This is what his wife had misinterpreted as an error of haloperidol double-dosing. I again met with Mrs. GS and the administrator and explained what had happened. The wife said she understood and that she was not upset. The lorazepam resulted in increased sedation, and difficulty in accepting meals. In addition to my written note, I asked the nursing staff to contact the physician by phone and update me.
Wife now reports alternating episodes of morning yelling and sedation.
With the mixture of anger, frustration and disappointment, and the nagging feeling of maybe I could have done something else, it is difficult to bare failure in a column. It is small solace that we did GS some good temporarily. Mostly I hope this case sparks some ideas for improved consulting effectiveness. P.S. I will be back to that facility next week to try again. Dr. Snodgrass is an independent consultant and president of Triad Management Group.