Hand to Mouth: Living in Bootstrap America

by Linda Tirado

  Well, scratch that. I have had trouble finding decent medical care. It’s why I didn’t have prenatal care for my oldest daughter. I found out I was pregnant in October, days before the last election I ever worked on. I had a suspicion I was pregnant—I mean, that’s why I’d peed on seven pregnancy sticks, all of which had turned out positive. But I couldn’t bring myself to believe the results, since I’d been told so many times that it was practically impossible for me to get pregnant. I made a command decision that all those store-bought tests had to have been defective. So I went to the local Planned Parenthood and requested a blood test. But after the nurse heard about all the tests I’d already taken she just laughed and went straight for an ultrasound. Sure enough, within three seconds she told me that I was already six weeks gone.

  I didn’t think about the pregnancy much to begin with; I had a job to finish, then we’d sort out what to do next. I knew that I’d be facing weeks of unemployment after Election Day, and I could sort out prenatal and baby products and such then. The pregnancy prompted our decision to send my husband to school; we’d been thinking about it since he came home from Iraq, and it seemed as good a time as any to have a guaranteed income. The GI Bill, along with paying for tuition, pays a living stipend. It would just cover all of our expenses if we were careful. I could stay home with the baby until I was ready to go back to work, and then we’d be in a decent position until he graduated. The stipend wasn’t so much that we wouldn’t qualify for Medicaid, so the birth itself would be covered.

  It didn’t exactly go according to plan. First, we qualified for Medicaid, and I started looking for an OB. There weren’t a ton of doctors accepting new Medicaid patients. Planned Parenthood doesn’t do prenatal care. I found my clinic through a flyer, advertising that it did in fact accept Medicaid and was enrolling NOW! In the waiting room for my first appointment, I realized that I was at a faith-based clinic. It was a church ministry.

  Now, normally I’m cool with the Jesus folks doing the poor-people tending. It’s sort of their mandate, and I honestly do not care about the religious beliefs of anyone willing to make sure my kid gestates properly. But there are the charities that happen to be church-run, and then there are the church charities. I was at one of the latter. That distinction is important: Some ministries are set up by churches to provide a service, and some seem to be set up to proselytize, tacking the service on as an afterthought.

  When I showed up, I was ushered into an office, where I did the initial paperwork and learned about all the things the woman helping me praised Jesus for. Her pencil didn’t break, praise Jesus. The weather was decent, praise Jesus. I honestly do not know what was in the paperwork she was walking me through; I was much too fascinated by this person who was nearly finished with the third page, praise Jesus.

  After that, I was taken to an exam room, where I was greeted by a lovely young woman who took my blood pressure and asked me if I had a church home. She was followed by a nurse who told me that Jesus had a plan for this baby and congratulated me on making the decision to bear it. I asked about maybe getting another ultrasound—my weird hormones and the sudden ability to bear children had me freaking out that this kid wasn’t viable, and I was terrified of coming to terms with having a child only to discover that it wouldn’t make it. But I was told that they only did ultrasounds in the third trimester unless there was a problem.

  And that was the end of my appointment. No reassurance, no actual medical advice, no real exam. Just some routine tests and the clear message that Jesus wanted me to have this baby. I, certain that Jesus also wanted me to have an ultrasound and pretty sure that I could manage a pregnancy just as well without that sort of help, never went back. There didn’t seem to be much point in returning to a place that gave no better advice than to drink a lot of water and not get into a hot tub, which were both helpfully bullet-pointed on the packet of papers they sent home with me.

  I did take a few stabs at finding a different clinic. The ones with open spots didn’t take Medicaid, and the ones that accepted Medicaid were full. So instead, I read a lot of books, called all of my old friends who had kids, and compulsively Googled things to find out whether they were normal or whether I should present myself at the ER. Eventually, I did just that when my daughter finally decided to arrive.

