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Social History

Once Ms Jones is stabilized, you finish your history and begin to think about how all of these factors have brought her to emerg at this time.

Work

Mirna previously worked as a full-time grade five elementary school teacher but, since the closure of the school in which she worked a year ago, she has only been able to find work as a supply teacher in different grades and different schools across the city. The lack of continuity in schools, grade levels, support from the schools in which she supply teaches (especially when there is a problem in class), and ability to get to work through sometimes inadequate public transportation to far-flung areas of the city make her paid working conditions often very difficult. She cannot afford a car.

Responsibilities

In addition to her irregular paid employment, the patient has heavy family responsibilities. She has primary childcare responsibilities since her divorce three years ago. Her husband has custody every other weekend, but occasionally does not take this opportunity, claiming that he is "busy" and will see the children another time.

Family

Mirna’s children are fifteen, ten and seven years old.

The patient’s father, who is in the early stages of Alzheimer’s disease, lives in the same city; her mother is deceased. The father lives alone, but is increasingly disabled by his condition and will soon need another form of living arrangement. While he has limited access to some publicly funded home care, it is not enough to meet his needs and he cannot afford to purchase additional private home care. As a consequence, in addition to the patient’s childcare responsibilities, she often provides eldercare for her father. While she does not want to see him in a "home" (neither he nor the patient can afford long-term care since it is not covered under OHIP), at the same time, she fears she will be unable to look after him when he is no longer able to live by himself.

The patient has a younger brother, but his level of involvement in his father’s care does not match that of the patient.

Economic Status

The change in the patient’s marital status as well as her employment situation has resulted in a significant decline in her income. Her former husband is chronically late with child support payments and often refuses to pay for all three children, maintaining that the oldest child is not "his" since he is not the biological father, even though he acted as a father figure to the child throughout their marriage. As a young woman, the patient was a single parent before marrying her former husband and returning to university to pursue a teaching degree. The patient is very concerned that her children will suffer economically as a result of her divorce.

Her oldest daughter has indicated a desire to go to law school, but the patient does not see any way of paying for it given her work situation and her former husband’s attitude toward the child. She also does not want her daughter to be responsible for a large debt given the significant rise in university tuition. Her sons want to enroll in extra-curricular sports activities after school. These used to be free but now costs are offloaded to parents because of cuts to public education, but she lacks the discretionary income and her former husband refuses to help.

Marital Status

The decline in her standard of living and her inability to provide the things her children desire cause her to feel guilty and inadequate as a mother. While she feels antipathy for her former husband (she discovered he was engaged in an extramarital affair and left him), she occasionally feels that things would have been easier financially if she had not ended the relationship. While she feels betrayed by her former husband’s infidelity, at a deeper, more painful level, it has also undermined her sense of self as a worthy lifelong partner, both emotionally and physically.

You note that she is prepared to tell the husband that unless he pays child support for all three children on time, she will write a letter to his employer advocating that his wages be garnished.

1.Review Mirna's social history. How are her social and economic situations influencing her health ? What are the sources of stress for the patient, and what is the link with cardiac disease?
2.You notice that the patient has heavy family responsibilities. What options and resources do you have to offer her?
3.Do you think that this patient feels strong social support? How important is this factor for her health ?