Robert "Bobby" Coward, 48, is all smiles after receiving a shave from his home health care aid, Lois Wilson, at his at his home in Washington on Monday. A car accident in 1991 left Coward paralyzed. (Joseph Victor Stefanchik/The Washington Post)

The small, white pill was put on the tray table in front of him. Bobby Coward, a 48-year-old quadriplegic, licked the side of his hand and tried to pick it up by making it stick to the slicked skin.

It fell, then skittered across the table. He tried again. It fell again.

He re-wet his hand, and this time, the pill stuck. But just before he got it close to his mouth, the pill fell, bounced off the wheel of his chair and landed on the floor.

His long-time home health aide, Lois Wilson, bent to retrieve it for him.

It was Inauguration Day, the closest thing Washington has to Mardi Gras, and hundreds of thousands of people were gathering to celebrate the second term of the country’s first black president.

Coward lives on East Capitol Street in Northeast Washington, just three miles from the ceremony. But on some days, it might was well be a continent away. This is the Washington that struggles — with health issues, with unemployment, with poverty, with crime.

“Last time, I went [to the inauguration]. But I had a loaner chair, and it didn’t hold a charge very well. So I couldn’t go very far and ended up just looking at a bunch of behinds,” said Coward, who lost most of the use of his limbs in a car accident more than two decades ago and whose sense of humor about his own body is a little wicked.

On a recent visit to the Capitol, as Coward rolled his chair over the high ramps that cover the streams of electrical cords that snake across the grounds, the incline was so steep, he tipped backwards. He was hurt in the fall and was rushed to the hospital. He fought with Capitol officials to change those ramps, and by Monday they were sloped much more gently for the disabled.

Even so, Coward decided not to fight the crowds and watched the inauguration on television.

His day began at 8 a.m., when Wilson, who’s 52 and lives in Southeast Washington, arrived on the U2 bus. She has been Coward’s home health aide for nearly a decade. And they have a quiet rhythm to their morning routine.

There was the process of getting Coward out of bed, and into his chair. Then the complicated and methodical bathing. The facial shave, the head shave. With each task, the former airplane technician quietly said, “Thank you, Miss Wilson.”

Anytime there is something — the smallest thing — that Coward can do for himself, Wilson lets him.

She straps a spoon to his hand so he can eat his waffle-and-bacon breakfast, which she cooks on a George Foreman Grill in the room that is his living room, bedroom, kitchen and command center.

There is the pill, which she lets him take by his own method.

She steps back whenever he gets a phone call. And he gets plenty. Coward, an Air Force veteran, became an activist on behalf of the disabled when he found so many roadblocks on the road back to his old life after a spinal cord injury. He was driving down Marlboro Pike in 1991 when he swerved to avoid a police cruiser and his Bronco rolled over. He woke up in the hospital with a broken neck.

Wilson worked in catering, in an office and in a day-care center when she went to school to become a medical assistant. But there were no jobs in her field when she graduated, so she tried home health care.

She got a job with Home Care Partners, a nonprofit that provides care for 800 mostly elderly clients using local funding, or, in the case of Coward, Veterans Administration money.

The need for home health care is growing because so many older folks want to age in place, but the funding isn’t, said Marla Lahat, executive director of Home Care Partners. Provisions for providing more funding through Medicare and Medicaid were ultimately cut from President Obama’s health-care reform legislation.

Coward said he was disappointed in that, but vows to keep fighting for more care, something he believes can be accomplished during the president’s second term in office.

Like Coward, Wilson thought about trying to go to President Obama’s second inauguration. But it would have meant leaving her clients in the lurch.

“I can never call in sick or skip work. I mean, I can, but then I see them in their bed, and I think of all the things I know how to do for them, and how they want it done,” she said. “And I just can’t not be there for them.”

So as she washed Coward’s frail body, gently went over his bedsore, put his eyeglasses on his face, they both watched the television together, just a few miles and worlds away from the pomp and parades of Pennsylvania Avenue.

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