COST OF LIVING

Personal essays about the emotional and financial toll of the American health care system.

Debut author Maloney is candid about her experiences as both a patient and caregiver. In the title essay, she writes about regretting her suicide attempt, but she’s nearly as rueful about how her ignorance led her to seek treatment at a hospital that saddled her with an astronomical bill. Working as an emergency room technician, she’s alert to how every pill, shot, and scan adds to a patient’s burden. As a medical writer, she learned about pain management, a portion of the industry that pays her outsize fees in a discipline flooded with largesse despite OxyContin’s devastating impact. Clearly many things are economically out of whack here. But much like other recent memoirists—Jia Tolentino (Trick Mirror) and Anna Wiener (Uncanny Valley) come to mind—Maloney comes at these injustices not with fury but with a flatness that almost seems determined to avoid feeling at all. This can be effective when Maloney lets the facts do the work, as in her chilling description of her planned overdose: “I normally took 900 milligrams; two pills at 450 milligrams each. So I took all of them instead.” And it’s clear that abuses by various systems have given her plenty of motivation to put on masks: “I am careful to regulate what I say, how I say it, who I am, who I appear to be.” At times, the linguistic flatness reads as disengagement; it’s unclear, for instance, what her accounting of the costs of various medications in one essay is meant to say about herself, pharmaceutical pricing, or our tendency to overmedicate. Nonetheless, Maloney’s self-awareness is mostly engaging, and her resistance to big emotional gestures is understandable, particularly as a woman socialized “to say yes to everything….I am a string of yesses all the time, yes, yes, yes.”

Sharp personal essays light on lyricism but potently suffused with disillusionment.