The Emotional Rollercoaster Of Caring

Keith Carlson has given us another moving account of the emotional rollercoaster that is familiar to carers of people with complex issues. Of Train Wrecks and Ghosts tells us what it is like to look upon the outcome of years of self-abuse:

He sees me for the first time in weeks and says, "I'm hungry and they won't feed me." How do I explain to him how his lower esophagus disintegrated under the pressure of uncontrolled vomiting and that he must be fed directly into his small intestine, bypassing the stomach which now has no connection to his mouth which craves food and drink nonetheless? How do I tell him that his cocaine and heroin addiction, poor self care and choices have finally come home to roost, and that all of the warnings we gave him over the years were real?

We read about a woman struggling to keep her children, who is dealing with the ravages of HIV and a relapse from her sobriety. Carlson acknowledges his own emotions in the face of her current turmoil:

I hurt for her, even as I silently and internally process my profound disappointment and sadness.

There is an echo here of his previous exploration of Lofty Goals, Harsh Realities that will be familiar to anyone who has cared someone with addictions, particularly when these are secondary to mental illness. Carlson's aspiration is that

as long as diseases afflict living beings, may I be the doctor, the medicine, and also the nurse who restores them to health.

He tells us about the reality of dealing with a patient who has relapsed. He experiences very real frustration and understandable emotion at the consequences of the relapse both for the patient and her children. He realises that he needs to step-back from the situation and re-focus so that he can care for the patient and not lose his energy by paying undue attention to her behaviour.

At times, disappointment in my ability to maintain my composure in the face of my patients' failures to live up to my expectations can cloud my vision of who they are, of their own unfolding process. My cynical "social-worker self" sees addiction, cycles of neglect and poor judgement, seemingly avoidable mistakes and missteps. These perceived errors are easy for me to see, of course, and my agenda--- no matter how well meaning---cannot permanently get in the way of truly seeing with clarity and non-judgement, or else my powers as a stabilizing force for healing and growth are lost.

Carlson, like many carers in similar circumstances, feels the need for some "healing distance" that will allow him to renew those personal strengths that allow him to do the work that he does. Carers can need to remind themselves that a poor outcome is not necessarily a reflection of the quality of their efforts and love:

Sadly, there are some individuals who we eventually learn must implode on their own, beyond the reach of our assistance. At that time, compassion can still be front and central, even as the person's certain denouement looms on the approaching shore.

Carers do need to pay attention to their own well-being. I am disturbed that all the recent reports about the care of elderly people has not addressed the need for a programme for supporting carers adequately.

Reconciliation And Acknowledgement

In Godspeed, Keith Carlson has offered another inspirational and poignant account of caring that enriches our understanding of compassion, essential dignity and the vocation of caring.

Godspeed is a poignant reminder that there are sicknesses that extend beyond the body and affect all of those around the person who is afflicted by these complex ills. Even when somebody has a complex medical history, the true sadness and disruption of that life may lie in the spiritual realm, or in the psychosocial miasma that surrounds those health problems.

The patient is a "human time-bomb" of clinical and other ills that Carlson has tried to defuse or render less harmful many times in the past. Carlson's efforts could not succeed without the patient's co-operation and so those attempts could not achieve their aim. Despite his remarkable resilience, the patient's serious illnesses seem to be about to overwhelm him.

Yet, despite "the body bristling with tubes and the technology of desperate measures", Carlson offers us a glimpse of what the man is to his family, and what he might have been. He is a "lost soul" whose family care about him and grieve for what he might have been:

Caring For People With Schizophrenia

The excellent Dr. Crippen has posted a remarkable account of an elegy he gave at the funeral of his friend Emma, whose life came to a premature close after years of living with schizophrenia. The account of Emma's life would be incomplete without talking about the destructive force of schizophrenia, from the time when she was a teenager until her untimely death.

Schizophrenia. Perspectives on it vary so much. There is the demonising view of some popular news reporting that implies that all schizophrenics have the potential to become dangerous to all those around them. And yet, historically, it was not that long ago that schizophrenia (like severe depression) carried a romantic air about it - it was seen as the fine line between madness and creative genius. Schizophrenia has become the universal metaphor for conflicted duality. It stands for self-indulgence and stoicism, inferiority and perspicacity, alienation and virtuosi of empathy, victim and persecuter.

The eulogy is a poignant summary of Emma's life. Dr. Crippen's charts the decline of Emma with respect and much affection. It is particularly sad to read of the gradual loss of those activities that she enjoyed: and to learn that someone who loved reading so much gradually found herself unable to read. However, we learn to admire her resilience and that she retained her humour, and sometimes mined the vein of her insight into her condition: