As I twist myself into this healthcare pretzel to get a simple lump examined, I imagine citizens of Sweden or France or England or all the other first world countries in which healthcare is sewn into the fabric of society hearing my story and saying, no, it can’t be that bad. Well, yes, I want to tell them. It can be. This is what it’s like for us. People die in America because they can’t afford insulin or because they must ration the insulin they have. Sometimes they can’t even afford the cost of the check-up to let them know they need insulin to stay alive. Or their doctor, trying to maximize profits by seeing as many patients as possible in a single day, is too rushed to notice anything amiss or to order a simple test.
My first cousin, Jeremy Copaken—with whom I spent every Thanksgiving, many Passovers, and countless weekends as a child—will die in 2014, just after his thirty-ninth birthday, of undiagnosed diabetes. At home, alone, on his living room floor, halfway between his TV and couch, hours after visiting a too-harried doctor and saying, “I don’t feel well.”
In America, people in their thirties should not be dying from diabetic shock on their living room floors. It’s a manageable, easily diagnosable illness. Jeremy was obese. Shouldn’t some doctor somewhere at some point along the way have thought to test him for diabetes? It’s a blood test. One fucking blood test.
In 1952, George Merck, the CEO of his eponymous pharmaceutical company, declared, “Medicine is for people, not for profits,” on the cover of Time magazine, and his company subsequently donated $200 million worth of river blindness medication to Africa in the late ’80s because it was the moral thing to do. Today’s Merck is using its $6.2 billion in profits to buy back shares of its own stocks and to keep its shareholders and CEO happy. Merck CEO Kenneth Frazier received a 2019 pay package worth $22.6 million while also selling $54.8 million in his own stock between July 2018 and July of 2019.
Several smart economists studied the numbers in 2017 and all but named the pharmaceutical industry a Ponzi scheme. How do these companies get away with this? Well, in 2018, Merck spent $10 billion on research and development of new drugs. This seems like a lot of money to help fund new research until you realize that they spent 40 percent more—$14 billion—on share repurchases and dividends. Moreover, from 2008 until 2017, the company distributed 133 percent of its profits to shareholders. Let’s pause to consider that number again: 133 percent of Merck’s profits are handed out to its shareholders. (Yes, I had to read that number twice, too.) Even I, who was as pitiful at playing Monopoly in my youth as I am in understanding simple economics today, can tell you that a business that gives away more than 100 percent of its profits to shareholders is Bernie Madoff–level unsustainable.
What this means is that those of us in America who need drugs and healthcare—meaning all of us—have to make up the difference. Today in the U.S., George Merck’s 1952 Time magazine quote would be flipped on its head: Medicine is for profits, not for people. And drug companies and private insurers are now incentivized, by their own business models, to save a buck over a life. It is telling that Frazier gets lauded in the press not for helping to save millions of lives with Merck’s groundbreaking immunotherapy cancer treatment, Keytruda—a true breakthrough, let’s all acknowledge that—but “for building Keytruda into a franchise that can be used to fight a range of tumors, navigating challenging political currents, and delivering strong returns for shareholders.”
This push to keep shareholders happy means the pharmaceutical lobby is the most powerful lobbying group in the U.S. today by nearly a factor of two, pumping nearly $4.6 billion into lobbying efforts since 1998. Meaning every year they donate not just millions of dollars but rather hundreds of millions of dollars to those candidates and lawmakers who will protect their financial interests.
In 2017, U.S. congressman Raúl Labrador, whose campaign was partly funded by pharma-dollars, said, “Nobody dies because they don’t have access to healthcare.” Of course we know that this is not true. In fact, if we’re getting down to the statistical nitty-gritty, one can reasonably argue that Chief Justice John Roberts, in his majority opinion in National Federation of Independent Business v. Sebelius, personally killed 15,600 Americans by creating the legal rationale that would allow states to opt out of the ACA’s Medicaid expansion. According to a 2019 economic study, which looked at death rates since the Supreme Court’s decision in 2012, those states that ignored the Supreme Court’s decision and opted in for Medicaid expansion saw death rates drop, saving 19,200 lives over the course of four years. Had all states opted in, those 15,600 lives could have been saved.
