Forum — From the October 2017 issue

DeLisle, Mississippi

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When I was six, a pit bull tried to rip out my throat. I was walking down my parents’ oystershell driveway when the dog attacked me, probably because another dog, brown and shaggy in my memory, was nearby and in heat. My attacker was white, muscled, wide across the chest, and tall; brandishing his weapon of a mouth, he blocked my path and sidled close to me. He was so still, and his back bumped my waist. “Move,” I told him. “Get.” Instead, he growled and jumped, and I fell beneath him. His growl rose to a pulsing grind. He sliced my scalp. My ear. My back. I curled in on myself, collapsed the target, and fought him. Beat his ribs with my fists. Kicked his soft underbelly. I screamed so loudly that my aunt ran down the street with a broom and beat him off of me, and then she walked me home. I wailed, covered in blood. On the way to the hospital, my mother put my head in her lap. I don’t remember crying in the car. I was in shock.

Back from the hospital, through the cotton muffling my reconstructed ear, I heard my father say this: “She survived because she fought him. If she hadn’t —” He shook his head and stopped speaking.

Now my father’s words sound different. As an adult and a parent who works in part to provide health insurance for her children, I think about the fact that his health insurance, which he acquired through his job at a bottling factory, paid for the doctor who reattached my ear. Paid for the nurses who held me down as they administered a tetanus shot. Paid for me to go back to the hospital to get the stitches taken out. That Medicaid, which covered us children after our father lost his job, meant that I could return to the doctor for aftercare. That my parents did not have to pay the bulk of my medical bills themselves and lose their car, destroy their credit, go into bankruptcy. That I was able to seek treatment and avoid scarring, infection, sepsis, and death.

Both my maternal and paternal families have lived in rural Mississippi for generations, since well before the advent of Medicaid in 1965. There were thirteen children in my grandmother’s family, all delivered by midwife. My grandmother’s twin died at birth, and my great-grandmother put my grandmother in a drawer, a makeshift bassinet, and assumed that she wouldn’t live through the night. My grandmother is in her late seventies now, but when she was growing up she had no access to preventive services, and her body bears testament. Her dental health was so abysmal when she was young that she was fitted for dentures in her twenties. She says that her uncles taught the children to brush their teeth by chewing on twigs, mushing them into a pulpy mass that they could use to scrub. This would have been in the 1940s. She grew up on a steady diet of beans and fatback and biscuits. Access to fruit and vegetables depended on the crops her father grew.

In this country and this state, access to health care depends on access to health insurance. This, in large part, depends on race and class. My family members have had access to health insurance on and off in their adult lives. My grandmother, and many of my other relatives, worked in the kinds of jobs that would not have provided them with insurance: My grandmother has been a hairdresser, a seamstress, and a domestic.

Once her children were over eighteen and no longer covered by Medicaid, they, too, hustled for jobs that would provide them with access to doctors. My mother and father both lived for years without health care because their jobs could not or would not offer it. When my mother worked as a domestic for fifteen years, she did not have health insurance. When my father worked as a gas-station attendant or in an oyster factory, he did not have health insurance.

My grandmother and her siblings and the children of my family have suffered a variety of health conditions related to their diet, genetics, and the lack of good long-term preventive medical care: diabetes, kidney disease, lupus, preterm birth, high blood pressure, high cholesterol, and cancer. Add to this depression and bipolar disorder and other undiagnosed mental illnesses. Many have died needlessly. Before dying, many fell into alcohol and drug addiction. My extended family presents a stark picture of what it is to live in a state, in a country, that does not think that access to quality physical and mental health care is a human right.

My senators supported the Obamacare repeal wholeheartedly. I contacted them many times, concerned that millions would lose their health insurance and that the bill would underfund those with special needs, with disabilities, and hamstring the elderly. In my community, repealing the Affordable Care Act would mean that insurance premiums would rise exorbitantly, that families would have to choose between health care and electricity. It would mean that those struggling with addiction would continue to fight alone. It would mean that those diagnosed with cancer (there have been many in my small town) would find themselves facing lifetime caps again: would find themselves facing death. The politicians supported the bill.

Right now, more than 700,000 Mississippians are covered through Medicaid. Half are children — more than 350,000. Ten percent are the elderly, and this number includes many people who can’t pay for nursing homes. Around 10 percent are parents, caretakers, and pregnant women. Astonishingly enough, Medicaid pays for two thirds of all births and 75 percent of nursing-home care in Mississippi. My family members who work — and even under the A.C.A. can’t afford to purchase private health insurance — may face the ugly fact that their prospects of being covered under Medicaid in the future are abysmal.

What does it mean to live as an adult without health insurance in Mississippi? For much of my twenties, I was that adult. It meant praying that I wouldn’t get into a catastrophic accident that would saddle me with exorbitant emergency-room bills. It meant that when I swam through the floods of Hurricane Katrina and developed a staph infection from whatever toxic sludge floated in the storm surge, I suffered with it for weeks until I was able to visit a free clinic. It meant living with failing vision, displaced dental fillings, abscessed teeth, and strep throat. It meant living with migraines so crippling that I could not stand. Migraines that felt like a burning spike was being driven into my right temple again and again while my eyeball was being squeezed out of its socket. Migraines that came every afternoon at the same time (three o’clock) for two and a half months, every spring and fall, every year. Migraines that could be averted only with an Imitrex shot. Imitrex shots, with insurance, cost a hundred bucks, came two to a pack, and should have been used once a month. When I was uninsured, I couldn’t see a doctor to get a prescription and couldn’t afford the medicine even with one. Living without health insurance meant suffering depression so deep after my brother died that my mind was unspeakable. For years.

Sometimes I imagine what it might be like to leave Mississippi, a state that’s been milk-drunk on an ideology of white exceptionalism and self-determination since its infancy, its slaveholding beginnings, when it was the Wild West of the United States. When black children and women and men were gold. When every white man, with enough capital, could be a master, every white woman a mistress. How slaveholding and the vast cotton fields shimmered for them all: the original American dream. But then I remember who I am, where I come from, whom I am with, here in modern Mississippi. Where illness and disability are marked as personal failures and ascribed moral fault. A place I can leave but my family can’t. Where the descendants of the enslaved are tied and knotted by the bonds of institutional racism before we are even born, marked by the neglect of our mothers’ pregnant health. How these ties tighten as we age, pulled taut by the stress of racial prejudice, so that we, too, bear preterm babies, manifest diabetes, fall rigid with stroke, swallow gun barrels and pull the trigger.

My nephew wears glasses three years out of date: His last pair was paid for in part by Medicaid when he was covered as a seventeen-year-old. He has painful back spasms often; we’ve talked about having me pay for acupuncture treatments. I do the best I can within a system designed to deny him access to health and education at every turn: I buy his college textbooks, help him pay for job training, and give him gas money so that he can one day find his way to a job that will offer him some health insurance. For other relatives, I’ve cosigned loans to help them pay for doctors’ visits and surgery. I gave my grandmother the money to purchase nicer dentures one Christmas. When I have means, I grease the cogs that I can. I write to my congressmen. I retweet and sign petitions and send letters and give keynote speeches about health inequalities in the South; I do what I can with what I’ve been given.

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is an associate professor of creative writing at Tulane University. Her novel Sing, Unburied, Sing was published last month by Scribner.

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