Emerging From the Shadows - A Patient's Story

Tom Brown has lived most of his life in the shadows. Always fearful and worried about being discovered by someone who might break his trust or hurt him. He discovered the Clinic through the kindness and care of a couple who gave him shelter. They immediately recognized that he needed medical care but that he had no insurance, which is a similar story for many of our patients.

What’s unique about Mr. Brown’s story is that he is a U.S. citizen, but without proof of identity. He doesn’t have a birth certificate, social security number or an ID - all of which are required to receive assistance and basic services. He could qualify for Medicare but is unable to prove his citizenship.

Imagine always living in fear, being paid only in barter and under the table, worried about what would happen if the government and IRS found out. At times, Mr. Brown had a roof over his head due to lots of hard work and someone's generosity, but many years were spent homeless. He has been on his own since he was 15 when he ran away from an abusive relative, his grandmother, who he lived with after being orphaned as a child.

Last year, Mary called and brought Mr. Brown to the Clinic who was in need of primary medical care. he hadn’t been to a doctor in years, except for a few emergency room visits that resulted in hospitalization.

I was struck by how soft spoken Mr. Brown was, partly because of untreated hearing loss, but in general how his quiet way and demeanor were a reflection of his living off the grid, always in the shadows. I also noted and admired how persistent Mary was in terms of getting Mr. Brown to the Clinic and being present for his first couple of appointments. For all the subsequent follow-up and specialist appointments, Mr. Brown came by himself, faithfully taking public transit to the Clinic, always careful to be on time. Besides all the care received at the Clinic, we also referred him to Operation Access, our partner in donated surgical and specialty care, which enabled him to have a necessary surgical procedure at no cost.

A review of Mr. Brown’s chart and ongoing care revealed questions as to why he couldn’t be signed up for Medicare. In one of the conversations with his benefactor Mary, she shared her and her husband’s concerns of what would happen to Mr. Brown when they fully retire in the next couple years, sell their home and move away from the area. Mr. Brown has been living in a converted gardener’s shed on their property and does light yard work and maintenance in exchange for the room and board and other help. This case really needed dedicated social services time and expertise, becoming one of the first cases for our new, first ever Licensed Clinical Social Worker, Lynn Loar, who volunteers weekly at the Clinic. After sharing Mr. Brown’s details and story with Lynn, she was willing to do the research to try and track down Mr. Brown’s birth certificate, get a Social Security card and jumpstart the process to build an identity leading to some benefits for him. After several conversations with Mary who was so thankful and willing prep Mr. Brown for this meeting and to allay any of his concerns, I set up an appointment for him to meet with Lynn, our social worker.

Sadly, Mr. Brown was a no show for the appointment with the social worker. Calls to Mary revealed that he was really anxious and fearful about being discovered after all these years. He was concerned about legal protection. After assurances that the Clinic would continue to see him as a patient and some coaxing and coaching, a meeting was set up at the Pope Francis Legal Clinic to speak with legal counsel. Mr. Brown did attend this meeting.

There certainly will be more to this story. We will see Mr. Brown again as a patient, and if he is willing, continue to help him with the depth of resources available. Mr. Brown is a refugee from his past and in need of refuge now. “Foxes have dens and birds of the sky have nests, but the Son of Man has no place to lay his head.”

Names and some details have been changed.

By Anne Brussok, DM