I am, perhaps, the epitome of the wounded healer. As a social worker for nearly two decades, I have cared for elderly clients, advocated on their behalf to receive the help they needed, heard the panic in their voices when the person who was supposed to help them was late again.

Yet in the past two years, I have found myself homebound and in need of help from others, specifically a home care worker I will call Miriam. Becoming accustomed to being the care receiver instead of the care giver, getting used to the intricately intertwined nature of the relationship between myself and Miriam, has entailed confronting a number of vexing moral dilemmas involved in such a relationship.

I have struggled with physical ailments since the day I fell through a hole in the first floor of an unfinished house when I was nine. That trauma triggered a congenital degenerative joint disease, resulting in twenty major surgeries since 1962.

In the spring of 1997, increasing pain in my left hip forced me to resign my position as a social work supervisor, and since then I have had hip and knee surgeries that have left me disabled and incapable of getting around without pain. I receive physical therapy three times a week and continue to use a walker and wheelchair. I am single and live alone.

After my hip surgery in 1997, it took two months for the state Department of Rehabilitation Services to find a homecare worker who was willing to provide twenty hours of assistance with bathing, shopping, laundry, cleaning, and meal preparation each week. During her first visit, Miriam made it very clear that she would come only if I would sign her time sheet indicating twenty hours of pay for nine hours of work. Miriam felt justified because "everyone does this" and because she lived an hour from my home, received no mileage reimbursement, and was paid only $6.50 per hour.

After much struggle and soul searching, desperate for assistance, I reluctantly agreed to her request. I felt as if I were being blackmailed and was upset over violating my strong ethical principles, but necessity seemed to demand capitulation.

A Stranger in the House
In the beginning, Miriam came to my house for three hours, three times a week, always in a hurry to get home before rush hour. She behaved as if she cared for me solely on her terms, which increased the tension inherent in having to put up with another person's personality, manners, customs, and schedule.

Miriam came from a country near India, but life in the United States did not meet her expectations. She lived in a one bedroom apartment with her two teenage children, and because her husband had recently left her for another woman, she often arrived at my door in tears over the hurt and betrayal she felt. She did her work distractedly and incompletely, leaving me to finish tasks that caused me both pain and physical setback.

During this time, I became Miriam's confidante and companion as she struggled with emotional problems caused by her children and husband. I began to feel resentful: she was supposed to be helping me! Torn between anger and compassion, I suggested that Miriam seek counseling. She replied that her beliefs would not permit her to do so, and, out of the need for physical privacy and emotional protection, I started to withdraw.

I was afraid to tell her how I felt, fearful she would leave if I did not listen to her woes. I became testy and irritable, especially on the mornings Miriam would have to bathe me. I felt humiliated by having someone else perform this intimate act, and hated feeling helpless and vulnerable, emotions that were exacerbated when Miriam made remarks about my scars or appearance. I don't think she meant to be unkind, but her comments added to my deep and overwhelming shame.

As the months went by, Miriam and I developed a guarded yet comfortable interdependence. Her personal and financial problems escalated, however, and Miriam began to spend fewer hours in my home. I was reluctant to report her to the agency, out of a strong sense of loyalty and my own need for the few hours Miriam showed up. I did, however, finally tell her that I could no longer sign her time sheets. I also requested that she work the hours that had been approved, since my friends were bearing burdens she was being paid to do.

Help from Friends
It has been ten months since my knee surgery, and, since Miriam took another job and several workers have either canceled or not shown up at all, I have given up on looking for outside help. There is a price to pay, though, through the pain, fatigue, and setbacks in my progress.

I do have two wonderful friends who come every week to help me with laundry, cleaning, and transportation to various appointments, while other friends and my family provide enormous financial and emotional support. Despite an extensive personal and professional support system, I cannot rally the formal help I need. What options does someone more frail than myself have? Now I know how my clients feel as I experience the multiple losses of dignity, mobility, independence, privacy, and self-respect.

As I struggle with loneliness, isolation, and physical and emotional pain, I do find comfort in my faith, family, and friends. Time set aside each day for prayer helps alleviate the despair I sometimes feel, and keeps me focused on the blessings I have received. I also appreciate the virtues of patience and of humility, knowing that in accepting care from another, the gift of grace is given to us both.

I have overcome some of the pride that perhaps blocks the help I seek, and in the process have forged a new and more honest relationship with my family, my friends, and myself. My religious upbringing taught me that lying and cheating are serious offenses against God and man: These beliefs played no small part in facing the guilt caused by the moral uncertainty of signing Miriam's time sheet for hours she had not worked. In many ways, receiving home care has tested and strengthened my faith, and increased my capacity to endure. Now, not knowing what shape or form my future will take, I wonder if my experiences are meant to help others.

Nan O'Connor has served as an officer and board member of several community social service organizations, most recently as founder and chairman of the Skokie Valley InterAgency Network.