Control

A new patient was brought here by his wife. His doctor told her that she thought she could handle his severe Alzheimer's disease. However, she just wanted to have a neurologist so that she could find out about new developments. It's a little odd, since she's very intelligent and belongs to the Alzheimer's association and is on the web and was a lawyer who just recently retired and (I know this is a grammatically incorrect run on sentence) she certainly knows that any major development in Alzheimer's would be all over the news. However, she just wanted to have a neurologist to find out about new developments in the field. She recounted his history for me. They just moved here from Arizona. He is an an assisted living setting that she feels is very good for him. She brought some of his records for me to review - those from his second neurologist. She didn't bring the ones from his first neurologist who she mentioned had made some mistakes which were confirmed by their primary care physician. She also said that there was a significant conflict between herself (she's "the second wife") and his daughter. They had agreed that the daughter shouldn't be visiting him with many people all at once because (according to the wife and her research - she was able to research this issue extensively, but wouldn't be able to find out about new developments) many people all at once agitate people with Alzheimer's in generally and especially him. This had required lawyers and negotiations. She had letters from his last neurologist stating that she was the only one who should dictate his care, and letters that he shouldn't be exposed to multiple people. It was probably a detail oversight (lawyers commonly miss the details) but there were multiple copies of these two letters, which is why I say "letters". There were only single copies of the medically relevant information. Anyway, what she wanted is that I write letters saying that his daughter shouldn't be allowed to take him out on her own. She wanted this "for her files". It was all very confusing to me. It turns out that she was concerned to some extent about a cabin that he owned. Also, she had left Arizona without discussing it with his daughter. I mentioned this many times, but she didn't want that. Anyway, when there is a family dispute about who should be a guardian, courts typically appoint a "neutral" party. There are professional guardians who take on this responsibility for people. They just do what's best for the patient when it appears that people in the family want to do what's best for them.
Obviously, this wife wants to have complete control. She came here to try to get my assistance. I told her that I couldn't really help her, because I really don't know that it isn't good for the patient to go out with his daughter. I don't know how any doctor can know this. I don't know how a neurologist in Arizona knew that going out to lunch with his daughter was harmful for the patient - ahead of time. I also told her that this sort of decision making was usually made by a custodian.
There is a lot that goes into the control of people who lose thinking. I'm notsure what happened with this family. There is a great conflict between the patient's wife and the patient's daughter. I don't blame anyone. I won't take any sides. The situation is sad and frustrating. There was a failure in planning. This is something that the family should have discussed very early on - the minute that the diagnosis was made. The patient should have set out clearly how things should have been handled: who should become the custodian if one were necessary. He should have prepared an irrevocable will that couldn't be modified by a custodian. None of that, it seems, occurred. She is a lawyer, so it's not a case of ignorance. It's just a case of control. People want control.