A 26-year-old man was brought to the emergency department by his aunt. He said he had trouble sleeping and, because of that, had a “nightfall problem.” (See footnote.) He said all he needed was a sleeping pill. He seemed grumpy and was not really cooperative in telling me what was going on. The aunt was the one who gave me the interesting details about their sad situation.
After getting a degree in accounting six months earlier, he had been unable to get a job. The aunt felt sorry for him and took him in. She was providing him a place to stay and all his meals. She planned on this being a temporary arrangement until he got a job.
Since he moved in with his aunt, he had not even tried to get a job. He took over her family room where he spent his time, day and night, watching TV. He wouldn’t let her use the remote to watch the TV herself. Sometimes, he would sit for long periods of time throwing a basketball against the wall, banging it over and over again. Despite all the aunt did for him, he was demanding and unappreciative. And he didn’t sleep. The patient would not corroborate what his aunt said, but neither did he deny it.
My heart really went out to these people, especially the aunt. I wanted to help them and carefully considered my options. If he had been suicidal, I would have immediately sent him to see a psychiatrist. Since his condition didn’t immediately put him or anyone else at risk, I discharged him to go home. I gave him a prescription to help him relax and sleep. I also provided information about community resources where both the patient and his aunt could seek more long-term assistance.
When they left, I hoped they would find help. If not, I wondered if the aunt would kick him out before he finally did something that would really get him in trouble. One thing about emergency medicine, I usually don’t get the answers to questions like that.
* This was the first time I had heard of nightfall in men. http://www.articlesfactory.com/articles/health/what-does-one-mean-by-nightfall-in-men.html
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