Emily Maloney, COST OF LIVING
Zibby is joined by author Emily Maloney to talk about her book of personal essays, Cost of Living, which grew out of a piece that is featured in the Best American Essays compilation. The two discuss the current state of healthcare in America, as well as what Emily sees as the industry’s potential future. Emily also shares her 15-year process of publishing this book, at which stage she decided to incorporate anecdotes about her parents, and what she is working on next.
Transcript:
Zibby Owens: Welcome, Emily. Thank you so much for coming on “Moms Don’t Have Time to Read Books” to discuss Cost of Living: Essays.
Emily Maloney: Thank you so much for having me. I’m really excited to be here.
Zibby: Yay. This is a great cover, by the way.
Emily: Thank you. Right?
Zibby: I’m in a cover moment where I’m analyzing every cover in detail. As soon as I saw it, I love it, the bright color, the medical tape all over. I’m trying to explain it for people listening. It’s bold but also relates to the healthcare theme. It’s just awesome. Aren’t you happy?
Emily: I love it. I was so lucky to get a great cover. They sent me one version, and that was it. I’ve heard so many horror stories from people who had had disastrous experiences with their covers. I just feel really, really lucky. Karen Horton at Holt designed it. She’s amazing.
Zibby: That’s awesome. Why don’t you tell listeners a little about what your collection of essays is about?
Emily: For sure. I was diagnosed and treated for bipolar disorder when I was in my late teens. You had asked what the book’s about. The book is about being diagnosed and treated for an illness I turned out not to have and accumulating a lot of medical debt and then my efforts to pay off that debt working as an EMT and ER tech and then later in the pharmaceutical industry. It’s about how the American healthcare system is broken at every single level, unfortunately. It’s interesting, the experience of the pandemic for a lot of people has brought that to light, but it’s been broken for a really long time. It’s just, we haven’t necessarily been paying attention.
Zibby: I had never had this insight and insider view into ER life and all of that. When you were cataloging, how you had to account for each suture and each everything and it affected what the treatment team did based on what you had to use to do effective treatment, breaking it down like that was pretty horrifying to read about, to be honest. I know it’s a business, but I don’t know.
Emily: It shouldn’t be a business, but it is. We’re just at the mercy of whoever is billing us, essentially, and the corporations that are behind that. That’s really what’s truly unfortunate in all of this. People aren’t getting the care that they need. If they do, it’s coming at great expense.
Zibby: The really interesting part — a lot of this stuff is interesting. Let me back up. You wrote about — I should change my tone as I’m all cavalierly talking about your suicide attempt or whatever. Let me try to titrate myself a little more appropriately because it’s not funny at all, but very heartbreaking and sad. You write about that and then the aftermath of that and how not only did that happen for you, but it led to this hole that you could not pull yourself out of in terms of debt just to cover the cost of that. Interestingly — I hope it’s not giving anything away. If I can — if not, I’ll delete this. Over time, so much time had elapsed that actually, you found out you didn’t even have to keep paying the collection agency, which I couldn’t — I was like, what?
Emily: Apparently, it’s beyond the statute of limitations. There’s new legislation that has changed this truth just in the last few months that basically, they won’t report medical debt on your credit report moving forward. Not everyone knows this. People will just try and get away with what they can in terms of collection agencies and in terms of hospital billing. It was sort of remarkable that I had been paying all of this money to a debt that was no longer legally collectable.
Zibby: Unreal. Too bad you couldn’t go back and get it back.
Emily: Right? I could do so many things with that money.
Zibby: You shared a lot about yourself and your family. I really appreciate that vulnerability and honesty in the way that you did it. I was hoping you could talk a little more about your parents. You wrote, “My father had grown up in conditions that were best described as extraordinary poverty and abuse, and so imbued in him was both a frantic urge to make a lot of money and the tendency to spend it all before anyone else did. This was how we operated, in a constant churn of being flush with money and then broke-ish.” Tell me a little more about growing up and your parents.
