The Shriek Heard Across Campus
On the morning of June 28, 2012, I was in Montpelier, Vermont for the Vermont College of Fine Arts (VCFA) MFA in Writing summer residency. I’m a faculty member in their low residency program and, as such, make pilgrimages to Vermont twice a year. While in residency, the rest of the world falls away. For ten blissful, strenuous days we exist in an alternate universe where writing and books move planets.
The faculty lives in a New England dormitory, women on one floor, men on another. Despite the lack of privacy, it’s fun. I don’t know what the men do, but on the women’s floor we tend to gather in the bathroom and hallway, in various states of dress, make-up, and hair, catching up, gossiping, asking for advice and dispensing it freely.
That’s exactly what we were doing when the early morning bucolic sound of women’s hushed laughter was broken by a crystal-shattering shriek quickly followed by my colleague, fiction writer Abby Frucht, shooting into the hall, yelling, “The Supreme Court just upheld Obamacare!”
Being pulled into the real world was a jolt, and so was the news. After about two seconds of stunned silence, we began cheering. As we hugged and cried, our voices abundant with wonder and disbelief, a similar cheer filtered down from the men’s floor.
Why the celebration? We’re professors in a low residency program. Like our professional kissing cousins, adjunct professors, we’re called part-time employees and, therefore, our employers aren’t required to provide health insurance. Though our official status is part-time, adjuncts and MFA in Writing low residency professors often work long hours for minimal pay and few, if any, benefits. I worked full-time at a four-year liberal arts college where my teaching workload was nearly half of my low residency workload. And though some low residency professors have full-time gigs at other institutions (thus they have health insurance), many of us do not. We’re working writers pinched by a society that doesn’t place much value on artists, intellectuals, and educators. Yet, we are legion: Seventy-five percent of college professors are adjuncts.
Abby’s reaction, though not as loud, was repeated campus-wide. “My shriek,” she says, “was entirely unscripted. It came from my body as much as from my mind. I’d been buying my own health insurance forever, and in a good year it cost me close to a third of my VCFA salary, and in bad years it cost me half my salary. My policy didn’t include drug coverage, and I couldn’t change plans because of a preexisting condition. Now, with my new plan, I do have drug coverage, my premium has been cut in half, my deductible by two-thirds, and my most expensive drug, which was $300 a month when I had to buy it myself, is not just discounted but is free. Still, my shriek was more for my son than for me. He has juvenile diabetes, is insulin dependent, at the time was unemployed, and could find coverage only through a high-risk pool, which we were fortunate to have available to us. I like to think I was shrieking for lots of other people, too, but to tell the truth I think the only other people I was shrieking for that day were you and the others in the dorm who were in our situation.”
While Affordable Care Act (ACA) opponents were muttering dire warnings of a falling sky, our troop of the uninsured hugged and cried and filled that same sky with utterances of shocked joy.
To Dream the Impossible Dream and Other Follies
I’m a melanin-challenged Florida native who throughout my youth wanted nothing more than to look like Sophia Loren. In my fair-haired quest to do so, summers were spent at the beach, the community pool, or in the dirt of my backyard, slathered in baby oil spiked with iodine. I had a friend who thought baby oil was for wimps and went straight to Crisco. My mother, a former nun, insisted that if I endured a beatific cycle of late spring/early summer blisterings and peelings my skin would toughen up and by summer’s end glow a saintly golden brown, thus beginning my transformation into Sophiahood.
Daily, I baked under the subtropical sun, dreaming of my eighteenth birthday, an emancipation that would free me to dye my hair Sophia Black. Men would swoon. Magically, my southern accent would be supplanted by Sophia’s rolled r’s. My mother, a harsh woman, would never beat me or call me ugly again.
I was so faithful, so observant, even my scalp sunburned. I entertained classmates by pulling off huge sheaves of peeling scalp skin. They marveled at the tiny holes where hair strands once grew. My sister routinely took a safety pin to blisters the size of canned hams on my shoulders and giggled as blister juice meandered down my chest. Twice, I woke up unable to move my face. I ran to the vanity mirror and screamed, although it came out more like an extended grunt because I couldn’t open my mouth. Tears streaming, I ran into the kitchen, which is where I knew I’d find my mother. She liked to lean against the counter, smoking, her ash falling into the sink, above which hung a three-D portrait of the Virgin Mary. She laughed. “They’re just blisters. Grow up!”
