Cost of Living

Starred review from November 22, 2021
Maloney artfully unpacks the fraught connection between money and health in her brilliant debut collection. She began working as an emergency room technician to pay off medical debt that piled up after a suicide attempt, and with subtle wit and moving vulnerability, she explores how survival is dependent on capital, offering a unique perspective on the American health-care system. In “A Brief Inventory of My Drugs and Their Retail Price,” Maloney decries the cost of the medications prescribed to her for her mental health care: “Why was living so much easier for everyone else?” she laments. “Training Days, or On Experience” details the evangelizing EMT instructor who introduced Maloney to the harshness and patriarchy present in her field, while “Something for the Pain” amounts to a compassionate take on the relationship between chronic pain sufferers and big pharma. As she writes, “I am always suspect of people in pain. Or I was. Or I can be.” Maloney is masterful at beginning in a place of skepticism and ending with empathy, all while weaving in her own fascinating story. Readers will be eager to see where she goes next.

December 1, 2021
Personal essays about the emotional and financial toll of the American health care system. Debut author Maloney is candid about her experiences as both a patient and caregiver. In the title essay, she writes about regretting her suicide attempt, but she's nearly as rueful about how her ignorance led her to seek treatment at a hospital that saddled her with an astronomical bill. Working as an emergency room technician, she's alert to how every pill, shot, and scan adds to a patient's burden. As a medical writer, she learned about pain management, a portion of the industry that pays her outsize fees in a discipline flooded with largesse despite OxyContin's devastating impact. Clearly many things are economically out of whack here. But much like other recent memoirists--Jia Tolentino (Trick Mirror) and Anna Wiener (Uncanny Valley) come to mind--Maloney comes at these injustices not with fury but with a flatness that almost seems determined to avoid feeling at all. This can be effective when Maloney lets the facts do the work, as in her chilling description of her planned overdose: "I normally took 900 milligrams; two pills at 450 milligrams each. So I took all of them instead." And it's clear that abuses by various systems have given her plenty of motivation to put on masks: "I am careful to regulate what I say, how I say it, who I am, who I appear to be." At times, the linguistic flatness reads as disengagement; it's unclear, for instance, what her accounting of the costs of various medications in one essay is meant to say about herself, pharmaceutical pricing, or our tendency to overmedicate. Nonetheless, Maloney's self-awareness is mostly engaging, and her resistance to big emotional gestures is understandable, particularly as a woman socialized "to say yes to everything....I am a string of yesses all the time, yes, yes, yes." Sharp personal essays light on lyricism but potently suffused with disillusionment.

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January 7, 2022

Maloney's debut collection of essays is an intimate view of the United States health care system from her perspective as both a patient and a caregiver. She narrates her personal experiences as a patient in the U.S. mental health system, clearly depicting an aspect of health care that doesn't currently help people in need. Maloney paints a picture of the greed of some health care providers, who she says line their own pockets rather than help people who are in pain; the frequent burnout experienced by workers in high-stress environments; and what she calls the dangerous nature of training hospitals. Maloney's book also gives information about billing, insurance coding, debt collection, hospitals, pharmaceuticals, and mental health providers, in a way that will stimulate conversations about the flaws in the system. Maloney's behind-the-scenes look at health care and how the system works is in equal parts heart-wrenching, humorous, and infuriating; an important work for readers who have experienced health care in the United States or who seek to understand the industry. VERDICT Maloney's nontraditional health care memoir serves as a warning for those who've never had to stay in the hospital stay, and sends the message that there is work to be done.--Leah Fitzgerald

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