Depression: The Case of Mrs. R

Mrs. R

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Mrs. R is a 70 year old female who presents with increasing fatigue, weight loss and poor appetite for the past two months. She was born in Nuevo Laredo and immigrated to the US as a teenager. While she speaks some English, she is more comfortable speaking in Spanish. She brought her 8 year old granddaughter with her to translate.

In gathering the history you find that over the past year she has been taking care of her 75 year old husband who suffered a massive cerebrovascular accident which left him paralyzed on the left side of his body. Recently he has started to become more combative, but Mrs. R just shrugs and says that she must take care of him. You attempt to collect more detail about the caregiving situation but the granddaughter reports that her grandmother says that this is just something she has to do and God will help her.

After a thorough physical examination, you suspect she might have an intra-abdominal cancer and suggest a series of tests including laboratory tests, a colonoscopy and possible CT scan of the abdomen. Mrs. R. indicates “OK” and you make arrangements. A follow-up visit is scheduled two weeks later, and Mrs. R returns with her granddaughter. She has not gotten the colonoscopy, and the granddaughter reports that she has been too busy caring for her husband to complete the procedure. She did however have her laboratory tests done which reveal a slight anemia and you again suggest a colonoscopy. Mrs. R apparently agrees and the colonoscopy is rescheduled.

Mrs. R misses her next two appointments and returns to the clinic two months later with her 40 year old daughter. You bring in a professional translator to assist with the interview and care plan. Through the translation, it becomes apparent that Mrs. R has been having crying spells, difficulty sleeping and feeling generally bad over the past 6 months. Also she thought that her “stomach problem” was “empacho” and that the bowel preparation she was given for the colonoscopy was enough. And if she had a good bowel movement she wouldn’t need the “light tube in the rectum.”

On testing using the Geriatric Depression Scale (Spanish Version)-Short Version, Mrs. R scores 8 abnormal responses of a total of 15 questions suggesting depressive symptomatology. Counseling was given for caregiver stress, respite plans made and anti depressant medications begun. Colon endoscopic evaluation reveals Dukes A colorectal carcinoma.

Questions for Discussion

Questions for Discussion

1. What are the implications of using the 8-year old granddaughter as interpreter?

2. On reviewing the case, what might you have done differently to assist with the assessment?

3. How might you have elicited Mrs. R’s own perception of her condition?

4. Legally, who is responsible for making decisions?

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