Home Health An everyday story of US healthcare – or how a visit to the ER can cost you $10,000 – The Guardian

An everyday story of US healthcare – or how a visit to the ER can cost you $10,000 – The Guardian


The fear of dying in New York was uppermost in my mind as my bruised foot swelled and turned black: I could never afford it

I had dropped my kids off at school and was lifting one of their scooters, when I turned sharply and felt something ping in my foot. It wasn’t much; a bad cramp, I thought, more painful than usual, which would probably wear off by the time I got home. I limped back to my apartment, took painkillers and put it on ice. By the next morning, the foot had begun to turn black. By the evening, the flesh was rising like dough. “Ew,” said a friend, when I showed it to her that night. “You need a pedicure. Also: you need to see a doctor right now.”

It’s either laziness, Britishness, or a strain of my general belief in denial, but in most circumstances I’d rather suffer than bother the doctor. In the US, this impulse is compounded by the knowledge that, however much you spend on health insurance, even the smallest engagement with the medical establishment will result in a cascade of bills. I’m still fighting with my insurers over a $1,000 charge from last summer.

“It’ll be fine,” I said, and an hour later, when it wasn’t – the skin was now purple and gently contoured like foam – booked a 10pm video appointment with a podiatrist. He logged on via his phone from what seemed to be the parking lot of a restaurant in Long Island. “What’s all this?” he said. “Do you really need this appointment?” I showed him the foot. He squinted at the screen, crossed the lot and got into his car, where he turned on the light and squinted again. “OK, I don’t want panic you, but you need to seek emergency care right away.” My friend, meanwhile, had sent a photo of the foot to her brother in California, who is a doctor and also very much her brother. “Ew, she needs a pedicure,” he replied. “No one needs to see that. Also, that could be a blood clot, she needs to get to the ER.”

I left my kids with my friend and got in a taxi. “How bad is a blood clot?” I’d asked my friend’s brother before leaving, and he’d reassured me it was no big deal as long as it didn’t detach. “Then what?” “You’ll die instantly.” This was concerning, particularly since the solution, he said, was “not to jiggle the leg”, but at that point my fears lay elsewhere. It’s expensive to die in New York, and as we crossed Central Park, I rang my insurers to get pre-authorisation (a promise with approximately the value of Neville Chamberlain’s piece of paper, but you may as well try.)

Then I rang my friend Oliver. It’s curious to me now, what surfaced in that moment. “Can you make sure, if anything happens, that you take the girls to England,” I asked, as he scrambled to catch up. “What? Are you near the hospital? How far off are you?” “Make sure they know about England,” I repeated. “Take them for the summer, on holiday, to England.” I sounded mad. It’s amazing, looking back, that I didn’t mention the Isle of Wight, and which hotel they should stay at. “OK, but just let me know when you get to the hospital,” he said.

The ER was half-empty. I have always wondered whether, in an emergency, my personality would undergo an exciting change, converted in the heat of the moment from a sort of vaguely up-myself diffidence to something more thrusting and American. Now I know. “How are you, how can we help?” said the check-in clerk and reflexively I replied, “I’m fine.” For five minutes, I sat in the waiting room wondering if I was about to keel over and should be raising more alarm. Another five minutes passed, and the triage nurse came over. Even delivered in my apologetic, half-assed fashion, the words “suspected blood clot” had an immediate effect and I was sent straight through to the doctor.

It wasn’t a blood clot. It wasn’t a broken bone, either. No one that night could figure out what it was, except maybe a rip in the tendon, although they were very thorough and drew blood to rule out the possibility of low platelets. I don’t know what lesson to extract from all this, either, other than something reassuring about consistency of character.

Mainly, I’m aware, with weary resignation, that although the swelling has gone down and the foot is definitely on the mend, in other ways this is just the beginning. After an ultrasound, X-ray, blood test and patient transport all over New York’s premier hospital, I’m waiting for the inevitable $10,000 bill and the hours I will spend on the phone to contest it. It’s the story of American healthcare; the real pain starts now.













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