Oliver Sacks and Spanish Social Security

Para leer este post en Español, haga clic aqui.

A bald man wearing a lanyard slaps a “Donate Blood!” sticker onto my right breast. Headphones in, hands sweaty, and my music turned up, I flash him the “A-OK!” symbol and scurry into the health center. His mouth is moving but all I hear are electric guitars.

I am twenty-five and I have lived with Type 1 Diabetes for seventeen years. Today I am using the national health system in Spain, where I live and work, for the first time. I am more terrified than any human adult should be. I’m afraid that the woman at the front desk will kick me and my American accent out. I’m afraid that, if I am allowed to see a doctor, she will tell me that I must sell my soul in exchange for insulin and test strips.

The front desk woman isn’t pleased to see anyone and she tells me that my inclusion in the national health system is impossible. I’m used to this, though. I have accomplished many impossible things in Spain. So I persist. I push my documents across the desk again. Twenty minutes later, I have a health card and a doctor’s appointment.

My doctor is beautiful. I know this because I have eyes and also because the old man sitting next to me grunts his approval. She calls me in. She thinks that my first name is Elizabeth, which it isn’t, but I don’t correct her. It’s easier to pronounce. I sit down and she says “Dime” –“Tell me.” I tell her what I need. I thank the universe for the fact that I know what I need. She makes me an appointment for bloodwork and writes me referrals for an eye doctor and an endocrinologist. I ask her upwards of three times if these specialists are included in my healthcare “plan” and she says yes every time, obviously unsure as to what I mean when I say “plan.” I’m skeptical. She writes me a prescription for insulin (my out-of-pocket contribution will be two euros) and test strips. She’s skeptical about the number of times I test my sugar a day, so I give a short speech about the proven benefits of tight control. But alas: the health system can’t afford it. That’s fine, I convince myself, because I’ve got some stockpile and time to change the world. I have to return in an hour to pick up my test strips and to speak with a nurse.

My nurse interviews me about my care habits and my last A1C. After a few minutes she reveals that she, too, is a type 1 diabetic. I’m not religious but I want to throw my hands up and yell “Praise the lawd!” We talk about medical technology and about the American health system. She compliments me on my education (thank you, America!) and I compliment her on her country (thanks for letting me live, Spain!) “Isn’t it great” she says, “when we meet each other?” It is. There’s less to explain. There’s an unspoken understanding between scarred fingertips.

I leave with 250 test strips and a fancy new machine. I leave singing love songs to Spain. I return to my apartment and read an economist’s thesis on the sustainability of the Spanish health system. I feel like I’ve just committed robbery and I’m genuinely worried about it. How can this be?  I wonder, and when will the bill collectors show up at my door? I understand conceptually, intellectually how this can be: taxation, the welfare state, a universally accepted belief that government has a responsibility to take care of the people living in its country. But today is the first day I have internalized the fact that, even despite the limitations of universal healthcare, I won’t have to worry about being provided the most basic tools I need to survive. And for today, that is enough.

In Awakenings, the late, great Oliver Sacks writes:

“Common to all worlds of disease is the sense of pressure, coercion, and force; the loss of real spaciousness and freedom and ease; the loss of poise, of infinite readiness”’

Sacks studied and wrote about the human brain, about patients who suffered from disorders that were often debilitating and almost always incurable. Despite the severity of these conditions, he so often touches on this universality of disease that I find myself nodding along saying: “yes, that’s exactly it!” For me disease has always involved, to greater and lesser degrees, a sense that I have lost control over those basic tenets of human life: choice, freedom, readiness. Some days it is almost imperceptible, while others I feel trapped by it. But just as these feelings of loss are common to all worlds of disease, so too tend to be the necessary ones of optimism and acceptance. I try not to view disease as loss or limitation. It’s not productive. Sometimes, however, it takes a gain to recognize something you’d barely recognized as a loss: security. The knowledge that I won’t suffer or go into debt because I have a disease that I neither chose nor caused is one that, in these 17 long years with diabetes, was unfamiliar to me.  It’s a feeling that I can only call, for lack of a better word, priceless.

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