Tuesday, October 21, 2014

Dr. Orthochick: The Hoarder

The nurse walked over to me and said "just to warn you, the woman spells like cat pee and human pee and the house they found her in looked like it was out of Hoarders. And we don't know why she's here, even though her son is with her and he lives with her. I think she might have fallen."

This 75 year old lady actually did smell like many different types of pee. I'm not sure which species were represented, but i'm pretty sure half of the domesticable animal population had left their scent on her. In addition, there seemed to be a few days' worth of human pee as well. Because that's not gross enough, when I asked her to roll to the side so I could listen to her back, I discovered her back was covered in dirt. And little twigs. And dead leaves. As far as I could tell, she had been lying in filth for days. I asked her what happened but she told me to mind my own business. Then she said she was at walmart that morning. I asked the son if she had, in fact, gone to walmart that morning, but he said he didn't know. So I decided to try and get the story from him.

me: OK, so what happened?
Son: What?
Me: I heard that your mother fell?
Son: Did she?
Me: Do you live with her?
Son: Yes
Me: So what happened?
Son: I don't know.
Me: Why did you come to the emergency department?
Son: What?
Me: WHY ARE YOU HERE?
Son: I don't know
Me: OK, let's talk about this morning. Why did you call an ambulance?
Son: I was going to take her to a checkup but the ambulance brought her here.
Me: Why were you going to bring her in an ambulance? Is she not able to walk?
Son: She says she can walk
Me: Can she?
Son: I don't know
Me: Well...don't you live with her?
Son: Yes
Me: So...do you see her walking?
Son: I don't know.
Me: OK, when was the last time you saw your mother before this morning?
Son: I think it was a week ago. I don't know.

I gave up, did a full trauma exam on the woman, which probably exposed me to every pathogen present in pee (and yes, I know pee is sterile, but that's only when it's in the bladder. On its way out the urethra it gets exposed to a ton of bacteria) and also got dirt all over my hands and stethoscope. She had bedsores on her hips and she couldn't raise her arms above her head or lift her feet off the bed. (The son said "she's pretty strong" after observing his mother's inability to lift her legs) She looked pretty dehydrated. So we ordered the standard "patient fell" workup (pelvic and femur x-rays, chest x-ray, head CT, EKG, bloodwork) and called internal med to admit her.

My attending also ordered carbon monoxide levels on her after hearing about the level of acuity demonstrated by the son.

I don't really know what's going on, but this looks like elder abuse. Or, at the very least, elder neglect. I'm not saying it's intentional because the son didn't seem to have two brain cells to rub together, but it's a little scary how people can fall through the cracks like that. I tried calling the last PCP she had and he said he hadn't seen her since 2005. I found an ER report from December in a different city where they noticed her appearance and filed a complaint with adult protective services, but that means that there's a good chance this woman hasn't been out in public for 5 years. Clearly she doesn't have a competent caretaker, and I'm guessing she hasn't been getting her meds since neither she nor the son could tell me what they were. And I didn't see the house she was living in, but judging from her appearance, it should be condemned. So you have her and the son living together in squalor and no one else knows/cares and so no one gets her (them?) help.

12 comments:

  1. That is the end of the family tree running out. Meds can't fix stupid.

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    1. Jesus Christ, Mark, they aren't stupid. It's called mental illness.

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    2. How do you know people aren't "stupid" VS "mentally ill"?

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    3. Because I have highly intelligent hoarders in my family, that's why.

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    4. And how do you know they aren't mentally ill versus stupid?

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    5. The term "Mentally ill" is a recent invention of man. Before mental illness, peoples behaviours were attributed to choices they made. Behaviours were called "sins" or law breaking if bad choices, or they were called "virtues" if the behaviour was judged good.
      Thomas Stephen Szasz

      Today, what do you get after a diagnosis of "mental illness"? A prescription for drugs.

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    6. I feel sorry for your patients, Mark.

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    7. Before mentally ill, behaviour was thought to be based on the devil. Those who acted strangely were thought to be possessed or full of sin caused by Satan's work. If not simply incarcerated, they were sometimes tortured to "get the devil out." Most died a horrific death.

      It's amazing the way medical science has changed and grown. We no longer use leeches to draw out "bad blood," either.

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    8. For Moose, there are no "brain chemical imbalances". The myth of the chemical cure
      also the mentally ill have a much shorter life span.
      "The average life expectancy for people with major mental illness ranged from 49 to 60 years of age in the states they examined — a life span on par with many sub-Saharan African countries, including Sudan (58.6 years) and Ethiopia (52.9 years). by Thomas Insel M.D. September 6, 2011.

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  2. So sad. When I was on my psychiatric rotation, there were a whole family looked up there only because they gave sever mental retardations. 2 sisters and one brother. They parents -I heared were of low IQ and both died on a car accident- . It was the only way the authorities could keep the three out of the street, one of the sister was pregnant and she claimed it is her brother son. It was heart breaking.

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  3. That's really awful. Hope there's something you can do to get this poor lady on the radar so she doesn't get sent "home". A nursing home would be better than where she came from.

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  4. This is the kind of challenge that makes me applaud hospital social workers, who can often coordinate the right help for a situation like this. May God bless them and their challenging work.

    Reporting the suspected elder abuse might be a way to get the home situation investigated. I don't know if there would be another way if you didn't suspect elder abuse, but social workers should know about the available resources. Sounds like this woman would unfortunately be better off even in a subpar nursing home.

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