Rocket docket

Hello friends. This week I've written a sketch of recent courtroom activities for those of you that are interested in that sort of thing. If the minute details of social security procedure don't rivet you, just skip to the end where you will find a fun picture of the birthday cake made for me as a surprise by my court room hearing monitor (whose other business is cake baking). Otherwise, read on. You have been warned.

Yesterday five of the ten St. Louis Social Security judges conducted what we term a “rocket docket.” The idea was to schedule as many preliminary hearings for unrepresented claimants as possible on one Saturday morning. We would bring them in, advise them of their right to counsel, review their medical evidence briefly and order consultative examinations for those who needed them. Their cases would then be rescheduled in two or three months.

Gary Jewell, our Hearing Office Chief Administrative Law Judge (HOCALJ) is the brains behind our rocket docket. He realized that a significant part of the backlog of cases is created by unrepresented claimants who show up at their first hearing only to announce they now want to hire counsel. By law we must adjourn their case to give them time to find a lawyer. This means we set aside an hour for their hearing, but the hearing only lasts ten minutes. They later get another hour hearing. This may not seem like a big waste of time, but the true waste is behind the scenes. Each ALJ spends at least an hour reviewing medical evidence in preparation for each hearing. When hearings are adjourned or cancelled not only has the judge spent time needlessly preparing but the staff spent hours and hours obtaining medical evidence, preparing the files and sending notices for hearings that never happen.

About 30% of our claimants are unrepresented. An astounding 50% or more of unrepresented claimants simply never show up at their hearings. Of course, we don't know they are not coming, so we soldier on, spending hours preparing for hearings that never happen. The result is that court rooms often sit empty. Courtroom staff sit twiddling their thumbs. We prepare and wait for those who never come. Other claimants who need hearings are delayed while we process claims that never go anywhere. Enter the rocket docket.

Yesterday each of the five rocketeer judges had 20 – 25 unrepresented claimant cases scheduled for the morning from 8:00 – 11:30 at 10 minute intervals. In all 110 cases were scheduled. Since our office completes about 285 cases a month this is a pretty significant docket. Between the time notices went out and yesterday's hearings about 30 of these claimants hired counsel, so we adjourned their cases for a future hearing leaving 80 cases to hear. Of these, only 35 actually showed up so we only averaged 7 hearings apiece. We dismissed the other 45 cases. Of the 7 cases I heard only 1 decided not to hire a lawyer. We gave everybody a handout about how to contact lawyers. We scheduled independent consultative exams for about half of the people we saw. In all a very productive morning, 65 cases moved forward efficiently, 45 dismissed without a lot of wasted effort.

Going in I expected this process to be pretty easy. I imagined I would give a short talk on the right to counsel, glance over the medical records to see who could benefit from an exam, and done. My first case actually followed this pattern. But, as you all know, life has a tendency to be a little more complicated than that. My second hearing involved a claimant who only spoke Arabic. We had no access to a translation service on a Saturday. Fortunately he brought a friend who spoke English to translate. We began. I said a sentence. The friend turned to the claimant and whispered into his ear. “No, say it out loud, so I can hear,” I admonished. Things went pretty well after that until I asked the key question, “So, do you think you want to hire a lawyer?” This provoked an extended conversation in Arabic between the two friends. I stopped them and explained that the conversation had to be between me and the claimant. Many apologies later the claimant decided it would be best to hire a lawyer. Whew.

All the remaining cases were also fairly complicated. I struggled to help these folks understand their rights in Social Security's byzantine system, including a 23 year old woman with developmental disabilities and irritable bowel syndrome and a man with psychosis accompanied by his only somewhat less psychotic brother and sister.

The last case of the day for me involved a 35 year old man. Small and mild mannered he explained that he had hired a lawyer, but that they recently refused to keep representing him. I checked the file and sure enough found a withdrawal from representation. What happened? He didn't know; they didn't tell him. I looked at his records: blind in one eye, deep vein thrombosis in the left leg with chronic pain and anti-coagulant therapy, and HIV+. From the point of view of a claimant's lawyer a pretty good case on the face of it. So why had his lawyers fired him? After a few more questions I discovered that he had returned to work for a few months. Now he was out again. Work had proved too strenuous for him. His only work was as a day care provider. His employer does not know of his diagnosis, and he doesn't want to tell them. In fact, other than his doctor and the Social Security world no one knows of his diagnosis.

