* * Anonymous Doc

Tuesday, March 1, 2011

Elderly patient comes in after falling at home. In the course of admitting him, we check his labs, and some of the values are way off. We ask about his medication, to make sure he's been taking it, he says his wife's in charge of that. We talk to the wife, she says she's on top of it, he never misses a pill. Okay. Wife is taking notes, very involved in her husband's care, they live on their own, lovely couple.

Fast forward two days to today. They've been model patients. The wife has repeated a couple of stories she's told me, but I'm not thinking much of it. They're delightful.

Her husband's doing well. We're thinking about discharging him. I go in to talk to them. The wife gives me a blank look.

"I'm sorry, have we met?"

"Uh, yes, I'm Dr. Whoever, we've talked a few times since your husband came in."

"I don't remember you."

I turn to the husband. "You remember me, right?"

"Sure I do."

Okay. So the husband can't physically take care of himself, and the wife-- who's in charge of his medication, and I presume in charge of everything else-- seems more and more like she may have some kind of dementia. And so I'm not sure I still believe he's been taking all of his medication.

Sort of a dilemma though. Because she's not the patient.

We can't feel good about discharging him to go home to a situation where one of them is physically capable and one of them is mentally capable, and it's not the same one. But we can't keep someone a prisoner... we can try and get the family to help, we can get a visiting nurse to make home visits and manage the medication... we can call social work and hope they help but, I don't know, it's a hard situation and I don't know that there are any good answers.


  1. Yes and, sadly, we're going to be seeing more of this as the baby boomers age. I have no idea what's going to happen or what the solution is.

  2. Oh that soo sounded like my grandparents several years ago when they were still living. grandfather had macular degeneration, could see almost nothing, and some renal disease. Grandmother had dementia. They lived by themselves. One was the eyes, the other was the mind. I still remember when my grandfather fell in the kitchen and broke his hip and his wife just stared at him, and picked a phone number at random and called someone. happened to be her daughter in law ( my mom), but Grandma was clueless who my mother was. She just kept saying, "There's a strange man laying on the floor in my kitchen, and I'm not sure what to do."

    So sad to see those you love, go through things like this. Grandfather passed away a few days after that, and grandmother's dementia got really bad. She passed 18 months after he did. Both were in their mid 90's.

  3. Electronic pill organizers is probably the solution to this specific problem: http://www.boston.com/business/healthcare/articles/2009/08/30/new_gadgets_prod_people_to_remember_their_meds/

  4. Ha! We know your surname now Mr. Whoever!