An elderly patient was at my clinic for the second time after I discharged her from the hospital. In her previous visits, she was always accompanied by her daughter who is the main caregiver. However during the first visit, her daughter had to attend to something which has already been scheduled a long time before so the patient was accompanied by her sister.
During that visit, I noticed that the patient was not compliant with some of the medicines that I recommended. These medicines were very important because they aim to prevent the patient from being admitted again.
Most of the time, patients comply very well when they understand what the treatment is for so I took the time to explain to the patient again what these medicines will do for her. I have explained these to her when she was admitted at the hospital but I thought that she was probably overwhelmed at that time. Overwhelm is very common among patients because of the sheer volume of information and the fact that there is always a disturbance in their psyche when they are in an illness state.
So I explained to her and asked her several times whether she understood very well. She said she did and we separated on a happy note.
When I texted her daughter to ask how she is doing, she said that she is still quite uncomfortable and I was puzzled as to why. My primary objective for this patient is for her to be free of any discomfort to give her the best quality of life despite the illness.
When they came back to the clinic, she was again accompanied by the daughter. Upon interview, I noted that the patient complied with what I explained the last visit but stopped the rest of the medicines. So again, I explained lengthily why there is a need to continue the medicines and how these can give her a lot of comfort. However, I suspected that perhaps explaining is not all that the patient needs.
After our consultation, I took aside the daughter and spoke to her in private. Upon talking to her, my suspicion was confirmed. The patient may be depressed.
Where Do You Draw The Line?
According to the daughter, the patient used to be a very sociable person. She loved going out especially going to the malls. However, upon her diagnosis, she started isolating herself and did not like going out anymore. It was also very difficult for them to ask her to take her medicines and she was constantly irritated at home.
Patients normally go through a lot of emotions upon the diagnosis of cancer. To go through these emotions is normal. However, after the diagnosis of cancer and a period of adjustment, patients need to be able to carry out their roles while incorporating treatment and other changes in their lifestyle. Inability to do so warrants intervention.
When the patient or their family is already becoming so dysfunctional, when the consequences of such emotions are already mounting or when these changes have persisted for more than two weeks then these emotions are already crossing the line to being abnormal and needs to be properly addressed.
The Face Behind the Mask
Some form of distress is very common among cancer patients. According to Michelle Riba, MD of the University of Michigan Comprehensive Cancer, “About 50% of patients with cancer having some form of diagnosable psychiatric disorder sometime during their course of care”.
It is often difficult to identify distress because the symptoms can overlap with the symptoms of cancer and its treatment. According to the US National Cancer Institute, the following are misconceptions about cancer and how people cope:
- All people with cancer are depressed
- Depression in a person with cancer is normal
- Treatment does not help the stigma
- Everyone with cancer faces suffering and a painful death
Patients who are in distress and who may need help can present with any of the following manifestations:
- Difficulty falling asleep or maintaining sleep
- Loss of appetite even in the presence of one’s favourite foods
- Feelings of hopelessness, helplessness, lack of worthiness, too much self-pity
- Lack of capacity to enjoy things, lack of energy, being constantly tired
- Loss of interest in activities and pleasure
- Being constantly agitated, irritable, gets angry very easily especially with trivial things
- Preoccupation with worries
- Inability to concentrate
The Patient is Not The Only One
Everybody usually focuses on the person diagnosed with cancer. Most of the time, we do not think of the other people who are similarly affected. I often tell patients that when a family member is diagnosed with cancer, the whole family is affected. The disturbance physically, emotionally, psychologically and financially affects the entire family.
The Stigma Of Psychiatry
After speaking to the patient’s daughter, I spoke to the patient again. I told her that I am suspecting that she may be depressed and suggested that she see a psychiatrist. The patient said she would think about it.
Many patients have a very negative reaction when advised to see a psychiatrist. They often think that something is terribly wrong with them. They are afraid to be viewed as “Crazy”, “Insane”, “Cuckoo” , “Out of their mind”, “Hopeless”. But the contrary is true. Patients who submit themselves to scrutiny are actually more insightful and have more likelihood to benefit.
I had another patient who behaved similarly to the patient above. I asked her to see a psychiatrist and she agreed. After a few visits to the doctor, she came back to my clinic more vibrant, happier, peaceful and so is her family.