Mable cares

Mabel presented herself for a disability hearing as a physically healthy, but somewhat frail appearing female about 50 years of age.  Medical documentation was essentially useless in explaining why she was not working full time.  She had a substantial history working in the factories and processing plants around Gainesville during her earlier years.  What happened to interrupt this history was not clear from the records.

At the appointed time Mabel arrived for the hearing with her daughter, who asked to testify for her mother at the hearing.  The judge agreed to include her testimony, along with her mother’s.  They were both sworn in, and after his standard opening statement, the judge began his usual information gathering routine.

Directing his first questions to Mabel, he asked how she spent a typical day, what all she did, and any difficulties she experienced along the way.

Mabel’s inability to communicate verbally was clear from the outset.  She tried to choke out a word or two, but essentially was unable to form and share information in simple sentences.  The judge asked more questions about specific activities like cooking, house cleaning, or yard work, and Mabel was still unable to share any useful information about her abilities, inabilities, difficulties, strengths, or problems.  She mostly stammered, stuttered, and struggled to communicate in response to the judges questions, and finally gave up.

The daughter was fidgeting substantially by this point, and eventually raised her hand to fill in the blanks left by her mother.  Reminding the daughter that she was also under oath, he repeated many of the same questions for the daughter to answer for the mother.  The complete story was revealing.

Some seven years earlier Mabel’s husband was diagnosed with cancer.  Its progression and treatment left the husband bedfast for a considerable period of time.  Mabel was his primary caretaker, and was also trying to work outside the home early-on in this process.  After five years of caretaking her husband died, relieving Mable of the constant caretaking chores.

Shortly after her husband’s death, Mabel’s son was involved in a car crash.  His injuries left him with complete quadriplegia.  Following his initial stabilization he was returned to his mother’s home, where she was known to be an accomplished caretaker. We are now two years following her son’s caretaking needs, and Mabel has been struggling with these constant chores for the better part of seven years.

Caring for an individual with quadriplegia is almost a full time job when it is done right.  In her son’s case the only thing he could do was talk.  He was unable to perform any useful functions beyond telling his mother what his needs were at the moment.  As the days, months and years wore on Mabel was totally exhausted from the constant caretaking, and associated stress twenty-four hours a day, every day.

The rest of the daughter’s story was that her mother’s ability to function began to slip away gradually. She added that she was the primary caretaker for her brother at present, and had taken over the needs gradually as her mother’s ability to respond appropriately faded away.

Putting this testimony into a civilian context, the experience resembles what is described in the literature as combat fatigue.  Based primarily upon the reports and experience of soldiers who are in combat, without relief, for days, weeks, and months, the picture often presented was similar to that displayed by Mabel over seven years.  The complete inability to communicate coherently was the clearest indication that relentless stress had taken its toll on Mabel, who had checked out of the civilian scene almost as gradually as she had entered.

Because of the serious inability to perform the required duties, the military made it policy to follow a strict rotation for soldiers in combat.  Three to six months appeared to be a practical limit to the period of time during which soldiers could maintain reasonable performance levels before their ability started to degrade substantially.  Mabel had been in this stressful environment for seven years, and was showing the direct effects.  No doubt she was granted a favorable decision on her application.

A fascinating accumulation of historic antecedents to combat fatigue was also available.  Individuals who had experienced a broad assortment of difficulties in earlier life were far more likely to develop the disorder.  The military had a tailor-made solution to this problem through assigning susceptible individuals to non-combat, support activities.  Mabel’s only backup system was her daughter.

The good news, also from the literature, was that once the stressful circumstances were removed there was a slow, but spontaneous recovery of those functions lost due to stress.  Mabel had lost all the functions required to be usefully employed.  With luck and her daughter’s support, hopefully Mabel has regained most of her earlier abilities.

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