There have been many valid topics raised since I was here last, but I can't speak to them now. Before I forget, I did want to thank Bobert for his well-presented case study of Adam. I remembered it after I'd logged off and was hitting the hay. It is a shame it ended sadly.
The discussion of the changes in welfare and other comments early on reminded me of a patient who was being seen in a clinic I ran. She was an older client...nice lady...who was on welfare...food stamps, etc. who had sarcoidosis. She was very positive, despite her own illness and living situation. She was divorced, and her husband was supposed to be providing her with alimony, but the state couldn't find him. (More on that later.) In addition, she was unemployable. To make matters worse, she had a child, who she adored. I think he was about 5...but this was almost 30 years ago, so forgive my memory lapses. He had cystic fibrosis. (Yeah, I couldn't make this up if I tried.) The woman was in a constant battle with social services because they wanted her to put her child in an institution. Not because she wasn't taking good care of her son, which she did. She was well-groomed herself and smart. At a hearing, she pointed out that it would cost the state, at that time, $1000 a month to institutionalize her son, yet all she wanted was a $500 a month increase in his care benefits. The state, naturally, refused to see the logic in this argument. I'm serious. We couldn't believe it. Still, she forged ahead. Her son was thin and pale and, well, a mess, but she had a stroller...one of those foldable kinds...which she had rigged with his oxygen tank and all of the gear she needed to suction him, which he frequently needed. You could feel the love when she entered a room.
At any rate, one day she came into our offices...we were in a state-owned and operated building, a floor just above the Public Health Nursing Dept. We operated several of our FP clinics onsite, as well as another set of clinics in a house offsite. She'd been crying, and after we'd calmed and sat her down, we asked what had happened. She had her son with her, and he seemed his usual self. Well, amid further tears, she told us that welfare had discovered, during an unannounced visit to the house she rented an apartment in, that she had a male living with her...he was also on welfare. They gave her an ultimatum...either he went or both their benefits would be adjusted to...well, you get the picture. Back then, you were not allowed to share rooms or apts. if you weren't married. That meant two men or two women on welfare weren't allowed to do so either. Which, of course, led us to wonder, well, then, how the heck was anyone to get ahead? We set the client up with our onsite social worker, who knew how to wring the most out of the system with the least amount of ruffled feathers. (BTW, the husband? Our client kept giving welfare his address and phone number, yet they couldn't find him in the next town over? This was before NYS got the legislature to pass the aptly-called "deadbeat dad" law and got the justice system to enforce it rigorously.) That's just one story out of how many? I have more. Even now, though, it takes a lot out of me to relate, let alone relive, them as I do so.