Let’s call her Joan. Joan was a lady of some sixty years who was brought to hospital by her daughter because she was always crying, sleeping poorly and not eating well or looking after herself as good as she once did. I asked the daughter to go to the coffee shop and give me some time with her Mum.
Joan sat in the dilapidated arm chair in a cubicle. She had obviously made an attempt at making herself presentable but the distinctive feature of her presentation was she looked sad. Very sad. I introduced myself with a smile and outstretched right hand as I sat on the bed alongside the chair – just a little bit of role reversal intended to make it all a little easier for her. She took my hand but avoided eye contact so I held on, gently. That caused her to look up. I smiled again, still holding her hand, and she managed a wan smile so I let go. The ice was broken.
“Your daughter seems very worried about you.”
“Yes, she is, but there is nothing wrong, really.”
“Hmmm. You are wearing engagement and wedding rings but your daughter brought you here. Can I ask where your husband is?”
“He died.” She replied, flatly, then burst into tears.
I brought down the box of tissues from the shelf above the bed and offered them to her. She took a couple and tried to dry her eyes but without success.
“Crying is OK. You can cry as much as you like. I don’t mind and we’ve got heaps of tissues. Would you like a cup of tea?” She nodded. “Milk and sugar?”
“Can I have milk please but no sugar?”
“Absolutely. You just sit there for a few minutes and I’ll be back with a brew.”
The Patient Care Assistant was busy so I made it myself and took it back to Joan along with a small plate of sandwiches from the stock kept in the tea room fridge. She thanked me and sipped at the tea trying to ignore the sandwiches but I persuaded her to nibble a quarter at a time. Eventually, only the crusts were left.
Joan’s husband had died six months previously – suddenly; unexpectedly – from a heart attack, early one morning when making tea for Joan who was still in bed. She heard the crash as he collapsed. She rushed out and he died in her arms with the sound of the ambulance in the distance. And her symptoms dated from that event.
I worked through the questions of a medical history looking for symptoms of illness and especially of severe depression. I had no doubt she was depressed but I was sure it was a secondary depression consequent upon the death of her husband. Then I changed tack.
“Who is in charge of your life?” I asked.
She looked up with a quizzical expression. “No one.” She replied with just a hint of indignation.
“OK. And who used to be in charge of your life?’
This time there was a suggestion of a frown as she replied, “My husband..... I suppose. But he was never bossy or aggressive or anything like that.”
“I was not suggesting anything of the sort. But I think it may have been him who made the significant decisions like how money was spent and that sort of thing. Did you do everything together?”
“Yes. We both played bowls twice a week and liked going to the pictures every now and then and gardening too.”
“And now you are lost without him. There is a huge space in your life that your husband once filled. And you don’t have his support or encouragement to do anything about it. Have you played bowls since he died?”
“No. I just can’t bear the thought of going there without him.”
“But you must have friends there?”
“Yes. They used to come around for a cup of tea and invite me to the club but they don’t seem to come any more.”
So it went on. Fortunately it was a very quiet day and I was able to spend a lot of time with her.
Eventually, with the help of the hospital social worker, the daughter and a friend who had turned up after learning that Joan was at the hospital we worked out a plan that Joan accepted. It revolved around her deciding she had to take charge of her life now and, with the support of others, gradually get back into a normal, but different, lifestyle.
She thanked me for my time and shook my hand as she left. The sadness had gone but she still had a long way to go.
On another day a man in his mid-thirties presented and as soon as I walked into the cubicle I was reminded of Joan. He, too, was profoundly sad, dishevelled, unkempt and unshaven. Again, I could find no clear evidence of physical illness but he was certainly depressed. It also turned out to be a reactive depression. His wife had been imprisoned for repeatedly driving while drunk and told him she wanted nothing more to do with him. She refused to allow him to visit her.
Again, I arranged coffee and sandwiches and spent a lot of time with him. I managed to upset the nurse supervisor when I asked that he be allowed to shower and shave. There are pretty strict rules around what we can let patients with mental illness do in the department. Giving them razors – even disposable safety razors – was a definite no-no. But I stood my ground and insisted he did not have a mental illness. She eventually capitulated, the patient showered and shaved and presented again feeling and looking much better.
After further discussion with him it became apparent that his marriage had begun to fail some years previously. There were no children – he wanted them; she didn’t. She drifted into alcohol and drug abuse and he just did not know what to do about it. And so, in the long run, he finished up telling me all about it.
He knew the marriage was finished and had decided he would not have her back even if she wanted that. He realised his best course of action was to initiate divorce proceedings and them get on with a new life. Coming to those conclusions had been very traumatic for him and he felt guilty about it. Further, he had not shared his problem with anyone else and had rejected approaches by his own family who could see he was struggling. Spontaneously, he shook my hand and said, “Thank you very much for your time. I going to see my Dad and talk to him about all this stuff. I didn’t want to worry him but he was always someone I could talk to.” With that he left.
There are many lonely people in our society. This man and Joan are but two examples.