Saturday, May 2, 2009

When You Can't Move On

I had a patient on Friday in my Hepatitis C clinic who was coming in to be evaluated for treatment. Not everyone with Hep C needs treatment, and it's not an easy treatment to tolerate.

To get right to the point, he had problems with depression before so I asked him how he was feeling. He said that this week marked the 10 year anniversary of his mother's death. He's the 2nd oldest of many many children. His mom had some sort of head bleed and was on life support. His dad was having a rough time of it and was quite elderly himself.

The other children (all grown adults) kept saying that the decision to withdrawal life support was the dad's. This was clearly wearing on the dad, and my patient couldn't understand why the oldest didn't step up and make the decision -- one way or another -- to help the dad out. So, my patient took the burden and stood up for withdrawing care.

He tearfully said that decision has weighed heavily on him ever since. He'll hear of someone "waking up" from a year-long coma and wonder if he did the right thing. I tried to reassure him that a 22 year old waking up from a few months after a car accident and an 80-something waking up after a ruptured aneurysm are very different things. I tried to explain that the young people aren't usually vent-dependent -- they have their brainstem intact, whereas his mother didn't. I don't think I helped him too much.

I hope he can find some peace soon, it's been 10 years that he's been torturing himself with this. I referred him to Psychiatry, where hopefully he can get in with a therapist and make some progress. His Hep C is definitely taking a backseat to his mental health. I hope the next time I see him he'll have been able to move on.

1 comment:

DK said...

It's interesting...I have a couple of patients who are Hep C positive and we talk a lot about what it would mean to start interferon treatment. One of them is really interested, but needs to have a little longer period of stability from his mental illness point of view before either I or his hepatologist are comfortable giving him the green light. I had a guy on inpatient last year who got really suicidal once he started treatment for his Hep C, so I get nervous. But the thing that I think is most important with my clinic guy is that the interferon thing is really just a useful and convenient catalyst for getting him to mind his mental health, finally, and get him into therapy so he can really do the work he needs to do regardless of what's going on in his liver. It's nice, you know, when the things we do to help in one arena really spill over and make a positive difference in another.