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Patient Declares He Is Dead

Is it severe depression or a physical problem?

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I had to read the nurse’s note twice. “Patient complains he is dead,” it said.

I looked over at room 4B, the emergency room’s psychiatry unit, where an elderly man in a terry-cloth robe was sitting, head down, shoulders hunched. He looked depressed and toothpick thin but clearly alive.

I walked into the room, flipping through his medical records. The patient was an 82-year-old widower who resided in a South Carolina assisted-living facility nearby. He had a history of hypertension, mild senile dementia, and depression. He was taking several medications, including an antidepressant. His wife had died three years ago. His health had been stable until three months ago, when he began losing weight. During that time, he had lost more than 10 pounds. Aside from the recent depression, he had no history of psychiatric illness.

“Hi,” I said to the man. “How are you doing?”

“Leave me alone,” he ...

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