I explained his rights. He plans to get a new lawyer. I suggested he get some counseling to help him deal with his situation and directed him to some local HIV/AIDS resources. He thanked me and left.

As I stepped outside into a suddenly blustery day, I could not help but wonder about our so-called social safety net for citizens with disabilities of our county. Are we serving them well? Do we dare call ourselves a civilized country? Just a block down Broadway on the steps of the Old Courthouse where Dred Scott was tried about 300 gay rights activists were demonstrating in the cold.

We're a young and foolish country still, I mused, but the idea of civil rights for all is still warm, deep in our national consciousness. We will grow up some day and grant those rights freely to all. I turned my coat collar up and carried my surprise birthday cake back to my car.

Wild hickory nuts

Today is my sixtieth birthday. This momentous event has put me in mind of the many unique and interesting people with whom I have had the good fortune to have shared some time. Here's a short remembrance sparked by a recent event.

Merry and I made our first expedition into the Ozarks two weekends ago. We spent two sunny warm autumn days exploring and stayed overnight at Rock Eddy Bluff Farm near Dixon, Missouri. Our accommodation was an old-fashioned log cabin complete with luxury outhouse, gravity feed sink, gas stove and solar powered LED lights. The broad porch overlooks a deep hollow leading down to the Gasconade River. Sitting on the porch in the late afternoon sun we were surrounded by a forest of tan leaves of many hues from the various oak trees with a few hickories mixed in.

On our walk to the river I discovered a spot where freshly fallen hickory nuts covered the ground. Merry gathered some to take home. This put me in a mind of how I came to meet Euell Gibbons.

Back in the fall of 1967 I was attending Bucknell University as a sophomore history major. My roommate for that semester was Eric Jones. Where I grew up (Hanover, PA) there was no one like Eric. Eric was a full-fledged Quaker from Philadelphia. He had shaggy hair and wore handmade sandals with socks, all the time, everywhere, in all weather. He talked about the Philadelphia Folk Festival and coffee houses. He introduced me to what he termed “real folk music," in other words, something besides the Kingston Trio and Peter, Paul & Mary. He had attended private Quaker schools in Philadelphia and invited me to the local Friends Meeting. I was not particularly interested.

Not interested until he casually mentioned that about once a month after Friends Meeting Euell Gibbons led a hike to gather wild foods followed by a “wild dinner.”

I knew about Euell Gibbons from my Boy Scout days. I had read and re-read his classic, Stalking the Wild Asparagus. I loved his folksy style and the way he expressed his clear affection for the outdoors. I did not know he lived in Central Pennsylvania. I jumped at the chance to meet him.

A few weeks later I went to a Quaker meeting for the first time with Eric. It was not what I expected. After a few minutes sitting quietly one person after the other stood to talk about their favorite Bible verse or their interpretation of their faith. I had thought Quakers just meditated until the spirit moved them These Quakers were downright talky.

I looked around the room but didn't see anyone that looked remotely like what I imagined Euell Gibbons to look like. After the service a tall, gaunt man stood and invited anyone who wanted to go along for a walk to meet him outside. It was a cool sunny late fall day. I remember we walked along a railroad track outside of town. Euell seemed to know the name of every plant. Every few feet he would stop, pick up a plant, explain what it was and how it could be eaten. We gathered what edible plants we could find and put them in buckets. At the end of the walk the buckets were taken back to Euell's farm where we all pitched in to make a big salad, soup and some roasted root vegetables.

