Oh, your precious lame ducks.
John Galsworthy, The Man of Property, Part 2, Ch. 12.
All of Us In General Practice Become familiar with the situation that lends itself to the label ‘lame duck survival’. Typically, two people are involved; perhaps they are sisters who have not married and live together, or are a married couple without children. When one member becomes permanently ill or handicapped the balance of the partnership often alters: the healthy partner takes on the role of caretaker, manager and controller; the other becomes totally dependent. This is not the catastrophe one might imagine; the once dependent partner—the ‘lame duck’—survives, often coping remarkably well.
Mrs C’ s case illustrates an extreme example: she became responsible for a whole flock of ‘lame ducks’.
Married at an early age and against the wishes of her family, Mrs C strictly and carefully raised four healthy children (two boys and two girls). Gradually it became apparent to her that the attractive young man she married was becoming ineffectual and difficult, dependent yet aggressive; his behaviour was strange and incomprehensible. Eventually he became psychotic and was diagnosed as a chronic schizophrenic.
Mrs C’ s two daughters married (at a relatively early age, as their mother had done) and each had two children. For some reason these offspring (all male) became difficult and ‘hyperactive’; Mrs C agreed to take a large share of the burden of minding her grandsons. This she did in addition to taking on a job as a chef’s assistant (to prop up their ailing family finances) and looking after her psychologically disabled husband.
Mrs C had a strong personality indeed, but worse was to follow. Her older son, handsome and bright, refused tertiary education and chose apprenticeship to a bricklayer. Without warning he became severely depressed and suicidal and, despite hospitalisation, electroconvulsive therapy and antidepressant medication, took a rifle from his treasured gun collection and shot himself. As a suicide attempt it was unsuccessful but it destroyed his eyesight. Discharged from medical care, he went home to the care of his mother.
By now Mrs C’ s parents were old, infirm and becoming totally dependent. Being their only daughter, Mrs C was expected to look after them; this she did.
Eventually the death of Mrs C’ s aged mother (from renal failure) alleviated her caretaker load a little. Then one morning, totally unexpectedly, the dominant and apparently indestructible Mrs C was found dead in bed. Her family was stunned; even as he administered the last rites, the parish priest expected her eyes to open at any moment.
Mrs C’ s father was admitted quickly to a nursing home as a chronic invalid. Her two daughters and their difficult sons matured remarkably quickly. The indifferent Mr C sold the family home and, with his blind son, moved into a town house where he lived in a zombie-like state with tardive dyskinesia and monthly phenothiazine injections. Amazingly, Mrs C’ s son began to function relatively well: perhaps he assumed a type of caretaker role? (Mrs C’ s younger son, her fourth child, had managed to escape the family turmoil. Although dependent on his mother, he matured through a trade apprenticeship and marriage and is well.)
DISCUSSION AND LESSONS LEARNED