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)  

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5 CommentsLeave a comment

  1. Love the last jab. 😉 Its a reality we deal with every day, isn’t it? People come to see us for help, when their problems are self inflicted. In my hearts of hearts, I really don’t get it. I just don’t understand how you let it go so far, so off balance. I am not a swimwear model, and I do have asthma. But you don’t see me stuffing my face or lighting up cigs either. As a health care provider, it IS our job to treat our patients, no matter how they got there. Even ran over by pigs, even overnight soaking wet in an outhouse with only your drawers’ on cause you were obliterated….Even if you’re on your death bed at age 65 from smoking too much crack and cigs…..it is STILL our job. But I guess we don’t have to understand it. Yep…every one of those (except the pig farmers) were on your and I’s tax dollar. A hard one to swallow being a 1099. (Its tough to see it separated off your check and actually WRITE a check FOR it). But I’m with ya Josh…Ethics sometimes get sticky….and you can’t save everyone…and unfortunately some people really are too stupid to learn or do it any other way. “Stupid” of course encompassing any states of laziness, lack of importance, lack of education, lack of determination, self control, or self esteem. Harsh huh? Reality is like that. Great post though. Its kinda nice to know someone else grapples with some of these issues too.

    • I think most of us struggle with this. The life of the Christian is not to different, we are called to help “the least of these” and at times people won’t/can’t/are unable to accept help when it is offered to them. The key is loving people, sometimes it’s THAT which is the most difficult. For the record I’ve never smoked and am not tempted too, that was pure litterary device.

  2. LOL…I never thought you DID smoke LOL. I understand about being the ‘good Christian’ and “loving one another…as He hath commanded”. But I think for me, love sometimes isn’t a factor…maybe it should be. I just want to give them good care…but if they’re idiots…well, honey, I can’t fix stupid…I can’t pull you out of your gene puddle…and I can’t usually can’t buy your years back on your life either. I do however do a really nice job with teaching, and I know my patients have been well taken care of. Somehow I think maybe I make a difference…dunno….but I solved their problem at the time…and I guess that is my job. After thinking a few more moments about it…there are the patients you get and you genuinely feel for them, will bend over backwards to help them and do an exceptional job at relating, helping and fostering whatever they needed. You helped. I guess THAT is the bottom line…isn’t it?

  3. Its funny, I kinda feel bad for the smoker. I feel like he’s addicted to work. I mean its cool he doesn’t want to be lazy, but seriously, he’s literally killing himself to work. I feel like he needs to be told that his worth does not come from the job he does.

    But, you see, I’m coming from DC where overwork is WAY more of a problem then underwork (did i just make up a word?).


  4. yeah, but at least he HAS a work ethic…ya know? The other guy is just glummin’ off the rest of us…

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