Thursday, April 30, 2009

The far side of midnight

After the coughing and hacking, after the dollop of honey that was supposed to alleviate the coughing and hacking, after the subsequent gagging and gasping for breath and other associated symptoms of a nasty cold grown nastier, there came a tightness in my chest settling down like dusk.  Everything prior to that moment suddenly seemed minor annoyances, mere grievances of the most inconsiderable ilk. The tightness quickened and deepened, consolidating into a throbbing mass centered beneath my left breastbone. Twinges of muscle spasms jittered down my left arm and orbited my collar bone. My cough stilled as if submissive to a dominant threat. 

“Is this it?” I wondered, and leaning on the kitchen counter watched the hands of the clock join in perfect unison to herald the witching hour. The question, unanswerable by anything other than what lurked on the far side of midnight, was shadowed by a sardonic reflection: Funny, I didn’t feel like I was ready to check out.


Memory plays fast and loose with facts. Things we remember, whether actual events or whispered fables filtered through the prism of former times and layers of maturity (and hence comprehension), are often proven to be pliable if not outright false. And yet they are our stories, our histories, the underpinnings of the lives we have constructed. Real or imagined, what we remember defines what we are.

I remember this: a small service station baking under a blazing Texas sun, worried faces, my grandfather sitting on a small chair or stool in an open bay, hunched over, ashen-faced, my grandmother at his side—both younger, much younger, and still alive, though for him the clock was running out—the wail of sirens singling us out, traffic parting, the screech of tires signaling an explosion of activity, followed by a long uncomfortable silence that fell like a shadow on our rapidly growing assemblage and the children most of all. Voices hushed and muted, an interminable, incomprehensible church service. My grandfather, Claude Volney Parker, a hardscrabble West Texas rancher, transformed from living flesh to fading memory in the space of a heartbeat. Or its absence.

It was June 19, 1959. I was almost six years old, too young for factual reportage but at an age where the brain absorbs impressions like a sponge. In the larger scheme of things, whether it happened at a service station or the post office is immaterial. What matters is that it illustrated with lethal clarity a weak link of ancestral lineage.

From an early age, we three brothers were told that behind our seemingly superb health lurked a genetic flaw, an assassin affixed to our DNA that when summoned stepped forth from the shadows to swing its metaphorical scythe into the aortas of Parker males. Though the timing of this event varied between individuals, it could be with some precision narrowed down to the latter part of our fifth decade or the opening strains of the sixth. Not every male fell victim, but enough did to warrant an undercurrent of uncertainty when approaching the age of fifty. Once that barrier was breached, one could breathe somewhat freer.

Or not. My father, the teller of this tale and a notorious “realist,” was fond of saying that only two things were guaranteed—death and taxes. The latter was a certainty timed to a monthly cycle, the former an unpredictable variable we hoped would be later rather than sooner. But, he warned, you never know.

I have carried this knowledge like excess baggage throughout my annual circumnavigations around the sun. Though I researched the basics of heart disease and learned by rote the signs of heart failure, prior to my latest episode it was a cautionary anecdote and no more. Until, that is, I went to a major medical clinic in Denver and made the mistake of relating it to a physician while simultaneously complaining of chest pains. With stunning rapidity I was hoisted onto a gurney, wheeled into an ambulance and whisked at high speed to a hospital halfway across town, where I remained a prisoner for the next 24 hours.

The word “prisoner” is not used indiscriminately. As member in good standing with a major international health insurer, I was expected to abide without question the rules imposed by the medical establishment. At one point, where my anger threatened to bring violence upon the staff, I demanded to know what would happen should I simply dress myself and stalk out the door. The doctor politely told me I was free to go, but that I should expect a fairly sizable bill with zero chance of recompense by the insurance company. I stayed.

Not having health insurance changes the equation. In fact, it changes it to a degree at once deadly serious and comically fatalistic. 

According to the Institute of Medicine, being uninsured beats diabetes and HIV/AIDS on the top ten list of causes of death in America. It can literally kill you, not directly but obliquely, by the uninsured failing to schedule regular checkups, screenings and tests, or to allow diseases to run rampant before seeking medical attention. Frequently in matters of health, too late is just that. 

Being without health insurance still surprises me. It wasn’t calculated or planned, or at any rate wasn’t supposed to last more than a few months, a year at most. That it has stretched out for almost a decade is disconcerting but truly bothersome only when needed. Which, fortunately, isn’t often. However, monthly charges offered by major insurers amount to that of a new car payment, though the car is tangible and insurance is not. Astronomical deductibles jack associated costs further into the stratosphere, leading one to eventually conclude that the medical establishment, in cahoots with insurance providers, are a modern Bonny and Clyde unleashed upon a defenseless society.

I’m not asking for sympathy. What is, is. But there comes a time when my chest tightens and lightning plays along the periphery of my limbs, and questions arise that have no ready answers: is this it, do I go or stay, which is worse, potential salvation or probable financial ruin. And all the while  my deceitful heart hammers away. I listen and wait. Mostly, I wait.



shoreacres said...

In 1990 I left the "real world" - the world of meetings, high heels and subsidized health care - to begin my own business. It is now nearly 20 years since I made my choice, and I lived without health insurance for 13 of those years.

During that period, I required surgery. What was once a major procedure could be done without an extensive hospital stay, but still - the cost would be $5,000.
It was impossible. I told the business office person (with whom I met more frequently than medical staff) it was impossible. She asked, can you pay cash - put it on a credit card? I said I could, but preferred not to. She told me it would be worth my while. If I did pay cash, the cost would be $1,200. $3,800 less.

Your point is relevant: "Astronomical deductibles jack associated costs further into the stratosphere, leading one to eventually conclude that the medical establishment, in cahoots with insurance providers, are a modern Bonny and Clyde unleashed upon a defenseless society."Seven years ago I began providing my own health insurance, at a cost of $145/month. Today, my monthly premium is $314/month, and my deductible has risen from $500 to $5,000. I'm in excellent health, but have not been to a physician for two years. The cost of any baseline testing, lab work and so on is prohibitive. In order to pay my monthly insurance premiums, I have to economize every way I can - including no doctor visits.

At age 62, it's a waiting game. Whether I'll be able to continue paying such premiums until I'm eligible for Medicare, I don't know. But I do know what it's like to feel a twinge, something unusual and strange, and then to freeze, looking off into the middle distance and wondering.

Tom Parker said...

Linda -- You illustrate my point perfectly. Someone once told me (angrily) that I could afford health insurance if I wanted to. Yes, I could. But then I wouldn't have the camera I use, or the lenses, or the external hard drive to back up the photos and writings, nor would I have—you get the point. I would have an insurance premium I was afraid to use and that was for the most part worthless unless some major disaster happened. So what's the point? Better yet, what's the option?