The Fitzgerald Family Kristy McCandless California State University, San Marcos
Meet the Fitzgerald Family The Fitzgerald family lives in a small town outside of Providence, Rhode Island. Sara and Brian Fitzgerald have three children: Jesse, Kate and Anna. The majority of the Fitzgeralds’ lives have revolved around fighting Kate’s illness since she was diagnosed with promyelocytic leukemia at the age of two. After Kate’s diagnosis, Anna was genetically engineered to be a donor for her sister Kate. Anna is constantly subjected to needle pokes, blood draws and bone marrow extractions to keep her sister alive. Now, Kate needs a kidney and Anna is expected to donate one of hers, no questions asked. Anna files a lawsuit against her parents to gain the decision-making privilege regarding what to do with her own body. The Fitzgerald family is torn between the tension of Anna’s lawsuit and keeping Kate alive as she continues to get weaker and sicker. The Fitzgerald family is both closely bonded and broken apart. They love each other deeply, but are disconnected. The stress of Kate’s illness has burdened each family member in a unique way and has compromised their relationships with one
Kate Fitzgerald Kate is a fifteen year old that was diagnosed with an aggressive form of leukemia at the age of two. Doctors consider her to be a miracle cancer patient as she has lived well past her predicted survival date. She has undergone frequent chemotherapy and radiation treatments and is now in renal failure. Kate has come to terms that she might die and secretly requests that her sister file a lawsuit so that she won’t have to continue donating body tissues to keep her alive. Kate is very self-aware and sees the toll her illness has placed on her family and gently pulls away as she accepts the course of her illness. Kate is in the identity versus role confusion stage of Erikson’s psychosocial development. Kate has a hard time time seeing herself separately from her cancer, which causes her to fall into an identity crisis. Since the future is uncertain for Kate it is difficult for her to think about her role in the future as she moves toward adulthood.
Sara Fitzgerald (mother) Sara is a 42 year old mother whose whole life revolves around her daughter Kate and keeping her alive. Prior to Kate’s diagnosis, Sara was a successful lawyer; however, she gave up her career and devoted her life to caring for her daughter. Sara’s single-minded focus on Kate’s illness has taken away from her marriage and relationships with her other children. While she undoubtedly loves her family, she struggles to see each family member as their own entity, separate from Kate’s cancer. Sara is in the generativity versus stagnation stage of Erikson’s psychosocial development. Sara has been successful in this stage in that she has started a family and is raising her three children; however, her unrelenting focus on Kate has caused other areas of her life to become stagnant, such as her marriage, career and relationships with Anna and Jesse.
Brian Fitzgerald (father) Brian is a 43 year old father and career firefighter. Brian is kind, perceptive and understanding. He is able to look passed Kate’s illness and see a situation from each child’s perspective. Brian brings a calming peace into a household that has been turned upside down by Kate’s battle with cancer. Brian uses work as an outlet to escape the emotional turmoil that exists in his family. Brian is in the generativity versus stagnation stage of Erikson’s psychosocial development. Brian is established in his career and focuses his love and attention on raising his three children. Brian is able to see the bigger picture and has been successful in this phase of life.
Anna Fitzgerald (sister) Anna is an eleven year old girl that was engineered in vitro to be the perfect genetic match for her sister Kate. Essentially, Anna was created to serve as a tissue and organ bank to keep her sister alive as she battles cancer. Anna loves her sister deeply and cares for her throughout her illness. Anna is driven and persistent and will do anything for the people she loves, including filing a lawsuit for medical emancipation to fulfill her sister’s wish to die. Anna is in the industry versus inferiority stage of Erikson’s psychosocial development. Anna feels industrious and confident in her ability to achieve goals as demonstrated by her taking the initiative to gain control over her own body and achieve medical emancipation. Anna’s success in this stage shows her competence.
Jesse Fitzgerald (brother) Jesse is a seventeen year old male that often feels unimportant and ignored within his own family. With Kate’s cancer and Anna’s role as her donor, Jesse is the invisible child and acts out to get attention from his parents. Jesse is both sensitive and vulnerable and feels guilty and helpless for not being able to save his sister from her cancer. Jesse is in the identity versus role confusion stage of Erikson’s psychosocial development. Jesse struggles in this stage as he does not have a strong sense of self nor does he have a role within his family since the focus is on Kate’s illness. As a result, he experiments with different identities and has feelings of unhappiness.
