
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: FRIDAY, December 30, 1994                   TAG: 9501170009
SECTION: EDITORIAL                    PAGE: A-11   EDITION: METRO 
SOURCE: LORI BELL MICK
DATELINE:                                 LENGTH: Medium

DEPRESSION

IN THE late spring of '93, I was told that Mother had only a few months to live. The medical diagnosis was congestive heart failure. A more serious problem, however, was that Mother was starving, a condition not due to lack of essential nutrients but to depression.

Mother lived in a single apartment in an assisted-living center. My father had been dead for seven years. What follows is my personal account of the unsuccessful attempts I made to obtain treatment for Mother's depression, and the indifference that the medical profession displayed toward mood disorders in the elderly.

Acceptance of the fact that Mother was dying came slowly and with resistance. Having had a personal confrontation with familial depression, I recognized the importance of family support as well as medical intervention. I wanted to be with Mother, to care for her and to seek help for her depression. But how, when I lived and worked a thousand miles away? A partial answer came when I was offered a teaching position in a small, private college in Iowa.

I moved to Iowa in the summer of '93. Prior to my arrival, Mother's caretakers had asked her physician to prescribe medication for her depression. He had not responded to their request. Mother's friends, relatives and minister remarked on her unrelenting sadness. What little energy she had was being expended by ceaseless crying. I was confident that Mother's physician of 40 years would not ignore my requests.

During the next days, I made several visits to his clinic, each unsuccessful. The first time I was told he was on vacation and would return in two days. When I returned he was "out of town." Only after persistent prodding by Mother's caretakers "to return to the clinic and not to leave until you get help" did I make a third visit. When again I asked to see Mother's physician, the receptionist told me to take a seat in the waiting room.

A nurse with a clipboard approached me and queried impatiently, "What can I do for you?" I said that Mother was dying, that she cried incessantly and could not eat. I was hopeful that her physician would treat her depression. The nurse directed me to "wait here until one of his associates can see you."

Later, an associate beckoned to me from the hall, and with only a momentary glance up from a chart he was studying, he asked, "What can I do for you?" I said that I was seeking help to treat Mother's depression. He said he was sorry, but that her physician would be the appropriate one to prescribe an antidepressant.

I returned to Mom's bedside. I sat in the rocking chair and rubbed her thin arms. I cried and she cried. Then my spirits lifted. I remembered that one of Mother's nurse aides from the Home Health Care organization had suggested that I call the University Psychiatric Care Clinic. I dialed the number. A well-controlled voice described the procedures. She said that the next opening would be in approximately five weeks and several assessments would need to be given before a treatment plan would be implemented.

Mother's body grew more emaciated, the skin more translucent. She was aware that she could not control her emotions. She asked frequently if someone might "help me stop this crying."

Then one evening while I was reading to Mother, I remembered that in the late '70s she and my father had befriended a young intern at the medical school. He was now a physician in another state. I dialed his number. I told him that Mother would not eat nor cease crying. He asked to speak to her. She sobbed throughout the entire conversation. When I took back the receiver, he told me that if he were Mother's physician, he would treat her depression. He urged me to return to Mother's doctor. I did not return.

In the autumn of '93, at noon, mother died. Part I of her Certificate of Death states that the immediate cause of death was cardiac arrest due to diffuse arteriosclerotic disease and degenerative disease. Under Part II, where space was provided regarding Other Significant Conditions Contributing to Death, I would have added, malnutrition brought on by untreated clinical depression.

I value the few weeks that Mother and I had together. My presence eased her loneliness, panic and fear, but I was unable to get help for her depression. At Mother's funeral, friends would remark: "She looks so peaceful at last."

Today, a year later, I have many questions. Why do we not treat elderly depression as aggressively as we treat adolescent depression? Is not a day, an hour, a moment in the life of the elderly as valuable as in the young? Does not dying with dignity mean not only prescribing medication to reduce physical suffering, but also to adjust chemical imbalances and thus elevate mood?

Did mother's peace have to come only in death? Might those few remaining weeks of living in despair have become weeks or even months of peaceful remembering?

Lori Bell Mick lives in Montgomery County.

by CNB