An Uninsured Tail

I've never liked the idea of health insurance, perhaps because I'm told I have to have it. People are shocked when I tell them I don't. Insurance is a product that we seem almost requried to buy. It is a sellers market, but it wasn't always so. Not so long ago, people were completely uninsured. Somehow they got along without it--you and I are living proof.

I've always thought that I'd get by all right if something happened to me. State and city will not let me die out in the street. I have the right to health care, even if I'm broke. I know this as a fact, but always wondered what would happen if...I wrote this article for those of you who share my curiosity.

Sunday I was with my girlfriend, Olga, checking out the TV GUIDE and looking forward to a pleasant afternoon.

"We should do something," she said. "It's such a beautiful day."

"How about if we open the windows and smoke a joint?" I suggested.

"Willie, you're disgusting! All you ever want to do is smoke and drink and watch TV."

"And screw," I added hopefully.

"We are going to the beach," she told me. "You will thank me for it later."

Four hours later we are coming home, down Fulton Street, next to the park. The beach was nice, I'm feeling good. The motorcycle's humming under me, its tank is full of gas, but I'm running out of luck. I don't see a small dog run into the street. The car in front of me is stopping faster than my motorcycle can. As Olga tightens her grip on me, I try to get around; there isn't time. For a moment I cannot believe that this is happening.

The impact doesn't knock me out. I've landed on my ass and Olga's sprawled out on the street a couple of yards away. She looks at me in disbelief. She isn't hurt, but I am bleeding freely from the face and my left leg. The motorcycle lies beside the car I've hit. Slow traffic weaves its way around us. Assholes and voyeurs gather like vultures to gawk at us. They debate what should be done about the bike.

"Shouldn't we move it?" someone asks. "It's leaking gas." She's got that right. About a gallon so far.

"I don't think so." a man answers. "We should wait for the police." He'd rather see my bike burn up than move what might be evidence.

I find that I can stand. I get the bike back up and kick the fender straight, then wheel it to the sidewalk. Olga helps me.

"Willie, you okay?" she asks.

"Don't know. My leg hurts pretty bad, but I can walk."

I light a cigarette; my hands are shaking. Cops arrive before I finish it. An ambulance pulls in behind them; I refuse it.

"Are you sure?" one cop asks.

"Yeah, I can make it on my own."

He waves the ambulance away. "Well, you just saved yourself a hundred bucks," the cop informs me.
Olga finds a cab. We pay six bucks to get to San Francisco General Hospital and people's medicine. It is October 31, 3 p.m. Emergency is crowded.

As I stand in line for my admission interview I see the wounded all around me. Winos, whites and blacks, a hobo with a back pack, some Chinese and Latinos. Quite a variety of people, but we have a lot in common: we are poor and uninsured, the rats and coyotes of the great society.

It hurts to stand in line. My leg is throbbing, I've begun to sweat. My face feels cold. A Chinese man's ahead of me. Very old, hee must be eighty, can't speak English. They can't figure out what's wrong with him. A staff interpreter arrives and seems to understand a little bit of what he's saying.

Now a young guy, drunk, in his mid-twenties, comes up to the intake desk moaning, babbling, bleeding from the stomach. "Stabbed," he tells the woman at the desk, "Knife."

"What's your name?" she asks. "Where do you live?"

"Uhhgugugung."

"What's your name?" she asks again. "We have to know."

He starts to slump and braces himself with a bloody hand, leaving a red streak across the counter. "Umph," he mumbles. I can smell his breath from here, behind him, cheap wine mixed with vomit. The intake lady backs away from him him, not sure what's coming next. I wouldn't want her job.

I'm starting to get dizzy, going into shock. A doctor comes by with a cast around his leg. He pushed a 'T' rack in front of him, a plasma bag bounces merrily along with it. A tube coming from the bag is tied around his arm. Very weird, an injured doctor. Now I see a nurse that has a Charlie Chaplin mustache and a bowler hat on top her head. I think I'm crossing over to the Twilight Zone, but Olga sees it too.

"It's Halloween," she tells me.

"Jesus!"
At last they take the stabbing victim somewhere on a gurney, and the man from China goes off with a nurse dressed in a clown costume. I wonder what he's thinking, poor old man, alone.

It's my turn to be questioned by the stern-faced intake lady. "Name?" she asks. I tell her. "Do you have insurance?"

"No." She asks a few more questions, then it's over and I take my place among the others who are waiting.

After an hour and forty minutes, someone calls my name. I go up to a window and receive a bright orange plastic I.D. card. Some time later, clown nurse comes by with an empty gurney, I climb on and say goodbye to Olga. There's no need for her to wait, I might be kept here overnight. The nurse wheels me away and into inner sanctums of Emergency to meet the intake person. As I strip, he asks me what has happened. "Motorcycle," I admit.

"I thought so," he writes something down as I relate the incident, then looks me over. "You're going to need some stitches in your face. I think your leg is broken. Just wait here, a nurse will take you down to X-Ray."

I'm left outside of one of the emergency rooms. The stabbing victim is inside.

"How big was the knife?" Two doctors question him.

"Gnuuuk!"

"Come on! We've got to know."

He gestures with his hands, like someone describing the size of a fish.

"Six inches?" one doc asks the other.

"Looks like."

Clown nurse reappears and takes me down to X-Ray. "What happened?" she asks.

"Motorcycle."

"It figures," she nods wisely.

