Reflections for November

### CC3 Neurology Admission Note NAME: Lear, King MRN: 1234567 ADMITTED: 01/29/2009 DICTATED BY: Shakespeare, William CC: Elderly right-handed male of uncertain age with c/o altered mental status—“my wits begin to turn.” ### Sources: Patient, who is likely an unreliable historian, patient’s daughters (Goneril, Regan, Cordelia), patient’s home health aide (Mr. Fool). ### HPI: For the past several months, the patient has shown a decline in cognitive function, with increased forgetfulness, and difficulty with ADLs, as well as a labile mood. His daughters believe the precipitating event was their father’s decision to divide up his kingdom; however, there are some intrafamiliar conflicts regarding distribution of assets (knightly entourage, castle space) and the daughters cannot be relied upon to provide consistent history. Yesterday, after a domestic dispute, the patient ran out into the stormy “tempest” without appropriate outerwear. He then proceeded to remove his clothing while crying “off, off, you lendings! Come unbutton here,” at which point EMS was activated by concerned onlookers. Daughters report patient has audiovisual hallucinations and episodes of disorganized speech/fluent aphasia in the recent past; EMS confirms that in the ambulance he began to exclaim, “Look, look, a mouse! Peace, peace; this piece of toasted cheese will do’t. There’s my gauntlet; I’ll prove it on a giant. Bring up the brown bills. O, wellflown, bird! i’ the clout, i’ the clout: hewgh.” The …