The Case of “Hector”
Case Study 1: Chronic Hepatitis (Cirrhosis of Liver) & Wernicke-Korsakoff Syndrome
I. Case History
Hector is a 44 year old, Hispanic male of low socioeconomic status. He lives on the southwest side of Chicago, Illinois in a neighborhood that is heavily populated with people of his ethnic background. Hector lives in a 3 bedroom home that he is currently renting.
Family History/Current Relationships
Hector was born in San Juan, Mexico and was raised in a two parent household, and has four siblings. Hector is the youngest of the four children. He comes from a Catholic background. Hector’s father worked as a carpenter, and his mother was a homemaker. Hector’s father was an alcoholic and was both physically and verbally abusive to the family. Hector lost his father at age 10 due to a physical altercation that took place at a local watering hole, which resulted in a fatal injury. His mother decided to relocate to the United States where she could receive the support of her family. At age 23, Hector met his current wife. Hector lives with his wife Consuela (age 40), and his 3 children Veronica (age 8), Mateo (age 6) and, Alejandro (age 2). Recently, his mother, and two cousins have moved into the home due to medical and financial reasons. Hector indicates that although times are hard, he is very committed to his family and grateful for their ongoing support.
Hector considers his family to be his primary support system. He indicates that they work very hard to be there for one another no matter what the situation. He indicates that he has a few friends but feel that they are not necessarily positive support systems, but can often times provide an outlet to stress.
Hector has not graduated high school, but when time permits, he attends classes at a community agency who is assisting him with prep classes that will enable him to take the G.E.D. However, Hector admits that he is not able to consistently pursue obtaining his G.E.D because earning a living is his priority at this time.
Hector indicates that he is the primary provider in the home at this time. He indicates that they are able to receive some government assistance (Medicaid, food-stamps, WIC), but the income is supplemented, depending on his ability to obtain work. Hector currently works as a seasonal worker for a construction company. He reports that when he is actually called in to work, he can make decent money. However, there is question as to whether Hector receives his salary “under the table”. Hector does not have reliable transportation. Although he owns a mini-van, he reports that it is in constant need of repair. Hector chooses use public transportation and carpooling as a primary mode of transportation, because his license is suspended due to receiving his second DUI/DWI.
II. Description of Presenting Problem
Hector reports that he knows that he has an issue with alcohol, and has had the issue for over 20 years. Hector reports that the problem with his drinking has affected his family immensely, but it helps him to cope. However, most recently he was hospitalized and was diagnosed with chronic hepatitis. Hector reports a history of alcohol and drug use but he considers his use of drugs (cocaine, crack, heroin, etc.) as experimental. However, the use of alcohol has been ongoing. Hector indicates the first onset of use to be at age 14. He reports he began drinking alcohol and smoked marijuana with friends almost daily throughout his teenage years. Hector reports that he currently drinks about a six pack daily, and can usually drink 4-5 pints of vodka on average weekly. He reports when finances permit he will often indulge in top shelf Tequila.
Hector was brought into the hospital by his foreman because he was acting strangely on a job. Hector’s foreman related that once he gave him directives or instruction, he would often forget those instructions or the event altogether. He also noticed some balance issues, which is a liability in the construction business. Therefore, the foreman thought it was important to get him in to see a doctor because he seemed “out of his head “, and confused. The hospital kept Hector for a one week period and diagnosed him with chronic hepatitis C (cirrhosis of the liver) and Wernicke-Korsakoff syndrome. Initially, Hector had no idea that he had these conditions. He attributed his fatigue, nausea, abdominal pain, memory lapses and poor appetite to “bad hangovers”. However, he has been receiving health education from his physicians, and the nurse case manager and he understands that chronic hepatitis (inflammation, liver damage) can be caused by a group of viruses (A, B, C, D, and E). He has also learned that the infections can cause many symptoms such as fatigue, nausea, poor appetite, abdominal pain, fever, and jaundice. His attending physician has also explained that Wernicke-Korsakoff syndrome (brain disorder caused by the lack of vitamin B1) can be the result of alcohol abuse and can cause memory loss, problems learning new information, long term memory gaps, confabulation (making up information that cannot be remembered).
III. Discussion Questions
1. What are the psychosocial implications that Hector may face as a result of his conditions?
2. What are the vocational implications that may be problematic for individuals with his particular diagnoses?
3. Are there specific assistive technologies available to assist in maintenance of independence?