An Open Letter to America on the Anniversary of a Cancer Christmas

Last Christmas Eve I spent in the E.R., immune system critically compromised and hair beginning to fall out from chemo, with my temperature spiking dramatically. I had taken as many fever reducers as I was allowed and had cocooned myself inside five blankets; but my parents, after watching me shiver for several hours unabated, decided they needed to take me in. Before leaving for the hospital, we quickly snapped a family photo, I wearing my signature surgical mask, and we piled into the car for the trip, sun long down and roads long empty. They tuned the radio to Christmas music, and in the backseat, I tried to think about how short the drive would be with no traffic, about how brief the wait would be in the E.R. with everyone at home, about how lucky I was to have a family that cared about me enough to drive me at this time on this day—about anything, in fact, that wasn’t the lyrics cruelly crooned over the airwaves, seemingly on repeat: “I’ll be home for Christmas (if only in my dreams”).

We arrived at the emergency room, and from there, everything went swimmingly. (It sounds, I realize, tongue-in-cheek to say this, considering I had cancer and a fever, and it was Christmas Eve; however, there was no wait, the nurse who took my blood pressure wore reindeer antlers, and my fever began to break shortly after we arrived—so, “swimmingly.”) After a few hours, the doctor running several tests, the nurse’s I.V. (“just to be safe, honey,”) keeping time with staccato drips, I was discharged, learning my fever spike was actually an uncommon, but harmless, side effect of the chemo drug I had received that afternoon. We made it home before midnight; before, dare I say, even Santa; and my family and I had a lovely Christmas.

Five months later, I was riding my bike to the library from my grandma’s house (quaint, I know), moving swiftly, aerodynamically, with nothing but peachfuzz on my head, when my pocket started buzzing. Thinking it must be my grandma wondering where I was, I pulled over and quickly answered; however, my “hello” was not met by my grandma: it was met by a man’s “Is this Ryan Covington?”

A little bewildered, I said “Yes, who is this?”

This was he: the representative of a debt collection agency to which responsibility had been transferred for recovery of a delinquent charge totaling $1,487.36 issued on December 24th, 2018 by Emergency Associates of America, LLC to the account of Ryan Edward Covington whose contact number had been listed as the one he was calling and whose complete contact information, including preferred phone number, full name, date of birth, and physical address, he would like to confirm before proceeding.

I hung up. And penning now (I hope) the lamest sentence I will ever write, at twenty-seven years old, I rode my bike to my grandma’s house, fell on my bed, and cried. I cried because I had thought it was over: my tumors had disappeared, my bloodwork looked good, and my hair was growing back. None of this meant it was over to the collector, however; by his count, there were at least 1,487.36 reasons why it was not.

To be clear, the amount itself did not frighten me. I was no stranger to scary numbers separated by commas billed to my name, having gone through surgery and three months of chemotherapy. What frightened me was the unique cruelty of being surprised, by a bullying debt collector no less, months after the fact, and told whatever money I thought I had been saving was not really my own; in fact, it had never been mine and was owed in arrears, and any delay would mean them filing a report to the credit bureau, and everything I said would be recorded and used against me (“so pay up quick—capiche?”). Even having taken medicine that was given to me by people wearing hazmat suits, that would burn my skin off if it bled out of my veins, that approached so close to being poison as to barely warrant distinction, I could still say I was never asked to swallow a tougher pill than this.

Luckily, this particular one I did not have to swallow. Hunting through a torrent of stale emails, spending hours on hold with the hospital, ricocheting between departments, I finally discovered the number for Emergency Associates of America, LLC—a company unaffiliated with the hospital, one that contracted doctors to emergency rooms and billed separately for them. Though my insurance told me they would not cover the bill (Emergency Associates of America, LLC not being within their network, even though the hospital was) I discovered the LLC had issued the charge during a period when the hospital had approved me for financial assistance. Forwarding them the relevant paperwork, I experienced the too-rare satisfaction of watching a medical bill dissolve like the bad dream it is.

I would like to say that was the end. In the intervening months, however, I have been contacted by other debt collectors with more surprising charges—the most recent agent beating even my family in welcoming me back to the U.S. So far, I have been able to resolve all of these issues the same way, costing me nothing but time and effort. But I am kept up at night thinking of all the Americans who are not as fortunate as me. Many do not have the bountiful free time my job affords me to spend on hold with hospitals and medical companies. Many have not gone to college and studied a major that allows them to act as their own medical and legal scholar. Many do not have a sister-in-law in medicine who can hold their hand through every step and give them advice. Many have mortgages and marriages and multitudes of children—none of which cancer, I assure you, gives a shit about. It just comes and tries to kill you and, if you say “no,” politely appends six digits with a comma to an account with your name on it before trying to kill you anyway.

To clarify, I am fine; so are my bank account and credit, thanks to the Affordable Care Act and a truly staggering amount of luck. But I have been made enduringly aware that nothing more than a bad dice roll stands between many of us and permanent financial perdition come a medical crisis. I have no idea how many Americans lose this gamble, but I do know how many fortunate circumstances had to align for me to be saved: they were the same amount it would take to wake up to a fire in your kitchen, watch it put itself out, and discover it had done no damage, instead having toasted your bread the way you like and heated your morning coffee.

This Christmas, I wish you and your kin good tidings. I wish you visions of sugar plums that dance, and I wish you a happy New Year. But after said New Year, I wish you to carefully consider your opinion on healthcare and choose your candidate based on more than partisanship. 2020, it seems clear, will be the year we decide what coverage will look like for the next generation. If you might be fired from your job one day and lose your insurance, or you work as an independent contractor like I do, or there is a chance you could develop a health problem that counts as a preexisting condition, please make your voice heard and vote. All of us stand to lose if someone repeals the Affordable Care Act without a clear plan, relinquishing government oversight to profit-driven interests. If not for the ACA and a hospital charity, I would be over $100,000 in debt this Christmas, that money not being an investment in education or a small business, just an exorbitant ante against dying in my twenties, precluding me from investing in anything—whether education, a business, marriage, or children—for years to come.

For a price I could pay, my cancer was cured last year; it was the greatest present I will ever be given. Though I cherish the gift, receiving it also made me certain that anyone in need should be afforded the same. I don't know how the penultimate stress of fighting bankruptcy ever became coupled with the ultimate stress of fighting death, but I do know the cost of maintaining their union is too dear for a moral society. And, while death, which imbues every moment with poignant beauty, is simply a truth of life, beyond our present powers to fix; medical debt, which serves no edifying purpose, is simply a truth of our present system, within our powers to improve.

Please think about this issue when following the presidential race this coming year. If you care about it as much as I do, please let the world know. Please speak. Please vote.

Love,

Ryan