Ever since I finished reading Emily Maloney’s essay collection Cost of Living, I haven’t been able to stop thinking about the first time that I noticed the financial burden of living and dying. I believe for me it was when I was fairly young, shortly after my uncle passed away by suicide and I watched my parents help plan the funeral—which of course included the discussion of how our family would pay for it. It’s a strange feeling to grieve while also calculating the price of saying goodbye to a loved one. This is the power of Maloney’s debut, as she highlights not only how internal suffering can become external trauma, but also how capitalism monetizes both, and places a price tag on our very lives.
Cost of Living explores the author’s long history with the American health-care system, both as a patient and a caregiver. Maloney was hospitalized at nineteen after attempting suicide, leading to years of doctors visits and new medications that put her into deep medical debt. In an effort to pay off this debt, she became an emergency room technician, where she would learn firsthand how hospitals often balance patient care and cost-cutting measures. Subsequent essays follow Maloney through other jobs across the medical world, including her time in a paramedic training program and later as an employee at a pharmaceutical company leading trade show efforts.
Maloney writes about her own mental health treatment throughout her life with a careful remove, stripping away many elements of feeling and emotion to instead focus on the physical. It’s an effective move, as some of the most gripping and wrenching descriptions are those that show readers how the various medications she took steal her sleep, the enamel of her teeth, and more. Other times the speaker presents largely as an observer, watching as patients arrive, tests and treatments are performed, and bills accrue. Readers may find that they want to see a bit more of Maloney in some of the later essays that begin to blend reportage with personal narrative, but her sharp insights and dry wit toward the absurd system she finds herself in surely makes up for it.
Ultimately, Maloney creates a remarkably holistic and nuanced portrayal of what it means to pursue help in a system that seeks to make us indebted and dependent. In one of the collection’s standout pieces, “A Brief Inventory of My Drugs and Their Retail Price,” she writes in a bulleted format about her life through the lens of what prescription medications she was taking at the time and what it has cost her—both physically and financially. Beginning with Zoloft, which her doctor at the time believed would “keep the ghosts at bay” as it did for her father, the essay unravels into a gauntlet of side effects and staggering payments, from the drug that was like “licking a car battery,” to the one with a cash price of $1,289.64 monthly. But it is the final and “most constant” prescription, Lithium, that puts the full scope of the collection on display:
“It cost me the enamel on the backs of my front teeth, my body’s ability to regulate its weight, friends, and apartment, years of opportunities, the possibility to drink, the prospect of spontaneity in anything I did, and ultimately, my thyroid. $19 a month on Drugs.com.”
It’s easy to imagine that in the hands of another writer, Cost of Living would focus only on the author’s health journey or their experience as an emergency room technician, but Maloney manages to show us much more. In fact, across the collection the author tackles a wide number of topics, such as her therapist inappropriately testing different treatments on her, the relationship between pain and addiction, and the people that make the decisions and the profits. Healthcare is both the most personal experience and the most dauntingly and infuriatingly impersonal, and Maloney puts both realities into clear view.
Cost of Living is an early entry on my list of most memorable reads in 2022, and it’s sure to be a collection readers will want to hold onto, return to, and dwell on for years to come. It prompted me to reflect on my own care in the past and what it cost me, as well as question where the fault truly lies. Is it with the doctor who treats their patient like a guinea pig with new drugs or schedules tests that will cost a fortune? The administrator who prioritizes the hospital over the patient? The insurance companies that hold our debt like a weapon? Or the drug companies that hold the treatment and the purse strings?
Of course, everyone is implicated, and fault probably lies at least partly at everyone’s feet. After all, the system is functioning as designed. Because in America, it’s often not a question of whether you can find someone to set your broken bone or diagnose your fungal infection or prescribe you the drug that will—as the ads promise—cure your most trying afflictions and heal your suffering. It’s a question of how much it’s worth to you, how much of yourself you’re willing to give or lose.
Cost of Living
by Emily Maloney
Henry Holt & Co.
Published February 8th, 2022
Michael Welch is a daily editor for the Chicago Review of Books. His work has appeared or is forthcoming in Prairie Schooner, Kenyon Review Online, Iron Horse Literary Review, North American Review, and elsewhere. Find him at www.michaelbwelch.com and @MBWwelch.