More accurately, the finger was still hanging on by some skin and a bit of gristle. This took place in Los Angeles and I went to an emergency room to see about having it reattached. The triage nurse looked me over and asked if I'd done it while punching someone. I told her no, and she said, "Ooh, a finger banging injury!"
I spent a few hours in the waiting room sneaking whiskey and watching a show on Telemundo hosted by dwarves, only to have the attending doctor tell me in short order that I'd need surgery. The best he could do was to pack me full of pills, wrap up my hand in a mess of gauze, and send me on home. He refused to set the bone, claiming it would be pointless.
As I half-consciously endured the six hour drive back home, I wondered the following: Could I ignore this for a while, apply for insurance while claiming to be uninjured, and then go see a doctor? Could I set the bone myself with some pliers and bourbon? Why did the nurse assume this was a sex-related injury?
Back in San Francisco, I called a friend whose wife is a resident at San Francisco General Hospital. She told me about the Healthy SF program and suggested I apply. In an age of denial of coverage due to pre-existing conditions, I was shocked to find out I could get coverage retroactively. My days of lying to doctors were over! I went straight to SF General and began the labyrinthine journey through "socialized" medicine.
Announced by Mayor Newsom in 2006, Healthy San Francisco is touted as the "first-in-the-nation model to provide low-cost health care to all uninsured City residents." And as of the end of January, over 50,000 uninsured city residents were obtaining their medical care through the program.
Depending on your income level you'll be required to pay for treatment, though at greatly reduced rates. For city residents closest to the poverty level, care is fully covered; my own coverage would cost me $20 per month as well as a fee of between $10 and $20 for office visits and $100 for the surgery I'd need.
But first, the bureaucracy! This rivaled any scene from The Trial. There's a sort of absurdist humor that comes with pushing the lowliest among us to even lower points; depths the likes of which had not previously been plumbed. It's pure tragicomedy; demanding copies of tax returns, bank statements, and utility bills from someone with a mangled hand, doped up on illicit pain drugs. But the eligibility requirements must be met, and if all this was necessary in order to get me all patched up, then so be it.
It took two days for me to procure the requisite paperwork and fill out all the forms the city needed, but at least my administrator was patient and accommodating even if I was, at times, barely coherent. Finally, my documents were stamped and I was approved for the program.
On the third day I was given an appointment to see a doctor. With my hand curled in a palsied claw clutched protectively against my chest, I handed in my paperwork and new ID card. I was then told I'd need to take the completed paperwork to another office in order to pay my $20 fee. Once the transaction was completed—through a layer of bulletproof plexiglass—I was to return to the original waiting room, and there I sat with the other folks who had to rely on the good will of San Francisco.
A young couple sat next to me, the man's hand bandaged similarly to mine. We got to talking and I asked what had happened. He told me that part of his finger had been chopped off after a motorcycle accident. He was lucky, though, his girlfriend added, because if they'd been able to save the first knuckle of the finger he wouldn't have been eligible for full coverage.
Sitting across the room from us were a thuggishly dressed young white kid and his staid father. Whenever an attractive woman walked by the kid would smack his lips and mutter "Oh damn, I would wreck that shit!" And each time his father replied, "Seth, you're 15. What are you gonna do?"
Hospital waiting rooms, like buses, give you a view of humanity that manages to cross social lines. No one wants to find themselves in a hospital; all of our circumstances were pained. Over a month's worth of visits to SF General I sat with gunshot wound victims waiting to have their dressings changed. I saw a man in the hallway who kept shitting his pants. I watched a young woman translate a doctor's message to her old, sick mother, who then wept quietly.
A thin man with scabs covering his face and a thick gold chain around his neck told me that the doctor wanted to cut off his finger. "Does it look that bad?" he asked me, holding his grotesquely swollen and bent finger up for my inspection. "They're gonna cut it off!" Another man sat across from me, looking as if he'd been poured into his wheelchair. He just moaned.
When I showed the doctor my finger he ordered x-rays, but immediately predicted surgery. He was similarly unable to do anything at the time, which of course you can't blame him for, especially since my finger had already begun to heal in its new, disturbing angle. I was then to see another administrator in order to be approved for surgery. Then, once approved, I needed to go back to the cashier and pay the $100. My surgery was scheduled for two weeks later.
In the world of non-emergency surgery, an appointment two weeks off is rapid. I've heard stories from British and Canadian friends who, though happy with the care provided by their countries' healthcare programs, lamented the often months-long wait for surgery. By the anecdotal standard of one friend waiting six months for knee surgery, Healthy SF was a model of efficiency.
Two weeks was a godsend, but with my finger hanging precariously off my hand, two further weeks thusly incapacitated wasn't an attractive option. So I went home, convinced I could do myself no further harm, and sat at my kitchen table and drank. After several tall glasses of bourbon I readied my large pliers, took the biggest gulp of booze I could manage, bit down on a wooden dowel, and snapped my finger into a semblance of normalcy. Then I taped it together with my ring finger and passed out.
The next two weeks were a wash of booze and prescription drugs only broken up intermittently by hospital visits to prepare for surgery. It's not that the pain of a crushed finger lasted that long or was so unbearable, it's just that once you get locked into a real bender and a bout of self-pity (No job! Girlfriend gone missing!), the tendency is to keep it going. Some days I bribed my roommate to go buy me cans of soup and a handle of Maker's Mark. On other, better days, I managed to buy groceries. Finally, though, the day of surgery arrived.
I woke up from the anesthesia as if coming up through deep and warm water. My arm was bundled like a giant Q-Tip. My buddy picked me up and set me on my couch with a sandwich, a jug of water, my bottle of pills, and a puke bucket. Two weeks later the cast came off and I was able to see the three jagged pins protruding an inch out of my hand. Oddly enough, they didn't hurt.
Over the next month I visited SF General at least once a week. Some days I'd traipse around to three departments before sitting for an hour to see a doctor. Other days I'd be out in 20 minutes. To be honest, it was no more of a hassle than any other time I'd gone to the doctor or to the ER, even with insurance. Finally, I got used to it. I brought a book and developed a stealthy crush on one of the young doctors who seemed to regard me with a type of curious pity in her eyes.
At the end of the month I finished my physical therapy and never looked back. But I've got a functioning, albeit slightly crooked, finger to remind me of Healthy San Francisco forever.
If you are an uninsured San Francisco resident and are in need of medical care, contact Healthy San Francisco for more information. When applying, it helps to have a few things handy, such as your most recent tax return and a bank statement. You'll also have to meet other eligibility requirements, so the best time to sign up might be now, before you get sick or injured. Trust me, it's a lot easier to navigate enrollment when you're not stressing about gangrene.