Modules

Complexities of care of the elderly

Part 4

  • Penny: Hi dad, you look better.

    Jack: Great. Does that mean I can go home?

    Penny: Dad, Dr. Edelman says you need an operation. That you won’t get better without it. You’ve got to agree.

    Jack: Sure. I’m going to be jumping around on a peg leg like a pirate. Argh.

    Penny: Dad, you need to take this seriously. This is not a joke.

    Dr. Edelman: We have much better ways of dealing with amputations today. Have the surgeons come and seen you and explained that with a below the knee operation you might be able to walk quite normally with a prosthesis?

    Jack: Who are you kidding. I want to be at home, on my own. And if I can’t do that, I don’t care.

    Penny: I can’t let you think like that, Dad, you’ve always been a fighter. We’ll figure out a way … I can come and visit more often or, maybe we can get someone to come in to help or I can see about taking some vacation days.

    Jack: Your mother gave me orders for 42 years. Okay but I don’t want just anybody washing my socks.

    Penny: I’ll wash your socks dad. At first we need to make sure you’re okay.

    Jack: Okay then. How much time would I have to spend here if I have the operation?

    Dr. Edelman: The absolute minimum time we can manage. This must raise many questions for you.

    Jack: Ha! I still don’t think an amputation is going to help.

    Penny: Dad.

    Dr. Edelman: Well then to keep the time to a minimum, let me talk to the surgeon. Adjusting to these changes can be challenging so I’m going to ask a psychiatrist to come and see you. I know him well. He’s helped a lot of people in your situation.

Commentary

What is the reference to “Jumping around on a peg leg like a pirate”? In some instances, the physician might ignore the reference, viewing it simply as another of the patient’s emotional outbursts. In this case, Dr. Edelman follows it up, perhaps as a way of trying to make better contact with Jack’s world. What would you do if you did not know the meaning of the reference?

  • Ignore it?
  • Laugh, as it seems to be a joke?
  • Confess your unawareness of the reference and ask for more information?

Although he is still ambivalent, Jack now seems willing to consider surgery. Does the conversation convey that he has given verbal consent? Should Dr. Edelman present him with the consent form, or would that unnerve this independent-minded person, leading him to refuse again? How much can family members or physicians try to influence a patient’s decision? What about Dr. Edelman’s decision to request a psychiatric consultation? What are the advantages or disadvantages of involving a psychiatric assessment?


 

Next: Part 5

Continue