Emily: My parents are remarkable people in a lot of different ways in that they were the first people in their families to graduate from college and to be able to make something of themselves in the world. At the same time, I think that they were weighed down by their own traumatic histories. That made the discussion of money — I both had a significant education in money, and also, there were gaping plot holes. On one hand, I got a checking account when I was very young, and a credit card. I was taught how to use these things. On the other hand, I didn’t feel like I had enough money to pay for the things that they said I needed to pay for out of that checking account or whatnot. Then eventually, that money just stopped coming in. I had to scramble and figure out what I needed to do. With my parents, like most people in the book, everybody’s trying to do the best they can with the resources they have. Sometimes with my parents, that could be muddy, the discussion of money and our relationship to it. Originally when I wrote this book, my editor said — I had not included my parents as much. To the degree that I did, it was just a little bit. My editor said, “I don’t understand. You grew up in Lake Forest, Illinois,” which is a really affluent suburb. “Why didn’t your family help you with this crippling medical debt?” I’m like, ah, I have to answer that question, and so I did. Definitely, it can be a fraught topic, a little bit of a minefield, for sure.
Zibby: Crazy. Having done this really deep dive into medical industry and finances and this whole economy around health care and everything, where do you fall on it today? Where do you hope it goes? What are you hoping to change? How do you feel in general? Maybe that’s too big a question.
Emily: No, no, absolutely. I feel like we’re in a crisis point, like I said, made worse by the pandemic. I think that the only real way to go forward is a single-payer healthcare program, whether that’s Medicare for all or some other government-regulated healthcare industry. I think health insurance should be illegal. I know a lot of people work in that field. With the amount of bureaucracy that will inevitably come from Medicare for all or something along those lines, I do feel that there are other routes toward employment. I do think that we’re at a really, really important point where we could make a change if we wanted. If we could just influence lobbyists, maybe we could actually make that change. I’m not sure how realistic it is at this very moment, but I maintain being hopeful.
Zibby: Do you feel that any other countries totally have it right? Is there one country you look to and you’re like, if only we had a system like blah, blah, blah?
Emily: I think that they all have their pluses and minuses. I do think that for everything that people complain about who use the NHS in the UK, it’s not a bad way to go. A lot of those things are covered. The other thing in the United States that’s really remarkable is that we have this incredible shortage of physicians. There’s just not enough residency spots. People who go to medical school, who complete their medical degree, who pass their exams are still not matching into US-based residencies. I think that’s sort of incredible. We’re at this point where we have a shortage of physicians. We just don’t have enough residency spots to get those people trained. That’s another thing that I think we need to really open up in order to get people.
Zibby: There was a huge — I’m not sure when this episode is coming out. Sorry. This is mid-May as we’re talking. There was just a huge article this week about the shortage of doctors and what we’re going to do about it and some picture of ER rooms struggling, or operating rooms, rather, struggling, not enough hands on deck. I literally said to my husband, I was like, “Oh, great. Now we’re out of doctors.” It’s like, what else? What else could go on?
Emily: We’re out of doctors. We’re out of nurses because so many have left as a result of being totally burned out with the pandemic and also the fact that recently there was this cap on travel nursing pay. A lot of nurses who had come back out of retirement to work these travel contracts, they don’t think it’s worth it unless they’re making good money. That’s a delicate balance too.
Zibby: It’s not so dissimilar to the veteran situation we have. Everybody is applauding. We were all banging on whatever. I mean, I wasn’t. I wasn’t in the city at the time. Anyway, people were banging as people — there was so much collective goodwill towards doctors and nurses that they were the heroes. Everybody still believes this, truly, that they were the heroes of the pandemic and literally saved as many lives as humanly possible for the manpower that they had. Now two years later, it’s not that people don’t feel like that, but of course, now life is slowly going back to normal. Are we still giving nurses and doctors enough credit? There used to be signs in people’s lawns. “Thank you, doctors. Thank you, nurses.” What happens after? How do you then just go back to normal life for those people who were in the front lines? How do we as a society correctly — not correctly, but adequately reward them for that? We can’t just be like, okay, thanks. That was awesome. Moving on.
