Legal Guardian


 My receptionist announced that Dr. S.Q. Lapius had arrived.  I told her to send him in.  Snow was melting on his collar, and when he doffed his astrakhan lamb’s wool hat that Gumbenich had sent him from Moscow a shower of snow settled on the carpet.   “Please sit down, Simon, I’ll only be a minute,”  


“Don’t tell me I have to wait till you finish all those insurance forms, Harry.  We’ll be here all night.  You know I have a chess match later.  Have you forgotten why I’ve come over?”


“No of course not, Simon.”


“Well then, where’s her chart?”


I looked at him blankly.


“Of course you’ve forgotten.  I want to go over the case I sent you today.  Dr. Burton’s mother, Jennie Burton.”


“Simon, let me ask you a question.  How did you come to refer that case to me?”


 “Burton called me this morning and asked if I knew an understanding young doctor who could help his mother.  She has, it seems, a variety of medical problems, and Burton is concerned.  So of course I mentioned your name.”


“Quite a case.”






”Can you help her?”


“Not a chance.”


“Really?  That serious?  Goodness, what shall I tell poor Burton?”


“Tell him that he should stop minding his mother’s business.”


“Harry you’re acting very strangely.  You must have had a difficult day.”


“Sure it was difficult.  Burton brought his mother to the office.  She is leaning on two canes when the nurse escorts them to the examining room.  I take a history and Burton answers all the questions.  The old lady never opened her mouth.  I thought maybe she was hard of hearing.  Then I ask Burton to leave preparatory to examining her, and called the nurse in to help the woman out of her girdles, corsets, and ace bandages, an effort that has to take at least ten minutes in each direction.  As soon as the nurse goes to help her, she lifts her cane and says ‘don’t come near me, I don’t want to be examined.’”


“I said, ‘there must be some mistake, Mrs. Burton, your son the doctor, made the appointment.’”


“’Good, she says, then examine him.  I don’t want no examination.  I’m all right.’”


“’But your son says you are not all right.’”


“’Shows you what kind of doctor he is,’” she says.  Then she picks up the cane again and says, “’if you touch me I’ll scream.’”


“I figure I better talk to Burton.  He was in the waiting room.  ‘Look here, Burton,’ I said, ‘your mother is kicking up her heels in there.  She won’t let us examine her.’”


Burton says, ‘But she’s sick.  She’s even a little senile.  She doesn’t know what she’s doing.  Go ahead and examine her.’”


“’Are you her guardian?’  I ask him.”


“’No of course not.  I haven’t declared her legally incompetent.  But she is nevertheless.’”


“’You know quite well, Burton, that if I touch her against her wishes it constitutes an assault.  Take her home.  You have a legal problem to settle before you can settle your medical problems.’”


“Well, Harry,” Lapius, said frowning, “of course you were correct.  I’m sorry I got you into that.  I didn’t realize what the situation was.  But it seems that once people reach a certain age and develop a certain level of infirmity, their children assume a guardianship they don’t legally possess.  They reverse the generations.”  He paused and brooded for a moment.  “I’ll bet this problem will play havoc in some of these geriatric hospitals.  For example, say that there is an old lady, senile, with a sudden gall bladder attack.  She requires surgery.  The hospital calls the nearest of kin who signs permission for surgery.  There are complications.  A son in Chicago finds out about it and sues because his sister hasn’t the legal right to sign permission.  Or if they hospital gets the patient to sign permission, the son in Chicago may sue on the grounds that his mother is non compos mentis and not qualified to sign.  Too often we assume powers we don’t really possess.”

“So what’s the answer, Simon.


“Not all problems have answers, Harry.”


Comment 2008

About 10 years after this article was written I had a patient 90 years of age who needed a  pacemaker.  She was mentally intact, but insecure, and instructed me to talk to her daughter about the problems she faced. I spoke with the daughter and explained the problem and the need for the pacemaker, and how simple a procedure it was. The daughter nodded. I subsequently returned to the patient requesting that she read the “informed consent  and sign permission for the pacemaker.. She refused and said her daughter would take care of all these matters. The daughter refused to sign the documents. During the time that passed while I was searching for another relative, the patient died. When I accosted the daughter to demand why she refused permission for her mother to have a pacemaker she said, “I have been caring for her my entire adult life. Now I am seventy years old. I need a life too!”