Breast Cancer While Broke

Here's how I coped when I realized I literally couldn't afford to live.

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I was in pajamas watching Miss Marple when I first noticed I had cancer. It was the middle of the day, but I was in bed with a cold, surrounded by the detritus of minor illness: balled-up tissues, cups gummy with the remains of juice. The lump under my armpit felt like gristle in a chicken breast. I told myself it was an inflamed lymph node. On TV, Miss Marple clutched her handbag suspiciously, but I was only 32, mostly healthy, and underinsured. A doctor's visit cost money, and like so many millennials, I don't have any, so I put it off.

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It was two months before I got the lump checked out. According to CNBC, that's not unusual for my peers. People in their 20s and 30s often skip or hold off on health care because they simply can't afford it. I had $70-a-month insurance that would partially cover a catastrophe, like an emergency-room visit or hospital stay, but was mostly a means of avoiding the fine that comes with having no insurance at all. The Affordable Care Act brought insurance to millions of people, including me, but high co-pays meant just as much waffling over whether an illness was "doctor's-visit-worthy" as before.

My gynecologist told me the lump didn't feel serious but sent me for a biopsy. The doctor who did the biopsy told me it didn't look like cancer and sent me for a mammogram. The nurse who did the mammogram said not to worry. Everyone chanted my age: 32, 32, 32, as if it were a talisman against cancer.

The talisman, like my health insurance, was worthless. I got a $1,500 bill for the biopsy, a $200 bill from the gynecologist, and a diagnosis of breast cancer. The kind-voiced nurse practitioner on the phone with the news told me that my New York State–run insurance was so bad she couldn't even find an oncologist who would take it. "We'll keep trying," she told me. I never heard back from her.

When I got my diagnosis, I was teaching two classes at a community college, writing corporate blog posts during my office hours, and selling $22-dollar-per-pound cheese at night. I'd realized too late that a Ph.D. in creative writing doesn't come with any guarantees for an academic job. I tried a nine-to-five reporting gig for a year. But a decade of full-time collegiate writing and researching left me able to finish my two daily 650-word reporting assignments about digital marketing and search-engine optimization in about two hours, meaning I spent the other six idly reading the Internet or crying in the bathroom.

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So I decided that piecing together an income by pursuing disparate interests was a more exciting way to live, closer to the life of a grad student than a grown-up. With nothing more than rent to worry about, it didn't matter that I had less than $1,000 in my checking account and $150,000 in student-loan debt. It wasn't until I found out I was too broke to even discuss my treatment options with an oncologist that I realized why people trade fun for stability.

It wasn't until I found out I was too broke to even discuss my treatment options with an oncologist that I realized why people trade fun for stability.

Not long after I got the news, I locked the door to the bathroom in the Brooklyn apartment I shared with two roommates and my partner and stripped from the waist up. I didn't even have a bathroom mirror, just a hall mirror in a chipped gilt frame propped against the window screen. A cross breeze often knocked the mirror askew so that I had to reposition it before I squatted to knead and stretch the skin of my defective breast, trying to see an outline of the thing that would cost me my protracted youth.

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Before I had cancer, I could pretend "poverty" was performance art. My clothes mostly used to belong to other people: an old man's plaid bathrobe, a silly mom sweater embroidered with chessmen. My gaudy dishes came from garage sales and antique stores. The couch came from the returned-or-irregular section of Ikea. Money seemed like such a silly thing until I needed it.

Just like the doctors who'd chanted my age as insurance against breast cancer, I'd used it to convince myself there would always be plenty of time to open a savings account or buy brand-new dresses and an unstained couch. But unfortunately, growing up didn't happen when I decided I was ready. There's no clearance rack for oncologists, no secondhand chemo.

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After my diagnosis, a generous gift from my partner's family saved my life. Money and better insurance bought me time with solicitous, kind doctors who seemed invested in both treating me and making sure I was happy with that treatment. After appointments, they called just to see how I was doing; they gave me their email addresses in case I had questions. I was completely out of place in the leather-chaired waiting room at my breast surgeon's office, eating free chocolate cookies as I stared out a window at Central Park.

