1. Gerber, Lois BSN, MPH, RN

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Diana* was having a bad day. This 65-year-old patient had been referred to our home healthcare agency for follow-up and teaching related to her new diagnosis of type 2 diabetes mellitus. Fibromyalgia and osteoarthritis were secondary problems.

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This was my second visit to her home. Her husband Tony opened the door to welcome me in. "She has me jumping every 2 minutes to get her something," he said.


I shook his hand. "I'll see what I can do."


Dressed in a silk negligee and wearing full makeup, Diana sat on the edge of her bed. Her face was distorted with pain. "This sugar problem is too much. I can't handle it. My back and leg are killing me. I had a spinal fusion for the pain 2 years ago, but it didn't work."


Tony fluffed up the pillow. I helped her lie down in bed and checked her medication list. "Have you taken your muscle relaxant?" I asked.


She responded yes before checking her watch. "I'm due for another pill in an hour. Why does everything happen to me? My doctor won't give me oxycodone for my pain anymore."


I took a deep breath. "It's hard to understand why illness happens to some of us. There are ways besides oxycodone to treat your pain. New research shows taking opioids long-term hurts people more than it helps them. What about using ice packs or doing some light stretches?"


"I've tried everything," Diana said. "Nothing works."


"Hmm," I said, "we'll need to do something different. I'll check with the doctor. Maybe get a physical therapy referral." This situation was more complicated than the diabetes teaching I'd originally anticipated.


Diana agreed to the referral. I phoned Dr. Key.


Dr. Key told me that recent imaging from Diana's lumbar spinal fusion showed successful resolution of the disk problem. "If she's still in pain, let's refer her to a pain management clinic as well as a physical therapist," he said. "A nurse will send the referrals over this afternoon."


At the next visit, Diana, lying on her bed on top of her satin comforter, appeared disengaged as I took her vital signs. Her eyes held a faraway look. "Dr. Key wants me to go to a pain clinic. I have an appointment tomorrow."


Tony, who sat on a flowered upholstered chair by her bed, rubbed her feet. Diana pulled them back. A flicker of sadness crossed his face. He reached to the nightstand for a glass of water and held the straw for her to drink. She took a sip, then pushed the glass away.


I laid my stethoscope down. "Pain is a language unto itself. Makes it impossible to concentrate on anything else." After helping her into a chair, I asked, "Are you up to learning to use your glucometer?"


"I guess," she mumbled. "Tony's been doing it for me. Why do I have to learn?"


"It's good Tony knows how and is willing, but it's also important for you to be as independent as possible in taking care of yourself."


"All right. That's what the doctor says."


With my direction, Diana reluctantly tested her blood glucose level. "See, it's normal, so I shouldn't have to do this every day, right?"


"I understand how you'd think that, but controlling blood sugar levels keeps you from developing complications like heart disease, eye problems, or nerve damage in your feet," I responded. "You need to keep on top of it."


"That's what I tell her," Tony said. He squeezed her hand.


Diana stared hard at him. "That's what I hate. You're always hovering. You treat me like a child. If I weren't sick, I'd be out of here."


Tony walked out of the room. His overly solicitous behavior was straining their relationship.


Overcompensation and resentment

Likely because of anger at Diana's dependency and the couple's reduced social contacts, Tony's frustration had turned to guilt and overcompensation. Diana, on the other hand, needed Tony's assistance and had allowed him to take on a fatherly role and do things for her that she could do for herself. Yet her resentment at his overattentiveness caused her to be sarcastic and withdrawn.


"Illness and pain are a family issue," I told Diana. "Everyone, not just the patient, is affected. Perhaps, a social worker can help get things back on track."


Diana scoffed. "We've done marriage counseling. It didn't work."


"This is different. It's more focused on the health problems. Most of Angela's clients have concerns like yours. She really understands how to help families adjust."


Tony, having heard our conversation, stepped back in the room.


"I'd love that," he said. "This has been a struggle for years."


Tears filled his eyes. "I love her, but I don't know how to help her anymore."


"What do you think?" I asked Diana.


She shrugged. "Whatever."


"I'll get the referral set up."


At the next home visit, Diana responded appropriately to my diabetes teaching, yet she still acted bored and aloof. Tony, however, was an active participant, asking questions and following up on suggestions.


"A new person"

I met with the Angela, the social worker, 2 weeks later. "They're both responding to my counseling," she said. "Diana's softened. Tony's backed off. He joined his old golf league."


"She's gotten some pain relief from the physical therapist's exercises," I added. "Dr. Key put her on an antidepressant. That's helped too."


"Yes, easing the anxiety around pain is important," Angela said.


Three weeks later, Diana opened the door as I was walking up the sidewalk. "This is a great day. The pain is almost gone. Come in."


Tony walked in the room to greet me. "Angela helped me see how I was babying Diana. I'm changing. I'm giving Diana more space to do things her way."


Diana smiled. "I move a lot slower than Tony, but he's more patient now."


I nodded. "It's good to see you both happier and working together."


Diana rubbed Tony's shoulders. "Amazing how everything has come together in the last month. I feel like a new person, one ready to tackle my diabetes head on. Foot care's today, isn't it?"




Nordqvist C. What is causing this pain in my back? Medical News Today. 2017.


Jacobs BJ. In sickness, health, and (sometimes) anguish. AARP. 2013.


Singh MK. Chronic pain syndrome. Medscape. 2017.


* Names in this article have been changed to protect anonymity. [Context Link]