Modules

Complexities of care of the elderly

Part 3

Five days later, the infection has been controlled, and the blood sugar and hypertension have been treated. Penny has spoken twice with Dr. Edelman. Although Jack’s confusion has cleared, Dr. Edelman is concerned about his ability to live independently.

  • Dr. Edelman: Well. Hello Mr. McTeer. How do you feel today?

    Jack: How am I supposed to feel? Hooked up to these tubes, I’ve got nurses bossing me around, telling me not to get out of bed. And the food – it’s horrible.

    Dr. Edelman: I’m used to hearing complaints about the food here. What did you have for breakfast?

    Jack: Porridge. It’s awful. I don’t eat stuff like that.

    Dr. Edelman: I can certainly have the nurse look at different options for you. Now Mr. McTeer, I wanted to talk to you about getting in and out of bed. The nurses are worried you may worsen the ulcer if you try to walk on your own just yet. Do you remember how the sore on your leg got started?

    Jack: I don’t know. I, I bump into things all the time.

    Dr. Edelman: Do you remember when it got started? Penny said you looked fine the last time she saw you at home. Ah, did you talk to her about your leg back then?

    Jack: When she comes she’s only interested in what’s in the fridge and doing the laundry. She’s not interested in how I feel or what I do.

    Dr. Edelman: Oh that’s not what I heard. She seems quite concerned about you living alone. Have the two of you talked about that before?

    Jack: Hmm. She wants me to go into a home — like this, where people tell you what to do and feed you porridge for breakfast. Well I won’t go! I know it would be easier for her, but I can look after myself.

    Dr. Edelman: I can see that this is very important to you. We can discuss it later, maybe when Penny is here. Right now I really need to talk to you about the treatment for your leg. The infection is under control but the ulcer will not heal. This is due to poor circulation in your leg because of the diabetes and it’s just not going to heal on its own. It will probably get infected again and probably get worse. Does this make sense to you?

    Jack: Well just give me the antibiotics again. I can live with that.

    Dr. Edelman: That’s just it Mr. McTeer. You can’t live with this ulcer, and if it doesn’t heal, we’re just going to have to look at treatment options including amputation. I‘m going to have the surgeon come and see you again. How does that sound?

    Jack: It sounds like hell! There’s no way you’re hacking bits off of me! I came into this world with two legs I’ll go out with two.

    Dr. Edelman: It may well be that if we don’t amputate and get good circulation going, things might get very bad indeed. You could get very ill … (Jack interrupts)

    Jack: You think I’m afraid of dying? Is that it? And I’ll ruin your record for saving lives well, too bad. I won’t let you near me with a knife.

    Dr. Edelman: You do realize you could die if you don’t have surgery?

    Jack: Sure. So what?

    Dr. Edelman: Well, I’d like you to think about what I just said, Okay? And we’ll talk again later. Can I at least have the surgical service come in and see you to explain what they might do?

    Jack: It’s not going to change anything no matter what they say.

Reflective exercise 2

We now know a little more about Jack and his daughter. Penny reveals some of the personal struggles in her life. Dr. Edelman gets some information from Jack about his feelings by challenging his view of Penny (“That’s not what I heard.”).

Dr. Edelman also gets some idea of how Jack views his life and future, and how he feels about operations and being in an institution. Jack’s response to the suggestion of seeing a surgeon sounds ambivalent. Is he saying yes or refusing to answer? Has he given consent to the consultation?

At this stage of his illness, do you think Jack has the capacity to make a decision about his future?

Resources

You may find the following article beneficial for background information about communicating with primary caregivers:

If you require further reading, we have prepared a PubMed search with additional resources.

We have also gathered information on elder abuse for your review:

If you require further reading, we have prepared a PubMed search with additional resources.

 

 


 

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