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After Foreclosures, Hidden
Addictions Emerge Among Elders
By Sanjay Basu, New America
Media
April
23, 2012
Editor's Note: This story,
is part of a series exploring the impact of the
recession on health care for poor people. Dr. Sanjay
Basu, MD PhD is a resident physician in the Department
of Medicine at the University of California San
Francisco.
Herman, a 61-year-old black man, sat on an exam table
at San Francisco General Hospital’s General Medicine
Clinic. He nervously tugged at the felt edge of his
fedora hat. As his doctor, I asked him -- as tactfully
as possible under the circumstances -- if he would
submit to a drug test.
I had been Herman’s doctor for almost three years, but
I could tell that this was clearly the first time
anyone had asked Herman if he was taking drugs.
Herman was not pleased.
Increasingly, physicians are asking elderly patients
like Herman -- patients near or even past retirement
age - -if they have been taking illicit drugs.
According to the Centers for Disease Control, the
number of positive tests has increased by over
four-hundred-thousand during the recession, especially
among the elderly who have experienced the greatest
number of home foreclosures.
A few years ago, at our first visit together, I asked
Herman about his life. He was divorced. His mother
lived in Oakland; his daughter had moved to the
Midwest after getting married. He was alone and not
exactly alone -- the way many elderly Americans find
themselves.
He showed me what he did for a living -- sketching out
an architectural diagram of the Bay Bridge
reconstruction -- the complex physics of moving
massive metal panels. It was Herman's way of telling
me how proud he was, as a black man who went to
segregation-era schools in Alabama, to have become a
civil engineer.
But after the start of the recession, Herman quietly
asked our receptionist to change his insurance
designation to “self pay.” He had been handed a pink
slip at work.
The Great Recession did not undermine his life in one
blow, but with many humiliations and defeats, over
weeks, then months. One day, Herman stood in the door
of the clinic holding two Samsonites, his chihuahua in
tow, clicking its paws across the white office tiles.
“Foreclosure,” Herman sighed as he sat down.
“Everything I have left is in these bags.”
He was on his way to the East Bay to live with his
mother. But -- always being prompt -- he hadn’t wanted
to miss his usual doctor's appointment. He apologized
for having nowhere to put his belongings.
Herman appeared unkempt for the first time. Like many
of the clinic's oldest patients, he was the type of
person who had always been meticulous about his
appearance -- wearing a sport’s coat to the doctor's
office. The week of his foreclosure marked a
transition. He was perspiring, his hair tousled and
his shirt dirty and partly unbuttoned. The foreclosure
of his home completed, the foreclosure of his body was
apparent.
Hypertension is often a medical consequence for
persons facing financial distress. Herman had been
diligent about taking his medications, but suddenly
his blood pressure recordings crept upwards. “I’ll be
honest,” he explained. “At this point, it’s the pills
or the poultry.” He meant that he was forced to
sacrifice his prescription co-payments to pay for
groceries.
At subsequent visits, Herman casually asked whether
medical research had found a cure for insomnia, then
laughed at the suggestion that he might be depressed.
He started nodding off in the middle of his doctor
visits. He began to mumble, and complained of
abdominal pain and chronic constipation.
After he had taken offense at my suggestion of a drug
test, he complied and submitted a urine sample. Like
many other elderly patients, he tested positive for
drugs.
According to a statistician at the Department of
Public Health, who wished to remain anonymous in an
interview, San Francisco has been witnessing a
“geriatric crack epidemic.” Particularly at the start
of the recession, many emergency room doctors saw the
resurgence of a variety of drugs and of drug use --
once only associated with the young and out-of-work --
now common among the elderly who have lost their
pensions and property.
In Herman’s case, his urine wasn’t positive for crack,
but for oxycodone, a painkiller. A few weeks after
having moved to his mother's house in Oakland, Herman
had found his mother’s pill bottle in the bathroom
cabinet, stashed away from after her hip surgery. At
first, the pills let him sleep. Then they made him
numb. Then he "just needed them."
Confronted with the positive test, Herman just sucked
in his lips, like a child after a misdeed confronted
by evidence from an adult. His chihuahua shuffled
under the chair and lowered its head to its paws with
an exhausted snort.
Herman entered a rehab facility. He was one of the
lucky ones. The rehab facility has been overwhelmed
with patients since the recession began. He spent
several sweaty nights there, emerging clean again.
But he is still without his home, or a job. Each time
he comes to clinic with a forced smile, often averting
the eyes of our staff.
He utters only a few words at the start of each visit
to my office. "Doc, we can talk about my high-blood
pressure again," he says. I oblige.
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