The Constant Carer
George Howell
Our lives collapsed into these four walls
And with it went the world and all its surprises
So that only routine remains
I will always love him
But now he is only a patient of disease
For there is nothing more but to survive
I do not condemn this
But what is wrong with me?
I am of health, if old
Though the demands I face are greater than ever
This is not my suffering
That machine has me shackled too
I am estranged from so many possibilities
And who am I to complain, this is my duty
This is his illness
The doctor likes to ask how I’m coping
Yet he is the sick one
But why then does it help
Sometimes I think that this is our illness
Mr Jones suffered renal failure last year. He is treated with dialysis and is also relatively immobile due to problems with his hip. Consequently, Mrs Jones from whose point of view “The Constant Carer” is written, has to care for him full-time.
I found that I could identify with this, as it is very alike to the situation with my own grandparents where my grandmother cares for my terminally ill grandfather.
The most striking similarity between the two cases is that the carers are still very physically fit and healthy, yet their quality of life is restricted by how they support their spouse.
Mr Jones has dialysis administered three times a week in a clinic and if he misses one of these appointments then he becomes very ill. Therefore it’s essential that he is always available for them, so the couple are forced to stay at home and live the same routine all the time. As his hip makes it very difficult for Mr Jones to move, this routine involves Mrs Jones doing all the housework, grocery shopping and helping him to the toilet for example. She described it as a very heavy workload that is never ending. Although I could tell on my visit that Mrs Jones is very physically capable, this is still a demanding lifestyle for someone of her age.
Also, the way in which they are bound to their home prevents them from doing things they enjoyed such as seeing friends or going on holidays, which Mrs Jones told me she used to love.
My grandmother has a very similar role in her duty of care, and consequently I found that I could easily empathise with this. Consequently, when portraying it in the poem I thought about the shared traits that my grandmother and Mrs Jones have. I didn’t try to emphasise that their responsibilities in the household was what they resent, as from what I understand this is untrue and I feel this suggests they are annoyed by their good health and love for their husband. Instead I see that the focus of their distress from being a full-time carer is how it removes enjoyable parts of their lives, and does so without reward “But what is wrong with me?” (line 9).
When interviewing the Jones’s, Mrs Jones was very reserved about voicing any complaints concerning her duties. She seemed surprised whenever I directed questions at her, as if I would only be interested in talking to her husband. At first she tried to direct the attention away from herself but opened up more as the interview progressed. The impression this gave me was that she does not consider her own needs as comparable to her husbands, given that he is “the sick one”. She seemed to feel that as his wife, this workload in supporting him would only be expected. I also think she is not comfortable in getting outside assistance, for example, I asked if her family gave any help and she replied that they did but didn’t stress this as though it was more or less negligible.
This attitude must cause Mrs Jones to feel very isolated which will give her more grief “And who am I to complain, this is my duty” (line 15).
This contrasts with my grandparents’ circumstances and so I did not anticipate it – as I had done other aspects that featured in the interview. As a result, I think this evoked a deeper empathy from me, and is the subject of the last two verses of the poem. Consequently I found that whilst writing, I stressed the emotional aspect mostly, as I began the process of appreciating Mrs Jones’s helplessness.
I realised as I reflected and wrote the poem, that I feel as much sorrow for Mrs Jones as I would expect to for any chronically-ill patient. Hence I finish by suggesting her position of dis-ease makes her comparable to a chronic patient, such as for example, her husband – “Sometimes I think that this is our illness” (line 20).
*names changed to preserve student-confidentiality
I like this poem as it is similar to a patient I have seen myself on GP placement, but who coped with it in a very different way. It is really interesting how the poem is from the perspective of the carer rather than the patient, because as a medical student it is easy to only think about the disease and the effect it has on the patient when in fact, it can affect many other people who are involved too. The poem shows how Mrs Jones is in a constant battle with herself between feeling trapped and stuck with a duty she doesn’t want, and then feeling guilty for feeling that way. It makes my empathise with her and think that maybe our healthcare system needs to provide for family members as well as the patients. Very thought provoking
This poem is a poignant explanation of a similar situation that I have seen in clinic, in this case the wife seemed to enjoy caring for her husband and they found a lot of humour with the dynamic, joking that he leaned on her now! This poem also made me reflect on my own experiences of being ill and helped me to better understand the internal battle that my family and friends felt. Overall this poem is incredibly thought provoking, and refreshingly honest as it allows us to see the true depth of emotions that the wife is burdened with instead of just a front that a patient might put up.
I was drawn to this piece because in my first GP placement at university I met a patient who has been struggling with renal failure for around two decades. Throughout his experiences of dialysis, two transplants, a lot of medication, and secondary conditions arising from renal failure, his one constant was his wife who remained with him through it all, even on his more difficult days where getting out of bed seems like an impossible task. This piece explores the toll the patient’s conditions takes on his carer, his wife, who may not get the care and/or recognition she deserves herself.
I have only just discovered this wonderful website and this moving poem written almost 14 years ago now. I cared for my husband at home while we both lived with his dementia. Although our situation was different, so much of what you said in the poem resonated with me George. I wrote a poem called “Shadow lives” which expresses similar sentiments.
You were so right to consider the unpaid carer and the care partnership, something which is attended to a little more often, 14 years on. If the unpaid carer is not mentally and physically well enough, then it is the patient who will suffer the consequences as exhaustion, resentment and overwhelm enter the dynamic. People are more than the body and this can be forgotten by medical practioners at times; but not you George.
Thank you for the poem and I hope you have continued to develop a holistic and client centred approach to medical practice, in spite of all the pressure and limitations today, making it easier to do otherwise.