  Any hospital in a large city is used to random pregnant women showing up to give birth. I think, though, that most of them have a doctor. They wanted to know who mine was, and I told them that I was pretty sure whoever was on call that night would be my doctor.

  I actually don’t remember most of the process. I was in a room, then another room, and I was kind of too busy being in labor to really care what was happening. Tom took care of the paperwork; we gave them the Medicaid card and that was pretty much it. Then I had a baby. I think the process was probably streamlined given that there was going to be a baby soon whether or not the paperwork was done, and they much preferred that I give birth in the birthing room instead of in the waiting room, where it would be rather hard to clean up afterward.

  We were visited by social workers a lot in the next days. I don’t know what all I filled out; they showed up at random times. If I was awake, they had me fill out paperwork. If I was asleep, they woke me and had me fill out paperwork. I’d failed to plan ahead and bring pay stubs with me, which the lady was kind of miffed about, so I had to bring those in later.

  —

  I’ve been called crazy. It’s not untrue. I suffer from a syndrome called We Don’t Know What the Fuck Your Damage Is. That is to say, I’ve been diagnosed with so many things that it’s impossible to tell what’s likely the real problem. I mean, clearly I struggle. Things that are simple for most people don’t come naturally to me. I have trouble bending my will to anyone, including myself. I’m reckless and impulsive. I’m irrational and prone to anger when I am in certain moods, and those moods occur more frequently than you’d expect. I go through depressive phases, lasting days or months, and I can destroy my entire life through sheer inattention in three weeks flat, because even if you can’t muster the energy or the will to open your mail, they still want the money for the bills. At times I’m an insomniac, and at others I can’t get out of bed. None of these things are typically so bad for me as to be unmanageable, but managing them sometimes doesn’t leave much room for anything else.

  It’s not like mental health clinics are thick on the ground, like the people who need their services. Being poor in and of itself is an aggravating factor in a lot of mental illnesses; the stress is pretty brutal. If you’re already kind of fragile, it can be really rough. I won’t say that a good clinic for poor people doesn’t exist somewhere, but I’ve never found a mental health professional who was willing or able to deal with only the parts I needed to fix, the insomnia and paralysis and depression (at least some of which is situational, and I’ll discuss that more in Chapter 4).

  When I have sought treatment for these things, the professionals seem to only want to talk about my anger. They talk about my fatalism, my caustic outlook. They see these things as problems to be fixed. Personally, I think that anger is the only rational response to my world sometimes, but when you’re asking for services, you don’t get to pick what they treat you for. Either you agree with them or you’re labeled uncooperative and kicked out of the program.

  The last time I found myself really struggling and went in, they told me that I would have to spend hours in treatment each week. And that was the only option. It was either that or no treatment at all. So I chose the latter. Now, to be fair, I showed up in a right state. I was having a bit of a meltdown because I was terrible at my job and putting in too many hours to be failing that hard, and my husband was having a rough patch, and the kids were sick, and I had just realized again that this was it, this was life, this was how it was going to be until I died. The best I could hope for was that not all of these things would happen at once too often. I can see them thinking I was seriously this critical all the time.

/>   I went to the clinic hoping that I could develop a relationship with a therapist who would then be able to prescribe me the drugs that have made me competent and invulnerable, the ones that stave off emotional disaster so that I can simply get through the crunch. Even at my most breakdowny, I generally realize that I am reacting irrationally. What I need from the mental health system that I have never been able to get is just enough support to maintain.

  What I need, what would probably actually improve my life outcome, is someone who I can call, can see frequently for short stretches when I’ve hit a rough patch, and can then not call when I’m okay. Someone who knows my history and won’t question it when I call and ask, apropos of nothing, for something to help me sleep or avoid panic attacks. I need someone who’s worked with me for long enough to understand that I don’t really like medicine and that if I’m asking, it’s serious. In short, I need the kind of mental health support that many people with quality insurance take for granted.

