Families: August 29, 2005
Monday was a rather depressing day for the Psychiatry Consult & Liaison Service. We saw a number of patients in situations that were particularly difficult for us to bear.
A 46-year old woman who is a slave to alcohol. Her family is intervening, and one of her sisters, a corporate lawyer, is laying down the law. She'll go as far as paying for her rehabilitation out-of-pocket. If that doesn't work, she's threatening to invoke Section 35, a Massachusetts action which will allow the state to forcefully commit a patient to drug rehabilitation.
Her family is in the hospital discussing options. Sadly, this family reminds me of another that I encountered when I spent a week at the Betty Ford Center Family Program. A successful sibling, out of desperation and frustration with his brother's alcoholism, personally paid for his brother to come to grips with his disease at Betty Ford. It may have worked for a time, but substance dependence is a relapsing, remitting disease, and the odds are that his brother went back to the bottle, and dragged his entire family with him down a deep, dark hole.
I don't have much hope that this woman's family will escape the same fate. Mitch notes that putting forth the effort is important to the family, just so they know that they tried everything. Her battle against alcoholism is going to strain this family for quite a while, and it's likely that they've already been through some very rough times.
A 56-year old man who had a below-the-knee amputation (BKA) of his right leg five years ago. Obese, diabetic, wheelchair-bound. It's difficult to stay in shape when you're in a wheelchair. He's been so depressed and feeling guilty about his condition that he refuses to leave the home, afraid of looking like a freak to the outside world. His sedentary lifestyle has worsened his health, of course, and it's hard to prescribe any sort of physical activity, as his heart now has an ejection fraction of 15% (normal is around 55%). He's visiting a vascular surgeon because now his left leg is infected. Without the proper care, he'll lose his left leg, too.
This case is particularly painful because the patient is an articulate, intelligent, and insightful individual, and to see these feelings weigh upon him is difficult to observe. This is a man who has felt ill every day, every hour for the last five years. He has thoughts of suicide, but has decided that he can't do that to his family. Still, he is rapt with guilt, feeling he is a burden to his family. His family cares for him, of course, and would be devastated should he pass on.
We said goodbye to Clive, who was absolutely giddy about finally leaving the hospital:
Mitch: Well, Clive, you look pretty happy.
Clive: Yeah....I'm going to stay at my mom's house for a while.
Mitch: Okay, well, take care. You remember this guy, don't you? (pointing at me)
Clive: ....Yeah.
Mitch: Do you remember his name?
Clive: ....Wong Sang Chang...hee hee...(never let it be said that schizophrenics can't have a sense of humor)
Mitch: Well, that's close, but his name's Mike.
Clive: ....Oh, right...(Clive shakes my hand)
Mikey: "Mike" is a little easier to remember, isn't it?
I'm going to miss Clive. Aside from his manic episodes, he's a really sweet 42-year old kid. He walks out with his parents. I'm touched by the commitment of his parents, who have cared for Clive all of his life. If they're tired, they don't show it at all. Clive's mom is an adorable little old lady (LOL) who has a shopping list of medications for Clive - but she's ready to take it all on.
A 45-year old man with squamous cell carcinoma of the tongue. This tumor has grown to the point that it forces the front of his tongue to protrude out of his mouth. He can't eat, drink, or talk. He needs a trachea tube to breathe. Every couple minutes he has to wipe the drool bubbles collecting at his lip. A little less frequently, he has to clear the phlegm plug that is hanging from his trachea tube. Interviewing him is interesting, as he can only communicate with pen and paper. This takes a while. When he's not writing or suctioning the phlegm from his tube, he's staring at his tongue using a small mirror. He can't stop staring at his tongue. We think he has a form of obsessive-compulsive disorder (OCD).
I'm assuming due to the size of the tumor that the cancer was not detected early, and it's likely that it has metastasized to adjacent lymph nodes. This tumor is just going to keep on growing until it kills him. His care is complicated, and his family now refuse to let him live at home because they cannot help him deal with his disease. He'll most likely spend his last days at a specialized nursing facility.
This is only my first rotation, so I am mindful that there will be gloomier days ahead. But...what a way to start the week.
*****
A 46-year old woman who is a slave to alcohol. Her family is intervening, and one of her sisters, a corporate lawyer, is laying down the law. She'll go as far as paying for her rehabilitation out-of-pocket. If that doesn't work, she's threatening to invoke Section 35, a Massachusetts action which will allow the state to forcefully commit a patient to drug rehabilitation.
Her family is in the hospital discussing options. Sadly, this family reminds me of another that I encountered when I spent a week at the Betty Ford Center Family Program. A successful sibling, out of desperation and frustration with his brother's alcoholism, personally paid for his brother to come to grips with his disease at Betty Ford. It may have worked for a time, but substance dependence is a relapsing, remitting disease, and the odds are that his brother went back to the bottle, and dragged his entire family with him down a deep, dark hole.
