Photo by Jasna Bogdanovska

Staff reader Megan Howell talks with Angelique Stevens about systemic inequities, her memoir-in-progress, and the lived experiences that inspired her essay “Care Credit” from NER 43.3.

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Megan Howell: Two prominent motifs in your essay are teeth and cockroaches. At first, they seem diametrically opposed: you’re able to escape the roach-infested houses of your youth while continuing to deal with dental issues. However, you also hunt for roaches as an adult. Reflecting on your childhood, you write, “I don’t know what made me think that just moving from one place to the next would alter [my family’s and my] situation, but that was my first lesson on the nature of change. In my child’s way, I learned that evolution is layered and multifaceted and takes years to actualize.”

Do you think that any part of you, physical or mental, has managed to escape the effects of childhood poverty? 

Angelique Stevens: Yes and no.

Yes. Last night, I came back in from walking the dog; and from my backyard, the moon rose under a gorgeous velvet blue sky outlining beautifully my modest early century mint-green four-square; and I thought how lucky I am to own this city house with a fenced-in yard and three floors and a kitchen that needs upgrading and a furnace as old as me. It’s astounding to me that all of this is mine considering where I came from. In many ways I have indeed left poverty far behind. I turned 52 this year. I’m healthy. I’m a full professor at a community college considering retirement in a few years. I have travelled all over the world. I am an extraordinarily grateful and highly privileged member of the middle class in the United States and of a small percentage of people worldwide who can not only sustain their lives but do other things like travel, take time off to write a book, spend two months in South Sudan.

No. And there’s not enough room for this answer, because when you start to peel back the layers of poverty in this country, you realize that those effects run very deep. When I wrote that line about the nature of change, that “life doesn’t just flip like a quarter when the situation improves…,” I understood that to be not just representative of my own life but also of the ways in which our country processes change. The quarter flips, the situation improves, but so much remains the same. So much of our American ideals are dependent on this “bootstrap” ideology, that people, like me, who “make it out” are pegged as an example of a meritocracy at work: those who work hard and make good choices can single-handedly change their lives. But so much of that philosophy disregards the overwhelming systemic inequities that contribute to poverty, those embedded in our healthcare industry, our educational institutions, our governmental policies, federal housing regulations, our prison industrial complex, and most importantly in our history: one rooted in genocide, slavery, and white supremacy.

A few months before my sister died of a suicide overdose, she told me that she had been picked up for marijuana, said she wasn’t going back to jail no matter what. I believe it contributed to her final spiral into deep depression and psychosis. None of us knew growing up that marijuana had been decriminalized in New York since the 70’s, yet Gina had gone to jail for it and none of us had the money to pay the fine. And now I see that the people who suffered the most from this are disproportionately poor and black and brown. I saw the news yesterday that Biden flipped a quarter, pardoned everyone convicted of marijuana possession under federal law, and it completely destroyed me. I was on the floor heaving sobs. Those are the kind of effects that I’ll continue to live with and in until I die.

MH: What made you decide to name this piece “Care Credit”? Why not “Roaches”? Or “Teeth”? Or “Teeth and Roaches”? 

AS: I love this question and mostly because I didn’t come up with the title. I had been calling it my cockroaches and cavities essay for a long time and considered just naming it cockroaches and cavities. I originally named it “Formations” because of the nature of change I’m trying to highlight here. Then it became “Patterns” because of the ways in which we repeat patterns in our own lives and down through generations and in our larger history. Then someone suggested “Care Credit” and I thought that was the best fit because it takes the focus off the individual and puts it on the health care system, on economics, on the larger ideas this essay is speaking to. But there’s also the irony in the use of “care” in the title as if this industry is more about care than profit.

MH: One thing that I noticed in both your essay and in life is that the body is the closest thing we have to natural, objective truth. We can’t argue our way out of illness or death. Insurance, however, is completely made-up, though our political system often treats it as natural and thus inalterable. How do you process this distinction when both your teeth and lack of good insurance have done so much real damage to you? Does it matter? 

