Monday Afternoon, Case 2

This afternoon I travel to the home of a 91 year old patient. This is a new referral and I have no information about the patient--just the name and address. As I park in the driveway, another gentleman is leaving, he looks distraught. I approach the front door, and am greeted by elderly woman in a nightgown. I ask if she is the patient, "No" she answers. She invites me in and introduces me to her mother who is laying on a daybed. The house is clean but decorated with a cacophony of family photographs, dolls of various sizes, decorated Easter eggs, and an artificial Christmas tree. The tree prominently fills the corner of the dining room and it is so covered with ornaments that the limbs of the tree are concealed. The patient slowly sits up and glares at me. "Who let you in? Are you here to kills us?" I try to introduce myself but the patient continues her verbal barrage--"What did you take? Are you here to steal my things? Is that a gun? Do you have a gun?" I attempt to calm her, but she only becomes more agitated. The other woman, the patient's 66 year old daughter, tries to intervene. "Shut up you!" yells that patient. The patient begins to pace, accusing me of stealing, plotting to kill her, planning to take everything that is hers. She briefly leaves the room and returns with a metal quad-cane. She approaches me and begins to brandish the cane in my face. Her daughter tries to appeal to her, but the patient quickly includes her into a conspiracy of her own making, we are now both part of the plot to kill her. "I'll knock your head off!" the patient screams, then she swings the cane at me, indeed aiming at my head. She then lashes out at her daughter with kicks, followed by a swing of the cane. "I'll call the law! You're a bunch of thieving bastards! I'll cut your heads off!" Her face is contorted in anger, her eyes are glazed with hate, and spittle runs down her chin. The daughter is apologizing for her mother's behavior; she pleads, "She only gets like this sometimes." A granddaughter with her two children enter the front door for a family visit, but they are not recognized and are immediately assimilated into the patient's self-derived conspiracy. The great grandchildren have "evil intent" in their eyes, and she waves the cane at them. The granddaughter is the one who "contacted" me and "let [me] in." She swings again at me with the cane and tries to kick, then bite, her daughter. The granddaughter and grandchildren leave, the children looking a little un-nerved . The patient begins to relax and says that if I am to be "friends with her daughter" that is fine with her.