My job enriches my existence, mostly by offering me a direct look into varying phases and forms of human existence and coexistence.
I see people at the most vulnerable times in their lives:
When they are very young, fragile and unaware.
When they have suffered trauma either by accident, foolishness or intention.
When they are unable to pick themselves out of the doldrums of depression.
When they at the door of death.
At these times, their quality of life often depends largely upon another person, usually a family member or a paid carer who will hopefully, try to meet their care needs.
Sometimes however, the role of this other person becomes dubious for various reasons.
Maybe they become overwhelmed and overburdened with their caring role.
Maybe they are simply oblivious of the detrimental effects of their actions.
Or maybe they just enjoy having a hold over another person.
My next case made me ponder all these possibilities.
Let's call her Zara.
She has come in today for a routine check for her baby usually carried out between six to eight weeks after birth, just before or alongside their first vaccination.
It is also usually an opportunity to check on the mum and see how she is coping with the challenges of looking after a newborn.
Zara's husband attends with her.
He points her to the chair by the door further away from me, drops the car seat with the baby in it at her feet and sits in the actual patient seat next to my table.
He tells me straightaway that she would like some sleeping pills and strong opioid medication.
The story unfolds....
She has a long history of depression and anxiety is going through a bad spell. These controlled drugs are the only things that work for her so he has been buying them over the internet for years but now cannot afford it.
"The only time she feels well is when she is pregnant." He says
"That is why we now have ten children. "
I am taken aback. By his brazeness, by her blaséness.
He goes on to explain that her oldest child has given up on college to look after her mother in between pregnancies, and to help look after her youngest siblings.
The discussion goes around in circles, with me constantly inviting Zara back into the conversation, explaining why I would not be giving her those drugs.
I eventually insist on examining the baby, which is what the appointment was made for, I remind them.
I ask about the other children. They cannot seem to agree on the ages of the last three children including baby, all under 3 years old. He dismisses it by saying "It is on your system."
I ask her partner why he has not considered a Vasectomy.
He laughs in my face, as if I am being ridiculous.
When he realises I am serious, he shrugs and says, "If I do that she will go and get pregnant outside. "
"But you have said she never leaves the house, has no mobile phone and does not use the Internet."
My eyes are actually saying:
So how is she going to get pregnant outside, and how is she getting her regular supply of these drugs which she is obviously now addicted to? Who is looking after all those poor children and what the heck is going on at your house?!!!
Anyway, every service that needed to be involved were drafted in: Adult and child social services, Psychiatrist, Gynaecologist etc, all of whom were already aware of this family.
My mind travelled to a previous case I had been involved in, with a middle aged man who was very depressed and had not stepped foot outside his front door for about two years..
His sister was the only person who visited him, every other day, bringing him food and alcohol.
She had only called the doctor now as he was feeling generally lower and seemed swollen.
I had no relevant records to go by as he had not been to the doctors for several years so I asked him to come to the surgery. He couldn't as he was too fat now to get out of the door.
I visited him in his flat. He was lying on a sofabed in the corner of the room, morbidly obese. There were bottles of alcohol in various clusters across his living room where he now slept. He was coherent and interactive. He described himself as an alcoholic.
I will skip the clinical details.
By the next day he was dead.
I appreciate that dealing with addiction and addictive personalities can be really difficult and sometimes one cannot do wrong for doing right. I will probably never know the intentions in these cases but my thoughts are:
I realise that sometimes the roles of responsibility to others, be it as parents or carers or in other supervisory roles, can actually become a hindrance, enhancing their vulnerability and detrimental to any attempts to take responsibility for themselves.
As a carer, one must recognise when the situation is beyond their capabilities and reach out for help early.
When does care become cruelty?
May we not have reason to overburden others beyond their capabilities.
May we be wisely guided in our roles of responsibility, that we do not love others to their death....literally.