Shelia Vulcain of Chicago

While she struggles to manage multiple chronic conditions, she feels as if "each doctor deals with only what they have to deal with then and there, and that’s it."

At 71, lifelong Chicagoan Shelia Vulcain has ridden out some tough situations. In 1983, the eldest of her three sons was murdered: "Our children are not supposed to go before us, it’s not right." In 2000, Shelia was diagnosed with a heart condition and sought medical disability retirement, "but my employer said, ‘There’s nothing wrong with you!’ For months I had nightmares about dying at work."

In 2002, as she stood at a busy Chicago intersection, Shelia suffered a stroke and collapsed on the street. "But right across the street from where I fell was the Northwestern University Hospital emergency room," she recalls. "Was I lucky, or was I lucky?!" After the stroke, Shelia retired on medical disability.

With help from a senior assistance program associated with Chicago’s historic LaSalle Street Church, Shelia continues to live on her own in a senior citizens’ apartment building. But in recent years, she has struggled with the worsening after-effects of the stroke and other health issues. Though she likes most of the health care providers she now sees, Shelia often wonders: Is each of them actually familiar with the treatment orders of the many others? And do they grasp how hard it can be for seniors to keep track of, let alone follow, all those orders?

Shelia knows she should have kicked the tobacco habit earlier in life. After the stroke, "the doctor raised it and I quit at that very time, I threw the cigarettes in the garbage and haven’t smoked since." But the long years of smoking have taken a toll, and resulted in a long list of doctors. Shelia counts them off: "The whole pulmonary thing is a mess, so I’ve got a pulmonary doctor for emphysema and the COPD (chronic obstructive pulmonary disease), the emphysema and chronic bronchitis. I have the gastroenterologist working on my hiatal hernia. Then I have the cardiologist, she’s really cool " but at the end of next month, she’s folding up shop and going into practice someplace else. I’ve had a rheumatologist for the arthritis, though sometimes I had to wait so long to see her that I just walked out. I have a foot doctor because since the stroke, my foot and other things on my left side have started messing up. And I have a chiropractor I should see monthly -- but when the weather is bad, I don’t go because with my breathing problems, I can’t take the bus to get there."

Shelia tries to laugh off her infirmities: "The fact that, more and more, I cannot lift things is a big help to me financially because now I go shopping a lot less," she says. But it’s no laughing matter when weakness and pain keep her from doing her own laundry, housekeeping and grocery runs. One day recently, Shelia says, "there were things I needed so I decided to go out on my own " but by the time I came home from the store, my left hand was holding my stomach because it hurt and my right hand was holding my back because it hurt. I had to stop all along the way, and I was thinking, ‘Where is ‘Kesha when I need her?’"

"’Kesha" is Shakesha Dye of the LaSalle Senior Center. An affiliate of the LaSalle Street Church, the LaSalle Senior Center operates nearly a dozen programs serving about 1,000 seniors monthly. Shakesha coordinates the center’s Senior Assist Program, which helps struggling seniors with day-to-day activities from picking up prescriptions and sorting medications to shopping and light housekeeping. Shelia says Shakesha has been a godsend on all kinds of tasks.

When Shakesha isn’t working for LaSalle, she’s researching her senior project to complete her undergraduate degree. Shakesha says her research question -- "How can communities encourage quality of life for older adults by supporting their independence?" " was inspired by her work with Senior Assist. And she’s forming her answer to that question from her experiences with people like Shelia. "I see more productivity out of the seniors, and better quality of life, when they can continue to be self-reliant," Shakesha says. "When seniors are supported in maintaining their health, that helps maintain their independence, it improves their lives -- and I think it improves the nation’s health situation overall."

Shelia says she’s trying to do her part to be healthy, but that health care institutions don’t always make that easy. "When I started out being sick, I was working, I had health insurance and money from the job and so I was a cool patient," she says. "But now I’m not so cool -- I’m not working, I’m on Medicare and so I’m pitiful and I go where they tell me to go." Shelia says that when medical providers prescribe certain regimens, although she does her best, some "doctors’ orders" can be impossible to follow: "After my fall, one of the doctors prescribed physical therapy, but after a while I had to call the company and tell them, ‘I can’t afford to pay my part of this anymore.’ My apartment building has exercise classes in the community room, though " so three times a week, yours truly goes to those classes!"

For all her determination to keep going, Shelia says, "I’m an old lady! And I don’t remember things as well," so increasingly she struggles to keep track of all the health care practitioners, prescriptions, appointments and fees. Shelia says that Shakesha "is so darned helpful" when it comes to coordinating all that " but she wishes her own health care practitioners were, too. "I tend to think they’re just working in their own specialties," she says, "and as soon as something happens to you, you go to your everyday doctor and he gives you the name of another doctor" ... Each doctor deals with only what they have to deal with then and there, and that’s it."