The hated adolescent: Reactions of family and hospital staff to an aplastic anemia patient.

Abstract

A case of a 16-year-old with aplastic anemia who presented extraordinary management problems during a 10-week hospitalization is analyzed from several perspectives. The case is viewed in the context of convergent systems which did not interface smoothly, hence the patient's "unmanageability." These convergent systems included the patient's family, the ward personnel, which included nurses, house-staff, and three attending physicians over the 10-week period, and the patient himself. The patient's medical course and psychological course are also delineated on a weekby-week basis over the course of the hospitalization.Perhaps nowhere is the attitude of parents more important than with a difficult adolescent who is hospitalized. Effective participation and a positive attitude on the part of parents are instrumental in the course of the adolescent's hospitalization and, in particular, in the effective linkage between family and staff on a medical service to support the adolescent patient (1). The following presents a case of an adolescent with aplastic anemia who was hospitalized for a bone marrow transplant. He had an extremely difficult course of hospitalization, necessitating a plethora of medical and psychological interventions. Unfortunately, even an extraordinary amount of attention and a variety of interventions did not appear to make any difference in reducing the management problems with this patient, nor in reducing his level of emotional distress.In attempting to understand the health care professionals' lack of impact on this situation, it became obvious that it was more than the case of a "difficult" or "hateful" patient (2). The unique difficulties of the family system, coupled with the unique nature of the ward this patient was on, greatly influenced the course of this patient's hospitalization and the reaction of hate toward this most unfortunate boy.

Family Factors Affecting Bone Marrow Transplantation

“…BMT, like other organ transplants [9], is clearly a demanding procedure for the pa tient, the family, and staff [28]. This case report was provided to show how family and medical factors may interact to affect out come of BMT.…”