Sunday, July 11, 2010

LOL

I love the names of the LOL's in my practice. (LOL was Little Old Lady in the medical field, long before we were all rolling on the floor text-messaging.) Ernestine, Thelma, Genevieve, Lula, Ruby, Nellie....each is more awful and somehow more lovely than the next. You don't get to be a nonagenarian if you are a sourpuss. I don't know why, but almost as a rule they are gentle, relaxed people. Chicken or egg? Does being 90 make you relax, or do the %#&holes kick it early? Sounds like some NIH research funding is needed....

Anyway, I saw one of my LOL's this week. She's 93. The cardiologist's notes said that he thinks she's depressed. I asked her about it. "I'm just disgusted with myself." And she cried. Her siblings are all dead. Her kids are aging, she's watching them start their own death march. Though she lives independently still, she requires help with shopping, home care, etc, and resents that. She doesn't feel that she contributes anymore. "I'm just a burden..."

What can you say? There's plenty of platitudes, of course, but really, when life sucks eggs, what can you say? Which of us wouldn't feel the same way that she feels? In residency we learned the BATHE technique, which in retrospect is really a way to teach physicians with poor listening skills how to make a patient feel listened to. It's the anti-therapy, carefully avoiding any deep thoughts, advice, psychological assignments. We never learned therapy.

I had a co-worker suggest therapy to me this week. I was crying. Let me sum up my last 3 weeks: Henry's 6th birthday approaches. My boss dropped dead of a heart attack. My disabled parent is currently doped up on haldol in a hospital 2500 miles away without insurance coverage. I had a personal loss of my own. It has SUCKED. And so I was crying, not uncontrollably so, but crying. She suggested therapy. Therapy. WTF is a therapist going to say about my crying over the last 3 weeks?

So looking at this sweet 93 year old, who indeed is a burden, who indeed is the last of her generation, whose options are to either die or get worse, I could not try to talk her out of her sadness. I'm not even sure that I remember what I said to her. It was somewhere along the lines of "it really sucks and I'm sorry", translated for someone born in 1917.

Maybe in 80 years, when all the Brittany's and Madison's are old someone will find their names awful and lovely too. But life will still be sad sometimes, and that's not pathological. That's life...

12 comments:

socks said...

Applause, applause, applause!

The Shrink said...

I recently saw a patient who'd tried to kill themselves, but suggested they stopped their antidepressant and sent them home - they weren't ill, they were miserable because life was less than peachy.

As you say, older adults who feel they're a burden also can present as pretty glum, disinterested, hopeless and weary, but this is 'cause their situation's pretty glum and has nothing to do with illness.

Even folks who present formally for assessment with high suicidal risk can present without mental illness and I send them home, too.

It's easy to medicalise low mood and suicidal thoughts/feelings/acts as "depression" or "mental illness." But we shouldn't do what's easy, we should do what's right. And if they're not ill, they're simply low in mood 'cause at that point their life's grim, well that's a normal human emotion (not an illness) so has naught to do with doctors or drugs.

rlbates said...

So very well said!

radioactive girl said...

Sometimes life really sucks and it is ok to be sad and upset and cry and be angry because none of it is fair at all. I am there right now a bit and I am sorry you are having a sucky time too. I wouldn't say I'm "depressed", I would say I am reacting to bad news and it is normal and fine. Exactly what I think is the case for you. We shouldn't be zombies, and it is fine to feel our emotions even when they aren't good. I actually think expressing them (by crying or whatever) is healthier than being completely in control at all times.

Thinking good thoughts for you!

Aussiedoc said...

I think the most striking thing for me about General Practice is how little our society allows for grief. I've had elderly people come to me months after their partner of 50 years has died and tell me "my kids think there's something wrong with me because I'm still sad".

Of course you're sad? Do you ever get over a loss like that?

It's like unless you're sunny all the time you must be pathological.

I wonder if this is the same in those cultures where loud continuous grief is ok? Would be an interesting study.

...tom... said...

...

Of course, I had to Google "BATHE technique" before replying here.

Dr. Smak's post is already on page 6 ...with a bullet.


I am definitely paying attention to the 'questions' my doc asks me at my next visit..!!


...tom...

P.S. My mom was a 'Wilma' and my mother-in-law an 'Erma'. Names never seen these days. Neither made it into their nineties ...but neither probably was quite as 'gentle and relaxed' as your examples.

Anonymous said...

Life does indeed sometimes suck and there's nothing we can do about it. I'm sorry for your patient, and I'm sorry it's a sucky time for you right now. (You seriously deserve a break.)

My mother's name was Edna. My grandmothers were Nettie and Irene. But my great aunts -- my mother's father's sisters -- were Virginia, Nevada, Arizona and Missouri. THEIR great aunt was Indiana Territory. Now there are some names! There are lots of little Chelseas and Savannahs out there, but you just don't run across many Indiana Territorys!

Stickhorsecowgirls said...

Brought to mind a poem by Oliver Wendell Holmes famous poem "Last Leaf on the Tree" and also a poignant story titled "God is Near" in one of James Herriot's books. It is his story of how as a young, inexperienced veternarian in Yorkshire in the 1940's, he cares for the aging pets of an invalid woman who senses her own impending death.It is so profound and beautifully written that I shall never forget it.
My sister called me tonight to tell me that here husband's 90 yr. old grandfather who is failing --told her yesterday that although he has pulled through previous struggles, that he believes he will not survive this one. He wonders what awaits him, but stated that he is not afraid. He wanted to know what she (as an RN) thought. She said she was honest with him, said she did not know if he will come through. He then wanted to talk with her about what afterlife would be like.
She told me that when she worked at the VA Nursing Home, when patients said they thought they would not survive, they usually did not. Today he said he thinks he will die tonight. Her husband is staying with him. Both of his grandparents are failing and have been married 70 years! Even as a babyboomer, I can say that it's true--Aging isn't for sissies! As I see my mother struggle in the confusing fog of Alzheimer's, and recall the agonizing struggle my late in-laws endured as compared to the relatively quick death of my father to a heart attack, I can tell you how I hope to go!

Stickhorsecowgirls said...

Oh, almost forgot-- I did get a chuckle out of your bit on the names. My grandmother's names were Elsie and Myrtle! Believe me I was not going to pin that on either of my daughters! Ewww My mother is Bonnie and she is of the generation of Peggy, Shirley, Edna, Ethel, Mabel, etc. All bad! I'm from the generation of Debbie, Becky, Sharon,Janet, and Patricia. My girls went to school with Lindsay, Courtney, Britney and Megan. When I last taught preschool, we were getting little girls named Ruby, Irene, Ella and now my new little granddaughter is named Emma Rose. Hmmm--I preferred a nice classic name like Katherine or Elizabeth or Suzannah--but no one asked my opinion! lol

Anonymous said...

Every time I read a sad and real post like this, its makes me want more children. I think this is irrational, but suddenly I want to gather a large brood towards me and by creating another life somehow try to ward off all the sadness and death, and to make sure at least some/most of my children outlive me.
I think Michelle Duggar must feel the same way and act on her impulse.
I am so sorry that your Henry's birthday is not celebrated with him here. Sorry about alll the other things going badly right now.
Rebecca X

Elizabeth said...

I would worry more if you were not crying with everything that has happened in the last year, let alone 3 weeks..

Anonymous said...

um, sometimes we have to let others care for us (hard for many independent souls) and hopefully it is something they do willingly and lovingly it can bring joy to them- it can be truly a blessing for both cared for and caregiver