Thursday, April 24, 2008

Taking "Help" Too Far

TIME Magazine has a horrific story about a man condemned to life imprisonment for the crime of breaking his hip.

Cleaned up with a nice, strong pin in his hip, Sandy turned out to be one helluva nice guy. ... I would never have guessed that five days ago, before Sandy had been admitted to the medical service, he had been lying on the floor of his apartment with a broken hip for at least three days. Dehydrated, delirious, with bone-deep pressure sores all over his back and rear end, he was the lone city-dweller's living nightmare: no one knew for days that he had was injured, until, finally, a friend who hadn't heard from him in a while called Sandy's landlord to check on him.


As I saw him each morning after surgery, Sandy had one consistent message for me: "I gotta get back home." This was a motivated patient with a goal — home. I had started to tell him about rehab — the great majority of our hip fracture patients get a week or so of intensive physical therapy as soon as they are medically stable — but Sandy would have nothing to do with it. "Please don't let them put me in the warehouse — I'm fine, doc — just need to get back to my own bed, feed the cat, catch up on the papers." I didn't press the rehab thing, figuring that the case managers, whose full-time job is patient-disposition, would deal with it. Maybe having a clear goal helped, because he did get better amazingly fast — from nearly dead to bright and vigorous, walking 150 feet down the hall, joking with the physical therapists, in less than a week. I was pretty happy with that hip nailing.


But already the "helpers" were making plans behind Sandy's back.

I have visited psych facilities and I liked Sandy — I didn't want him in one. No, he didn't remember being on the floor and, yes, he was foggy with details of time ... But when I asked for specifics, they were wrong. That was it. He was confabulating. And he had almost no short-term memory. I wouldn't stand a chance going up against the nursing-home proponents. It was a sad realization — in those few words, a little chat about things of no real consequence, this fine American of 75 years had lost his right to self-determination. He was to be consigned, in his own eyes at least, to the rest of his life in prison. For not remembering.

It's better for him, was the standard medical answer. He'll be looked after, fed, cleaned — oh, and there are many activities ... And his apartment — it was so dirty ... He could hurt himself. How can he pay his bills? ...


So I watched as the will of the collective was exercised upon my patient. Tightly strapped down, lest he fall and be hurt, they rolled him out of sight. What can save one from this? Only a loving family. Or perhaps revolution.

People who work in the "helping professions," especially social workers, are by definition people who think living and dying alone is the worst fate imaginable. They simply refuse to believe that people consciously, rationally, sanely prefer to live alone, even in extreme poverty, even in extreme filth, even in extremely bad health, rather than live in comfort and luxury that includes other people.

I am not talking about people with diagnosed mental illness like schizophrenia or recognized dementia like Alzheimer's. I am talking about the deplorable tendency of society's "helpers" to misdiagnose as mental illness a simple - albeit un-social - desire for solitude.

Sandy probably could use someone willing to spend an hour a day visiting him, making sure he had food and other necessities, maybe doing a little cleaning or a few chores if Sandy wanted him to.

But the simple lack of short-term memory, however severe, hardly warrants life in prison.

And I have no doubt that for someone who cherishes his privacy, his solitude, his independence (however compromised by physical decay) would consider any group living situation - however physically comfortable - to be, indeed, prison.

I sincerely believe that Sandy, if given the choice between dying on his filthy apartment floor after three days in excrutiating pain, and enduring 25 semi-comfortable years in a cage full of other people, would absolutely choose the former.

Sartre nailed it more than half a century ago: Hell is other people.

Cross-posted at Blue in the Bluegrass.