A Tale of Two Disabilities

If it wasn’t clear to me that disability is a state of mind, it has become so over the last month. I have two patients with bad disease, but the wide difference between them has been weighing on me. Both are about the same age and both have what some might argue are self-inflicted disease.

One is applying for disability essentially because he is so obese that he cannot work. It is hard for him to get out of the house. We- the state tax payers- already pay for his medical bills because of his poverty. We sent him for evaluation for gastric bypass, but he was too heavy, needing to lose ~15 pounds to show that he was mentally ready for such a drastic change in his life. He has since gained weight and I have since filled out some paperwork related to his new disability claim. A lawyer out of Utah that specializes in “Bariatric Law” is helping him.

The second patient is a lifetime smoker. Until recently he has smoked upwards of 3 packs per day. He now has terrible lung disease at a premature age as a result. He has been in my office with an O2 saturation of 75%….having just come from work. This is a guy that continues to work despite the fact that he cannot wear his oxygen while at work. His lung disease is so bad that it is giving him heart failure. His 5 year survival rate is around 30%. All this guy wants to do is work. It would not take him a lawyer to get on disability; it would take quitting his job. That’s all, he already qualifies for disability, but he does not want to quit his job. We- the state tax payers- now pay his medical bills, but he previously was paying for office visits out of his own pockets and continuing to work. Last time I had him in the hospital he wanted to leave before I thought he was ready because he didn’t want to take any more time off work. This is not a bikini model sun tan lotion applier kind of a job. This is a factory job, on a line.

Self inflicted disease? Perhaps. Totally different world views? Clearly. The problem for me is the emotional reaction each of these patient’s evokes in me. I probably don’t really even need to spell it out, because I suspect most people would feel the same way. Many would be quick to point out that it is very hard to weigh over 400 pounds, the strain on his body and joints is immense and he probably really can’t work. Which is probably true, but the other patient is literally killing himself to work (wearing his oxygen all the time would basically help halt the heart damage and help him live longer and healthier).

Regardless of what anyone might feel about these patients, the obviously underlying message is that disability is a state of mind. Two patients with disease which results directly from a combination of addiction and bad genetics (not everyone that smokes gets lung disease and not everyone that over-eats gets to be 400 pounds), but one has whatever feature of personality that lets him continue to work and the other is perfectly content to let us pay for his 3500 calories per day just to maintain that weight lying in bed all day. Oops that sounded like judgementalism. I need a cigarette

Published in: on April 13, 2010 at 7:02 pm  Comments (5)