Note: These "patients" have been constructed for the purpose of this case, and have no basis in reality. Any resemblance to persons living or dead is purely accidental, and a possibly a demonstration that randomness leads to strange coincidences.

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Patient: CRAWFORD, DorisRank Order:        
Gender:  F 
Race:  W 
Age:  N/R 
Marital Status:  Married 
Time waiting:  7 months 		 Religion:  Naz 
Employment:  N/R 
Education:  N/R 
Family residence status:  N/R 
Insurance:  through husband's company; $10,000 major medical; 
Composite RecordReferral TextCommentsPersonalitySocial HistoryAttitude (patient & others)Family Records

Patient Family Information (top)

Members of patient household
relationshipageempl. or School
husband56Machine tool
Other Members of patient family
relationshipnotes
daughter 
son 

Comments (top)

N/R

Social History of Patient (top)

Early history, including family and peer relationships, cultural and geographical background, health, economic and other factors which may have effected patient. Include present family situation.

Nervous breakdowns, 20 years of therapy (including shock); marital relationship intact

Personality Structure of Patient (top)

Include self-image, stability, focus of life activities, ability to cope with stress, etc.

 Poor ability to cope. Sometimes wishes she died in November so as not to be a burden on her family. She does this to elicit sympathy. Family babies her. Initially stunned by diagnosis. Now seeking information on where to go and what to do next

Attitudes (top)

Patient's Attitude Toward Illness and Proposed Treatment

Include initial impact of illness, changes in life activities, reactions to and ability to follow medical treatment program, and goals patient sees for self with proposed treatment

 N/R

Attitude of Significant Others

Include attitude toward illness and proposed treatment, ability to participate in proposed treatment, ability to give emotional support to patient, and changes in relationship with patient since onset of illness.

Excellent emotional support from husband

  • Husband is very willing to run dialysis machine
  • Husband is fearful of transplant
  • Husband is sad and anxious about illness
  • Husband is accepting of role changes

Strongly urge family to attemd (recovery organization) meetings.

Referral Text (top)

Refer: Mrs Crawford was referred for evaluation for home dialysis and/or kidney transplantation - 7/20/75

Social factors:Mrs. Crawford is a 54 year old white woman who has suffered decreasing kidney function for the past year. She now faces the need for hemodialysis.

Mrs. Crawford has had mental breakdowns in the past. For 14 years, up until approximately 20 years ago, she was being treated for her nervous condition. This included shock treatments as well as psychiatric consultations. As a result, she has poor control over her nervers and will frequently cry for short times when a strong emotion affects her. This does not, however, seem to interfere with her intellectual functioning.

The patient and her husband live in ***. they have 2 married childred, both in (same state). The daughter, ***, lives 30 miles from her parents. Mrs. *** has four children. the *** son has one adopted child.

Mr. Crawford works up to 10 hours a day at ***. Has has a *** Insurance plan through the company that will not cover the costs of hemodialysis equipment and training. Medicare has been applied for through the new Social Security Program for kidney patients, but will not begin benefits until Mrs. Crawford has been dialyzing for 3 months.

Reaction to Illness: The initial reaction to Mrs. Crawford's illness was dear of dying. Due to lack of understanding about her condition, the family becaome confused and anxious that she might be dying. Now that Mrs. Crawford sees hope in future treatment plans, she is lessening her fear and is becoming interested in touring the hemodialysis units; which she did with little apparent stress. (Two weeks ago the thought of touring the unit was far too overwhelming for her.)

Mr. Crawford is very much concerned about his wife. He regrets that she had so many years of sichness and does what he can to hepp her happy. He oftern tends to 'baby' her and she reacts with childlike behaviors; sich as whining about her condition. At the present time, he is nervious about his wife's health.

Recommendations and Plan: Mr. and Mrs. Crawford feel that home training is the best treatment for them. The idea of transplant causes the much anxiety at the present time. It would appear the home dialysis should be successful because oa good home and back-up person (Mr. Crawford) are available.

Complications will arise when the training program interferes with Mr. Crawford's working hours. However, Mr. Crawford is willing to do whatever is needed.

It would be beneficial if a training program could be found near the *** area. this would neam exploring home training possibilities at *** Hospital in ***.

[signed]
Clinical Social worker
Mr. Crawford has applied for Medicaid 7-75

Followup Notes:
Since Mrs. Crawford has had her fistula installed in July, 1975, she has been peritoncally dialyzed once. the procedure frightened her a great deal and she sought support from her husband to help her deal with this. After dialysis she continued to gain sympathy from those around her by means of a submissive and child-like attitude. This behavior has obviously brought her a great deal of attention from her family in the past and this encouraged her to continue to use if during present hospitalizations. She should be helped to develop a more independent and responsible attitude toward her condition be reinforcing her when she shows evidence of such attitudes.

Mr. Crawford is very anxious about his wife and deals with this anxiety byt being as physically active as possible. He works long hours and hurries home to cook and clean the house, partly from necessity but also from 'worry.'

Since the Crawford's insurance is inadequate for hemodialysis coverage, Mr. Crawford has applied for Medicaid. He has also filled out the necessary formd for Medicare.

Social work will continue to work with this family.

[signed]
Clinical Social Worker

9-76 - Couple successfully completed home training in '75 - however, were subjected to six weeks of anxiety because insurance company refused to tell them whether or not they would be covered for home training - @ about $1,000 per week. It would have meant going very deeply into debt for them - + did retard their learning of home dx problems.

Note: These "patients" have been constructed for the purpose of this case, and have no basis in reality. Any resemblance to persons living or dead is purely accidental, and a possibly a demonstration that randomness leads to strange coincidences.