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nostalgic

The Nail
I wasn't familiar with the Christmas fairy tale of the American suburbs back then. We had arrived two weeks earlier, and after drab, gray Moscow of 1990, this little town North of Boston seemed like Disneyland.

Alternating hopping on one leg with limping on two, and wincing with pain, I still found the energy to look at the glowing snowmen and the generous garlands of colorful lights hanging off the roofs and trees. I marveled at the reindeer, pulling bright sleighs with blown-up Santas, the lit-up Nativity scenes, and even the rare menorahs in otherwise dark windows. The Christmas lights distracted from the pain, at least somewhat, and spared my husband the exasperating question, "Are we there yet?"

A brisk walk from our house to the nearest hospital would take at least half an hour on healthy legs, but on one leg and a promise it was at least an hour-long trudge.

What a silly ailment to have - an ingrown toenail. Could this get any more ridiculous? My toenails had nestled deep in my toes for as long as I could remember, and had grown right into the flesh since my early childhood. As a little girl, I learned to cut them out of there with the upmost care. Pick up the tip with some not-too-sharp-but-pointy tool, hold it there, and cut. Then hop around, pain free, for another two-three weeks, and repeat. I never had a problem with those toenails until about a week after coming to the US.

Maybe I hadn't washed the tools well, or had cut too deep, but the toe had swollen to about twice its size. At first, it was red, but then turned blue, and the pain went from annoying to "it's killing me" in a matter of days. Walking was torture. I kept waiting for the pain to go away. One day, two days, five days ... it wasn't getting any better. My husband and mother-in-law began to worry in earnest and insisted I visit a doctor.

What doctor? We were refugees and had just received our Medicaid cards, but didn't know what to do with them. After a couple of phone calls, I found out two things. One: the doctors who treat feet are called podiatrists here. Two: the country was in recession, and the health care funding had been cut. Medicaid no longer covered podiatrists. We didn't have any money.

I panicked and called my friends in Brighton, MA, to ask for advice. "Go to the closest ER," they said, "but in the evening, when the doctors' offices are closed. Tell them your pain is intolerable and you need urgent care. They'll do something, and Medicaid will pay for it."

Great advice, except Brighton is a part of Boston, and has trains and buses galore, as well as a few hospitals here and there. We, on the other hand, were in Medford, and the only bus that stopped anywhere near our house went in the opposite direction from the closest hospital. People drive around that town in their own cars--you can't live in the suburbs and not have a car. We would have a car, of course, we sure would, in another few months, but at the moment....

At the moment, howling and limping, I finally stumbled into the ER, elated to find warmth, not to mention a couch. It was approximately 8:30 in the evening.

The receptionist looked at me a bit strangely. An ingrown toenail? Medicaid? Have a seat. She didn't have to ask me twice. It was heaven--to sit down, lift the inflamed leg up, and rest the other one, tired from doing the double duty. My husband dropped on the couch next to me, exhausted. For most of the trip, I hung on to him for dear life. We tried not to think about going back home. In any case, I'd leave this place "fixed"--cured. Nothing else mattered. We melted into the warm cushions.

I didn't know at the time that Emergency Rooms often serve as sewers of the American Healthcare system. It's the last refuge of the poor who don't have health insurance and can't afford to go to a doctor. ER's of the major city hospitals can't or won't charge them, so off they go, en masse, to the nearest hospital, with any and all problems ranging from ear infections to gonorrhea. The city hospitals are long used to it--their ER waiting rooms are filled to the capacity almost every day, especially after dark.

Medford, however, is not part of the city. It's a middle-class town, filled with colonials, new cars, lit up snowmen, and manicured lawns. All faces in the ER that evening were white, prim, and ... different. I was an obvious outsider. I didn't care--it was warm, I had my couch, and the overhead TV set was showing something about the Soviet Union. Back then, I could only understand English if someone talked directly to me, preferably slowly, but comprehending an average CNN report was still out of the question. Fortunately, CNN repeated the same things over, and over, and over again. Watching CNN for hours turned out to be the best method of learning English. Whatever I didn't get at first became clear after several repetitions.

