Paying Out of Pocket

The health clinic buzzed with the sounds of the sick and the dying. I sat as far as I could from anyone who might infect me with something more serious than a cold and flipped through an issue of National Geographic that was left on a table for patients to read. It occurred to me while I was looking at a tasteful picture of an orangutan scratching its ass that the magazine had likely been touched by a countless amount of sick fingers, and there I was, thumbing through every page. I tossed the magazine away and waited with my hands in my lap for someone to call my name.

While I was sitting there, a kid with sunny yellow hair and an army of freckles on his cheek came up to me holding a green toy tractor about the size of his head.

“Mister,” he said, using his free hand to wipe a thick stream of brown snot from under his nose, “I’ve got a tractor.”

“I reckon you do,” I said, shifting in my seat.

Despite the waiting room being a wide open space, the kid pushed that tractor in a circle around my chair, making motor noises with his mouth and covering my area with sick spittle. I looked at my watch. The care I was looking to receive didn’t seem as urgent as the company name suggested. I glanced around the room for somewhere empty to sit, away from Tractor Boy and everyone else. The only available seat was directly beside a middle-aged woman in a flowery purple dress that looked more like a shower curtain than something meant to be worn in public. She had leather skin that may have been white once, but now resembled an old belt or an especially tough piece of jerky. She was using the back of her chair as a pillow and snoring away, gargling mucus in the back of her throat. Her legs trembled as if her skeleton was trying to free itself from her awful skin while she was sleeping. I decided to stay put.

“Hey kid,” I interrupted his game. “How about you drive that nice tractor of yours somewhere else? I was kind of hoping for some peace and quiet.”

He stared at me in stunned silence. You’d think that I had just slapped him across the mouth and called his mother a whore. He couldn’t believe that I’d ruined his fun. Where the hell else was he supposed to drive his tractor if not in a loop around my chair? If he’d been more than four or five years old, I believe he’d have tried to kick my ass. He bit down on his bottom lip like he was about to deny my request in dramatic fashion, but in the end, the little boy and his tractor rolled along.

I closed my eyes and tried to find my center. I pictured a crystal clear stream bubbling alongside the greenest pasture my mind would allow. There was a mountain in the distance, white with snow. Eight majestic reindeer grazed in the pasture and not one of them had a red nose. Birds flew overhead, their serene song mysterious yet familiar. I thought I might know that song from somewhere. I was trying to figure it out when the grass crunched under someone’s foot and the reindeer scurried away in a panic. I looked around the pasture for who or what had invaded my space, and sure enough, there was that little bastard with the yellow hair pushing his tractor through the field, blowing spit all over my nice green grass.

I opened my eyes and there he was, standing in front of me with his arms crossed over his chest like he meant business, a stream of snot glistening on the back of his hand. There was a woman standing beside him and I recognized her purple dress and jerky skin immediately. 

“Who do you think you are telling my son where he can and can’t play?” the woman wheezed. It was the voice of a million-and-one Marlboro Reds. I was surprised not to see her pulling around a tank of air everywhere she went.

“Nice dress, lady,” I said.

“You ought to be ashamed of yourself,” she said, hocking up a wad of mucus and spitting it on my shoe. “Come on, Worm, let’s go.”

She grabbed her son by the collar of the shirt and dragged him and the tractor away. I stared at the phlegm on my shoe and thought that it was shaped kind of like those flowers on Leather Lady’s dress. I wondered if the kid’s legal name was Worm or if his mother had given it to him as sort of a nickname. Neither one would surprise me. 

When the nurse called my name nearly an hour later, I felt like an angel had plucked me from the soils of despair and given me a new lease on life. I wasn’t even mad about the wait anymore, I was just glad for it to be over. The nurse was waiting by the glass door with a clipboard, tapping her foot impatiently and smacking gum like a toothless cow. She looked as miserable as I’d been feeling since I got there. The circles under her eyes were so dark, they looked more like bruises that a boxer might acquire. She reminded me of a raccoon after a long night of running from bloodhounds. I read her name tag.

“Hello, Stella,” I said. 

“You James?” she asked.

“Guilty as charged,” I grinned, trying to put some shine on this encounter.

“This way.”

She didn’t so much as fake a smile or seem particularly thrilled to even be breathing the same air as me. That was some high quality customer service. I followed her through the door and glanced back at the waiting room as it closed behind me. Worm was standing there watching me, still clutching his toy tractor. I waved to him. He didn’t wave back.