I don't answer. After I get pictures taken, I am parked outside Emergency again to wait my turn to get fixed up. My knee is swelling like a pumpkin. I'm hurt worse than I had thought. My head aches, I am feeling loads of pain, and fear. What's wrong with me? How bad? It's been three hours since the accident.

The clown comes back, a urine bottle in her hand. She isn't very funny. "You can do it under the sheet," she tells me. "There's too much going on for anyone to notice."

It is indeed a busy hallway. A young black woman gets wheeled in. They park her just ahead of me. She's all dressed up--date, I guess, or party. Car wreck. She is bleeding from a lot of places, crying. Her attendants leave her. She, like me, lies waiting now, in this cold white hallway, very much alone.

They finish with the stabbing victim. I am sure the woman will go next, but as they wheel him out, another gurney comes around the corner with two doctors and a nurse running alongside. A man's been shot and is very close to death. White uniforms appear from all directions, some bringing sparkling chrome equipment.

It's going to be a while before I see a doctor. I decide to sneak a piss. As I begin to urinate the place falls silent. I hear someone say, "His heart has stopped." The car wreck woman next to me is freaking out, she moans and flails her arms. Her hand slides down the while tile wall and leaves a streak of blood. A cheer comes from inside the emergency room. They have restarted the man's heart.

It's just like in the movies. Heroes, noble healers. S.F. General has a rep for having the best trauma center in the state - they get a lot of practice. I just home they get to me before I croak. I've been here in this fucking hallway two hours now. Another hour goes by, and then, at last, they come for me.

There are three doctors in the room. Or is a doctor, an intern, and a resident? A doctor and two interns? Three interns and no doctor? Hard to keep it all together now. Someone is putting stitches in my face, I hope he's good at it. They practice on the poor, I hope this one's seen a lot of us. One of the other two begins to build a cast around my leg.
"Come on," the one who seems to be in charge admonishes my plasterer, "We haven't got all day!" His words don't seem to help the situation. "Not like that, for Christ sake! It goes this way. You are too damn slow."

It's taken me five hours to get inside this room. I wish they would take their time and do it right. It's like a combat zone, like M*A*S*H on television, only not so funny. They are quickly finished; right or wrong, it's done. The doctors leave. The plaster dries and I get off the table.

"Here's your crutches," someone tells me. Then he steps back to observe. "That looks all right. Take this, you're going to need it." He gives me a prescription for some pain pills. "Go that way," he points.

I make it to the check-out desk. The woman I need to see is talking on the phone. "And so I told him I don't care what Jerry says. I've never even thought about a thing like that. Can you imagine?" She goes on and on. I stand there waiting, feeling blood run down my leg inside the cast. My leg is aching, hip to ankle, and my face is hurting too. "Can you help me, please?" I venture.

Now she looks at me as if I am some sort of scum that's floated to the surface of her private pool. How dare I interrupt her conversation. "In a minute," she replies. She rattles on about her life as I begin to feel a surge of anger.

Up to now I've only felt defeat and shame; without money or insurance I am totally dependent on their mercy. I am powerless inside this place that I, as a member of the working class, have built and paid for. "Hey, miss! I really need some help. It hurts to stand here."

She puts down the phone and looks at me with undisguised hostility. Grudgingly, she finds some papers, flops them down for me to sign, then looks at my prescription. "I can't fill this," she informs me. "Doctor has to put his number in this square." She's pointing to a blank space on my script. "You'll have to have him fill this in.'

"I don't know where he is."

"I don't either," she replies as she picks up the phone again.

The hallway's looking longer than Route 101 and I've got no idea what my doctor looks like, let alone where he might be. Well, fuck it. I will do without the pills. Just let me get back home to my own bed and sleep. "Do I keep all these papers?" Birdbrain doesn't answer so I ask again, but she ignores me.

I give up and hobble to the lobby where I find another nurse. "Am I supposed to keep these papers?"

"Oh, no sir. Didn't they take these from you inside? They should have. Here, I'll take them for you."

I thank her for her kindness. It is 10 p.m. I've been inside this place for seven hours.

There are several cabs outside. I stumble into one. The driver looks at me like I'm from outer space. Another fifteen minutes and I'm back at my place, looking in the bathroom mirror. I can see why the cab driver was freaked. Both eyes are black, my face is caked with blood and dirt. They just washed off the area they put the stitches in, no time for more. I wash myself and go to bed. I have survived. I'm going to be okay -- I think.

It didn't go like that. After one month of crutching, my right arm was paralyzed. I had pinched a nerve that runs up through the armpit, because the crutches I was issued were too high. I couldn't move or feel my fingers, and I had to get a cast put on my wrist to keep it straight. The doctors seemed to think it was my fault.

"I've never given out wrong-sized crutches to anyone in my entire career," one told me.

In truth, I can't remember who it was that gave that to me. I think this guy was afraid I'd sue him. I would have if I'd had the time and energy.

*****************

If you don't have insurance, I would recommend that you find out which hospitals in your area accept medically indigent patients. Pick one, then go and register, before you have an accident or sickness. If you go on a weekday it won't take a lot of time. They ask the standard questions: name, address, how much you make. If you're a part-time worker, like myself, then estimate a monthly wage. They don't check out the facts you give them.

A discount factor will be put into your record according to the wages you report. A seven-hundred-dollar-a-month wage will get you a discount of approximately sixty percent. You will be given a plastic card to carry, just like a credit card. That's essentially what you're doing, establishing a credit account with a hospital. The card can save you going through a lot of shit when you are hurt or sick and want help in a hurry. I hope you get one, and I hope you never have to use it.

by Willie the Rat