Healthcare Debate: A Canadian’s Uninsured ER Visit in NYC

IV tube
IV Tube

Never Google your symptoms, everyone knows that. But I couldn’t help it. I am uninsured, a non-resident alien and unemployed.

I click on the first link that “chest pain on left side” brings up. All symptoms point to heart attack or angina. I start to panic, mostly thinking about how I will pay for a visit to the ER if I need it. Wait, is this a cold sweat? I open several other pages successively until my tabs are filled with self diagnosing websites.

I hastily glance down at my phone and my best friend texts back “You should be fine. Just sit, watch some TV and hopefully it’ll pass.”

I trust her opinion, since she’s been my iMessage MD from her first day of med school. But my mind is racing with the most horrid possibilities and I am freaking out.

My non-American friends and I like to trade horror stories of going to see the doctor and having to break the bank. $1000 for blood work here, $30 000 for an appendectomy there. These stories are passed around like warning tales, where we grimace in unison and quickly vouch to never get sick.

Just yesterday, the Centers for Medicare and Medicaid released the prices of the top 100 most common inpatient diagnostic procedures for the fiscal year of 2011 for more than 3000 US hospitals. Interestingly, the rates differ from hospital to hospital and from the insured to the uninsured.

“As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.” (source: You can find the charts here.

The American healthcare system intrinsically intrigues me because I am Canadian and grew up with universal healthcare. Aside from the $40 I pay to my family doctor every year as a “registration fee” (which didn’t start until a few years ago), healthcare is free. I don’t pay for blood work or ultrasounds. I don’t pay for consultations with a dermatologist. I don’t pay for anything and neither does anyone else. When I first arrived in New York, the idea of having to pay to see a doctor was unfathomable.

Healthcare is a basic human need that a country should make accessible to all their citizens, regardless of economic prowess. It defies the purpose of life saving when the focus is on money/business rather than the patient’s well being. It is often the most vulnerable and  low income patients that are in dire need of medical attention so the vicious cycle of being sick and not being able to afford health care only compounds the problem. That’s where universal healthcare is far superior than private healthcare.

But I understand the complaints of universal healthcare being slow.

I’ve waited three months to see an endocrinologist who spoke to me for less than five minutes and scheduled me to see her again in another three months. It seemed like her second year med student did more for me than she did. It’s frustrating and annoying.

I’ve also had really great care from my family doctor, granted I’ve known him for over 20 years. Whenever I am home in Toronto, he makes sure I get my blood work done, ultrasound taken care of and writes my prescriptions like he’s signing off greeting cards. (Just kidding, he’s very strict with medication.) And this is all in one afternoon. I always leave with a hop and a skip because I feel safe and reassured that I am fine. I don’t worry about the debt I’m in because there is none.

My coping mechanism for getting sick in New York is to simply not. Though when I do come down with the flu, I end up staying in bed and relying on the old wives remedy I know aka Nyquil, Gatorade and the fetal position with lots of Hulu in bed.

Today was different. Today I might’ve actually worried myself sick because I was/am scared how expensive a visit to the hospital can be.

Is this a pain in my jaw or am I just over reacting? It is hard to distinguish. I check my pulse, trying to remember from my life guard days of how many seconds to count for and then how many to multiply for. Chest pain, jaw pain, fast heart beat, cold sweat. Oh my god, I am definitely having a heart attack, I whimper internally. I wonder how much the hospital is going to cost, my logical brain pipes in after recalling foreigner hospital stories.

Immediately, the pain in my left chest intensifies. My heart is now beating so fast I feel as if there are guppies jumping out of my throat. My extremities tingle and I become light headed. Tunnel vision develops. I squat down so I don’t faint and knock myself out.

I grab my wallet and phone and run out to the elevator. I squat down again while dialing my best friend, telling her I’m heading to the ER.

Amber is calm on the phone, which calms me down, just a bit.

“Take a cab and I’ll meet you there,” she reassures me.

