EVANSTON, Ill. — A few months after Emily Maloney tried to kill herself, she finally opened her mail. She was 19, living in Iowa City, an undergraduate at University of Iowa. She felt she never really knew how to be a person in the world. In high school, back in Lake Forest, Illinois, she wore wedding dresses and combat boots to class, she wore bowlers and tuxedos. She said she never did fit in alongside the young scions of Chicago’s business barons. She graduated early, and now, alone in Iowa City, she was depressed. She was recovering.
The mail piled up.
We met the other day at a coffee house in Evanston, down the street from her home. She’s 36 now, with big dark eyes and an agreeable, casually blunt disposition. That suicide attempt — that was her first and only attempt, she explained, but she had been hospitalized before, on the fear that she might kill herself. She spoke informally, then with the precision of the health care industry, which she knows now a little too intimately.
“I was hospitalized multiple times for being actively in the throws of potentially planning but not yet executing an attempt. I would go into my therapist and say things are just great. I always wanted to be a good patient so I would take anything they prescribed, whether it was good or bad for me. I would tell them everything was good but these are my feelings and then they would say, ‘Whoa, no, something is terribly wrong with you.’
“Ultimately, there was the attempt.”
After months passed, she reached for a piece of mail, sliced it open and found a notice from a collection agency. It was a large five-figure medical bill. She remembers thinking:
“Suicide should be cheaper.”
She writes this early in “Cost of Living,” her first book, a riveting new collection of essays about her history with therapists, drugs they prescribed, her chaotic Illinois upbringing and the inevitable cost of health care. It’s a clever title. Her medical debt, she writes, “was the cost of living, and I accumulated it on the telemetry unit, fifth floor, at a community hospital in Iowa City, hundreds of miles from home.” She figured she owed: “Twenty-five dollars a month times how many years equaled a bed in a monitoring floor.”
If the suicide attempt is the dramatic heart of the book, its bill becomes a churning antagonist, a catalyst for describing how Maloney paid off a debt, month by month, for a decade. Ironically, here’s how: She worked for Chicago-area hospitals and drugmakers.
Soon after she began working in an ER, she felt she had finally found her people. She felt at ease. She connected with the work. She was just not very good at it, she laughs.
She told me that she had always had a lot of jobs but she was “never a great employee. Because I work hard and burn out quickly. There are other ways, but I don’t know them.”
In the author bio for her book, it notes that she worked as a pastry chef, dog groomer, general contractor, tile setter and catalog model and sold ceramics at art fairs; if there were more room, it could have added that she also trains horses, and, more relevantly, worked as a medical publications manager for health care agencies, including Deerfield divisions of both the Danish drugmaker Lundbeck and Takeda Pharmaceuticals.
The juiciest material comes from her six months at what she identifies as “a level II trauma center just outside Chicago.” In the book, she never mentions a hospital by name or identifies where she worked; she changed the names of co-workers. She wants the book to read as personal experiences that might have been experienced at any hospital in the country. In conversation, however, she notes that among the places she worked was the emergency room of what was Rush North Shore Medical Center (after an ownership change, it’s now Skokie Hospital). Her duties included administering CPR and running the EKG. Among her side jobs: Studying patient charts and giving an estimate of the care — information then translated into a bill.
I asked her if she was good at this.
No, she was not especially good at this.
But she was observant.
There’s nothing particularly shocking or damning about “Cost of Living,” but rather, it often reads like a kind of prolonged, resigned sigh at the way health care works, at professionals often doing their best with limited resources, at long hours that lead to glazed-over expressions staring down everyday, everyhour, concerns. A child requires staples in his head. (“How much should it cost to put staples in a child’s head?”) There’s the physician who, Maloney describes, “orders too many tests and blood cultures on everybody who might have an infection, which is nearly everybody who comes into the hospital.” There’s the medical equipment sales rep who offers a $50 gift card to any nurse who can save a patient using a new chest-compression device. Everything costs something, and “suicide attempts,” she writes, “were particularly resource dependent.”
There’s a physical cost, a psychiatric cost, physician surcharges, bandages ...
As much as Maloney liked medical environments, she decided during her time at Skokie that she should become a writer. She got into the MFA program at the University of Pittsburgh, where chapters of “Cost of Living” (including the title essay) were developed. She had not expected to be there or writing books. She never made any career plans.
Before it went condo, she grew up in Lake Point Tower, overlooking Navy Pier; then lived in River Forest; then finally, moved to Lake Forest. She describes in the book her family’s fortunes swinging back and forth, from flush to “broke-ish.” They were involved in real estate, but then 2008 happened. She describes her family in the book as loving, hippish, but unconventional, demanding the use of certain toilet paper but missing utility bill payments. Her mother, Cynthia Maloney, who hadn’t yet read the book, told me, “I don’t think Emily had a full understanding of everything that went on back then, but then it also doesn’t matter. Because this is her story — don’t you think she’s great? I mean, she’s a brilliant writer.” She describes her daughter leaving school regularly to take the train into Chicago and visit art museums. She says her Emily rarely fit into easy molds.
One chapter of her book is a kind of taxonomy of every therapist she’s ever seen, beginning when she was a toddler. Another chapter — “A Brief Inventory of My Drugs and Their Retail Price” — is an accounting of the more than two dozen prescriptions she received. “Ultimately,” she told me, “I don’t know if any of them were really a good idea.”
As she describes working in health care companies, as she explains her own health care, you piece together an unsettling portrait, composed of the professional, the threadbare and the arbitrary. She told me about a disaster drill at one job, where fake patients were treated beside actual patients, to illustrate the staff’s flexibility. Which quickly became a sobering illustration of their meager resources. That was a decade before the pandemic.
Again, not shocking, just the cost of living.
Before the suicide attempt she was misdiagnosed with bipolar disorder. Several years after her attempt, she was diagnosed, she said, with “nonverbal learning disability. I learned how to behave, just not until later in life. I talk fast and think slow.” That made sense to her. She was also diagnosed with thyroid problems and a vitamin deficiency. She knows how head-spinning this sounds. In fact, when she thinks back on her suicide attempt — she swallowed a bottle of lithium — she notes if she had been taken to a different hospital, declared indigent, subject to county care, she wouldn’t have had debt.
Indeed, 10 years after she started paying down her medical bills — at $25 a month — she called the collection agency to tell them her bank had been acquired and she had new routing numbers. It was a routine, nuts-and-bolts kind of call. She had new checks printed. The woman who took the call looked at her account and informed her: Actually, this debt is now beyond the statute of limitations. If Maloney stopped paying now, no one would go after the remaining balance and nothing would be reported to a credit agency.
“Have a nice weekend,” the woman said and hung up.
Maloney sat in silence.
No, no, that’s not right, she thought. Someone would call back in a minute to say a mistake was made. But no one ever called. These days, she working on her next book. “Funny thing is, if my bank had never been bought, if I didn’t have new routing numbers, I would still be paying off that suicide attempt, long into the foreseeable future, forever.”