Emily: Great job. Thanks so much.
Zibby: Great job. Keep it up. Hope you’re around the next time. Stay tuned.
Emily: Stay tuned for the next pandemic. I think it’s a serious problem because these folks are really burned out. Of course, also, there’s a shortage of therapists right now. There’s not enough therapists to provide care to the not enough physicians and nurses and other health-care staffing personnel to provide care to patients. In the end, everyone suffers, unfortunately. I hate to be like, well, it’s terrible, but it really is. We’re at a serious crux where we could go one way or another. Hopefully, we rise to the occasion. If not, it’s going to be a difficult few years, for sure.
Zibby: Okay. Well, thank you for —
Emily: —
Zibby: At least it justifies my chronic anxiety about everything.
Emily: It’s true. It’s true. You come by it honestly. We all do now.
Zibby: There’s a reason. I’m not manufacturing these things.
Emily: No, absolutely not. We’re at a significant crisis point. Somebody needs to do something about it.
Zibby: Do you think there is anything that the layperson can do?
Emily: I joke that the French are really good at protesting. If something goes wrong in French health care or in French society, people turn out into the streets and set cars on fire. I’m not suggesting that we’re advertising or recommending this.
Zibby: Please, no. We are not recommending this.
Emily: I think there is an apathy on the part of Americans when it comes to protests and attending protests and participating in protests. That can be another roadblock, or folks who don’t know how to get involved in something or don’t know maybe what the best way to go about getting involved would be. Obviously, the more politically correct thing to say is you have to vote for people who will get into office who will make these changes, but it’s a little bit more complicated than that because of the lobbying power of the insurance companies.
Zibby: Let’s switch gears because this is too depressing for me.
Emily: I’m sorry.
Zibby: That’s okay. That’s all right. The writing of this book, tell me about that. What was it like for you to write this book? When did you know you wanted to write this book? Tell me the backstory and how it all played out.
Emily: I was working in the ER. I had taken a break from college. I kept owing money to the university, running out of money, and then dropping out again and then trying to get back in. This was during one of those breaks. I started a job in the ER. Then at nights, I would come home and write about all the crazy things I had seen that day. This was back in 2008. It took a really long time for me to figure out how to write, how to learn how to write, how to do the writing. It took many, many years. I eventually attended an MFA program that I graduated from. That’s where a lot of these essays coalesced. Then after that, it was sold. Then I rewrote it three times. I wrote it as an essay collection. Then I wrote it as a memoir. Then I wrote it back as an essay collection. It definitely took a significant portion of my life, probably the last fifteen years or so. I’m hoping that with my next book, I could do this a little faster.
I realized I actually had a book probably not, honestly, until — I thought of it as a book when I submitted it as my thesis. This was really my graduate thesis for my master’s of fine arts program. I didn’t know exactly how it would really coalesce until much later. I was on assignment. This is the story of the title essay, “Cost of Living.” I was on assignment for VQR, for the Virginia Quarterly Review. I had pitched them this great story about West Virginia EMTs and what they’re doing and how they provide care. It was going to be deeply researched and reported. I was going to go out with these guys and find out what their world looked like. I had a problem with my source. The story just crumbled before my eyes. I emailed my editor. I said, “The story is dead, but do you want something from my MFA thesis?” I attached this essay. I said, “Please take it. I don’t know, maybe you’re interested. This is kind of nuts. I’ve never done anything like this before.” He emailed back and said, “I think we can do something with this.” That became the title essay. It had a terrible title at the time. It was “The Cost of Suffering” or something like that. The original title for my MFA thesis was Amputation for the Greater Good.
Zibby: Whoa.
Emily: Wrong.
Zibby: There’s a lot of darkness to this.
