June 2014 | ISSUE 12
Take II – Long-Term Patient Project

By Julia Ng

My patient, Phillip (not his real name), came under the care of the hospital’s home care team after repeated, unexplained falls caused by low blood pressure. Otherwise, Phillip’s physical access to healthcare resources for routine checkups is limited by his frailty. Because of his frequent falls, his worried children also prevent him from stepping out of the house alone to visit a doctor. As such, Phillip wishes he had a straight bus to the hospital, and is grateful for the home care.

The home care nurses play an important role in overcoming physical barriers deterring patients like Phillip from receiving their necessary checkups. On occasion, a doctor accompanies the nurses to update family members on Phillip’s condition. Such in-house consultations also allow the healthcare team to examine how Phillip copes at home.

In my opinion, this greatly benefits the healthcare team as they are able to elucidate if living conditions are worsening a patient’s condition and if so, how their living conditions could be improved for the health of the patient. Such underlying factors may not surface during a hospital consultation. Should I practice in a hospital setting in the future, it would be good to investigate the patient’s home during history taking if nothing in the patient’s history and diagnostic tests explains a confounding ailment.

Phillip’s primary care provider is his daughter. She accompanies him from morning till evening in his unit. She also does the household chores. As if out of habit, she would hand Phillip his hearing aid whenever a visitor appears, and doubles up as a Hokkien translator for him, should he fail to understand visitors’ questions.

Although Phillip has other children, his daughter is unparalleled in the amount of time she spends with him. Grandchildren pay the rare Chinese New Year visit; otherwise, he rarely spends time with his children and their families. It is with a hint of disappointment that Phillip speaks of his grandchildren—he starts off excited about his memories of them, but his excitement soon fizzles out when he realises that his interaction with his grandchildren can be contained in such sparse memories.

He also seems to have little interaction with friends or neighbours. When queried about his close friends and colleagues from the police force, he nonchalantly replied that most of them have passed away, or are too frail to pay him a visit.

On hindsight, Phillip reminds me of my grandmother who suffers from mild dementia. Though they have a primary caregiver, the interaction that keeps them satisfied and hopeful about tomorrow comes not from a face they meet every day; a timely reminder to all of us (children, grandchildren, friends) to do better.