By Jenny Fine
On the morning of July 6, 2022, I called my mother to check in. She stopped me mid-sentence with, “Jennifer, we have other things to talk about right now. Beth passed away in her sleep last night.” I hung up the phone and told my 92-year-old grandmother, who I live with as a caregiver. As these words – “Beth’s dead” – left my lips, she collapsed onto the softness of her brown velvet floral loveseat. “My Beth?!” she exclaimed, looking up at me. I nodded yes. My sister had died. For the first time in my life, I saw Granny cry.
Rushing out the door, I remembered just two years earlier when I got a similar call. In May 2020, Gerald, Beth’s husband, died of a massive heart attack while driving to work. It was a Saturday morning. He left in a hurry and forgot his wallet. It wasn’t until that evening that Beth got the news from my aunt, whose hand-me-down truck Gerald had been driving. I slept next to my sister for two weeks following her husband’s death. It was the first time in 35 years our bodies lay together in sleep’s tenderness and vulnerability. But Beth didn’t sleep.
Two months after Gerald died, Beth lost her full-time job and she started losing weight. Three months later, she learned that the rental house she and her three boys lived in would no longer be a rental property. They would have to move. The trauma of these multiple and sudden events changed Beth, who was traditionally highly organized. Our family stepped up to help pack for the move. She found a new job that paid $13 an hour with no benefits other than her boss’ generous discount on the rent. She found a new home, literally and figuratively, at work. Though we moved the boxes into her new rental property, Beth never unpacked them.
Since Gerald’s death, Beth had been exhausted. If she wasn’t working or feeding her boys, she was sleeping. I’m not fully clear on when Beth sought medical help, but I know that she called me three times during the last year of her life to say that she had made an appointment with a primary care physician. Each time during the scheduling call, Beth’s Medicaid insurance would be preapproved, and the appointment was scheduled. As a new patient, the wait was often long, sometimes months, and each time, the day before the appointment, the doctor’s office would call to check Beth in and collect her insurance information for payment. Each time, Beth provided the office with the same preapproved Medicaid insurance information. Contrary to her initial call, she was told that their office didn’t take Medicaid and that her appointment was immediately canceled. None of the offices offered her direction on who takes Medicaid or where to go for help before hanging up.
Beth’s skin clung to her bones. She kept working to survive, but without help, her body was slowly wasting away. She wasn’t able to eat or drink without getting sick. She told me that everything tasted rotten. At an ER visit a week before she died, the doctors sent her home and told her to schedule an appointment with her primary care physician.
On July 5, 2022, a day before she passed away, Beth went to work. She spent her last day between tasks with her head on her desk. When she left for the day, she told her boss, “I’m going home, feeding my boys, and putting myself to bed.” At 3:00 a.m. the next morning, Bryce, her middle son, heard her throw up in the bathroom – a sound he said was more and more common to hear coming from her room at night.
When I entered her bedroom after receiving word of her death, I found my sister on her side, her back toward me. I collapsed onto the bed beside her, looking at her face. Her eyes were closed, her mouth slightly open. Her arms were outstretched embracing Gerald’s pillow. Her feet were crossed at the ankle.
The coroner leaned back on Beth’s dresser, arms crossed, studying all that remained of Beth lying on the mattress. “Well, looks like pancreatic cancer to me. See, that photo of the woman in the license is not the same woman here. I tell you, my sister-in-law is right up there in the hospital, right now, fighting pancreatic cancer.”
Looking at Beth again, he said, “She doesn’t appear to have suffered.” Bryce, 15 years old, said, “Well, she suffered for the last eight months.” Pausing, the coroner continued, “I’m just gonna be honest with you, The State of Alabama doesn’t care about your sister. We don’t care why she died. If you want to know the cause you are welcome to pay for an autopsy. They are about $10,000 and I know a guy in Birmingham. Let me go get his card.” The coroner left the room.
After Beth had been lifted from her sleeping spot, placed on the gurney, and wheeled away, we sat silently in that awful house. Meanwhile, Kaleb, Beth’s oldest son, boarded a plane in South Korea, preparing to return home after finishing his first deployment in the Army. Beth was scheduled to pick him up from the airport that evening.
