Verified by 
Yesterday was one of those days… I felt like what I was preaching was falling on deaf ears.
“Medicines like those,” I was saying, explaining why I was reducing the sedative-hypnotic medications for my 80-year-old patient who had ‘lost her balance’ and fallen, appear to reduce anxiety, but have several detrimental side effects.”
“She has been on those medicines for a long time,” her daughter reported.
“Yes, I understand, but I believe that they have contributed to the change in her behavior and have affected her balance. In addition I believe her body has become dependent on them.”
In fact, the family conference today was in response to my patient’s exhibiting signs I considered to be consistent with drug withdrawal.
“Without them, she doesn’t sleep well, and she is anxious and fearful.
“Those medicines cover up the anxiety and restlessness, but do nothing to help solve the problem. In the long term these types of medicines can be disempowering rather than empowering. They act to suppress consciousness. Working to understand why and where you feel loss, and emotional pain is important, and it takes awareness to do that;Long term, it’s a better solution than taking a medication. Medicines that suppress consciousness really postpone the work that needs to be done to get to acceptance.
Since she will be with me here a few weeks…now is good opportunity to begin the real work of healing.”
Most people cannot do that without some counseling and some direction and support, and I am fortunate to have counseling available at the rehab hospital. I consulted the Psychologist to work with her. On rounds the following day after our Psychologist worked with her, our conversation went like this.
“But I am eighty years old, don’t you think it’s too late for that?
“Your anxiety will improve as you work through your fears no matter what your age…your symptoms will improve as you understand your feelings of loss and put them in the proper context,” I told her. “Despite your age, I believe you have what it takes to heal a part of yourself that is injured. And I am talking about more than your injured leg…”
The case manager called me into the room with her family the next day while she was in physical therapy. The daughter of my patient asked me to put her mom back on a sedative to calm their nerves, particularly at night.
“You do not see her at night, you do not have to deal with her…unable to sleep, tearful. She needs those medicines,” her daughter told me.
In my rehab practice trust is a needed ally; and side bar conversations for me, by their very nature are clandestine, prompting suspicion rather than trust. So rather than do a side bar conversation without my patient there, I had the therapists bring my patient back to the room so everyone could hear everything. Her daughter restated her concerns, and I told her again she might be withdrawing from the meds.
In this case compromise would be part of the solution.
“I will prescribe a low dose anxiolytic that will help avoid the withdrawal symptoms, while we get you are working with the psychologist, it usually takes a few days, even weeks for counseling to be effective.
“I think it would be great if you spent some time at those sessions, too,” I said tomy patient’s daughter.
“Sometimes there is much to be gained working with the families as well as the patient.” I was hoping to get them both involved and begin the real work of healing.
As we left the room, the case manager felt my frustration…
“Well what are you expecting?” She asked me. “That a light was going to turn onfor them to instantly “get it?”
I laughed, because she made a good point. I was not sure the lights would come on and each of them would ‘get it’. But I guess I hoped for it. I guess I was hoping for themovie version of story: medications are stopped, they work with the counselor, the conflicts between herself, her daughter, aging, and ‘the unknown’ are resolved. She discharges in 12 days and lives an active life of meaning with a harmonious spirit…a piece of her healed…
But this is real life… those endings are hard to come by.
Oh yes…by the way…12 days later when she was due to leave the rehab Hospital, I went over her prescriptions for home, prepared to continue the anxiolytic.
She looked down at the prescription pad, and then up at me with bewilderment.
“Well if I don’t need those medicines, I don’t want them! Why didn’t anybody ever tell me there was another way?”
