Patient narrative: insurance

[From Irish Times >>>] SIGNING ON: It’s one thing to learn to live more frugally – no more second car, no more Sky+ – but quite another to need medical care without insurance

REAPPLYING for interest only; renegotiating the credit-card rate (and realising, as the nation must, that such tinkering around the margins makes no discernible difference); restructuring the credit-union loan; replacing two cars with one; reducing the eldest’s hours to just those provided under the preschool scheme; disposing of the landline, Sky+ and several small dreams.

Switching off everything, including the radio, now that the country has, post-election, acquiesced, formally, to the EU-IMF “deal”. Reading the paper online. Exercising off-peak. Turning up, closing time, Thursdays, at Tesco, for last-minute reductions. Buying two for one. Not buying flowers.

Taking a kitchen stool outside, stepping into the bin with boots on. Jumping. But not for joy.

Waste not, want not. Shop around. Read the expiry date. Cancel. Claw back . . .

Except it’s not enough. So he and his wife set about a further series of cuts. And that is how they make the mistake.


The four-year-old is up in the forest, down on the beach, every other day. Her skin glows. They cancel their private health insurance for Dad (off smokes, off alcohol, daily in the gym and therefore technically healthy) and her, maintaining it for Mum and baby only. Then, one day, he asks his daughter to listen to the wind, whispering. Realises she is deaf to anything other than conversation. (He suspected something was awry – “fey” instead of “face”, “how” instead of “house”. No problems detected in early developmental tests. But he’d still been concerned enough to ask at creche. “Nothin’ to worry about,” they’d said. Bit of a dreamer is all. Could be just a Dublin accent developing.

Worry diminishes the ability to detect vital detail. Too busy with bills, bank statements.


The GP writes a referral to Temple Street Children’s University Hospital. A letter arrives some weeks later, telling them there may – in other words, there most definitely will – be a waiting period of 18-24 months. By which time their daughter will have started primary. And her slow descent.


They know enough not to rely on the HSE. They’ll go private, somehow. He puts his motorbike up for sale on Donedeal and in the meantime heads into the mountains every chance he gets.


In the audiology clinic in Cabra his daughter attempts, unsuccessfully, to play with a boy who has one of those high voices deaf kids often possess. His parents are pale. No attempt at conversation. The nun in charge is old, exhausted. Trying to retire for years. Beneath her almost taciturn reserve he perceives a caring, committed woman. She compliments him on his daughter’s manners. A surge of pride. (What was it Jackie Onassis said? “If you bungle raising your children, I don’t think whatever else you do well matters very much.”)

The nun informs him that, although she is not formally qualified, her diagnosis is that the child is significantly, if not profoundly, deaf.


The consultant is courteous, even charming. Their daughter has 50 per cent hearing loss in one ear, 55 per cent in the other. She’ll require surgery to insert grommets in the inner ear. He recommends she avoid swimming (no problem, as the family’s gym membership is long since cancelled) and flying (chance would be a fine thing), at least for six months afterwards. They discuss details of their insurance, then the fact that they are out of work, that the policy, though reinstated recently, was cancelled. He promises to do what he can. They hand €150 to the receptionist, trying to smile.

In the car the child sleeps while the grown-ups remain church-quiet, anxious.


He can’t be dealing with them, their robotic f****** responses. His wife is less likely to scream down the phone. The insurers argue that their daughter’s is a pre-existing condition, that as they cancelled her policy before they visited their GP – the point of origin, as they perceive it, for her condition – she is not covered. Sorry. He rings the consultant. The calm in the man’s voice. (I used to be like that, at work, and beyond, thinks the unemployed man. I remember it. Vaguely.)


The consultant goes to bat on their behalf. He is not put on hold, nor made to suffer Muzak. He questions, quietly, the right of the insurance adjuster to his expert opinion: has he studied paediatric medicine? The child’s condition was not a pre-existing one. She had, at the time the policy was cancelled, the time at which she was examined by her GP – who, for the record, is also not an expert – a simple build-up of wax. The insurer baulks at this. The consultant reminds the insurer that he has both private and public lists, that it is well within his remit to advise those on the public lists to consider going private because of the excessive waiting periods. The insurer backs off. This is how the system works. Find someone with influence to fight your corner. Or sink to the bottom. With the rest of the dregs.


The operation is a success. They’re back in the forest.

– “What’s the wind whispering, Dad?”

– “Em, it says, ‘Not to worry, everything’ll be okay.’ ”

– “No, Dad, it says, ‘You’re a silly-head. An’ you can’t catch me. . .’ ’’


Her laughter lifts him up and out of himself, reminding him, forcibly, who he is supposed to be. (Leastways in front of his kids.)


He writes a thank-you note to the nun. Buys a decent bottle of claret, puts a fiver in the car, drives to the consultant’s. Just because he has been forgotten it doesn’t mean he should let slide his manners, his upbringing.

The man he used to be.

The writer of this piece wishes to remain anonymous. His identity is known to the Editor


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