Wednesday, February 01, 2006

Family to the Rescue

Two patients of mine have been (at least temporarily) rescued from dire situations. One patient has been living in various local halfway house-type institutions for the last two years, and the other was recently evicted from public housing for drug-related complaints, as previously recounted here.

Magically and synchronistically, both were whisked into relatively comfortable situations this week, coupled with strongly-worded caveats from their respective family members that if they don't tow the line and behave, they will be unceremoniously ejected into the street. This type of tough love is necessary for these two men, both of whom have struggled with addiction, made poor choices, and are wont to make further poor choices when given the opportunity. In the latter patient's case, schizophrenia coupled with addiction has wrought an even greater challenge vis-a-vis the potential for sobriety and stability.

From my perspective, when family begin to take initiative and assume responsibility for their disabled members, my share of the work can either increase or decrease dramatically. The outcome depends a great deal on the family members' ability to manage the client's physical and mental ailments, negotiate the healthcare system, while managing to maintain some semblance of normal home life, especially when young children are involved. Wherein both of these men are people of color, I have found---in a very general sense---that families of color are much more likely to take in (rather than institutionalize) an ill family member. Although this is an admittedly gross generalization and simplification of a multifaceted phenomenon, I think there is some truth to the notion that many non-White cultures---be they Mediterranean, African-American, Latino, or Asian---are much more likely to live in multi-generational households with mentally- or physically-challenged members in the mix. Are there studies of such phenomena? I may just have to find out for myself.

Speaking of families, how likely would I be, for instance, to take in an aging and infirm parent, providing physical care and social support in the final years of my parents' lives? In terms of the Middle-Class White American Dream, having a decrepit elder mar the perfection of one's picket-fence and two-car garage success story is not generally an accepted part of the equation. Middle-class Americans are raised on the isolationist, nuclear-family-centered, self-oriented image of personal success and growth---frequently both emotional and geographic---away from family. The success of nursing homes and assisted living facilities, I believe, is directly born from the idea that we cannot sully our carefully calculated lives with the burden of an elderly family member to care for. As an individual raised in such a cultural climate, I am as guilty (if guilt is necessary) of similar notions, with little thought towards what I would do if one of my parents was left infirm and unable to care for themselves. So many of us keep in the back of our minds the notion that we would find the perfect institution where we could visit our elderly parents with flowers on Sundays, while they were entertained and cared for during the week by loving staff and recreational experts, well-fed, medicated, their every need fulfilled while we enjoyed our regularly-scheduled lives. Do I foresee a similar rosy scenario? Is this realism or denial? Have I not also been enculturated to covet my privacy so much that institutionalization is the only choice for an aging parent?

While doing community development work in the most rural and poor areas of Jamaica, it became very clear to me within the context of that culture that the elderly and infirm were not automatically institutionalized when their care became more needy and complex. Nursing homes are few and far between in a society such as Jamaica, reserved for the truly destitute who are devoid of any known family able to assume their care. However, to describe the scores of abandoned children languishing in the back rooms of the children's wards of many Jamaican hospitals also underscores the fact that even in such cultures where the elderly are apparently honored and revered, devastatingly sad stories of poverty, illness, and societal abandonment abound. Every society is rife with contradictions and conundrums, especially where the care of the poor, ill, young, and old are concerned.

Returning to my New England homeland, it remains to be seen how my patients fare in their new situations with family, and how their families cope with these challenging circumstances. As my position and available energy warrant, I'll help to facilitate proper care, transportation, appointments, medication refills, referrals to specialists, and all of the other tasks which I arrange under the auspices of my workplace. The bulk of the responsibility rests on the shoulders of the clients themselves, who must recognize their predicament, acknowledge their reliance on the kindess and largesse of their families, and behave in ways which engenders further trust and positive relationships, not to mention positive health outcomes. For the moment, I watch, wait, support, and orchestrate as best I can, and watch the family chips fall where they may. Again, as always, there but for the grace of Goddess go I.
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