To Be Old and Alone, Drunk in the Cold

We have all heard this story before. Elderly person lives alone, something happens, no one finds them until finally someone goes to check on them.

According to family, this particular elderly patient lives alone. Spouse died about 7 years ago. Patient likes to drink... about a "6 pack a day" [which in medical terms usually means about a 12 pack a day or so]. Family brings over the booze. Aren't they swell? Can't bother to stay, but may as well get em drunk so they don't remember?

Meals on Wheels brings the food 3 days a week. Not sure if they just bring 1 meal, or what. Not important at this time. But this time, they showed up to find the patient unresponsive. Called rescue. Brought to ER.

Somehow, the patient got into a shut room in the house that has no heat. Yes, no heat. Body temp upon arrival at ER: 87.5; thus the unresponsiveness. Hard to say what exactly has happened or for how long the patient was in the room. Patient is not talking much at this point in time. Patient is sent to the unit.

FF to the next morning. I am lucky enough to say hi to my new regular body temp patient. Temp is now 98 degrees. Bair huggers do wonders, I say! But this is no longer the problem. Toes will be lost as they are getting darker as the day goes on. Started with just a couple of spots of purple on 2 toes and by the end of the shift, all the toes on both feet were purple and spreading to the balls of the feet. Fingers on both hands are purple down to the middle knuckle. Not a pretty picture, really. I figure this person who was once able to hold a can of beer in one hand and smoke a cigarette in the other will no longer be able to do it exactly as before. Talk about stolen quality of life of their own accord, or was it?

But this is not all of the problem. BNP is 2900. EF is 25%. Significant systemic edema to include JVD. Apneic for 30-45 seconds with compensatory respirations lasting 90 seconds. Did I mention full code? Flipping between a fib and sinus with a whole lot of frequent multifocal pvc's. Heart is getting just a tad bit irritated. Luckily BP is holding steady at around 100/70. HR 70s-80s. Mental status is caput. Barely alert, mostly restless and increasingly so. Came up with 2 PIV sites, one leaking and discontinued. The other is going good until the restlessness includes pulling off the gown and subsequently pulling out the IV. PLT are 60, so it takes awhile to stop the bleeding. A colleague and I then secure another site in each arm. One for fluids, one for 'just in case.' DT's are in the infancy stage.

Doc questions whether to start the nutrition or address the apnea. ABC's of course, and CPAP is started. Will this eventually matter though? Glucose on arrival was less than 25. The brain does not live without glucose. Is the mental status a reflection of hypoxia, low glucose, etoh withdrawal, or just a combination of the three?

All I can do is take care of each small thing as it presents and think big picture. Follow md orders. Hope like hell this patient doesn't suddenly crash unexpectedly. Will the apneic period suddenly overcome? Will we have to code this patient? Will they stop breathing or go into an unfavorable rhythm? My eyes are on the patient at all times.

Luckily, they survived to the end of my shift. For the most part, patient is stable but critical. It could go any direction at any time. Sometimes I hate the days when you just have to hope beyond all hope that they make until you leave.

But my biggest gripe out of all of this is WHY for god's sake do people not check on their elderly relatives/neighbors? Especially the ones that live alone. You know they live alone. Anything could happen at any time. Especially when you, as a family member, bring them alcohol every other day or so and then not check on them daily!! A simple phone call might suffice? If they don't answer.... Check on them! [Another case in point: eldery man lives alone, drinks. Falls on space heater but is so intoxicated, is unable to move off of the heater in time and suffers 2nd-3rd degree burns on both legs.]

Luckily this patient (above) had their meals delivered, but is this enough? It simply is not the responsibility of these volunteers to ensure the safety of another person. Sure, they do many things when they deliver food, but it is just not enough. It just makes me sad inside, because deep down I know this is not an isolated incident. It happens all of the time. ALL of the time. Sometimes it is difficult in this 'me' type society that we live in now to address all of these issues that really may or may not pertain to our own family or our lives. But something has to be done to address this problem. I wish I knew the answer as to how.