When I first saw this little old man, he was severely dehydrated and malnutritional. 86 years old, from home. Was sent into the hospital by his wife and son. Fell at home with mental status changes.

HMM, from HOME? He looked like a typical nursing home patient to me. Incontinent bladder and bowel, wearing a diaper. A feeder (ie, needs someone to feed him). Oriented to nothing. Nonverbal. Very hard of hearing. Takes 2 person's assist for transfer from bed to chair. Really skinny and bone. Multiple skin tears and bruises on the legs and arms. I looked at him again wondering how his wife and son can take care of him at home all by themselves. This little old guy is a FULL TIME job.

I SEE. History of alzheimer's. All the little puzzles put into a bigger picture. He is probably a stage II to III, I think, when he starts losing the ability of daily function. He will forget how to meet the basic needs of survival -- eat, drink, shit and pee. All the skin tears and bruises may be the results of lots of falls at home when he wanders. But this can NOT be his first fall. I checked his last record of hospitalization -- WOW, 6 years ago.

The suspicion started building up. Could it be an elderly abuse case? I asked the nightshift if there were any visitors coming to see this little old guy at the evening hours. NOPE. He has been with us for 2 days and no one called or visited him in the hospital. How UNUSUAL?

So I made a phone call to little old man's emergency contact person -- his wife. "Mrs. Copenhaven, I'm calling you today to see how your husband functions at home before this admission to the hospital." I asked. "Can he walk at home?"

"Yes, he uses a walker," she said, "but he wanders a lot at night." REALLY? You are telling me that last week he was able to use a walker and now requires 2 person's assist to get out of the bed? HMM, I don't know... 

"...he started to pee on the floor...I thought he did it just to spike me," she continued. NO ONE would pee just to SPIKE someone else unless he is OUT OF HIS MIND.

"...he does not like my cooking...but he will eat some burgers my son bought from McDonald's," she continued. I see. This explains why he is so skinny and bone. The wife probably did not cook or feed him because "he does not like her cooking."

"...my son and I are having a cold. We do not want to bring the bugs to him when he is sick, " she continued. WELL. But I don't understand why none of you bothers to make a phone call to the nurse and find out how your husband (or father) was doing. NOT even one phone call?

I DON'T KNOW. There was something wrong with this family but I could not really pin point what it is.

So we took in the little old man, feeding him every meal, hydrating him with IV fluid continuously. On the third day he started talking to the staff. "Time for dinner, Gerald," I came to the room trying to feed him. "OK," he said.

He was pleasant. Did everything he was supposed to do -- the therapeutic treatment. We helped him on the chair twice a day. He ate. He drank. We helped him back to the bed for napping in the afternoon. Changed the diaper. Then up again for dinner. He ate a lot without complaining, considering this is hospital food.

On the third night, however, things started to change. He was strong enough physically and mentally. He became restless. Trying to get out of the bed. Asking about his car. Totally a sun-downer. Confusion starts when the sun comes down at night. The night shift told me that for the patient's safety she put a lab buddy -- a soft belt on his waist -- to restrain him at night time.

The fourth day we helped him on a chair with the restrain on.

An hour later, the room's call light was on. We walked in when the little old guy's roommate pointing at him. Mr. Copenhaven was found stripping naked, pulling his IV off, pulling his heart monitor cable off, trying to get out of the chair.

"Get me out of here. Where is my car?" He said. I was trying not to let him grab me, putting his clothes back. "Honey, you need to put the clothes on." I said.

"DON'T HONEY ME," he said. WOW. Who is this mean, old little guy? "You DON'T make me do anything!" he continued, "I do WHATEVER I want....get me OUTTA here....YOU BITCH." HOLY JESUS. What happens to my nice little old man? I was trying not let him grab me, pinch me, spit on me while putting his gown back. ELDERLY PSYCHOSIS!

Agitation was an understatement for this little old guy. I called our nurse practitioner and got a PRN dose of Ativan STAT. Gave the first dose at 1300. Twenty minutes later he was dosed up on the chair. We put his clothes back on. Finally he was VERY quiet.

HMM, I wonder if the little old guy was an abusive man. Maybe an abusive husband? An abusive father? Thats why his wife thinks he spiked her by peeing on the floor? Thats why little old man does not have any visitors or phone calls? Thats why he is so skinny and bone because family has given him up?

Hey, here's a good message to all abusive men. Karma is a bitch! What goes around, comes around.