I have a friend who works hard, sometimes two jobs at a time. She gets fired over and over, for reasons she doesn't always understand. Nearly anyone would have seen the firings coming, but she never does. And every one of them takes another piece of her courage, her will to live, and her belief in herself.
She is 40 years old, and she's mentally ill, and she's poor, uninsured and American. And she's falling into a crack so wide it's about to swallow her job, her car, her home, and her life.
My friend lives in a Southern state currently trending for Obama, who she supports with incredible passion.
She calls herself an "East Coast Jew," and says Southerners tend to find her too loud and sarcastic. She probably is, but she's also a terrific writer (we met in a writer's group a few years ago), as well as extremely intelligent and witty. It doesn't help that she's mentally ill, and seems unable to read body language and social cues. That's a large part of why she keeps losing her jobs despite being a freak for punctuality and obsessive-compulsive about the details of her work itself.
Right now she's working only one job, and having no luck finding a second in this economy. She's had to cut her spending to the bone, and has had to stop doing the one social thing she did, volunteering at her local animal shelter, because she can't pay for the gas to get there and back.
Worst of all, she hasn't been able to buy insulin for almost two months, despite severe, long-standing diabetes.
I spent last week trying, from my San Francisco phone and computer, to find her a source for free insulin. I talked to every diabetes organization I could find, her state's health and mental health agencies, people I know who had connections. My friend even has a social worker who tried up and down and sideways, too. We can't find it.
She's eating from a food kitchen, and the starchy food is making her blood sugar worse, so with no insulin, her diabetes is worsening by the day. Last year she ended up in the hospital for a week with a diabetes-related health emergency that cost the state over 40 grand that they've had to write off -- but they won't pay sixty bucks a month for insulin for her, to keep it from happening again.
I've watched her over the last year try, ineffectively but sincerely, to get help. She's made amazing effort, finally getting into emergency therapy paid for by her county, getting diagnosed with what I suspected she had, bipolar disorder -- and not mild, either.
Unfortunately, her free county mental health care only covered three months of therapy -- she now has to get by with a weekly talk with a "life skills counselor" and monthly visits to a psychiatrist, whose care and the medications she prescribes are funded by a grant not likely to last much longer. And the process of medicating her is difficult and has a lot of mental and emotional ups and downs -- not to mention some difficult physical side effects, including sleep disruption and diarrhea.
She's painfully lonely due to her difficult personality, and this summer I convinced her to volunteer at her local animal shelter. She loves dogs, and they seem to love her, and it was one of the best things she'd ever done. She just had to stop going, though, because she can't afford the gas to get there every Saturday any more.
She can't apply for disability, even if she'd get it, which is nothing to count on, because for all the months or years it would take to be approved, she wouldn't be allowed to work -- during which time she'd starve to death, because she has nothing and she has no one to help her.
So every time she loses a job, she sinks deeper into a financial hell -- unpaid taxes, unpaid bills, unpaid student loans -- and it takes her a few days longer to start looking again. She lives on the edge, always late with everything, paying hundreds and hundreds of dollars a year in late fees, racking up interest on bills she'll never be able to pay. She gets ripped off all the time, too, most recently by paying an "accountant" whose ad she saw somewhere to do something about her tax nightmare. He took her money and did nothing, and last week the state came in and wiped out her newly-deposited paycheck for the back taxes she was trying to work out a payment plan for.
Could she have handled that better? Yeah, no question. She screwed up. She does it all the time -- this is the third time in a year that creditors have wiped her checking account just after she put some money in. Why does she still have a checking account? Why does she make the same mistakes over and over? Why does she make so many bad decisions?
Because she's sick, her brain doesn't work right, and she just doesn't get what's happening.
I've tried to get her to call Legal Aid in her state and ask if they can help her declare bankruptcy, and I think I may have finally succeeded. She is actively suicidal, but when I spoke to mental health folks in her state, they were pessimistic. If I called the police in her town, they'd check on her, they told me; if she sounded rational, they wouldn't do anything.
And I know her. She'd pull it together for the cops, then never speak to me again.
After her account got swept clean for back taxes, she called me to let me know her check to her phone/cable/internet provider would bounce, and she'd lose contact with me as soon as those were shut off. I asked how much the check was for; not much, but she'd gotten so far behind, and bounced so many checks to them, that they will now only turn her services back on if she puts $900 on deposit with them.
I begged her yesterday to commit herself to the hospital as a danger to herself. "I can't miss work," she told me dully. "I already can't pay for everything. What will happen if I miss three days of work? And what difference would it make?"
"They'll give you your insulin, and three meals a day, and you can sleep," I told her.
"For three days. Then what?"
And what could I say to that? She already has a social worker. She hasn't been able to do much for her beyond setting her up at the food bank. Oh, and in three months she'll be able to get her eyes examined, because she can't really see out of her glasses anymore, and says she's scared to drive but has no choice.
I've never been to her house, but from her description it's a nightmare. Some rooms are so full of stuff she can't open their doors. Her father once came in, when she was in the hospital and called begging him to help her, and was so apalled at how disgusting (her word) her place was, he told her she had to clean it up or he wouldn't help her.
She was lying in a hospital bed when he told her that. Then he went home, and even when her social worker called him, insisted that she just needed to "pull herself together" and everything would be all right. And really, he's an old man, and she's 40 years old, and I guess he just doesn't see why this is his problem. And neither do I.
I fell in love with Howard Dean because he seemed to understand the nightmare that was the lack of health care in this country. I thought Obama would get us there, too, but with the economy collapsing the way it is, who knows how long we'll wait?
I know wealthy mentally ill people with health insurance end up falling off the edge, too, but I look at my friend and think: A decade of untreated diabetes and bipolar disorder. Chronic pain, fatigue, and depression. Eroding sense of self. Options vanishing every day. And nearly everything wrong in her life could be made far better if she had the very things she would have if she'd been born in another country and not this one, a country like Canada or Australia or England. Not a perfect life, not the solution to all her problems, but basic medical care, insulin, a little money from the government.
And every year I pay in taxes enough money for her live on, so the government can flush it down the toilet.
I've sent her gift cards to the grocery store and paid for her medication several times over the last couple of years; I'm not willing to give her cash because of her erratic behavior around money, and because despite my compassion for her, I know that if she saw me as a cash cow, I'd never be able to believe anything she told me. I don't know if that's her mental illness or just some kind of survival mechanism.
And even if I was willing to do more than I have, I have a family member facing foreclosure right now and my income's gone down, and I can't afford to give her enough help to make a difference.
Besides, I don't really know how to help her, and tell me this: why should I have to? I'm her friend, not a therapist or doctor. I'm a pet columnist three thousand miles away. She has severe physical and mental health problems, and needs social services and medical attention.
I'm not sure any of this matters anyway, because her health, both mental and physical, are deteriorating so fast these days that I expect she'll die by her own hand, or be living on the streets, by the year's end.
"This is all my fault," she told me Friday night, her voice completely flat. "I keep fucking up."
"You're sick and poor," I told her. "It's not your fault."
She laughed, although it was still flat. "I'm sick and poor, and American," she said. "That's the problem."
And it is.