Story from 4/13/10

I only had one patient today, but I stayed very busy. On Tuesdays, Alissa is at the front desk by herself, and so I often go help her. Today's crisis was Bobbi, who works in Administration, needing a copy of the limited-english translation policy (or how we officially deal with people who cannot speak English) for Terry Reilly. She contacted Alissa and I at 8:55am saying that she urgently needed it by 9:30am for a meeting, and had heard it was left at the Boise clinic. Rummaging as quickly as I possibly could through 3 huge binders I found in the clinic, I called her back at 9:21am saying I could not find any policy of the sort. As we both sat on the phone dejected at the news, Stacey, one of the MA's, came in and said, "Have you checked the Intranet?" And volla, there it was on the front page of the corporate web site, in a very visible spot in the top left corner! Wow, disaster averted. Ha.

Baby we were born to run!

Will you walk with me out on the wire
`cause baby Im just a scared and lonely rider
But I gotta find out how it feels
I want to know if love is wild,
girl I want to know if love is real...

We gotta get out while we're young
`cause tramps like us, baby we were born to run!



- Born to Run, 1975 - Bruce Springsteen

This song, which many music buffs say was a turning point in young Springsteen's aspiring career, hits deep-seated chords of the American dream. Love, possibility, risk, and aspiration. It tells a story of Springsteen's feelings as a youth, trying to escape Asbury Park, New Jersey, and hoping to make it big. How entrenched is this idea in the American psyche? The land of opportunity, right? The place of big risks and big rewards; a thriving country where individuals have the freedom to follow their dreams. All you have to do is work hard enough and anything can be yours in this town.

Yet, my job this year has been to work with those who might disagree with some of the themes resonating through ol' Bruce's track. Those who have tried to improve their lives, exhausted their options, and have gotten nowhere. I'm talking about the people in our society who have to apply for Social Security Disability. These people--Cliff, Elizabeth, Gary, Paul, just to name a few--most certainly had the same aspirations as you, me, or even a young Bruce, but they somehow got derailed on their train outta town. What happened? Does anyone know? Does anyone even care?

My patient at 10:30am wanted to apply for disability. She was a typical patient in many ways, which I feel I can authoritatively say since I'm closing in on 150 clients I've helped with the disability process. One unusually positive distinction is that she showed up 35 minutes early for her appointment! This woman means business! Disability business! :-)

She comes in and tells me she "had applied in October but her case was put on hold until January by the judge to gather more information and she hasn't heard about it since." I'm going to assume that you do not have enough knowledge of the disability program to process what she said. Well trust me, none of it made any sense. I've worked with disability long enough to conclude that she has absolutely no idea what she's talking about, which is the case more often than not with the patients I see.

So I began my standard protocol of calling Jeanne T., the SS public-affairs specialist for Boise and an incredible contact I've made this year. She has helped me through so many jams. In friendly conversation with her, I find out that my patient last applied in June 2009, when her case was denied because she started working, and she had never appealed it. No "judge". No "gathering of more information". No "applying in October". I've become a modern-day Sherlock Holmes deciphering fact from fiction with many of my patients. The next step for this patient, according to Jeanne, is to re-apply and note a reason for why she was working in 2009.

I hang up the phone and with a cordial smile begin asking questions.

"Social security has on file that you were working in 2009 and that is why you're case was dismissed. What can you tell me about that?"

The truth, unfortunately, proves to be tough to hear and difficult to process. Yes, she was working in the Fall of 2009. She had left the SHIP program about 6 months earlier (a transitional house for drug abusers), and was down on her luck. No job, no family, and no connections in the area, she was hired by an advocacy group to be a "protester" in front of the capital building for the Carpenter's Union. Her job was to hold a 2 pound sign and walk in circles for $12.50/hr. Although the work was easy and the pay very respectable, she was fired for not being able to be on her feet and walk for 6-8 straight hours. This patient has a history of seizures and uncontrollable diabetes, with notes of very poor circulation in her legs from several ER reports in 2008 and 2009. And this job, standing with a sign in her hand protesting for who knows what, is what disqualified her for disability.

Another similarity between this case and my others is her very sparse medical history, primarily due to finances and access. She was recommended to physical therapy for pain in both knees 3 years ago, but could not afford the $100/hr to pay the therapist and did not have insurance. So no physical therapy. Now her knee seems to be worse than ever. Her diabetes, as the science is now very well known, resulted from years and years of mismanagement of her body. I wasn't able to ask or delve into this issue, but I feel I can attempt to put the pieces together. Probably grew up in a very poor family, no healthy eating options, no emphasis on exercise, no motivation to stay healthy. She's now between 35 and 50 years old, but her medical chart, lab tests, and medication lists seem to tell another story about presumed aging.

And I've failed to mention her untreated wrist injury (she can't grasp anything with her right wrist anymore), major depression (who imagines being between 35 and 50 and having no one to turn to?), and PTSD (when she was young, she was repeatedly sexually molested by her step-father and was raped in 1998). Tragically, disgustingly, that-can't-be-true-ly, I have heard all of these things before with patients.

At one point in our conversation, she began uncontrollably crying. I've learned to keep a fresh box of Kleenex right next to my patients, as crying is often a typical response to the re-telling of the life experiences my patients go through. I've experienced this scene so many times over the last 9 months that all I could do was sit there, allowing her to mull over her situation, and look her in the eyes, not saying a word, and try to simply be present with her in her pain.

