Sometimes families need more intervention than the patient

I spent 45 minutes of an hour-long session with a patient on the ward this afternoon, listening to the patient's son, rather than assessing the patient. The son (55) is on the verge of a meltdown due to the stress and strain he's under dealing with his father (and apparently other issues going on in his family as well, including as he said at the end, the fact that his marriage has been strained for some time). He insists that his father has memory problems which lead to safety issues at home, including but not limited to the fact that the patient has left the gas grill on before by accident. The son was saying there is no way his father can come home, carers won't make any difference at all since they don't provide 24-hour care, and his father needs 24-hour supervision. (Although the patient is insisting he manages, and wouldn't have carers anyway). The son was basically saying he gets no sleep and is on the "edge." Meanwhile, when I was able to actually work with the patient for a bit, he was able to respond to questions appropriately and scored a 24/30 on the MMSE (which ain't that bad). Now, I don't not believe the son-- his father has cancer of the lungs and a brain tumor that causes seizures, and having been told it will be terminal eventually, ideally the son would like his father to be in palliative care (the patient is currently against anything that involves leaving his home). I only met the patient today and was able to spend only about 15 minutes talking with him. I did see part of his session with the physio, and he is able to walk with a frame, get up out of a chair, etc. However, I do think the son is going to have a hell of a fight, because his father could be cared for at home (and social services won't support an application for residential care unless a patient cannot be sufficiently cared for at home), and if the patient does have the cognitive deficits the son is describing, he hides them well. And as far as palliative care-- well, that initiative would have to come from the doctor, and to override the patient's wishes, again it would have to be proven he is not of sound mind. Ai-yai-yai. I let the patient's son just get it all off his chest, he so needed to, but in the end, I had to tell him it will be the social worker and/or doctor who may or may not be able to help him get 24-hour care for his father.

And then, a really scary sight on my way out the door, a patient with an oxygen mask on at the end of the ward was getting attention from the SHO because his face had literally turned mustard yellow behind the mask. I've never ever seen that before.

On a lighter note, the domestic staff and porters are on strike again, and Annette was helping out with the afternoon tea. One of the Day Hospital patients asked her, "So what do you do here?" And Annette told her she was an Occupational Therapy Assistant. And the patient said, "Oh, you're one of them." I died laughing over at the nursing desk.

Back later on tonight with a more upbeat topic.