Pre-Covid-19, that was a big number—a battlefront casualty number—these 15,600 dead Americans. And our brains are terrible at processing big numbers: 2,977 people were murdered on 9/11, but, even though I personally knew three of them, I had to read every single obituary in The New York Times “Portraits of Grief” to feel the gaping hole each left behind. We build monuments to those murdered in acts of war or terrorism, carving their names into shiny stone, but exterminate more than five times the number of people who died on 9/11 with corporate greed and political indifference, and deaths like my cousin Jeremy’s remain an uncarved rounding error.
Or as that paragon of kindness and empathy, Joseph Stalin, once allegedly exclaimed: A single death is a tragedy. A million deaths is a statistic.
The London-based American actor Rob Delaney, of Catastrophe fame, lost his two-year-old son, Henry, to a brain tumor in 2018. He’s so appalled by the absurdities of the U.S. healthcare system that he still lives abroad. “How to say this simply?” he wrote in a 2019 Twitter thread. “I lived in the US until I was 37 & had private health insurance most of my life. For the past 5 yrs I’ve lived in the UK & use the NHS. The NHS is a HUGE part of why I might never move back to the US….Most critically the UK spends dramatically LESS per patient than the US. IT COSTS LESS.”
The United States also lags behind the following countries, all of whom have nationalized healthcare systems, in healthcare quality and so-called “amenable mortality” scores—that’s a number that measures the rates of deaths considered preventable by a combination of timely and effective care: the Netherlands (96.1), Australia (95.9), Sweden (95.5), Japan (94.1), Austria (93.9), Germany (92), France (91.7), and the United Kingdom (90.5). The U.S., which spends more on healthcare per capita than any other developed nation on earth, only scored an 88.7 amenable mortality score: a solid B, okay, sure, but—call me picky—when it’s a binary matter of life and death, I’d rather live in a country that gets an A when graded on its ability to keep me alive. Not needlessly dying due to a lack of timely and effective care for a preventable illness only 88.7 percent of the time doesn’t seem like a reasonable score for a country with a higher GDP than the eight countries ranked above ours.
I wonder how long I’d have to wait to have a breast lump examined for free in the Netherlands.
It’s important to note, too, that, as I sit here writing this, seven years after I needed that free breast exam, Title X, which was a landmark federal program aimed at supporting women’s health for low-income Americans, has been all but dismantled. This means that a formerly free breast exam now costs $160. Pap smears, which test for cervical cancer, have gone from free to $264. And two of the most foolproof methods of birth control, which require a doctor’s insertion—an arm implant and an IUD—have skyrocketed from zero to in some cases more than $1,000 a pop.
I sit at my desk, still staring at my to-do list, hyperventilating. I’ve crossed off the tasks that don’t require financial solutions, but those that do weigh on my chest like lead aprons, one atop the other. My heart hurts. My lungs won’t fill. If it were just “find cheaper apartment/move,” I’d still be experiencing minor anxiety, sure, but combined with the rest of the list, it paralyzes me. I am the Little Engine Who Couldn’t, a negative subversion of my favorite book as a child. I think I can’t, I think I can’t, I think I can’t.
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nbsp; My office window faces east, into the bricks of a large apartment building on Edgecomb Avenue overlooking Jackie Robinson Park. Several musicians live in that building, and when I’m not trying to concentrate on crafting sentences, I’ll open my window to let in their notes: Bach, Beethoven, jazz, ragtime, piano, a saxophone, an electric guitar: You never know which genre or notes will waft in from which type of instrument, but you’re guaranteed to hear whichever they happen to be repeated multiple times, for many hours, until their creator gets them just right. It has given me comfort to know there were others like me nearby, sitting alone in their rooms, polishing their little offerings to the world.
