I looked after a chap in his home, with his wife, through much of last year. Notionally he was depressed, but he seemed much more jaded and despondent than clinically depressed, to my reckoning. I saw him at intervals, roughly once every three weeks or so, throughout the Autumn and Winter. His GP asked for help, since the chap wasn't eating or drinking much, was largely bed bound and seemed to be fading away. He's got a good GP who works hard for his patients so I'm always happy to go the extra mile (or 6.8 miles in this case) to help out.
He refused all medication but I'm stubborn so a nurse and I visited every few weeks. He didn't want us to. We got him eating and drinking again. We got him more mobile. He no longer needed his frail wife to carry him to the toilet. He no longer wanted to die. He was no longer chain smoking in bed and burning his sheets/smouldering holes in the carpet. He still didn't want us to visit. By now, 6 months on, with him coping well enough and no evidence of mental illness and telling us to go away, I didn't feel we could keep intruding in to his home and persuade him How It Had To Be any more.
I knew it wouldn't go well.
Once when I saw him he was too breathless to finish sentences and his lips were a glorious shade of puce. Focal signs in his chest. GP tried to arrange admission but he'd not go in. The GP tried this a lot. He always said no.
Earlier this year things broke down. He became confused, wouldn't listen to his wife, didn't appreciate who she was or what she was trying to do, wouldn't accept help from his son or daughter, absolutely refused to go in to hospital. The GP was desperate. The GP asked if I could admit him. I visited the chap, saw a scene of woe, he was thoroughly confused which was just sufficient to persuade an Approved Social Worker to take the pink form the GP and I'd hastily penned and apply for him to be detained under section 2 of the Mental Health Act 1983 for admission and assessment on one of my wards.
Within a couple days on a cephalosporin he improved. Temperature, tachypnoea, dyspnoea, cyanosis, all better. Too, he was less confused. But still too frail to mobilise. Pretty infirm, really. Abdominal masses. Abnormal LFTs. Chest signs. Blood count that's halved in 6 months. Anorexia. Trophic changes of his skin with widespread pressure sores on admission (that are getting better now he's on the right sort of matress and nurses are attending to this). CT imaging is awaited. I suspect something sinister and have said exactly that to his family, along with words like "cancer" so we're all crystal clear we're looking for stuff that's not dysthymia or an adjustment disorder.
Meeting with family, we're all clear his mental health is the last thing that's concerning us now. But when his confusion's resolved and he's no longer detainable under the MHA 1983, he'll not accept informal admission. Saying that, he's too frail to self discharge and flounce out.
What to do, what to do . . .