WHEN THE DAUGHTER FROM CALIFORNIA ARRIVES

Yes, we’ve all met her. The ‘Daughter from California’ was described by David Molloy in 1991 in an article in the Journal of the American Geriatrics Society. The case vignette involved an 83-year-old dementia patient residing in a nursing home. She had a hip fracture. Her daughter suddenly arrived from California and demanded irrational, aggressive treatment for her mother, who was on palliative care. She was abusive and accused the medical staff of negligence. This was quite contrary to the other daughter’s wishes, despite the fact that she had been the long-term caregiver and had seen the cognitive decline and terminal condition of her mother. The behaviour of the daughter visiting from California is attributed to the feeling of guilt stemming from neglecting her mother’s health needs and the denial of accepting her current condition. There is a clash of egos and conflict between the family members in decision-making for a mentally incompetent patient at this critical juncture. I am sure all of us have met these uninvolved sons and daughters from California, New York, Ontario, or Timbuktu, making sudden appearances during the family meetings and counselling sessions for terminally ill intensive care, neurology, and oncology patients. Why is it that ‘code violet’ is becoming more common in this day and age?