Ladyparts

by Deborah Copaken

  *2 I’ve lost count of the number of times my daughter has texted me in a blind panic about her birth control pills, when some glitch in her prescription delivery service—now required by our health insurance, if we want them to help cover her pills—sends her scrambling to fill in the gaps with her friends’ pills. (Her friends’ pills!) She, like all Americans on the pill, must visit her doctor in person for a new prescription every year. This not only costs money, it costs time and effort, and then something always goes wrong anyway.

  *3 Name has been changed.

  TWELVE

  Health Today

  OCTOBER 2013–JANUARY 2014

  A couple of weeks before my new job as executive editor at Health Today is set to begin, my little one accidentally bumps his head into the lump on my breast, and I wince. I call the Breast Examination Center of Harlem to see if there are any cancellations. Miraculously, they have one a few days later, so I take it, after which I receive a call from Sloan Kettering’s main switchboard, telling me they did not like what they saw on my scans. They want me to come into their Upper East Side office immediately for more tests: another mammogram, possibly an ultrasound, possibly a biopsy, depending on what they find.

  I cannot afford these tests. I explain this to the accounting department at Sloan Kettering: that I still don’t have health insurance but I will, at my new job, and it will kick in a month after my start date. They’re not happy about waiting six weeks for a biopsy, but I’m not happy about spending thousands of dollars I don’t have, so what else is there to say? Healthcare in gig-economy America feels like a constant game of Frogger: You can’t hop to the next level until the logs line up with the turtles.

  Eight weeks later, after I’m gainfully employed and safely afloat on a new healthcare log, the radiologist who does the ultrasound is not happy with what she sees either. It sort of looks like a cyst, she says, but she does not like that the fluid inside it isn’t registering as pure black—meaning clear liquid—on the ultrasound. “See this here?” She points to a gray, fuzzy patch in the middle of the lump. “We need to get that biopsied and clip it. In case you need surgery.”

  I get the biopsy and the clip. Biopsies are painful. I did not know this. You need to lie down when you get home, I’m told, to recover. Ice and pain relievers will help. I do not yet want to tell my new employer or my kids what’s going on inside my left breast, however, so when I’m back at the office later that afternoon following the biopsy or cleaning off Elvis’s dog shit from my bed later that night while George and Brittany deal with the caked-on pieces of turd somehow caught in the wheels of my ex’s desk chair, I suck up the pain, do my work, change the sheets, light a candle to mask the stench, and make us all dinner as usual.

  (Elvis, George’s beagle, is still getting used to living in the Commune. He sometimes deals with his anxiety by taking a dump on my bed.)

  Three days later, Sloan Kettering calls with a diagnosis of “atypical ductal cells with focal atypia and foam cells,” aka atypia. I have no idea what this means. Foam cells? Sounds like a boob latte. But over the course of the next forty-eight hours, I will learn that medical reactions to such a diagnosis vary widely. The first breast surgeon I visit, who’s not at Sloan Kettering but is in network for my new health insurance, does her own diagnosis and says, no, it’s not atypia, it’s DCIS (ductal carcinoma in situ, aka stage 0 breast cancer because it has not spread beyond the ducts). She wants to put me on tamoxifen, an antiestrogen hormone therapy that will send my still-ovulating body into immediate menopause, kill my libido, wreak havoc on my sleep, dry out my vagina, and make it itchy. (Fun!) She mumbles something about possibly getting a mastectomy and definitely getting radiation and possibly chemotherapy.

  Whoa! I think. What? I call my friend Ayelet to cry. Though we live on different coasts, she’s always the first person I call whenever I need emotional release or advice, as hers is always sound and given with love and lack of judgment. She urges me, immediately, to call her friend Peggy Orenstein, who’d recently written a seminal story on the overtreatment of DCIS for The New York Times. Peggy, in turn, urges me to get another opinion, even if it’s outside my insurance network. “Go back to Sloan,” she says. “They know what they’re doing.” This second, more expensive opinion, from a female oncologist at Sloan Kettering I found by watching videos on their website and choosing the one with whom I’d want to share a cup of tea, is more wait-and-see and measured.

  This lovely, calm doctor—who will soon leave Sloan to become chief of breast surgery at a different cancer hospital in a different state—says she first wants to stick me into an MRI to make sure nothing else lights up before we do anything, and no, tamoxifen is not necessary at this time. I choose this less alarmist, more expensive oncologist outside my healthcare network, but I worry both about the co-pays and about missing another day away from the office so soon after the start of my job. Then again, it’s better than having to go into immediate menopause as a result of taking tamoxifen, and to miss work every week for radiation and chemotherapy.

  I’d arrived at work on my first day as executive editor of Health Today eager to write and assign stories about our healthcare system, various illnesses, and scientific breakthroughs in medicine. Health, I tell myself, is one of those topics that many of us like to read about. And while I would rather spend my working hours writing my own books, I feel grateful and lucky to have landed an editing job with benefits, covering a topic I care about, living, as we all do, in a dying body.

  During my multiple interviews leading up to the job, I was told several times that I’d have a budget to assign and publish stories covering all aspects of health. “I find it offensive that publications such as the Huffington Post expect their writers to produce ‘content’ for free,” I’d said to one of my interviewers, testing the waters to see if we were aligned on the issue of fee for hire. “Work is work. Writing is writing. It should be properly remunerated.”

  Free content—and those willing to produce and publish it—has decimated my profession and eroded trust in the news. Anyone with a laptop could publish any un-fact-checked, unedited nonsense they wanted to publish and push it out onto social channels. The Russians will make excellent use of this chink in our national armor during the 2016 elections, as we will learn all too well, but now, in the fall of 2013, I see this more as a pressing moral issue about the value of work and the obligation of those who financially gain from that work to provide fair compensation.

  If I ask a carpenter to come to my home and build me a shelf, it’s not okay for me to send him away without payment. Or to tell him, “Maybe someone else who needs shelves will come over to my house and see this beautiful one, and they will pay you to build shelves for them!” Similarly, I do not want to be put into a position where I’m asking people to write for free. This is my line in the sand, the same as my father’s refusal to represent tobacco companies in his law firm. “You have to know where the line is,” Dad told me often, starting on the day he turned down a giant sum of tobacco dollars for the sake of his conscience. “If you earn your money off the suffering or deaths or exploitation of others, that’s not a moral income. That’s blood money. And I’d rather see you be a waitress or a housekeeper than take blood money. Serving food and cleaning toilets is noble work, contributing to the greater good of society. Helping a tobacco company kill people is not. Do you understand the difference?”

  I was six years old when he first said this, sitting shotgun in his beloved red Mustang, trying to chomp on a still-warm-from-the-oven egg bagel without my front teeth. “Yes, Daddy, I do.”

  The woman with whom I was meeting, a vice president of Health Today, nodded vigorously in mutual agreement. Of course, of course, we would never expect anyone to write for free. I’d spoken to another of my interviewers, one of the company’s founders, about producing hard-hitting investigative stories about sexism in healthcare. Great idea, I was told.
I talked about redesigning the site, to make it cleaner, more easily navigable. Yes, that’s exactly what we want, everyone said. Welcome to the team!

  None of my ideas, I realize by the end of week one, are possible. They’ve hired an editor from a different health magazine to be both editorial director and my boss, and she’s been put in charge of the redesign, which I’m relieved about, knowing nothing about doing such things myself. She calls me, a few days before my start date, to ask me to have lunch with her, during which she announces that she’s asked the company to push back my start date by two weeks, so that she can get settled in before I arrive. It’s an odd power play, and I’ll have to call both my landlord, to tell him my rent will be two weeks late, as well as Sloan Kettering, to push off my second round of breast tests by another half month, but I have no desire to make waves or to butt heads right out of the gate, let alone with someone to whom I’ll be reporting. “No problem!” I say. I just want to keep my nose to the grindstone, do good work, replenish my empty bank account, procure health insurance, and have enough time at the end of my workday to rush home—my commute will be over an hour each way—and sit down for dinner with my children and the rest of the Commune.

  On the first day of my new job, my desktop computer won’t turn on. So I ask my new colleagues what to do. The last time I’d held a corporate job that required me to go to an outside office every day, back in 1998, the internet was just getting started. I still shared a personal email address with my husband. I didn’t yet have a cellphone. And our NBC computers were old clunkers. When they broke, as they often did, you’d walk down to the IT department and ask someone to come back to your office to help you fix it. Now, I’m told, I have to fill out a help desk request on the computer. Since my computer won’t turn on, and no one else can fill out the request for me—it has to come from my specific log-in for record-keeping purposes—this is a conundrum. I look around the large open-plan room and spot what looks like the IT department off in the distance. “Do you know who can help me fix my computer?” I say to one of the young men sitting there.

  “You have to fill out a help desk request,” he tells me.

  “I know. But that’s the problem. My computer won’t turn on.”

  “Have you checked that it’s plugged in?”

  “Yes.”

  He shrugs. “Sorry. I can’t do anything without a help desk request.”

  “Can you help me load my work email onto my phone, so I can work off of that?”

  “Again, that would require a help desk request.”

  Every minute of his day, I would soon understand, is being monitored for efficiency. How long does it take between the time a help desk request comes in and the person requesting it marks the issue as resolved? These were numbers that could be counted. If you were slow, you could say goodbye to your job.

  “The turnover here is insane,” one of my new colleagues warns me that first day. “One minute you think you’re making a new friend at work, the next they’re collecting their family photos and walking out the door forever.” This would turn out to be an understatement. One day, an entire section of my floor is fired before I’ve even had a chance to figure out what that part of the room does. Or rather: did. Never before, outside a funeral or terrorist attack, have I seen this many grown men and women hugging and crying together in unison.

  This fear-based management style, where every piece of equipment on every desk is logged and accounted for; where minutes must be filled with labor and then noted in a ledger; and where those in charge squeeze out every drop of worker sweat, has its roots in American slavery: “You report to someone,” writes Matthew Desmond in The New York Times Magazine, of offices such as mine, “and someone reports to you. Everything is tracked, recorded and analyzed, via vertical reporting systems, double-entry record-keeping and precise quantification. Data seems to hold sway over every operation. It feels like a cutting-edge approach to management, but many of these techniques that we now take for granted were developed by and for large plantations.”