Acute Promyelocytic Leukemia Acute promyelocytic leukemia (APL) is a form of acute myeloid leukemia, a cancer of the blood-forming tissue located in the bone marrow (National Institute of Health, 2017). Bone marrow functions to produce red blood cells, white blood cells and platelets. APL disrupts this cell production causing immature white blood cells called promyelocytes to accumulate in the bone marrow. The overgrowth of promyelocytes leads to a shortage of normal red blood cells, white blood cells and platelets. Since there is a decreased number of red blood cells, patients with APL are often anemic and appear pale and fatigued. Further, patients have an increased risk of infection due to a low count of mature white blood cells. Patients also experience excessive bleeding and bruise easily due to a lack of platelets and a substance released by the cancer cells that perpetuate bleeding. Additionally, fever, loss of appetite and weight loss are commonly associated with APL (National Institute of Health, 2017).
Duvall According to Duvall’s eight stages of family development, the Fitzgerald family is at the fifth stage - families with teenagers. Duvall’s stages are based on the age of the family’s oldest child. In this case Jesse is the oldest child at age seventeen. He is still living at home; however, Jesse will be moving out soon and the Fitzgerald family will transition to Duvall’s next stage - families launching young adults (Kaakinen, Coehlo, Steele, Tabacco & Hanson, 2015).
Family Culture and Religious Traditions ● ● ● ●
The Fitzgerald family does not have any religious affiliations Family culture built upon respecting, loving and supporting one another Family dinners/Family meetings Visiting the hospital as a family
Family Strengths - Deep love for one another - Whole family helps take care of Kate - Support from extended family -Strong sister bond -Strong and supportive family foundation -Financial stability -Humor and laughter
Family Weaknesses - Family member’s needs are compromised to satisfy Kate’s needs - Family defined by illness - Bottled up feelings - Anna is suing her parents - Jesse commits crimes as an outlet for feeling ignored and forgotten
Family Communications Family communication tends to revolve around Kate and keeping her alive, which causes other family members to keep thoughts and feelings to themselves. Bottled up feelings causes family members to act out as cries for attention. Since the Fitzgerald family is under high stress they often yell at each other when there is disagreement. When family members are angry at each other there is often eye-rolling, angry gestures and body language that demonstrates tension (i.e. crossing of the arms, turning away from the person they are speaking to). On the other hand, the Fitzgerald family also shows love for one another with hugs, kisses and cuddles. Loving touch is an important form of communication within their family.
Family Assessment & Intervention Model The Family Assessment & Intervention Model focuses on how families react to stress, while building upon their strengths to identify problem solving strategies. This model believes that families are open, dynamic systems interacting within their environment. Stressors subject families to imbalance so families have lines of defense to prevent penetration into the basic family unit. If stressors get through a family’s line of defense then reconstitution or adaptation must take place to restore family stability (Kaakinen, Duff-Gedaly, Hanson & Coelho, 2015). In the case of the Fitzgerald family, Kate’s illness has penetrated the family’s lines of defense causing a need to adapt. Sara quit her job to stay home and commit herself to caring for her daughter and the other children have had to grow up receiving less attention. Raising a child with a chronic disease has caused the Fitzgeralds’ to be subject to frequent stressors. According to this theory it is important to identify the Fitzgerald family stressors, which include the worsening of Kate’s cancer, Anna suing her parents for the rights to her own body and Jesse getting into trouble with the law. Despite being bombarded by stressors, the Fitzgerald family has many strengths that include, unconditional love for one another, quality family time, financial and medical support and help from extended family. By building upon the Fitzgerald’s strengths they can adapt and reconstitute to restore stability (Kaakinen, Duff-Gedaly, Hanson & Coelho, 2015).