It only took four almost-identical news flashes to realize that Gorbachev had reshuffled his cabinet once again, and Shevardnadze was no longer the Minister of Foreign Affairs. He left for his home country of Georgia (where he would be President for many years to come). Did I get that right? If not, I hoped to understand it better when CNN returned to the topic.

They did come back to it, again and again. I was beginning to hear and comprehend every word, separately. The clock showed 10 p.m., then 11 p.m. People came and went; even those who arrived an hour or two after me were long gone.

After about three hours, we approached the receptionist again and politely inquired how long we still had to wait. She looked me over, head to toe, and said, "Well, you've probably been waiting enough. They'll call you soon." I understood every word, but didn't get the meaning.

"What did she mean by 'enough'?" I asked my husband when we returned to the couch.

"I don't know." He shrugged. "Maybe if you have chest pains, ten minutes is enough, but for an ingrown toenail it's three hours."

"But the place is empty! There's no one else in the waiting room. In all the time we've been here, I saw three or four patients, and they've been gone for at least an hour."

"How am I supposed to know? She said 'enough'...."

They called me in another thirty minutes. The nurse, who immediately reminded me of Ratched from "One Flew Over the Cuckoo's Nest," took my vital signs and left. I sat on the hospital bed for another hour. When a doctor finally showed up, it was well past midnight. The doctor took my toe between his thumb and forefinger and looked at it for about 30 seconds with an almost squeamish expression on his face.

"You have an inflammation of tissues around your nail, but there's no gangrene. You've no business being in an Emergency Room. Go home and see a podiatrist first thing in the morning."

"But ... I can't go home." I felt my heart jump to my throat. "I walked here. I barely made it. I can't go back."

"You have no business being in an Emergency Room," he repeated slowly as if I were deaf or dumb. "There is no 'emergency' here. It's something a podiatrist should address--a doctor who specializes in foot problems."

"I can't! I won't! I am not leaving!" I squealed. "I have Medicaid, and they don't cover podiatrists. I don't have a car; I can't walk. I was told you'd fix my toe. I won't leave. I won't go!"

I stopped to catch my breath. The expression on the doctor's well-groomed face turned from irritated to disgusted. The nurse's face reflected nothing but horror. I didn't give a damn--I wasn't leaving until they helped me.

"I will cut your toenail now, but please remember not to go to the ER with problems like this," the doctor said icily.

He left, but returned a few minutes later with a tray of instruments and a filled syringe. He took the syringe and plunged the needle into my toe, barely looking where or how he did it. I shrieked. After making me wait for that shot for over four hours, the doctor paused for less than ten minutes before proceeding to cut my nail--the anesthesia barely worked. I tried not to look at my foot and not to cry. Instead, I looked at my husband, at the nurse, at the doctor.... The expression of disgust never left his face. He took something that looked like huge pliers and quickly hacked half of my toenail. I couldn't help but scream. He then put some ointment on my wound, hastily dressed it, and got up.

"Don't come here again."

The door slammed shut.

By the time I hopped home, it was half past two. The anesthesia wore off and the foot was throbbing with pain. Swelling would subside a few days later, revealing a permanently mangled toe. The nail never "ingrew" at the tip again--it attacked my skin with its entire length, digging into the tender flesh on the left side. I had to cut it from the nail bed upward, lest it grew sideways and made walking all but impossible. It was hard to do this by myself, and the already-disfigured toe was now often inflamed. It would be years before I could afford a podiatrist.

However, that night I didn't know any of it. I dropped on the mattress--we didn't have a sofa--in front of our TV and turned it on. One of the public channels was showing Gone with the Wind. The foot hurt like crazy; we didn't have any medicine; we didn't have money to buy any medicine. I couldn't sleep anyway, so I started watching the movie. On the screen, starving Vivien Leigh was rabidly stuffing herself with food. Sated, but deeply unsatisfied with what and how she ate, she stood up, dirty and humiliated, and shook her fists at the skies. "I will never be hungry again!"