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.