Yet, there's always two sides to a story. Always. She's been in jail twice in the past five years for drug charges, and I believe her addiction started when she was very young. This was a choice that she made, although an influenced-by-peers-and-surroundings-choice, a choice. Who knows what other secrets she might be keeping from me in the hopes of gaining my sympathy? The possible bad decisions, abandoning her kids or marriage, illegal actions, failure to develop a work ethic, quitting on a job. I'm not concluding that she did any of these things, but I'm also not naive enough to recognize that this could possibly be the case.

She also played the role of victim more than anyone I had seen in the last 30 days. "I went to my doctor for a physical yesterday and she told me that I could not work ever again. I can never work ever again," she explains.

Really? Because I've seen hundreds of case files since August and even more face-to-face interactions with patients, and I've NEVER, EVER heard a doctor tell someone between 35 and 50 years old that she could "never ever work again'. Especially this woman. I believe she's in pain, but this is not the worst disability case I've seen. I think this woman can work. She was just working 6 months ago and earned enough to disqualify her for disablity!

So I ask, "Well, what do you think about that? Do you really believe that you can't ever work? That you can't even work as a cashier, or work at Wal-Mart, or do anything else?" I try to push, but not too far.

"I could never be a cashier because I can't handle money or stand for 8 hours. I could not work at Wal-Mart because they wouldn't hire someone like me".

And here....comes the excuses. Like a sudden downpour of rain on an unexpected Spring afternoon. More and more they come. In 30 seconds, there is no longer any reason for me to even suggest any more working options. She obviously has it in her head that working is for some people, but not for her.

And here lies the paradox. The problem might be the right word (I knew I should have been an English major!). So many people look down on those applying for disability for the interaction that just occurred between the patient and me. The logic goes, "If you give someone the option not to work, he/she will find a rational why working is not for them, and start collecting checks and watching day-time TV for the rest of their lives." After the conversation I had with the patient, I believe she views herself as the ultimate victim, and she is convinced she can't work. Should this be considered a disability in and of itself? A lack of self-worth? A sense of hopelessness for one's future? An absence of family, community support structures, and social networking? The argument can be made.

And how did she get to this point? What possibly could have brought her into the office of a 24 year old with a not-as-manly-as-Ian's beard asking for help with disability? I believe that it is a failure of every other safety net that we "priveleged people" have come to take for granted. Family, opportunities, an education, support networks, hope, religion, interpersonal skills, emotional balance and intelligence. When all these pleasures in life fail, then, and only then, do you decide to apply for disability. Make no mistake, it's a lonely road.

As I progress further into the year, I find that my emotions are in constant flux between warm and cold. Warm, in the sense that I know I am providing a critical service to my patients. Not the disability help as much as being there to listen, to empathize, to respond to their frustrations, and sit in a room with them while not trying to establish any sort of social hierarchy or power structure between the two parties. Equals. Time is never a factor, as long as I can reasonably balance it within my daily schedule. It warms my heart to provide this service.

But I also switch to feelings of coldness. This numbness that broods when I acknowledge the inequalities in our society, the lack of opportunity I see for the patient in front of me, the enormous complexity of the problem at hand and my inability to ever solve it. It makes me instinctively want to shut down my emotions, get the application done as quickly and efficently as possible, and forgot the relationship I have just forged.

What else can I do besides start the long, tedious, and arduous application with her? In my situation as a JV, I don't see much else. Until next time, the battle continues....Thanks for reading.

Top 30 songs

So, in the same spirit as the Top 30 books, I'd like to compose a "Top 30 songs" list. As previously mentioned, this would be a ever-changing compilation of songs that I would always like to keep at the forefront of my mind. Here it goes:



One Big Holiday by My Morning Jacket

Let the Beat Build by Lil' Wayne

Da Art of Storytellin' Part 4 by Outkast

Wagon Wheel by

The Story by Brandie Carlyle

Maybe by Ingrid Michelson

Halo by Beyonce

Entire Dark Side of the Moon Album by Pink Floyd

Love Story by Taylor Swift

Kids by MGMT

Two Weeks by Grizzly Bear

Mad by Ne-Yo

Miss Independent by Ne-Yo

Got Money by Lil Wayne

I'm so Paid by Akon feat. Lil' Wayne

Sophisticated Cissy by The Meters



More to come later...

Top 30 books

In Matthew Kelly's book, "The Rhythm of Life", there's a section where Kelly explains how much he enjoys reading and how much he has gotten out of certain books in his life. He continues to say that every person should have a "Top 30" books in their collection--30 books that you can read over and over again and always get something out of, 30 titles that should always stay at the forefront of your memory.





So, I decided to take him up on that. I want this list to be constantly changing and evolving, but here we go with a preliminary as of 4/5/10 (and there's no particular order for books in this list, that would be too complicated and un-necessary:





Blink by Malcolm Gladwell


Outliers by Malcolm Gladwell


Strength in What Remains by Tracy Kidder


The Lamb's Supper: Mass as Heaven on Earth by Scott Hahn


A Father Who Keeps His Promises by Scott Hahn


Lord, Have Mercy by Scott Hahn


Hail, Holy Queen by Scott Hahn


First Comes Love by Scott Hahn


The Old Man and the Sea by Ernest Hemingway


New Orleans Mourning by Julie Smith


Chiefs by Stuart Woods


Born in Blood and Fire (Latin America Book)


Consider the Lobster by David Foster Wallace


The Book of Basketball by Bill Simmons

More to come later...