I speak into the phone, but with confusion. My voice is stoic because I am scared to the end of my wits.”I don’t know if I can make it in a cab. I…I…,” The sensation of light headedness and fainting lessens with fresh air, but I worry about fainting on 1st Avenue and freaking people out.

From my room to the Beth Isreal entrance, a reasonable five minute walk, felt like 10 seconds in my panic. It was as if the fast forward button was on.

I call Amber back to tell her I’m in front of the ER. I call my parents to ask if I should go in, despite not having insurance. My dad is verbose and I feel my mouth cavity numbing again. I yell into the phone for him to just tell my mom and I’ll call him back. He tells me to get all the tests I need and not to panic.

Easier said than done.

I know the way emergency rooms work. Chest pains and shortness of breath zips you through to the front of the line. And that’s exactly what I had.

The register puts on my hospital bracelet on and lies me down for an EKG. The stern nurse is not happy when I fidget out of nervousness. Her thick jamaican accent scolds me three times for moving, each time kissing her teeth and the last time, making me feel like I’m in trouble by saying “What’s more important, your life or your phone?”

I was waiting for Amber to come though and wanted her to spot me easily. Something about having someone there, especially someone I knew so well, was comforting. I text her every new location I move to, hoping she’d arrive soon.

I choose a seat right by the entrance of the ER’s wait room so she can see me. A woman on a wheelchair is squirming and screaming. The nurses don’t pay attention. A homeless woman is sleeping in the far corner, her luggages in tow. I debate whether to call my parents again.

I ask Amber to call my dad for me and text her, “Okay thank you. I can’t wait to see you.”

Finally reverting back to somewhat of a regular heartbeat, I begin to cry, but quickly using my sleeves to dry off my eyes. I lean back in the chair and take deep breathes until the germaphobe in me cringes.

I’m called to my ER bed and wonder how much the bed will cost.

Every step of the way, I make sure to let the nurse or the register know I am uninsured. I would then throw in a line about being deported, which only resulted in verbal sympathy.

Amber questions the tests being done just as I expect, need and want her to. I sign a few forms before being able to read them word by word. The admin lady whisks in and out of my pod with paperwork as the afternoon in the ER bustles with it’s expected fervor. This time, another jamaican accent is so friendly it put us at ease. “What chu mean you gon be deported? Just get married!” She tells me she will get her son to marry me and the three of us girls giggle away like it’s a sleepover. “You just gotta go like this,” as she puts her arms around Amber’s shoulder, “and you get yo papers!” She makes a comment about Obama, immigrants and healthcare, but it flies over my head.

Amber studying for her exam tomorrow, while with me in the ER
Amber studying for her exam tomorrow, while with me in the ER

My 10 hours in the ER boils down to blood tests, chest x-rays, a lot of waiting and more blood tests. The diagnoses is that I had an anxiety attack because of the chest pain, though source of pain is still a mystery and needs to be followed up with a cardiologist.

I would say in addition to that, the main culprit if you will, was that the constant paranoia about how much it would cost to see a doctor exacerbated the anxiety. It may sound silly, but after a year of unemployment, a full Columbia jschool tuition and living in Manhattan, an uninsured hospital bill can be financially and mentally crippling.

Perhaps my support for universal healthcare is most fittingly repeated here. Would this anxiety attack have happened if I was in Canada and knew emergency care is a right and not a choice? It’s tough to say. But certainly every time I don’t feel well in New York, I am faced with the reality of avoiding the doctors because I cannot afford it.

Both my nurses are foreign born, which makes reiterating the uninsured issue a lot easier. Marriage jokes are thrown around again. I ask about the intoxicated homeless folks that come in — I had two right outside my pod.

“They’re on Medicaid and probably have better insurance than you and I combined together,” my RN laughs while taking my vitals. He then tells me the scam that is the “American college system”, where he left Jamaica to study graphic design, but ended up pursuing nursing just to be able to stay in America. He’s not on any special visa, just a gold band around his ring finger.

So was this peace of mind worth the whole ordeal? Absolutely. I am an advocate of preventative healthcare and always being safe than sorry.

But really, I won’t know until I get the bill.

And that’s for another blog entry.

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