Monthly Archives: July 2015

Looking after family member with multiple somatic complaints

I’m not sure if it’s right to say “looking after”, because the son was never in the picture throughout the patient (mother)’s time of visiting our clinic. It was always patient’s friends who brought or drove her here for consultation. Sometimes we’d see some younger friends, some are friends of the patient’s age.

She’s one who had worked hard all her life, as a teacher, housewife, mother. Till the husband had a stroke, and she had to take care of the husband, and also take over the husband’s business. So in the day she taught in the school, after work she went to the shop, later in the evening she did housework, cooking, washing etc.

Then she had a breakdown, having tinnitus, pulling sensation at the back of head, stomach gas leading to poor appetite, consistently feeling anxious, and insomnia. Even when she managed to sleep, she would feel like she was dreaming whole night.

So she had to stop everything, and was recommended by a friend to see a psychiatrist. For the first few months she did get slightly better with medicine. But since April, she started to have more and more complaints all over her body, get weaker and weaker. Till last visit when she came, her friends had to carry her both arms to get her up and walk.

She wanted to admit herself into general hospital for a full checkup. That was also what the friends think she should have done. But the son wasn’t supportive, thought the mother was only attention seeking (according to the friends). He didn’t see the need to do so.

Few days after the visit, when I was calling the patient, the son picked up. This was the first time I heard the son’s voice after following up for almost a year. The patient passed away due to lung infection that very morning. It’s hard for me to believe that. I just saw her less than one week ago. She was weak, coughing and so, but …?!

It’s also hard for me to accept that the son was only into the picture on the day the patient died.

Back in the uni, we used to learn that some patients get themselves ill, or maintain their illness so that they continue to get attention and care from their family or loved ones (including some children who have Anorexia Nervosa maintained to keep the parents together or to get the attention from the carers; or some elderly parents who refuse to get better so that the children will look after them and come visit them).

But such theories, no, such assumptions, aren’t they very harmful? They can be lethal when you assume so and stop looking for the real cause behind those somatic and physical complaints. Was it really love and attention seeking? Or was it real physical illness, pain or injury?

So despite what he thought, if the son had brought patient to the hospital, the lung infection would probably have been detected and treated much earlier. The ending wouldn’t be the same. I wonder how the son feels.

How much can one tolerate?

I’m quite sure it isn’t just me, many of us — while we read those news or stories about women (not necessarily women, could be men or children etc) being abused by their partner for 10, 20 years, and still ‘decided’ to stay with the abuser, believing that one day they will change, — we would really wonder, what make them stay? why don’t they just leave? We would sometimes even call them silly, and they deserve it for treating themselves this way, for not leaving the abuser.

Recently there’s a woman who came to the clinic, it was supposed to be consulting on behalf of the husband, who is very bad-tempered, always agitated, had in the past kicked the children, broke their heads etc. And it wasn’t just the physical abuse, he called the wife and children names, restraint their finance, controlled what they dos and donts etc., he has also been abusing them verbally and mentally.

The woman is one that’s highly educated, she knew the patient in their uni, and they’d been in a relationship since. This man is of very highly sexual desire, so according to the woman, whenever they were out dating, there was always sex involved. One night when they were making out in a park, a group of five authorities came by. The then boyfriend walked them away to deal with them, and as he returned, he told the then girlfriend to go to a small deserted house nearby with the group of men, so that both of them wouldn’t be in trouble for what they did in the park. The girlfriend started to cry, non-stop, she said, “you mean you want me to be gang-raped by them to stay out of trouble? Is that what you mean?” She couldn’t stop crying, and at the end the authorities gave up and let them passed.

Still, she became his wife couple of years later, and remains his wife till today. In the past 30 years, she had been in hospital several times after being hit by him, there were countless times of fights and abuses, even the children were so scared of their father. The boys grew into aggressive men, the girls are in fear of men.

She still thinks the medication may help him and save his husband and their marriage, even when we keep telling her (initially we hinted her, but she couldn’t get it so we just had to be direct) that the medicine may control some aggression but it won’t change him from the inside, it’s not enough to do that, and it may not even be a pure mental disorder.

Sometimes I’d think it’s incredible as of how much one can tolerate. But of course I’m not in the situation so I wouldn’t know if I would be more incredible or ridiculous if I were in her shoes.

Must we help/save the person despite his/her will?

I recently called a sister of a new patient to check how the patient had been doing with the medicine and whether his state had improved, and came to know that the patient hung himself that very morning.

I’m not sure if I’m too sensitive, but I’ve received this kind of news considerably frequent in my job, the sister just didn’t sound sorrow (of course some people hide their emotions very well). In fact she later said that it was a relief not just for the patient, but also for the family.

The patient has 4 siblings who are all married with children. Their parents have passed away for few years. He was the only single and he lived on his own. Though the sister went to see him thrice per day, bringing him food and taking care of him. He had suffered from depression for many years, also done ECT quite a few times. The sister always did her best to help him. She said some siblings had given up on him, but she wouldn’t.

Now that he is gone, she just felt a weight off her shoulders. Then she started to wonder if she had done wrong all these years.

If it meant suffer to live longer, do you still want him to live longer? Just because people all should live as long as they can? Or just because you think it’s your duty to help him to live longer? So you would feel better? So you wouldn’t be blamed for not helping him if something happened? You could say that you tried your best? So you go against the person’s will (partially the illness), you save him no matter what?

It is a bit similar to those family members of terminally ill patient who decide and some even beg the doctors to save the patients, but when you really check, a lot of those sufferers would rather leave in peace, stop the pain and the carers’ suffer, than going through all those operations and chemicals and injections and medication and machines, while at the end still leave, in pain and with holes all over the body.

So what’s considered as selfish act here? And what’s considered right? Who can decide it? Who is the one to make the decision?

Related read: Can we allow a severely depressed patient to make the decision?