AS: Except for the few years I was in foster care, I didn’t have health insurance growing up and right up into my thirties. There’s a scene in my memoir in progress where I was hospitalized with a broken femur after a car accident. I was around eight and my parents didn’t have insurance either, but hospitals can’t refuse treatment to people with medical emergencies. On the morning they were supposed to set my leg by drilling a screw through my thigh, they gave me anesthesia; but, because of another hospital emergency, the doctor didn’t get to me before I woke up in the late afternoon. They did the surgery anyway with me wide awake. They injected a local anesthesia above my knee. A little while later, a bevy of nurses trailed the doctor into my room, each to hold one of my limbs while he drilled a seven-inch screw through my knee. The sight of that drill going through my leg and the pressure and blood and skin horrified me. I resisted them with every fiber of my being, but my tiny body was no match for them I screamed and wiggled and finally reached over and bit one of the nurse’s hands as hard as I could. Later, I was admonished for my actions.

I don’t imagine this kind of thing happens normally and I don’t imagine it happens for people with means. These kinds of stories are everywhere but you hear them mostly from marginalized bodies who, too often, experience the inequities of our health care system in violent and inhumane ways. Add to that the lack of insurance and those inhumanities are compounded, because we’re essentially saying to our people, that only those with means deserve good health care.

MH: You also challenge the idea that the body, teeth specifically, can tell a person’s whole life-story. You show how deft medicine is at revealing the traumas of poverty (e.g. lack of healthcare, unhealthy eating habits) while ignoring the personhood of its victims. Of your day-to-day life as a student and daughter, you state, “I wonder how that […] would conflict with the evidence of poverty plaguing my mouth in the form of missing teeth and cavities” (58). 

To what do you attribute medicine’s blind-spots towards your experiences? Classism? Racism? The indifference of the natural world and decay?

AS: I’ve been obsessed with being healthy lately, listening to podcasts, reading journal articles, following longevity doctors and scientists on the socials. I’ve mostly cut out sugar, refined carbs, and alcohol from my diet. I drink a shake full of greens and protein and collagen every day, I prioritize more time outdoors, less time doing menial things. Each week I strength train three times and try to cycle a hundred miles. For a long time, I believed that this is all part of the natural aging process, of reaching and passing that half century mark, of wanting to live a long and healthy life. I’ve learned that many of the diseases most likely to kill us, like atherosclerotic disease, neurodegenerative diseases, and foundational diseases like insulin resistance and type two diabetes are preventable. Not surprisingly many of those diseases are especially common for those without access to healthcare and preventative education; specifically black and brown people and those in poverty.

But lately, because I’m knee deep in finishing my memoir about my sister’s suicide overdose, I’ve come to realize that my obsession is deeply rooted in survivor’s guilt. It has more to do with the loss of my entire family than with the aging process. They all died prematurely and violently from these types of diseases. It wasn’t just our teeth, our lives were riddled with health issues like diabetes, which is so common in Natives, heart disease, asthma, arthritis. Add to that, lifelong mental health issues and addiction and the problem is compounded exponentially. Layer over that the systemic racism, classism, the perceptions of poverty so deeply embedded in our country’s psyche, and the stranglehold both insurance companies and the pharmaceutical industry has on doctors. After a while, it becomes extremely hard to pinpoint any specific reason for the blind spots embedded in the whole structure of health care.

MH: Our culture has recently taken up the cause of mental-health awareness. When discussing our mental-health crisis, well-funded campaigns and lauded write-ups often skirt around class. (“Inside the Adolescent Mental Health Crisis” from The Times is one example that comes to mind. Zero mention of childhood poverty.) In a way, powerful interests (e.g., billionaires, think tanks, etc.) are trying to escape inequality like so many poor people, beating back its widespread consequences (i.e., more depressed kids) while failing to address it directly. Only, they have the resources to eradicate poverty entirely. 

Do you think that their class-related shame is similar to yours growing up? Or does their power make it different? 

AS: Power changes everything.

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