Differentials of Disorganized Thinking in the Elderly

The charge nurse tells me that she is going to be bringing me an odd, but otherwise lovely patient presenting with some mild complain which could potentially be serious. I get the said patient into a room, I do the workup, she gets seen by a doctor – the usual stuff. But I begin to notice that there is something that’s just not quite right. The patient is extremely cooperative and polite but the stories just don’t add up. A conversation about health history quickly turns into one about the time the patient tried to kill 20 prison guards to rescue her favourite radio from being dismantled by giant cacti shaped monsters and how if I look hard enough at the old man in the suture room, he looks like Jesus (despite the old man being Sikh). Utterly confused (and somewhat frightened), I decide that further blood work would likely be necessary and an order for a urine tox screen wouldn’t be a bad idea. When the patient (surprisingly) lets me draw more blood and willingly gives a urine sample, I didn’t know if I should be thankful that getting samples was such a peaceful affair (even though the patient tried to fit herself under the stretcher when I was finished getting the blood samples) or if I should have reached for oars to paddle through shit creek if the patient decided to go postal. Looking back, I should not have tried so hard to convince my favourite doctor to order a head CT but rather, I should have expected grandma to be having an awesome acid trip as the police showed up to charge her with possession and dealing of cocaine – again.