How many other doctors like her are there? The rich and the poor use drugs at the same rate, but there is no doubt in my mind this woman sees everyone here as an addict or a criminal and is determined to punish us for it. There are no consequences for her, but some of us will die.

I think about last year, at the Bushwick hospital. I doubt there were any millionaires in that packed emergency room. They’d discharged me late at night, on a cocktail of painkillers but still pulsing with pain, to walk home.

These hospitals are located in the heart of the city’s gentrification but apparently those who can, avoid them. I’d never step foot inside one of those places, friends say when I describe my day. Everyone knows not to go to those hospitals. But I didn’t, and neither did the hundreds of other people who were in the psychiatric department this morning. “Why are these places packed if everyone knows this?” I think, to distract from other thoughts, about how, exactly, I will wait out the months it will take to get a new appointment, with a new psychiatrist, in Manhattan.

Anyone reading this likely knows health care is a gruesome, deadly separate-but-equal system in the United States. Anyone who can avoid these hollowed-out institutions on which so many working-class people rely is acting quite reasonably in doing so. They are carceral and dangerous—sometimes filled with literal toxins, as if this country needed more symbolism. They kill us, even if we kill ourselves. They tell us we are criminals, and we agree—a plea deal is the best anyone can get. They say we are addicts, and we wonder whether we must be addicts if we are to survive. None of this is news, it’s just another data point. These are hospitals in the richest city in the country, but the funneling of resources away from them reproduces segregation—it’s how they got this way in the first place. And it is worse elsewhere.

I don’t have any proscriptions beyond what many people are already doing: pushing for universal health care so at least we can get rid of the damn financial counseling department and all the co-pays (today’s experiment left me $45 poorer), funding long-term mental health care, and otherwise creating a world with less alienation, less poverty, shorter workweeks.

I’m just mad, and the stakes are so high. US life expectancy has dropped for the third straight year, in part because more people are killing themselves. If I were the suicidal type, this might be the end of my rope. (I cannot insist enough that I am not, please do not worry.) I just wish all of it would be classified correctly, as murder: the mistreatment, the abuse, the insurance mix-ups, the lack of access in the first place, the disdain, the bills, what that psychiatrist did today. It’s homicide, on a mass scale: take a number, wait until it’s called.