Patient Family Information (top)

Members of patient household relationship age empl. or School husband 42 bakery-20 yrs; stable hrs son 19 part-time; college in Feb daughter 14 school

Other Members of patient family relationship notes mother deceased father living - strained relationship; closer to sister brother family responsibilities sister family, responsibilities sister family and responsibilities

Comments (top)

• 3 bed room home
• furnished basement (fireplace and kitchen) used as family room - she sews in basement

Referral Text (top)

11/22/73

Summary of Interviews with Patient: On my initial contact with Mrs. Black, she was wearing a fluffy, fancy purple negligee, bright pink lipstick and had her black hair made up in a dramatic style. He husband was by her side talking to her. She was receptive to my visit and began to verbalize her worring, anxieties and personal problems. Her husband excused himself but returned fifteen minutes later. Mrs. Black went into great detail about the original reason for her admission to CCGH. She has been seeing various doctors all her life for her crippled left leg and kidney problems. Recently a (city) doctor stated that she needed a kidney transplant. This brought her to CCGH for evaluation. She was told her kidneys were adequate providing no other complications develop medically which might effect their functioning. Mrs. Black said she could hardly believe that one person could have so much "bad luck." She got very involved in describing her alcoholic father who has been mean and abusive to her since birth. She states he would beat her and caused her leg to be crippled. He never wanted to have children (there are 3 daughters and one son--Mrs. Black is the oldest) and has wished they would all die of cancer. He has tried to break up Mrs. Black's marriage also. Mrs. Black's mother died 3 years ago from cancer of the stomach. The patient idealizes her mother and becomes angry and hostile in describing her father.

Her own family consists of one son and a daughter. Mr. Black is a baker and Mrs. Black is a dressmaker in her own home. She becomes rather infantile and regressed when she tells how "good" her husband is to her, what lovely children she has, how clever she is, her many friends. etc. During our interviews, if Mr. Black was present, she questions her husband after every sentence--"Isn't that right?"

It appears that Mrs. Black had a traumatic childhood with a very destructive relationship with her father. The lack of a supportive emotional tie to this man has left her with a tremendous conflict. She expresses both love and hate for him. She feels she looks like him which causes her to identify with him. She is strongly religious (Catholic) and feels a great amount of guilt for feeling such hostility for her own parent. The love-hate cycle is so firmly rooted in ths woman that I found it impossible to intervene in it. She fantasizes that her father may have some magical powers to make those he wishes get cancer. She appears very neurotic and imagines the worst before she is given any facts.

Impressions: Mrs. Black has been manipulative and demanding to the medical staff. She seems to be crying out for attention, reassurances and recognition. Although Mr. Black has been patient and loving throughout the hospitalization, it appears that Mrs. Black needs long-term professional psychotherapy to deal with her feelings of insecurity and rejection. Mrs. Black does not feel she needs this type of treatment nor does she see her father as a source that has molded her bahavior.

It seems very unlikely that Mrs. Black will ever seek help to deal with the conflicts that torment her. She intellectualizes and rationalizes her feelings and thus uses these defense mechanisms to cope with the situation.

My work with Mrs. Black has mainly been to listen to her vent some of her anger, to be firm about her prognosis, and to facilitate her adjustment.

I will continue to see this patient until discharge

[signed]
Clinical Social Worker

12/9/74

Referral: Mrs. Black was referred to the Deparment of Social Services for evaluation for a home dialysis program

Medical: Mrs. Black was admitted in November 1973. She was readmitted in January with a diagnosis of chronic renal failure and underwent palliative treatment.

Summary of Contact with Patient and Family: Mrs Black was seen by a social worker in November during her hospitalization and a detailed history can be found on the chart. I will concentrate on patient's reaction and response to her diagnosis of renal failure. Family structure and social situation remained unchanged since initial DSW report.

It was apparent from various professional contacts with patient that she had a long standing personality disorder with hysterical features. During her recurrent admissions and Rx for her renal failure, Mrs. Black's anxiety and depression were more heavily concentrated on her fear of cancer than loss of kidney function. She was more apprehensive regarding death from cancer tha succumbing to terminal renal disease. Part of her apprehension was due to her personal experience with loss of her mother to cancer and currently, her mother-in-law who lived with her was slowly dying of the disease. Mrs. Black felt that her chances of survival from kidney disease were much better since there were reliable methods of treatment.

Mrs. Black's anxiety and fears were demonstrated by her demanding, whiny, clinging need for reassurance of survival. She was accepted into the home dialysis program and her husband continued to be supportive of her. Staff's approach to Mrs. Black was to provide some structure for her pervasive anxiety and to be firm and consistent in dealing with her fears. Her ruminations about cancer were not responded to or curbed while she was in the home training sessions. Time was allotted her each day after her program to discuss and handle her fears about dying.

Mrs. Black and her husband completed the home training program in May

Since returning home, Mrs. Black has resumed her role in the household and is again doing dressmaking to help augment the family's income. She is very conscientious about her appearance and makes it a point to look attractive for her husband. He in turn reinforces her efforts to resume normal tasks and activities and has consistently reassured her about his concern and affection. He remains the dominant partner in the marriage and has assumed most of the responsibility for the dialysis treatments.

Since patient is doing well at home, no further services are indicated at the present time.

[signed]
Clinical Social Worker