Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A social worker’s sickest patient

Raymond Abbott
Conditions
July 16, 2020
12 Shares
Share
Tweet
Share

Mary is a woman of sixty years.  She is obese.  Originally from rural Alabama, she told me her aunt and uncle raised her, and they were bootleggers, making their own liquor.  By age fifteen, she was drinking this homemade hooch.   She never told me how she made her way to New York and New Jersey, where her kids now live, and where she once had a husband.  She is unsure of what became of him.  She has a son in Texas, in the military, a career soldier.

Of all the persons I work within this case manager’s job, Mary is by far the sickest.  Her psychiatric illness does not appear to be her major problem, although she is on something called Clozaril, a powerful medicine that requires very careful monitoring and frequent labs.  She has significant heart and lung disease.   Allergies exist, perhaps asthma as well.  Sinus problems of a serious nature are evident.  She has liver disease, kidney disease, and she had one breast removed fifteen years ago.  She is diabetic and has circulatory problems galore, and foot problems which necessitate specially-made and fitted shoes because of massive swelling in her feet.  She has arm and wrist problems of an undefined nature, back trouble, arthritis everywhere, a blood disease which she is unable to name for me, and it goes on from there.  I marvel some days that she is alive.  She lives almost across the street from University Hospital.  She has to be transported everywhere she goes.  Often I am the person who takes her places, which sometimes is as much as three times a week.  Then I pick her up when she is through.  When I am not transporting her, she has a home aide who comes in and helps her clean her apartment   In addition, there are visiting nurses, one psychiatric, one medical, who see Mary in her home every week.  Her support system, built up over years, is like nothing I have ever seen.  It is complex and very expensive.

Her housing is subsidized.  She pays $154 per month to live in a project next to the hospital.  It is not a great place, no great digs, but the location is convenient for her.  I have worked as a social worker in projects in other cities where living is very unsafe. But where Mary lives, I regularly go to all the floors of the three sixteen-floor buildings in the complex.

But things happen, and recently something frightening happened to Mary.  She was robbed by a man who pushed his way into her apartment when she opened the door to put out a bag of trash.  He shoved her down on her bed and stole $37.  He did not rape her, but threatened to return and do her considerable harm if she went to the authorities, and so she did not.    This happened on a Saturday, and on Monday morning, she told me and said she had not been to the police.  I encouraged her to report the crime and took her that morning to the housing offices where she told her story to the housing police.  They brought in the city police.

Mary was so traumatized, so afraid to be alone in her apartment, that she decided to move out of the project, indeed, out of the city.  She planned to move to New Jersey or Texas. I talked to Mary about moving but encourage her to stay in the city.

“No, no,” she says. “I am going to live with one of my children, in New Jersey, probably.” I remind Mary of all the medical support services she requires and how hard a place like New Jersey might be to connect up with similar levels of assistance (not to mention the time it will take).

“My son, he lives just down the street from the hospital,” she says.

“Yes, but are your children willing to take you to all these places you require?” I think I know the answer because I have had some dealings — some history — with the New Jersey crowd.  But Mary assures me that they will do what is expected of them.

When first I took this job and was given Mary as a client, she presented me (more than once) with phone bills in excess of $300, mostly collect calls and third-party calls charged to Mary’s number from, you guessed it, these same New Jersey relatives. Mary’s income is from something called Supplementary Security Income, SSI, and in Kentucky, it is $545 per month. We are what is called her “payee,” which means we handle her money, pay bills, give her cash each week for food, and so on.   When you start out with a $300 a month telephone bill and add $154 rent, there isn’t a lot left over for food and other necessities.

When I heard of her travel plans, I said to Mary, “Why not go to New Jersey (or Texas), stay a few weeks, see how you like it, and then make a decision?  We can keep everything on hold here,”

“Nothing doing,” she replied.  She was leaving right away, as soon as physically possible.  I tried several times to get her to slow down.  Once she leaves the state of Kentucky, her Medicaid card is pretty much worthless. This means no way to refill prescriptions.

She has $300 in her account.  I get a check ready for her because she plans to travel on the weekend, to Texas.

I have no knowledge or experience with the Texas relatives, her son.  He is in the military at Ft. Hood, Texas, that’s all I know.  Before Mary leaves town in this big rush, I receive a phone call from her sister.  She gives me hell because I refused to release the $300 in Mary’s account. I explain I had yet to hear from the Texas relative, not even a phone call.  Finally, Mary’s son calls. He says he wants his mother in Texas with him.  I explain, as best I can, briefly, his mother’s considerable medical requirements. I release the $300.00 check, and then Mary is gone, moved off to Texas.  I never get a follow-up.

Raymond Abbott is a social worker and novelist.

Image credit: Shutterstock.com 

Prev

COVID-19 through the eyes of my kids

July 16, 2020 Kevin 0
…
Next

The unseen debt of the pandemic

July 16, 2020 Kevin 0
…

Tagged as: Diabetes, Psychiatry

Post navigation

< Previous Post
COVID-19 through the eyes of my kids
Next Post >
The unseen debt of the pandemic

More by Raymond Abbott

  • Proud dental school patient shows off a rare gold foil filling

    Raymond Abbott
  • The teacher who changed my life through reading

    Raymond Abbott
  • The regret of leaving an old friend behind

    Raymond Abbott

Related Posts

  • Why social media may be causing real emotional harm

    Edwin Leap, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • How I used social media to get promoted to professor

    David R. Stukus, MD
  • How social media leads to a loss of creativity

    Edwin Leap, MD
  • Are patients using social media to attack physicians?

    David R. Stukus, MD

More in Conditions

  • COVID-19 unleashed an ongoing crisis of delirium in hospitals

    Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD
  • Emergency care nightmare: the urgent need for experienced nurses

    Rachel Basham, RN, CCRN
  • Debating the role of psychiatric assessments in medical decisions

    Christian Youssef & Francisco M. Torres, MD
  • 5 things to know about weight from a bariatric surgeon

    Maria Iliakova, MD
  • Physician autonomy and patient interactions in corporate health care

    Michele Luckenbaugh
  • Vague criteria can lead to misdiagnosis and prison

    L. Joseph Parker, MD
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Report: Persistence of Gender Inequalities in Cancer Care, and a Call to Action
  • Cancer Risk in NAFLD Higher With Early Disease Onset
  • FDA Displeased With Companies Purposely Adding Sesame to More Foods
  • COVID Vax Appointment Cancelled? New Shot Rollout Faces Challenges
  • Medical Residents Receive 100+ Job Offer Contacts, Survey Shows

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...