Caregiving Conundrum: To Intervene or Not

Post #22

As a caregiver at heart, my genuine concern for the health of others can make me a real nuisance sometimes. And I’ve noticed that the same thing can be said for my husband. His area of concern is safe conduct, while mine is usually healthy eating. He has learned to swallow his objections whenever he sees anyone jumping on a trampoline without a spotter, and I’ve learned to clamp my lips tightly whenever I see people chow down on donuts or candy. Inwardly we both want to scream “Stop! That activity isn’t healthy! Please take care of yourself!”

I’ve noticed that many caregivers struggle with where to draw the line between informing others of important ways to take care of themselves and continuing to inform them after the person we’ve “enlightened” has made the decision to ignore us and do as they please. Of course some caregiving situations require that we diligently reinforce safe/healthy behaviors, such as when taking care of children and people with dementia or developmental disabilities. Other situations can make things awkward or openly hostile when we continue to give unwanted advice because many people feel you are either wrong or have no right to tell them what to do. A negative reaction may come from anyone involved in a caregiving situation: an individual you are informally caring for, such as when you offer assistance to an elderly neighbor or an individual who shares your caregiving responsibilities, such as the manager of a retirement home. If there are two people involved, then there is always the probability of differing ideas on health and safety.

However, if a health issue is extremely urgent, as in the case where a person is showing signs of a heart attack or bladder infection, it is very important to make sure they get care in spite of objections. One such example occurred on a visit to my mom (a couple of years before she came to live with me). When I arrived from Texas I had no idea that my mom was experiencing any health problems and was surprised to see that her right hand was extremely swollen. I asked her if it hurt, and she said it did. There was also a scratch—she had tried to pet a stray kitten. I mentioned to my stepfather that we should take her to the emergency room because it could be a bad infection, but he dismissed my idea—not out of unkindness, but because he truly thought it was just “her arthritis acting up.”

The situation was very sensitive. I wanted to get my mom help, but I didn’t want to be pushy or to take over my stepfather’s role as primary caregiver. I also knew that he didn’t trust doctors unless they were osteopaths. At the same time Mom was in tremendous pain that hadn’t been treated because my stepfather only believed in a few natural remedies and wouldn’t give her pain meds. I believe in natural remedies too, but I also believe there are times when regular medicine must be used, so later I slipped her a a pain reliever secretly, which helped temporarily. After she went to bed that night I brought up the subject of taking her to an osteopathic doctor the next day. He finally agreed that we would go to the osteopathic hospital’s emergency room in a small town about 15 miles away.

The next morning after the normal breakfast routine, the three of us climbed into the car to visit Mom’s sister—and I believed that we were first going to the hospital as we’d discussed. However, my stepfather insisted on driving 60 miles in the other direction so my aunt wouldn’t miss their scheduled visit. Again that might have seemed cruel-hearted, but it was true that she depended on their twice a month visits as all other relatives lived much further away. I was inwardly upset with him, yet I knew that he really didn’t understand how serious Mom’s injury might be.

During the trip, my stomach grew tighter and tighter, and Mom was beginning to complain of more pain. I tried to entertain her with songs and books, and at a rest stop I slipped her another pain reliever. (Note: Normally my mom was very healthy except for her dementia, and I knew that no doctor had warned her not to take Tylenol or Ibuprofen.) We visited Mom’s sister, and all went well except Mom’s growing pain. She also felt hot and was beginning to look listless. I knew we really needed to get Mom medical attention, so I concocted a plan to drop by my paternal aunt’s house on our way out of town to give her. . . (I don’t remember what I gave her, but it’s not important anyway). I ran into the house by myself and explained what was going on. She could tell I was really concerned, and when she came out to the car to look at Mom’s hand, she was concerned too. She recommended a neighboring emergency clinic, which she trusted. Auntie even got in the car and offered to take us there. At this point, we were both being a little pushy.

At the clinic, I helped to fill out the paperwork, and fortunately my stepfather signed. When we saw the ER doc, he said that he was giving a prescription for an antibiotic, but if it was any worse the next morning Mom had to be taken to a hospital ER. He explained about the probability of the cat scratch causing the infection and how serious it was. The next morning we rushed to the osteopathic hospital.

This tiny hospital had no cars out front and no sign as to where the ER was located. My stepfather wanted to turn around and go home, but I encouraged him to park in front of the closest door so I could find out if they were open. The doors opened, but no one at all was in sight. I asked my parents to sit while I set out in search for someone who could help us. Through a set of double doors, I encountered a desk with one young woman perched behind the counter. In a soft voice I explained the situation: my mom’s cat scratch, swollen hand, and my stepfather’s refusal to see anyone but an osteopathic doctor.

The nurse explained that the hospital had both osteopaths and MDs, and she wasn’t sure who was on call. With perfect timing a young doctor entered, sporting a name tag with the identifying initials DO. I was so relieved. I explained the situation to him, adding more details, and he quickly went to the waiting room to retrieve Mom while I filled out the paperwork.

This young doctor was both kind and decisive. Mom was in danger of losing her hand; she had to go to a hospital where there was a good hand surgeon in case she needed surgery. There was some discussion over the fact that my stepfather didn’t trust the hospital in their hometown, but I finally convinced him that it would be difficult to go elsewhere unless we went back to the house and got all that mom needed at once—then we’d have to book a hotel. He relented. The doctor insisted on Mom being taken in an ambulance so that there would be no side trips. I rode in the ambulance with her, and my stepfather rode right behind where she could see him out the window.

Fortunately, all went well. Mom stayed three or four days in the hospital and received antibiotics through an IV. It was extremely difficult because once she started feeling better she didn’t understand why she couldn’t go home. She pulled her IV out once or twice. The last day she arose and dressed on her own and sat waiting with her coat on until she was given permission to leave. She kept her hand— and her distance from feral kittens ever after. (As you can see from the above photo, she never lost her love of tame cats.)

As I drove the nearly 500 miles home, I began to reflect on my response to the whole situation. Of course what I had really wanted to do that first night was to take Mom to the hospital even without my stepfather’s permission. I could have made a big scene or snuck her out of the house when he went out for an errand. However, my mom was already in the middle stage of Alzheimers—her reasoning capability had diminished, and she couldn’t safely take care of herself. A rift between my stepfather and myself would have likely meant that I was forbidden to visit. I had needed to act with kindness and respect so that I would receive the same in return. It was extremely important for Mom’s overall health that I be trusted as a visitor and back-up caregiver.

When offering health advice, especially related to someone who is not your direct responsibility, I believe it’s important to do so in a kind and respectful tone. If possible take time to assess probable ramifications, as well as multiple solutions. Act swiftly if urgent, act cautiously if doubtful, let all your previous experience and knowledge, as well as gut feelings and prayer be your guides.