I am a medical assistant at a primary care office. Part of my job is acting as a liaison between the doctor and the various nursing agencies that assist our patients.

I offer to you today the example of a loving husband and wife who have been coming here for many years. She has always presented as crazily in love with him, and he has handsomely provided her and their children with a beautiful house and all the material goods that most people can only dream of.

He has recently been diagnosed with pancreatic cancer. In case you're unaware, this is a type of cancer that is pretty much a death sentence, and a terrible one at that.

The doctor sent a nursing agency to assist in taking care of him. Miraculously, he is able to do most things himself, but is generally weak. The home health aid tells the nursing agency that his physical condition is so good that there is no need for her to be there, and that all his wife needs to do is cook him meals, prepare his medications, and transport him as necessary. This is the best possible news for someone with his condition - he's not shitting and pissing himself constantly, he's not falling, he's not screaming, he's not requiring huge dosages of morphine and ativan to sedate him constantly (at least for now).

The wife of course, thinks of it as the worst news. She cannot stand the responsibility she's been given, and insists on having the home health aid to cook and prepare medication for him (This isn't considered a medically necessary service). She insists medicare should pay for this, despite the fact that they have more than ample funds to privately pay for an aid.

The nurse says the wife wants him to return to work, and has been intolerable, leaving the husband alone at home, and not being available to reach.

Neither myself or the nurse were surprised by this. The nurse (who is a female, believe it or not) said to me, "I wanted to remind her of, 'for better or worse', but you know how it is".

Indeed, I do know how it is. Once the husband's usefulness and ability to provide is gone, the love is gone as well.