Case #7 TBI

Inpatient nurse requests crisis assessment for 63yo divorced father who just woke up from a coma after a suicide attempt. Case Hx: Clear medical hx. No mental health hx or known prior attempts. Method of injury: Friend found pt unconscious in car that was running inside pt’s garage. Suicide note found on scene, saying goodbye to two adult daughters, signed, “Daddy”. Attending Dr. presents MRI scan of brain showing multiple area 02 deficit damaged tissue. Doctor reports he meets criteria for TBI Dx. Right side 40% hemiplegia. Pt advised of rights and consents to be interviewed. Presents with some slurred speech, elevated mood/tone/demeanor. Denies knowing why he is at hospital. Denies attempting suicide. When shown suicide note, denies it is his writing.

Pt does not meet criteria for being a CURRENT immediate threat to self with imminent viable plan of self harm. Plan: Agrees to lesser restrictive group home w daily rehab. Dr. concurs. Pt seen a month later for follow up at group home. Observed doing the dishes smiling. Has improvement w/ ADLs and ambulation. Attending rehab therapist reports, “He now has the maturity level of a 12 year old and doesn’t even know he tried to kill himself with Carbon Monoxide”. Daughters arranging eventual in home caregiver.