1. Facilitate open family communication and obtain each family member’s perspective (Kaakinen, Duff-Gedaly, Hanson & Coelho, 2015). ●
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All family members will participate in an open dialogue and feel comfortable verbalizing true feelings regarding Kate’s diagnosis and its effect on each individual family member. Kate will express her feelings/wishes regarding her illness and tell her family that she wants to stop all treatment. Jesse will tell his family that he feels forgotten and ignored and admit that he acts out to gain attention from his family. All family members will feel heard, validated and understood.
Interventions 3. Provide supportive services to siblings of children with cancer and give anticipatory guidance on sibling’s condition and ways to meet sibling’s needs even when unable to visit the hospital (Wiener et al, 2015). ●
2. Integrate psychosocial professionals into pediatric oncology care setting to collaborate with medical professionals and family members (Wiener, Kazak, Noll, Patenaude & Kupst, 2015). ● ● ●
The Fitzgerald family will use coping skills when feeling stressed, sad or scared. The Fitzgerald family will recognize their strengths and use them to develop problem-solving techniques. The Fitzgerald family will have access to emotional support, counseling, community resources and support groups.
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Jesse and Anna will feel more involved and informed regarding their sister’s condition and plan of care. Kate’s siblings will have enhanced trust and decreased fear when she is in the hospital. Jesse and Anna can find ways to do things for Kate when they are unable to make it to the hospital (i.e. write a letter, draw a picture, make a care package, call her on the phone).
References Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health Care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. National Institute of Health. (2017). Acute promyelocytic leukemia. Retrieved from https://ghr.nlm.nih.gov/condition/acute-promyelocytic-leukemia Ward, S. (2014). Pediatric Nursing Care: Best Evidence-Based Practices. Philadelphia, PA: F.A. Davis Company.
Wiener, L., Kazak, A., Noll, R., Patenaude, A. & Kupst, M. (2015). Standards for the psychosocial care of children with cancer and their families: An introduction to the special issue. Pediatric Blood and Cancer, 62. DOI: 10.1002/pbc.25675 [Untitled image of Sara and Brian]. Retrieved from http://www.dailymail.co.uk/tvshowbiz/article-1170510/Cameron-Diaz-shaves-head-solidarity-cancer-stricken-daughter-film-ad aptation-My-Sisters-Keeper.html
[Untitled image of Anna and her mom]. Retrieved from http://www.japantimes.co.jp/culture/2009/10/09/films/film-reviews/my-sisters-keeper/#.WWEW8YS9n6o [Untitled image of Kate and her mom]. Retrieved from https://www.rottentomatoes.com/m/10010662_my_sisters_keeper#&gid=1&pid=h-6743 [Untitled image of Anna, Kate and Sara]. Retrieved from https://www.tes.com/lessons/nHI2U66FnaSYvw/my-sisters-keeper [Untitled image of Kate in the hospital]. Retrieved from https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwi1hujro_rUAhUFxmMKHXFxAUcQjR wIBw&url=https%3A%2F%2Fwww.pinterest.com%2Fpin%2F550565123168794070%2F&psig=AFQjCNH_NMEg7KDLRFvDjv XpRAhaAivy2A&ust=1499623702870967&cad=rjt [Untitled image of Kate, Anna and Jesse hugging]. Retrieved from http://www.btchflcks.com/2013/12/my-sisters-keeper-anna-and-kate-growing-up-on-screen-and-on-the-page.html#.WWEbyoS 9n6o
[Untitled image of Kate and her parents]. Retrieved from https://es.pinterest.com/pin/507921664196264573/ [Untitled image of Kate and her mom]. Retrieved from https://www.tes.com/lessons/nHI2U66FnaSYvw/my-sisters-keeper [Untitled image of Anna]. Retrieved from https://fdb.pl/film/88919-bez-mojej-zgody [Untitled image of Anna, Kate and Jesse]. Retrieved from https://es.pinterest.com/pin/471048442251573160/ [Untitled image of Kate and Sara in the hospital]. Retrieved from http://designerbabiesyesorno.weebly.com/my-sisters-keeper.html [Untitled image of Sara and Brian fighting]. Retrieved from http://www.dailymail.co.uk/tvshowbiz/article-1170510/Cameron-Diaz-shaves-head-solidarity-cancer-stricken-daughter-film-ada ptation-My-Sisters-Keeper.html