Our new patient, 88 years old, had been demented for years. She was admitted to the hospital with a deep, malodorous and infected pressure sore stretching from the top of her right shoulder down to the middle of her spine.
It took us a only few seconds to choose her antibiotics, but a half hour later we were still standing outside the door to her room, caught up in her case.
We wondered which nursing home could have allowed such a thing to happen. But it turned out that she had been admitted from home. We wondered if adult protective services, or maybe even the police, should be called. Then we learned the whole story.
Our patient came from a poor immigrant household without much community support. For years, as she felt herself slipping, she had emphasized over and over again that she never wanted to go into a "home" or be tended by strangers. She wanted to stay at home with her children. Nothing unusual there.
What was unusual was the precision with which her children followed her wishes. As their mother became really confused, then silent, then bedbound, they continued to care for her themselves in the back bedroom.