Warning: This piece contains This is Us spoilers and discussion of major plot points.
Fans of the (now dearly departed) series This is Us are notoriously perceptive and observant, carefully scrutinizing each scene for Easter eggs and studying every detail for potential clues and hidden meanings.
But there was one important thing that many people may not have noticed—involving some events that were shown onscreen and, perhaps more importantly, certain aspects that were never addressed or explored at all.
The question I couldn’t help but ask myself: How different would Rebecca Pearson’s journey have been if she and her family were poor?
The sad reality in this country is that your socioeconomic status and financial resources have a major impact in controlling what (if any) medical care or end-of-life support you can receive, and in determining your quality of life should you become sick or disabled.
As viewers of the show know, Rebecca Pearson (played by Mandy Moore) certainly experienced significant challenges throughout her adult life, but financial worries didn’t seem to be one of them. That made a big difference in the way she lived with Alzheimer’s, and the way she ultimately dies from it.
I should note that, while I had to stop watching the show about midway through its run, for reasons I explain below, I think the series is far and away one of the best things on TV in years. Everyone involved (particularly the supremely talented writers and cast) deserves all the accolades and awards they’ve earned.
My intention here is not to criticize the show in any way, but rather to point out that financial hardships, specifically those that affect access to health care and end-of-life care, are something that many people don’t even think about, unless it is something you have lived through.
In the context of the This is Us universe, it may have been difficult, if not impossible, to find a way to depict the financial struggles many families experience in trying to get medical care, elder care, or hospice support, given that at least two of Rebecca’s children seemed to be wealthy enough to cover all of the expenses involved with her care.
But ongoing awareness and discussion of the economic inequality involved in these situations is important, so I’m hoping to shed some light here on how drastically differently this storyline might have played out if Rebecca was part of a low-income, working-class, or even middle-class family.
My mother, who died from COVID-19 in February, had Lewy body dementia and Parkinson’s disease, and some of her most distressing symptoms were similar to those experienced by people with Alzheimer’s disease. I haven’t been able to muster the mental strength to get through full episodes of This is Us for the past couple of seasons, but have seen scenes and snippets online. I’ve watched Rebecca Pearson struggle with symptoms that are painfully familiar. But that’s not the most agonizing part. What hurts most is recognizing the crucial differences.
Note: While I haven’t watched full episodes of the last few seasons, I have seen (and read) enough to be aware of the major plot points and developments, and also consulted several friends who faithfully watched every episode, so I think I have a reasonably good grasp of what unfolded onscreen.
My mother lived in poverty her entire life. Whereas Rebecca seemed to have the best care money can buy, my mother often couldn’t find medical providers who accepted Medicare and/or Medicaid, and didn’t have money for copays and other out-of-pocket expenses. She was one of those senior citizens you read about who ration their medications and often forgo important treatments or procedures because they cannot afford them.
My siblings and I would of course do anything we could to help our mother, but two of my siblings are disabled and the rest of us are struggling to pay for our own medical care, so when she was living on her own, she often hid these things from us, not wanting to “burden” us with her problems.
Whereas Rebecca had lost and outlived two wonderful husbands, my mother had two abusive ones who, I believe, may have contributed to her physical and mental decline.
Even during the years that Rebecca spent as a single/widowed mother, she doesn’t seem to have had any financial worries. Early in the series, there’s a scene in which Jack and Miguel discuss life insurance, so I’m guessing it is presumed that Jack’s life insurance proceeds covered the family’s expenses for an extended period after his death.
As Rebecca’s Alzheimer’s disease progressed and arrangements were being made for her care, there seemed to be little (if any) thought or discussion as to how she would pay for any of it. She is able to be transported cross-country several times, has the best medical care and plentiful private nursing support, and, once she reaches the point of being unable to live on her own, has a choice of several terrific options for housing and living arrangements.
Even the fact that she is able to die in the comfortable surroundings of her own choosing—and that her children and grandchildren were able to make the trip to be at her bedside or attend her funeral—is a luxury many people do not have. If you are unlucky enough to die poor, you often have little or no say in how you spend your final days and moments.
Rebecca died under what many people would consider the best possible scenario: at home, in no apparent physical pain, with her children by her side. My mother died alone in a storage room, following a period of intense suffering while receiving no pain medications at all.
My mother lived with the debilitating symptoms and physically and mentally grueling toll of her diseases for years, and her journey took a vastly different path from what viewers saw Rebecca experience. We live in a high-poverty, rural area and health-care resources are limited, especially if you don’t have money. For many years, our town had no neurologist at all, and the nearest one was more than 30 minutes away. Despite the fact that both her Parkinson’s and dementia had seriously progressed by that point, my mother was told she would probably spend close to a year on a waiting list before she could even be seen for an initial appointment.
Even once my mother contracted COVID early this year and was in an urgent, critical state, we were repeatedly reminded by hospital staff and administrators about the costs involved all along the way, and on numerous occasions we faced demands for upfront payment for services that weren’t covered. (Shockingly, this included things like the ambulance transport to take her from one facility to another while she was unconscious and incapacitated, and could not be transported by car).
She died in a nursing home storage room, having never actually received any hospice care because the staff had been unable to find any hospice services that would accept her as a patient in time.
I am hoping that by illustrating some of the key differences in how this storyline might have played out if the characters’ financial circumstances and access to resources were different, I might prompt some discussion about these issues. Even better, I’d love to see dialogue about possible solutions to help us provide better care and support for our sick, elderly, and disabled.
Everyone deserves adequate medical care and a dignified death. Nobody deserves the horrible ordeal my mother endured in her final days. It’s true that most families don’t have a rich TV star or wealthy financial trader turned potential Senator in their mix, so trying to replicate Rebecca’s access to care is unrealistic. But while not everyone has the means to afford gold-standard care, every citizen should be able to at least, at bare minimum, get treatment focused on compassion and keeping them free of pain and suffering.
We should all be ashamed, collectively as a country, that so many of our loved ones are much more likely to experience something like my mother’s ordeal than anything remotely close to the journey of Rebecca Pearson.
We should—and must—do better.