Emily: Very dark. I just thought, no, that’s not going to work. Basically, we worked on it. Then it was in Virginia Quarterly Review and then got picked up by Best American Essays. After that, I thought, oh, I can organize the book around this. Actually, the title of the book should be Cost of Living. It took me a while, but I figured it out eventually.
Zibby: I love it because Cost of Living has so many different meanings, but you literally were calculating what you would have to pay just for them having saved your life at this one point. It’s an actual number. Obviously, of course, it’s much more than that. I love those multiple-meaning titles and all of that. That’s a funny origin story for the book. What are you working on now that might or might not take you fifteen years?
Emily: Oh, gosh. I have a new book under contract. It’s called Burn This House Down. It’s also incredibly depressing. My brother, a few years ago, burned my parents’ house to the ground and was booked for felony arson, has no remorse for what he did. What came out of that was he was eventually diagnosed with anti-social personality disorder, which is what people use to refer to people who are sociopathic or psychopathic. That’s the DSM diagnosis for those folks. I’m using my own family story as a jumping-off point to talk about some of these larger issues to talk about how we both celebrate and fail white male psychopaths, in particular in TV and film and popular culture. It’s even less uplifting but hopefully also still a little funny in a sardonic way than Cost of Living. I also have other projects that are in the pipeline. I have a horse book, which is a little less dark.
Zibby: I hope so.
Emily:
Zibby: That would be nice. How bad could the horses be? Oh, my gosh.
Emily: It’s like Seabiscuit meets The Boys in the Boat.
Zibby: Oh, that sounds great.
Emily: It’s an Olympic story. It’s got a long history. I was involved with horses growing up around that culture. It offers me an opportunity to sort of pull back the curtain on a subculture that otherwise, people don’t necessarily know about unless they are a part of that culture. That’s another project that I have going. We’ll see what rises to the surface.
Zibby: You know, there is a book with a similar title by Gina Frangello.
Emily: Yes, yes.
Zibby: Do you know what I’m talking about?
Emily: Blow This House Down.
Zibby: Oh, yeah, Blow This House Down.
Emily: It’s not in this room. It’s in the other room.
Zibby: It was really good.
Emily: It’s fantastic. She’s a Chicago person, so I see her at readings, more pre-pandemic.
Zibby: You’re in Chicago now?
Emily: I’m in Evanston, so I’m just outside the city.
Zibby: Nice. My mom went to Northwestern.
Emily: Cool.
Zibby: What advice do you have to aspiring authors?
Emily: Good question. It’s a long road, but you just have to keep working. I think that’s the single piece of advice I can give to people. Also, I think there’s a lot of talk on the internet and in various communities, classes, etc., about, you have to write a certain kind of way or that you have to put together things in a particular fashion, but I don’t know if that’s really true. You live in a world where it’s your lived experience. Your experience is maybe weird or different than other people’s experiences, and so you can write about those. I think that that is really remarkable. I have nonverbal learning disability, which is a developmental disability similar to autism. The way I see the world is, apparently, really different from the way that other people see the world. I’ve seen that manifested in responses to this book. Also, I’m wired for sound. I know that if you’re wired for sound or if you’re wired for a visual experience, if you’re sensitive to visual imagery or if you’re someone who needs to write by hand, you might write by hand. There’s no wrong way to do this. You just have to do what works for you.
Zibby: I like that. Maybe even try to get a diagnosis so you know what’s going on with yourself.
Emily: Well, if that helps, then sure. If that helps, then absolutely.
Zibby: If that helps. Always good to know.
Emily: It can be helpful sometimes.
Zibby: Unlike in your book where you were misdiagnosed for so long. I guess that comes with a double-edged sword in that advice as well. Thank you, Emily. I am excited and yet scared to read your next book. I will brace myself. Thank you so much. This was a really thought-provoking and very important book. I’m happy to have read it and to have a new arsenal of knowledge about the health-care industry through which to see everything.
Emily: Thanks for having me.
Zibby: Thanks a lot. Buh-bye.
Emily: Thanks. Bye.
