Dear Louie,

So often after the fact, after the death, after the divorce, after the auto accident, the survivors, those interested in the tragedy, those who lend aid, those folks who have stood by are left with nothing, a real loss and emptiness of spirit.  Because one is empathetic, caring, and attentive does not guaranty peace and calmness after the loss.

I well recall a two a.m. visit to the medical floor of the hospital.  I was summoned by the charge nurse to attend a critically ill patient, a patient of one of the older physicians of the community.  On arrival, I was greeted by the charge nurse, who also was the night nurse on duty.  She was distressed and agitated.

She had slurred speech and was not able to manage the floor, or for that matter, to manage herself. 

She was tipsy; she was drunk and on duty.

When approached as to her condition and the condition of the patient for whom I had been called, she freely admitted that the patient was sleeping soundly and in no distress, 

but she, the charge nurse, could “ no longer go on."  Fortunately, it was a quiet night, and a nurse from the E.R. was called to the floor for the remainder of the night.

I spoke with the charge nurse and drove her home to the care of her husband. 

After a brief fifteen minutes of discussion and arranging for an office consult the next afternoon, a Thursday, a golf day, I went home. 

That subsequent two-hour visit was most revealing.

Both the nurse and her cousin are long dead, having died in the 1960’s.  The story, however, has been repeated many times over.  

It seems as though the nurse’s sister, a most competent secretary in a large company in Milwaukee, had, over the years, become an alcoholic. 

As her habit had grown, her dependency on her nurse sister had increased, and she had moved to the home of the nurse.

There, she had resided.  

Over the past four years she had continued to work, play, and drink.  She developed liver disease, lost her job, and moved in with her sister.  

In spite of support, encouragement, and eventual care, she had deteriorated and died of liver failure.  She had never married, had had an affair with her boss, and had begun to drink when rejected.  

All of these matters had been shared with the sister, the nurse.

Quiet accommodation to the developing pattern of her sister’s alcoholism and resulting dependency and care had added to the burden of a philandering husband and a gambling son in the family of the “night nurse.”  

When her sister died, the loss and the separation and a feeling of guilt for “not doing enough” had finally stressed her to the point of “drink.”

Slowly, she had sought solace in a Manhattan before supper, then a brandy after supper, before her night shift, then a “thimble full” at break time while on duty.  

On the night of “the call,” she had begun to worry about her ability to function appropriately and to fear for the patient’s welfare.  

She feared for her actions and, in desperation, called for someone to rescue her, someone to bear part of the burden.  

The afternoon session ended at three o’clock, the sun came out, consultation with a psychiatrist was made, and a four o’clock tee time was met.

This encounter again emphasized that the caregiver often becomes the victim. 

So often in the care of chronically ill, especially in the care of elderly parents where one child carries the major burden of interest and care, at the time of death, the caregiver carries the burden of the greatest guilt for “not doing enough.”  

The family members who observe, and many times do not even care, bear no responsibility.  They show no guilt for their inattention. 

They are oblivious to the developing depression noted in the family member who bore the brunt of care.  

So many who never cared for the ill, for the sick parent or sibling, will never step forward until the line forms for the “last will and testament.”

Their selfish actions are hard to explain.  But equally difficult to understand is the depression of the caregiver and, as in this case, the destructive consequences.

Ah, such is life, Louie.

Keep the faith, my friend,

JIM