COMMENTARY

Abandoned? Harassed? How Patients View Family Visits

Mark E. Williams, MD

Disclosures

October 20, 2021

One morning, I introduced myself to two roommates at our nursing home. I was new to the floor and was meeting them for the first time. They had been in the facility for several years and over time had needed more help with their daily activities. I don't think they were particularly close, but regrettably, you can't always choose your roommate.

One Patient Felt Abandoned

In the far bed was Beatrice. She was over 90 years old and a matriarch with a large extended family. She was petite but fiery, and she spoke passionately with her words as well as her hands. Her corner was decorated with family pictures, images of saints, and a rosary.

"Good morning, Beatrice," I said. "I am your new doctor. How are you doing today?"

"Doctor, I am really upset," she said.

"Are you in pain?" I asked. "What can I do to help you?"

"I am not in physical pain, but my family has abandoned me. They don't care about me and only think about themselves."

"I am so sorry to hear that," I said. "I saw a young lady leaving your room not long ago. I thought she might be a relative visiting you."

"That was my granddaughter, Sophia," she said. "She or her sister comes in every morning to feed me breakfast."

"That doesn't sound like abandonment to me," I said.

"She is very sweet and my son, Domenico, comes after work every day to feed me supper."

"Beatrice, I am confused," I said. "If someone comes in every morning and evening to feed you, how can that be family abandonment?"

"Because no one comes to feed me lunch."

Beatrice was sincerely frustrated. In her mind, if family members really cared about her, someone would take time off to feed her lunch.

"I am not sure I can help you with that," I said. "I am impressed that you are fed twice a day by your family."

"Doctor, I don't expect you to help. It's their responsibility to care for me and not abandon their mother."

I completed her examination and turned to the next bed.

The Roommate Felt Harassed

Beatrice's roommate was Amelia. She was from an affluent Eastern European family. She was stocky and tough, with broad cheek bones and bright eyes. Her side of the room was also decorated with religious symbols. It had a well lived-in feeling with a single antique chair and dresser. On the dresser were slightly faded photographs in antique frames.

"Please have a seat, doctor," she said, motioning to the chair.

Frankly, I was worried that my weight might be an issue. I gingerly sat down and appreciated how comfortable the chair was.

"Tell me about yourself," I said.

"There is not much to tell," she said. "I had a small stroke and I am not able to care for myself."

"Do you have family who live nearby?"

"Yes, I do, and they continually harass me. They want to visit me, but frankly I prefer my privacy. I was an only child and am perfectly comfortable living by myself. We reached an agreement that they would visit me only on high religious holidays and would stay for no more than an hour."

We chatted, and then I completed my examination.

A Study in Contrasts

I was stunned by the juxtaposition of these two women, both genuinely upset with their families. One was upset because her family would not feed her daily lunch, despite multiple daily visits by family members. Her roommate was bothered by her family's (incessant, in her mind) requests to see her more often.

Each woman would have scored very low on a self-administered quality-of-life questionnaire. But the context of their malaise seemed unreasonable to me.

Upon Reflection…

I appreciate now what I think of as a "law of the universe": Frustration equals expectations divided by reality. We cannot always change our reality. So, when a patient says they are frustrated, I take that as an opportunity to discuss the realistic nature of their expectations.

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