What We Do For The Least of These

Three times a week, he waits for me, sitting in his broken wheelchair, behind a glass door. He is legally blind, cannot hear, and has lost both legs below the knee. For weeks I have been trying to get him equipment. I have made calls on his behalf, trying to locate the equipment he needs that Medicare will not pay for. He is not the first, nor is he the only, of my patients who needs a new wheelchair. The brakes are now broken, and his wheelchair ramp needs repair. I repair what I can, eye glasses, Hoyer lifts, walkers, canes, tub benches. I realize I need better wheelchair repair skills than I currently have.

Another man, behind another door, who has no use of his left side due to stroke, sits in a borrowed wheelchair that is too small for him and is contributing to scoliosis of the spine. He is barefoot, wears a dirty t-shirt with a hole and pants that do not zip held up by one suspender. Nothing has been washed, he is in the same clothes he was in the last time I came. He has no sliding board to assist in the transfer from wheelchair to bed, no tub transfer bench to assist in washing himself. His son is asleep in another room and cannot be roused. The smell is unbearable. He is proud as he tells me he does his own washing, in a bucket, with bits of soap.

I spend ninety minutes on the phone, making every call I can think of, yelling at people I do not know, trying to make some progress, trying to make some meaningful change. The answer always seems to be the same, no matter who I call. They need something from someone else, before they can do their job. I am banging my head against a concrete wall. My patient is not a theory, he is not a statistic; he is an elderly man who cannot walk who needs a bath, a clean set of clothes and sheets, and a wheelchair that fits. For the love of Christ, it cannot be that difficult.

And yet, it seems to be. At the end of the phone line, sitting somewhere in an air conditioned office and wearing clean clothes, a "representative" tells me that they can do nothing, yet again, for my patient. I am told that my patient needs to make calls, fill out paperwork, and the most they, the representative, can do is "drop off a brochure." I am dangerously close to losing it. "Well," I say to the representative, determined to choose my words carefully. "My patient has no family available to help, has severe mental and physical limitations, cannot walk, is sitting in a borrowed wheelchair that is causing curvature of the spine, pisses in a cup and cannot wash himself adequately after shitting into a plastic bag because that is what he has available, but by all means, DROP OFF A BROCHURE."

After ninety minutes, I am late for my next appointment, and must move on. "You must call, and follow up. You must ask your son for assistance. It can be better. But you have to be a squeaky wheel on your own behalf." We are both frustrated. "At least you tried," he says. You've done more in an hour than anyone else has gotten done in four months." I don't feel like I've gotten anything done. He is sitting in the same wheelchair, and he will be wearing the same pants the next time I come. We have done no actual therapy, because his need for equipment is so great, it has to be first priority. He has plenty of brochures, but nothing has changed. I will be quizzed by a bean-counter about my use of therapeutic minutes.

Around the country tonight, people will watch the evening news, and shake their heads, and get angry, thinking of all the people out there trying to "cheat the system." System? What system? I see old men in wheel chairs with no legs who cannot make phone calls on their own behalf because they cannot hear, and who cannot get anyone to follow-up on completing paperwork or sending a fax. I see elders in America who are so poor they are washing their own torn t-shirts in a bucket, who cannot get assistance unless they pay $400 of their $900 Social Security check to a program to bring them "down to Medicaid-eligible."

I call everyone I know who might have equipment lying around unused. I call the donation houses to get my patients wait-listed for a wheelchair that fits and bathroom equipment so they can take a bath safely. Medicare will not pay for "bathroom equipment." I want a number-cruncher, and the American voters who think all of my patients are out to cheat the system, to come with me on patient rounds. I would like to show them the challenges these people are facing just to get out of bed and take a bath every morning. I would like to show them exactly what we are doing for the least of these, our brothers.

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