Ask Dr. Don
“Sometimes I wonder if it’s worth it. Even after my other stays here [in nursing home rehabilitation], when I went back to my apartment, so many people had to do things for me. All my life I have done things for myself and taken care of other people. It is really hard to have to depend on them. I feel useless and like I am becoming a burden to my daughters, even though they never complain. It’s like God has forgotten to take me. Why am I still here?”
As health decreases for a patient, it is important to emphasize to the patient that providing care is not a burden. For the sick elderly finding themselves in a new situation of progressive dependency, it can be a vulnerable, scary and humbling position that should be addressed by the patient, family and doctor. Although it may be a foreign position for the patient to be in, hopefully it can be seen as a new phase in their relationship with loved ones.
Loss and Waiting
Nursing home residents often ask me, “Why am I still here? I am old, sick, and all my friends are gone. “ This summation of their loss of health, function, and independence frequently leads them to conclude that they are “useless” and a “burden to their loved ones.”
I was recently asked to see Mrs. H., an 87 year-old, chronically ill patient who came to the nursing home after a recent hospitalization. She was too weak to return to her independent living apartment and had come to the nursing facility for rehab in hopes of being able to regain at least marginally independent function. The nurse told me her daughters were afraid Mrs. H was depressed.
When I asked about her mood Mrs. H told me that she had been “a little down but not really depressed” the previous weekend due to the lack of progress in rehab. She needed extensive assistance to change positions in bed, transfer from the bed to a chair, and to get dressed or go to the bathroom. However, over the past few days Mrs. H had improved with therapy and was now able to stand for several minutes holding onto parallel bars and even walked about ten feet with two aides assisting.
As Mrs. H. had had two previous hospitalizations and subsequent rehabilitation stays in the nursing home within the past year due to chronic illness that was not “fixable”, it was clear to me that she was failing. Our current efforts were unlikely to provide much lasting benefit regarding her future ability to remain independent. The gains were really minimal and the effort required to obtain them was very hard on Mrs. H. She acknowledged these realities when I mentioned that rehab seemed to be very tough and that she looked worn out.
“Sometimes I wonder if it’s worth it. Even after my other stays here, when I went back to my apartment, so many people had to do things for me. All my life I have done things for myself and taken care of other people. It is really hard to have to depend on them. I feel useless and like I am becoming a burden to my daughters, even though they never complain. It’s like God has forgotten to take me. Why am I still here?” she wondered.
“I don’t know. However, in the greater scheme of things there seems to be symmetry to your current situation. You were always helpful to others when they couldn’t care for themselves and now you are useful in another way. It is your need of their assistance that allows them to feel useful and lets them balance life’s scales. It is not always through giving that we help others. Sometimes, by graciously accepting other’s help we give them their greatest sense of worth and satisfaction.”
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