This patient is more than just a street person

When I first landed this job as a case manager (social worker), I was given Robert R. as a client. He was at his worst then, soiling himself virtually every day, with no change of clothing available. I remember him wearing a piece of colored cloth around his waist, which served as a belt.

When he would come in in such a condition, sometimes even tracking in feces on his shoes, people (including my supervisor) would say to me, “Do something!”

What? I wondered what I could do with him.

At first, I did little. And then I took money from his account — we are his payee, and we handle clients’ money. And I went on my own to Kmart and bought him underwear, trousers, shirts, socks and, yes, a belt. I stored them under my desk.

When he came in soiled, I handed him a change of clothing and made him go put them on in the bathroom and told him to ditch his underwear (if he wore any, and I had my doubts), but bring his shirt and trousers to me.

Everybody thought I was nuts to do this, but I took those shirts and trousers home with me — never the underwear — and washed them.

So that at all times, I had changes of clothing on hand, and I was prepared for him at his worst.

Still, it was no way to live, either for Robert or me, and I was looking for a solution.

I noticed in the case record that Robert had been scheduled for a colonoscopy to determine just what his problem was.

Somehow that never got done.

Actually, it was scheduled only once, with Robert expected to check himself into the hospital on a Sunday, the day before the procedure. Well, he got to the hospital all right, but he went to the emergency room and told them he had problems with his butt. He was examined and sent home.

I had the name of someone I thought was pretty good when it came to that particular procedure. I learned this doctor, one David Jutz, also accepted Medicaid.

So I got Robert an appointment to see Dr. Jutz, the colon specialist. Of course, the day I took Robert in to see Dr. Jutz, Robert hadn’t cleaned up much, if at all, in way of preparation.

I all but beg him to do so, but he doesn’t.

With Robert out of earshot, I said to the doctor, “Sorry, he is not cleaned up. He is more or less a street person.” The doctor simply grimaced, indicating to me that he has seen this sort of thing before.

After a rectal exam, which I decline to witness, even though invited in by Dr. Jutz — the doctor informs Robert and me that there is an ulcer, a “fissure,” I think he calls it, in the lower colon, and that it needs to heal — but it isn’t healing for some reason; maybe because of Robert’s diet. So he wants Robert to take two FiberCon capsules each day, and that should deal with the problem. Dr. Jutz sounds confident in his optimism. It sounds a bit too simple to me, but I go along, of course.

Robert needs to take the medicine in the evening before bedtime, the doctor says, and I know right away this plan will become a problem because Robert cannot be trusted to take medicine regularly. Why is that? I don’t know why. Soon enough, I discover Robert is not taking the FiberCon at night, or anytime.

I learn this when I observe him opening the bag he carries around with him, kind of a gym bag, and there, on top of some clothing, are several unopened packages of FiberCon.

So to get him to comply, I arrange that he take the FiberCon at midday when he takes his psychotropic meds. The taking of meds daily for Robert is always observed by a nurse.

I contact Dr. Jutz to tell him of the change, this taking of the FiberCon at midday.

“That’s a lot better than not at all,” he tells me by way of an assistant. So that becomes the plan.

Gradually the FiberCon works — or so it seems. Instead of coming in every day loaded down with poop in his drawers, it decreases in frequency to every other day, and then after a time, it seems no longer to be a problem. I ask Robert how things are going, and he says, “Much, much better.”

It is pretty miraculous when you think about it. And so simple a solution, too.

Robert is more than 60 years old, caucasian, with a craggy, wrinkled, sun-damaged face; he has coarse facial features and wears a beard. His graying hair is thick and in need of a haircut; at the same time, it is very dirty and greasy. I suspect he does not willingly wash his hair. His beard is likewise dirty and long.

I believe he is of German ancestry. He has a large family in the city, many brothers and sisters, but they stay away, although one brother, so Robert tells me, comes around a couple of times a year.

Robert has a wife and two daughters someplace in Canada, whom he has not seen since he left them, many years ago. Both girls are nearly grown.

He remembers their names and where they last lived, but expresses no interest in making contact. I tell him one day that with computers and the like, he could easily locate them if he chooses, but he has no such interest. I do not pursue the subject. Some things are better left undisturbed.

I believe he said, in those years, he was a full-blown alcoholic, but now he does not drink at all and hasn’t for many years.

I am sometimes surprised by such revelations because Robert is truly a street person, living in shelters and flophouses or wherever he might land. In such a milieu, alcohol often plays a major role. It did for him, but something made him stop, and he has completely stopped.

I know when I’ve had to transport him to Dr. Jutz’s office, I am direct with him.

“You can’t shit in my car, so take care of it before we go!” He would always promise not to foul my car, and he never did. Still, others I work with think I am crazy to transport him at all. But I believe he has more control of his bowels than he lets on. And it appears I am right, too. But that is all I am right about because soon after that, Robert is found dead one morning in bed.

The cause of death was never determined. Well, maybe it was, but I was never provided with a follow-up.

Raymond Abbott is a social worker and novelist.

Image credit: Shutterstock.com 

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