Do we also need to care for the in-home caregiver?

A wife struggling to manage medication for her husband reminds me that I wish we could do more, maybe through community paramedicine, for our patients

He said she didn't give him his medications’ she said she did. After 27 years of marriage, it had come to this.

For the last seven years she was his caretaker. He was confined to his bed for the most part after three heart attacks and a stroke rendering him disabled. It looked like she was running out of steam, the burden thrust upon her taking its toll.

Their house was a mess - laundry, dirty dishes, paperwork and pill bottles were strewn about haphazardly; clutter filled the room where he spent the majority of his life. A small TV sat at the end of his bed, his portal to the world. I wonder what he watched as the days dragged on, his room a cell rather than a place to rest from leading a fulfilling life.

People forget the caregiver far too often. Their lives and ability to embrace it are as diminished as the person they are caring for. Often they fall into depression, and become sick themselves. Sometimes, they even steal the medications from the person they are caring for.

There is only so much we can do

He was hysterical, sitting up in his bed, struggling to breathe through the hole in his throat. The stoma remained clear, but I was concerned his movements would somehow clog his airway. She had a glazed look about her. At first I thought she had been drinking; her speech was clear but slow, her pupils dilated.

"He needs to go to the hospital," she explained in a dreamy voice. "He says I didn't give him his nighttime medication, but I gave them an hour ago."

I looked on top of one of the dressers that crowded the room and saw a dozen pill bottles, some empty, others tipped on their side, duplicate prescriptions, half-eaten candy bars and trash filling every inch of the space.

"Do you have a list of his medications?" I asked.

She handed me a crumbled piece of paper she picked up from the floor. Lasix, Cardizem, Lisinipril, Lipitor, the list was lengthy. Two names jumped off the page, Oxycontin and Vicodin. There were no bottles on the dresser that matched.

"What about these?" I asked her.

"I had to hide them. He takes 30 if I let him."

"Where are they?"

"I have them." She opened a bedroom door. A giant Rottweiler was on the bed looking at me. She entered the room; I stayed outside as she read the names from the bottles from behind the door. She pronounced the names like she had never heard of them.

There is only so much we can do. I wish we could do more. This would be a perfect opportunity for a community paramedic to do a follow-up visit.

Unfortunately, a community paramedic program is a very long way off in Providence, R.I. We have a leadership void in the EMS division of the Providence Fire Department. Without vision and support from the administration and the firefighters’ union, we will continue to respond to 911 calls, offer little or no follow-up and chase the radio every shift.

I had seen enough. We got the man ready, put him in the stair chair and brought him out of his prison. He was crying quietly, saying he loved her and didn't want to leave his home. I left his wife alone with her husband’s prescriptions.

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