part0028

Although Margaret had been here on dozens of occasions before, this was a new experience for her. Margaret sat nervously rotating the rings on her finger as she glanced around the busy waiting room. “Margaret?„ the nurse called from the doorway. In an instant she was standing and heading to meet her new doctor.

As Margaret settled into the chair in the examining room, she smoothed her plaid skirt and tried to relax. “This is silly,„ she reflected to herself, “I am a fifty-four-year-old adult, but I’m acting like an anxious twelve year old!„ But then the feeling flooded back. “How could he retire?„ she thought. “He’d been my doctor for thirty years, delivered my two children, supported me when dad died five years ago from that awful stroke, and then ‘poof,’ just like that, he shuts down his practice,„ Margaret ruminated. Now she had to start all over again with a new doctor.

A knock on the door interrupted her thoughts. “Hello Margaret! Good to see you again,„ said Dr. Hass cheerily as she entered the room.

“Hello, Doctor, thanks for agreeing to see me,„ Margaret replied.

Dr. Hass had first met Margaret two years ago, when her 80-year-old mother, Roma, was found to have a large ovarian cancer. She experienced serious postoperative complications and never fully recovered. Roma subsequently required chemotherapy in a specialized center and moved into Margaret’s home during her treatment. Two years later, she was still living with her daughter. Roma’s health was showing some decline as of late. She was now incontinent, somewhat confused at times, and unable to read or do any fine work as a result of the postoperative complications. She was also unsteady on her feet and unable to negotiate the stairs in the house, making her effectively housebound.

Prior to this visit, Dr. Hass had seen Margaret on many occasions with her mother and had visited them at home, but she had never seen Margaret on her own.

“So, Margaret,„ asked Dr. Hass, “how can I help you today?„

As Margaret took a deep breath, she could feel the tears sting her eyes. “Get a grip on yourself,„ she thought admonishingly. “Well,„ she began, “as you may know, Dr. Kahn has retired and I need a new doctor.„

“Yes, I did hear about his retirement,„ Dr. Hass replied.

“I just got a letter telling me he was closing the practice. There had been no indication at my last visit with him, a month ago, that he might be leaving. Then suddenly he’s gone.„ Margaret paused momentarily, and as she continued she could feel her face begin to flush. “I had known him for years and had good relationship with him, or so I thought.„

“It sounds as if it was quite a shock for you,„ observed Dr. Hass. “Yes, yes it was,„ said Margaret, her emotions barely beneath the surface, “I trusted him with my care, and then he abandoned me,„ Margaret began to quietly weep.

Dr. Hass passed Margaret a Kleenex and said, “You seem very upset by his retirement.„

“It’s the thought of starting all over again with a new doctor that I find so difficult,„ said Margaret wiping her tears.

“I’d be happy to take over your care if you are comfortable with that arrangement,„ offered Dr. Hass.

“Thank you, doctor,„ replied Margaret with a sigh of relief. “Tell me a little about what’s happening with you currently,„ inquired Dr. Hass.

Margaret took another deep breath. “Well, as you know, mother’s health is continuing to decline.„

“Yes,„ nodded Dr. Hass, “In the past our focus has always been on your mother, but how are you doing?„

As Margaret’s story unfolded, Dr. Hass learned that part of her current problems were related to her mother’s illness – she found it very stressful looking after Roma. Her life had been limited by not being able to leave her mother unattended for any length of time, and her relationship with her husband was feeling the strain. Margaret felt somewhat guilty that she had been making inquires about long-term care for her mother, but as she explained, “I feel like I have no choice.„ Her mother was incontinent, a stressing situation for them both, as Roma had always been very fastidious about her personal hygiene. Margaret wondered how much longer she would be able to care for her mother as she became more frail. “I wonder what I will be like when I am her age,„ she concluded.

While much of her life has been devoted to the care of others, Margaret did feel she should have interests of her own and was beginning to enjoy the freedom of not having children at home before her mother moved in with her. Margaret had been very devoted to her mother and wished to care for her but found she was not able to continue to do so, especially as her siblings did not help much. Her brother took Roma for a day a month, and one sister visited every two weeks. She was unhappy with their lack of support, and felt resentful that the burden of responsibility fell upon her shoulders. Her husband felt she had done more than enough for her mother and that it was time for her to be placed in a long-term care facility. “I know my husband is right,„ sighed Margaret, “but when I visit those various nursing homes I just feel so guilty about putting mother in such a place.„ It was clear that Margaret felt torn between her loyalty to her husband and her loyalty to her mother.

Margaret’s life had contracted drastically since assuming her mother’s care. Margaret had given up her church activities to be with her mother. “I really miss singing in the choir. It was such a pleasure,„ Margaret said with regret. Her friends now visited infrequently, as it was awkward with her mother. Her greatest loss was not being able to spend time with her young grandchildren. “They are such a delight,„ she stated, smiling proudly, “and they are at that precious age. Oh I do miss them, but I can’t leave mother to go visit them.„ Her sadness was readily apparent.

The second major issue for Margaret was the loss of her relationship with her doctor. His sudden retirement had been a serious blow for her. Dr. Hass felt fortunate that she already had some contact with Margaret and certainly now had a better understanding of her context. The challenge would be to gain her confidence and trust.

“Margaret,„ said Dr. Hass as the visit concluded, “there is certainly a lot of stress associated with caring for your mother. I can see that it is causing distress and perhaps we need to talk further about how together we might make some changes that are good for both of you. What do you think?„