Wednesday 23 July 2008


I received an urgent referral from a GP for a gentleman in his 90's. His GP was worried that he had depression and was seriously ill. I saw him at home with a CPN and his family to unpick why he'd gone to his GP and what the issues currently were.

He said he'd been, "in a dark place," which is why he went on Friday (and not Thursday, or Saturday). It was then, that day, that things, "got too much," and his family whooshed him off to his GP. He didn't want to go, but humoured them and 'fessed up that he wasn't coping.

His wife has always looked after him. She's got dementia, he's now looking after her, all the time. He's declined support (in fact, support's been arranged for him and his wife in the past but after a couple visits he's turned them away from his door, feeling he should be able to do it all himself).

His GP thought the gentleman wasn't coping because he was physically unwell with chronic illness, he was fretting over his wife's physical illnesses, he was caring for his wife all the time (meaning both day and night) so wasn't getting enough uninterrupted sleep/was tired all the time and had unrealistic expectations of how he should be caring for her. He wants, "to be independent," and not rely on others. His GP initiated a SSRI antidepressant at a therapeutic dose.

When I saw him he was cured. This was on day 4 of his antidepressant. He was fine, thank you very much, sorry for troubling you and making you come out. All's well. He thinks his GP is ace and has cured him.

One hour on and it's clear that he had a period where he wasn't coping at the end of the week, but is coping now. All that's changed is that his wife's getting physically better and he's had a better sleep since then. He feels his pills have cured him, "Even though the doctor said they will take 10 days to work."

He declined further support. I found some financial benefits he's not availed himself of that he should, but there wasn't anything I could improve upon. From suicidal and not coping one day to cured and symptom free 4 days on. If that truly is the case, it's miraculous and needs writing up. I rather fear he's not cured. I fear he'll not cope too well in the near future when his wife has her next exacerbation of COPD.

I'm seeing him again and offering ideas. But maybe he's right. Maybe he is cured.


Elaine said...

You can take a man to The Shrink, but you can't make him.....

Anonymous said...

A man who no doubt worked all his life and, even tho he perhaps smartens himself up to go out with a jacket, his shirt sleeves are most likely rolled up underneath it.

He's the last person to admit to defeat or even that he's struggling. These are the remaining people of a generation that didn't know how to whinge or complain and even less expected anyone to take reponsibility for their problems.

Didn't he have kids?

Anonymous said...

Could his miraculous recovery be an act stemming from his apparent belief that it is he and he alone that should care for his sick wife?

Cat said...

This is a scenario I've seen many many times - in fact, I have a couple of couples at the moment who I am working with who consistently have refused any support and I am working on trying to find a glimmer in there. It's difficult because you can often see where things will head but you can't force help on people who are adamant they don't want to accept anything because they should be caring for their partners.