I received the call from the PCP’s office referring the patient for distress due to the loss of her husband. On the referral form, there was a note regarding a history of alcohol abuse and current severe depression. I made contact with the patient and set an appointment for the following day.
My intake sheet asks if the patient is married, for how long and, if no longer married, why not. I was struck by the patient’s entry, “Husband died, by me”. Why, ‘by me’ I asked? She tearfully said his family blames her for his death because, when he collapsed at home, she did not apply effective CPR. I told her that, even when done well, CPR was likely to succeed only a small fraction of the time. I then went through her husband’s medical status, they were preparing to bring oxygen into the home for him for his emphysema, and reassured her that there was little she, or anyone, could have done. It was not her fault.
Her crying had stopped, but her mood was still very low. “He was my best friend,” she said. “The family took down all the pictures of us, and replaced them with pictures of him with his former wives.” I reflected that she and he had been very close for well over 20 years of marriage. I suggested she could probably imagine what he would do or say in almost any situation. She agreed. I asked her to imagine that he was standing behind her and, as she turned to him, he would tell her what he thought about how his family was behaving. She began laughing before she turned.
Over the course of the hour I spent with her, I could relieve her of her guilt over her husband’s death, I was able to explain the nature and progress of human grief, and show her that she was actually on a normal track. I could suggest that, though he was dead, he was not wholly gone, as she could talk to him any time and even hear his replies. The comfort he always provided, he could continue to provide. She agreed to come back for another session, and left with a distinctly lighter mood.
Being able to spend an entire hour at a time is one of the luxuries of my practice. Being able to sense and respond to the many factors driving the patient is one of the skill sets of my work. Driving toward sustainable outcomes that allow the patient to live more effectively with whatever challenges they face is my overarching goal. I have the time, and the skills, to do this kind of work, and this is what makes the behavioral specialist referral effective for the patient, and the PCP.
It’s another reason why the Michigan Blues’ Patient-Centered Medical Home Program is encouraging physicians to include behavioral health professionals as part of the care team.
Kenneth L Salzman, PhD, is a psychologist in the Lansing, Michigan area