Excuse me. People Like Who?

Good Morning, Saints!

And only a few people should think that refers to them. The rest of you? Y'all are sinners just like me. So, stop fooling yourselves.

Just kidding. But seriously.

Yesterday's blog was a killer, huh? I'm really interested in seeing how her situation plays out. I promise to keep you posted.

In the meantime, let's lighten the mood. (And I get really pissed every time I think about this situation, so I will do my best to keep the profanity to a minimum. But my best might not be good enough. So, um, sorry in advance).

Most of you who might be reading this grew up where I grew up. If we were poor back then, I didn't know it because everyone around us lived the same way for the most part. I never wanted for a thing, so in my mind it was all good.

It wasn't until I went off to college that I realized that "rich" people really existed. That there were people not on scholarship, who could afford to pay cash for college and didn't need financial aid was AMAZING to me. It was a sign of the sheltered life that I had led in my small community and at my 100% black, working class high school.

But the advantage that I did have was that my parents had instilled in my brothers, my sister and me that once you became an adult, what Mama and Daddy have no longer applies to you. That means that a wo/man who is not willing to work just does not want to eat.

Now I might be the most bleeding heart liberal in the world when it comes to certain things. I am sympathetic to the suffering of the sick, the poor, the homeless, children, and the elderly. I might be delusional, but I truly believe that my ordained purpose in this life is to change something big in this world through the work that I am doing. Sometimes it feels like a suicide mission, but hey, they are much worse fates than martyrdom.

What I am NOT sympathetic to is grown, able-bodied fools trying to get over on the system for a check that they don't deserve.

Case in point...

I have, or I should say had, a 30-something year old, 6'2", 210 lb., male patient (wearing a wife beater, basketball shorts, a doo-rag, and a huge CZ earring in his right ear --yes, I judged him. As I should have) come to me for the first time complaining about numbness, tingling and pain in his left foot. If you read Drug Seeking 101, you know that this raised an eyebrow for me immediately. But I gave him the benefit of the doubt because he said that a car had run over his foot a few months ago and it had "not been right since."

He'd gone to the emergency room and all the x-rays were negative according to him, but he felt that he needed to see an orthopedist for a second opinion. In the meantime, and of course, he wanted something for pain.

I examined his foot. And the exam was completely normal. He had full range of motion. His plantar and achilles reflex were normal. His pedal pulse was normal. I had him close his eyes and he easily distinguished between light touch and pin prick sensations. Hell. I even did the monofilament test on him which was also completely normal. So either nothing was wrong with his foot or he was doing a really bad job of trying to fake it.

He said that the problem was mostly when he did a lot of walking, which was most days. My best guess at that point was that when his foot was run over, there was some damage to the lower portion of the nerve responsible for feeling in the top of the foot. And when  he did a lot of walking, the tissue surrounding the nerve became inflamed causing a bit of compression of the nerve and the resulting pain and numbness that he felt.

I explained to him that we could send him to ortho, but because it was not an emergency, the provider who was contracted to see our uninsured patients was swamped and it would be January before he was able to see anyone. In the meantime, I prescribed him ibuprofen, strengthening exercises, rest, and ice or heat to his comfort. I also suggested that he go to one of the local drug stores and get an inexpensive brace for support, but he said that he had no way of paying for one. So I gave him one of our stretchy ace wraps and showed him how to wrap his foot for support.

I guess I really looked like Boo Boo the Fool that day. Or this guy took my kindness for weakness. Either way, I think that he thought he had found a professional pawn in his scheme to work the system.

For the next couple of months, I saw this fella every week. Sometimes twice a week. One day it was his foot. Then it was food poisoning from the new Hibachi restaurant from across the street, which was funny because 50 other people from the shelter ate there. And he was the only one that got sick.

Once, he came in with an empty pill bottle asking for refills. The medication was acyclovir and had been originally given to him at the ER. (I'll let you google it to see what its used for). I explained to him how the medication was usually taken and that it was only taken on a daily basis when frequent re-occurrence was an issue. He said that wasn't an issue, but that he had read on Wikipedia that the virus can migrate to your nerves and spinal cord and cause brain damage. He said that he felt like he was running a fever and he was worried that the condition had moved from his genitals to his spinal cord. (O_o). Yeah, folks. That is why you need to refrain from the internet medicine.

After that particular visit, I figured that it would be in my best interest to get his records from the hospital. I had him sign a release and in quick turn around, the hospital had faxed his complete ER record to our office.

And when I sat down and began to read, I thought that someone was playing a really funny joke on me.

Multiple visits over the past few months for:

1. A "spider" bite. With absolutely no signs of a vector wound, swelling, rash or anything at the site where he said he was bitten. The ER provider commented that there may have been "some delusional thought" present and "patient may need referral to mental health services." 