Two years after my sister’s death, the question that I have lived with every day is, what happened to her? Beth was a hardworking, tax-paying Alabamian. How could Alabama not provide the most basic access to healthcare to help a tax-paying citizen? How do we reconcile as a society, as a state, as a people that the barrier standing between poor Alabama and healthcare isn’t a stranger, isn’t an enemy from across the ocean but one of our own, an elected official?
Healthcare is so often made into a political issue when the reality of it is a matter of life and death. Alabama’s current governor, Kay Ivey, continues to refuse federal tax dollars that will pay 90% of the total cost of expanding Medicaid in Alabama. Kay Ivey refuses to allocate Alabama state tax dollars to make up the 10% of the remaining cost of Medicaid expansion. However, this does not stop Alabama taxpayers from paying for Medicaid expansion—Alabama federal tax dollars fund Medicaid expansion in other states, just not in Alabama.
The program has paid for itself in three years in states that have expanded Medicaid. Rerouting patients from emergency care facilities to general practitioners for long-term preventative healthcare will alleviate the chronic disease that overwhelms the healthcare system.
As a state with a large faith community, how do we live with the onus of abandoning ‘the least of these’ in our community? Providing healthcare for all Alabamians would strengthen our workforce and be an affordable and simple investment in dignity and respect for all citizens. We rely on these vulnerable and valuable members of our society to build and repair our homes and refill our sweet tea mid-meal at the local restaurant. All bodies are worthy of dignity. All bodies require care. As Alabama continues to close rural hospitals across the state, the gaps in healthcare are becoming everyone’s problem. Kay Ivey, Governor of Alabama, holds the power to change our healthcare system. Yet, she refuses to accept allocated federal Medicaid funding while misappropriating federal COVID money to build private prisons.
The state of Alabama has had more deaths than births in 2020, 2021, 2022 and is on track for the same record in 2023. As a cancer survivor, Governor Ivey must know the life-saving importance of access to healthcare. Poor Alabamians who fall into the Medicaid coverage gap are left to believe we are not worthy of preventative medical care. If this isn’t true, why won’t Governor Ivey accept the federal money to provide healthcare to more than 174,000 uninsured Alabamians? What is keeping Governor Ivey from leaving a legacy of life-giving healthcare for all of Alabama?
To quote Alabama Arise, a statewide organization focused on advancing public policies to improve the lives of Alabamians who are marginalized by poverty: “Medicaid expansion would save lives and create jobs. It would extend health coverage to more than 340,000 Alabamians. It would boost our workforce. It would stabilize our state’s rural hospitals. It would address the prison crisis by strengthening community mental health and substance abuse treatment services. And it would pump hundreds of millions of dollars into the economy every year. It’s a bargain Alabama can’t afford to pass up.”
Beth Fine was an adored wife, a loving grandmother, a tender mother, a dear sister with a hilarious spirit and a sassy approach to life. She deserved help, she deserved care, and she deserved to die with dignity. Our healthcare system is failing us.
Beth’s middle child, Bryce, turned 19 years old in August 2023; he has now entered the Medicaid coverage gap. This cycle cannot continue.
If you fall within the Medicaid coverage gap or are a concerned citizen, you can act to have your voice heard. Get involved in the Alabama Arise campaign to expand Medicaid, or write or call the governor directly.
Jenny Fine is a visual artist living and working in New Brockton, Alabama. She currently teaches as an online adjunct professor in the Department of Visual Arts and Art History at Florida Atlantic University and is the primary caretaker for her 93-year-old grandmother and disabled father. Based in the photographic form, Fine’s practice attempts to “reverse the camera’s crop” by returning space, time, and animation to the latent image of memory. Through a cross-disciplinary collaborative approach, Fine creates images and environments inspired by her rural southern landscape and her family’s stories. Visit www.jennyfine.com to view more of her art practice.
Banner image: “sync/swim, no. 2,” performance still, Alabama School of Fine Arts Dance Department in collaboration with the immersive installation, 2022, by Jenny Fine.
