One Slipped Through the Cracks

I have not allowed patients to get to me emotionally for some time. My force field is intact… you can cry, you can scream, you can insult me and my mother, but you won’t break me. Until Friday that is…

It started off innocently enough; she was just there for a follow-up visit. She is in her 80s and we were supposed to be talking about her diabetes. We have the same first name. She was born and raised in Ireland. Being a redhead, I often get mistaken for being Irish. I asked her how she was doing, and she started to tear up. She said she had been having a rough couple of weeks. It turned out that her husband, who has been struggling with dementia, tried to commit suicide two weeks ago, and had to be moved from an assisted living center to an Alzheimer’s unit with constant observation.

I told her that I was sorry to hear that, and started asking her more about how she was dealing with it. She quickly admitted to depression, but said that the last thing that she wanted right now was more medication. I told her about my grandmother, who no longer recognizes me. To my surprise, I found myself tearing up a little bit, too. We talked about how dementia is almost worse than death because the disease ravages so much of a person’s character. It is like they are gone, but yet you can’t grieve their loss because you continue to see them. As a family member, you get stuck with this horrible conflict of emotions. Visits become more and more difficult as the disease progresses. At the same time it doesn’t feel right to not visit your family member, even though they don’t know who you are, or can even become fearful of your presence. She said that she was feeling guilty about not seeing him every day, but it had gotten too difficult for her emotionally to visit him more than once a week.

I really didn’t know what to say and was trying to block myself from becoming too emotionally involved, so I stalled by talking about her diabetes for a bit. After answering a few questions, I wrapped it up by saying that I thought she was making excellent progress controlling her blood sugar, but that I was concerned about the emotional stress that she was dealing with. She said that her daughter was her only source of support, but that she was stressed out about the situation and had her own family to raise. I asked her if she would like to speak with a counselor or maybe someone at her church.

She then said that she had given up on her church after they had not bothered to come to see her in the hospital last summer. Apparently, she had undergone heart valve replacement and had asked a priest to visit her after having dreamed of her own death after the surgery. The priest blew her off on a bishop, who never showed up or even called to check on her later. Just like that, a woman who had attended church every week for over 80 years quit going. I could tell from her tone that she was still very angry and hurt by the incident. She mentioned that she had thought about going back, but didn’t want to go during Lent.

She waited for me to say something, and I started wondering how I ever got from a simple follow-up appointment to someone wanting spiritual encouragement. So often I feel that there are certain boundaries that shouldn’t be crossed when it comes to discussing religion, particularly in a professional setting. Clearly, she wanted me to say something though, so I just said that I thought that she needed someone to talk to. She said that a social worker involved with her husband’s case had mentioned a support group. I said that I thought that would be a good idea and that if she didn’t want to talk to strangers, she could always just go and listen. She said that she did think that she would return to her church. I told her that I would have been very hurt if I had been in her situation as well, and suggested that maybe she attend a smaller parish, where she might feel like part of a community.

Finally, I went and got my preceptor after I’d spent over a half hour talking to her individually. I briefly told him about her situation. Although he told her that he was sorry when he walked in the room, he didn’t say one other word to her about it. Five minutes later, we were done with the appointment. As she left, she thanked me for caring so much and told my preceptor and the front office receptionists that I was very nice. I could tell that I had lifted her spirit just by listening, and was glad that I had addressed an issue that otherwise would not have been covered. I know that everyone has their area of expertise, and that a lot of physicians aren’t comfortable dealing with depression and other issues, but at the same time you can’t just ignore them! I have a friend who is a psychiatrist, and I really admire him for being able to help people the way that he does. I could never do it; I would rather deal with fallout from the local knife and gun clubs. I guess I internalize things too much, ending up exhausted and drained.

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I talked with a couple of my friends about the situation over the weekend because clearly this patient tugged at my thoughts. So far, two out of two agree that I should send an anonymous note to her priest. I certainly don’t want to draw any attention to her in any way that would cause her to feel ostracized, but I just feel like maybe they could use a reminder of how important their interactions are with sick patients. A woman was calling out to them for help, on what she believed to be her deathbed—what a horrible time to be forgotten!