I went on several of these walks during that year. I got to know Euell fairly well. It surprised me that he smoked cigarettes and that pizza was his favorite food. At that time he had just recently become a minor celebrity. Until his “Stalking” books became a success he led a pretty hard life. His wild food hobby had started as a real necessity during the dust bowl when his family lived in New Mexico. He claimed to have bummed around the country after leaving home as a hobo for years. He was a long time lefty in the Woody Guthrie vein. He and his wife were steadfast members of the Quakers and of the local peace movement. I remember him as a pretty humble man who never did much to make himself stand out.

A few years after I graduated I was pleasantly surprised to see that Euell had been invited to write a couple of articles for the National Geographic and that he appeared on television on The Tonight Show with Johnny Carson and on Sonny and Cher. I was a bit surprised to find him pitching Grape Nuts in a TV commercial in 1974 during which he uttered a phrase I never forgot. When describing the taste of Grape Nuts he said in his Will Rogers voice, “Reminds me of wild hickory nuts.” http://www.youtube.com/watch?v=_XJMIu18I8Y My friends and I laughed. Some moaned that Euell had “sold out.” Personally I knew he had lived a hard and principled life. I was happy he had achieved some small measure of fame and economic success.

Euell died in 1975 from an aneurysm secondary to his Marfan’s syndrome. Although it's been more than 40 years since I met him, I still hear his voice and feel his influence every time I take a walk in the woods.

Wise Ass Historian

This last Wednesday Merry and I attended a reading and book signing by Sarah Vowell at the Mad Art Gallery in St. Louis. To be honest I was only vaguely aware of Sarah Vowell and had never read anything she wrote, but Mer had seen her on John Stewart, and assured me I would enjoy the occasion.

What an evening of discovery. The Mad Art Gallery is located in the Soulard neighborhood, one of the oldest intact areas of the city next to the big Anheuser-Busch brewery, near the Mississippi. The Gallery was created out of a very classy 1930's art deco police station. As you walk in you see that the giant Sergent's desk, surrounded by tons of polished brass grillwork, has been transformed into a bar. The original terrazzo floors are in good shape as is the original lock-up, open for inspection. The main room held about 200 folding chairs and a “paint-by-numbers” exhibit of familiar masterpieces (Mona Lisa, Warhol's Marilyn, etc.). It filled up fast. Looking around we felt we must have a good deal in common with many of the people in the room.

The event started pretty much on time, apparently a mid-western trait. The nervous, fast talking owner of the gallery welcomed everybody. Then the “events coordinator” of Left Bank Books, a local independent book store and organizer of the Great River Writers events, took the stage to vent some of her incredible, bubbly energy. Finally, the director of the Honor's College of the University of Missouri, St. Louis, took the podium to introduce the writer. After patting himself on the back for five minutes, droning on and on about his program [Why doesn't someone tell too-full-of-themselves college professors that normal people are just not that interested in them? UMSTL, I mused, how do they pronounce that? I later learned the correct pronunciation is “ums-stil”] he finally yielded the stage to the honored guest.

Sarah Vowell is a short, pale woman with dark hair cut short and blunt. There is something of a goth look to her. She has a slight vocal tic and speaks in bursts. She read from her latest book, Wordy Shipmates. She is terrific from the first sentence. Now mind you, Wordy Shipmates is a retelling of the earliest history of the Massachusetts Bay Colony. Ms. Vowell not only likes and deeply understands these quintessential religious fanatics, she makes their story interesting, and at times funny.

During the question and answer section, I realized why I like her so much. She has taken the time to truly understand who these people were, how they lived, why they thought the way they did, then she successfully tells us why we should care about any of that. The message of this book, it seems (I have not read it, yet), is simple – we have inherited our deepest assumptions about democracy from those crazy Pilgrims. We owe it to ourselves to know something about how and why they managed to survive.