2. The feeling that someone had "messed with" him while he slept. Turns out that he was constipated.

3. Several visits in relation to having unprotected sex. I won't explain further.

4. Food poisoning. Multiple visits. And it turns out that he had already been seen in the ER when he came and saw me for the same episode of food poisoning.

5. Foot pain. 6 times in 4 months. Always with the same outcome. Completely negative work-up.

These, among other things, are for what this man kept abusing the use of the emergency room. The more I read, the more I thought that maybe there was some legitimacy to the idea that he may suffer from a type of hypochondria or obsessive compulsive disorder. But other than the frequent medical visits for seemingly ridiculous reasons at times, I had no real justification for that.

And then, a few days later, I got my answer.

I stopped by the main office to check my mailbox. I had gotten near the bottom of the stack of paper that I had pulled out of my cubby when I saw his name in the RE: line of a letter from the disability determination division of Vocational Rehabilitation.

You mean to tell me that all this time, he really wasn't crazy? That he was actually trying to build a disability case?

Chile, puh-lease. Cuz he was NOT doing a very good job of it.

And then I began to have flashbacks.

On several occasions when he'd come to see me, he'd asked me about contacting lawyers to pursue the person that had run his foot over in order to have them pay him medical bills. I told him that seemed reasonable. He'd also asked about getting a copy of the note from his food poisoning visit so that he could take it back to the Hibachi place and see if they would pay for his medication. I told him that didn't make sense...because the visit with me didn't cost him anything and our program was going to pay for his medication.

What was this kid really playing at?

Was he going to get a lawyer to sue the spider that bit him?
Or have the person that "messed" with him in his sleep brought up on charges and slapped with a civil suit?
And whoever made it necessary for him to take acyclovir? They better lawyer up. Right now.

It would be a few weeks before I saw him again. Apparently, he had been banned from the shelter for something he had done. I never found out what. That might be because I didn't ask.

Then one day, on my way home from work, and I actually saw him walking a few blocks down from the shelter. With a pimp in his stride. I watched him as he hot-footed it, jay-walking across a couple of intersections trying to beat traffic. I had to chuckle to myself. Obviously, that foot was doing alright today.

Two days later, he shows up wanting to be seen. KB asked him what he wanted and he said that he needed a refill on his ibuprofen. I stood on the other side of the partition and listened to her explain to him that according to the computer, he still had 4 refills on his ibuprofen. He could call in a refill request and just go down to our pharmacy and pick it up.

His explanation was that he did not have the number to the pharmacy because the label on his pill bottle was "messed" up and he did not have transportation to get there. He felt that it was our responsibility to get him his medicine.

So this is where I had to step in.

I tried to politely explain to him that in the real world, he could not walk into a provider's office and get the staff to go pick up prescriptions for him. It was his responsibility to do so and on occasions when KB has done so, she has done it as a courtesy. Not as an obligation.

I also explained to him that ibuprofen is also sold over the counter and that he could get some from the drug store at the next block.

The gentleman looks at me and says, "Every time I come in here, you get in my face."

My reply was, "Every time you come in here, you whine like a child."

Ok. Maybe not the best thing to have said. Cuz that set it off.

"I'm a man. That is why you don't like me. I'm a man. Plus, I know you don't like people like us."

I think my head spun around 10 times on my neck when I heard him say that.

"Excuse me. People like who?" I asked him.

At that point I noticed that the look in his eyes had changed, like he realized from the look on my face that maybe he should choose his words carefully. His lips parted. But no words came out. So I pressed him.

"Say what you mean? People like who?"

And then my rant began. For the next 60 seconds, I went off on him. I wish I could remember verbatim what I said, but the jist of it was to explain to this fool that he had no idea who I was or where I was from. That I could work anywhere in the world that I wanted to, but being there was my choice. That he was a lazy, able-bodied, description fitting, clown trying to get over on the system. That I have a 85 year old grandmother who would still get up and go to work everyday if she could. That his suffering was self-inflicted and that he, unlike most of the other folks there, had made a choice to be in his situation.

KB finally got up, put her hand on my shoulder, and said to me, "Its not even worth it."

And she was right. But it dang sure felt good to tell him off.

He sat there looking dumbfounded for a second and then he said to me, "I didn't want to come here anyway. My case manager told me to come here."

KB looked at him and said, "Well aren't you a man? A man wouldn't let anyone make him do something he doesn't want to do. Matter of fact, you don't ever have to come back."

I don't think he was expecting that. But he got up and left. And, miracles of miracles,  his limp was gone.

You see sometimes the cure for what ails you is a good old fashioned telling off.

Some of the best medicine in the world.

Towanna