Fictional Friday: Nicholas

Nicholas is a 27 year old gentleman with wavy blonde hair and piercing blue eyes. He is thinly-built, lanky, a bit over 6 feet tall and maybe 140 pounds. He sports a thin goatee, and has a pale complexion with small scars on his face. Nicholas and his mother have come to my office to discuss the Medicaid Waiver program. His mother explains that she has put off requesting help for Nicholas for many years. However, she is now in poor health and worries about his future.

Nicholas has a moderate intellectual disability. He has limited reading and writing skills, and has never held a job. He dropped out of high school after 9th grade. Nicholas also has Attention Deficit Hyperactivity Disorder, Bi-Polar Disorder, and frequent anger outbursts. Nicholas's mother explains that although he seems "street-smart" he has been exploited several times. A couple years ago Nicholas disappeared. They reported Nicholas as a missing person to the police. He had a history of eloping when angry, showing up a couple days later. This time was different. For several months his family had no idea of his whereabouts or whether he was even alive. They called every extended family member and friend who might possibly know where he may have went. They prayed. They worried. And waited.

Then one day shortly before Thanksgiving, Nicholas called his elderly grandmother's home. It was the only phone number he could remember. Nicholas didn't know where he was. Fortunately, his grandmother had caller ID, and the family was able to track his location. Nicholas was in rural Georgia, living in a small trailer. He was befriended by a woman he met at a local fair, and after a series of unimaginable circumstances Nicholas was abandoned, without money, food, medication and the skills to survive by himself. His mother and brother drove for 10 straight hours to retrieve Nicholas. Their emotional reunion was powerful and overwhelming. Nicholas was sick, malnourished, and had open sores on his face and arms. The trailer in which he had been living had no running water or electricity. He couldn't remember when the last time he had bathed.

Nicholas's mother emphasizes that she is fiercely independent and reluctant to seek services, but acknowledges that Nicholas will one day need the assistance of others. She hopes his siblings will help out, but worries that Nicholas's behaviors have long worn out his welcome with them. His mother is exhausted, and the emotional strain clearly shows on her tired face. She has numerous health problems, and virtually no support system.

We complete the appropriate paperwork and Waiver application, and I explain that the Waiver wait list means that Nicholas is years away from receiving services, if he is even determined eligible for services. It's hard to be optimistic in circumstances such as these. I can't give false hope, and families need to have accurate and honest answers. Sometimes the answers are hard, and insufficient. There are many people like Nicholas with unmet needs. The difficult reality is that we live in a time in which needs surpass the resources available. But there are ways the system could be more efficient and effective. As a society we can, and must do better.

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Note: Nicholas is a fictional character, based on a composite of real individuals. Composite characters who appear in my "Fictional Friday" posts are based on people with real stories, with particular details, names, and certain specific circumstances changed so as to protect privacy.