We ask the Reverend precisely why he needed 24-hour care and why he had been in the nursing home for 15 years. He is not able to provide a reasonable explanation.
Table 1
Reverend R’s life story: A series of traumatic events
| Period | Event |
|---|---|
| Childhood | Sexually assaulted by an uncle |
| Young adulthood | Develops depression; 1 hospitalization in his 30s; sexually assaulted by male nurse while hospitalized |
| Adulthood | Motor vehicle accident results in traumatic brain injury and leads to nursing home placement in his late 40s |
| 3 months ago | Hospitalized for abdominal pain secondary to recurring bowel obstruction; medical history includes colon cancer, cerebral palsy |
| Presently | Loses pregnant, 24-year-old fiancée in a traffic accident |
The authors’ observations
Reverend R talks almost incessantly about the atrocities he suffered throughout his life. Times of happiness and success are the exception.
We begin to doubt the veracity of certain details of his story. We question the plausibility of a young nurse having an intimate relationship with and becoming pregnant by a 62-year-old nursing home patient who was an ordained minister. Reverend R’s claim of being the nursing home’s public relations director and performing sermons there seems unlikely. His stories are inconsistent; whenever we question him, he creates a reply that he is convinced seems believable. A collateral history is imperative for us to establish a diagnosis.
FOLLOW-UP: His story starts to fray
At a follow-up visit the next day, the Reverend states that he has been sad and at times he will “fall apart” in response to his fiancée’s death. He says that a video of the memorial service his fiancée’s father gave him had been “hard to watch.” We ask if he has the video; he says that he sent it back to the nursing home.
The authors’ observations
It seems strange that Reverend R is concerned that talking with us could compromise his return to the nursing home. His questions and behavior are paranoid; we did not observe this type of behavior during our initial interview.
We investigate Reverend R’s claims. A hospital dismissal summary from 13 years ago documents that Reverend R had been caught pulling out his NG tube. Additionally, he was observed drinking out of the sink when he was advised to take nothing by mouth.
Within days of that hospitalization, he presented to our outpatient gastrointestinal clinic for a second opinion regarding his abdominal pain. His father demanded that the Reverend be admitted. When told that hospitalization was not warranted, Reverend R and his father became angry and abruptly left the office.
Our hospital’s nursing staff is a vital source of information because they observed Reverend R often during his 3-month stay. They are suspicious of his history because they noticed discrepancies, such as Reverend R telling one nurse his fiancée died on a Thursday and another she died on a Friday. He spoke of people visiting him, but the staff never saw any visitors.
The nursing staff reports that at times he would use profanity and was quite hostile. A member of our team saw him yelling at a female chaplain. In our initial interview he told our team that the chaplain had reprimanded him for having premarital relations with his fiancée.
We find no evidence of an accident that resulted in the death of a 24-year-old pregnant female. Obviously, there was never a funeral or visits from the fictitious fiancée’s father. The sexual assault by the male nurse while hospitalized is possible but not probable, given the other falsehoods Reverend R told.
The seminary Reverend R told us he attended exists, but we are not able to determine if he was educated there. He told some staff members he had obtained a Master’s degree and others a PhD.
Reverend R refuses to sign a release of information form for the nursing home. We speak with the nurse who worked with Reverend R’s psychiatrist, who confirms that the patient’s diagnosis was depression. She tells us that the Reverend said he relocated to that area to live closer to a man with whom he had a romantic relationship. Reverend R confided to her that his father never approved of the relationship, but his mother accepted it.