Burn after burn, I’d peel away skin, praying to the Virgin and Sophia, herself, that I would glow Corinthian Leather Tan, not This Hurts Like a Bitch Red. No luck. With each burn, my freckles multiplied like little brown amoebas. This I counted as a victory. With just a few more sunbathing marathons, surely the pigmented spots would merge into one ginormous, infinite, everlasting freckle. My face would be glorious: the color of malted milk. I loved malted milk. Praise Sophia!
What Really Happened
In graduate school, I sold my first novel, Sugar Cage, and with the success of the book plans for law school evaporated. I’d be a full-time writer because, you know, who needs security? I had no corporate or academic sugar daddy from which I could extract health insurance. But it didn’t matter. I was young and healthy. It was the 1990s. My financial planner recommended Mutual of Omaha’s health plan. It was fantastic, affordable. They put me in an insurance pool with other lone wolves. Life was good.
In the sleepy lull between Christmas and New Year’s 2001, friends visited from Sweden. While they watched a movie, I took a shower. I dried off and spied out of the corner of my eye an unusual spot on my back. I asked one of my visiting friends who was a doctor to look at it. “Oh my,” he said. “You must have this checked immediately.”
For me, immediately meant right after New Year’s. I didn’t have a regular physician. Worried about how long it might take to get an appointment, I went to a doc-in-the-box the first week of January. She examined the lesion and said, “You have to see a dermatologist that specializes in cancer. I’ll make the call for you now.”
Alone in the cold exam room, shivering in my physician-supplied paper dress, feeling knocked off my axis, I heard her scream, “Three months! You don’t understand. She’ll be dead in three months.”
Whoever was on the other end of the line was unmoved. The doctor returned, shaking as she handed me a phone number. “You must convince them to see you now,” she said.
I knew what she feared: melanoma. A friend of mine had recently died of it. The lesion was on her scalp, hidden beneath a luxurious jumble of thick red curls. I got dressed and drove directly to the dermatologist, but the office manager was unyielding. Next stop: an attorney—a longtime friend—who promptly phoned the dermatologist. When he was told three months, he did what attorney’s do: threatened to sue. Suddenly, three months shrunk to two weeks.
On January 18, 2001 the official diagnosis arrived: malignant melanoma, a cancer that, according to the Cleveland Clinic, claims one person every hour.
I was not to be among them. Thanks to early detection and friends in high places, I had a full recovery. There’s nothing attractive about the suture scar on my back where both the tumor and muscle were excised. But I’ve grown to love the ugly thing. It reeks with survival.
Amazingly, Mutual of Omaha didn’t drop me. My rate popped only by the usual yearly percentage. Two years later, however, I dropped them because I took a full-time position as a five-year visiting writer at a private liberal arts college. The benefits were terrific. There was something decadent and freeing about an institution handling my insurance needs.
In 2008, when the teaching gig ended, I was confident I could do what I did before: self-insure at a reasonable rate. Nothing could have been further from the truth. I stepped into a world where insurance rates were as high as monthly mortgages. Scared, unwilling, and with no small measure of shame, I entered the ranks of the uninsured.
I attempted to see a dermatologist yearly, but it wasn’t easy. Some doctors refused to see me. Others tossed me to their assistants. As the years wore on, the examinations grew more cursory. I worried. What would happen if the melanoma returned? How would I pay for treatment? I researched medical tourism, telling my husband, who worked for a Canadian corporation that ironically didn’t offer health insurance to its American hourly workers, we should start a catastrophic illness savings account in case we had to fly to New Delhi for surgery or chemo.
My worry, it turned out, was merited. My husband, after experiencing forty-eight hours of severe abdominal pain, went to a walk-in clinic where he was told to go to the emergency room. After waiting five hours, they gave him a shot for pain and a CAT scan that proved inconclusive. The physician’s assistant (he was never seen by a doctor) said it was probably diverticulosis, adding, “Go home and look it up on the Internet.” The bill: $6,600.
