No doubt you’ve seen a movie or TV show where a sudden cataclysmic t-bone car crash happens without warning. It’s a really effective way to shock the audience, kind of a horror film technique applied to regular dramatic scripts, and it’s become so common that it’s now a trope. I think it’s so effective because we’ve all experienced a situation where something hits us with a WHAM! … totally out of the blue, physically or emotionally … and our lives suddenly go sideways.
Sometimes that WHAM! hits us collectively. Covid-19 is just that sort of shock, a global car crash that has turned billions of lives sideways. Sometimes that WHAM! hits us individually.
A little more than two weeks ago I wrote this note about a personal healthcare issue I was having.
No Country For Old Men
We all know someone who is in urgent-but-not-emergency need of some medical procedure that can’t be scheduled while Covid-19 is storming the hospital ramparts. I’m one of them. … Continue reading
My healthcare issue – varicose veins in my ass, commonly known as hemorrhoids – wasn’t life-threatening. Neither was the complication I developed three weeks ago – an anal fissure. Now there are two words you never expected to read in an Epsilon Theory note! Certainly I never expected to write them. It’s a brutal term, right? Sounds awful. I promise you, though, the reality is worse. The pain is … otherworldly. The pain is … transcendent. But again, not life-threatening. This isn’t a sideways moment.
So Friday morning a week ago, I had a hemorrhoidectomy where the internal varicose veins were removed and the anal fissure was repaired. The surgery went well. I was sent home, prepared for the long (and painful) recovery ahead.
And then that evening my bladder stopped working.
And my life went sideways.
I have two observations from that sideways Friday night, one about pain and one about privilege. Pain first.
I thought I knew pain. I thought I knew the limits of pain. But in the ER that Friday night, in the course of several … ummm … poorly executed catheterizations, I discovered that I knew nothing about the limits of pain. I discovered *chef’s kiss* pain that night, and I’ll never be the same.
So obviously I’m better now, nine days later. I can pee and poop on my own, which unless you’ve ever had the experience of NOT being able to pee or poop on your own, I don’t think you can fully appreciate. Certainly I couldn’t have. Is there still pain? Of course, but it’s an entirely different kind of pain, an understandable pain that has an established beginning, middle and end. What I experienced over the weeks before the surgery and especially in the ER visits was pain beyond understanding. And that’s what left a scar.
They say that pain is a teacher. This is a lie, at least when it comes to pain beyond understanding. I suppose understandable pain could be used as a correction, as part of a causal learning process. Pain beyond understanding, though … pain beyond understanding teaches you nothing.
They also say that pain and pleasure are opposites. This is also a lie, again when it comes to pain beyond understanding. Pain beyond understanding is its own thing, sui generis to use a ten-dollar phrase. It becomes your entire world when it hits. It is All. Pain beyond understanding is a jealous god. It is your jealous god, and you will give yourself over to It. I’ve heard people talk about religious conversions in this language, in the sense of being brought low and placing themselves in the hands of a higher power. For me it was a lower power. In the early morning hours that Saturday in the ER, I capitulated. I gave myself over to the jealous god of pain beyond understanding and whatever mercy the ER staff would bestow.
I am 56 years old. But I had never felt old. I had never thought of myself as old. I had never felt … fragile … until I experienced pain beyond understanding. And not just a physical fragility. No, the physical fragility is something that I can bring into understanding. It’s something that I can work on; something that I know how to improve on. It’s the emotional fragility that I feel far more keenly than the physical fragility, because even as the pain and the physical fragility subsides, the emotional fragility remains strong.
And I don’t know how to fix it.
Experiencing pain beyond understanding has not inured me to pain, it has sensitized me to pain. I am constantly checking in with my body for any signs of pain. I am more aware of pain and reactive to pain – no matter how slight, no matter if it’s physical or emotional – than I have ever been. I don’t like this pain-sensitized person, this Neb Tnuh. Neb is self-absorbed. Neb still hears his jealous god whispering in his ear, tickling him with an ache here and a prick there. Neb is distracted, at a time in his life and his family’s lives when concentration and focus have never been more important.
I think there are a lot of people in this world who, at one time or another, have experienced pain beyond understanding and so endure this emotional fragility that I’m describing. I think that on a collective level, we are ALL suffering from an emotional fragility brought on by the pain beyond understanding caused by Covid-19 and its physical and economic repercussions.
And we don’t know how to fix it.
