The following are quotations from the letters 11th/30th August 1995.
11th:- From the Hospital Consultant to a GP.
"Firstly the patient had apparently suffered a minor CVA and had been sent either to Casualty at the Southern or had been admitted there briefly. Once home again, she developed a chest infection according to the son "the wrong antibiotics were given" and the patient became worse. She was subsequently admitted because of bowel problems to the surgical wards and had only been discharged two days prior to my visit.
The patient was sitting in misery bemoaning her fate. She was loath to speak or even look at me. The problem was attributed by the son as irritable bowel syndrome. Although the patient confirmed this, she was quite unable to describe symptoms which might be responsible for her affect. She did admit being able to go to the toilet without difficulty. This was not a problem. She was not caught short. Her problem was of an abdominal sensation which was not really pain! She did say that her abdomen sometimes felt numb.
I was unclear whether the patient was depressed or manipulative. As I recall the patient has complained of odd problems in the past such as having an "upside down stomach". Moreover her somewhat intense son appears to compound the pressures resulting. I doubt if the problems at home can be solved. However, I suggest two measures which may help control them.
a) A formal psychogeriatric opinion should be requested by you. We would like to clarify once and for all as to whether the patient is depressed. If this is not readily available please let me know and I can pass this up the Health Board line.
b) A surgical re-assessment to assess the extent and relevance of the "irritable bowel syndrome" would be desirable.... I do not feel that we will be able to reassure the patient or the sons. However, this would help clarify the patient's future management and help refute any future claims by relatives that we were ignoring the mother's "sufferings".
30th:- The GP's reply
"I also had a long visit at Mrs. Stewart's home when I spoke to her sons at some length. We had, I think, a full and frank discussion about the problems of being 87 years old. I made it quite clear that, while we would try and do everything to relieve Mrs. Stewart's discomfort, there was no "cure" for the ravages of time and we all had to be realistic about what help could be provided.... the situation at home seems to have improved dramatically over the past few weeks.... In view of this marked improvement in the home situation, I felt it would perhaps be wise to delay seeking Psycho-geriatric opinion. I think firstly it would be difficult to get Mrs. Stewart and her sons to accept the need for this, and secondly I would be a little concerned about what hornet's nests might be stirred. Obviously, should the situation deteriorate, this is a selection which I agree we will have to re-consider."
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