1997 Volume 37 Issue 6 Pages 439-444
A 31-year-old woman who had been suffering from generalized type of myasthenia gravis in remission was admitted to Kyushu University Hospital because of general fatigue and disability of daily life. Antidepressant did not improve her complaints, but caused agitation. Furthermore, she denied medical treatment. The physician made a revised medical contract to improve her motor activity. However, it was difficult to motivate her because she thought it difficult to walk unless her complaints of general fatigue disappeared. Then, after promising the complete help with her daily living without walking by the nursing staff, she gradually became able to walk, but, at the same time, became more dependent on the nursing staff. This, in turn, made the nurses frustrated with her and the physician because of the increase in the amount of their labor. After the conference with the nursing staff, the physician told the patient that her myasthenia gravis would be in remission although her memories of symptoms of myasthenia gravis might remain, and that for the disappearance of her complaints, she should do her daily activities by herself even if she felt general fatigue. Eventually she became able not only to walk, but also to eat and excrete by herself. After the discharge from our hospital, we told her to report back her daily activities once a month instead of visiting the outpatient clinic, because the physician wanted to avoid further involvement and complication and expected her to live more independently. As the result, she was able to get a part-time job.
