Frozen Shoulder

Friday morning I was on the subway, heading to the orthopedist when calls started coming in from my very sick client, three in rapid succession. I couldn't answer on the train. and I was worried because he doesn't normally call that early. By the time I was off the train and crossing Washington Square Park, Jeff the volunteer was testing me, "he's in an amulance on the way to the hospital," he wrote "they think he might have had a stroke. They had to call me because he couldn't remember his door code to let them in." The next call is from the Allen hospital ER, so I sit down on a park bench, edging away from the guy with the tiny dog in his lap who says "she's NOT friendly, she's really NOT friendly." "What is he like at baseline?" the PA asks me. "He's not communicating with us, just repeating everything we say." I knoe echolalia is a sign of brain damage, so my heart sinks as I tell him "He's very verbal and normally talks a lot." I think of the client as a 17 year old, how he used to drive me crazy with all his jokes and playing around during group. I remember the time he was playing around with some nuts, playing with his food like a young child, and in frustration I said loudly, "JJ, put those nuts in your mouth!" and the whole room cracked up laughing before I realized what I'd said. "When was the last time he was known to be normal?" asks the PA. "I was texting with him yesterday afternoon and he seemed fine," I told him. I take down his number and hang up. I think Jeff might have spoken to him more recently, so I send him the number and continue to Broadway, to the orthopedist with the fancy waiting room. She tries to move my shoulder and says "it's definitely frozen." She asks what happened to it and I tell her I have arthritis. "Rheumatoid arthritis? You're young for osteoarthritis," she says. "My grandmother had it really badly I tell her," as she pulls up the x-ray which clealy shows the arthritis. But there's something else. "there's something in your shoulder, like a bone spur that broke off or a piece of cartilage." I tell her about the PEPFAR action, how we were interrupting the Senate appropriations committee when a Capitol Police officer, a big guy, slammed into me on that side and then shoved me into a wall. She starts testing the strength of my shoulder. "It's weak," she says, "I think there might be a tear too." She starts to prescribe something, then looks at my long med list in the computer. "I don't want to add to all this," she says suggesting an over the counter gel. She hands me a referral for an MRI. My insurance hates MRIs so I know it's going to be a battle. It's sunny but not too hot as I head down Broadway to get the train to work. I'm looking at the buildings as I pass, thinking about how much it's changed in my lifetime, when I come to a bright orange flyer taped to the window of an empty storefront. "PLEASE DO NOT KILL YOURSELF" it says in large letters. Below is a blurry picture of a man. The text goes on to say he found his brother in 2022 and exhorts people to "Get help" and call 988. As I approach Houston street, I look around to see if there are any more. As activists when we want to get the word out about something, we put up a lot of posters, but I only see the one. On the train, I text a photo to my friend Sean, who does a lot with suicide attempt survivors. He's as puzzled as I am. "what do you think?" he texts. "I think this is someone in a lot of distress," I reply and he agrees. The next day I wake up at 4am, as usual, for Connor's second dinner and I see a missed call from the hospital after I went to bed. I call back and get an ICU doctor. "We moved him to the ICU because his blood pressure is too low." "that's happened before," I tell her, which she seems to know. "He's agitated," she says. "He won't let us take his blood pressure on his arm, only his leg, which is not as accurate." "Usually when he does this, he wants something" I tell her. "It's usually pretty basic like an extra blanket because he hates to be cold. If you can find out what it is, you can bargain with him." "we're having a psychiatrist assess his capacity tomorrow." This client has had his capacity assessed at least a dozen times by now. It's a high bar to take away someone's medical decision making and they usually don't do it, but with a stroke in the mix, I don't know. "You're his proxy, right?" Nothing good ever follows those words. "If they find him not competent, we're going to ask you to consent to a central line, so we can monitor his blood pressure internally," she says. I know he would hate that, he even hates regular IVs. The next day I wait for that call, but it never comes. Jeff visits and reports that he's doing better, sitting up and talking clearly. Somehow he has landed on his feet again. A few days pass, and then this morning, Jeff texts that he's back home. Jeff has just gone to drop off some supplies for him and says he's speaking fine but says his legs feel like tree trunks. I'm suspicious. It seems too fast and I know this client's patterns. "Does he have discharge papers?" I ask "because the dialysis center is going to want those." Jeff asks JJ and then gets back to me. "No papers, he left AMA." That's what he almost always does. It's late in the day, the light starting to fade, when JJ calls me. I can hear the weakness in his voice. "Can you get me an egg drop soup? i left from the ICU" he says. "It was too cold there and they were starting to be assholes, leaving me in my own shit." I know hospital staff get frustrated with his frequent refusals of things like IVs. I wish I could get him soup, I know what it's like to be alone with a body that won't let you cook. Before my laminectomy, I could not stand long enough to do anything in the kitchen and wound up mostly relying on things that could be easten as is, apples, cheese, carrots. I want to help him, but I have $40 left and five days until payday so I really can't. Our society's priorities are so twisted that people whose lives touch other lives - social services, nurses, child care - make very little and people who play games make millions. While I'm pondering this, JJ happens to look up. "I have ramen!" he says, "and tea". I can hear him struggling to stand with his heavy legs and shuffling across the floor to heat the water. Since he left AMA he's not signed up for PT or anything. He's concentrating on his cooking, so I wish him a goodnight, go upstairs and comb Odie, my foster cat, who seems to shed twice his weight in hair frequently. The phone rings again and I grab it thinking JJ might have fallen or something, but it's a salesperson from Total Access, our condom wholesaler, wondering why we haven't ordered recently.