I saw a lady at her home who'd taken to her bed and stopped eating. Her GP asked a Community Psychiatric Nurse (CPN) to see her at home because she was depressed. On reading the referral she seemed to have significant infirmity so the nurse and I went to see her together, with her family, to sleuth out what was going on and what we could do to help.
The patient was not well. She'd lost a massive amount of weight. Lying in bed, breathless and gasping, with open leg ulcers and a cough, she looked profoundly unwell. Her mouth was dry and had oral candidiasis (thrush) in it. She was clinically anaemic. She had focal signs in her chest suggesting a left lower lobe infection. Her lungs were over expanded, pushing her liver down. Her abdomen was tender. She was clinically dehydrated.
She was too breathless to talk with me in anything other than two words at a time. She said she was thirsty but was too tired to sit up to drink and had to be helped up.
Her mood wasn't great but, really, it was the last thing her family or the CPN and I were worried about. Her GP had seen her the day before (and then initiated the referral) and had her district nurses visiting daily to dress the leg ulcers and had arranged a mattress to reduce pressure areas.
The CPN and I spoke with the family about depression and how we would treat that where ever the patient was (at home or on a medical ward) but that her physical health was causing us concern and this needed addressing, rather than just treatment or admission under our care.
We left and I 'phoned her GP and explained what we'd found (that she was physically ill and not needing urgent psychiatric input at present, but I'd happily follow her up where ever), the GP arranged admission that afternoon. 3 days later she died on the medical ward.