Deferred Maintenance

By Enjoli Hall

How and why I made healthcare my top priority in my first semester

Twenty-nine. The number of visits I made to a doctor’s office during my first semester as a PhD student. In any given week, my Google calendar was a fall-themed collage of classes, advising meetings, on-campus events, and doctor’s visits. Scheduling my doctor’s appointments was akin to a research assistantship—I mapped the locations of Black female primary care physicians. I analyzed what combination of dental procedures I could afford with my insurance benefits. I reviewed literature on the antidepressants recommended by a counselor. I wrote reports detailing my medical history on intake forms. I presented my life story to the six therapists I was forced to meet with in order to evaluate my request for an emotional support animal in university housing. While I couldn’t add these lines to my CV, perhaps I could add a few years to my life.

Some of the appointments I scheduled might be considered “routine” check-ups: annual eye exam, seasonal flu shot, pap smear. But many of the appointments were for managing chronic pain and depression. Sometimes, these appointments were not planned, such as impromptu visits to the urgent care clinic on campus for frequent headaches or toothaches. What nearly all of these appointments have in common is that they were the result of deferred maintenance. In my field of urban planning, the term deferred maintenance is often used to describe the practice of postponing maintenance and repairs on essential infrastructure to save money, balance budgets, or reallocate resources to address more immediate needs. For example, a landlord might postpone fixing leaky pipes in an apartment to save money in the short term. Or a local government might delay replacement of lead pipes in its city’s water system due to budget shortfalls. The cumulative effects of deferred maintenance can be catastrophic—an apartment building that could have been rehabbed now needs to be demolished; a city’s population is poisoned by its water supply with lasting public health problems.

Prior to starting grad school, I deferred diagnostic tests, annual exams, small procedures, and mental health therapy for years. I was a first-generation, low-income college graduate barely making ends meet in an industry and city that people don’t choose to make money. While I am adept at understanding the functions of macro social systems such as racism and the economy, I often struggle to navigate individual institutions and bureaucracies to get my needs met. I could not afford the co-pays, the time off from work, or the transportation to get to doctor’s visits of all sorts. Sometimes I tried to schedule appointments, but would get discouraged when the closest doctor was located over an hour away, open during limited hours, not accepting new patients, or did not take my insurance. These challenges are common when you live in a poor, low-density region serviced by an inadequate public transit network. Or when you grow up in a community that discounts mental illness as laziness or a bad attitude: “You don’t need a doctor, you need discipline. Your problems will go away when you get a better job or a boyfriend.

I internalized my mental anguish as of my own making and normalized my physical discomfort as a fact of daily life. In effect, I deferred maintenance on the mental and physical systems that sustain my well-being. As a result, what were cavities became root canals. The situational depression I developed in college spiralled into clinical depression—a mighty vortex that seemed to grow more intense with each post-grad job, relationship, and life event. And what might have been managed with months of counseling sessions, probably requires several years of regular therapy. At times, it is very difficult to reconcile the access I’ve had to some of the most elite universities in the world with the barriers I’ve faced to accessing basic medical services. I don’t know how to describe the feeling of sitting in a class and knowing your lived experience is the outlying data point of educational success, the case example of why we need multifaceted definitions of “access” that consider affordability, availability, and awareness in addition to physical distance. When your GRE score is in the 99th percentile, and so is your cholesterol level.

I am sharing my story not because I think it is unique, but because I suspect it is quite common in some ways. Despite increasing awareness of the academic, financial, and sociocultural challenges experienced by minority, low-income and first-generation students, I have observed a persistent stigma and silence around health issues. I understand the disincentives and potential penalties that students—especially marginalized students—may encounter in sharing these stories. Or even just saying to someone “I have depression.” Our position in these programs is often marked by precarity and presumed incompetence. We’re constantly expected to prove our basic capabilities to handle the rigors of advanced research to our peers and professors. Our admission was not enough; at best it was a professional courtesy, at worst it was a statistical accounting. We should be so grateful. Talking about mental or physical illness—how it alters the way we process information, the way we move through space, the way we structure our schedule—carries tremendous risk in a profession that rewards intellectual acuity and constant productivity.

Grad school is hard. But for someone like me, it means improved access to care such as on-campus, free and subsidized providers, health screenings, and wellness services that I could not obtain for the last several years. The services are not comprehensive and my stipend is not enough, but it is more healthcare and more income than I’ve had for years. So, I am making my health my top priority. I cannot afford to defer maintenance of my mental and physical health any longer. Because the grim reality is, if I do not attend to these issues now, I might not survive to the end of my PhD program. I know this is only the very beginning of months and years of chronic pain, frequent appointments, and unforeseen consequences, but I am grateful for the opportunity to repair. My pain might not be my fault, but I am responsible for my healing.


Enjoli Hall is a PhD student in the Department of Urban Studies and Planning at the Massachusetts Institute of Technology (MIT). Enjoli’s research is focused on racism, social inequality, and urban policy, and the impact of these forces on local government planning, policy, and finance. Her work focuses on cities and counties facing chronic poverty related to deindustrialization. Enjoli’s research draws on over five years of experience working with non-profits, foundations, and research centers in her hometown of Buffalo, New York. She has worked in a variety of roles in community development, ranging from adult literacy tutor to youth advocate to program officer to regional planner.

 

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