A problem like Maria

I've been seeing the same middle aged Italian lady at least once a fortnight for a couple of months now. We'll call her Maria. Her symptoms are minor, and despite my best efforts to help, her name continues to appear on my morning surgery list. As the weeks have gone on, I have begun to dread seeing her, to dread that feeling of not knowing what on earth I can do for her.

On Tuesday however, she came with her mother, and all of a sudden I began to understand what I had missed before. Maria's mother is in her 80's and suffers from dementia. You can see that she was once charming, and I saw glimpses of that from time to time, but the disease has changed her. She has become impossibly forgetful, making conversation hopeless and frustrating for all. There is aggression at times, and she was openly rude both to me and to her daughter, who sat helplessly beside her, tears in her eyes.

Maria has been looking after her mother on her own for some years. She needs to work, and so during the day she pays carers to come and sit with her mother. This is of course expensive and she cannot afford any help in addition to this. Her mother becomes frightened if left on her own and has a tendency to wander, and so Maria spends every evening at home. She has few friends and no other family.

She is a saint. In looking after her elderly mother she is doing what I think we would all hope to be able to do, and yet it is slowly eating away at her happiness and destroying her life. Her options are limited. She earns too much to qualify for NHS help, and too little to pay for it herself. She can't bear to consider a nursing home for her mother, and I've no doubt that she would not be forgiven if she did.

It is now all too clear why I had not been able to help Maria. I think her frequent visits have more to do with her unhappiness then the symptoms she describes. The thing that troubles me most is that I'm still no clearer as to how I can help.