Other patients had soft-looking blowouts and Tom Ford tote bags. I had a bright-purple ponytail that stained my collar and a backpack. I couldn't afford to sit in that chair eating that cookie without help, and my gratitude is mixed with the sad knowledge that there are other women who didn't have access to the same resources I did, still waiting for a call that says a doctor will see them. As Republicans have already started working on their repeal of the Affordable Care Act in the wake of the recent election, cutting even the scant access I depended on before I discovered my breast cancer, I worry the call is never coming, and soon the line itself will be disconnected.

I not only wanted the tumor out of my body, I wanted to be done with my breasts, full stop. Finding a doctor in New York City I'd trust to cut off my breasts and rebuild them again was costly, and I had to upgrade my insurance to a plan I would have balked at in the days when I thought I was healthy. Two months after my diagnosis, I woke up at Mount Sinai two breasts lighter, with drain tubes curling from my ripped torso like new appendages.

Two months after my diagnosis, I woke up at Mount Sinai two breasts lighter, with drain tubes curling from my ripped torso like new appendages.

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When I went back to my apartment, my life seemed too crowded. My roommates were younger than me, one a psychologist in training, the other cobbling together side gigs: sometimes she was a tarot reader, other times a yoga teacher, on Mondays and Fridays an English teacher, on Saturdays, a model. Before my surgery, it had seemed like I had so much in common with everyone around me, but now, in such close proximity, I felt even more broken.

I was so obviously hobbled by my illness, my chest flat beneath my pajama top and my arms crossed protectively over my hunched body on the rare occasion that I left my room. While I still loved my roommates very much, my life, like my body, would never look the same again.

Each day, the scrape of my slippers marked my creeping progress to the bathroom for my one and only appointment: dumping scummy pinkish fluid from my drains. Afterward, I scratched the volume in ounces into a notebook like a time card. My roommate, all curves and waist-length braids on her way out the door to yoga, would ask if she could bring me things from the outside world. Her boyfriend, recently back from a trip to Peru, tried to look anywhere but at the empty drains pinned to my shorts like saddle bags. The bathroom mirror blew over and smashed one morning: seven years' bad luck.

Two weeks after my mastectomy, my partner and I moved. Our one-bedroom apartment in Bed-Stuy costs double my parents' mortgage, but it affords us the luxury of watching sitcoms together in the living room with our TV trays full of dinner, of counting out pills during chemo at the kitchen table, of never having to pretend you haven't been crying for a roommate just trying to grab something from the fridge.

Two weeks after my mastectomy, my partner and I moved.

It's not the life I thought I wanted, but now that I have a proverbial "room of my own and a door with a lock on it," I can say it's what I need. My last day of chemo was September 1, and the following week, I was back at my hustle, talking about the "darkness of man's heart" in Lord of the Flies with my classes full of college students before rushing home to file 500 words on winter beauty trends by deadline. But unlike before, there's a real urgency now. My savings account has money in it, and I'm saving for a life: reconstructive surgeries, a move to a cheaper city. Real health insurance runs me $300 a month in addition to what I still owe the doctors who cut the cancer out of me.

Now that I'm cancer-free and soon won't need as many doctors, my partner asked if I wanted to check out my options for state-run insurance during the open-enrollment period. It could probably save us several thousand dollars to switch. "Are you kidding?" I asked him. "That's about to be over." While my old insurance wasn't perfect, the future of affordable health care looks bleak — and who knows whether people with preexisting conditions will still be able to get insurance on the open market. I currently spend about 15 percent of my salary on medical expenses, but I can't afford to entrust my life to a system Donald Trump has promised to snatch out from under me.

Adulthood has been about realizing the hard way that there's more to be scared of than a life that seems too normal. In fact, having cancer taught me that being able to afford the luxury of feeling normal is one of the greatest privileges you can have.

The day after I came home from the hospital, I conducted a phone interview for a case study I'd been asked to write shortly before having my mastectomy. I went without my afternoon Percocet and asked questions about ROI, engagement, metrics, and data. I typed out the answers with my phone propped against my shoulder, murmuring encouragement to spur on my interviewee. Over the next week, I turned his answers into a 1,200-word write-up for a client who never knew I'd been sick, much less that not 24 hours before I'd conducted the interview, I'd been eating hospital Jell-O in an attempt to prove I was healed enough to go home. I didn't want to work in the hospital bed with my roommate moaning from the other side of the divider curtain, but I would have.

"Thank you so much for the opportunity," I told my client when I filed the draft. And I meant it.

Emily Alford is a writer living in Brooklyn. She recently completed her first novel, Bless the Girls.

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