- © 2004 Canadian Medical Association or its licensors
That man haunts me still, even though it was twenty years ago when I met him. His wife was the patient, but I cannot recall her features. She was in an advanced stage of dementia and was suffering from bedsores. Her husband had brought her in to the community hospital where I was an intern. It's his face I remember: lined with suffering, lit up with love and concern. He had been looking after her at home for five years now, while she steadily grew worse and lost all communication with him. He told me that he had made a box for her about a year ago, because her contractures and flailings put her in danger of falling out of bed. The box kept her safe from falling, but he was apologetic that it might have made the pressure ulcers worse, despite the cotton batting he lined it with.
He had come to the emergency department because she was dying and he didn't know what else to do. There were no children. I admitted her with a sad heart and wondered how many other wives there were out there in the vast city, kept in a box, attended to by spouses who didn't know what else to do. She died within 24 hours of admission, and I was glad for her sake as well as his.
I met him again just last month. I could have sworn it was the same man — the same stooped shoulders, the same patient look that comes with years of caregiving. His wife had the same list of problems: dementia, bedsores and contractures that made it difficult to find a blood pressure or administer a bath. There was the husband: sole caregiver, no children, lovingly attending to his wife just like twenty years ago. Only now the environment and context in which I was seeing them was radically different. I saw them not in the sterile environment of the hospital, but at their home, as part of a community palliative care program. And the man was not alone, but supported by personal care workers and nurses who assisted him daily in attending to his wife's needs: dressing her ulcers, adjusting her diet, bathing her. And there was no box. In its place, in the corner of the living room, was a shiny hospital bed, complete with a specialized mattress that continuously relieved the pressure on her painful ulcerated skin.
The picture was exactly the same, yet so different that I caught my breath. This time I was glad, not only for the patient, but for the medical system in which I worked that allowed such progress over twenty years. And I was especially glad for him, and for the other husbands like him, who would not have to fashion a wooden box to keep their wives in, at least not this side of the great divide of death.
Beverley Smith Family Practice Teaching Unit The Scarborough Hospital Toronto, Ont.