This article in the Halloween edition of the NY Times reminded me of something I’ve wanted to learn more about.

Maybe you can help me.

Who'll sign on the dotted line when you can't?

I call it Probate Mysteries. [Not a sexy enough title to land a cable drama slot, but OK for a blog.]

You see, once every so often, a patient comes into the hospital in terrible shape, and there’s no one attached to them.

No family. No friends. No neighbors.

The next of kin on their demographic form is invariably unreachable.

When I say terrible shape, I mean terminal. Either with dementia so advanced that she doesn’t know who or where she is, or in some type of coma from which she’ll never wake up.

It’s time to get her affairs in order.

Only, there’s no one from the family to help with decision-making.

And if you guessed that this patient had no advance directive regarding her health care, you’d be right.

It’s not an accident that folks who have no relatives living or are estranged from them tend to hide from the health care system until it’s too late. [No judgement implied.]

Our fantastic hospital social workers work like private investigators to find someone who can help with the “disposition” of the patient–and by that I mean help with a placement (not always immediately to the morgue, mind you) and a more suitable living arrangement. And help to start untangling the patient’s finances.

Medical school teaches us nothing about these types of situations, other than efforts to help us figure out who an appropriate surrogate decision maker should be. But when there literally is no surrogate we can find, we rely on the hospital’s lawyers to find a guardian ad litem, a court-appointed fiduciary to help facilitate matters of the estate.

Once I was involved in such a case, and rumors swirled that the patients in question were a couple of ample means. Tragically, the husband and wife were both severely affected with Alzheimer’s, and totally incapable of making any decision, medical or financial. And they’d had no children. They’d outlived their siblings.

I will admit that I thought about volunteering as an heir. They wound up in a nursing home, where I think their ample funds were “spent down” to care for them in their final days.

I’ve always wondered how many stories there are out there like this. And with an aging population, it’s conceivable we could hear more such stories….