I don't have much hope that this woman's family will escape the same fate. Mitch notes that putting forth the effort is important to the family, just so they know that they tried everything. Her battle against alcoholism is going to strain this family for quite a while, and it's likely that they've already been through some very rough times.
*****
A 56-year old man who had a below-the-knee amputation (BKA) of his right leg five years ago. Obese, diabetic, wheelchair-bound. It's difficult to stay in shape when you're in a wheelchair. He's been so depressed and feeling guilty about his condition that he refuses to leave the home, afraid of looking like a freak to the outside world. His sedentary lifestyle has worsened his health, of course, and it's hard to prescribe any sort of physical activity, as his heart now has an ejection fraction of 15% (normal is around 55%). He's visiting a vascular surgeon because now his left leg is infected. Without the proper care, he'll lose his left leg, too.
This case is particularly painful because the patient is an articulate, intelligent, and insightful individual, and to see these feelings weigh upon him is difficult to observe. This is a man who has felt ill every day, every hour for the last five years. He has thoughts of suicide, but has decided that he can't do that to his family. Still, he is rapt with guilt, feeling he is a burden to his family. His family cares for him, of course, and would be devastated should he pass on.
*****
We said goodbye to Clive, who was absolutely giddy about finally leaving the hospital:
Mitch: Well, Clive, you look pretty happy.
Clive: Yeah....I'm going to stay at my mom's house for a while.
Mitch: Okay, well, take care. You remember this guy, don't you? (pointing at me)
Clive: ....Yeah.
Mitch: Do you remember his name?
Clive: ....Wong Sang Chang...hee hee...(never let it be said that schizophrenics can't have a sense of humor)
Mitch: Well, that's close, but his name's Mike.
Clive: ....Oh, right...(Clive shakes my hand)
Mikey: "Mike" is a little easier to remember, isn't it?
I'm going to miss Clive. Aside from his manic episodes, he's a really sweet 42-year old kid. He walks out with his parents. I'm touched by the commitment of his parents, who have cared for Clive all of his life. If they're tired, they don't show it at all. Clive's mom is an adorable little old lady (LOL) who has a shopping list of medications for Clive - but she's ready to take it all on.
*****
A 45-year old man with squamous cell carcinoma of the tongue. This tumor has grown to the point that it forces the front of his tongue to protrude out of his mouth. He can't eat, drink, or talk. He needs a trachea tube to breathe. Every couple minutes he has to wipe the drool bubbles collecting at his lip. A little less frequently, he has to clear the phlegm plug that is hanging from his trachea tube. Interviewing him is interesting, as he can only communicate with pen and paper. This takes a while. When he's not writing or suctioning the phlegm from his tube, he's staring at his tongue using a small mirror. He can't stop staring at his tongue. We think he has a form of obsessive-compulsive disorder (OCD).
I'm assuming due to the size of the tumor that the cancer was not detected early, and it's likely that it has metastasized to adjacent lymph nodes. This tumor is just going to keep on growing until it kills him. His care is complicated, and his family now refuse to let him live at home because they cannot help him deal with his disease. He'll most likely spend his last days at a specialized nursing facility.
*****
This is only my first rotation, so I am mindful that there will be gloomier days ahead. But...what a way to start the week.
posted by Mikey at 11:35 PM
5 Comments:
Yo Wong,
I have to agree with Cathy. It is readily apparent that you've earned and are every bit living up to the title of the blog. You rock.
BTW, what do you recommend for a thirty-something lawyer with a nigh-obsessive compulsion to mosh on the T to the music on his iPod (so far, not the music on rotation in my head meats)? Oh, and by "mosh" I mean thoroughly freakin' decimate the guy standing next to me with his damn backpack bumping into my fresh tattoo work.
For you, I'd probably prescribe nothing. Although starting off the day to death metal may be a red flag for something. Perhaps a morning listen to something more serene would be of use.
As for Guy-with-backpack-rubbing-up-against-you, CLEARLY he needs to be put in restraints.
If by "restraints" you mean a vicious choke hold, then I agree with you whole-heartedly.
Kinjo: I've always found that a well-timed body check when the train lurches can often be just the thing. Or you can pretend to trip over something and give bag-toting guy a good stomp on the foot. Own your space!
Jocelyn
I agree that an "accident" would be better than an Ultimate Fighting Championship maneuver. Of course, I am relatively passive on the T. I just don't need the agida (or the bad karma), so I tend to just breathe deep and ignore. I'm a big softy, I know.
Post a Comment
<< Home