it’s hard to report this patient’s conditions and remain objective. there are some very hard challenges to his mental, physical and fiscal health. though it is encouraging to note that he seems to be fine spiritually.

as a baseline the theraputic levels of medications he reports to have returned him to feeling as if he was back to being 17 again. this includes physical fitness and weight, mental ability and maturity, as well as ability to face new challenges.

his biggest challenge is family life. he feels that the obligations of the men from his mother’s life (her father, brother and husband) were thrust upon him. he has not decided to take them. his instinctive reaction is to share what he can give freely and avoid the rest. this clashes with urgings to comply with precise detailed demands done in her own specifications by his mother and others as if he was an extension of hers. he feels that would make him subserviant, under a bond of obediance, and not willing to commit to that. he still holds out for a win-win situation. his defense is her inability to feel another’s emotions and her lack of goals that he could accomplish in his own way.

after a divorce he has one teenage child. visitation is a problem as he has no drivers license and she lives at least 50 miles away. his ex-wife will occasionally visit bringing his child, but does not routinely call with news and updates on activities like the separation agreement specifies.

amy, his daughter, does not seek him out. this in itself is a huge issue. since a big stressor is this patient’s father’s estate which his mother won’t sell, it devolves on him to protect it without having any authority to do so. and so the next generation would be handed the same responsibility unless his brother steps in. his brother has been sent mail to the old address.

amy does not reply to email and doesn’t extend conversation on the phone. but the patient is very proud of her achievements as related by her mother. the patient would like to allow amy to learn more of her heritage and the estate. then she could make a decision about whether she wanted to appropriately handle the tradition.

i can already hear the voices saying that amy is a minor and that the ex-wife will have to act in behalf. true. will she adhere to an advanced directive ? what about when he needs the gall bladder and eye surgery ? he won’t be able to take care of himself, he can’t impose on others, certainly not an 83 year old mother. and unless the doctor places him a hospital, there really isn’t an alternative.

and this is the exact situation that will happen when the health coverage he has expires in 12/31/2006. since his money to pay for the coverage will be exhausted at the same time, the issue is moot. what he needs to find there is how much medicare part d will cost, if a secondary insurance is available and for how much (is it affordable). then he has to see if he can get a job to pay for it or change his environment and get a job. in other words, he’s not assured of being healthy much longer.

back to amy and ex-wife. the patient needs family to keep social contact because he’s naturally a loner, listening but not talking. with his migraines talking and concentrating actually hurt.

phone calls and emails are great for keeping up to date but lack spontaneous interaction and exchange. love is a verb first and a noun second. that means it implies action between two or more individuals.

because the patient has secondary physical custody and scheduled visitation, but cannot compel the minor child, he is willing and able to go by her residence. however, he is currently without a driver’s license and when processed it is recommended that he be limited to daylight driving locally. so he has no way to get there and no right to be able to do anything if he did.

it’s particularly painful to see that no family members have become involved. it takes a depth and breadth of experience to fathom what is happening. both the patient and his mother have been slipstreamed into the system and so appear functional. yet the test for functionality determines only that an individual can make reasonable and prudent decisions. but the emphasis should be on prudent, looking for the future and possible emergencies.

in this case the patient’s mother is only capable of making decisions if confronted with facts to make a decision from. is that actually making a decision ? she isn’t capable of handling an emergency or anything outside of her realm of expectations. but the patient can’t evaluate that. someone else has to.

as for the patient, he’s able to proactively make decisions. but it’s questionable as to whether he can respond to an emergency situation. certainly a fire or robber in the home is beyond his capacity. and with the windows barred closed it’s somewhat of a hazard itself anyway.

the oxford english dictionary defines support as “give help, encouragement, or approval to be actively interested in.”

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