A social worker's sickest patient

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.