I’m equally stuck on a fix for my second observation from the night when my life went sideways. This observation isn’t about pain. It’s about privilege. I know that’s a terribly overused word, and I tend to cringe whenever I hear it. But in this case it’s exactly the right word. It’s the only word.
I believe that if I were black or poor, much less black and poor, there was a non-trivial chance that I would have died last weekend. I know that sounds melodramatic. But it’s really not.
The privilege of class that I’m talking about is not that I’m able to afford a decent health insurance plan, that I don’t have to worry about whether or not I can go to the ER when my bladder stops working. That’s a very real thing and a very real privilege, but it’s not what I’m writing about here.
The privilege of race that I’m talking about is not that I got better facilities or more effective therapies from the nurses and the attending doc in the ER that night. Nope, they were entirely equal opportunity in their maddening mix of mostly nonchalance and occasional attention, in their absolute refusal to consider this a complication from that morning’s surgery (which would have pushed all sorts of liability red buttons), and in their determination to get me out of the hospital as soon as humanly possible, even if that meant returning to the ER for a new admission every four to six hours until I could see a urologist. On Monday. I’m not making this up.
No, the privilege of being a well-to-do white guy in a Connecticut hospital ER at 1 AM on a Saturday morning is that I was able to advocate for my own survival to the (mostly) white nurses and the (exclusively) white doctors, and they would actually listen to me. I was able to speak with the attending docs as their peer (or as much of a peer as an ER doc sees anyone). I was able to speak with the nurses and all the clerical representatives of the insane bureaucracy that is a modern medical facility as a person of authority. I was able to advocate successfully for an additional three hours in the ER and another set of tests, which I know doesn’t sound like much, but which I promise you was everything.
The privilege of being a well-to-do white guy in a Connecticut hospital ER at 1 AM on a Saturday morning is that everyone recognized that there would be consequences if my sideways moment got any worse. It would be annoying and possibly dangerous to their position if I had an “adverse outcome”, plus I spoke in a language and from a position of authority that was comfortable to them, that everyone was accustomed to responding to. None of that would move mountains. None of that would get me admitted to the hospital. But it was sufficient on the margin for me to get the time and the additional tests that I advocated for. And that made ALL the difference.
One of the first lessons I learned as an investor is that markets happen on the margins.
So does life.
That’s what a sideways moment IS … a point in time where your very life becomes a probabilistic exercise, where you are well and truly at the mercy of one of two merciless social institutions: hospitals or the police. Each is an insane bureaucracy designed to deny exceptions to the rule, designed to grind everyone equally beneath its wheels, designed to eliminate marginal considerations.
One day, your life or the life of someone you love will go sideways, and the outcome of that sideways moment will depend on a stranger in one of these two massive institutions – healthcare or public safety – treating you differently on the margin. In my sideways moment last Friday night, I got that marginal difference in treatment, and you’ll never convince me that my race and class weren’t the edge in winning that marginal difference. That’s privilege.
We should all have that privilege – the privilege of advocacy, the privilege of mercy, the privilege of empathy – and it’s my life’s work to see that we do.
Glad you’re doing better, Ben. The Pack needs you at full fighting strength.
“We should all have that privilege – the privilege of advocacy, the privilege of mercy, the privilege of empathy – and it’s my life’s work to see that we do.”
Proud to be part of the pack Ben. Especially today. Be well.
Absolutely. Germaine Greer wrote beautifully about this. All the best for your healing.
Ben, I’m hoping for a quick recovery for you and anxiously awaiting your next essay after your bill arrives.
Thank you Ben. In practical terms this may have been the most cogent text you have constructed. As a young physician at a university teaching hospital I was initiated into the then new system of IPA’s and HMO’s. Skeptical of what I was seeing at the time (?late 1980’s) I decided to pick a random hospital floor and measure the thickness of the medical charts compared with the type of insurance coverage afforded the patient. Patients with Private insurance had literally twice the chart thickness as patients covered by HMO’s due to the number of consultants and tests used in the treatment of privately insured patients. I have volumes of anecdotes of unequal patient care but being white, affluent, and educated confers privileges in care not available to others.
Really incredible writing on this difficult topic. Get well soon.
That caused memories to flood back! First, best wishes for a speedy recovery.
