Case Study

Isabelle and her husband Victor lived together for 53 years in a small, close-knit Italian American section of a big city. Victor made a living for the family working as a forklift operator. Isabelle, a stay-at-home mother when her _children were young, returned to work as a sales clerk once the youngest two children entered high school. Isabelle enjoyed her years of full-time mothering, but she also loved the social interaction and camaraderie she found in her job. The family has four grown children, Paul, 51, Sophia, 49, and twins Lenore and Joseph, 45. Paul and his wife own and operate a small restaurant in a nearby suburb. They have two young adult children. Sophia, also married with two children, teaches in a middle school about an hour away from her parentsÕ home. Lenore has recently remarried after a divorce. She lives with her second husband and her three children in the city. Joseph is a salesperson who has never married but lives in another state with his longtime partner, Joanne.

At this time, the family is struggling to come to grips with VictorÕs recent death. After years of robust health, _Victor was diagnosed with pancreatic cancer. During the last 4 months of his life, he was in and out of the _hospital as his health demanded. Isabelle tried to care for him as best she could, but it was very difficult. The side effects of _VictorÕs treatment protocol left him feeling ill and in need of _constant care. The family members tried to help, but the greatest burden fell to Paul because, in this family, the _oldest child is perceived to have the most responsibility.

As time went on and it became clear that Victor was dying, Isabelle mentioned to her children that their father had not wanted any extraordinary measures to be used to keep him alive in his final illness. Victor had never put this in _writing, but Isabelle was sure of his wishes. VictorÕs family _physician, a deeply religious man, VictorÕs older brother, and Joseph all strongly disagreed with this plan. They believed that every effort should be made to save VictorÕs life. One night, Victor lapsed into a coma and was having trouble breathing. Joseph prevailed upon his mother to allow the physician to insert a ventilator. JosephÕs siblings were very upset about this turn of events, for they believed it caused their father unnecessary suffering. Victor died several days later.

Now 4 months after the death of her husband, Isabelle is grieving the loss of her spouse. She lives alone but is seriously contemplating asking her son Paul to let her move in with his family. She quit her job at the department store because she felt she was unable to concentrate well enough to perform in a satisfactory manner. She has been unable to sleep through the night, and her mind keeps returning to memories of Victor during his illness.

Relationships are strained among the children. Neither daughter speaks to Joseph or Joanne because of their _disagreement about VictorÕs care. Joanne believes that Joseph should Òmove onÓ and concentrate on her and their life together. Lenore avoids calling her mother because she does not want to hear her repeat the same troubles over and over again. She uses her hectic schedule as a full-time mother as an excuse. Sophia is somewhat more attentive, but she is also uncomfortable listening to her motherÕs reminiscences. She wants to believe that her mother is still the same vibrant person she has always known, so she discounts the sadness she hears in IsabelleÕs voice. Paul is overwhelmed by the responsibility he feels for his _family, his business, and his mother. He knows his mother is grieving, but he cannot find a way to make her feel better. For her part, Isabelle feels that she has come to the end of her life as well. She believes that she will end up like many of the other lonely widows she knows in her neighborhood.