Further Adventures of the Geriatric Doctor-in-Law

My hordes of readers will recall “The Other Side“, about five posts ago. With both my parents long passed away, I am finding out for the first time about caregiving of frailty semi-first-hand through my wife’s folks. With my background, it’s now routine for a frontal lobe light bulb to go on as I recognize in one or the other of my in-laws the same impossible dilemmas I’ve seen hundreds of times in my patients over the years. And believe me, it’s a whole lot different from this side of the fence.

Robin’s mum Liz is forgetful from early Alzheimer’s disease, and also unsteady on her feet, both problems I see every time I visit patients. But as family we’re trapped in a complicated situation where I don’t have the option to say (like I’m accustomed to saying to patients) “Everybody feels that way, don’t worry,” and to get in the car and drive home.

One evening a few weeks ago Liz, alone in her apartment, fell backwards out of a rickety chair and spent fifteen minutes on the floor, and then another hour crawling over to the couch to try to get back on her feet. Fortunately my sister-in-law showed up and everything was fine, more or less. Liz, bless her heart, doesn’t want anybody to know she fell, refuses to give up the rickety chair, and won’t use her “Lifeline” button to call for help. She could have been on the floor all night.

Worse, she takes the attitude that eventually she’s going to fall and break something, land in the hospital, have complications, and die anyway. So what’s the point of all this fuss and worry about “safety”?

My wife Robin and I (and the rest of the family) in turning this situation over and over see it in various lights. Liz has always been independent and self-determined, but she probably doesn’t understand and gather together the facts as well as she used to, so she may not realistically be facing her risk because of the dementia. Next, putting ourselves in her place, this is about bitchy nanny-type relatives, kids (!) telling her what to do: only one ounce of gin. No going up stairs. Plus a lot of what is on our minds is just selfish: we are not the kind of people that just let their mum walk off the edge of a cliff… Or a different kind of selfish: something bad always happens just as we’re leaving for our place up the coast or on holidays, or in the middle of the night. It just makes sense to prevent it if we can.

What matters most? Should one way of looking at things take precedence in some situations (an injury or shortness of breath), and another in others (facing Liz who asks apparently reasonably, “Can’t I just do it my own way?”)?

And here I am as I was with my father-in-law Nigel going into the nursing home, having seen the video three hundred times, but never having to act in it myself. At the end of the usual show (as the doctor) I’m walking out the door thinking, “I’ve controlled the shoulder pain. They’ll just have to work the psychosocial stuff out.” But when I have to do that working out, as the limitation-of-responsibility attitude of my exit lines suggests, my long experience as a doctor for old people doesn’t give me any head start at all. The problems my wife’s family and I face are incredibly difficult and quite individual to the people involved.

Stay tuned for another post on what I think I’ve learned from my doctor-in-law experiences.

About John Sloan

John Sloan is a senior academic physician in the Department of Family Practice at the University of British Columbia, and has spent most of his 30 years' practice caring for the frail elderly in Vancouver. He is the author of "A Bitter Pill: How the Medical System is Failing the Elderly", published in 2009 by Greystone Books. His innovative primary care practice for the frail elderly has been adopted by Vancouver Coastal Health and is expanding. Dr. Sloan lectures throughout North America on care of the elderly.
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