Some people go into denial. It has nothing to do with having or not having insurance. Of course she knew something was seriously wrong. And as I haven't read the book, I cannot tell you what the author was saying through the story, but in the film, I always got the feeling that she knew what was wrong with her, and didn't want to face the fact of it. She probably remembered that her mother was the same age she was in the film when she started not feeling well, and also knew that she was likely dying.
And dumb or not, it was her choice. And considering that once she did land in the hospital, the doctors confirmed that there was really nothing they could do, because there is/was no cure for her illness because it is/was so rare, it really didn't matter when she finally went in for "help." The results were the same. She was dying, end of story.
Of course, there is always the remote possibility that she didn't know or suspect anything was seriously wrong with her. She was exhausted, yes, but she was also raising a young child by herself. She may have thought that exhaustion just came with the "job" of parenting.
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