What sets Sarah Vowell apart from other historians and other writers in general is her desire to understand exactly how other people live, then to explain why she cares about what she has discovered. She does this in an easy going, irreverent way. To get a sense of what I'm trying to say here I recommend you take a look at this clip of John Stewart interviewing here recently about this book:

http://www.thedailyshow.com/video/index.jhtml?videoId=187572&title=Sarah-Vowell

Near the end of the program a high school social studies teacher asked Ms. Vowell how to make teaching about early America interesting to 11^th graders. In reply, she allowed that this may be a nearly impossible task, but suggested keeping the focus on the people, their oddities, their foibles, and their unique perspective. This perfect answer reminded me fondly of our friend, Kathy Sabino, who labors mightily in this field at Hamilton High. It is, in the end, the task of us all to understand why and how others have come to different conclusions about important human issues. To the extent each of us personally succeeds in such understanding, we make a civilization out of the ant heap. This wise ass historian is doing what she can to help.

Being Represented

Merry has been back in Syracuse this week getting 303 Summit ready to rent. I've been holding down the fort, walking the dog and deciding more cases. I think I'm starting to get the hang of it. Knowing how to effectively prepare for hearings is surely an art not a science. I've asked the lawyers who appear before me to send me briefs and medical records well in advance, but invariably I get them the day of the hearing. Actually that doesn't surprise me, I did the very same thing in my own practice.

When I review files for a hearing I find the cases can be divided fairly easily into three broad groups: (1) those that should obviously be paid, (2) those that should obviously be denied, and (3) hard cases.

I puzzle a short time about the small number of cases, maybe ten percent, that should obviously be paid. Why were they ever denied? Were they really that much less disabled just two years ago when they applied? I usually conclude that it is just very bad luck with the SSA bureaucracy.

About a quarter of the cases I review fall into the obvious denial category. I'm sure these folks think they are disabled. They are generally young, have no more than a high school education and have worked at unskilled, strenuous jobs. They are hurt enough not to be able to keep doing what they know how to do. Lighter work is hard to find. They are not motivated to get retrained for something they can physically manage. They have no savings and no back-up plan. Many are working for a temporary service or at odd jobs. When they come before me, I listen to their story, tell them about vocational rehabilitation and turn them down.

Because Social Security only pays attorney fees when a case is won, virtually none of these people are represented at their hearing. A few have tried to get legal assistance but were unsuccessful, presumably because the lawyer they consulted was smart enough to discover the case was going no where. Most have never even consulted a lawyer. They show up at their first hearing and are advised of their right to counsel. Their hearing is rescheduled, then they come back a second time without a lawyer and lose, or just never show up again. This pattern is so predictable that our office schedules an occasional special hearing day just for this type of case.

At least two thirds of the cases I review are quite difficult to decide. Most of these cases can probably be won with skillful representation. I'm fascinated by which of these claimants manage to hire competent counsel, which hire incompetent counsel, and which seem unable to find counsel even with significant effort. I've not heard enough cases yet to even form a theory about why this happens.

Let me give just one example of a case that looked like one I would deny when I reviewed it, but which was won easily by competent counsel. This week I held a hearing for a young (40) man who dropped out of school at age 12 (after sixth grade). He never worked at a real job, but sold drugs on the street. He spent nearly the entire rest of his life in and out of jail for petty offenses, mostly burglary. He has a congenital spine disorder that has gotten worse over the years, but is not now disabling. He has hepatitis C and is HIV+, but is not now symptomatic. His IQ was tested in school at 80, a low average. He is mentally ill, but his prison records did not show any loss of function. When I was reviewing the case all his medical care had been in prison and looked pretty routine. Now he was out of jail and applied for SSI benefits.

He tried a few times to get private lawyers to represent him, but failed. Fortunately, a legal aid lawyer took the case, got a competent psychological evaluation and easily won the case in my courtroom. Without representation he may well have lost. Being represented made all the difference.

Lemp Junque

When we moved into 2115 Ann one of the things we noticed was the hole in the living room wall where a heat register was missing. A matching register adorns the dining room. It's of an unusual design. The heat duct is a hole about a foot square at the base of the wall. This hole requires a register with a frame shaped like a narrow right triangle that sits on the floor and holds a decorative grate that covers the vent. We did not notice the one missing in the living room during our inspections of the house probably because it was covered by furniture. Not a real big deal, but where would we find such an object? Our helpful real estate agent, Chuck, told us we might be able to get a suitable replacement on Cherokee Street.

