Review: 'Cost of Living: Essays,' by Emily Maloney

America is in the midst of a health care crisis, and it's even worse than you probably think.

Not only are hospitals overwhelmed by COVID-19 patients, but health care workers are walking away from their jobs in alarming numbers. And those lucky enough to find treatment for their illness are often hit with bills they can't afford; Americans are currently in medical debt to the tune of $140 billion.

Emily Maloney understands the country's medical crisis intimately. She's worked as an emergency room technician, but also has extensive experience as a patient — she was treated for mental illness following a suicide attempt, but later found out her sickness didn't have its roots in psychiatry at all.

Maloney writes about her experiences in "Cost of Living," a fascinating new essay collection that considers what it means to give, and receive, care. It's a book that couldn't be more timely.

In the title essay, Maloney writes about acquiring a huge amount of medical debt after a suicide attempt landed her in a hospital. "This debt was the cost of living," she writes. "I couldn't imagine the amount of money I'd spent — the debt I'd incurred — in attempting to end my life. Suicide should be cheaper, I remember thinking."

Only later did she find out that her illness was due to vitamin deficiency, hypothyroidism and a developmental disorder. At that point, she'd been through 26 different prescription medications.

She writes about those medications in "A Brief Inventory of My Drugs and Their Retail Price," a stunning essay that takes the form of a kind of pharmacological litany. There's Zyprexa, $400 a month, which made her feel "like being underwater," and Wellbutrin, $80 a month ("When I stopped taking it, everything showed up bright and harsh and intensely beautiful.") The effect of the list is almost hypnotic; it's a stunning essay that puts into sharp relief the cost of trying to feel better in a country dedicated to capitalism.

There's not an essay in "Cost of Living" that's less than gripping, due in large part to Maloney's exceptional prose. In "In Telemetry," she describes trying to explain her insomnia to a psychiatrist: "Everything felt too bright and brittle. My speech was loud and taut — I had too many syllables and not enough breath to say them." And in "For Pain," she writes about a teenage girl injured in a traffic accident: "The pain, like anything else, was not constant, but close: it chased the edge, lapped at the shore."

Maloney is a careful writer; although her book makes clear what it's like to be both a patient and a caregiver in a medical system that's broken, she never turns didactic. She lets the readers fill in the blanks, asking them to put themselves in the shoes of those whose lives have been upended by illness. This isn't just a thoughtful, compassionate book; it's also an essential one.

Michael Schaub is a member of the board of the National Book Critics Circle. He lives in Texas.

Cost of Living: Essays

By: Emily Maloney.

Publisher: Henry Holt and Co., 240 pages, $27.99.