I’ve never been the same since the cancer diagnosis. The specter of its return haunts me. Going for check-ups (every three months, six months, and finally yearly) is valium-worthy. What if they find something? Or miss something? How long will I have? Every mole and freckle—new or old—is a possible death sentence. Add not having health insurance, and the worry becomes its own disease.
Every time I called a doctor, always their first question was about insurance. When I said I had none, there would be a pause or a sigh or a curt admonishment that payment was expected in full at the time of my appointment. I felt the same shame as when I was a little girl sitting in the Social Security office beside my widowed mother who was demanding to know why our monthly government check hadn’t arrived.
It is the same shame I felt when I went to a new dermatologist several months ago, smart phone photos of a lesion on my leg at the ready, and when he looked at my chart and saw that I didn’t have insurance, said, “I’m not going to charge you my usual rate. This has to be biopsied, so I’ll ask the lab if they’ll reduce their fee, too. No guarantees.”
There I sat, a woman with seven published books who taught in a highly ranked MFA program, and I was accepting charity. I felt Dickensian: moved by his humanity and thoughtfulness, ashamed at my inability to pay a four-figure monthly premium, and enraged by my predicament.
“Thank you,” I said, adding a veiled reference to Obamacare, “Hopefully, the next time I see you, I’ll be insured.”
Don’t Worry, Be Happy
I was so excited about finally having access to health insurance I signed up on the very first day. Well, I tried. We all know how that went. But I was patient. I waited until November, when most of the site’s bugs had been exterminated. My husband and I received a subsidy, which is the only thing that made the insurance affordable. A month later, a well-meaning healthcare.gov clerk mistakenly canceled our policy. The error was rectified only after I spent five hours on the phone demanding to speak to one supervisor after another. But the difficult journey was worth the destination. The panic that had ruled my life for nearly six years was gone.
This March, I returned to the same dermatologist who’d discounted his rate. It was time for my yearly full body exam. When the receptionist asked, “Insurance?” I handed over my newly minted card, batting back tears. I was respectable again.
As I sat on the exam table in that stupid white paper dress, I noticed he looked three times at a piece of paper the receptionist had handed him. It was a photocopy of my insurance card.
And, boy, did he do a bang up job, freezing off things I didn’t even know I had. When he decided to biopsy a mole I’d never seen on the back of my left thigh, I couldn’t have cared less. Go ahead, I thought, cut away . . . I have insurance; everything is going to be okay.
The VCFA semester is nearly as busy as its residencies: student manuscripts to read and evaluate, student phone conferences, admission reviews, performance evaluations, recruitment emails and phone calls, committee meetings, junior faculty mentoring, lectures to write, introductions to craft, and more. This spring, I’ve been so busy teaching and so worry-free thanks to being newly insured, I’ve given little thought to this or that freckle or mole.
Yesterday, while reading a student manuscript, my doctor called. The biopsy came back positive. In two days, the lesion will be removed. We’re back to discussing sutures, after care, and clear margins. We are not talking about the future.
Yet I’m oddly calm. I have no doubt this latest brush with cancer is simply an inconvenience. The only time I’m scared is when I consider what it would be like to go through this without insurance. As more colleges and universities convert tenure track jobs to non-tenured positions, and as more businesses of any ilk decide to label their workforce part-time regardless of hours worked, more Americans will rely on ACA for their healthcare coverage. Searching for a silver lining, I discern something positive about artists and writers and time clock punchers having a common bond through healthcare. Perhaps as a country we’ll be more creative. If we’re not worried about how we’ll pay if a health disaster strikes, we’ll have more room to write books, paint paintings, compose songs, dream.
In the meantime, I’ll be okay. I’ll never show my thighs in public thanks to what I suspect will be a whopper of a scar. And as much as I hate it, I know I’ll never look like Sophia Loren, not even a tiny bit. But she’ll never write a book without the aid of a ghostwriter. My petty heart takes comfort in that. As for my recovery, I plan to spend it writing, teaching, watching old Sophia Loren films, and not worrying. After all, I’m a part-time writing professor with health insurance. What could go wrong?