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A letter from central coast, California, USA 4 May 2020

Lisa Kalayji

The pharmacy department is a fair way down the length of the enormous store – past the pet food, greeting cards, stationary, and toiletries, across from an olfactory sea of scented candles and shelves full of colourful coffee mugs that say things like ‘Mondays don’t like me either’ and ‘good day for a vaycay’. I dodge to and fro on the way there in a vain attempt to keep two metres distant from each person in an obstactle course of nervous pensioners, small gaggles of giggling teenagers, and weary parents with carts full of Legos and craft supplies.

I stand on the floor sticker designating an appropriate distance from the other patrons until I’m called forward. I recognise the person behind the cash register – I worked at the Starbucks kiosk at the front of the store during the winter holidays, just after I arrived back in the US, and she often came there on her breaks. She doesn’t seem to recognise me as the former peppermint mocha jockey (or maybe she just can’t see enough of my face under the surgical mask currently digging crevices into my lower eyelids), and even if she had, she seems too tired to make small talk. She wears a lanyard with a clear plastic pocket hung from it, but instead of a photo ID, it contains a card inscribed with a single word in large, boldface print: ‘IMMUNOCOMPROMISED’. I pay a merciful $15 for a generic antibiotic and make my way out, slowing to glance around the eerily vacant, unlit café by the door as I leave.

Symptoms of the infection don’t abate until I take the last day’s tablets, and a week after picking up the medication, I’m curled up in a ball on the living room sofa and back on the phone with the clinic. I’ll have to come in person this time, they say. Now as before, the appointment will cost somewhere between $130 and $400, but they couldn’t risk hazarding a guess. If my one-time $1,200 stimulus payment from the federal government had arrived even a couple of weeks later than it did, I’d be staying at home with cranberry concentrate supplements and hoping not to develop a kidney infection that would eventually become septic shock. After hanging up, I complain bitterly to my housemates, fondly remembering the kidney stone surgery in Scotland for which I paid nothing and indulging in a brief diatribe about the merits of nationalised healthcare to an audience that needs no persuading before reaching for my keys.

I arrive at the clinic to find a nurse standing outside querying people at the door.

‘Hi!’, she chimes brightly. ‘What’s your issue today?’

‘I’m here for a follow-up appointment about a persistent UTI’, I explain.

‘No other issues going on? No fever or cough or anything like that?’, she asks, an almost apologetic ‘I have to ask this question’ nested in her vocal inflection.

‘No’, I respond, smiling knowingly and shaking my head.

‘Ok, just have to check. Sorry for the violation of your privacy.’

She hates this. She holds the door open for me as I thank her and step into a near-empty reception room.

I sit down to fill out some paperwork and wait my turn. As I tick symptom boxes, a TV mounted high on the wall opposite the reception desk emits the familiar vocal drone of a news broadcast: ‘Nearly 47,000 now dead in the US from the Coronavirus, and the numbers are climbing’. The woman sat opposite me breathes heavily into her polka-dotted fabric face mask.

I’m taken through to be tested for signs of infection before seeing the same nurse practitioner I had met a week earlier through a screen. She refers me to a local lab for tests, but prescribes a different antibiotic to try until the results arrive. I pay the $170 consultation fee – a bit more than last week’s ‘telemedicine’ appointment – and then later, $17 for tests at the nearby lab and $15 for the second generic antibiotic.

There is a letter in the postbox when I get home. I ‘may qualify’ for a state-funded healthcare programme for low-income residents. The local social services office ‘may contact’ me. The letter doesn’t specify when, but the online application mentioned something about 45 days. In the meantime, any existing insurance policy must continue to be paid for, and steep tax fines will be levied against anyone who remains uninsured. Laying the letter aside, I pick up my phone to check what’s been happening back home (‘back home’ meant California when I was in the UK – now it’s the other way round). The death toll amongst medical practitioners continues to climb. The NHS, which still lacks adequate personal protective equipment for staff, is now funded in part by private citizens’ warm and fuzzy fundraisers – sort of like the Go Fund Me campaigns Americans use to pay medical bills, except cuter. Britons are still expressing their support by clapping for the NHS.

Five days later, I’m back on the sofa and trying to sit up without using any of my abdominal muscles. To my very great relief, the nurse practitioner makes good on her promise and prescribes a third antibiotic without requiring me to attend and pay for another consultation. The lab results came back, so hopefully this more specifically targeted drug will work.

Back ‘home’, Boris Johnson has returned to work after having recovered from his own bout of COVID-19. He urges Britons to hold their peace while the consequences of many years of funding cuts to the NHS, a dystopian ‘herd immunity’ response to the virus, and weeks too late, the implementation of a shelter in place policy play out. The news headlines prominently feature his name: have you heard that he and his partner have just had a baby?

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