I followed Stella down a pristine white hallway with floors so glossy they could just about be used as a mirror. The hall led us to an opening with a digital scale and a height rod that was mounted into the wall. 

“Take your shoes off and step on the scale,” Stella said, blowing a pink bubble and wishing she was anywhere else.

I obliged.

The glowing red numbers on the face of the scale danced up and down before settling on 215.4. I’d have liked to see a lower number, but with me being over six feet tall, I thought I carried the weight well enough. The way Stella whistled when she saw the number made me think otherwise.

“215.4,” I said. “Is that bad?”

“I’m not qualified to answer that question,” she said, scribbling something on her clipboard.

“But you whistled, so I just thought—”

“I’m not qualified to answer that question, you’ll have to save it for the doctor. Please step off the scale.”

“Fine,” I said, stepping down.

“Follow me.”

I picked up my shoes and started to follow her.

“Shoes on, please,” she said after I took one step in my socks.

“Can’t I just carry them?”

“Shoes on.”

I slid my shoes on and double-knotted them for good measure. I gestured to them with my open hand to show her that I was good to go now. 

“Your room is this way,” she said, leading me further down the hall. My room was the first door on the right, about fifteen steps from where I’d had my weight measured. Stella opened the door and ushered me inside. 

“Okay, James,” she said. “Take off your shoes and hop up on the table.”

I looked internally and tried to find my center again. It was hollow. I kicked my shoes off and made sure one of them flung in her direction. Stella was unfazed. She blew another pink bubble and nudged my shoe aside with her foot. I climbed up on the table and dangled my shoeless feet over the edge.

“I need you to answer a couple of questions for me,” she said. She didn’t give me a chance to respond before reading the first question off of the clipboard.

“Do you have health insurance?”

“No.”

Stella clicked her tongue and checked a box on her sheet.

“What’s the reason for your visit today?”

“I have a cold,” I said. “Maybe the flu.”

“Have you recently been diagnosed with COVID-19?”

“I haven’t been diagnosed with anything yet, that’s why I’m here.”

“Are you indicating that you have not been diagnosed with COVID-19?”

“That is what I’m indicating, yes.”

“In the previous seven days, have you come in contact with anyone who has been diagnosed with COVID-19 or anyone who has been exposed to COVID-19?”

“No.”

“You’re sure?”

“No.”

“I need you to be sure.”

“How can I possibly know whether every person I’ve talked to the past week has been exposed to COVID or not? We’re all exposed to it all of the time, aren’t we?”

“So you have been exposed to COVID-19?” Stella asked, studying me seriously.

“Jesus Christ,” I said. 

“I’ll just check no,” she said and lowered the clipboard. “That concludes this portion of your visit. The doctor will be in shortly.”

Stella hurried out of the room and let the heavy door slam behind her. I decided then and there to protest the chewing of bubble gum for as long as I may live for fear that seeing a pink bubble would remind me of her. I hoped I’d never have to see her face again.

The minutes dragged by while I was waiting for the doctor to come in. I passed the time by fantasizing about a giant, house-sized shoe falling out of the sky like Dorothy Gale’s house and landing on Stella’s head. The doctor still hadn’t shown up by the time I was finished with that, so I rewound the fantasy and played it again. It was even better the second time around. 

I was damn near asleep when the doctor finally came in, studying my chart. He was a pudgy man with thinning silver hair that was combed over a bald spot wide enough to skip a stone across. I could tell just from the way he’d zipped into the room that he was going to be more charismatic than Stella had been.

“Whoa,” he said. “215 pounds? I’m gonna have to check the weight limit on those tables.” A wrinkly smile stretched across his face until his skin became tight like a latex glove.

“I’m kidding, I’m kidding,” he continued with a car-salesman gleam in his eye. “Say, why the hell did you take your shoes off? You can put those back on.”

I didn’t know how this appointment could get any worse. The doctor gathered my shoes and brought them to me. His hands were pale and pruney, about how a finger looks after removing an old bandage. They grossed me out. A fly buzzed somewhere in the room, likely begging for a way out. I don’t know. I don’t speak fly.

The doctor started talking again while I was sliding my shoes on.

“I’m going to be honest with you, James,” he said. “Your blood pressure concerns me.”

“Nobody took my blood pressure,” I said.

“That’s what concerns me. These nurses are getting lazy. I’ve got to do everything myself. Here, slide your arm through this cuff. Perfect, just like that. Now, quit yapping for a minute and focus on taking deep breaths for me.”