My family was in an emergency situation with my then 17 year-old daughter. After a life flight for her from a Texas lake to the best medical center nearby in San Antonio, my wife and I trailed at 100 mph via SUV to catch up. The emergency doctor on call saw her, and us; and said her hand might be saved with the help of the best specialty practice in the city (on a Sunday evening of Labor Day weekend). Otherwise, it would simply be amputated with the technology they had. He knew arranging an ambulance for the transfer would lose more valuable time so he drove with us, I’m sure breaking hospital policy, to the surgery center. I drove him back while they opened the building, and assembled a team of 4 to operate on her. She was in surgery from 8 pm until 6 am the next morning, and in recovery for the next 6 days there. My family and her caregivers were the only occupants until the center opened its normal weekday practice on Tuesday. The center gave us a free hospital room to use as our hotel, and the nurses and her primary doctor guided us through the harrowing experience. The reconstruction of her vascular system and the reattachment saved her hand. The steps that even made that possible were as remarkable.
I didn’t process it then as a function of our health plan or our whiteness. My flip-flops, bathing suit, and baseball cap conveyed a redneck vibe more than any hint of wealth. Instead, it permanently changed my appreciation for the professionalism, selflessness, and dedication of that entire chain of health professionals. It did ground me on the aspects of life where we are completely at another’s mercy. My daughter became an ICU nurse.
I know that outcomes differ in a non-colorblind US society. That experience instigated a desire to treat each person I meet as someone of value that I might need to rely on some day, particularly in service positions. Reading the quality of these posts is one of the few things I see in the world around me that gives me hope for my kids kids.
As a fellow sufferer of your condition, I can empathize, although I have never been hospitalized or had surgery for that. At least not yet - I’ll tell you, the magic orange powder will forever be your friend. But this essay is spot on and rhymes with the point I have been making with my activist friends and family who are hell-bent on ridding their communities of policing. Law enforcement is just the point of the spear of a spectacularly unjust judicial system. The system is what needs burned. And you can see it in health care too, just as you see it in the justice system, individual outcomes are directly related to what an individual can afford. That is by design. We also have the best public policy money can buy and our individual votes really don’t matter. That is also by design. BITFD
Oh man, Ben, SO sorry you went through such a horrific experience! But so very thankful you’re getting better (at last!!!). The part where you mentioned the liability angle with your surgery when you were in the ER struck a chord, as I lost someone extremely close to me in January as a direct result of what I believe was a botched heart surgery. I’m sure there is great work and care going on (as Patrick described), but in general from my experiences over the years, I have little faith in the healthcare field.
As an extremely wise man once said, “Don’t let us get sick.” --Warren Zevon
This is an account from a note I wrote at the time of pain ‘beyond understanding’ from, I presume. the same sort of event that Ben experienced. Perhaps it shows our UK National Health Service in a better light than that of the private medicine in the US as I was just a regular emergency admission far from home and was not able to access any privilege.
Nevertheless it was not much fun.
So, having enjoyed 2014 and thinking things were set fair for 2015 I set off for my brothers 65th in good spirits, until 2 pints in at around 9pm I went to the loo, and couldn’t. As bad luck would have it, it was black Friday ie the Friday before Christmas and I was in the wilds of Northamptonshire. Suffice it to say that after a long period of thinking that if I could just relax things would be ok I ended up taking a 15 mile taxi ride at 2am to Northampton NHS walk in centre. Here I was subjected to two unsuccessful catheterisation attempts before being ambulanced to the A&E, after another 45 minute wait first a nurse (2 attempts) then a junior doctor (3 attempts) tried to catheterise me before a consultant urologist arrived who after 2 more attempts said give him some morphine. It was by now 7am, so I was now up to 10 hours of bursting bladder pain. He then introduced a catheter straight through the wall of my upper groin. I should mention that I was still wearing a suit and this was done without any sort of anaesthesia, he just got a scalpel cut through the skin and stuck the catheter through the bladder wall. Unfortunately he had forgotten to put a closure on the other end of the catheter pipe and after 10 hours there was some pressure built up. It was the classic loose end of the hosepipe scenario with everyone grabbing for it and all getting a shower.
After a night in Northampton general I drove back home to London thinking that I would see my GP arrange the necessary hospital appointment and get the prostate drilled out as it appeared was necessary. This was 21st December 2014, eventually after several more trips to A & E and innumerable bouts of infections I was finally operated upon on April 7th.m For the whole time in between I had a pipe sticking straight out of my lower abdomen with a tap on it.
In retrospect it seems laughable but for those three months it was pretty middling.