On bodies, borders, and the price of care that never appears on a bill

I have a complicated body. I always have.

Autoimmune thyroid disease. Gastroparesis. Celiac. PCOS. Neurodivergent. Most of it present from birth. Most of it diagnosed before I was twenty-five.

I’m in my 40s now. Which means I’ve spent nearly two decades navigating the U.S. medical system with a body that doesn’t follow simple rules, in places that often prefer simple answers.

I had eight pregnancies in ten years. Four healthy children. And somewhere in between, a medical system that often treated my suffering as an inconvenience to be explained away, passed along, or quietly dismissed. Rather than a problem worth solving.

Now, I’m not completely naïve about why. I see the layers. Some of it is being female. Some of it is the long history of under-research on bodies with uteri. Some of it is being in the southern United States. And some of it is simply that not every doctor enjoys complicated problems.

At twelve, cramps that made me cry and bleeding that lasted months were called normal. I was taught to ignore my body and intuition. Someone with a clipboard would decide whether it was normal enough to treat. And that was the end of the conversation.

After my second child was born in Texas, I couldn’t climb stairs. A single step sent sharp pain shooting between my legs. It took months of arguing with my insurance company before anyone acknowledged that pelvic floor dysfunction, exacerbated by a hairline fracture in my pelvis from childbirth, was a legitimate medical problem.

Three months of physical therapy. Twice a week. Baby in a car seat beside the table. Twenty dollar copays each visit. On top of a family premium that cost more than some people’s rent.

After my third child, I ended up in an emergency room because of the amount of blood coming from hemorrhoids. Two hundred dollar ER copay. On top of the monthly premium. On top of the exhaustion of coordinating care between providers who didn’t speak to each other, of chasing records, of filling out the same forms in different rooms of the same building.

Someone asked me if it was cheaper to die in Texas. At first I thought the comment odd, but my brain quickly understood. Because honestly the math was plain. $35 a month for a $250,000 life-insurance policy on myself in Texas. $1,900 a month for family health coverage that still left me bleeding in waiting rooms; feeling too sick to be ignored, but never quite sick enough to be helped.

Every ER visit carried the same quiet message:

You probably shouldn’t be here.

Even when my doctor told me that was exactly where I needed to go.

Then we moved to Canada.

Now, I want to be careful here, because I’m not interested in writing a simple before-and-after story. Canada has wait times. Canada has gaps. I still don’t have all my answers. Bodies in their 40s, especially complicated ones, rarely come with clean explanations. And anyone promising you that idea; one switch, one pill, no trade-offs… well they’re selling something.

But something happened when I walked into a Canadian emergency room.

I wasn’t feeling well. I didn’t know why. And I carried that familiar dread that anyone with a complicated medical history learns to carry. The quiet calculation: Is this serious enough? Should I just go home?

I handed over my OHIP card at the front desk.

Fifteen minutes later, triage. My blood pressure was high enough that they ran an EKG. Normal. Thirty minutes later, I was registered.

I was labelled low priority, but not dismissible. Three hours later, a room. A nurse. Blood work. Two hours after that, a doctor who never once suggested I was overreacting. He assessed me. Treated my immediate symptoms. Told me he’d pass everything along to my GP.

When I walked out, I realized something strange. I wasn’t more stressed than when I went in. Sure, I didn’t have answers. But I didn’t feel anxious, dismissed, or like I was taking up space either.

I also didn’t have a bill forming in the back of my mind. I didn’t have records I’d have to chase down myself. I also didn’t feel processed through a system.

What I felt was simple: seen.

I picked up my thyroid medication recently. Synthroid, name brand. The generic doesn’t work for some of us, a known, documented issue. In Texas: $120 every three months. Here, without private insurance, at Costco, that same 90 day supply, including the dispensing fee: $16.71.

I’m not here to argue that the Canadian system is perfect. What I’m trying to explain is what friction costs.

It costs the energy you needed to heal. It costs money that could have gone somewhere else. It costs hours spent on hold, filling out forms, filing appeals, explaining your body to people who have already decided how the story ends. It creates the quiet background hum of dread that follows you into every waiting room, every appointment, every bill.

In the American system, I eventually realized, friction isn’t a side effect it is a feature. It’s the mechanism by which care is rationed in favour of profits, without anyone having to say that out loud.

When I left that Canadian ER, I wasn’t relieved because I was healthy. I still don’t know what’s happening in my body. But now I have a name for tears and exhaustion: friction. I also now know what the absence of friction feels like.

It’s a new feeling, this system, however imperfect, trying to be on my side. And the old feeling, I had not realized how much I’d been bracing for impact in every medical situation, until I finally stopped.