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.
Back to summary list| Patient: DAVIS, Mark | Rank Order: | ||||||||||||||||||||||
| Gender: M Race: N Age: N/R Marital Status: Single Time waiting: 22 months |
Religion: Baptist Employment: N/R Education: 12 years; high school Family residence status: renting; gov't subsidized Insurance: Blue Cross (union) | ||||||||||||||||||||||
| Composite Record | Referral Text | Comments | Personality | Social History | Attitude (patient & others) | Family Records | |||||||||||||||||
Patient Family Information (top)
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Comments (top)
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Referral Text (top)7-7-75 Mrs. Davis appears to be a concerned mother (as judged by frequent visits that are harming her health), but obsesses about her diabetes when being instructed about Mark's medical plan. This topic change must be a defense against her anxiety about Mark's condition. Nurses think it shows disinterest in him. 7-9 Mark has begun acting incoherently (possibly as a reaction to his fear of death). He doesn't know what is happening around him and acts hysterically when something startles him. It is likely that, this being his first week on dialysis, that his body chemistry is upset. 7-14 - Dr. *** of psychiatry is working with Mr. Davis Mrs. Davis receives $27/month from Social Services for rent and $105/month from Social Security. 7-27 Patient much better oriented. Many questions about procedures. Needs much reassurance. Will probably have surgery this week for stomach ulcer and abscess. Surgery not performed. Patient doing well. 7-2-75 - Please evaluate this patient in terms of resources as a renal transplant or home dialysis candidate. Referral: Mark was referred for evaluation, in terms of resources as a renal transplant of home dialysis candidate. Social History: Mark is a 24 year old Black male who presently lives with his mother, Mrs. Davis (age 60), his 22 year old sister, ***, and ***, 3 year old daughter. Mr. Davis died 22 years ago, which required the family to live on ADC until the children were grown. Now both Mark and *** work at a (automobile parts plant) in ***. Mark has worked as an assembly-line worker for approximately 5 years. This has been strenuous work. Neither Mrs. Davis nor *** can be used as donors because of medical problems. Mark has Blue Cross coverage through (union). Reaction to Illness and Impression: Mark has just recently come out of a uremic coma which frightened the family considerably. Now that he is alert, his mother and sister have been very nurturing toward him. Mark apparently needs this nurturance and attention at the present time, as he responds positively toward it an requests that they stay with him. Mrs. Davis wants Mark to make the final decision about hemodialysis and transplantation. he is not as yet ready to make a commitment to either one. Mrs. Davis and ***, in the meantime, have shown s great interest in the dialysis program. I have given them a tour of the hemodialysis units during which they asked many questions and showed no apprehension about having a machine in the home. Mrs. Davis, however, is reluctant to volunteer herself as a back-up person, and would prefer *** to take this responsibility. *** seems very willing to accept this job, as she hopes of becoming a nurse someday. *** may be more capable for health reasons. The family plans on moving to another section of *** in two months to a home that has a paneled room and plumbing accessibility for dialysis purposes. Presently they live in a government subsidized apartment complex. Recommendations and Plan: It is impossible to give a decision on which program Mark will select at this point. However, in either case, home dialysis should be strongly considered; either as a permanent thing, or as a temporary measure until a cadaver transplant can be performed. It would be desirable to find a training program near ***. I will continue seeing Mark and his family to help them with their decision and any problems that may arise in this regard. Vocational rehabilitation may be necessary in the future to train Mark for less strenuous work. He does have desires to go to college. [signed]
Mrs. Davis is taking a variety of drugs for her diabetes and nerve problems. I feel these medications may affect her ability to give the hemodialysis machine her full concentration at all times. Follow-up Notes (7/6/75): Mark has decided upon a cadaver transplant. While waiting for the transplant, he would prefer to commute to a local hospital, *** or ***, for dialysis treatments. Apparently he feels home training would be an additional burden on the family that would be unnecessary (since he has his own transpiration to the local hospital). [signed]
Follow-up Notes (8/12/75): Mark has had an extremely difficult time adjusting to the impact of his illness. After recovering from a uremic coma he was able to only minimally understand the meaning of renal failure. He later develop a severe psychosis which required the services of Dr. *** of psychiatry. Gradually he regained his control and increased his understanding about his own condition. Presently he is happy and walking around the hospital on his own. He looks forward to having a transplant and has fairly adequate understanding of what will be involved in that procedure. Mrs. Davis, Mark's mother, had felt it necessary to stay in *** while Mark suffered through various crises. Her presence both helped and interfered with Mark's progress. He seems to need her nurturance, yet she has to be urged to help him to become more independent from her-a task she found very difficult until the purpose of enhancing his self-sufficiency was explained in such a way that she felt herself to be an important person in the project. From that time on she worked hard on following recommendations for helping Mark recover from his psychosis. Due to a lack of funds, Mrs. Davis was sleeping on an empty ward of the hospital. Also her own health was in danger because of her inability to properly feed herself. (Mrs. Davis is a diabetic) Now that Mark is better, she is able to come to *** only on weekends, a plan that is best for all concerned. This family could benefit from continuing support. For this reason, social work should remain in contact with the family. | |||||||||||||||||||||||
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.