Amy: You seem to be a very busy woman. Tell me more about that, if you will. What is a typical day like for you?
Mrs. Adams: I get up early because my daughter drops off Alison every morning at 6:30 a.m. She is a single mother, and I take care of Alison while she is at work because she cannot afford day care. Alison is with me all day. I bathe her and dress her. I have to do everything for her, and I worry that I can’t do these things because of how my hands feel and how tired I am.
Amy: You have serious obligations to your family. You feel that you can’t let them down.
Mrs. Adams: Yes, and I’m scared that I won’t be able to do what they need me to do because I get stiff, and it feels like I’m getting weaker. As I said, it’s hard enough to take care of myself right now. I have a hard time even pulling up my pants because it seems like I don’t have the strength. Buttons are hard, and it’s really hard to tie my shoes.
Amy: What other activities fill your day?
Mrs. Adams: That’s about it. I try to clean my house while Alison is asleep. Otherwise, I have to do all my errands in the evening. I take public transportation, and I have to walk a long way to the stores and laundromat. I’m too tired to do that now.
Amy: Let me see if I have this right. You’ve recently had an increase in arthritis activity. It has primarily affected your hands and wrists, and since you live alone, you have to find ways to get your cooking, cleaning, and shopping done, not to mention taking care of yourself. Perhaps most importantly, in your view, is that you’re having a hard time taking care of Alison, and you don’t want to let her or your daughter down. You need to be strong for them.
Mrs. Adams: That’s exactly how I feel.
Amy: Let me tell you what I’ve found in your evaluation, and then you can tell me what you think about what I’ve said.
Amy relates the specific findings from the evaluation and how it relates to Mrs. Adams’ overall health and functional ability.
Amy: How do you feel about that?
Mrs. Adams: I think all of those are serious problems, but since I look after Alison every day, I don’t see how I’ll find the time to come to therapy.