60 yo M, PMH includes prior ETOH abuse, p/w acute/subacute stroke, ketoacidosis from malnourishment, and decubitus ulcer/osteomyelitis. 

And yet, this 60yo guy still lives with his mother. He is a social recluse, and is so stubborn, belligerent, and miserly, refusing to eat or leave his room/bed, that he has to fall out of bed from a stroke before his mother dares to call 911 and have him taken to the hospital. At the hospital he is agitated with altered mental status, and refuses to cooperate. He gets snowed with Ativan, and is finally treated. He was transferred to Jeff yesterday, and now he’s my patient as we coordinate care for his osteomyelitis.

More alert today, he is impulsive and agitated. He occasionally threatens to kill people and claims we are holding him captive. He thinks it’s 1963, then 1863 after I ask him again. He says the president is George Bush, who has screwed up everything. He has right sided weakness with R-sided facial droop. His eyes only stare straight ahead. 

I spoke with his brother yesterday, who said that he used to be more coherent, but has always been a miserly character, difficult to get along with. He attributes the recent wasting away to depression over the past few years. He seemed to have very little will to live. He lost his job about 25 years ago and never married. He became an alcoholic and refused to trust anyone. 

The story makes me think of my never-married uncle. Though, my uncle is far more active and less belligerent, there’s a neurotic sentiment about him that makes me feel connected. According to mother, he had a bad experience with rejection from a girl (who later died very young) in his younger years and never recovered. He too remains a social recluse, and I think he’s lived his life with a lot of regret. Nowadays he’s taken my brother and me on as his pseudo progeny, to feel like there’s more to his life.

I don’t know where I’m going with this, but here is a beautiful picture from India that weaves together water, sky, and earth.