Dear GP1 + Yours etc handwritten. Return to Awards Home page here
There was no real result hence our change to GP2.
These notes were written in October 2013.
They are updated in red text on 19 September 2014.
An entirely improved situation now with GP2 at the helm.
These notes have been written by family members to aid the process of medical decision-making. The “I” or “me” in this account is TDH's husband.
The notes are grouped as follows in order for you to assess priorities and look further down for more information:
- Childhood: brought up to avoid causing problems for other people.
- Appointment lists: TDH arrives with five points but two max are raised.
- Night-time: TDH is awake for a long time. Later sleep disturbed by frequent WC visits.
- The day: in bed until 1230, obsessive bathroom activity until 1430. Watches TV, often slumbers until 2130.
- Meals: problem with spacing them out.
- Other factors
6a General anxiety v doing nothing. In denial.
6b Won't go out - if an appointment is before 1500, I try to change it.
6c Abdication – doesn’t participate in simple household tasks such as a
shopping list.
6d The dietician –1 lb per week weight-loss. Is this serious?
6e Good-looks and self respect – more important than keeping warm.
6f My respite time - tears and tantrums.
7 Where do we go from here?
7a A written reply is not anticipated or expected.
7b TDH’s records
7c Is TDH suffering from depression?
7d All family members to discuss the detail of her ailments.
7e Always accompanied by a family member
7f Request for early morning visit
7g Request for double-length appointment
All items are important.
In particular:
7f Request for early morning visit
7g Double appointment in the afternoon/early evening
1 Childhood
1a
Any medic in front of TDH should be aware that she was brought up to minimise inconvenience for everyone she is in contact with. She had a childhood dominated by an archetypal stepmother. Her mother died when she was eight and she was sent to a clergy-daughters boarding school.
1b
There were five children and TDH was the last. A few years older than her was Helen, the step-mother favourite. She would sit in the WC and read books while the nine-year old TDH was made to do housework etc. The latter was often sent into the garden only to return and find all doors locked. Their father was Director of Education in Dorset and wrote books on astronomy. He was never in touch with the family in the sense of knowing about situations described here.
2 Lists
Throughout our time, when TDH is/was due for a GP appointment, we would establish what needs to be discussed. A list of five points during our discussion is always reduced to, at best two during the consultation. From that it can be seen that a double appointment is the ideal. The feedback discussion after is dominated by "But there wasn't time."
3 Night-time
3a
We can now turn to the present and start with night-time. On average, we reach bed at 2300. TDH takes an hour from turning the TV off. She never sleeps until c 0200. That will be later if the good-night routine of cuddle on the sofa, at bedside etc has not been followed to the letter. She is hypersensitive to deviation from routine. While trying to sleep, she will ruminate on the day's events, who said what to whom etc.
3b
TDH always takes from 20 to 30 minutes in the WC. At night add 10 minutes. She is up at least four times and often five times every night. She now has pills which have taken effect. She now gets up once a night, rarely twice. Sometimes it is nought.
I have suggested on more than one occasion that TDH uses a commode in the bedroom at night. She has always refused.
3c
She often comments on her various ailments and pains in her left shoulder predominate.
3d
The Ensure drinks she has been prescribed give rise to a foaming sensation in her mouth day and night.
4 The day
4a
Progressing to reveille, I get up c 0800. TDH is left to sleep until 0930. She may wake c 0900. I bring fruit juice, teapots etc, porridge and then fruit with yoghurt. TDH is deeply religious and reads her Bible a long time each morning. Add dealing with tablets, and it is well past 1230 before she reaches the bathroom.
4b
TDH indulges in obsessive washing. She takes about two hours to wash every morning from head to toe and has done for at least four decades. We arrived in Ross in 2004. She couldn’t use the bath so I installed a shower. She has used it about three times and uses the excuse of the hot water not being consistent.
Update 19 Sept
A DN visit two months ago led to her barging into the bathroom while TDH was washing. TDH was not amused. However, subsequent discussion led to a paid carer helping TDH to shower. It had no effect and she persists in not using the shower. There's nothing a GP could do about this situation. Recording this situation helps the reader understand it in this context.
4c
She emerges from the bathroom any time from 1400 to 1445. Lunch, on average, is at 1430. I prefer 1300.
4d
TDH spends the rest of the average day sitting in her electric disability chair. She watches TV most of the time. I bring tea for us both c 1630 and the evening meal between 1830 and 1900. We watch TV until c 2130.
5 Meals
5a
An important dimension within the complex diverticulum situation as it affects TDH is spacing out the meals. It has been said that she appears for meals late in the day. Eating while sitting in the bathroom isn't a choice. When the main meal of the day is put in front of her, unless it is fairly substantial, she wants more. The process takes an hour. It ends c 1530. There's a break until cup of tea and biscuit c 1700. The bread and marg meal starts c 1830 and, again takes an hour.