We already knew that Cherokee St. is a near-by small shopping district consisting of several blocks of antique stores. Merry seemed to welcome the opportunity to seek this obscure object. Over the next few weeks she made several forays to Cherokee St., but no luck. She did get a tantalizing lead, however. She was told at the east end of Cherokee St. a guy operates a shop specializing in antique fixtures out of the abandoned Lemp Brewery. He has occasional hours. You can only tell he's there if a bicycle with a sign is chained out front. Merry drove by, but no bicycle, then found out he is only there on weekends.

Last Sunday we decided to try again. The brewery complex is huge, covering several city blocks. On one corner, next to the Interstate, chained to a light post was a beaten-up green antique bicycle with a small sign - “Junque.” All the windows in that area of the brewery are boarded up, the doors secured with rusty chains. There appears to be no way in. We walked along one side of the complex and looked down the next street. Part way down the block is another old bike chained to a post.

There is a gated truck entrance next to the second bike. The gate is ajar. Inside a passageway leads under interconnected brick archways to a freight dock and an open courtyard. Old machinery, giant gears, lumber and assorted tools are spread around this area. The disused freight dock is littered with an impressive assortment of wood working tools. As we wander through we can hear a small engine roaring. I spot a go-cart looping around the dirt courtyard between the boarded up buildings. Three men in work clothes are deep in conversation behind the dock. As we approach a tall thin man welcomes us to go inside and take a look around. We climb steps behind the dock and step inside.

We are in a cluttered warehouse space. We see more construction equipment and work benches, then dozens and dozens of bins, shelves, cupboards, drawers, salvage. Amazingly, it's all very well organized. A bin of broken black marble here, white marble there, terra cotta roof tiles in the corner – on and on. The proprietor finds us before we wander too far.

Merry describes our missing heat grate. He puzzles for a second walking deeper into the room. He mutters something about frames, grates and Chicago, I think. We come to a shelf covered by heat grates. He reaches into the heap and pulls out the exact thing we are looking for. He shows us the other grates in the stack. There is only one that looks like what we want. $25 is the price. We take it.

He leaves us to wander the room. There is an incredible assortment of building material everywhere. Mantle pieces, picture frames, mirrors, fire screens, hooks, pipes, wooden nickels, you name it. A small sign proclaims a 10% discount for materials to be used as public art. We explore for awhile.

It's exciting. An organized resource of ancient treasure. I woman appears and enquires whether we need any help. It turns out she's a friend of the owner sent to make sure we were alright. She tells us about the restaurant she's just opened that crosses an ice cream parlor with a martini bar. We discuss where in upstate NY her daughter, who wants to be a writer, should go to college. A few more people wander in. It's a contractor leading his clients on an expedition. They live in our neighborhood and are rehabbing a house. We acquire the contractor's card. The owner returns and we pay.

Back on the street the place seems like a hallucination. At home, the grill is an exact match.

Paying attention

Recently a colleague asked me how, after more than 20 years of daily interaction with people with injuries or illnesses, I manage to avoid becoming hardened to the suffering I witness.

I believe this to be a cornerstone question for any work related to the suffering of others.

I understand how people become jaded to suffering. After working in this area for awhile, it's hard to keep the sad stories from running together. Instead of focusing on the unique details, it's just another case of low back pain with disc herniation at L4-5.

I think we become jaded toward suffering, not primarily because of monotony but to protect ourselves. In order to make sense of people's stories, you must possess empathy; it's necessary to the process of understanding. Exercising empathy takes a lot of energy. Mostly,it requires close attention to what the other person is saying.

But such attention necessarily opens a window into the other person's messy life. These details overlap the problem we are committed to solving. She cannot understand that we don't need to hear for the ten thousandth time that she is behind on her car payment, or that money problems are wrecking their marriage. We are impatient with his lack of concern for what we are trying to do for him. He doesn't say “Thank you” when we get him necessary medical care. We put ourselves out for them, listen to them rant, but they don't reciprocate. It's downright tiring. Worse, sometimes they are miserable, unhappy people who hurt so much they don't care how nasty they are to others.

