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Other Members of patient family relationship notes aunt two children live with Aunt now, ages 6 and 4 uncle   sister

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Referral Text (top)

Diane, or "Cat" as she prefers to be called, is a 23 year old black woman with a diagnosis of malignant hypertension and renal insufficiency. My first contact with her was in August, ****, the first of several subsequent hospitalizations here.

Until the time of her admission, she had been living in a little house she purchased with ADC - 225 assistance with her two children. Both her parents had died of high blood pressure, she told me, and she had been raised by her uncle and his wife. The wife, "my auntie," as Cat refers to her, has always been kind and nurturent to Cat and her sister, but she perceived the uncle as punitive and abusive. (I have no way of judging how serious this is.) When she was hospitalized, her children returned to the uncle and aunt. Cat has since lost her house and has been living with them too, primarily because she is too sick to be alone.

"Cat" has never been married and the children, both pre-schoolers, do not have the same father. Aside from her aunt and to a lesser extent, her sister, she has no one to whom she can look. During her extended summer hospitalization, her boyfriend dropped her. Her sickness, her concern for her children and her house, and the loss of this significant person, depressed "Cat" very much. She felt, in addition, that her uncle was physically abusive of her children as he had been of her when she was young. "Cat's" prospects economically are very limited: she has no marketable skills, little education and less physical strength.

She seems basically a simple, affectionate person who forms relationships easily. She has little understanding or patience with bureaucratic procedures and red tape, however, and can be utterly defeated by them. ADC is about the worst thing in the world for a person of her temperment to cope with: checks withheld because she forgot to do something she did not understand to begin with, resulting financial pressures, etc.

Her high blood pressure did not respond to medical treatment and much to the dismay of staff members, several persons, rightly or wrongly, blamed it on her.

Because of her deceptively childlike attitude, they often responded to her as they would a to a child, scolding her, accusing her of violating dietary prescriptions and not taking her meds. In addition to the pressures from her responsibilities outside the hospital, the general attitude of the staff contributed to her depression. However, a few empathic MD's helped her very much to deal with her depression. On her most recent hospitalization, "Cat's" depression regarding the hospital and her illness lifted very much primarily due to the efforts of a graduate nurse who included "Cat" in a research project on the effects of positive reinforcement on dietary observance and many staff members noticed a difference in her.

"Cat's" life at this point in time is entirely, it seems, centered around her health, her children and her aunt and uncle. Realistically she has not the strength or resources for anything else. She fears death, but has sometimes thought she ought to give up and die. Her concern to protect her children motivates her to live, however.

She responds readily to any positive interaction. She has had and will probably continue to have problems with diet because the kinds of foods she and her family are accustomed to eating and can afford are usually bad for her. I believe that the less she is treated in a patronizing way and the more respect she is accorded, the more she will respond to medical and dietary prescription.

She has always wanted a transplant and is on the cadaver waiting list. (Her sister was medically unacceptable.) She will need support and reassurance during the wait, on dialysis at ***. I will continue to see her as she comes into the clinic.