  “Low-road capitalism,” the University of Wisconsin-Madison sociologist Joel Rogers calls our American style of capitalism, in which jobs lack flexibility of purpose; training pertains only to that one job in that one office—you can’t take your skills with you to your next job because they won’t transfer; bosses closely monitor and measure workers’ rule-compliance and performance; hierarchies are rigid; wages are low; and workers are denied the chips of collective bargaining that could both get them out of this rut and keep them from getting fired without cause or severance.

  In fact, the Organisation for Economic Co-operation and Development—an intergovernmental organization headquartered in Paris, with thirty-seven member countries all committed to democracy and to the market economy—places the United States dead last on a list of seventy-one nations ranked according to how difficult it is to fire workers. Meaning that every other country in this large and detailed study has much stronger protections for workers than the U.S. Here, firing people is literally as easy as saying “Goodbye, don’t come back tomorrow.” The invisible axe constantly hanging over American workers’ heads feels like the psychological equivalent of war coverage: You do your job as best you can under fire, never knowing which pink slip bomb, if any, has your name on it.

  On my second day on the job, I bring in my own laptop and plug it into the office ethernet. Success! I’m in the system. I fill out a help desk request, and an hour later someone from IT walks over and figures out what’s wrong with my desktop: “It’s broken,” he says. He swaps it out for a working computer, at which I sit down and type up a list of magazine writers with whom I’d love to work. I email this list to the editorial director. Great list, she says, but you’ll never get the budget to hire any of them.

  My mandate, she tells me, is to manage and grow the company’s current roster of sick and dying people—my bloggers, as they’re optimistically called, though half of them are barely literate and some are barely alive—who’ve all volunteered to write, gratis, about what it’s like living and/or dying with their various ailments. Specifically those ailments with pharmaceutical interventions, like type 2 diabetes, so that targeted pharmaceutical ads can be published next to their blogs. We’re not interested, I’m told, in publishing stories about type 1 diabetes. There are no ad dollars in insulin.

  It’s all about the ads, I suddenly understand. There’s gold in them thar pharmaceutical hills, and my company’s business model is to mine it. This had also been true of my former industries (magazines, newspapers, and TV news) with one major difference: an established and long-standing firewall between ad sales and journalism. “Church and state,” it was called, though like the pope and the president, the two would meet up now and then to unruffle feathers. Nevertheless, a legitimate news outlet could assign a hard-hitting series about the greed of Turing Pharmaceuticals CEO Martin Shkreli—dubbed “the most hated man in America” after he raised the price of the antiparasitic drug Daraprim from $13.50 to $750 per pill—and still have at some point accepted ad dollars from Turing. They could report on the American obesity epidemic, naming soft drinks as one of the main culprits, and still run ads for Coca-Cola. If a particularly harsh and revealing investigative story, such as “Fast-Food Nation,” led to McDonald’s pulling all of its ads from the pages of Rolling Stone, so be it. It’s not a magazine’s job to kowtow to advertisers. It’s to report the news, however unfavorable to everyone’s bottom lines, including their own.

  At Health Today, this notion was reversed. The ads dictated the content; the tail wagged the dog. Put simply, the content I’ve been hired to edit is secondary to ad delivery: a bait-and-switch lure not unlike the plastic toy in the box of sugar cereal; the 15 percent off your purchase in exchange for signing up for another credit card you don’t need; the free stay at the Vegas hotel tonight so you can lose all of your chips tomorrow to the blackjack dealer.

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nbsp; The writing itself, if you can even call it that, is simply a way to get people who type in search terms such as “Crohn’s disease” or “fibromyalgia” or “COPD” into Google to see ads for pharmaceutical products targeted to those illnesses. The company has amassed a crack team of SEO (search engine optimization) specialists tasked with making sure ours is the first site that appears in such searches. I like the SEO dudes. They’re the only ones, at first, who’ll invite me to have lunch with them. While the rest of us sit in an open office, the five of them sit cheek-to-jowl in a private office built for one, a tiny anthill of young, already disillusioned men whose combined heat and stress forms condensation on the glass wall separating us from them. With the company on the verge of going public, the CEOs are not happy that our rivals consistently rank higher than we do in searches. More worrisome, because our main competitor has made a concerted effort to publish content consumers trust, the majority of their traffic is organic—a sustainable business model—while ours is purchased—an unsustainable model.

  Every day at Health Today begins to feel like that scene in I Love Lucy, where Lucy is working in the chocolate factory, unable to process all the chocolates whizzing by. A new essay comes in, I’ll rewrite it from scratch while fact-checking its claims, three more will come in, rinse, repeat. I don’t mind the work—writing and editing are enjoyable activities for me—but each blog post begins to sound the same as the one before. There’s no nuance. Nothing original. Nothing that makes me want to copy the link and share it with friends. And I don’t feel comfortable asking my own friends who are writers to contribute work if I can’t pay them.