  When I’ve had the guts to see a doctor about an ailment, I haven’t had the access, and when I’ve had the access, I haven’t had the guts. Until quite recently, I was scared to death that if a doctor ever did find something really wrong with me, I’d be completely uninsurable, so I never went to the ER for anything that wasn’t obvious and small, like a bad flu or potentially broken ankle.

  Mostly, if I’m honest, I’ve been scared of the look. It’s in doctor’s offices and around social workers where I get the lectures, the judgments, the stares. People treat me like I’m a fucking idiot, as though I am incapable of noticing this rather large problem, rather than incapable of addressing it before it becomes such a large problem.

  I came in for a fair bit of judgment over a cyst I developed. Doctors assumed I was just too ignorant to notice it, rather than the truth, which was that I lacked insurance and it wasn’t life-threatening. I promise you, I was aware of the cyst I had for years. You can look up the gory details—it’s called a pilonidal abscess. I think it’s due to a tailbone injury I had as a teenager. A couple of times a year, my ass would swell and I’d smell like a rotting corpse for a few days in addition to the rather painful fact that I couldn’t sit or stand in any position that didn’t add to the pressure of the infection. It wasn’t until just after my first daughter was born, when I had three months of Medicaid left, that I could have it excised. Prior to that, it landed me in the ER more than once, and every time, I’d be told patronizingly that I could simply have it taken care of, and probably should. Every time, I asked the doctor if they’d be willing to do the surgery at the rate I could afford; while I didn’t have any takers, it did, at least, ensure that I didn’t have to hear yet another explanation that surgery exists—as if it were something I’d never heard of simply because it was something I couldn’t have.

  Preventative medicine, man, it’s a miracle. You can go to orthodontists and surgeons and eye doctors and rehab facilities after you throw out your back so that you don’t wind up bedridden and debilitated. You get antibiotics and painkillers and blood pressure medicine.

  Seriously, vision care alone is a miracle that only happens to the rich, never mind the rest. They don’t get deep forehead wrinkles at thirty from spending their twenties squinting, they don’t get headaches that cause them to take a large amount of ibuprofen every day—which, as all the bottles are pretty clear on, can’t be good for you. They can see something in the first second it comes into their field of vision instead of five seconds later. The glasses and the decent food and the orthodontists—all of those things require money.

  There is a price point for good health in America, and I have rarely been able to meet it. I choose not to pursue treatment if it will cost me more than it will gain me, and my cost-benefit is done in more than dollars. I have to think of whether I can afford any potential treatment emotionally, financially, and timewise. I have to sort out whether I can afford to change my life enough to make any treatment worth it—I’ve been told by more than one therapist that I’d be fine if I simply reduced the amount of stress in my life. It’s true, albeit unhelpful. Doctors are fans of telling you to sleep and eat properly, as though that were a thing one can simply do.

  Now, I’m not saying the system doesn’t work at all. I’ve had lifesaving treatment, like when my throat swelled so much they had to put a tube in it to keep me breathing. I’ve got friends who can leave their houses only because they found a program to get them a wheelchair. Many people have needs that the system is built to meet, and it does that fairly efficiently to the extent that there’s money.

  The trouble is that we’ve left so many holes in the safety net Moby-Dick could swim through it. The system can’t support everyone who needs the help, and it’s led to a pastiche of half-finished treatments and conflicting diagnoses. We have the technology. Maybe we can start using it? There are a lot of us that would be awfully pleased to get some antibiotics.

  4

  I’m Not Angry So Much as I’m Really Tired

  Almost nothing is more degrading than standing in a welfare line. The people who are looking at you know exactly how much money you make, because they know how poor you have to be to qualify. And the workers are either lovely or the worst human beings you’d ever care to meet. I had a caseworker who called just to check in because she knew I’d gotten a new job. And I had one who ignored me completely, just had me sit silently at her desk until she needed me to verify my information. Then she ignored me some more, and then she told me I could go. I left, with no idea what had just happened. I called the state to find out what changes she’d made to my file the next day rather than speak up during that incredibly effective stonewall.

