8 November 2017
Planning for the ages – if not now, then when?
It was a busy Saturday morning at the clinic in the midst of a major influenza epidemic. The waiting room was “standing room only” when I received a call from my receptionist.
“Leon, it’s Mr Webber on the phone. He’s one of George’s patients. He seems distressed and needs to speak to a doctor urgently. He won’t tell me what it is about.”
I will never forget Bill’s opening remarks when we were connected. “Doctor, if you don’t come now and do something about my mother in law, Edith, my next phone call will be to the homicide squad to report a murder.”
I managed to ascertain that he and his wife were finding it extremely difficult to manage Edith and promised to do the home visit at lunch time.
I was met at the front door of a modest 1950s double-front brick-veneer home. It was much the same as many in the street created during the subdivision of market gardens into residential real estate in the inner south-east of Melbourne. The style was beautifully captured by the artist Howard Arkley (suggest you Google him for picture) whose paintings are now worth almost as much as the houses he painted.
Bill Webber, aged 72, was a tall, solidly built man, possibly a sportsman in his day. His appearance, however, disguised the fact that he suffered from type 2 diabetes, hypertension and ischaemic heart disease and had triple coronary bypass two years ago.
He ushered me into the kitchen where his wife Vera sat, tearful and forlorn. I had not previously met Vera, however it was apparent from looking at her hands that she was afflicted with rheumatoid arthritis.
Bill explained that he and his wife had been caring for Edith for the past seven years. She was now aged 96, suffered from dementia, was frequently incontinent and spent much of her time in bed.
Bill was still getting chest pains, and with Vera incapacitated with arthritis most of the heavy lifting fell on his shoulders.
Edith had been on the waiting list for a public nursing home for two years, but the promise of a bed seemed just as elusive as ever.
Bill felt let down by the system. Home help from the council and district nursing were helpful, but did little to alleviate the day-to-day caring needs.
The family situation was further complicated by the recent marriage break up of their daughter who now, as a single mother, was caring for two teenage boys and needed financial support.
I was led to the bedroom where I met Edith. She was a large woman, possibly over 90kg.
She was clearly disoriented and confused and the smell of urine seemed to permeate the room. In the course of examining her, I noted an early bed sore on her buttock. Vera felt that the confusion had got worse over the past two days.
I suspected a urinary-tract infection and felt urgent hospital admission was warranted. This was at a time when I had access to public-hospital beds at the local community hospital (now a cancer centre).
In the current climate, with a bit of luck, she would be admitted to the “short-stay unit” of a large public hospital while investigation and treatment were implemented and placement organised. Many elderly now crowd these so-called “short stay” places, a euphemism for “where to from here”.
I was grateful to be able to prevent a homicide, but not nearly as grateful as Bill and Vera.
This case illustrates a problem that will become increasingly more common as our community grows older, resources for care of the elderly become more and more stretched, and people in their late 60s and 70s, who should be retired and enjoying life, find themselves caring for their very old loved ones.
Many, despite their own ill health, may fill the ranks of the “sandwich generation” where they care both for their elderly parents as well as their 30- to 40-year-old children, some of whom are suddenly facing domestic crises.
As GPs, we care for several generations within one family. We provide both acute care as well as ongoing care.
Our diagnostic and management processes focus not just on the individual, but also on the family and the community.
As we age, the dependence on family and community resources will only increase. We need to plan for these eventualities now.
For if not now, then when?
Dr Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for almost 40 years
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