Orientation

A nurse and I were in a patient's house, talking with a widowed gentleman who'd apparently not been faring brilliantly.

He has diabetes and hypertension and hyperlipidaemia, presumably these have contributed to his vascular dementia. Mostly he manages pretty well, with support. He is keen to stay in his own home and his social worker's sorted out care for him 3 times a day (he was unable to manage his medicines, so needs home care to prompt with that, as well as support meals and drinks), he attends a day centre once a week where he gets a bath and has some new fangled telecare that means if he leaves his home at night and doesn't come back after a few minutes, his daughter's automatically 'phoned. He's never yet wandered at night, but it's a sensible precaution.

Having vascular dementia there's not a lot that I can personally do. The GP has sorted his physical health and the risk factors. His social worker has sorted practical care. A nurse went through information with him and his family, over a few weeks.

We found ourselves in his home because a new home carer had alerted her manager that he was unwell, confused and "had it in" for his brothers. Homicidal thoughts. High risk. A 'phone call to us sought an urgent review. We knew it wasn't urgent, but we were in the area so popped in to see him.

It was clear he had no new psychiatric problems (in particular there were no mood changes and no persecutory beliefs) and no new physical health symptoms. He was stable and much the same as I'd seen him a year or so ago, when I first saw him for initial assessment and diagnosis. The nurse, who's seen him too, was talking through with him what home care had said of him thinking badly of his brothers.

"Aye," he said, "the both of 'em have been having it away with a lass, she's only 18!" He was mortified that they'd got her pregnant. The nurse looked at him and without even blinking said, "Let's have a look at that, shall we? Your brothers, are they still alive?" We knew his history.

The man paused for a fraction of a second, confusion then surprise then a smile shifting across his face. "No, they're both dead, been dead for years, love. Why'd that daft thought come into my head, then?!"

The nurse had sorted it. There was no homicidal risk. There was no psychiatric illness for me to fiddle with, nothing specific for me to do. But it was still an oddly satisfying visit.