5b
I try to track the foaming mucous sensation problem mentioned earlier. There's no real correlation.
6 Other factors
There are other conditions – other factors ( I won't call them symptoms) which TDH experiences. They are probably associated with carees across the board.
6a General anxiety v doing nothing. In denial. Much better now.
6b Won't go out - if an appointment is before 1500, I try to change it.
Much better now.
6c Abdication – doesn’t participate in simple tasks.
Much better now. I had taken over all household tasks by 2004. TDH often ensured that the larder was stocked by looking and writing the shopping list. By 2008, visits to the kitchen were banned and she continued the lists by asking questions. By 2013, she lost interest in that but memory aspects are relevant.
Similar comment re washing. I'd put it into the machine and hang it out. Until 2013, sitting down, TDH would separate it all and put socks into pairs etc.
Much better now in both respects.
6d The dietician –1 lb per week weight-loss. Is this serious?
6e Good-looks and self respect – more important than keeping warm.
6f My respite time - tears and tantrums. Better now.
6a General anxiety v doing nothing
In denial
All family members have researched TDH’s illnesses online. While watching TV, eating her meals, she has a mass of papers etc beside her. These include A4 sheets on her illnesses. She has read them but doesn’t feel prompted to come to the surgery. We maintain pressure on her to do something but it is very difficult. Much better now.
At first we thought a main probem could be bowel cancer but it is it diverticulitis causing bowel trouble?
TDH is complacent over illnesses and thinks there is no help to relieve symptoms even though she has the info to raise her understanding.
This letter aims to end the continual process of pleading with her to talk to you.
Much, much better now with GP2.
6b Won't go out
As winter nears, the prospect of her leaving the house diminishes. If an appointment is before 1500, it is my role to try to change it. Much better now.
Continued at 7g.
6c Abdication
TDH gave up the role of house organiser / housewife many years ago. Rarely does she participate in simple tasks such as producing a shopping list. Better now.
That said, she arrives, but rarely, in the kitchen complaining that the surfaces are harbouring germs. Much better now.
6d The dietician
The dietician is Laura Samuel who weighed TDH on 25 October. She was 9 st 9lbs. On 30 August she was 10st 5lbs. LS remarked that = 1 lb per week loss. Cause? Is this serious?
The Ensure drinks she has been prescribed give rise to a foaming sensation in her mouth day and night. Rarely used now.
6e Good-looks and self respect
TDH went to the WC c 0300 one night. Came back and said it was freezing. The heating had been on from 0530 . I asked if she had used the wall-heater. “No ‘cos it makes my hair go frizzy.”
Much better now. The warmer weather helps.
6e My respite time
There ought to be a heading – Tears and Tantrums. This aspect comes to a head when my respite time looms. It is each Wednesday from 1330 to 1830. Occasionally, I extend it. On Monday and Tuesday of any week, there are tears and tantrums. Much better now.
7 Where do we go from here?
7a A written reply is not anticipated or expected.
7b TDH’s records
7c Is TDH suffering from depression? Much better now.
7d All family members to discuss the detail of her ailments.
7e Always accompanied by a family member
7f Request for early morning visit
7g Request for double-length appointment GP2 has given hours of patience.
All items are important.
In particular:
7f Request for early morning visit
7g Double appointment in the afternoon/early evening
7a A written reply is not anticipated or expected.
7b TDH’s records
This document can be sent as an email if it is thought that TDH’s records would benefit.
7c Is TDH suffering from depression?
TDH is complacent over illnesses and thinks there is no help to relieve symptoms even though she has the info to raise her understanding. Much better now.
She has severe pain in her left shoulder. She has had a sore throat for months (no cold or flu symptoms). Is this related to theesophageal pouch and undigested food rotting in it?
7d All family members to discuss the detail of her ailments.
The family requests that you recommend to TDH that she signs a document allowing all family members to discuss the detail of her ailments. Done.
7e Always accompanied by a family member
The family requests that you recommend to TDH that she is always accompanied by a family member when she consults you. Done.
7f Request for early morning visit
There are tests to be carried out before TDH gets round to making an appointment. Further to the “Going out “ problem at 6b.
We request that someone phones TDH to arrange an appointment at home before she takes in any food and drink. Thank you for phoning two weeks ago. You may have heard me in the background insisting that she talks to you about the tests. It was very difficult. This request now takes the situation forward.
7g
Trying to get her out of the house.
Much better now.
7h Double appointment in the afternoon/early evening
We request that a double appointment is agreed so that I can phone and make it.
If you prefer to discuss this document before the appointment is made, please advise a member of staff to contact me.
As said earlier- an entirely different situation prevails.
With thanks from our daughters and me.
Best wishes.
A F H
19 Nov 2013