On September mornings like today’s, when the sun is still high enough in the sky, light infuses my office until it glows. It kills me to have to give up this room of my own. Yes, it’s under six feet wide, and its floors are so sloped that the magnetic balls my son likes to play with after school roll from one end of the room to the other, but it fits my desk, a chair, and a narrow shelf, and it is the place in which I have done work that has fed me, both literally and figuratively. The spines of said work, translated into various languages, now line that narrow bookshelf, atop which ten copies of a new French translation are now stacked, waiting for me to find a place to store them. One of the reasons we’d moved to Harlem, back when the rents were still cheap, was so that I could have this home office. One of the reasons I stayed in my failing marriage for so long, aside from not wanting to hurt my kids, was to keep writing in it without worrying about where I’d get my healthcare.
I stand up. Lean my arms and forehead against the glass pane. Stare down at the sharp angles of my neighbor’s patio below, then back up at the sun: How do I do this? I wonder, meaning the rest of my life. Who am I without the work I do in this room? The questions bring on a new eruption of tears. I consider jumping. Joining Dad. The crack of skull against slate. The blissful release of letting go. The definitive no and I think I can’t and fuck this shit, I’m done.
I open the window. Poke my head out. Contemplate the impact of an object falling four stories. I’m terrible at physics. There’s velocity, time, and gravity, but how do you calculate the actual force of a body in free fall? A shiver runs up my spine as I lean out too far. I readjust my center of gravity and pull my shoulders back in. The late summer air is already cooling. Soon ice and snow will cover the slate below. Branches will crack under its weight. One October, when the trees outside my office window had hit peak foliage, a freak snowstorm erupted. The combination of red, orange, and yellow leaves dusted in powdery white had thrilled my children. They’d all crammed into my tiny office to stare at the snowliage, a reminder that life could still hold unforeseen beauty.
Somewhere, a violin bow strokes the first few notes of “The Sound of Silence,” the song my father insisted my son perform at his funeral. We’d all joined in to sing—my three sisters, our kids—while my son strummed his guitar, none of us able to move past the line about silence like a cancer grows without choking on our tears.
I cup my ear to better hear the tune. Enough, I think, imagining how Dad might react to my self-pity at a moment when resilience and strength are required. You can’t kill yourself. Of course you can’t. You have children. You can’t do that to them. You wrote a whole fucking novel about how you can’t do that to them, back when your marriage was disintegrating into toxic sludge, and ideations of suicide became the daily drumbeat of your hours.
You remind yourself that, in escaping your marriage, you’ve taken the first step toward a mentally healthy and tenable future existence. You knew it would be difficult, this whole starting over from scratch part, which is why you kept putting it off, and though you hadn’t really understood just how difficult, you did understand, as every Nora Helmer had before you, that walking out the door of your marriage semi-intact was preferable to coming unglued inside it. You wanted this separation, you remind yourself. You made it happen. So count your blessings, motherfucker. You cannot kill yourself today. Nuh-uh. No way. No!
No. If it were possible to “command + F” a marriage, the most commonly used word in mine would have been no. No, I won’t. No, I can’t. No, I don’t like that. Stop it, please, no! Is it any wonder, then, that the first phrase that strikes me at this first moment of its untethering is Yes, and…
Yes, and…is the basis for improv, which is when two people or more perform a comic scene together on the fly, without script or plan. So, for example, if your scene partner says, “Oh my god, I’m late for work, can you watch my pet hedgehog?” you cannot counter that with “No, I’m busy,” or “That’s not a hedgehog.” You have to “yes, and” it, responding with something along the lines of “Yes, and I’ll be sure to sauté him with some shallots and vermouth,” because now your scene partner has something to work with: hedgehog Provençal.
Obviously, I’m not great at this, but good lord do I enjoy trying. Performing onstage, back in college, had always provided me one of the more pleasurable, illicit substance-free ways of both coping and staying present: a relief from the pressures of academia; a means of joining a supportive and judgment-free artistic community; a way of letting go and turning off those parts of my brain that either remained stuck in the past or worried about the future in order to live fully in the present. I also feel an almost compulsive need to laugh, or to at least find pockets of laughter…somewhere.
