A seventy-four-year-old woman was brought to the ED by her daughter. I approached them and introduced myself. The patient didn’t look at me or respond. She stared off in an angry or disgusted way. So, it was the daughter who told me the patient’s story. She said her mother’s behavior had been bizarre for the past five months. This included not paying her rent, and accusing her daughter of being abusive and stealing from her. The daughter said her mother had even threatened to kill herself.
During the previous week, the patient’s grandchildren, of whom she had custody, had been taken into foster care by Child Protective Services. Since then, the patient had been telling people her daughter had kidnapped the girls. Then, when the patient began running back and forth in the streets, saying she had nothing to live for, the daughter brought her to Emergency for help.
After listening to the daughter recount this story, I interviewed the patient with the daughter in the room. The patient said she was the guardian of two young grandchildren who the daughter had sent to Washington without her permission. She stated that her daughter and the daughter’s boyfriend were verbally abusive and had been taking unfair advantage of her financially. That day, while getting off a bus, she saw her daughter and a teenage granddaughter drive up and get out of their car. They started to yell at her, so she tried to run away. The daughter allegedly grabbed the patient and pushed her into the car. The patient said she had an ache in her arms and shoulders from being roughed up. She had no medical problems and she denied being suicidal.
I examined the patient and found no serious injury or any evidence of a medical problem that would cause bizarre behavior. I was not sure which of the conflicting stories to believe, so I did what any good emergency physician would do: procrastinate. I went to see someone who needed more urgent medical care and put off deciding what to do about this woman.
It was a good thing I decided to wait. A while later, a second daughter arrived. She said the first daughter was trying to make their mother appear insane. She was apparently doing this in order to get custody of the granddaughters who were in the patient’s custody. This second daughter seemed believable and her story was in agreement with the patient’s. When I looked for the first daughter, she was nowhere to be found.
I notified Adult Protective Services. A police officer came and took a report. He told the patient how to file for a restraining order against her accusing daughter. Since the patient had no need of medical care, we discharged her with the second daughter who said she could keep her safe.
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