Monday 18 February 2008

Caring families

It's good, when of venerable years and in our dotage, that family care for us.

I saw a new patient. I like to see folk at home at least once but on this occasion I saw him in out-patient clinic, through his choice. His GP had referred him with depression.

What was the gentleman's tale? He'd been widowed for a decade and was quite used to living on his own. He'd become more frail, couldn't walk as far as he used to, couldn't manage all the shopping and proffited from additional support. His son and daughter-in-law offered to look after him. He relocated from "down South" to my neck of the woods, moving in to his son/daughter-in-law's home which was difficult. He doesn't like moving. He's got to know the local church, so feels connected and a part of the church once more, which is good for him. He knows some of the folk in his locale now, passing the time of day if he seems them in the streets or corner shops, which is good for him. He spends time talking with his son, when they're alone, his son listens, which is good for him.

He doesn't get on with his daughter-in-law now and when she's in the same room as his son, his son sides with her and hardly talks with him. He says she's heartless and unforgiving, but who knows what the truth is. Not me, for sure.

He's not lonely. He's low in mood. He's got poor sleep, initial insomnia, broken sleep, early morning wakening, diurnal variation in mood, loss of appetite, loss of weight, loss of energy, loss of motivation, no hope or optomism for the future, feels worthless and devalued and frequently (daily) has passive suicidal thoughts and feelings (i.e. wishes he'd go to sleep and die, but isn't planning on actively killing himself). He's a quiet, stoical and almost regal gentleman, open and honest but wan and faded, he looks resigned and beaten.

Why? Well, his daughter-in-law is kicking him out of the house. This is the precipitent for his low mood. I don't have a pill to cure this problem.

Worse, I've feelings of disquiet . . . couldn't she have made this clear before he sold his home down South, or before she'd got a new bathroom with the profits, or before she'd bought the new car and conservatory with it?


Ms-Ellisa said...

That's not nice...

It's horrible.

How can you tell if he's telling the truth or if it's some form of Alzheimer's desease or other case where older people seem to think other's are against them?

Can someone tell between these things?

I hate it when families don't care for older people. It seems disrespectful and ungrateful...

After all, as parents, they did take care for their children when it was their turn, right?...

Disillusioned said...


Like you say, no pill for that.

Is there any way you can get the son onside - make him see what is happening to his father? There seems to be a bond between them, from what you say.

Of course, there may be another side to the story - though it is hard to see what that might be.

XE said...

That's horrible. Absolutely horrible. No wonder he's depressed, I feel terribly sad just hearing about the situation. I'll be thinking of him and hoping for a happier home life for him soon.

Made by Mandy said...

"He's a quiet, stoical and almost regal gentleman, open and honest but wan and faded, he looks resigned and beaten."

Most of that could be written of my Dad.

When he is well he is not so quiet, although for many years he was a shy and reserved man.

Lately, he has looked beaten but I have seen less than resignation (certainly today). Anyway, enough of my stuff.

Our families age...mostly (some die young, sadly) and we are more likely to hit old age than not. So, in some ways the people you provide care for are reflections of ourselves to come. Perhaps the Ghost of Christmas To Be.

I love my Dad, and I guess and hope that most people love their parents and do what they can for them. That is not to say love and care are easy options. They aren't options really..or shouldn't be.

But when conflict is involved, and an older family member is seen as a burden well that is tragic. Maybe the daughter in law should think about her old age and how she would like to be treated when she is not so able. Just a thought and I don't know what is going on in that dynamic so can't really judge with any certainty.

More food for thought,isn't it?

Milk and Two Sugars said...

You got his position across well. I find myself feeling down on his behalf.

Elaine said...

This is such a sad story. My worry is that the daughter in law is getting so much of the blame. What about the son. Surely he knows where the funds came from to buy all that stuff and had the power to say "No". Looks to me like the son is dumping dad just as much as the daughter in law.

The two weeks on a trolley team said...

This is truly a sad story. no wonder my old psych tutor said you guys all have to have regular "debriefing" sessions. We see so many nasty things in paediatrics, but this is one of the first times that reading a medical story has made me properly sad.
You guys do a great job.

Dr. Thunder

Made by Mandy said...

Fair comment Elaine.

twoweeksonatrolley...classic blog title. :>)

Cockroach Catcher said...

Whatever age range you see you are going to come across such sad stories. A classmate of mine who was in psychiatry in Canada until twelve years ago decided that he had seen enough of these cases and retrained as a lawyer. Now he is enjoying his work. He told me he in fact sees the same cases, only he now deals with them in different ways. He would probably have helped the father sign proper contracts with the son and daughter-in-law in case of such eventualities. He might also find a way round it if that had not been done. I suspect here the father thought he was doing his son a good turn and gave him the money before the seven year rule caught up with him. As a regal gentleman he will now have to look to our “Supreme Leader” for care.

The Cockroach Catcher

The Little Medic said...

One of the reasons I just can't cope with psych. I don't know how you do it!

The Shrink said...

We never get debriefing sessions, isn't that what gin and tonic's invented for? :-)

The situation is difficult. The son has had unsuccessful relationships and wants this to work. When stick between supporting his father or supporting his wife, he chooses his wife.

Lawyers couldn't really have changed the situation since the only legal redress, realistically, is financial. Even a skilled barrister getting a judge on side couldn't get a court to rule that the man should be cared for compassionately and make it so.

If he had sought legal advice he's have undertaken a Lasting Power of attorney for both health and social welfare decisions so could be in an even bigger mess.

imPRESsed1 said...

Sorry, I know this is off topic, but why are the traditional MAOi's so underused in depression Tx today? It seems that they can be quite effective for treatment resistant cases, ans should maybe considered second line therapy for atypically depressed patients. Do you use MAOis in your practice at all?