  I’ve felt the poorest with the people who were supposed to be helping me. I get that their jobs suck and they’re overworked, but I go out of my way to not be another asshole customer. I have my paperwork and a list of questions ready to go. I have all my references, my pay stubs, medical bills, everything. Indexed. Sometimes I don’t have a document, but then it’s on my list of questions, to find out what I can use as a substitute. But often, none of that matters, because I am poor and asking for the benefits that I am qualified for and entitled to as a citizen, and in some people’s eyes that makes me less than human.

  Often enough, I feel less than human—or less than the human that I know myself to be. For example, I love to read. I’m a naturally curious person, apt to ask uncomfortable questions without realizing it because I just want to know something. But I don’t read when I’m working at minimum wage or near it. I’m too tired. I fall asleep because the effort of moving my eyes across the page and processing information is simply too much; my brain won’t allow me to use what little energy I have left on frivolities like self-improvement. It just wants me to stare blankly at a wall or flickering screen until I pass out.

  Understand that when I say I am tired and in the same breath bitch about a lack of hours at work, it’s because I’m counting the totality of the shit that I have to deal with while being poor. It is super-inconvenient, all the time.

  There’s one episode of my life in particular that was just the worst. I was working two jobs, with no car. I lived two miles from one job and three miles from the other. It wasn’t an inhuman amount of mileage; some people run that for fun. But then afterward, some people go home and relax.

  So I’d get up in the morning, walk to work at about five a.m., and wait tables from six to about noon. I’d be home by about one, at which point I’d pass out unless I had errands to run. Then I’d get up at six, shower and fix my hair for the bar, walk three miles, tend bar until one or two in the morning, and either beg a ride from a co-worker or walk home. I’d get home at two or three, unwind, take a short nap, and start all over again.

  Now, nobody can maintain that forever, and if I’d been lucky enough to get that many hours, I’d have been doing okay. The problem was that both these jobs were weekends or prime eating-out days only—three or sometimes four days each. So I’d spend Monday re
cuperating from the weekend, Tuesday trying to find better work (which also required more than a few miles of walking around dropping off applications), Wednesday taking care of the house, and Thursday taking a spare shift from one or the other job.

  In other words, my commuting time was comparable to a typical suburbanite’s: one, maybe two hours. Except mine was on foot, and it was to jobs at which I was on my feet all day. It’s why I’ve never felt much need to exercise; I spend hours each day lifting heavy things and bending into impossible positions to get through stockrooms. I’ve stood and repeated so many times that I can assemble a cheeseburger in twenty seconds flat, assuming it’s got multiple toppings. Less, if it’s simple. You get plenty of miles in while running around a retail store or factory floor.

  So I was either working or walking to or from work, about sixty hours every week. How did I spend my remaining time? Well, remember that I was walking. I lived in a fairly central location, but it was just about a mile or two from anything I needed, like a grocery store or a Laundromat. I did laundry twice over the weekend because I could make my clothes last two shifts but not three, so that was six hours. I went grocery shopping once a week, so that was four hours. I slept, so that was around fifty. I spent eight hours or so every week looking for work locally. I went to the unemployment office once a week to check the job boards, and that was five hours. I generally picked up a spare shift on Thursdays, so that was another six or so. I showered at least twice a day, what with all the walking, so that was about seven hours a week gone to washing or drying myself. And that leaves about three hours a day for everything else.

  I was always and forever dreading the next time I’d have to get off the couch. I would finally sit down, and I would realize that if I had any hope of waking up at a reasonable hour tomorrow, I really did have to be in bed in three hours, and the dishes still needed to be done, and the toilet needed to be scrubbed, and I’d promised someone I’d make them dinner because I owed them and they got sick and called in the favor.