The patient was a quiet man in his late 40s, laying still and minimally responsive to questions. His bloodwork showed severe dehydration. This was a man who could not answer where he was, when it was, or who he was. He was most likely dehydrated because he did not have the mental capacity to ask for water. While in the hospital, he was occasionally cantankerous, verbally abusive, and refused all food. One morning, we were unable to locate him and thought he had escaped from the hospital but ultimately found him in another patient's bathroom clutching a box of chocolates he had received from his former partner the day before.
He needed more intensive care than we could give him: It was clear to me that this man had advanced dementia and belonged in a skilled nursing facility. Unfortunately, he had come to us not from a nursing home but from a jail cell—transferred to the hospital by the facility's medical director due to an altered mental status. I restored his fluids and got ready to discharge him. But I had no interest in sending him back to jail.
