Patient Family Information (top)

Members of patient household relationship age empl. or School lives w/ brother & family N/R

Other Members of patient family relationship notes brother

Comments (top)

Referral Text (top)

The following information is offered to help expedite the application for assistance of my patient.

Problems: Hypertension-patient was admitted with bp's and headache requiring immediate intramuscular apresolinel was brough to program of oral medication giving reasonable control with diastolics of 90-110.

Chronic renal failure-we were not able to determine an etiology because patient refused renal biopsy and arteriogram, and IVP was not helpful (kidneys were nl size, visualized poorly, calyces had no deformity or dilation) but assume patient's chronic uncontrolled hypertenion was the etiology. Status at present-patiend has only 2% normal function-continues to have rising BUN's and creatinines between courses of peritoneal dialysis.

R area fistula placed 12/7/75 by Dr. *** continues to function well. It will be seen by Dr. *** Tuesday at ***. Patient will definitely continue to need hemodialysis rest of his life.

Peritonitis-abd feels much better over last 2-3 days, no fever, minimal abd tenderness (diffuse) without rebound.

Disposition-patient is definitely disabled from his former occupation of manual labor, and will remain so indefinitely. He does not have his former strength or endurance, and cannot risk an accident to his fistula (which could easily cause fatal blood loss).

Discharge notes:

1. Hypertension essential
2. chronic renal failure secondary with 1, with uremia
3. peritonitis secondary peritoneal dialysis, resolved
4. anemia secondary with 2

My patient will live with his brother for a week, but then will need to find a place of his own.

Respectfully yours,

[signed]

2/3/76 - Mr. Howell ius a 43 year old black man who has been separated from his wife for at least 15 years and who rarely sees his grown children. His employment history is sporadic, practically if not entirely due to his poor health and excess fatigueability. He has no financial resources at all aside from Welfare.

He was first referred to Social Service in November-at that time he was very sick. Even then, however, he had a gentle dignity about him. At that time, he painted a picture of his family situation which was probaly more a reflection of his feelings than of the reality. He told me he had no one-that his sister and two brothers who lived in *** were not 'too tight' with him. Nevertheless they visited him, brought him gifts, and when he was to be discharged, two of his brothers came to pick him up and stayed for part of a Patient Orientation Session (a program regularly conducted by this hospital for inform patients of the treatment options for kidney diseases). He has been staying with his brother ***, ever since. ***, a warm rotund man, is earnestly trying to patch up Mr. Howell's marriage. "He ain't got nobody and she ain't got nobody-I can't see why they can't get together."

The Department of Social Services is *** has been extremely cooperative in helping Mr. Howell. They arranged for a special appointment at my request so that he would not have to wait; they have been very understanding about extra payments for lodging in *** while he was dialyzing here, etc.

Through the months, Mr. Howell and I have developed a good relationship. He revealed more of his way of life-partying and stylish dressing and good times. He spontaneously reflected on how far away that all seems now and how he wished he had given more of himself to 'peoples' ... which I interpreted to mean stable social relationships which would sustain him now. His style of life contrasts the reponsible, hard working family men his brothers are. He has a combination of self-insight, lack of any need to impress, humor and dignity whoch makes him a charming if irresponsible person.

The medical people here have some concerns about his choice of treatment-he is inclining toward dialysis because "I can't get a good kidney." He means that the statistics on cadaver kidneys do not impress him, yet he does not feel he can ask his hard working brother to take time off from work (they live from paycheck to paycheck) to give him a kidney. I read into this also his concern about taking something from them and never having given anything to them. His own life style has been fairly self-centered. He speaks of persuading a daughter to come live with him and " run my machine for me." He also has a little trouble controlling his diet...which makes dialysis more problematic. I have introduced him to some transplant patients and also to one of our surgeons, who won Mr. Howell's respect not only because he was a black man like himself, but also because he is an ex *** football player. Mr. Howell continues to weigh his options.

Mr Howell needs time and informational input, I think. I believe his refusal to consider his brothers as donors is a sign of responsibility and I don't think that he should be pushed. He is too aware of his lack of contribution to his family to be able to make such a demand of them. He knows that chronic dialysis in a center is nearly impossible, yet he will have little luck finding a back-up person for home dialysis. It seems to me that a cadaver transplant is his only visible option, but he will have to arrive at such a conclusion himself. My plans are to introduce him to as many cadaver transplants as possible. I think he will also need a referral to VocRehab-preferably in the *** area, although I will initiate it through this hospital when he has stabilized enough.

Mr Howell has many strengths; humor, insight, courage and independence. I think these can be capitalized upon for successful rehabilitation

[signed]
Clinical Social Worker