The cuff tightened on my arm. I breathed in and out, racking my mind for images that brought me peace. The beach. A crackling fireplace. Shania Twain on the cover of Rolling Stone magazine. The fly kept on buzzing. Bzz. Bzz. It flew in circles around the doctor’s head, orbiting him like Worm’s toy tractor. 

“Just as I suspected,” he said. “Your blood pressure is elevated.”

“What?” I said, still watching the fly.

“Hypertension, James. You’ve let yourself go and now your heart is paying the price. If you don’t get this under control, you’re going to die young. I’ve seen it happen. Everyone thinks it won’t happen to them, but you’re never too young to die. Especially those of you who are morbidly obese.”

“Excuse me?”

“Oh, that’s a technical term,” the doctor assured with a laugh and a slap on my shoulder. “You’re not even the fattest person I’ve seen today. I’m going to write you a prescription for something called Amlodipine. I think you’re a good candidate for it. You’ll have to follow up with your primary caregiver for refills, but I’ll get you a thirty day supply. Take it once daily—morning or night doesn’t matter as long as you take it at the same time every day. It’ll make your legs swell up like a son of a bitch, but don’t worry, that’s just your veins dilating to help with blood flow.”

He scribbled something down on his prescription pad and handed it over to me.

“I’m also going to mark down some information for your primary caregiver. You do have a primary doctor, correct?”

“No,” I said.

“Well, you’re going to want to start there.”

“I can’t. I don’t have insurance.”

He clicked his tongue the same way Stella had.

“I reckon you’ll want to start there instead, then. You won’t need insurance for the Amlodipine. The generic stuff isn’t going to break the bank. But listen, you can’t put a price on your health. Get yourself some insurance, find a primary caregiver, and then you need to have some blood work done. With blood pressure as high as yours, you’ll have to make sure you aren’t having trouble with your liver or your spleen or your kidneys. Follow all that?”

“I think so,” I said.

“Good. Okay. Well, James, it was nice to meet you. If I should see you again, I hope you’ll have lost some weight.” He laughed merrily and patted my belly with his disgusting, decrepit hand. “Stella will be in soon with your paperwork.”

“Wait,” I said, trying to process everything that was going on, including that I was going to have to see Stella again after all. “What about my cold?”

“Your cold?”

“My cold,” I said. “That’s the whole reason I’m here.”

“Ah, yes,” the doctor scratched his bald spot. “Have you tried NyQuil?”

Stella came back some time later. She went over the paperwork and handed me a leaflet of low sodium foods to try and high sodium foods to avoid. All of the good food was on the latter. The leaflet also suggested I should quit drinking alcohol and try this thing called Exercise. Stella wore a devious grin while she was passing along this information. I truly believe that woman might have been the devil.

When I left the clinic, Worm’s mom was putting him in the backseat of their car and hacking up a lung while she struggled with his seatbelt. I thought she was going to pass out. Worm had a lollipop in his mouth and a tractor sticker on his shirt. I figured that made him pretty happy, and that all things considered, he deserved to be. I wondered if I’d ever feel happiness again, myself.

I went and filled my prescription. The doctor was right about one thing: my legs swelled up like a son of a bitch after I took the medicine. All that misery made me hungry, so I skimmed through the low sodium leaflet to see what I could eat. Most of it was green. I threw the leaflet in the trash and ordered a pizza. I had a couple of beers, too.

That night, I dreamed that I was a fly buzzing around a white office, looking for a way out. There were no doors or windows, just blinding lights overhead and a big pink bubble floating around, following me everywhere I went. I knew that if I landed anywhere, the bubble was going to catch up to me and I’d be stuck inside of it forever like the belly of some insatiable beast. I flew for so long that my wings gave out and detached from my fly body. I fell to the floor and laid there unflinching, resigned to my inevitable fate.

I got a bill from the clinic the following week. Five hundred dollars just to be told that I should try taking cough syrup before bed—and that’s not counting the price of my prescription or the cough syrup I had to buy. 

I shopped online for insurance plans but it was evident right off the bat that I was in the wrong profession or maybe part of the wrong species altogether. There wasn’t any way that I could afford even the cheapest plan if I intended to keep enough money to live off of. I couldn’t damn well believe it. I made too much money for state insurance but not nearly enough to afford it on my own. Seeing that made my blood pressure spike, Amlodipine be damned. When I closed my laptop, uninsured and uninspired, I was feeling sick all over again.

There wasn’t a thing that NyQuil could do about it.