Alice Swann is a big woman with a broad, kind face, the grandmother of her Marbury neighborhood. Her house is always open, and everyone knows her.
She has a way of looking on the bright side although she is way over her head in unpaid medical bills that keep coming. She will tell you proudly that she is married to "The Miracle Man of Charles County," as he has been dubbed by the local newspaper.
Sixty-four-year-old miracle James Swann now lives at Hadley Memorial Hospital in Southwest D.C., where a respirator pumps life into his body, doing the work his emphysema-crippled lungs can no longer do.
"The doctors never thought Swann would make it," said his wife, 55, recalling New Year's Day of 1980 when Hadley doctors called to tell her he was teetering on the very edge. But James Swann pulled through and was later released -- and "he's still here."
Swann is indeed still here, some eight months and $51,000 after he was again admitted to the hospital, gasping for air. He has suffered from chronic emphysema -- deteriorated lungs -- since 1971, and can no longer breathe on his own. A plastic tube hitched to a hole in his throat connects him to a respirator that pumps in a mixture of air and oxygen to inflate his lungs. Without that machine, he would live one, perhaps two hours.
Swann is a small, fair-skinned man, but his face and hands are much darker now, made ruddy by increased blood pressure as he struggles to breathe. He rarely speaks because it is too difficult, but he has learned to mouth words, to speak with his eyes, gestures and a charming smile.
He is also stubborn, often refusing to be shaved or bathed for days until his wife comes to assist.
Long ago the doctors said time had run out for Swann. Now, the money has run out.
Alice Swann's modest salary and her husband's Social Security check add up to $631 a month -- hardly enough to pay for food, heat, telephone, a second mortgage for repairs on their small house, transportation to work and to the hospital, plus $243 per day for hospital care.
The Swanns are among the 8 percent of all Americans who fall between the cracks of private medical insurance and government-paid health care, according to a congressional study.
Medicare, the federal program that covers medical expenses for citizens who are over 65 or disabled, will pay for a portion of the cost for 190 hospital days per illness and Swann long ago used that up. To renew his coverage, he must be discharged for at least 60 days or go to a nursing home.
He is not eligible for payments from Medicaid, the staterun program that covers the medical expenses of poor people, because the maximum allowable income per couple in Maryland is only $242 per month. In the District, that figure is $394 and in Northern Virginia it is $316.
Thus Swann, who is seriously ill and requires a great deal of care, is trapped in the Catch-22 of the long-term care system. Hospital care is prohibitively expensive, but most nursing homes will not accept respirator patients because they require too much supervision.
Ten years ago James Swann was a school custodian and the family's medical needs were covered by Blue Cross and Blue Shield. But a breast tumor and diabetes hospitalized Alice Swann in 1972, at the same time her husband's lungs collapsed. Their policy lapsed and the nightmare began.
Eventually he began collecting Social Security disability payments and Medicare took care of part of his medical bills. Alice Swann took what she describes as "a very sweet job" cooking for priests at Star of the Sea Catholic Church in Indian Head. "I come to work when I can, after I see to Swann."
James Swann stayed home for a few years with the aid of oxygen masks, but infection, heart ailments and coma that resulted from his lung illness forced him into several area hospitals. Last May he was admitted to Hadley Memorial and now he cannot leave.
"We can't wean him off the respirator, we've tried many times," said Dr. M. Taleghani, Swann's physician at Hadley. "He can't go home."
Jim Suzuki, administrator of the small Seventh-Day Adventist hospital, said the institution will not force Swann onto the street, but said that it cannot afford go on losing money either.
"There's no way to recoup the cost. We try to pass it on to consumers," said Suzuki, but he pointed out that the hospital takes more than its legal share of the area patients who cannot pay their bills.
A hospital social worker said that if the institution decides it must collect some payment, a lien could be placed against the Swanns' home.
Some relief for the Swanns came last week, when the Medicaid office in La Plata decided to award the couple coverage for six months because of their exorbitant bills. However, explains Hadley business manager, Carrie Clark, Medicaid will now pay only for the last three months, and "The patient will be responsible for bills prior to that time."
Because the Swanns are $3,400 over the annual limit, an amount determined by Medicaid officials after taking into account the couple's income and other factors, they will be expected to shell out half that amount to pay medical bills every six months when Medicaid cards are renewed.
The solution to this dilemma could be a nursing home or special care hospital which Medicare would pay for. Hospital social workers have been unsuccessful in finding him a place to go.
"It's really said about this case," said social worker Gigi Holodnak. "He's almost a model patient, he's not out of it, and he can do some things himself."
One of Maryland's four state-run chronic-care hospitals could perhaps take care of Swann, but tightening purse strings are forcing closure of one of those facilities, the Thomas Wilson Center near Pikesville, leaving its nearly 200 patients to be redistributed around the state.
Swann was on the waiting list for the Thomas Wilson Center, and is on the waiting list at the Greenbelt Nursing Center. The state's other chronic-care hospitals are Western Maryland Hospital in Hagerstown, Montebello in Baltimore and Deer's Head in Salisbury on the Eastern Shore, according to a Maryland health department official. The capacity of those hospitals will be increased to make room for Wilson patients, according to the spokesman. When asked where respirator patients might go, the spokesman said he wasn't sure, but suspects Montebello is best equipped for that.
"I really don't know where a person like that would be placed," said Mamie Murray of the Maryland health department's nursing home division.
Another possibility is the chronic-care unit at Prince George's County Medical Center, which usually does not accept respirator patients.
Whether there will be space for Swann is unknown at this time, and none of the hospitals is accessible to his wife.
Under similar circumstances Christmas would not have been very happy for most people, but Alice Swann is different.
"Christmas was just beautiful; I had a chance to make other people happy," said the deeply religious woman. "People from the church sent me a lot of food and presents. We had to carry Christmas up there (to the hospital). We took a Chirstmas tree and got Swann a ring."
James Swann had had his heart set on being home, and he wanted a ring. Because the family could not afford a ring, James Swann's godson gave Swann his own Marine ring.
On Christmas James Swann told his wife, "I don't want to go to that kind of home (a nursing home or chronic-care hospital), I want to go to my real home."
Alice Swann doesn't want him to go far away either. "If they put him away, I just don't know; he'll grieve himself to death . . ." She says the only thing she can do now is "trust in the Lord."