A 50-year-old man was referred for a psychiatric consultation because he refused a surgical procedure. He also had visual hallucinations of old friends and angels that were comforting for him. The patient was a homeless man who was brought in by the police after he was found on the street lying in a puddle of blood. He was bleeding from the rectum, was found to have a large rectal mass with extensive involvement of other pelvic structures. A hemicorpectomy was proposed, which the patient refused. The psychiatric consultant determined that the patient understood the nature, benefits, and risks of the proposed operation. As the hallucinations were comforting rather than frightening, no antipsychotic drugs were administered. Sufficient pain relief was recommended. The patient died in his sleep several days later.
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Leigh, H. (2007). The Chronic Patient, Palliative Care Settings, and the Dying Patient. In: Handbook of Consultation-Liaison Psychiatry. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-69255-5_17
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