After a nervous breakdown, “The Lottery” author, Shirley Jackson, started keeping a journal, in which she admitted her desire to escape her painful marriage in order “to be separate, to be alone, to stand and walk alone, not to be different and weak and helpless and degraded.” But even though she’d started writing a joyous new novel about a widow who sloughs off her married name and embarks on a new beginning, her fears of leaving her real marriage prevailed. She died of heart failure in her sleep at forty-eight, still married to her tormentor.
At this point in my own story, I am forty-seven.
Six months before Jackson’s death, she wrote these final words in her journal: “I am the captain of my fate. Laughter is possible laughter is possible laughter is possible.”
I impulsively google “improv classes NYC.” All of the classes at UCB (Upright Citizens Brigade) are already filled up this late in September, but there’s a $40 promotion for four introductory Level 0 classes with a few slots open at the PIT (Peoples Improv Theater). On a whim I can only describe as involuntary, I sign up for the class. Did I realize, before stepping onto this new stage of my life, that saying “Yes, and…” would be the thing that will save it? No, but it is there at my first class, held in a nondescript rehearsal room in the West 20s, where I will meet Brittany, the raven-haired, twenty-something aspiring actor who will eventually move into my former home office to become my seven-year-old’s live-in au pair. During improv class one day, Brittany had told me she was having both roommate and rent issues. Two weeks later, in exchange for free housing, food, and a $200 weekly stipend, sweet Brittany from improv class, with her voice of an angel, will become part of the glue that holds my family together.
Yes, and!
Soon after that, sixteen-year-old Hannah, my daughter’s best friend, will move in with us and sleep on a trundle bed in the room shared by my daughter and seven-year-old son. Hannah—blond, leggy, so dazzling she glows, but with dark undertones of my-alcoholic-dad-abandoned-me pain—has been skipping school every day, sleeping in until noon. Our home full of people getting up and going to work and school every day, her fed-up solo mother hopes, will be a good influence. “Yes, and…” I’ll tell her mom. “We’ll take good care of her, I promise.” We’ve been Hannah’s default second home for years at this point anyway, as her mom often has to travel for work as an event planner.
Which is how six of us, each at a moment of inflection—George from college, mourning the loss of his husband; Brittany from improv, trying to find her way in the world; Hannah from my daughter
’s class, struggling with chronic truancy; my daughter and son, adjusting to life without their father and older brother; and a forty-seven-year-old, newly untethered me, hoping for both a mammogram and transformation, in that order—begin living together under one roof, with my dog and George’s dog and two smelly cats, in what we will from then on lovingly refer to as the Commune.
Yes, and…in fact, will become my new rallying cry and modus operandi. When a stranger randomly knocks on my door, wondering if she can pay us a thousand dollars in exchange for using my home as a holding area for the actors and extras in her film, The Mend, I’ll laugh (I mean, come on, The Mend?) and say, “Yes, and I can cook them dinner as well.” When a young student director asks me to play a Russian spy in his graduate film, The Super, I’ll say, “Yes, and I can actually speak Russian at the beginning of the scene if you’d like.”
When I receive a call from my Parisian friend Marion, who’s wondering if her niece and two friends can come stay with us for two weeks before they head off to medical school, I’ll say, “Yes, and I can ask if they can be extras in an American film as well!”
One night, during the shoot for The Mend, my friend Soman, a frequent dinner guest at the Commune and our honorary seventh member, shows up as I’m putting out snacks for the crew and spots my daughter doing her homework on the living room couch, surrounded by two dozen actors crammed into every corner of the room, including our three French exchange students, who were all thrilled to be asked to be extras. “What’s going on?” Soman says, searching in vain for a place to sit.
“Don’t ask,” says my daughter. “Mom’s saying, ‘Yes, and’ to everything.”
On set of The Super, 2013
Skip Notes
*1 The term soccer mom has gone from descriptor, when it was first used in 1982, to sexist trope. Like other descriptors such as mistress, working mother, slut, Karen, and spinster, it has no male counterpart: usually as good a sign as any that those slinging it are using it more as insult than identifier.
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