The waiting-room had comfier chairs than a British one, and a couple of snack machines that accept credit cards. There was a television in one corner of the ceiling showing a cheap reality programme. Television isn't even an escape from reality any more.
The young man behind the counter had a religious symbol round his neck. He took R.'s details and asked if she had medical insurance. She doesn't. He gave her a card for a financial adviser.
We waited, eating burritos, until a woman called out R.'s first name. We went in to an office and R. told her what was wrong. She has had chest pains intermittently for ten years. Once, when she was poor enough for state medical care, a doctor told her it was probably nothing to worry about, but apparently a real diagnosis would have cost too much. American state medical cover, I suspect, is the reason I've seen two or three double amputees per day since I've been staying here, more than I see in a month at home. Cutting off legs is either cheaper than treating certain conditions properly, or becomes necessary when conditions go untreated for a long time.
In the last week, R.'s chest had become more painful than ever. That day, which was two days ago, it was making it hard for her to breathe, which qualifies it as an emergency, so the hospital was obliged to stablise her condition. Stabilise, not fix.
We waited again and ate more burrito. I was prepared for this to be the several-hour wait that you could expect from the NHS once they'd decided you weren't in immediate danger. It was only about half an hour. The same woman took us to a curtained-off booth and said she'd be back with a gown.
We heard the doctor before we saw him. His name was Tom - that's all his name badge said - and we found out later that he wasn't a doctor but a physician's assistant. American hospitals have the power to keep you in against your will, and Tom was telling the woman in the next booth that this would happen to her, to her great distress. He spoke to her as though she were a petulant five-year-old and he were bad with children.
"That's what
happens when you check in to a hospital that has no record of you, with an injury like that." I think it was a bloody knee.
He came in to R.'s booth a few minutes later and asked her the questions she'd already answered.
"How old are you?"
"27."
"Pfffff." (A word I've never heard before, only seen as an internet onomatopoeia.) "So it's not your heart, is
that what you're worried about?"
"No." She hadn't said anything of the kind.
Sits down. Sighs. "This is an emergency room. We deal with
bad stuff here. Now if this has been goin' on for a week, if it was
bad you'd have called as a week ago, wuncha?" I noticed he was chewing gum. Probably. It might have been tobacco.
He prodded her half-arsedly with a stethoscope.
"Okay, we're gonna get you a breathing treatment and send you home." He said 'breathing treatment' in the same tone as he might have said 'lollipop'.
He sauntered out. R., in tears, gathered her things and said we were leaving. "Where d'you think you're goin', honey?" Tom demanded as we passed him on the way out of the ward.
R. got a complaint form from the charge nurse, who took her into another room and asked what had happened. The charge nurse said it wasn't the first time Tom had been complained about.
"Who?" asked another nurse conversationally.
"Tom."
"Who?"
"Tom C—." (That's not a swear word; it's my attempt to look journalistic by omitting Tom's real surname, which is Crawford.)
"Who?"
"The jackass."
"Oh."
They said R. didn't have to leave, and sent in another doctor, who I think was actually a doctor this time. He was pleasant and seemed to listen to what R. said. He prodded around and said she needed a mammogram, but they wouldn't give her one. The nurses took blood and urine tests, did an X-ray, and gave her a breathing treatment, which turned out to be a plastic pipe that you suck nasty-smelling smoke out of.
R. left with a diagnosis sheet, not entirely unlike a printed Wikipedia article, of costochondritis or chest wall pain, and instructions to get a mammogram, which she can't afford. It said to come back if the pain was prolonged or caused difficulty breathing.
Yesterday the director of the hospital called R. about her experience with Tom. According to her, and various pieces of gossip, there have been several complaints, he's been given a severe talking-to, and they are not sure what to do about him.
This morning R. was worse, and her neck had swollen up so that she also had trouble sleeping and eating. We went back, and she eventually got a prescription for some painkillers and antibiotics. They said again that she needed a mammogram and again that they didn't do them.
If R.'s pay were doubled so that she could afford medical insurance tomorrow, the company might pay for a mammogram but wouldn't pay to treat anything nasty that showed on it, because it would be a "pre-existing condition"; if she lost her job and home and went back on to state care, they would say the same.
R. will probably be billed upwards of ten thousand dollars for all this. The hospital can't take legal action if she doesn't pay, which is just as well.
The U.S. is the wealthiest country in the world, and the only one in the developed world that dares treat its people this way. Barack Obama's medical plans, if he gets round to them, will probably make things cheaper, but R. and tens of millions like her will still be at the mercy of "the market", i.e. rich bastards who don't want to help.