"Great! Now everybody is mad at me!"

Recently I saw a patient. He was recently diagnosed with cancer and receive one cycle of chemotherapy. His course was complicated by hospital admission do to influenza while his blood counts were down and severe nausea. Needless to say, he was struggling.

He came with his daughter and wife and three of them live together. He is tired to the point where he can't do much but sit or lay in bed. He eats but does not drink fluids which is driving his wife and daughter insane. They nag and nag and get angry at him. They are angry at him for refusing to go to see the cardiologist because he is "too tired to even get out of the house".
We had a long discussion and mostly therapy session to set goal for him that is tangible and explained to his family where he is coming from. At the end of the visit, as they were leaving, he said to me, " Great! now everyone is and at me and I didn't do anything wrong!" My heart sank. I told him that it is not his fault. His daughter and his wife are trying their best but this is also new to them and they cannot understand why he is so tired when he looks so good. I felt terribly for him. Why does he have to feel guilty? He is the one with deadly cancer struggling and facing everyday with it. Of course his family  is also struggling with this issue on another angle. But...

We as clinicians see this frequently. Husbands, wives, daughters, and sons trying so hard to help the loved one who is struggling. But how much is ok? Nobody knows the answer. They are not in their rational state to think strategically like us who are looking in and giving advice. They often argue and fight about how much they eat and drink and not taking enough of the pain medications and that the patient is not trying enough and that the patient is not helping oneself. The patient becomes all of sudden the guilty party and gets angry and defiant. The patient often says, " they don't understand how tired I am and I cannot do anything about it and they are mad at me!" It is hard to find fault in anyone. I can understand both parties. It is such a complex and delicate issue.

We are taught to help patients to participate in their own care and to encourage them to know more and do more. We learn that light to moderate exercise is good to increase energy level during cancer treatment. We are taught to set tangible goals for these patients to meet us half way. But the patients' family nor the patients are informed about these strategies. They inevitably become the naggers and become frustrated and tattle tale to us about the "Bad behaviors" of the patient as desperate measure.

I don't know if this relationship will ever change. Of course with social worker's help and getting to know the family dynamics will help in the long run however not make it "all better".