As a judge I've become even more aware of the amount of energy it takes to adequately pay attention to people's problems. I spend hours reading hundreds of pages of medical reports, then an hour asking questions of each claimant about the details of their disability. At the end of the day I'm tired and emotionally worn out.

Over the years I have adopted some strategies for maintaining compassion and a healthy distance at once.

First, I remind myself daily that my role in other people's lives is quite limited. In this regard I try to implement some basic Buddhist concepts regarding humility. Every day for the past year I've read the “Eight Verses on Mind Training” in the morning before leaving for work. This practice helps me remember to keep my ego in check. [I've attached a copy of the verses for those of you unfamiliar with them.]

But I'm not a Buddhist. I don't subscribe to the most basic Buddhist beliefs. I know that the world and other sentient beings exist totally separate from my consciousness. The key insight for me is that I need each and every one of these others to bring me joy. I receive this joy at the moment of each conscious genuine interaction. When someone does something that takes me by surprise, even something distasteful, I feel this joy. The more I pay attention to the details, the more things take me by surprise. Paying close attention becomes its own reward, its own source of energy. In order to pay attention, I need to clear the noise of modern existence out of my mind. I do this by taking a little time to meditate and get focused before taking on my daily routine. I know if I fail to pay attention to the stories and lessons out there, my life will be governed by petty routine and become impoverished.

To the extent I can control my ego and open myself to what is outside of my limited consciousness, I can tap into the energy of existence. It's in nature and it's in other people. People with illnesses or disabilities carry this energy too. Partaking of their energy in this way does not reduce them; on the contrary, it affirms them.

Most days that's what keeps me going.

Depressed?

This past week I heard a case where the disabling impairment was severe depression. After the preliminaries, I needed to ask a series of questions concerning activities of daily living (known, of course, as ADLs). It was hard going. The claimant was tearful and confused. Most questions elicited head shaking or blank stares. My questions seemed to be pushing the claimant ever closer to the brink of a complete break-down.

I turned to her attorney and asked him to carry on with the questioning in the hope that his familiarity with the client would calm her down and elicit helpful responses. It didn't. In fact, the more he questioned his client the more anxious and tearful she became. I took over the questioning again.

During his questions he did manage to extract two pieces of information I thought might form the basis for questioning – that the claimant had two dogs and that she watched TV virtually continuously. I decided to try questions about her dogs.

“So, you have two dogs. What kind are they?”

“Little dogs.”

“What breed are they?”

“I don't know. One's old and fat. I think it's a schnauzer.”

“What's the other one?”

“A chihuahua.”

“OK, do you take them for walks?”

“No.”

“You said your older dog is fat, how much does it weigh?”

“I don't know, maybe twenty pounds.”

“Do you ever pick it up?”

“Oh no, I never pick them up.”

“What do you do all day with your dogs?”

“We just lay there. They like to lie down with me.”

Well, this line of questioning wasn't getting me much information, but at least the claimant had stopped crying. I decided to switch to TV shows.

“What TV shows do you like to watch?”

“I don't really watch shows, the TV is just on.”

“Don't you have any favorite shows?”

“I like Boston Legal.”

“Is that the one with William Shatner? Do you watch that a lot?”

“Yeah.”

“That's an hour program, isn't it? Can you follow the story for a whole program?”

“No, I don't watch the whole thing, I just like that William Shatner.”

“Why don't you watch the whole thing?”

“I can't follow the story. Can you?”

I couldn't help myself. I just blurted out, “Of course I can, but I've got special training.”

I smiled a sly, broad smile. Around the court room I could see the vocational expert suppress a laugh. My hearing recorder gave a quiet snicker. The claimant's lawyer had a grin on his face for the first time since the beginning of the hearing.

The claimant's face didn't change. Nothing registered.

I tried again. “You know, special training, I'm trained as a lawyer, that's why I can follow the story.”

“Oh.”

I knew at once I had discovered a new clinical test for depression. I paid the case.