I saw a lady in her 70's for a Mental Health Act 1983 assessment. She was on an acute hospital ward, having been admitted acutely confused. She'd decided to go home, had to look after her dog and kids. Her "kids" are grown up and live far away. Her Consultant Physician thought she shouldn't go home. Although all her investigations were normal she was, "confused and unsafe, please see urgently!"
So I did.
She was, indeed, confused. She believed nurses were poisoning her (because the opiate analgesia for her arthritis, which she was receiving now she was an in-patient but hadn't been taking at home, made her drowsy). They were torturing her, making her confused (because every night they moved the furniture and people around). At night she saw supernatural figures ghosting through the ward, disguised vaguely as people. She thought she was in a prison, but knew she'd done nothing wrong. She thought she was there because nurses had, "made something up" and, "it was in the papers, cruel lies about me."
She was in tears as I spoke to her. Over 40 minutes she spoke of how worthless she was, how nobody cared, which was proper, because she didn't deserve anything. She wanted to leave the prison, because she hadn't done anything wrong. "So why haven't you left yet?"
"Because I deserve to be here."
She felt empty and worthless and unloved. She saw herself as having no value. No wonder her children didn't visit her here, why would they? She didn't want to be there, she wanted to be home, but recognised she had to stay, "locked up" and was just, "waiting to go" now, to fade away and cease to be.
She was slowed down (psychomotor retardation), unexpressive (save for tears, a few times), unreactive, lethargic. She hardly looked up as she spoke, sadly, lamenting her miserable state of torment with stoic acceptance that this was all right and proper, and although unwelcome, was no less than she deserved. Marked dysprosody. She wasn't eating well. She didn't sleep well.
She was clearly depressed. She was unwell. Her medical team had noticed, had started an antidepressant and sought help. She can be helped.
Some patients make no demands, don't want to cause any trouble, don't want to be a nuisance and quietly fade away, putting nobody out. They're easy to ignore, especially when folk are busy. They're silent. Who advocates for them?
She's asked for nothing. I want to give her everything.